Nuno Almeida

Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease—Diagnostic Value and Complications

Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohns Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

Context adaptation of the communication stack

This position paper presents a middleware framework to support the development of context-aware adaptive communication protocols that can be reconfigured according, not only to the local context, but also to the context of the remaining remote participants. The advantages of the framework are illustrated using the concrete example of an adaptive group communication protocol. The protocol supports a distributed chat application that can be executed in both fixed PCs and mobile devices.

Anomalies in Wall Renders: Overview of the Main Causes of Degradation

The assessment of historical buildings is usually focused on: 1) structural features related to brick or stone walls, wooden floors and other structural elements, or 2) highly valued decorative features, such as frescoes, stuccos, and facade details. During the last quarter of the 20th century, some “secondary” elements also started to receive their share of attention from researchers and practitioners. Wall renders are one of the most important of such elements because of their role as a sacrificial protective layer and the numerous problems that were encountered in the past as a result of incompatibility issues in rehabilitation works. This article discusses the main causes of the deterioration of wall renders, with emphasis on lime-based renders; these renders thoroughly reviewed and their relative weight in the overall degradation is addressed.

Engineering risk management in performance-based building environments

AbstractNowadays, a wide range of stakeholders seek explicit performance and risk information on construction projects. These stakeholders include end-users, authorities, insurance companies and financial institutions, among others. They look for proof that engineering risks are being properly managed and that specified performance-based requirements are fulfilled throughout all stages of the project (e.g. technical requirements related to the building such as structural safety, structural serviceability, structural durability, fire safety, energy efficiency, or others). Such demonstration can be conveyed through statements of technical conformity, such as technical risk reports or engineering performance certificates. Statements of conformity are particularly valuable to make informed decisions associated with contractual or other legal warranties against building nonconformities. This paper describes the conceptual background and the methodologies undertaken to design and develop a management framework ...

Managing the technical risk of performance-based building structures

AbstractDuring the past decades, the construction industry has been gradually adhering to major conceptual approaches such as those of quality, performance and risk. This paper proposes a management framework that enables the joint application of these conceptual approaches throughout the various phases of building projects – a Risk-Managed Performance- Based Building (RM-PBB) framework. This framework is based on the policies, procedures and practices of initiatives that gather international consensus, including performance-based model codes and standards, internationally recognized management principles and guidelines, standardized requirements for different types of management systems and also agreed principles of conformity assessment and auditing. This paper presents a summary of the strategic and operational components of this RM-PBB management framework. It also shows the practical outreach of the proposed framework by providing an example of application of each component of the management framewor...

Comparison of the inspector and rating protocol uncertainty influence in the condition rating of sewers

Wastewater drainage systems asset management decisions, in particular regarding rehabilitation interventions, are largely dependent on close-circuit television (CCTV) inspection results. However, the results of CCTV inspections are affected by several sources of uncertainty. Within the present communication, the inspectors uncertainty is quantified by comparing periodic inspection reports from three trunk sewers of a Portuguese sewer system. The inspections were carried out by the same experienced inspector using the same equipment. Therefore, the uncertainties from the lack of experience and the difference of the inspector and equipment were ruled out. The protocol uncertainty is also quantified comparing the results obtained with the Water Research Center (WRc) and the National Research Council of Canada (NRC) protocols condition ratings. Both operational and structural condition rating were analysed, but emphasis was given to the later since it dictates the repair and replacement interventions.

Types of Exclusion and Efficiency Criteria for Paternity Testings

More than a hundred different genetic systems suitable for paternity testings have been described in man. This fact, being a remarkable achievement in itself by the very high exclusion efficiency that can be attained in the expertises, is at the same time a source of problems. Indeed, no laboratory is able to perform (at least routinely) all of them, and — on the other hand — besides technical problems, the cost of such an investigation would be prohibitive.

