A Case Report of Primary Aldosteronism and Extensive Hypertension-Mediated Organ Damage.

Primary aldosteronism, the most common curable form of secondary hypertension, is associated with greater hypertension-related organ damage and cardiovascular complications compared to primary essential hypertension. The authors present a case involving a 41-year-old Black male admitted to the emergency department with left hemiparesis and blurred vision persisting for one hour, accompanied by markedly elevated blood pressure (220/140 mmHg). The patient was asymptomatic by then, and, aside from a history of tobacco smoking and occasional cannabis use, lacked significant medical comorbidities. Further investigations revealed a right acute hemorrhagic stroke, bilateral grade 4 hypertensive retinopathy, chronic kidney disease with end-stage renal disease, hypokalemia, and an elevated aldosterone/renin ratio. An abdominal CT scan showed bilateral adrenal hyperplasia. The patient was diagnosed with primary aldosteronism with extensive hypertension-mediated organ damage. This case highlights the significant harm caused by undiagnosed primary aldosteronism-induced secondary hypertension, emphasizing the importance of timely diagnosis and intervention to prevent organ damage.

Can subcutaneous treprostinil be an alternative for treating pulmonary hypertension in patients with systemic sclerosis-related interstitial lung disease?

Pulmonary hypertension (PH) is one of the most feared complications of systemic sclerosis (SSc). There are currently specific drugs approved for PH group I (pulmonary arterial hypertension - PAH), but for PH related to lung disease (group III) the use of vasodilators is still controversial and not routinely recommended in patients with non-severe PH. However, SSc-PH-interstitial lung disease (ILD) has a poorer survival compared with SSc-PAH, making the management of these patients a challenge, ideally carried out in a reference centre. Herein we report the case of a a 45-year-old female with systemic sclerosis-myositis overlap syndrome, with documented lung involvement (ILD with fibrotic nonspecific interstitial/organizing pneumonia pattern), who was diagnosed with pre-capillary PH. She started sequential combination vasodilator therapy including parenteric prostanoid, with clinical benefit and without evidence of ILD worsening.

Latest advances in glucose-responsive microneedle-based systems for transdermal insulin delivery.

The development of a self-regulated minimally invasive system for insulin delivery can be considered as the holy grail in the field of diabetes mellitus. A delivery system capable of releasing insulin in response to blood glucose levels would significantly improve the quality of life of diabetic patients, eliminating the need for frequent finger-prick tests and providing better glycaemic control with lower risk of hypoglycaemia. In this context, the latest advances in glucose-responsive microneedle-based transdermal insulin delivery are here compiled with a thorough analysis of the delivery mechanisms and challenges lying ahead in their clinical translation. Two main groups of microneedle-based systems have been developed so far: glucose oxidase-containing and phenylboronic acid-containing systems. Both strategies in combination have also been tested and two other novel strategies are under development, namely electronic closed-loop and glucose transporter-based systems. Results from preclinical studies conducted using these different types of glucose-triggered release systems are comprehensively discussed. Altogether, this analysis from both a mechanistic and translational perspective will provide rationale and/or guidance for future trends in the research hotspot of glucose-responsive microneedle-based insulin delivery systems.

Systematic literature review to inform the Portuguese recommendations for the management of Raynaud's phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseases.

