Table Grapes: There Is More to Vitiviniculture than Wine…

Table grapes are fruits intended for fresh human consumption due to their sensory attributes and nutritional value. The objective of this chapter is to review the existing knowledge about table grapes, including a description of different varieties, with particular emphasis on the new highly appreciated seedless varieties. Following an introductory note on the world distribution and production of table grapes, also considering the impact of climate change, selected varieties of table grapes will be characterized in terms of their physiology, postharvest features, and consumer preferences. A morphological description of each variety, with emphasis on grape skin, grape rachis and grape cluster will be included. A final note on the drying of table grapes into raisins, and the most appropriate varieties for drying, will be given. The major changes occurring throughout the growth, development, and ripening phases of table grapes production will be discussed, regarding both physical (skin color and skin and pulp texture) and chemical (phenolic compounds, sugar content and acidity) parameters, as well as growth regulators

Amiodarone-induced thyrotoxicosis in a pediatric patient: A rare and demanding clinical case

Thyroid dysfunction is one of the most common adverse effects of amiodarone therapy, ranging from subclinical changes to overt clinical thyrotoxicosis (AIT) and/or hypothyroidism. Due to its heterogeneity, AIT lasts as a defiant entity, leading to a thorny treatment course, particularly in pediatrics. AIT can be classified as either type 1, type 2 or mixed form based on its pathophysiology. Differentiating between the main AIT subtypes is quite relevant, since there is specific treatment for both, however, this distinction may be difficult in clinical practice. We describe a rare case of AIT in a pediatric patient, with an uncommon congenital cardiac malformation, that started amiodarone therapy due to paroxysmal supraventricular tachycardia. AIT was reported 26 months after drug onset, with a sudden and explosive emerging. This case highlights the current AIT management challenges on the high-demanding pediatric field pursuing, ultimately, an enhanced patient´s care

Unusual Rhythm Behind a Narrow Complex Tachycardia

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The Atrium in Atrial Fibrillation - A Clinical Review on How to Manage Atrial Fibrotic Substrates

Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and is associated with a significant clinical and economic burden. Rigorous assessment of the presence and degree of an atrial arrhythmic substrate is essential for determining treatment options, predicting long-term success after catheter ablation, and as a substrate critical in the pathophysiology of atrial thrombogenesis. Catheter ablation of AF has developed into an essential rhythm-control strategy. Nowadays is one of the most common cardiac ablation procedures performed worldwide, with its success inversely related to the extent of atrial structural disease. Although atrial substrate evaluation remains complex, several diagnostic resources allow for a more comprehensive assessment and quantification of the extent of left atrial structural remodeling and the presence of atrial fibrosis. In this review, we summarize the current knowledge on the pathophysiology, etiology, and electrophysiological aspects of atrial substrates promoting the development of AF. We also describe the risk factors for its development and how to diagnose its presence using imaging, electrocardiograms, and electroanatomic voltage mapping. Finally, we discuss recent data regarding fibrosis biomarkers that could help diagnose atrial fibrotic substrates.info:eu-repo/semantics/publishedVersio

Twelve Years of Kawasaki Disease in Portugal: Epidemiology in Hospitalized Children

Kawasaki disease (KD) is the leading cause of acquired heart disease in developed countries. Reported incidences vary worldwide but incidence of KD has not been established in Portugal. The aims of the study were to describe the epidemiologic characteristics and estimate incidence rates of KD among hospitalized children in Portugal. METHODS: This study was a descriptive, population-based study, which used hospital discharge records of patients <20 years of age diagnosed with KD from the Hospital Register database for 2000-2011. Incidence rates were calculated using the number of KD patients and corresponding National census data. RESULTS: There were 533 hospitalizations of 470 patients with KD as the primary diagnosis in Portugal, 63 hospitalizations were transfers of patients between hospitals and there were no relapses. The mean age at admission was 2.8 years, with male predominance (male-to-female ratio: 1.6:1). Children <5 years and infants <1 year represented 83% and 23% of all the patients admitted, respectively. Mean annual incidence was 6.5 per 100,000 children <5 years, 4.5 per 100,000 infants <1 year and 7.8 per 100,000 infants 1-4 years. We found considerable differences between national territorial regions, with majority of cases in most dense regions. The mean length of hospital stay was 9 days, and the incidence peaked in spring (35%) and spring/winter (63%). Coronary aneurysms were reported in 8.5% of patients with a higher male-to-female ratio (3.4:1) and a lower mean age (1.93 years). Reported mortality was 0.4%. CONCLUSIONS: This is the first large-scale epidemiologic study of KD in Portugal. The highest incidences occurred among male children 1-4 years of age and in spring/winter.info:eu-repo/semantics/publishedVersio

Fresh Bovine Meat: Sensory and instrumental evaluation of tenderness.