Clinical Practice Impact of the Boston Bowel Preparation Scale in a European Country

Introduction: The diagnostic acuity of colonoscopy requires a careful evaluation of the colonic mucosa, so an adequate bowel cleansing is a key element of the procedure. It is internationally recommended that an evaluation of the quality of the intestinal preparation should be included in the colonoscopy report. The Boston Bowel Preparation Scale (BBPS) is a bowel cleanliness rating scale that has gained some preponderance in this context. However, its application implies some degree of subjective appreciation, and it is important to conduct interobserver reproducibility studies in different contexts. The objective of the present study was to evaluate the reliability of the BBPS in the Portuguese gastroenterological community. Methods: A prospective study involving Portuguese gastroenterologists with clinical practice in several contexts, and using different methods of evaluation of the intestinal preparation. Participants were invited to answer a questionnaire encompassing 93 static images and 12 video segments of colonoscopy examinations, with different levels of intestinal preparation. For each item, the participant gastroenterologist assigned a score of 0-3, according to the BBPS criteria. A statistical analysis was performed with SPSS 20.0 software, using the intraclass correlation coefficient (ICC). Results: From 45 invited gastroenterologists, 36 replied (mean age 39 ± 9 years). Fifteen (41%) had more than 10 years of colonoscopy experience and 20 (56%) performed more than 40 examinations per month. Twenty-seven (77%) usually used the BBPS in their daily practice. Statistical analysis revealed a strong interobserver correlation (ICC = 0.783) in the application of the BBPS, even in those gastroenterologists who did not use the scale in their daily routine (ICC = 0.775) and those with less years of experience (ICC = 0.820). The correlation in the videos was slightly lower than that observed in the static images (ICC = 0.74 vs. ICC = 0.78). Conclusion: The application of the BBPS in the Portuguese gastroenterology community is reproducible and can represent a way to harmonize the colonoscopy reports, contributing to its correct interpretation and subsequent patient orientation.

Small Bowel GIST: Clinical Presentation as Intussusception and Obscure Bleeding

http://dx.doi.org/10.1016/j.jpge.2015.12.007 2341-4545/© 2016 Sociedade Portuguesa de Gastrenterologia. Published CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4 umors and only 0.04% of small intestinal malignant neolasms. GISTs may occur anywhere along gastrointestinal ract, but most commonly arise in the stomach (40--60%) nd jejunum/ileum (25--30%).1,2 The clinical presentation of GISTs is highly variable epending on their size, location and presence of mucosal lceration. Abdominal pain and gastrointestinal bleeding when mucosal ulceration is present) are the most common ymptoms or signs although persistent significant bleeding s unusual. Intussusception and subsequent obstruction is very uncommon presentation of these lesions because f their tendency to grow in an extraluminal fashion.3,4 ery few cases of small bowel intussusceptions from stromal umor in adults have been described in medical literature.1--5 ntussusception is rather infrequent in adults, accounting or 0.1% of all surgical admissions and 1--5% of mechanical owel obstructions. In contrast to childhood, where intususception is idiopathic in 90% of cases, in adults a definable athologic lesion is established in over 90% of cases, with eoplasms considered to be the cause in 65% of them. Preoprative diagnosis is often difficult because the symptoms are onspecific.1--3 Intussusception is correctly diagnosed preopratively in only one-third of cases.1,3 The relative rarity of GISTs combined with nonspecific resentation results in delayed diagnosis. Frequently, this is nly possible after surgery and histological examination.2,3,5

Groove Pancreatitis with Biliary and Duodenal Stricture: An Unusual Cause of Obstructive Jaundice

Introduction Groove pancreatitis is an uncommon cause of chronic pancreatitis that affects the groove anatomical area between the head of the pancreas, duodenum, and common bile duct. Clinical case A 67-year-old man with frequent biliary colic and an alcohol consumption of 30–40 g/day was admitted to the hospital complaining of jaundice and pruritus. Laboratory analysis revealed cholestasis and the ultrasound scan showed intra-hepatic biliary ducts dilatation, middle third cystic dilatation of common bile duct, enlarged Wirsung and pancreatic atrophy. The magnetic resonance cholangiopancreatography showed imaging findings compatible with groove pancreatitis. An esophagogastroduodenoscopy later excluded duodenal neoplasia. He was submitted to a Roux-en-Y cholangiojejunostomy because of common bile duct stricture. Five months later a gastrojejunostomy was performed due to a duodenal stricture. The patient remains asymptomatic during follow-up. Discussion Groove pancreatitis is a benign cause of obstructive jaundice, whose main differential diagnosis is duodenal or pancreatic neoplasia. When this condition causes duodenal or biliary stricture, surgical treatment can be necessary.