OBJECTIVE: To perform a systematic literature review (SLR) aimed at evaluating the efficacy and safety of pharmacological and non-pharmacological treatments for Raynaud's phenomenon (RP) and digital ulcers (DU) in patients with systemic sclerosis (SSc) and other connective tissue diseases (CTD), in order to inform the Portuguese recommendations for managing RP and DU in these patients. METHODS: A SLR was conducted until May 2022 to identify studies assessing the efficacy and safety of pharmacological and non-pharmacological interventions for RP and DU in SSc and other CTD. Eligible study designs included randomized controlled trials (RCTs), controlled clinical trials, and their extensions for assessing efficacy and safety of interventions. Observational studies with a comparator were included for evaluating the efficacy and safety of non-pharmacological interventions and safety of pharmacological interventions. The risk of bias of each study was assessed using standard tools. RESULTS: Out of 71 publications meeting the inclusion criteria, 59 evaluated pharmacological and 12 non-pharmacological interventions. We found moderate quality evidence supporting the efficacy of calcium channel blockers, phosphodiesterase-5 inhibitors, and intravenous prostacyclin analogues in reducing RP frequency, severity, and duration. Intravenous iloprost had a small to moderate effect size in improving DU healing. Phosphodiesterase-5 inhibitors were effective in reducing total DU count, new DU occurrence, and enhancing DU healing. Bosentan effectively prevented new DU in SSc patients. No new safety concerns were associated with these treatments. The studies on non-pharmacological interventions were, in general, of low quality, and had a small sample size. Warming measures decreased frequency and duration of RP attacks; laser therapy improved RP-related outcomes; local oxygen-ozone therapy improved RP outcomes as an add-on therapy; bone marrow mononuclear cell implantation improved DU-associated pain; periarterial sympathectomy and vascular bypass reduced DU number and finger amputation risk. CONCLUSION: The available evidence supports the efficacy and safety of pharmacological interventions, namely nifedipine, sildenafil, iloprost, and bosentan in treating RP and DU in patients with SSc and other CTD. Scarce and low-quality evidence does support the use of some non-pharmacological interventions but with only a modest effect size. This SLR underscores the limited availability of high-quality evidence for determining the optimal treatment.

Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases: Five-year Experience of a Pediatric Tertiary Hospital in Portugal.

INTRODUCTION: Neurocutaneous syndromes (NCS) are a heterogeneous group of conditions with multiorgan involvement and diverse manifestations, evolving throughout life with significant morbidity. A multidisciplinary approach to NCS patients has been advocated, although a specific model is not yet established. The aim of this study was 1) to describe the organization of the recently created Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases (MOCND) at a Portuguese pediatric tertiary hospital; 2) to share our institutional experience focusing on the most common conditions, neurofibromatosis type 1 (NF1) and tuberous sclerosis complex (TSC); 3) to analyze the advantages of a multidisciplinary center and approach in NCS. METHODS: Retrospective analysis of 281 patients enrolled in the MOCND over the first five years of activity (October 2016 to December 2021), reviewing genetics, family history, clinical features, complications, and therapeutic strategies for NF1 and TSC. RESULTS: The clinic works weekly with a core team of pediatricians and pediatric neurologists supported by other specialties as needed. Of the 281 patients enrolled, 224 (79.7%) had identifiable syndromes such as NF1 (n = 105), TSC (n = 35), hypomelanosis of Ito (n = 11), Sturge-Weber syndrome (n = 5), and others. In NF1 patients, 41.0% had a positive family history, all manifested café-au-lait macules, 38.1% neurofibromas with 45.0% being large plexiform neurofibromas. Sixteen were under treatment with selumetinib. Genetic testing was performed in 82.9% of TSC patients with pathogenic variants found in TSC2 gene in 72.4% patients (82.7% if considered contiguous gene syndrome). Family history was positive in 31.4%. All TSC patients presented hypomelanotic macules and fulfilled diagnostic criteria. Fourteen patients were being treated with mTOR inhibitors. CONCLUSION: Offering a systematic and multidisciplinary approach to NCS patients enables timely diagnosis, promotes a structured follow-up, and encourages discussion to outline management plans for optimal care to every patient, with significant impact on the quality of life of patients and families.