The objective of the present work was to define the ideal tenderness of bovine meat and establish an index for the differentiation between hard and tender beef of commercial origin. Different beef cuts (“Chã de Fora”, “Rabadilha”, “Vazia” and “Lombo”) of different tenderness were considered for this study and were evaluated simultaneously by consumers using a hedonic scale and by instrumental methods. With these results, it was possible to compare the tenderness evaluation of commercial meat with Cachena meat

Establishing tenderness threshold of beef using instrumental and consumer sensory evaluation

The consumers consider tenderness one of the most important qualitative characteristics of meat, so they are willing to pay a higher price for beef as long it is guaranteed tender. However, tenderness is also a highly variable property, depending on many intrinsic and extrinsic factors, such as animal breed, feed, and management, and on their interaction. Establishing a tenderness threshold could serve as a precise quality control system to guarantee tender meat ant to assure consumer acceptability. A threshold is defined as a point on the sensory stimulus scale at which a transition occurs in a series of sensations or judgements. The present study aims to establish a tenderness threshold for beef steaks using a consumer sensory test. About 250 consumers were asked to rate consumption frequency, mode of preparation, and their palatability of beef. Consumers were further asked to assess which tenderness category was most appropriate for each one of four beef samples of commercial origin, considering an affective acceptance test through a 5-category hedonic scale (Very Hard, Hard, Ideal Tenderness, Tender and Very Tender). The same beef samples were evaluated through Warner-Bratzler shear force (WBSF) and texture profile analysis (TPA) to define their instrumental tenderness. The results obtained allowed us to conclude that there is a correlation between the sensory and instrumental evaluation of beef tenderness. However, a correct definition of the threshold must always consider both instrumental evaluation methods, WBSF and TPA. A tender meat should have shear force values between 15 and 32N and a compression force between 11 and 20N, while a hard meat should have a shear force greater than 37N and a compression force greater than 30N. Both instrumental tests give different information: WBSF test evaluates the meat fibres perpendicularly, as do incisor teeth, while TPA mimics the chewing with molar teeth. It is not possible to discard one of the instrumental tests, if the aim is to correlate beef measured tenderness with its sensory evaluation

"Cachena" a bovine rustic Portuguese extensively reared autochthonous breed: meat texture analysis

‘Cachena’ is one of the world’s smallest bovine breeds. Extremely rustic and wild, they are extensively reared, and fed with natural pastures. Meat valorisation is essential to preserve this breed, with a limited livestock. ‘Cachena’’s meat is tender, juicy, low-fat, and highly appreciated due to the association of animal, terroir and producer, balanced by the ecosystem’s sustainability. The aim of this study was to increase the weight of Longissimus dorsi (LD) and Psoas major (PM) muscles, without depreciating their sensory quality. Two groups of 16 animals were slaughtered: (A) 9-17 months old animals with 140-225 kg slaughter live weight (SLW); (B) 17-20 months old animals with 260-335 kg SLW. LD and PM muscles’ fresh weight was recorded, and microbiological and physicochemical parameters (pH and aW) were evaluated two days, while instrumental texture (Texture Profile Analysis (TPA) and Warner-Bratzler shear force (WBSF)) and sensory analyses by a trained sensory panel were performed four days after slaughter. Microbiological analyses were conducted following international standards to ensure food safety. LD and PM weights significantly increased with the animals’ age (P<0.01, LD, and P<0.001, PM). pH values were similar for both groups and aW was significantly higher in group A (P<0.001). Listeria monocytogenes and Salmonella spp. were not detected in any of the analysed samples. All analysed meat samples were generally tender, with PM tender than LD. Group A meat was tender (P<0.001) and easier to chew (P<0.001), for both muscles. Nevertheless, WBSF was higher (P<0.001). Regarding sensory analysis, no significant differences were observed in hardness, elasticity, succulence, and global appreciation between the two groups for LD meat. Moreover, fibrousness values were higher in group A (P<0,01). The higher SLW, from older ‘Cachena’ animals, associated to larger meat cuts, does not decrease meat tenderness

Challenges of developing a digital scribe to reduce clinical documentation burden.

Clinicians spend a large amount of time on clinical documentation of patient encounters, often impacting quality of care and clinician satisfaction, and causing physician burnout. Advances in artificial intelligence (AI) and machine learning (ML) open the possibility of automating clinical documentation with digital scribes, using speech recognition to eliminate manual documentation by clinicians or medical scribes. However, developing a digital scribe is fraught with problems due to the complex nature of clinical environments and clinical conversations. This paper identifies and discusses major challenges associated with developing automated speech-based documentation in clinical settings: recording high-quality audio, converting audio to transcripts using speech recognition, inducing topic structure from conversation data, extracting medical concepts, generating clinically meaningful summaries of conversations, and obtaining clinical data for AI and ML algorithms

Pulmonary Arteriovenous Malformation Closure in a Preterm Newborn

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