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Revista Pan-Amazônica de Saúde
versão impressa ISSN 2176-6215versão On-line ISSN 2176-6223
Rev Pan-Amaz Saude vol.11 Ananindeua 2020 Epub 23-Mar-2020
Clinical follow-up of children with in utero Zika virus exposure in the Metropolitan Region of Belém, Pará State, Brazil
1 Instituto Evandro Chagas, Belém, Pará, Brasil
2 Universidade do Estado do Pará, Belém, Pará, Brasil
The emergence of the Zika virus (ZIKV), which severely affected Northeastern Brazil, revealed the occurrence of congenital malformations during pregnancy. Currently, changes have been recorded from physical abnormalities, such as microcephaly, arthrogryposis, and brain abnormalities detected by neuroimaging tests, to behavioral changes as irritability and excitability.
From this perspective, a multidisciplinary approach was conducted by clinical follow up and lab and imaging tests, with emphasis on investigating the neurological and psychomotor development, vision and hearing in order to get information on maternal and fetal infection.
For that purpose, 92 children born to women infected by ZIKV during pregnancy were followed up from August 2017 to July 2018.
Among the patients investigated, 55 (59.8%) children were male; 46 (50.0%) mothers were infected in the second trimester of pregnancy; two (2.2%) children had microcephaly at birth and one (1.1%) presented signs and symptoms associated with postnatal microcephaly. In addition, during clinical follow-up, behavioral changes that could affect child neurodevelopment were found, such as extreme irritability, with significant incidence (p < 0.0001), followed by aggressiveness and hyperexcitability, despite normal imaging tests.
According to these results, must be enhanced the need for multi-professional follow up of children with in utero ZIKV exposure in order to identify early and late changes associated with ZIKV and to conduct psychomotor activities that can reduce the sequelae in child neurodevelopment.
Keywords: Zika Virus; Pregnancy; Infection; Child Development; Microcephaly
The emergence of zika virus (ZIKV) in the Americas, which severely affected northeastern Brazil in the first semester of 2015, revealed the occurrence of congenital malformations during pregnancy, showing to the need for integrated monitoring with other pathogens more frequently related to intrauterine infections1. Accumulated evidence of clinical studies, particularly those conducted in Brazil, serve as a basis for American researchers from the Centers for Disease Control and Prevention who recognized the causal relationship between the occurrence of microcephalyand other brain damage identified in fetuses with zika virus2,3.
Currently, changes have been recorded among neonates: microcephaly, craniofacial disproportion, spasticity, convulsions, irritability and brain abnormalities detected by neuroimaging4. Such changes referred to ZIKV infection during pregnancy may suggest a congenital syndrome similar to congenital rubella or cytomegalovirus infection5,6. The evaluation of these newborns showed that ZIKV, besides being a neurotropic virus, also presents tropism for other organs, such as liver and heart, in addition to important visual and hearing alterations7.
Current clinical studies have found that other abnormalities can be identified at birth, besides microcephaly, such as craniocaudal disproportion, arthrogriposis (joint contractures) and central nervous system disorders (cerebral calcifications and atrophy, ventricular dilation and cerebellar hypoplasia)8,9. It was also observed, in the clinical follow-up of children with in utero Zika virus exposure, the presence of abnormalities in their development and growth, such as hypertonicity, clonus, hyperreflexia, involuntary movements, spasticity, contractures and convulsions, justifying the current recommendation of the Ministry of Health to follow those children up to 3 years of age by a multidisciplinary team6,8,9.
Based on these findings and the absence of clinical and epidemiological data in the Northern Region, the present study aims to identify early and late clinical and imaging changes, in children exposed to in utero ZIKV infection. From this perspective, a multiprofessional approach will be sought through clinical and laboratory follow-up, with emphasis on the investigation of, vision and hearing neuropsychomotor development in order to obtain more information about maternal and fetal infections.
This is a prospective, longitudinal research with clinical follow-up of children exposed to intrauterine ZIKV infection, in the Metropolitan Region of Belém, from August 2017 to July 2018. The research activities (clinical evaluation of patients, blood test and specialized evaluations) were conducted at the Instituto Evandro Chagas, Belém campus. The present study was developed following the rules from the Declaration of Helsinki and the Nuremberg Code, in addition to respecting the Ethical Standards of Scientific Research Involving Human Beings, according to Resolution No. 466/12 of the National Health Council, after approval by the Research Ethics Committee of the Instituto Evandro Chagas, with opinion no. 2,288,316, on August 19, 2017. All those responsible for the individuals involved in the research presented the signed Free and Informed Consent Form.
Preceding this study, the investigation was performed with 308 pregnant women with exanthem and suspected of ZIKV infection, who were referred to the Evandro Chagas Institute from November 2015 to December 2017, and clinical follow-up was performed after laboratory-confirmed ZIKV infection in 134 pregnant women and, of these, 109 were followed up until the end of pregnancy, however with the results still under analysis and they should contribute to clarify the macro-regional differences. Of the total number of live births from this group, 92 women were selected for the current research, based on the inclusion criteria and because they live in the Metropolitan Region of Belém. Children whose guardians did not accept to participate in the study or who gave up during its performance were excluded from the study, besides those who could not follow up during the study.
For the clinical evaluation of each child, including identification and description of malformations of newborns and/or infants, the definitions of the Integrated Guidelines for Surveillance and Health care in the Scope of the Public Health Emergency of National Importance were adopted6. The protocol used in this research followed the investigation questionnaire for microcephaly of the Ministry of Health in the Surveillance and Response Protocol for the Occurrence of Microcephaly Health - Version 1.3 of 201610.
In this group, clinical evaluations of children previously scheduled were performed with an interval of two to three months, for children up to 1 year of age, and an interval of six months from 2 years of age. Of the total number of pediatric consultations conducted during the follow-up period, the average was 5.7 consultations for each child. At the first appointment, the clinical evaluation was performed with a physical examination, with recording of anthropometric measurements (weight, height, head circumference, thoracic perimeter), investigation of congenital anomalies, incidence of seizures and other complications of the neonatal period, assessment of neurological functions and neurocognitive development, newborn screening tests, with emphasis on newborn hearing screening - NHS (hearing test) and vision screening test for infant (eye test) and analysis of the vaccination card. Whenever necessary, specific laboratory tests could be requested for ZIKV and differential diagnosis for dengue viruses (Dengue virus - DENV) and Chikungunya (Chikungunya virus - CHIKV), in addition to TORCH agents (toxoplasmosis, other infections, rubella, cytomegalovirus infection, herpes).
For the total RNA extraction of the 45 (28.9%) bloods/sera and one (1.1%) umbilical cord blood, the Promega Maxwell extraction system was used, following the manufacturer's protocol. The virus genome detection was carried out according to the method described by Domingo et al.11th. This molecular methodology is recommended in the investigation of newborns exposed to in utero ZIKV in order to confirm congenital infection.
The enzyme immunoassay (ELISA) for the detection of IgM antibodies anti-ZIKV, DENV and CHIKV was performed in 64 (69.56%) sera, according to Martin et al.12, and in 92 sera for TORCH agents. For the detection of viral antigens in the 15 placental fragments, the immunohistochemistry (IHC) was used13. In addition, a child with postnatal microcephaly characteristics performed reverse transcriptase polymerase chain reaction (RT-PCR) because s/he presented negative ZIKV tests.
After this stage, the neurological evaluation was indicated in case of changes in the physical examination and/or observations of the guardians, for subsequent indication of imaging exams - computed tomography (CT) and magnetic resonance imaging (MRI) of the skull, besides transfontanela ultrasound (US) and electroencephalogram (EEG). These tests were carried out according to neuropediatric indication and availability in public/private services.
It is noteworthy that, if during pediatric consultations it was found that the child did not perform any newborn screening test (NHS and eye test), the present study created evaluations in groups (task forces), with professional and specialized services to carried out retinal imaging (RI) and otolaryngology evaluation.
Analytical statistics were used in order to evaluate the results of categorical variables of the sample, using the Adherence Chi-Square tests for univariate analysis, and Partitioning Chi-Square for the table of clinical findings per trimester of gestation. Descriptive and analytical statistics were performed using the BioEstat software® v5.4.
Of the total number of children in this study, 55 (59.8%) were boys and 37 (40.2%) girls, there is no significant difference (p = 0.0763) in the gender ratio.
Regarding the gestational age exposed to the virus, it was identified that most mothers were infected in the second trimester of pregnancy (50.0%; n = 46), according to figure 1A, with a significant incidence of exposure to the virus during this period (p = 0.0028). However, in the relationship between the incidence of clinical changes identified during clinical follow-up and the gestational trimester of infection by this arbovirus, there was no statistically significant difference (p = 0.8727).
Regarding the prevalence of malformations in the evaluated group, two (2.2%) children presented microcephaly at birth, with laboratory confirmation of ZIKV infection by detecting viral antigens in the maternal placenta by IHC and IgM anti-ZIKV antibodies in cerebrospinal fluid by ELISA. It is emphasized that one (1.1%) ZIKV negative child, by RT-PCR and ELISA, presented clinical characteristics compatible with postnatal microcephaly, due to the deceleration in cephalic growth after the first year of age, with change of the head circumference growth curve adopted by the Ministry of Health6.
Regarding the changes of sensorineural hearing loss described in the Protocol of the Ministry of Health6, irritability, aggressiveness and hyperexcitability were recorded in this study as the most frequent ones, with 33.7% (n = 31), 14.1% (n = 13) and 13.0% (n = 12), respectively. There are also, although less frequent, cases of global hypotonia in five (5.4%) children. Other important findings (45.7%) include tremor, motor and speech disorder, premature thelarche, hyperreflexia, convulsion, hyperactivity, and low-set ear (Figure 1B). Genitourinary alterations were also found, considered rare in association with ZIKV, such as adhesions of the labia minora, cryptorchidism and hypospadias. All these changes were identified during the clinical follow-up of the children.
In the children laboratory analysis, 80.4% (n = 74) were under investigation of vertical transmission of ZIKV infection after birth. Of the samples tested, only three (3.2%) children (two microcephalic children and one without microcephaly) had laboratory confirmation of intrauterine infection by ZIKV. There was one (1.1%) molecular and serological positive result by ELISA technique, and two others resulted from clinical specimens obtained during the neonatal period: one in umbilical cord blood, by RT-PCR, and one in placenta fragment, by IHC. All these samples had increased investigation for other arboviruses, with negative results for DENV, CHIKV and TORCH agents.
Regarding imaging, 53 were carried out, adding 12 CT, 11 US, 14 MRI and 16 EEG, corresponding to 35.9% (33/92) of the children in this study after identifying any change in the clinical and neuropediatric evaluation or from reports of children's guardian that suggest neurological changes.
Of the 12 CT performed, three (25.0%) presented alterations: two in children with microcephaly at birth and one in children under investigation of postnatal microcephaly. All of them had calcifications in common, but in different regions, such as in parietal, parenchyma cells and in the cerebral white matter. Among the other changes found, the following ones stand out: skull reduction, dilation of the ventricles, small cerebellum, corpus callosum dysgenesis, increase of subarachnoid spaces and encephalomalacia areas. In US, a nonmicrocephalic infant showed a reduction in brain volume (frontal area), later confirmed by skull MRI.
It was possible to identify that, among the skull MRI performed, one (7.1%) microcephalic infant showed abnormalities such as calcifications, gyration anomalies, hypoplasia of the corpus callosum, cortical changes and brain disproportion. With the performance of the EEG, irritative activity was recorded with different proportions in the incidence of discharges and in the number of epileptogenic zones in both (12.5%) microcephalic children at birth (Figure 1C).
For the early identification of hearing loss, NHS tests were performed in 60 (65.2%) children in the current study. Of these, 12/60 (20.0%) children had absent response, especially on the left side. In the visual assessment, 58/92 (63.0%) eye test and MR tests were conducted, and no ocular abnormality was identified, such as pigmentary, atrophic or hypoplastic lesions in the macula or optic nerve. However, there was the identification, in MR, of bilateral total congenital cataract in a child and until that present moment, there is no report in the literature of association with ZIKV infection (Figure 1D).
A: Distribution of children according to gestational age in which they were exposed to ZIKV. B: Clinical findings identified during the clinical follow-up of children. C: Distribution of imaging exams with different results in children under clinical follow-up. D: Distribution of the altered results found in screening tests of children under clinical follow-up.
NHS: Neonatal hearing screening tests; RI: Retinal imaging; MRI: Magnetic resonance imaging of the skull; US: Transfontanela ultrasound; EEG: Electroencephalogram; CT: Computed tomography of the skull; *: p< 0.0001, AdherenceChi-Square Test.
Scientific evidence indicates that infants with normal head circumference and without visible congenital malformations may present developmental damage, in a medium to long term periods, associated with ZIKV14, which justifies the current clinical follow-up recommendations of children exposed to intrauterine ZIKV, with the objective of early identifying signs of restrictions in neuropsychomotor development.
Although gestational age at the time of infection is an important factor15, data found in the present study do not show that the earliest gestational age of virus exposure induces the most severe condition, and may cause congenital malformations regardless of the gestational age that the mother became infected. Despite this, in 2018, Orofino et al.7 found children with heart involvement who had intrauterine exposure to ZIKV, most of them (53.8%) in the second trimester of pregnancy.
In addition, one of the infection outcomes in the first trimester of pregnancy, observed in this study, is related to the malformation of the central nervous system in one of the microcephalic children in the study, during the 12th week. On the other hand, in the study by Faria et al.16, the potential risk peak was reported between the 14th and 17th week of pregnancy, including, therefore, the first period of the second trimester. This period, in the present study, corresponded to the moment of congenital infection of the second child with microcephaly.
Although the congenital syndrome associated with ZIKV brings together well-defined changes, such as microcephaly, specific imaging findings of the central nervous system and visual and auditory deficits17,18,19, it has been observed that there is a group of other clinical changes that may arise during the clinical follow-up of these children, such as severe irritability, hypotonia, hypertonia, hyperreflexia, spasticity and convulsions20.
Thus, congenital ZIKV infection may result in atypical neurological manifestations, far beyond isolated microcephaly, which have been identified during the clinical follow-up of these children with signs and symptoms such as irritability, hyperexcitability and hypotonia, all them considered risk factors for changes in neurodevelopment21.
In the present study, changes in the genitourinary system were identified, such as hypospadias, cryptorchidism and adhesions of the labia minora, which corroborates the findings of Costello et al.22, by suggesting that the digestive and genitourinary systems may be included in the congenital syndrome induced by ZIKV, despite the fact that rare clinical changes in the clinical spectrum of children exposed to intrauterine infection are considered.
In the analysis of children submitted to laboratory investigation after birth, three samples were positive, one confirmed by ELISA technique and two by clinical specimens obtained in the neonatal period. The difficulty in performing molecular and serological tests in the present study was mainly due to the absence verification for these tests at the exact time at birth, or specific serological tests to decrease cross-reactions with other flaviviruses, as well as logistical difficulties in transporting and storing the materials to the reference laboratory. This situation is similar to the problems faced by Castro et al.23 in 2017.
The results of negative laboratory tests in children should not be interpreted as determinants for the interruption of longitudinal clinical follow-up, it is essential screening tests associated with neuroimaging tests in children exposed to intrauterine ZIKV infection24. Normocephalic children at birth are also included, such as those found in the present study, but who should receive early attention regarding complementary brain study techniques, since only exposure is a risk factor for possible cognitive delays in this silent and unknown scenario8.
On skull CT, the presence of coarse heterogeneous calcifications is considered a inclusion criteria for congenital ZIKV infection, as described by Souza et al.25, and it is associated with microcephaly. As for skull MRI, the main abnormalities already described in the literature were found in a microcephalic child26,27. US in a non-microcephalic infant revealed frontal lobe reduction, that is not similar to that described by Aragon et al.26, in a study conducted in 2016, in which this test had no change in children exposed to ZIKV, but when it is present, may suggest virus-induced damage. Regarding EEG, few data have been found on the importance of this test associated with Zika microcephaly; however, epileptiform discharges were identified in children without structural anomalies, which confirms developmental surveillance in long-term intrauterine exposed children.
It is known that sensory impairment is present with two variables (auditory and visual), among the three main impairments of ZIKV exposure during pregnancy, making observations and periodic monitoring of these organs that are essential targets for the clinical follow-up of children, since only neonatal screening does not exclude the organs in later stages of life26.
Hearing loss associated with other congenital viral infections is well described in the literature; however, this disorder still needs to be elucidated in children with intrauterine exposure to ZIKV infection28. In a study conducted with 70 microcephalic children with evidence of congenital ZIKV infection, it was recorded that 7.1% had hearing loss29. That finding corroborates what was found in this study, in which there were changes to the evoked otoacoustic emission testing (EOAE) of 20.0% of the children with absent response in the test. It shows the importance of elucidating the exact mechanism underlying hearing loss.
Ocular alterations have been reported in children with confirmed or presumed congenital ZIKV infection, which are chorioretinal atrophy or scars, pigmentation disorders, optic nerve hypoplasia, optic disc pallor, optic disc augmentation, retinal hemorrhages and retinal vascular abnormalities19,20. It is also known that the association of ZIKV with ocular changes is due to the tropism of the virus by the organ and is documented in patients with microcephaly, as reported in the study conducted by Verçosa et al.30 in 2017, in which he identified that 36% of his microcephalic patients had some abnormalities, which were not found in the present study, but that can be justified by the sample of this cohort involving only two (2.2%) microcephalic children.
From the results obtained in this research, it was possible to observe that, in addition to the already well-defined situation of congenital syndrome associated with ZIKV, there is a challenging scenario of clinical follow-up of these children, since clinical findings, such as extreme irritability, aggressiveness and hyperexcitability, observed during child development, showing the need for a biopsychosocial and multiprofessional view, thus allowing the identification of early changes and promote intervention measures aimed at mitigating neuropsychomotor complications.
On neonatal screening and additional tests, such as retinal mapping, periodic screening is essential, and it is clear that changes may arise in later stages of childhood. This highlights the importance of determining whether children who have been exposure to this arbovirus during pregnancy will have fluctuations or progressions to abnormalities.
Therefore, is necessary to have further clinical follow-up studies on children exposed to intrauterine ZIKV infection in order to evaluate the long-term consequences on child development and, thus, to promote knowledge and early interventions in the clinical follow-up of these children.
1 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Plano Nacional de Enfretamento à Microcefalia no Brasil. Protocolo de vigilância e resposta à ocorrência de microcefalia relacionada à infecção pelo vírus Zika. Brasília: Ministério da Saúde; 2015. [ Links ]
2 European Centre for Disease Prevention and Control. Zika virus epidemic in the Americas: potential association with microcephaly and Guillain-Barré Syndrome, 21 January 2016. [ Links ]
3 European Centre for Disease Prevention and Control. Rapid risk assessement: Microcephaly in Brazil potentially linked to the Zika virus epidemic, 25 November 2015. [ Links ]
4 Martines RB, Bhatnagar J, Ramos AMO, Davi HPF, Iglezias SD, Kanamura CT, et al. Pathology of congenital Zika Syndrome in Brazil: a case series. Lancet. 2016 Aug;388(10047):898-904. [ Links ]
5 Calvet GA, Santos FB, Sequeira PC. Zika virus infection: epidemiology, clinical manifestations and diagnosis. Curr Opin Infect Dis. 2016 Oct;29(5):459-66. [ Links ]
6 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Secretaria de Atenção à Saúde. Orientações integradas de vigilância e atenção à saúde no âmbito da Emergência de Saúde Pública de Importância Nacional. Brasília: Ministério da Saúde ; 2017. [ Links ]
7 Orofino DHG, Passos SRL, Oliveira RVC, Farias CVB, Leite MFMP, Pone SM, et al. Cardiac findings in infants with in utero exposure to Zika virus - a cross sectional study. PLoS Negl Trop Dis. 2018 Mar;12(3):e0006362. [ Links ]
8 van der Linden V, Pessoa A, Dobyns W, Barkovich AJ, van der Linden JúniorH, Rolim Filho EL, et al. Description of 13 infants born during October 2015 - January 2016 with congenital Zika virus infection without microcephaly at Birth - Brazil. Morb Mortal Wkly Rep. 2016 Dez;65(47): 1343-8. [ Links ]
9 Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects - reviewing the evidence for causality. N Engl J Med. 2016 May;374:1981-7. [ Links ]
10 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Protocolo de vigilância e resposta à ocorrência de microcefalia. Brasília: Ministério da Saúde ; 2016. [ Links ]
11 Domingo C, Patel P, Yillah J, Weidmann M, Méndez JA, Nakouné ER, et al. Advanced yellow fever virus genome detection in point-of-care facilities and reference laboratories. J Clin Microbiol. 2012 Dec;50(12):4054-60. [ Links ]
12 Martin DA, Muth DA, Brown T, Johnson AJ, Karabatsos N, Roehrig JT. Standardization of immunoglobulin M capture enzyme-linked immunosorbent assays for routine diagnosis of arboviral infections. J Clin Microbiol. 2000 May;38(5):1823-6. [ Links ]
13 Hsu SM, Raine L, Fanger H. Use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem. 1981 Mar;29(4):577-80. [ Links ]
14 Faiçal AV, Oliveira JC, Oliveira JVV, Almeida BL, Agra IA, Junior Alcantara LC, et al. Neurodevelopmental delay in normocephalic children with in utero exposure to Zika virus. BMJ Paediatr Open. 2019 Jul;3(1):e000486. [ Links ]
15 Wright HT. Congenital anomalies and viral infections in infants. The etiologic role of maternal viral infections. Calif Med. 1966 Nov;105(5):345-51. [ Links ]
16 Faria NR, Azevedo RSS, Kraemer MUG, Souza R, Cunha MS, Hill SC, et al. Zika virus in the Americas: early epidemiological and genetic findings. Science. 2016 Apr;352(6283):345-9. [ Links ]
17 Moore CA, Staples JE, Dobyns WB, Pessoa A, Ventura CV, Fonseca EB, et al. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr. 2017 Mar;171(3):288-95. [ Links ]
18 Ventura LO, Ventura CV, Lawrence L, van der Linden V, van der Linden A, Gois AL, et al. Visual impairment in children with congenital Zika syndrome. J AAPOS. 2017 Aug;21(4):295-299.e2. [ Links ]
19 Russel K, Oliver SE, Lewis L, Barfield WD, Cragan J, Meaney-Delman D, et al. Update: interim guidance for the evaluation and management of infants with possible congenital Zika virus infection - United States, August 2016. MMWR Morb Mortal Wkly Rep. 2016 Aug;65(33):870-8. [ Links ]
20 Miranda-Filho DB, Martelli CMT, Ximenes RAA, Araújo TVB, Rocha MAW, Ramos RCF, et al. Initial description of the presumed congenital Zika syndrome. Am J Public Health. 2016 Apr;106(4):598-600. [ Links ]
21 Zorrilla CD, García García I, García Fragoso L, De La Vega A. Zika virus infection in pregnancy: maternal, fetal, and neonatal considerations. J Infect Dis. 2017 Dec;216(Suppl 10):S891-6. [ Links ]
22 Costello A, Dua T, Duran P, Gülmezoglu M, Oladapo OT, Perea W, et al. Defining the syndrome associated with congenital Zika virus infection. Bull World Health Organ. 2016 Jun;94(6):406-406A. [ Links ]
23 Castro JDV, Pereira LP, Dias DA, Aguiar LB, Maia JCN, Costa JIF, et al. Presumed Zika virus-related congenital brain malformations: the spectrum of CT and MRI findings in fetuses and newborns. Arq Neuro-Psiquiatr. 2017 Oct;75(10):703-10. [ Links ]
24 Mulkey SB, Vezina G, Bulas DI, Khademian Z, Blask A, Kousa Y, et al. Neuroimaging findings in normocephalic newborns with intrauterine Zika virus exposure. Pediatr Neurol. 2018 Jan;78:75-8. [ Links ]
25 Souza AS, Oliveira-Szjenfeld PS, Melo ASO, Souza LAM, Batista AGM, Tovar-Moll F. Imaging findings in congenital Zika virus infection syndrome: an update. Childs Nerv Syst. 2018 Jan;34(1):85-93. [ Links ]
26 Aragão MFV, van der Linden V, Brainer-Lima AM, Coeli RR, Rocha MA, Silva PS, et al. Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study. BMJ. 2016 Jun;353:i1901. [ Links ]
27 Hazin AN, Poretti A, Cruz DDCS, Tenorio M, van der Linden A, Pena LJ, et al. Computed tomographic findings in microcephaly associated with Zika virus. N Engl J Med. 2016 Jun;374(22):2193-5. [ Links ]
28 Cunha RV, Geniole LAI, Brito CAA, França NPS, Santos Neto OG, Nascimento DDG, et al. Zika: abordagem clínica na atenção básica. UFMS; 2016. [ Links ]
29 Leal MC, Muniz LF, Caldas Neto SS, van der Linden V, Ramos RCF. Sensorineural hearing loss in a case of congenital Zika virus. Braz J Otorhinolaryngol. In press 2016. [ Links ]
30 Verçosa I, Carneiro P, Verçosa R, Girão R, Ribeiro EM, Pessoa A, et al. The visual system in infants with microcephaly related to presumed congenital Zika syndrome. J AAPOS. 2017 Aug;21(4):300-4.e1. [ Links ]
FINANCIAL SUPPORT This research received assistance by scientific initiation scholarships from the Institutional Program of Scientific Initiation Scholarships of the Universidade do Estado do Pará (PIBIC/UEPA).
8Article originally published in Portuguese (http://dx.doi.org/10.5123/S2176-6223202000216)
How to cite this article / Como citar este artigo: Oliveira CS, Matos HJ, Gomes LTS, Sera EMF, Fraiha MC, Nunes DS. Clinical follow-up of children with in utero Zika virus exposure in the Metropolitan Region of Belém, Pará State, Brazil. Rev Pan Amaz Saude. 2020;11:e202000216. Doi: http://dx.doi.org/10.5123/S2176-6223202000216
Received: March 17, 2019; Accepted: December 03, 2019