Evidências de validade de critério concorrente e preditiva do Instrumento de Rastreio da Comunicação de Crianças de 0 a 36 meses (IRC-36) / Evidence of concurrent and predictive criterion validity of the Child Communication Screening Instrument from 0 to 36 months (IRC-36)

RESUMO Objetivo Determinar evidências de validade de critério concorrente e preditiva do Instrumento de Rastreio da Comunicação de crianças de 0 a 36 meses (IRC-36). Método Participaram da pesquisa 78 pais/responsáveis de crianças que frequentam o serviço de puericultura das Unidades de Saúde da Família, além de 33 crianças com idades entre 0 e 36 meses, convidadas para segunda etapa do estudo. Na primeira etapa do estudo, 13 profissionais de saúde foram treinados para realizar a aplicação do IRC-36 nos pais/responsáveis das crianças. No segundo momento, os pais responderam a uma nova aplicação do IRC-36 e as crianças foram avaliadas com o Denver II. Resultados O IRC-36 apresentou correlação com o Denver II em mais da metade dos casos, confirmando a validade de critério concorrente do instrumento. Os resultados do IRC-36 da primeira etapa quando correlacionados com o Denver II, não apresentaram valores significativos. O valor de ponto de corte do instrumento foi 12, sendo este o valor de referência entre crianças em risco e sem risco para alteração da comunicação. O instrumento apresentou valor de acurácia dentro dos níveis preconizados e alta sensibilidade. A ocorrência de risco para alteração da comunicação apresentou-se maior na segunda aplicação do IRC-36. Conclusão O estudo apresentou evidências de validade de critério concorrente, indicando que o instrumento possui evidências de medidas de acurácia e de validade para o rastreio da comunicação de crianças de 0 a 36 meses sendo capaz de identificar risco para as alterações da comunicação.

ABSTRACT Purpose To determine evidence of concurrent and predictive criterion validity of the Communication Screening Instrument for children aged 0 to 36 months (IRC-36). Methods 78 parents/guardians of children who attend the childcare service of the Family Health Centers participated in the research, in addition to 33 children aged between 0 and 36 months, invited to the second stage of the study. In its first stage, 13 health professionals were trained to apply the IRC-36 to the children's parents/guardians. In the second moment, the parents responded to a new IRC-36 application, and the children were evaluated with Denver II. Results IRC-36 correlated with Denver II in more than half of the cases, confirming the instrument's concurrent criterion validity. IRC-36 results in the first stage did not significantly correlate with Denver II. The instrument's cutoff value was 12, which is the reference value between children at risk and not at risk of communication disorders. The instrument had high sensitivity and an accuracy value within the recommended levels. The occurrence of risk of communication changes was higher in the second IRC-36 application. Conclusion The study presented evidence of concurrent criterion validity, indicating that the instrument has evidence of accuracy and validity measures to screen communication in children aged 0 to 36 months, being able to identify the risk for communication disorders.

Evidence of concurrent and predictive criterion validity of the Child Communication Screening Instrument from 0 to 36 months (IRC-36). / Evidências de validade de critério concorrente e preditiva do Instrumento de Rastreio da Comunicação de Crianças de 0 a 36 meses (IRC-36).

PURPOSE: To determine evidence of concurrent and predictive criterion validity of the Communication Screening Instrument for children aged 0 to 36 months (IRC-36). METHODS: 78 parents/guardians of children who attend the childcare service of the Family Health Centers participated in the research, in addition to 33 children aged between 0 and 36 months, invited to the second stage of the study. In its first stage, 13 health professionals were trained to apply the IRC-36 to the children's parents/guardians. In the second moment, the parents responded to a new IRC-36 application, and the children were evaluated with Denver II. RESULTS: IRC-36 correlated with Denver II in more than half of the cases, confirming the instrument's concurrent criterion validity. IRC-36 results in the first stage did not significantly correlate with Denver II. The instrument's cutoff value was 12, which is the reference value between children at risk and not at risk of communication disorders. The instrument had high sensitivity and an accuracy value within the recommended levels. The occurrence of risk of communication changes was higher in the second IRC-36 application. CONCLUSION: The study presented evidence of concurrent criterion validity, indicating that the instrument has evidence of accuracy and validity measures to screen communication in children aged 0 to 36 months, being able to identify the risk for communication disorders.

