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A produção e o consumo mundial de carne têm seguido uma tendência em au- mentar com o passar dos anos devido a globalização dos produtos alimentares. De entre as carnes, a carne de aves destaca-se como aquela que sofreu o maior aumento relativo na produção e procura comparativamente as outras. Preocupações em relação ao aumento da produção e consumo de carnes têm vindo a realçar a importância que tem o aproveitamento do elevado número de subprodutos originados pelo abate e transformação de aves, e, portanto, métodos de valorização destes têm vindo a ser otimizados ao longo dos anos como é exemplo o aproveitamento dos subprodutos para a produção de alimento para animais domésticos e de criação. A Avibom Aví- cola, S.A é uma sociedade com estrutura familiar e dedica-se ao abate de aves com capacidade para abater por hora 11500 aves. Devido ao abate significativo a Avibom Avícola, S.A possui uma unidade de transformação de subprodutos em farinha pro- teica e gordura de aves, ambos utilizados na indústria de produção de ração animal. A gordura é suscetível ao processo de oxidação lipídica que reduz a sua qualidade e valor comercial aumentado a sua acidez sendo de interesse a utilização de antioxidan- tes sintéticos para a estabilizar, no entanto nunca existiu uma abordagem científica em relação a concentração ótima deste aditivo a utilizar demonstrando então a necessi- dade de realizar uma monitorização da estabilidade do subproduto transformado ao longo do tempo com diferentes dosagens. Esta monitorização permitiu compreender a eficiência que diferentes concentrações de antioxidante têm no subproduto transfor- mado realçando a necessidade da sua redução devido a sua ineficácia demonstrada para as condições da empresa na estabilização da gordura e realçando também a im- portância do controlo de outras variáveis, como a temperatura, na busca do melhora- mento da estabilidade da gordura de aves. The world production and consumption of meat has followed a tendency to in- crease over the years due to the globalization of food products. Among the meats, poultry stands out as the one that has suffered the greatest relative increase in pro- duction and demand compared to the others. Concerns regarding the increase in meat production and consumption have been emphasizing the importance of taking ad- vantage of the high number of by-products originated from the slaughter and pro- cessing of poultry, and, therefore, methods of valuing these have been optimized over the years, as an example the use of by-products to produce food for domestic and farm animals. Avibom Avícola, S.A is a company with a family structure and is dedicated to the slaughter of birds with the capacity to slaughter 11,500 birds per hour and due to the significant slaughter, Avibom Avícola, S.A has a unit for the transformation of by-products into protein meal and poultry fat, both used in the animal feed industry. The rendered fat is susceptible to the lipid oxidation process, which reduces its quality and commercial value, by increasing its acidity, raising the need to use synthetic anti- oxidants to stabilize it, however, there has never been a scientific approach in relation to the optimal concentration of this type of additive at use, thus demonstrating the need to monitor the stability of the transformed by-product over time with different applied dosages. This monitoring made it possible to understand the efficiency that different concentrations of antioxidant have in the transformed by-product, highlight- ing the need for its reduction due to its inability to stabilize the poultry fat in the com- pany's operational setting and highlighting the importance of controlling other varia- bles, such as temperature, in the search for improvement of the poultry fat stability.

Linking records could serve as a useful tool for scientific research and as a facilitator for local policymaking. This article examines the challenges and opportunities for researchers to lawfully link routinely collected health and education data with cohort data of children when using it as a tool for scientific research in Portugal. Such linking can be lawfully conducted in Portugal if three requirements are met. First, data processing pursues a legitimate purpose, such as scientific research. Secondly, data linking complies with the legal obligations of research entities and researchers, acting as data controllers or processors, and it respects the rights of children as data subjects. Finally, data linking is based on the explicit written consent of those with parental responsibility for the child. So far, the implementation of the General Data Protection Regulation in Portugal has not facilitated record linkage. It is argued that further harmonised implementation of that Regulation across European Union and European Economic Area Member States, establishing a minimum shared denominator for record linkage in scientific research for the common good, including without explicit consent, is needed.