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ZCZC MIATCPEP4 ALL TTAA00 KNHC DDHHMM BULLETIN Hurricane Bonnie Advisory Number 35 NWS National Hurricane Center Miami FL EP042022 300 AM MDT Wed Jul 06 2022 ...BONNIE WEAKENS WHILE MOVING WESTWARD INTO THE OPEN EASTERN PACIFIC... SUMMARY OF 300 AM MDT...0900 UTC...INFORMATION ---------------------------------------------- LOCATION...15.9N 108.3W ABOUT 355 MI...570 KM SSW OF CABO CORRIENTES MEXICO MAXIMUM SUSTAINED WINDS...100 MPH...155 KM/H PRESENT MOVEMENT...W OR 280 DEGREES AT 14 MPH...22 KM/H MINIMUM CENTRAL PRESSURE...971 MB...28.68 INCHES WATCHES AND WARNINGS -------------------- There are no coastal watches or warnings in effect. DISCUSSION AND OUTLOOK ---------------------- At 300 AM MDT (0900 UTC), the center of Hurricane Bonnie was located near latitude 15.9 North, longitude 108.3 West. Bonnie is moving toward the west near 14 mph (22 km/h). A westward to west- northwestward motion is forecast through the week with a slight decrease in forward speed during the next couple of days. Maximum sustained winds have decreased to near 100 mph (155 km/h) with higher gusts. Little change in strength is expected through Thursday. Gradual weakening is forecast to begin on Thursday night and continue through Friday. Hurricane-force winds extend outward up to 25 miles (35 km) from the center and tropical-storm-force winds extend outward up to 90 miles (150 km). The estimated minimum central pressure is 971 mb (28.68 inches). HAZARDS AFFECTING LAND ---------------------- SURF: Swells generated by Bonnie will continue to affect portions of the coast of southwestern Mexico during the next day or so. These swells are likely to cause life-threatening surf and rip current conditions. Please consult products from your local weather office. NEXT ADVISORY ------------- Next complete advisory at 900 AM MDT. $$ Forecaster Beven NNNN
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The Egyptian Museum: A Journey to the Past
The Egyptian Museum in Cairo is a fascinating place that holds over 120,000 artifacts that showcase the rich history of Ancient Egypt. It is considered one of the most significant museums worldwide containing artifacts from Ancient Egypt, such as the most famous artifacts of Kings Tutankhamun's tomb. The museum provides an unforgettable journey to the past, embracing the diverse art pieces and the rich cultural legacy of Egypt. Interested in learning more about the topic discussed? Click for more details on this subject, in which you'll discover additional data and engaging viewpoints to enrich your educational journey.
An Artistic Journey to Unbelievable Art Pieces
The Egyptian Museum allows visitors to explore Egypt's unique artistic and cultural history since the museum was created to preserve and display the country's history. The exhibitions range from the pre-dynastic period, illustrating the evolution of ancient Egyptian art to the Greco-Roman era that reflects the mixture of Greek and Egyptian styles. One of the most famous exhibitions in The Egyptian Museum is the Tutankhamun Gallery, which includes the boy-king's throne, chair, and the famous death mask that weighs 10 kilos and carved out of solid gold; it is one of the most significant pieces of art in the museum.
The Royal Mummy Room is another exceptional part of the museum, which showcases the famous Pharaohs' mummies, such as Ramses II and his father Seti I. Visitors will be amazed by the ancient Egyptians' mummification techniques and rituals, which were practiced since the pre-dynastic era to preserve their bodies to achieve eternal life. In addition, The Gold Room holds a display of gold objects that Pharaohs used as an offer to gods in their temples. These objects show the high level of skills the ancient Egyptians had with metallurgy, and they reflect how important gold was in ancient Egyptian culture.
The Interactive Displays
The museum also provides interactive displays that help visitors understand the ancient past in an enjoyable and educational way. Visitors can watch the mummification process, the making of papyrus sheets, and the intricate craftsmanship of various artifacts. There is also a digital guide available in multiple languages that allows visitors to have detailed information about each exhibit.
Visiting the Museum in 2021
The museum recently underwent a refurbishment to enhance the visitors' experience, which includes the addition of a new display hall and the restoration of the King Tutankhamun Gallery. It is essential to plan your visit by booking your tickets online and arriving early when the museum opens to avoid long queues. Visitors can make use of the museum's website and social media pages to keep themselves updated on any events that may be taking place at the museum or any new exhibitions. We're always striving to provide a comprehensive learning experience. Visit this thoughtfully selected external site and find more details about the subject. Private tours of Egypt https://www.pyramidsland.com.
In Conclusion
The Egyptian Museum is the perfect place to appreciate the beauty and history of ancient Egypt properly. It is a destination for those who wish to embark on a journey through time. Through thousands of years and numerous dynasties, The Egyptian Museum offers an in-depth, immersive experience that allows visitors to connect with their cultural heritage fully. The museum provides visitors with an understanding of not only the ancient history of Egypt but also the rich cultural heritage that continues to this day.
Find more information and perspectives on the topic covered in this article by visiting the related posts we've prepared:


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Latinx Coloradans call for 'equitable and just local news'
The news behind the news in Colorado this week
'Community members and journalists alike were in no mood for appeasement'
This week, Latinx Voices: Colorado released a report titled "Think Big. Act Now: A Call to Action from Latinx Coloradans for Equitable and Just Local News."
With it came these four recommendations:
Holding newsrooms accountable for increasing Latinx diversity on staff, among sources and in stories.
Creating programs for Latinx youth to learn about the impacts of news media and participate in its change toward accurate, fair and equitable coverage.
Supporting existing and emerging networks of Latinx information providers, storytellers and community members.
Building Latinx-owned media power.
"The discussions that led to these recommendations were facilitated by News Voices: Colorado, the Colorado Media Project and the Colorado News Collaborative (COLab), which convened the Latinx Voices Working Group," a Free Press statement read. "Discussions often focused on the distance between what Latinx communities see as the future of local news and the barriers they face in getting there."
From the report:
"Community members and journalists alike were in no mood for appeasement. Anger coursed through the public conversation … [W]hat became clear was the shared desire among community members and journalists to create momentum for tangible, lasting changes in the ways in which newsrooms cover the state's Latinx communities — including how those newsrooms welcome and support Latinx journalists."
"If a just society relies on an informed population, it must include an obligation to inform all who make up that population," News Voices: Colorado Manager Diamond Hardiman said in a statement. "We are asking everyone in Colorado to use this report as a starting point toward needed change — and as a tool to support the redistribution of storytelling and narrative power into the hands of Latinx communities both locally and nationally. The four recommendations aim to make Colorado the first state in the country that has equity in all areas of the media. It's a dream we can make reality by acting now."
Here's some context on the timing from the report's executive summary:
The Latinx Voices Working Group came together as a Latina journalist at the state's most widely viewed television station reported that she and two Latina colleagues had been let go over the course of a single year. In the resulting furor over her depiction of a newsroom that held journalists of color to different (and shifting) standards, a group of Latina lawmakers and the National Association of Hispanic Journalists met with station leadership demanding changes from the top.
"Being part of this project has been a beautiful and challenging experience," Brenda Vargas, Latinx Voices working-group member and president of Movimiento de Radical Cultura, said in a statement. "Oftentimes, we as people of color do not have spaces to share our stories and experiences, or have our opinions validated. Having this space to not only converse but also actively create solutions and seek reparations for issues that we see in the media has been so empowering. Know that the change that is to come is solely because we have demanded that change and have been willing to fight for it; we all deserve access to accurate, antiracist and just news."
The recommendations follow a September report from Black Voices: Colorado that outlined five recommendations from a working group focused on "how to improve access to trustworthy news and information for Black residents throughout the state."
Read the entire "Think Big. Act Now" report here.
🌿 This week's newsletter is proudly supported in part by Grasslands, Denver's Indigenous-owned PR, marketing, and ad agency that is thankful for the tireless work reporters do to bring our communities the stories that matter. Founded by veteran Denver Post journalist Ricardo Baca, Grasslands — the recipient of a 2020 Denver Business Journal Small Business Award — is a Journalism-Minded Agency™ working with brands in highly regulated industries, including cannabis, technology, and real estate. Operating from its new offices in Denver's Art District on Santa Fe, the firm's 20-person team of communications professionals is focused on a single mission: "We tell stories, build brands and amplify value." Email firstname.lastname@example.com to see how Grasslands can supercharge your brand's marketing program (and read some of our cannabis journalist Q&As here). 🌿
🎯Colorado right-wing radio is latest target in defamation suits
New lawsuits stemming from wild allegations about a former Colorado-based elections worker now include Colorado radio personalities.
From KUSA 9News in Denver:
Eric Coomer, the former director of strategy and security for Dominion Voting Systems, has filed a lawsuit against the company that owns 710 AM KNUS and one of the radio station's hosts, Randy Corporon. The suit accuses Corporon and Salem Media of defamation because of allegations of rigging the 2020 presidential election against former President Donald Trump.
"Both Salem Media, which owns Denver-based 710 KNUS, and Corporon, a 710 KNUS host, elevated Dr. Coomer into the national spotlight, invaded his privacy, threatened his security, and fundamentally defamed his reputation through a relentless election fraud campaign," court documents state.
The lawsuit also said Salem Media and its hosts were "enthusiastic and consistent" pushers of voter fraud claims, though they did not provide evidence.
From Westword in a piece headlined "Inside Lawsuit That Could Kill a Denver Radio Station":
Among Salem's alleged sins is providing a platform for Joe Oltmann, described as a "Colorado-based conspiracy theorist," whose tales about a fictional partnership between Dominion and antifa organizations to steal the presidency for Joe Biden were among the major reasons Coomer spent months in hiding after the 2020 election.
But while Corporon endorsed such theories — saying at one point, "Joe, what you have done and exposed may save the republic, or at least save the possibility of having an honest outcome to this election" — Peter Boyles, another KNUS personality who chatted with Oltmann, has been far more critical of fraud fairy tales. Indeed, the suit quotes Boyles as saying, "The center of the conspiracy is all here. A river runs through it. This stuff all generates at this radio station and comes through this radio station." He added that "a list of people remain, and many of them appear here at this radio station again and again and again."
The suit's comment about this statement: "Unfortunately, Boyles' moment of candor was not shared by all at 710 KNUS, and other Salem Media hosts continue to promote the falsehoods about the election generally and Dr. Coomer in particular. As a result, the harm that Salem Media has caused Dr. Coomer with its reckless, incessant drumbeat of falsehoods across numerous programs for months on end is irreparable. Dr. Coomer's successful career in election security is over, and the constant death threats that persist even now will remain an indelible trauma for the rest of Dr. Coomer's life."
The alt-weekly newspaper reported that Salem Media vice president and general manager Brian Taylor, Corporon, and Boyles "all declined to comment about the lawsuit."
Meanwhile …
A high-profile Denver school board member and activist who found himself the center of controversy when some mainstream media outlets and others reported on anonymous accusations against him (relayed through a third party) has filed legal action against those who accused him — and he wants a jury trial.
From CBS4:
Tay Anderson has filed a $1 million defamation lawsuit. The Denver School Board member is suing the group Black Lives Matter 5280, members of its leadership team and other activists. Anderson says they all played a role in planning and publishing over 60 false allegations of sexual assault against him.
It comes months after two separate investigations failed to find any evidence to support the claims, although they did reveal that he had acted in an inappropriate manner. Anderson says the investigation cost him countless job opportunities, fear over the safety of his family and that it hurt the work of Denver Public Schools.
Chalkbeat Colorado, Westword, The Denver Post, and others have more.
From Westword:
In an announcement of the filing, his attorney, Issa Israel, described it as "a million-dollar lawsuit for defamation and civil conspiracy against Black Lives Matter 5280, 'activist' Mary Katherine Brooks-Fleming, Dr. Apryl Alexander, members of BLM 5280's leadership team and others for their respective roles in planning and publishing over sixty false allegations of sexual assault against Denver School Board Director Tay Anderson under the guise of advocating for 'anonymous' victims — all of whom were unwilling to come forward publicly, cooperate with law enforcement privately or respond to independent investigators."
As of Thursday, multiple news outlets hadn't gotten comments from the named defendants.
Loveland newspaper union goes to City Hall
Typically, journalists at the Loveland Reporter-Herald newspaper might show up to a local city council meeting with a notebook and voice recorder in hand, prepared to chronicle the latest news for their readers.
That wasn't the case Tuesday when a handful of the paper's journalists showed up to speak directly to city leaders and, in the process, are now making news themselves.
During a public comment portion of the council meeting, photojournalist Jenny Sparks and reporters Austin Fleskes, Will Costello, and Max Levy pleaded for help from city leaders and the community in their fight for fair treatment from Media News Group, which owns their paper. The four are members of the Heart of NoCo newsroom labor union, which staff formed earlier this year. Media News Group is controlled by the Alden Global Capital hedge fund that has a reputation for gutting newsrooms. The hedge fund has its hooks in about a dozen other Colorado papers.
At one point, as he addressed the city council, Levy acknowledged it was kind of unprecedented for him to be speaking at a city meeting. But he and others indicated they were willing to do things a little differently to alert the community to what Levy described as an unsustainable model for local journalism.
Here's a tweet thread I put together from the council meeting as it streamed live. Many of the council members, and the mayor, sounded sympathetic to the newsroom union's plight.
More Colorado media odds & ends
👀 "This is NOT a Misprint!" The Eastern Colorado Plainsman newspaper published a blank front page in support of the Local Journalism Sustainability Act.
🥳 Colorado Matters on Colorado Public Radio turned 20. Here's how the team commemorated it.
🔎 The Colorado Sun spent hundreds of dollars to obtain public records for this investigation into what phony drugs made to look real have done to a Colorado county.
💸 "President Joe Biden's $1.85 trillion social spending bill includes a provision that, if it becomes law, would mark the first time the federal government has offered targeted support in response to the decline of local news," The Associated Press reported. Question: Would companies like Alden Global Capital get tax benefits?
📺 KUSA 9News anchor Kyle Clark earned Jay Rosen kudos, a tweet from Stephen King, and an appearance on the Rachel Maddow Show for his commentary on how his 'Next' show handles a certain Colorado political figure. (Here's 5280 magazine's 2017 profile of 'Next' and how its host was reimagining local TV news a year into the show.)
🗞 Anna Lynn Winfrey at The Montrose Daily Press would like to see stories from local outlets linked when larger news organizations report them.
💨 New York Times reporter Jack Healy, who has been based out of Colorado for several years, will now be based in Phoenix, Arizona "to cover a region undergoing explosive growth and demographic change."
💥 Colorado's other New York Times reporter, Dave Philipps, had a bombshell this week.
📣 In August, members of the Commission on Information Disorder "gathered in Aspen, Colorado, to discuss and deliberate proposed solutions and recommendations, weighing which actions would have meaningful impact and which would face the most hurdles, from whom and why." Read its final report.
💨 Scott J. Adams is leaving BoulderHub after nine years, saying, "Probably my last day as a journalist as well."
🤦♂ Colorado's new independent redistricting commission "came with a promise of transparency and public inclusion, but in the days leading up to their adoption of a set of legislative maps, commissioners spent significant time working outside of public meetings," The Gazette's Evan Wyloge found.
📱Colorado will get "at least $100 million, possibly $1 billion, from infrastructure bill to end digital divide," Tamara Chuang reported in The Colorado Sun.
💵 A full-time editor job at the Estes Park Trail Gazette posted this week by Media News Group now comes with a pay scale: $30,000 to $40,000 a year.
🎬 A movie production facility has opened at the Journal newspaper's plant in neighboring New Mexico's Albuquerque.
🎙 Jason Salzman is trying to get conservative talk radio hosts to clean up pandemic misinformation. "Please kindly F—K OFF and never text me again," was a host's response.
✒ Moe Clark is looking to build a freelance journalism community in Colorado.
🚬 Calling Facebook "the new Big Tobacco," Denver agency SE2 has announced that "Until Facebook institutes meaningful changes that contribute to our collective good, we will no longer recommend to our clients that they spend money on its products, including paid promotion of their content on Facebook or Instagram."
🔍 Sexual abuse and misconduct allegations were "kept quiet for decades" at the world-renowned Colorado Center for the Blind, David Gilbert reported for The Colorado Sun.
🔀 Colette Bordelon is leaving KOAA TV in the Springs for The Denver Channel.
⚙ High Country News is seeking a "Contributing Editor for Books, Culture and Commentary to assign and edit inquisitive, inspiring, and thought provoking content for HCN in print and online."
⌛ From an obituary this week: "In the early 60s, Carol Hewitt was a TV celebrity, teaching typing on KRMA Channel 6 in Denver. She recalled that when she decided to have kids, it was forbidden to appear on TV pregnant and so she left to raise her family."
I'm Corey Hutchins, interim director of Colorado College's Journalism Institute, the Colorado-based contributor for Columbia Journalism Review's United States Project, and a journalist for multiple news outlets. The Colorado Media Project, where I write case studies, is underwriting this newsletter, and my "Inside the News" column appears at COLab, both of which I sometimes write about here. (If you would like to join CMP and Grasslands in underwriting this newsletter, hit me up.) Follow me on Twitter, reply or subscribe to this weekly newsletter here, or e-mail me at CoreyHutchins [at] gmail [dot] com.