OBJETIVO: Determinar evidências de validade de critério concorrente e preditiva do Instrumento de Rastreio da Comunicação de crianças de 0 a 36 meses (IRC-36). MÉTODO: Participaram da pesquisa 78 pais/responsáveis de crianças que frequentam o serviço de puericultura das Unidades de Saúde da Família, além de 33 crianças com idades entre 0 e 36 meses, convidadas para segunda etapa do estudo. Na primeira etapa do estudo, 13 profissionais de saúde foram treinados para realizar a aplicação do IRC-36 nos pais/responsáveis das crianças. No segundo momento, os pais responderam a uma nova aplicação do IRC-36 e as crianças foram avaliadas com o Denver II. RESULTADOS: O IRC-36 apresentou correlação com o Denver II em mais da metade dos casos, confirmando a validade de critério concorrente do instrumento. Os resultados do IRC-36 da primeira etapa quando correlacionados com o Denver II, não apresentaram valores significativos. O valor de ponto de corte do instrumento foi 12, sendo este o valor de referência entre crianças em risco e sem risco para alteração da comunicação. O instrumento apresentou valor de acurácia dentro dos níveis preconizados e alta sensibilidade. A ocorrência de risco para alteração da comunicação apresentou-se maior na segunda aplicação do IRC-36. CONCLUSÃO: O estudo apresentou evidências de validade de critério concorrente, indicando que o instrumento possui evidências de medidas de acurácia e de validade para o rastreio da comunicação de crianças de 0 a 36 meses sendo capaz de identificar risco para as alterações da comunicação.

Case Report: Patient with deficiency of ADA2 presenting leukocytoclastic vasculitis and pericarditis during infliximab treatment.

Deficiency of adenosine deaminase 2 (DADA2), first reported in 2014, is a disease with great phenotypic variability, which has been increasingly reported. Therapeutic response depends on the phenotype. We present a case of an adolescent with recurrent fever, oral aphthous ulcers, and lymphadenopathy from 8 to 12 years of age and subsequently presented with symptomatic neutropenia. After the diagnosis of DADA2, therapy with infliximab was started, but after the second dose, she developed leukocytoclastic vasculitis and showed symptoms of myopericarditis. Infliximab was switched to etanercept, with no relapses. Despite the safety of tumor necrosis factor alpha inhibitors (TNFi), paradoxical adverse effects have been increasingly reported. The differential diagnosis between disease new-onset manifestations of DADA2 and side effects of TNFi can be challenging and warrants further clarification.

Assessment of calcinosis in Portuguese patients with systemic sclerosis - a multicenter study.

INTRODUCTION/OBJECTIVES: The study aims to define the clinical and subclinical calcinosis prevalence, the sensitivity of radiographed site and clinical method for its diagnosis, and the phenotype of Portuguese systemic sclerosis (SSc) patients with calcinosis. METHOD: A cross-sectional multicenter study was conducted with SSc patients fulfilling Leroy/Medsger 2001 or ACR/EULAR 2013 classification criteria, registered in the Reuma.pt. Calcinosis was assessed through clinical examination and radiographs of hands, elbows, knees, and feet. Independent parametric or non-parametric tests, multivariate logistic regression, and sensitivity calculation of radiographed site and clinical method for calcinosis detection were performed. RESULTS: We included 226 patients. Clinical calcinosis was described in 63 (28.1%) and radiological calcinosis in 91 (40.3%) patients, of which 37 (40.7%) were subclinical. The most sensitive location to detect calcinosis was the hand (74.7%). Sensitivity of the clinical method was 58.2%. Calcinosis patients were more often female (p = 0.008) and older (p < 0.001) and had more frequently longer disease duration (p < 0.001), limited SSc (p = 0.017), telangiectasia (p = 0.039), digital ulcers (p = 0.001), esophageal (p < 0.001) and intestinal (p = 0.003) involvements, osteoporosis (p = 0.028), and late capillaroscopic pattern (p < 0.001). In multivariate analysis, digital ulcers (OR 2.63, 95% CI 1.02-6.78, p = 0.045) predicted overall calcinosis, esophageal involvement (OR 3.52, 95% CI 1.28-9.67, p = 0.015) and osteoporosis (OR 4.1, 95% CI 1.2-14.2, p = 0.027) predicted hand calcinosis, and late capillaroscopic pattern (OR 7.6, 95% CI 1.7-34.9, p = 0.009) predicted knee calcinosis. Anti-nuclear antibody positivity was associated with less knee calcinosis (OR 0.021, 95% CI 0.001-0477, p = 0.015). CONCLUSIONS: Subclinical calcinosis high prevalence suggests that calcinosis is underdiagnosed and radiographic screening might be relevant. Multifactorial pathogenesis may explain calcinosis predictors' variability. Key Points • Prevalence of subclinical calcinosis in SSc patients is substantial. • Hand radiographs are more sensitive to detect calcinosis than other locations or clinical method. • Digital ulcers were associated with overall calcinosis, esophageal involvement and osteoporosis were associated with hand calcinosis, and late sclerodermic pattern in nailfold capillaroscopy was associated with knee calcinosis. • Anti-nuclear antibody positivity may be a protective factor for knee calcinosis.