Introduction Recovered Out-of-Hospital Cardiac Arrest (rOHCA) population is heterogenous. Few studies focused on outcomes in the rOHCA subgroup with proven significant coronary artery disease (SigCAD). We aimed to characterize this subgroup and study the determinants of in-hospital mortality. Methods Retrospective study of consecutive rOHCA patients submitted to coronary angiography. Only patients with SigCAD were included. Results 60 patients were studied, 85% were male, mean age was 62.6 ± 12.1 years. In-hospital mortality rate was 43.3%. Patients with diabetes and history of stroke were less likely to survive. Significant univariate predictors of in-hospital mortality were further analysed separately, according to whether they were present at hospital admission or developed during hospital evolution. At hospital admission, initial non-shockable rhythm, low-flow time>12min, pH4.75mmol/L were the most relevant predictors and therefore included in a score tested by Kaplan-Meyer. Patients who had 0/4 criteria had 100% chance of survival till hospital discharge, 1/4 had 77%, 2/4 had 50%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. During in-hospital evolution, a pH2mmol/L at 24h, anoxic brain injury and persistent hemodynamic instability proved significant. Patients who had 0/4 of these in-hospital criteria had 100% chance of survival till hospital discharge, 1/4 had 94%, 2/4 had 47%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. Contrarily, CAD severity and ventricular dysfunction didn’t significantly correlate to the outcome. Conclusion Classic prehospital variables retain their value in predicting mortality in the specific group of OHCA with SigCAD. In-hospital evolution variables proved to add value in mortality prediction. Combining these simple variables in risk scores might help refining prognostic prediction in these patients’s subset.

Acute Pericarditis in Crohn’s Disease under Pharmacological Immunosuppression: A Diagnostic and Therapeutic Dilemma

Objectives: The underutilization of manual thrombus aspiration (MTA) may have reduced the benefits of ischemic postconditioning (PostCon), as it reduces thrombus embolization. We aimed to assess the benefits of PostCon in patients with ST-segment elevation myocardial infarction (STEMI) after the systematic utilization of MTA. Methods: A total of 87 patients were enrolled in a prospective, randomized trial (43 PostCon and 44 controls). After MTA, PostCon was performed on the treatment group by applying 4 cycles of alternate reperfusion and reocclusion (60 seconds each) using the angioplasty balloon. The primary end point was infarct size assessed by the area under the curve (AUC) of troponin T (TnT) activity. The secondary end points were left ventricle ejection fraction (LVEF) and major cardiac events (new myocardial infarction or cardiac death) both at discharge and at follow-up. Results: The AUC for TnT was no different with respect to study arms (median [interquartile range]): PostCon = 8.9 (10.6) versus control = 8.2 (10.6), P = .68. Left ventricle ejection fraction improved from in-hospital to follow-up (9 ± 3 months) for the entire cohort (46.3% ± 7.3% vs 52.2% ± 10.7%, P < .001), with no differences between PostCon and controls (51.6% ± 9.5% vs 52.7% ± 11.9%, P = .89); major cardiac events at 14 ± 4 months of follow-up were also no different (PostCon = 1.0 (2.3%) vs control = 0, P = .49). Conclusion: In patients with STEMI treated with MTA, PostCon offered no benefits to infarct size, LVEF, or major cardiac events.

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Aims To prospectively validate the existing classifications to stratify subjects with diabetes mellitus (DM) by their risk of diabetic foot ulcer (DFU), in high and low risk settings. Methods A prospective multicentre cohort study was conducted, including 446 subjects with DM without active DFU followed in the hospital or primary care setting. Demographic, clinical characterization variables, and those included in the classifications were collected at baseline. Subjects were followed for 1 year, until DFU or death. Results: In our sample, with a mean age of 65 years, 52% were male; 32 developed a DFU, 7 required an amputation and 18 died. Differences were found between participants’ characteristics and classifications’ accuracy according to the setting. The great majority of the variables were associated with higher DFU risk. Globally, classifications were highly and equally valid, positive predictive values (PV) were inferior to 40%, negative PV superior to 90% and area under the receiver operating characteristic curve superior to 0.75. Discussion All the existing classifications are valid to be applied in high risk clinical context and have a very high capacity to categorize as low risk those subjects that will not develop a DFU. Further research is needed in the primary care setting.

Neuromediated stunned myocardium is a well-known complication of subarachnoid hemorrhage but has rarely been reported in association with other central nervous system disorders. The pathophysiology of this entity remains unclear, but a catecholamine-induced neurocardiogenic injury has been proposed as a causal factor. Typically, patients have rapid full cardiovascular recovery within a few days. We report a case of ischemic stroke, coexisting with ischemic electrocardiographic changes, increased cardiac-specific necrosis biomarkers, regional wall motion abnormalities and a cardiac SPECT consistent with inferior myocardial infarction despite normal coronary arteries. Interestingly, left-ventricular dysfunction in this case persisted longer than usually described despite full neurologic recovery. This case also illustrates the diagnostic challenges posed by this entity which frequently mimics acute myocardial infarction and emphasizes the investigation needed in this area.