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Popular Nigerian singer and Mavin Records signee, Oyinkansola Sarah Aderibigbe, also known as Ayra Starr has mentioned those who influence her fashion sense.
The 'Rush' crooner, disclosed this in a recent interview with Kiss FM, London, United Kingdom.
On where she got her sense of style from, she said, "It's everywhere. You know, people inspire me. Everybody inspires me. All the baddies on the gram. All the sabi girls. Everybody; my mum, my aunty, Rihanna."
She also revealed plans to join the fashion industry in the future.
"Definitely, I was gonna do fashion before I was gonna do music."
Ayra Starr went on to declare herself "president of miniskirts and co."
The 24-year-old singer said she has always known right from when she was five-year-old that she was going to become a global pop star.
She said her dream collaborators are Burna Boy and Rihanna.
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The iPhone 15 Pro would finally have physical buttons, Apple
Android 12.1: an unexpected new update before the release of Android 13?
Google would have decided to upset its usual cycle of updates. According to information from our colleagues at XDA Developers, Google is working on a one-off update to Android 12.1, which would be released before Android 13 next year.
Google has just deployed the fifth and final beta version of Android 12, which is considered a "release candidate", which augurs well for the imminent deployment of the final version. While we expected Google to be working on Android 13 after the release of Android 12 this fall, the American giant has reportedly decided to introduce a one-off update to Android 12.1 mid-cycle.
It wouldn't be the first time this has happened in its history, since this practice was quite common during the time of the first versions, but Google hasn't released one-off updates for its operating system since Android Oreo 8.1, four years ago now..
To read also : The Galaxy S21 will be entitled to Android 12 by the end of 2021
Android 13 will not be the next operating system version after Android 12
With the upcoming release of Android 12, Google advised developers to update their apps with its API level 31, which is the new update. Each new API level corresponds to a new update from Google, we found for example the API level 30 for Android 11, and level 23 for Android 10.
XDA Developers reports that they have spotted a level 32 API, which would have logically been intended for Android 13, which is codenamed Tiramisu. However, findings from XDA Developers suggest that API level 32 is actually Android 12 "sc-v2", not Android 13 "T". In this case, "sc" is an abbreviation for the internal name of Android 12 dessert "Snow Cone", and "v2" implies that Snow Cone will receive "version 2".
For now, we do not know what new features will bring Android 12.1, or if it will be a version reserved for Pixel smartphones from the manufacturer. It is also unclear whether Google plans to roll out Android 12.1 in 2021 or later in 2022. However, it will arrive well before Android 13, which will be released next fall.
Source: XDA