E depois da doença Covid-19?: Cuidados de enfermagem de reabilitação / What about after Covid-19 disease?: Rehabilitation nursing care

A pandemia COVID-19 apresenta-se como o maior desafio global do século XXI, é a primeira vez que um vírus atinge proporções alarmantes em todos os continentes, as sequelas desta doença ainda não são totalmente conhecidas, desta forma, é importante intervir na recuperação e manutenção da capacidade funcional de todos os doentes com a síndroma pós-COVID-19, sendo fulcral a intervenção do enfermeiro especialista em enfermagem de reabilitação. Procurou-se estudar a intervenção do EEER ao doente com sequelas da doença Covid 19, uma vez que é considerada uma necessidade emergente de investigação pela falta de informação disponível. A doença COVID-19 afeta principalmente o aparelho respiratório, que pode ir desde doença respiratória ligeira, sem insuficiência respiratória, até pneumonia mais extensa com hipoxemia significativa e eventual evolução para ARDS e/ou Sépsis. A esta doença está associada a necessidade de medidas de isolamento, logo uma maior restrição ao espaço físico e ao leito, existindo maior intolerância ao exercício, diminuição da força muscular, um padrão ventilatório ineficaz e falta de capacidade para eliminar eficazmente a expetoração (Rocha, 2020). A teoria de enfermagem que norteou este trabalho foi a teoria do défice do autocuidado de Dorothea Orem em que o objetivo é a recuperação do autocuidado. A teoria do défice do autocuidado, pretende definir os momentos em que os cuidados de enfermagem são necessários. A necessidade de intervenção do enfermeiro especialista em enfermagem de reabilitação é fundamental pelas sequelas decorrentes da COVID-19. A ação do EEER vai centrar-se na minimização das sequelas e na promoção do autocuidado com vista a melhorar a capacidade funcional. Definiram-se 7 objetivos que procuram responder ao desenvolvimento das competências do EEER e à problemática em questão, para tal procedeu-se a um revisão sistemática da literatura, nas bases de dados CINAHL Complete e MEDLINE Complete, tendo em consideração certos critérios de elegibilidade e exclusão definidos. Este relatório demonstra que na abordagem ao doente com sequelas após doença COVID 19 obtiveram-se ganhos ao nível das alterações respiratórias como a melhoria da dispneia e fadiga, a nível musculosquelético como o aumento da força muscular e ao nível do autocuidado e do estado funcional, constataram-se ganhos na independência.