Intramyocardial dissecting haematoma (IDH) is a rare complication of myocardial infarction, with very scarce reports in medical literature. Before the advent of non-invasive imaging techniques, the diagnosis of IDH was only made by necropsy. It can develop in the left ventricular free wall, the right ventricle, or the interventricular septum. We present a case of a patient with an IDH after acute anterolateral myocardial infarction, focusing on the utility of echocardiography in the diagnosis and follow-up of this unusual complication. By this imaging modality, it was possible to see the various acoustic densities of the progressive clotting of the intramyocardial haematoma, its extension through the haemorrhagic dissection, as well as its independency in relation to ventricular cavities and extracardiac space by confirming intact epicardial and endocardial layers. Based on this report, we believe that serial two-dimensional echocardiography, added, when necessary, by the use of contrast agents is the non-invasive method ideally suited to confirm the diagnosis and monitor its evolution at the patient's bedside.

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Neuromediated stunned myocardium is a well-known complication of subarachnoid hemorrhage but has rarely been reported in association with other central nervous system disorders. The pathophysiology of this entity remains unclear, but a catecholamine-induced neurocardiogenic injury has been proposed as a causal factor. Typically, patients have rapid full cardiovascular recovery within a few days. We report a case of ischemic stroke, coexisting with ischemic electrocardiographic changes, increased cardiac-specific necrosis biomarkers, regional wall motion abnormalities and a cardiac SPECT consistent with inferior myocardial infarction despite normal coronary arteries. Interestingly, left-ventricular dysfunction in this case persisted longer than usually described despite full neurologic recovery. This case also illustrates the diagnostic challenges posed by this entity which frequently mimics acute myocardial infarction and emphasizes the investigation needed in this area.

Listeria monocytogenes, although an uncommon cause of illness in the general population, is feared principally because of the morbidity and mortality associated with CNS infections. Cardiovascular involvement with L. monocytogenes is very rare, and has been limited to endocarditis. We describe a case of Listeria pericarditis, which occurred in a 60-year-old man with Child-Pugh B cirrhosis who presented to the emergency department with asthenia, anorexia, and respiratory distress. The echocardiogram showed severe pericardial eff usion and after pericardiocentesis, L. monocytogenes was isolated in the culture of pericardial fl uid. After surgical pericardiectomy with draining of the pericardial eff usion and antibiotic treatment with ampicillin, the patient experienced a slow, but full recovery. Documentation of L. monocytogenes pericarditis is an extremely rare entity with very scarce reports in medical literature, and is usually associated with a very poor prognosis. A case report is presented together with a review of the literature.

Dyspnea and hypoxemia are among the most common symptoms and signs that need to be assessed in clinical practice.This case illustrates how simple steps in history taking and physical examination can be crucial for diagnosis.We present a patient with intermittent hypoxemia, initially attributed to a pulmonary infection. However, the hypoxemia persisted even after successful treatment of the infection. Computed tomography angiography of the chest and ventilation/perfusion lung scan excluded pulmonary embolism.We then observed that the hypoxemia and dyspnea were triggered by orthostatism. An echocardiogram with a bubble test showed a patent foramen ovale, with a right-to-left shunt, without pulmonary hypertension. After percutaneous closure of the foramen ovale, the symptoms completely resolved.This is a case of platypnea-orthodeoxia syndrome, which is usually associated with patent foramen ovale or atrial septal defect and is typically observed in the elderly. The features and causes of this curious syndrome are discussed. Resumo: A dispneia e hipoxemia são dos sintomas e sinais mais comuns que avaliamos diariamente na prática clínica.Este caso ilustra como uma avaliação simples da anamnese e exame físico podem ser cruciais para o diagnóstico.Apresentamos um doente com hipoxemia intermitente, inicialmente atribuída a uma infeção respiratória. Contudo, a hipoxemia manteve-se apesar de tratamento eficaz da infeção. A angiotomografia computorizada do tórax e cintigrafia de ventilação-perfusão excluíram tromboembolismo pulmonar. Verificámos posteriormente que a hipoxemia e dispneia eram despoletadas pelo ortostatismo. Um ecocardiograma com administração de soro agitado revelou a presença de foramen ovale patente, com fluxo espontâneo direito-esquerdo, sem hipertensão pulmonar. Após encerramento do forâmen ovale patente, os sintomas desapareceram.Este é um caso de síndrome de platipneia-ortodeoxia, que geralmente se associa a foramen ovale patente ou comunicação interauricular, e é especialmente frequente em idosos. Discutimos as características e causas desta interessante síndrome. Keywords: Platypnea, Orthodeoxia, Patent foramen ovale, Atrial septal defect, Palavras-chave: Platipneia, Ortodeoxia, Foramen ovale patente, Comunicação interauricular