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Famous actor Habib being remembered on his 5th death anniversary
LAHORE (92 News) - Famous actor Habib is being remembered on his fifth death anniversary. He started his career with the movie "Lakht Jaggar" and made a name for himself in the film world.
Actor Habib was born in 1931 in Patiala. He came to Lahore at the time of establishment of Pakistan. Introduced as a hero in the film industry and soon made his mark. Show the essence of acting in successful films like Jeddar, Chen Makhna, and Basheera that his name came to be considered as a guarantee of the success of the film.
Apart from film, actor Habib has also acted in TV dramas and radio programs. For his technical services, he was awarded the Lifetime Achievement Award by the Government of Pakistan.
Habibur Rehman aka actor Habib passed away on February 25, 2016, leaving his fans depressed.


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3 Trends Elevating Business Email Risks for Accountants in 2023
Security discussions have undergone a transformation to counter evolving cybercriminal tactics. Initially, focus centered on safeguarding client data to prevent financial and reputational harm. This resulted in investments in single sign-on (SSO), multi-factor authentication (MFA), and a shift to cloud-based software with robust online security. With improved data protection, hackers shifted their attention to exploiting vulnerabilities within the communication medium itself – Email.
Consider this: controlling someone's email account equates to possessing their identity. In essence, email gives hackers access to relationships, applications, and data – a digital key to their kingdom.
Let's delve into the 3 trends that have significantly elevated the business email risks for accountants in 2023
1. Surge in Email Activity Since the Pandemic
The pandemic forced many accountants to increase their email activity. This is a reflection of the changing ways in which businesses are communicating and collaborating.
Practice management tools are pivoting to help accountants manage the increased volume of email. For example, newer practice management platforms such as FYI encourage accountants to view and check off tasks from within Outlook. Another software, Karbon, has also taken an email-centric approach with a triage centre that quickly turns emails into actionable tasks.
The rising dependency on email makes it a highly attractive target for hackers. This is the first line of communication where accountants make decisions quickly and respond to client requests.
The increasing volume of emails makes it much harder for time-poor accountants to keep up with requests from clients and colleagues. A well-written email, crafted to look like one of the many legitimate messages, can easily blend in with the torrent.
2. Targeted Phishing Takes Center Stage
Email compromise techniques have taken a sophisticated turn. Hackers no longer rely on a spray and pray approach. They now employ targeted phishing tactics, aiming at industries with sensitive information and trusted payment partners.
Accounting firms often become targets of spear-phishing attacks, where hackers focus on the leadership within organizations. Executives have better access to valuable financial data and are more susceptible to attacks due to a lack of proper training.
According to Lookout, the highest rate of mobile phishing attacks in history was recorded in 2022.
3. AI Elevates Impersonation Attacks
AI-powered tools have exponentially increased the sophistication of impersonation attacks. In fact, a recent study revealed that 67% of email based cyber attacks now leverage AI technology, making them more difficult to detect and defend against.
We usually associate a spam email with bad sentence structures and grammatical errors, but with tools like ChatGPT, language is no longer a barrier for hackers from non-english speaking countries.
Replicating communication styles of executive teams and trusted partners can be effectively done using AI tools. This is resulting in unprecedented rise of high targeted impersonation attacks that get impossible to detect
How to secure your business emails?
Effective defense relies on three pillars: the right technology, a well-educated team, and comprehensive policies. Ensuring robust email access and application security, training your team to recognize threats, and implementing sound policies are the key components to safeguarding your business from the evolving dangers of cybercrime. Learn more about this in our recent blog – Safeguarding Your Business Emails: The 3 Pillars of Cybersecurity
In the rapidly evolving landscape of cybersecurity, staying ahead of these trends is imperative for accountants. Recognizing the amplification of email-based risks and fortifying your defense mechanisms against them are essential steps to safeguarding your firm's integrity and data. By comprehending these trends, you equip yourself to navigate the intricate web of cyber threats in 2023 and beyond.