The COVID-19 pandemic presents itself as the greatest global challenge of the 21st century, it is the first time that a virus has reached alarming proportions on all continents, the sequels of this disease are not yet fully known, therefore, it is important to intervene in the recovery and maintenance of the functional capacity of all patients with post COVID-19 syndrome, in which the intervention of a specialist nurse in rehabilitation nursing is crucial. It was sought to study the rehabilitation specialist nurse intervention to the patient with sequels of Covid-19 disease, as it is considered an emerging research need due to the lack of available information. COVID-19 disease mainly affects the respiratory system, which may range from mild respiratory disease without respiratory failure to more extensive pneumonia with significant hypoxemia and eventual evolution to ARDS and/or sepsis. This disease is associated with the need for isolation measures, thus a greater restriction to the physical space and bedding, increased exercise intolerance, decreased muscle strength, an ineffective ventilatory pattern, and lack of ability to effectively eliminate sputum (Rocha, 2020). The nursing theory that guided my work as Dorothea Orem's self-care deficit theory, in which the goal is the recovery of self-care. The self-care deficit theory aims to define the moments when nursing care is needed. The need for intervention by the nurse specialist in rehabilitation nursing is fundamental due to the sequels resulting from COVID-19. The rehabilitation specialist nurses action will focus on minimizing the sequels and promoting self-care with a view to improving functional capacity. To this end, a systematic literature review was conducted in the CINAHL Complete and MEDLINE Complete databases, taking into account certain defined eligibility and exclusion criteria. This report shows that, in the approach to patients with sequels after COVID-19 disease, gains were obtained in terms of respiratory changes, such as the improvement of dyspnea and fatigue, and musculoskeletal level, such as the increase in muscle strength. In terms of self-care and functional status, gains in independence were observed.

A colaboração interprofissional no programa de educação pelo trabalho para a saúde / La colaboración interprofesional en el programa de educación por el trabajo para la salud / Interprofessional collaboration in the program for education at work for health1

RESUMO Objetivo: identificar os elementos das dimensões colaborativas interprofissionais presentes nos projetos institucionais a serem desenvolvidos no Programa de Educação pelo Trabalho para a Saúde. Método: estudo documental de abordagem qualitativa. A fonte documental consiste em cinco projetos de intervenção elaborados por cinco Universidades Federais da região Nordeste para serem desenvolvidos no Programa de Educação pelo Trabalho para a Saúde Interprofissionalidade. Os dados foram coletados e analisados entre julho de 2020 a março de 2021, com aplicação de matriz de coleta, de elaboração própria. Com auxílio de um software, o estudo está alicerçado no referencial de D'Amour para fins de estabelecimento de categorias conforme preconizadas nas etapas estabelecidas por Bardin. Foram assegurados os aspectos éticos para a pesquisa. Resultados: Foram identificados elementos das dimensões colaborativas do modelo de D'Amour nos 5 projetos, tais como: metas e orientação centrada no usuário; convivência mútua; confiança; ferramentas de formalização; intercâmbio de informações; centralidade e liderança; suporte à inovação e conectividade. Considerações finais: os projetos de intervenção elaborados pelas universidades possuem elementos indutores da Colaboração Interprofissional. No entanto, precisam ser melhor explicitadas as intervenções voltadas para a estruturação do atendimento colaborativo e exercício para a liderança.

RESUMEN Objetivo: identificar los elementos de las dimensiones colaborativas interprofesionales presentes en los proyectos institucionales que se desarrollarán en el Programa de Educación por el Trabajo para la Salud. Método: estudio documental de enfoque cualitativo. La fuente documental consiste en cinco proyectos de intervención elaborados por cinco Universidades Federales de la región Nordeste de Brasil que se desarrollarán en el Programa de Educación por el Trabajo para la Salud Interprofesionalidad. Los datos fueron recogidos y analizados entre julio de 2020 y marzo de 2021, con aplicación de matriz de recolección y elaboración propia. Con ayuda de un software, el estudio está basado en el referencial de D'Amour para fines de establecimiento de categorías conforme preconizadas en las etapas establecidas por Bardin. Se aseguraron los aspectos éticos para la investigación. Resultados: se identificaron elementos de las dimensiones colaborativas del modelo de D'Amour en los 5 proyectos, tales como metas y orientación centrada en el usuario; convivencia mutua; confianza; herramientas de formalización; intercambio de información; centralidad y liderazgo; apoyo a la innovación y la conectividad. Consideraciones finales: los proyectos de intervención elaborados por las universidades poseen elementos inductores de la Colaboración Interprofesional. Sin embargo, necesitan ser mejor explicitadas las intervenciones dirigidas a la estructuración de la atención colaborativa y el ejercicio para el liderazgo.

