ATTR amyloidosis during the COVID-19 pandemic: insights from a global medical roundtable

BACKGROUND: The global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing the ongoing coronavirus disease 2019 (COVID-19) pandemic has raised serious concern for patients with chronic disease. A correlation has been identified between the severity of COVID-19 and a patient's preexisting comorbidities. Although COVID-19 primarily involves the respiratory system, dysfunction in multiple organ systems is common, particularly in the cardiovascular, gastrointestinal, immune, renal, and nervous systems. Patients with amyloid transthyretin (ATTR) amyloidosis represent a population particularly vulnerable to COVID-19 morbidity due to the multisystem nature of ATTR amyloidosis. MAIN BODY: ATTR amyloidosis is a clinically heterogeneous progressive disease, resulting from the accumulation of amyloid fibrils in various organs and tissues. Amyloid deposition causes multisystem clinical manifestations, including cardiomyopathy and polyneuropathy, along with gastrointestinal symptoms and renal dysfunction. Given the potential for exacerbation of organ dysfunction, physicians note possible unique challenges in the management of patients with ATTR amyloidosis who develop multiorgan complications from COVID-19. While the interplay between COVID-19 and ATTR amyloidosis is still being evaluated, physicians should consider that the heightened susceptibility of patients with ATTR amyloidosis to multiorgan complications might increase their risk for poor outcomes with COVID-19. CONCLUSION: Patients with ATTR amyloidosis are suspected to have a higher risk of morbidity and mortality due to age and underlying ATTR amyloidosis-related organ dysfunction. While further research is needed to characterize this risk and management implications, ATTR amyloidosis patients might require specialized management if they develop COVID-19. The risks of delaying diagnosis or interrupting treatment for patients with ATTR amyloidosis should be balanced with the risk of exposure in the health care setting. Both physicians and patients must adapt to a new construct for care during and possibly after the pandemic to ensure optimal health for patients with ATTR amyloidosis, minimizing treatment interruptions

[pt] A INCLUSÃO NA EDUCAÇÃO INFANTIL: DESAFIOS E POSSIBILIDADES

A productive and engaging discourse is central to knowledge building (KB). What kind of pedagogical design would be necessary to facilitate sustained student engagement in deepening discourse that would result in their learning of key concepts as stipulated in the science curriculum and in productive knowledge building to tackle authentic problems? In both pre- and in-service science teacher education programs, teachers learn about designing various learning activities such as experiments, field trips, and computer-based simulations and to select and use appropriate learning resources to support student learning. On the other hand, in knowledge building classrooms, rather than assigning questions for students to inquire, teachers should guide students in identifying good questions and ways to become self-directed learners in developing and implementing their own inquiry strategies and to evaluate their own inquiry outcomes. Would the knowledge and skills learned in conventional teacher education programs be useful for orchestrating knowledge building classrooms? In what ways can an experienced science teacher build on his/her prior knowledge and understanding in transitioning into knowledge building pedagogy