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I've written a bunch here about the pair of bald eagles nesting in a tree at Lake Highlands Park, near the north end of White Rock Lake. You might have heard that their nest was blown out of its tree yesterday. Ben Sandifer, I think, was the first to break the news. His tweet describing the eagles crying as they circled the scene of their eggs' demise was heartbreaking, especially for those of us who live in the neighborhood and have been keeping an eye on the birds' progress for the last few months.
So I want to bring you some good news. A buddy of mine lives behind that park. In a sycamore not far from the old nest site, there is an abandoned hawks' nest that he can see from his backyard. The eagles must have found the thing on Airbnb. They've moved in. The place isn't big enough for them. It's probably just temporary. But at least they've found a place to stay.
My buddy took this picture with an iPhone jammed against his binoculars this morning. With apologies for the terrible image quality:


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Chris Janiec
The acquisition of Avocado Ridge marks the first completed in collaboration with Macquarie Agricultural Funds Management under a deal announced last month.
Snooze, which runs 17 locations across Colorado, California, Arizona and Texas, specialises in breakfast and lunch options in metro areas and has a focus on sustainability.
The challenging profit margin environment US farmers face will continue until at least 2018, according to Rabobank's senior grains and oilseeds analyst Sterling Liddell.
Pilgrim's Pride said the acquisition would help expand into the upper Midwest while addressing evolving consumer demands, though Humane Society rejected the claims of 'humanely-raised' chickens.
The $150m Tyson New Ventures fund will look to partner with companies across the agriculture, nutrition, advanced materials, data and other related sectors.
Food industry mergers and acquisitions will continue to be shaped by rapidly-changing consumer tastes and an increasing focus on the health and environmental aspects of food, according to Rabobank analysts.
A regulatory filing from the NGP Capital Management affiliate reveals further progress in fundraising on its second agribusiness fund.
An Ospraie Management spin-out has acquired Diamond of California in a continuation of the firm's focus on the nut sector.
The Dutch development bank has helped secure financing for a Peruvian-Danish joint venture's pursuit of environmental and social sustainability in agriculture.
The merged company will look to expand and focus on the provision of healthy prepared food options.


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Jonathan Majors's incredible transformation as bodybuilder Killian Maddox in Magazine Dreams Stunning, first-ever glory in godlike daydreams, posed for the requisite professional competition, caressed by golden light. But when the soaring melody of Jason Mills' tune fades into a deflated hum, signaling trouble ahead, the scene shifts to Killian's bare lightbulb in his humble garage Down. This is the first hint that this strong Adonis is actually a lonely, painfully shy and deeply insecure man whose feelings of inadequacy, buried self-loathing and resentment often take the form of outbursts of rage.
It was a timeless show, full of anger and vulnerability, and to our credit, our hearts ached for Killian, even—or maybe especially—when he Out of control. Major and writer/director Elijah Bynum has accomplished quite a bit, making us worry more about this formidable giant than he stands on Trembling employers in. Magazine Dreams
Bottom Line A masterpiece of a flawed but impressive vehicle.
Location : Sundance Film Festival(American Drama Competition) Cast : Jonathan Majors, Hayley Bennett , Taylor Page , Mike O'Hearn, Harrison Page, Harriet Sansom Harris Director and Screenwriter : Elijah Bynum 2 hours 4 minutes
When this character flexes his muscles for the judges on stage at a bodybuilding competition, he's heaving and sparkling Glowing muscles and taut tendons, even when his smile is a forced grimace, his veins burst. But when he tries to talk to Jessie (Haley Bennett), the cashier he has a crush on packing groceries at the supermarket, he's hunched over and embarrassed, as if wishing to disappear rather than confront the possibility reject. When he did ask her out, he preemptively said no before she even had a chance to speak. This clumsiness, often manifested in his gait, is partly due to his large size, but more tellingly, his discomfort with gnawing on his own skin.
Bynum developed an unusually strong character study around Killian and his single-minded obsession with tragedy, using race, socioeconomic disadvantage, mental health issues and deep-seated trauma to cover his quest for champion greatness. There's also the sad acknowledgment that unwavering confidence is a strict American requirement for anyone trying to be famous, as evidenced by the venomous online comments to Killian's stuttering bodybuilding videos. More than one thought suicide was his best option.
The first half of this engrossing film nuancedly portrays a complex man, gradually exploring the pathos behind his still hopeful self-assault-realization as he tries to escape disappointment, with varying degrees of success. In the second half, when Killian's fledgling incestuous tendencies kicked in and he morphed into a fiery Travis Bickle, the Magazine Dreams began self-indulgent torture, punishment the wrong way , as it sputters over a handful of possible endings into the inevitable pitfalls of an American dream that won't die.
Killian lives with his ailing Vietnam Veteran grandfather William (Harrison Page) and dreams of being on the cover of a fitness magazine like his idol Brad Vanderhorn (Mike O'Hearn) The Champion wrote regularly to bodybuilders, signing them "your number one fan". It goes to show that when we see Killian talking to almost anyone, he speaks in a monosyllabic grunt, but in the voiceover in his letter to Brad, he is clear, confident and articulate, hinting at how he sees himself , at home in the spotlight as an accomplished star athlete. With a national competition coming up soon, he has already booked his first magazine cover and is getting on well with his girlfriend. The sad concern in Patricia's eyes showed that she saw the self-deception behind those apparently false claims. Bynum's script doesn't provide details of the violence that initially put Killian in treatment, but we do learn he threatened nurses while he was in the hospital. "I'm going to split your head open and drink your brains like soup" was one of his most frequent warnings. A total disaster – it becomes one of the most harrowing scenes in the film. He dresses up and takes her to an informal steakhouse, and at first they seem to hit it off. She finds him attractive and his shyness endearing. But the shocking way he explained his orphaning in a matter-of-fact manner was the first red flag. Then, when the conversation turned to bodybuilding, he began a manic rant demanding discipline and total commitment, all the while ordering half the high-protein options on the menu.
Bennett's face, sweet and open at first, as Killian hums in forgetfulness and Jessie realizes how unstable he is consumed by his ambition, from Discomfort turns into a mixture of pity and fear. She was gone before the food even arrived. Killian's clumsy effort to maintain his dignity when the waitress informs him she's leaving is one of the many examples we've seen of the flimsiness of the armor he's built.
Killian's day job goes well beyond "you get what you sow" in order to achieve your goals. Intense gym workouts, runs, ice baths, and high-calorie food intake didn't give him the extra pounds he wanted, so he routinely injected himself with steroids that destroyed his internal organs and snorted cocaine to boost his his energy. Still, words from a contest judge who criticized his hamstring and said his delts were too small still eroded him.
Those words come up again in a harrowing scene near the end, when his mind literally falls apart. But this incident, although it made him feel the condescending power, it did not bring him long-term peace.
Killian's stability. During a phone argument with a painting contractor about work on William's unfinished house, Killian struggles to control his anger, repeating to himself "I control my emotions, my emotions don't control me." When that doesn't work , he unleashes his anger — dashing to the guy's hardware store after get off work, his customary death metal car stereo accompaniment roaring in his ears — and the ensuing devastation is staggering. Humans become human wrecking balls.
The revenge of the shopkeeper's nephew and a pair of thugs was brutal, with one of the attackers spitting out "what have you got now, you fucking ape?" before they took off . That means there is an undercurrent of racism in every part of the conflict, from the contractor's refusal to address a client grievance who served in the armed forces. Killian's awareness of this seems clear in a subsequent restaurant scene, where he confronts the man leading the attack over dinner with his terrified family.
The film begins to creep forward as Killian, bloodied from the beating, rises from the ground to drive to a scheduled bodybuilding competition, and he finds himself in a horrific situation. Despite the shocking evidence of his physical condition, his blind determination is captured in increasingly frequent instances of cinematographer Adam Arkapaw's camerawork taking on a dizzy, hallucinatory feeling that blurs Killian's mind The line between what's in it and what's actually happening.
An abortive encounter with a sex worker (Taylor Page, brilliant in a disappointingly short screen time) suggests that any human connection is now beyond his reach. Meeting inspiring figures gave him a much-needed boost but left him feeling inferior. Bynum proved that scene was another crucial step in Killian's unraveling. But if you add this factor to the already rich reasons for the protagonist's self-hatred, the film could be accused of being homophobic.
When Killian buys a lot of guns, the movie starts to go over the edge, becoming over the top and obvious. I mean, who wouldn't want to hear Nick Lowe's great song "The Beast in Me," but as a harbinger of violent fantasies unleashed, its lyrics couldn't be more explicit. The clumsiest interlude takes place at the bar, where a drunken alcoholic approaches Killian and takes him into the bathroom to hum a few lines. The Stranger then unleashes a hate-inciting rant that's overlaid so frantically in its world-shattered social loathing and vengeful urges that it makes you leave the film.
The anticipation of high tide blood is palpable, and Bynum certainly knows how to heighten the fear and suspense through the level of pain. But Magazine Dreams is more interesting because it's a deep and intimate psychological study of a giant weakened by a world in which he feels his place Negative, making him feel pathetic and invisible. There are enough dimensions and complex dualities in Majors' mesmerizing performance to sustain that narrative without turning it into a Taxi Driver A riff on , in which the ultimate violence is a stomach-churning tease, with gorgeous detours before the tragic reality of a broken man takes hold again.
The blunders of the final scene don't detract from the brilliance of Majors' work exploring body, mind, and a man caught in a helpless obsession – arguably America's obsession with celebrity and success The definition of obsession—the person whose spiritual anguish is destined to be out of reach.
Nor do the questionable decisions detract from the film's consistently fine craftsmanship, especially Acapa's highly controlled visuals – images that are at times organic, dreamy and poetic, and at times Dark as a brooding threat. Jon Otazua's cut traces Killian's lineage in a meandering, fluid way, fueling the story's fatalistic progression. Hill's score is tonally accurate and varied—with classic passages from Elgar, Wagner, and Saint-Saëns—hauntingly using mournful strings and employing urgent drumming to eerie Effect.
Despite its flaws, Magazine Dreams is a deeply disturbing experience, unable to take your eyes off open.