ABSTRACT Objective: To identify elements from the interprofessional collaborative dimensions in the institutional projects to be developed in the program for education at work for health. Method: Document study with a quantitative approach. The document source includes five intervention projects elaborated by five federal universities from the Brazilian northeast, to be developed in the interprofessional program for education at work for health. Data was collected and analyzed from July 2020 to March 2021, through the application of a collection tool elaborated by the authors. The study, conducted with the aid of software, is based on D'Amour references to establish categories according to the stages elaborated by Bardin. The ethical aspects of the research were guaranteed. Results: We identified elements of the collaborative dimensions of the model by D'Amour in the five projects, such as: goals and user-focused guidance; mutual socialization; trust; formalization tools; information exchange; centrality and leadership; support to innovation and connectivity. Final considerations: intervention projects elaborated by the universities have elements conducive to Interprofessional Collaboration. However, interventions targeted at structuring collaborative care and exercising leadership must be better elaborated.

Valuation of Goat and Sheep By-Products: Challenges and Opportunities for Their Use.

Goat and sheep meat production is a challenge for the meat industry as well as for environmental management. Yet within cultures, certain by-products, such as liver, the lungs, heart, brain, spleen, blood, tail and ears, are traditionally used in the production of typical dishes for regional or local cuisine. These by-products are a rich source of lipids, proteins, essential amino acids, B-complex vitamins, and minerals. They can be effectively exploited for higher (value-added) applications, including functional foods or feed ingredients, food supplements, enzymes and other chemical products such as hydrolyzed proteins and flavorings. This review article gathers data on: (i) the production of by-products obtained from slaughter and available for processing, and (ii) potential strategies for using and applying these by-products in obtaining new value-added ingredients. Other than proteins, the review discusses other macromolecules and possible uses of these by-products in culinary dishes, as hydrolyzed enzymes, and as food additives. Even though these by-products undoubtedly present themselves as rich in nutrients, there remains an unfortunate lack of documented information on the potential use of these by-products for their bioactive components, peptides that have various biological and technological properties, and the use of hydrolyzed versions of these by-products as precursors for the production of flavorings.

Ocular findings from otoneurological examinations in children with and without dyslexia: a systematic review with meta-analysis

Abstract Objective: To investigate ocular movements measures of vectoelectro-nystagmography and video-nystagmography in dyslexic children and compare with measures of typical children. Methods: A systematic review of observational studies comparing the ocular movements differences between dyslexic and typical children with no publication date or language restriction. The literature survey included the bibliographic databases MEDLINE, ScienceDirect, Scopus, Web of Science, SciELO, Lilacs and CENTRAL. Gray literature databases were also searched, including: OpenGrey.eu, DissOnline.de, The New York Academy of Medicine and WorldCat. The meta-analysis was performed using software RevMan 5.3 (Cochran Collaboration). Results: A total of 2375 articles were found of which 113 fell within the inclusion criteria. Among these, 52 were duplicates (found in more than one research source), and 45 articles were selected for reading in full. Thirteen (13) articles were included for analysis and discussion. Meta-analysis showed statistical differences between the two groups for the total number of saccades and duration of fixation. Conclusion: The study revealed that children with dyslexia have longer duration of fixation and fewer saccades during ocular movements on vectoelectro-nystagmography and videonystagmography when compared to children without dyslexia.