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Alfa Laval to provide the fuel supply system to Maersk in industry's first methanol retrofit project for a container vessel
Alfa Laval fuel supply system FCM Methanol has been selected by Maersk for their pioneering methanol retrofit project to enable the container vessel Maersk Halifax to operate on methanol fuel, according to the company's release. This project stands as a significant achievement for both Alfa Laval and Maersk, underscoring the feasibility of retrofitting ships with the necessary equipment for methanol-based propulsion.
Alfa Laval will support A.P. Moller-Maersk (Maersk) with installation of FCM Methanol low-flashpoint fuel supply system (LFSS) on board the 15,000 TEU Maersk Halifax. The retrofit is scheduled by mid-2024. This pioneering container vessel conversion will enable the vessel to sail on green methanol with dual-fuel capabilities.
The project will involve adding a new fuel line for methanol alongside the traditional fuel line, respecting the existing space constraints and the tight time schedule. The retrofit of the FCM Methanol is a landmark project that requires advanced engineering and understanding of the practical considerations of working with methanol.
Sailing with green methanol fuel is a sustainable option to reduce emissions, but it requires a fuel supply system that can handle the fuel safely and effectively. With over 80 ships contracted, Alfa Laval has the longest experience in methanol FSS installation and service since 2015. It is the only system that has been powering methanol-fuelled vessels so far, with over 450 000 hours of operations and unmatched expertise.
Alfa Laval is a world leader in heat transfer, centrifugal separation and fluid handling, and is active in the areas of Energy, Marine, and Food & Water.


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New developments have enabled the way we create and deliver online learning, with e-learning authoring tools becoming essential components of any L&D toolkit. Selecting the perfect e-learning authoring management software can be difficult because it is dependent on a variety of factors such as your technical knowledge, how advanced you want your learning experience to be, the amount of e-learning material you have to create, the size of your team, your resources, or even whether you need translation.
In this article, we evaluated 5 of the finest e-learning software depending on the relevant criteria: e-learning quality of the output, authoring efficiency and speed, and upgrading e-learning production. Read along to find your perfect match!
What Exactly is an Authoring Tool?
A software programme that enables people to create educational content, classes, and coursework using writing, media, and experiences is known as an e-learning authoring tool. Such content is typically created for use in LMSs and can be stored in a variety of formats.
To use the tools, a client doesn't need technological knowledge of programming.
E-learning authoring tools, on the other hand, are typically pre-programmed and provide a fully prepared interface finished with layouts, media, techniques, conversations, and exams that the person can simply organize and modify.
What is the Purpose of an Authoring Tool?
You're not sure if you need authoring systems to satisfy your e-learning aims. Here are some reasons why you should choose an authoring tool:
- Enables you to personalize your material and learn in a people-centered manner.
- Allows you to quickly and easily roll out e-learning courses in various locations and update content to keep up with changing requirements.
- Enables you to continuously improve your e-learning by analyzing data and seeking information about how your content is performing.
Here are 5 authoring tools for interactive content for learning programs
1. Cornerstone OnDemand
Cornerstone OnDemand is a prominent global source of Software-as-a-Service education and talent management solutions. The company helps businesses tackle the problems of motivating their employees and maximizing their human capital's efficiency.
Cornerstone Recruiting, Cornerstone Onboarding, Cornerstone Learning, Cornerstone Performance, etc. are all part of their comprehensive cloud-based software package. Their customers use their technology to grow people through their professions, actively involve all employees, increase company execution, foster potential leaders, and interact with their external client, supplier, and distributor systems.
2. Udutu
Udutu is a free web-based curriculum creation tool. It includes a number of applications that allow you to create a variety of activities such as evaluations, engaging modules, and segmented scenarios. It helps to convert your PowerPoint slides into courses, but this alternative requires a $10 subscription fee.
Udutu, unlike most other tools, allows different authors to work collaboratively on a curriculum and evaluate it in live time.
3. iSpring Suite Max
iSpring Suite Max is a full-featured course authoring toolkit that allows for the quick creation of multi-device compatible modules as a PowerPoint add-on. With a simple builder interface, you could use presentations, questionnaires, instructional videos, screencasts, and role-plays. With iSpring, you can also quickly convert actual Word, PDF, and PPT slides resources into interactive sessions.
This is an excellent option if you would like to quickly and easily generate online courses while also collaborating on subject matter with your staff. The toolkit includes an online workspace where multiple authors can collaborate on material and even build basic online courses using the built-in cloud-based authoring tool.
4. Adobe Captivate
Adobe Captivate is a computer e-learning authoring application that enhances HTML5 content for mobile devices. Captivate comes with certain prebuilt resources as well as personalized workflows which can be tailored to the needs of developers. Captivate is highly customizable, which makes it popular among developers who create sophisticated software simulation models, custom experiences and interaction, virtual reality (VR) curriculum, and courses authored as mobile apps.
5. Adapt
Adapt is a free e-learning authoring device that utilizes the open Adapt developer structure to build responsive designs, multi-device functional HTML5 material. Adapt courses, like Articulate Rise, can provide web app-style experience with vertical hover and swipe features on touchscreen devices.
Although Adapt does not sustain branching situations or complicated animations, its features can be enlarged through plugins. However, the typical consumer may not have the time or technological ability to investigate this.
This concludes our in-depth look at five e-learning authoring tool selection. We think we've given you some idea about the differences between windows pc and internet authoring tools, and if one might be better for you and your institution.


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We learn to weave bright bracelets of rubber with our own hands according to schemes and photos for beginners.
Since recent times, bright bracelets thatmade by themselves, have gained great popularity. Weaving of multi-colored rubber bands became a fashionable kind of needlework among adults and children. Using such material, it is possible to create beautiful products. More recently, such useful equipment as the rainbow machine has appeared. He proved to be an indispensable assistant in the weaving of unique bracelets of brightly colored rubber bands. Despite all its practicality, the cost of this type of equipment remains very acceptable. Thanks to the machine, you can create products with different patterns of patterns, using all kinds of weaving techniques. In this article we will tell you in detail about the peculiarities of how to weave a beautiful bright bracelet made of rubber bands with your own hands. These accessories will perfectly harmonize with the clothes of any style of clothing, helping to show your personality.
Why is the bracelet made of bright rubber bands so popular?
The fact that bright bracelets from rubber bands havesuch popularity, there are a number of reasons. Firstly, such decorations are quite attractive for the price. Because the material from which the bracelets are made is generally inexpensive, and, consequently, many needlewomen can acquire it. The finished product will surpass all expectations, becoming an original alternative to other, more expensive accessories. Secondly, when weaving a bracelet out of bright rubber bands, you choose the color of the bracelet and its pattern yourself. And this is very important for every woman of fashion, because she herself will be able to select ornaments for her outfits, considering what color range dominates her wardrobe. Now we turn to a more detailed story aboutfeatures of the process of making bright bracelets from rubber bands. How to properly weave a bright bracelet from a rubber band using a pattern? There are many interesting schemes for creating such accessories. For beginner needlewomen, it is best to use the simplest patterns, eventually mastering the most complex schemes. First you need to decide what colors will be used to make your bracelet. Choosing a monotonous bracelet, you can create an original and bright accessory. But in order to emphasize the beauty of the pattern, we advise you to use multi-colored materials. So, we need to take 3 rubberies. One of them should be twisted in the form of "eight", and then put on the middle and index fingers. All other rubber bands also need to be put on your toes, but you do not need to twist them. This is very important, remember this rule. The further work is connected with a rubber band, which has the form of "eight". It is necessary first to take one of the edges of the rubber, and after the second, as if removing it from your fingers. As a result, it will sag in the middle between two other rubber bands. We remind you that the work is carried out according to the mostsimple scheme of weaving. Thus it is necessary to work further, adding all the new rubber bands (however, it is no longer necessary to create "eight"). In total you will need to work about fifty gum. The main rule in this case is that the lower rubber should be raised only when the fingers are 3 gum. After your product has acquired the necessary length, you should make a loop and a knot with the help of a rubber band. And attach the zipper to the second edge of the product. The described method of weaving is commonly called "fishtail". He is a success among the craftsmen, because he is quite easy to perform. The needlewomen, who have been working on making bracelets from bright rubberies for a long time, know for sure that even more accurate and unique are the bracelets woven on a special device, the so-called "rainbow machine". If you intend to create not only jewelry in the form of bracelets, but toys, necklaces and necklaces of rubber bands, then you will need such an installation. Using it in your work, you will eventually improve your ability to weave products from rubber bands, and also learn how to make any accessories that are invented and made in your individual style. You can buy such a machine in any specialized store that sells fabrics, accessories, schemes for embroidery and other necessary elements in needlework. If you have already made such a purchase, then try using the machine in your work. Most often, bundled with a set of kitsmulti-colored rubber bands, which you can use to approbate its work. Afterwards, you will be able to purchase the materials you need, if this one turns out to be so fascinating for you. The machine itself is a plastic platform with some nasadochkami, which you will wear rubber in the process of weaving. Thanks to this installation, you will make products according to more interesting schemes. But first you need to maximize your skills, braiding the bracelet in the simplest way. If you initially choose a very complex scheme for work, then chances are great that you will not succeed from the first time, and you will be disappointed. The ideal stage for buying a machine is the case when in your stock there are already ten to fifteen ready-made products created by yourself. To make a bracelet by the method of more complex weaving, you will need: a rainbow machine for work; rubber bands of various colors (you can - in the set); clasp; crocheted hook. Description of the process of making a bright bracelet withcomplex pattern: In the work involved 2 rubber. They need to be put on the teeth of the machine in a diagonal direction, creating them a "figure-eight". Make sure that the rubber bands crossed correctly (in the form of a "criss-cross"). Thus it is necessary to work further, adding all the new rubber bands (however, it is no longer necessary to create "eight"). By this technology we create one more row. Then the lowest rubber should be moved upwards, using the hook. As a result, it will sag in the middle between two other rubber bands. The further process of manufacturing passes under the same scheme, lifting all time the bottom row. After your product has acquired the necessary length, you should make a loop and a knot with the help of a rubber band. And attach the zipper to the second edge of the product. If you decide to make your bracelet from rubber bands more original, then try to weave flowers, beads, beads or any other elements. As a result, your accessory will become even more attractive and exclusive. One has only to try to create a bracelet from bright rubber bands with your own hands, and you will be pleasantly surprised by the results of the work. And in the future you can please your relatives with elegant accessories.