Percepção de professores sobre intervenção educativa de base fônica / Teachers' perception of phonic-based educational intervention

Além do domínio nas habilidades de consciência fonológica, o aprendizado da leitura e escrita exige o desenvolvimento de outras competências, como, por exemplo, o processamento visual, auditivo e fonológico. Tais habilidades devem ser conhecidas pelo professor alfabetizador, pois ele precisa reconhecer as crianças com dificuldades e buscar estratégias cognitivo-linguísticas para que elas avancem. OBJETIVO: Desvelar a percepção de professores sobre intervenção educativa de base fônica voltada à facilitação da aprendizagem inicial da leitura e escrita MÉTODO: Trata-se de estudo longitudinal, de intervenção, realizado com duas professoras do 2º ano do Ensino Fundamental I de uma escola pública da cidade do Recife, PE. Ambas participaram de uma intervenção educativa realizada com sua turma, em 12 encontros. Ao final de cada encontro, as professoras responderam três perguntas norteadoras sobre as atividades realizadas RESULTADOS: A análise de conteúdo possibilitou a identificação de quatro categorias temáticas: 1- Desafios da alfabetização; 2- Estratégias facilitadoras da aprendizagem da leitura e escrita; 3- Contribuições da intervenção para o processo de alfabetização; 4- Contribuições da intervenção para a identificação de crianças em risco para os transtornos de aprendizagem CONCLUSÃO: De acordo com as professoras, a intervenção foi positiva, contribuiu para o processo de facilitação da aprendizagem e possibilitou a identificação precoce de escolares em risco para transtornos de aprendizagem, sendo importante o desenvolvimento de estudos de intervenção de base fônica para auxiliar a prática docente no ciclo de alfabetização

In addition to mastering phonological awareness skills, learning to read and write requires the development of other skills, such as visual, auditory and phonological processing. Such skills must be known by the literacy teacher, as he needs to recognize children with difficulties in the literacy process, and seek cognitive-linguistic strategies for them to advance. PURPOSE: To unveil the perception of teachers about phonics-based educational intervention aimed at facilitating the initial learning of reading and writing METHODS: This is a longitudinal intervention study carried out with two teachers from the 2nd year of elementary school I of a public school in the city of Recife, Pernambuco state. Both participated in an educational intervention carried out with their class, in 12 meetings. At the end of each meeting, the teachers answered three guiding questions about the activities carried out RESULTS: Content analysis allowed the identification of four thematic categories: 1- Literacy challenges; 2- Facilitating strategies for learning to read and write; 3- Contributions of the intervention to the literacy process; 4- Contributions of the intervention to identify children at risk for learning disabilities CONCLUSION: According to the teachers, the intervention was positive, contributed to the process of facilitating learning and enabled the early identification of students at risk for learning disorders, being important the development of phonics-based intervention studies to help practice teacher in the literacy cycle

Recurrent pyogenic infections caused by a novel Gln1420* mutation in the C3 gene.

C3 is a crucial protein of the complement system. Congenital C3 deficiency is extremely rare and manifests through recurrent, severe infections and should always be considered as a differential diagnosis of recurrent pyogenic infections. We report a case of a patient with a novel C3 gene mutation, responsible for complete C3 deficiency with impaired complement system activation and recurrent infections.

Legislation and quality of nursing education in the context of the COVID-19 pandemic.

OBJECTIVES: to reflect on the governmental normative acts issued for higher education during the COVID-19 pandemic and on the repercussions of these acts on the quality of nursing education in Brazil. METHODS: this is a reflection on the repercussions for the quality of nursing education, based on the normative acts applied to higher education, enacted from March to December 2020, available on the Ministry of Education website and in the current literature on the subject anchored in the National Curriculum Guidelines for the Undergraduate Nursing Course. RESULTS: educational legislation, in the context of the pandemic, distanced education from the world of work, as well as from the quality of training established in the guidelines. FINAL CONSIDERATIONS: remote teaching in nursing makes it difficult to train professionals with the capacity to effectively teach and learn in the real world of care and health promotion in the Unified Health System.