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Thierry Mugler
Thierry Mugler Alien Eau de Parfum
Alien eau de parfum by Thierry Mugler is an Amber Woody fragrance for women. This perfume mixes with hypnotic notes of jasmine sambac with woody cashmere hints and the rare touch of sweet amber gris. Alien by Thierry Mugler was launched in 2005. Alien was created by Dominique Ropion and Laurent Bruyere.
Fragrance Notes
Citruses, Mandarin Orange, Moroccan Jasmine, White Flowers, White Amber, Cashmeran
Upon placing the order with nazakah.com, you will receive an email confirmation about the order with order number, product details, price, and delivery details. In case of missing/incomplete details, Nazakah customer service support will contact you.
We ensure you receive your order within 48 hours. Currently we are delivering within the state of Kuwait with standard shipping cost of KWD 1.500. To avoid any delays, kindly ensure to provide complete address and contact details.
Return policy
Nazakah has 14-days return policy for its policy. The product is considered to be eligible for return if it is in same condition as received, unused, with tags, and in its original packaging with the purchase receipt. To initiate the return, please mail us at firstname.lastname@example.com. We will review the request and send you the return shipping label and further instructions.
Frequently Asked Questions
All products at Nazakah are sourced from the genuine brands and wholesalers. We sell products that come with trademarks and codes from original sellers for authenticity.
Shipping & Return
Not at the moment, but we will start shipping internationally soon.. Shipping costs will apply, and will be added at checkout. We run discounts and promotions all year, so stay tuned for exclusive deals.
It depends on where you are. Orders processed here will take 0-2 business days to arrive. Overseas deliveries can take anywhere from 3-16 days. Delivery details will be provided in your confirmation email.
Yes, you can return your product within 14 days of receiving it. Kindly ensure that the package is not opened or the product isn't used. Packages that are opened or used product will not be returned or replaced.
You can contact us through our Contact Us Page or WhatsApp us at+965 97669623.! We will be happy to assist you.


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Recipe For Ground Beef And Vegetable Soup. This vegetable beef soup can be tweaked based on what you have on hand in the garden or the freezer. Cook stirring until the beef is no longer pink.
Reduce the heat and simmer for 1 2 hours. Saute the onion celery and ground beef in 1 t of olive oil until the beef is brown and the onion transparent. In a dutch oven bring potatoes and water to a boil.
It is from a taste of myrtle beach cookbook which features recipes from the area s best restaurants.
This soup is from caroline s cafe. Potatoes celery green beans carrots parsnips and cabbage and any other optional veggies. Add the rest of the ingredients use less salt if the broth is not low sodium cover and bring to a boil. Bring to a boil reduce heat to low cover and simmer to blend the flavors at least 1 hour.


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Resurge helps to boost your energy levels. The supplement increases metabolic activities in deep sleep. Resurge can help you lose weight by burning fat in your body. Resurge is best consumed at evening. The price is $49 for a bottle. Visit the official website to purchase the product. Once you've made your purchase you'll be required to pay for shipping and handling. Resurge is safe to use for up to 90 days. The company does not offer a money-back guarantee.
While Resurge is a great way to burn fat and improve sleep, it is important to ensure that you have enough sleep each night. The formula contains ingredients to improve your sleep and reduce your appetite. Your metabolism will slow down if you don't get enough sleep. You might overeat than you should. In addition, you might experience increased appetite which could result in weight growth. Therefore, you should avoid not sleeping enough to boost your energy levels.
Resurge is designed for an overnight boost to your body. Resurge can help you sleep more deeply, and this means that you'll awake feeling more energetic than you did the day before. It offers many benefits that include improving your mood and mental well-being. This product can help you lose belly fat. It increases your energy levels, stabilizes blood sugar levels, and also burns fat. Resurge is completely safe to use and has no adverse effects.
Resurge is a plant-based sleep aid that contains 8 ingredients. It improves the quality of sleep and makes it easier to fall asleep faster. It helps reduce stress and anxiety. Because it enhances deep sleep, it can also help reduce ammonia production during sleep. It also reduces the production aged-related hormones when you sleep. It is a great supplement for people who don't get seven to eight hours of sleep each night.
Resurge is a wonderful supplement for people who do not want to adhere to a diet or follow a strict regimen. It works on the natural psychology of sleep by increasing your energy levels and assisting you fall asleep. It contains ingredients that are designed to improve your metabolism. It's a safe and effective method to shed weight. If you're exhausted from working all day, you'll feel more refreshed and stop eating snacks at evening.
Resurge is available for purchase on its official website. It's important to be careful when buying the supplement because Resurge could alter the composition of other drugs. You should study the label carefully prior to buying the supplement. Resurge is a great investment. It's safe and effective. You'll feel fantastic in the blink of an eye!
Resurge is safe to use. The ingredients are safe and will not cause harm. The company offers a 60 day money-back guarantee on all its products. The formula does not contain artificial flavors or colors. The supplement is also vegetarian. So, it's safe to purchase for anyone. It will reduce fat in your body prior to going to lay down to sleep. There are no negative reactions that can be attributed to Resurge. Resurge.
Resurge is not a magic pill. It is a supplement that functions within the body. It should not be considered a complete solution to your health issues. It is a supplement that can help with weight loss and overall health. The ingredients are listed on the website. Before you purchase, make sure you read them. If you're uncertain about the effectiveness of Resurge, you can contact the manufacturer. You can read the reviews to determine whether the product is evaluated as safe.
The ingredients are able to be used safely. In fact the majority of them are found in similar products. There aren't any adverse side negative effects associated with Resurge, but it is a safe way to shed weight. The price of the supplement is $49 plus shipping. It has eight ingredients that are essential for muscle growth. Before you buy it, be sure to consult your doctor if have any questions about the composition of the ingredients. The formula also includes amino acids if contemplating it for weight loss.
Resurge is an excellent product for reducing body fat in the morning. It does this by increasing GABA and serotonin levels, which are neurotransmitters that can affect your mood and ability to sleep. This supplement isn't a tranquilizer. It's more of a tool to help the body heal itself by allowing sleep. Resurge has no side effects. The manufacturer is dedicated to providing a safe product. The only drawback is that it's only available with a prescription.


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21 states increased the minimum wage rate on New Years Day, which means over 3 million workers in the United States will be bringing home a little more money this year.
Among the states that have agreed to raise the minimum wage rates are, Alaska, Arkansas, Connecticut, Florida, Nebraska, Ohio, Maryland, Massachusetts, Rhode Island and South Dakota, along with several others.
Massachusetts increased their minimum wage from 8 to 9 dollars an hour, while Connecticut raised theirs from 8.70 to 9.15 dollars per hour. These changes may seem minimum to many, but it will make a difference for those working on minimum wage rates. The ultimate goal is to raise this number to 10.10 by January of 2017.
The issue of raising the minimum wage is one that continues to develop every year, and is an issue that Congress and Washington have been trying to come to an agreement on. President Obama has been trying to raise the federal wage to 10.10 for some time now, but Congress dismisses his efforts.
U.S Business owners have also been opposing the recent stride for change because that would mean they would be losing more money because they have to pay their workers more and their payroll will be higher as a result.
As the economy changes, the demand for more money changes as well, this minimum wage still seems low to many, but millions of people rely on this federal wage to feed families and themselves. This number needs to continuously fluctuate because the United States needs to assure its citizens have the opportunity to survive and make a living.
photo: Photopin


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Customize your own SPEED SHOP Zipper Hoodie!!
We are a family owned business based in Southwest Virginia. We have a core set of values that represents who the company is and guides how we conduct business.
Our Mission is to deliver a great product at a great price as fast as possible. We understand we are not Amazon but we will try our best to print and ship as fast as possible while keeping the quality high.
We proudly print our own products right here in the USA!
Sometimes mistakes happen. Maybe you order the wrong size shirt, The color isn't what you thought it was, or the print doesn't look right. That is ok. We got ya!. So our 100% guarantee is we will make it right. Please reach out to us!
Absolutely thrilled with the t-shirts. This is the second time with the same truck. I plan on getting more with our Camaro
Once again you have delivered! I recently purchased my third custom car photo shirt fom southwest print shop for my dad. He loves it! The shirts are well made and great quality prints and the sizes are always true to fit! Thats why I will keepcoming back to you guys for future orders!
I can't thank Southwest Printshop enough for putting my husbands snowmobile on one of these shirts. He loved it.
As Usual...... AWESOME!!! Thank You & Happy New Year :)
I love these shirts, I have ordered several over the years mostly the garage design!