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Depression is a prevalent illness among the elderly, so psychotherapeutic interventions are needed to promote health and quality of life. This literature review aims to identify trials of any psychotherapeutic interventions aimed at reducing depressive symptoms in older adults. A systematic literature review with a meta-analysis will be carried out. The following databases will be searched: CINAHL Plus with Full Text, MedicLatina, MEDLINE with Full Text, and Psychology and Behavioral Sciences Collection. To minimize bias, four reviewers will independently assess the inclusion of studies. The fifth reviewer will be responsible for disaggregating inclusion and exclusion between two authors. The results of the analysis will be grouped in a table with the characteristics of the included studies, including author, year, sample, objectives, methods, assessment instruments, psychotherapeutic interventions, results, follow-up and a data compilation scheme. This scientific article is a systematic review protocol for which the data has already been extracted and is being analyzed. Examples of possible strategies to include cognitive restructuring and mental health programs for older adults in community settings. With this clear and direct identification of psychotherapeutic interventions, it will be clearer for mental health professionals to be able to intervene effectively to promote the mental health and well-being of older adults.PROSPERO registration numberCRD42023449190

Boerhaave syndrome (BS) is a rare but potentially fatal condition. Although surgery is considered the standard treatment, endoscopic therapy has acquired an important role as a minimally invasive management approach. The authors describe 2 cases of middle-aged male patients, presenting with spontaneous esophageal perforation after severe straining and vomiting. In the first case, the patient presented with a bone impaction in the upper esophagus successfully removed by rigid esophagoscopy. After the procedure, a chest X-ray/cervicothoracic computerized tomography scan (CT) showed a left hydropneumothorax and pneumomediastinum with oral contrast leak at the lower esophagus. In the second case, the patient presented to the Emergency Department with severe chest pain after an episode of vomiting. The CT showed a massive pneumomediastinum, subcutaneous emphysema, and an oral contrast leak compatible with BS. The patient was initially submitted to surgical suture, but contrast extravasation persisted after 12 days. After multidisciplinary team discussion of both patients, an upper gastrointestinal endoscopy was performed, which revealed pericentimetric wall defects at the distal esophagus. These were successfully closed using an over-the-scope clip (OTSC). After at least a 9-month follow-up, patients have remained clinically well with no relapse. The authors highlight the severity of these clinical cases and the endoscopic option that proved to be decisive in addressing BS. The favorable outcomes suggest a role for the OTSC approach in closing spontaneous esophageal perforation both as first-line and as rescue therapy after a surgical failure.

We calculated cross sections for the dielectronic recombination (DR) satellite lines of Fe xvii and benchmarked our predictions with experimental cross sections of Fe xvii resonances that were monoenergetically excited in an electron-beam ion trap. We extend the benchmark to all resolved DR and direct electron-impact excitation (DE) channels in the experimental data set, specifically the n ≥ 4 DR resonances of Fe xvii , complementing earlier investigations of n = 3 channels. Our predictions for the DR and DE absolute cross sections for the higher n complexes disagree considerably with experimental results when using the same methods as in previous works. However, we achieve agreement within ∼10% of the experimental results by an approach whereby we doubly convolve the predicted cross sections with both the spread of the electron-beam energy and the photon energy resolution of our experiment. We then calculated rate coefficients from the experimental and theoretical cross sections, finding general agreement within 2 σ with the rates found in the OPEN-ADAS atomic database.

(1) Background: The pandemic context has limited the social and family contacts of institutionalized older adults, and intervention is urgently needed. The aim of this study is to assess the impact of the implementation of a “Geriatric Proximity” intervention on the functioning, satisfaction with social support, affective experience, and feelings of loneliness of institutionalized older adults in the times of the pandemic. (2) Methods: This is a pilot study. An experimental group (subject to the “Geriatric Proximity” intervention) and a control group were constituted. Four assessment instruments were applied to both groups: the satisfaction with social support scale; the elderly nursing core set; the positive and negative affect schedule; and the UCLA loneliness scale. (3) Results: The control group shows no differences between the three measurement instants, while the experimental group shows between first and third measurements (all p < 0.05). We observed a reduction in the scores of loneliness scale, negative affect, and cognition functioning and an increase in satisfaction with social support and positive affect. (4) Conclusions: The intervention “Geriatric Proximity” showed a positive contribution by decreasing loneliness and increasing affectivity, satisfaction with social support, and cognitive function during the pandemic period.

We report measurements of hypersatellite radiation of argon ions in the electron energy region of 5200 eV to 7500 eV. Here, we observed a strong enhancement of this hypersatellite Kαh production. Trielectronic recombination (TR) is discussed as a possible channel for Kαh production leading to this enhancement where main TR resonances are expected to occur. Data analysis was mainly based on the extracted intensity ratio of hypersatellite Kαh to Kα lines (Kαh/Kα). In addition, the collisional excitation and the collisional ionisation of the K-shell ions were modeled as main background processes of the Kα X-ray production. The Kαh/Kα intensity ratio shows a significant rise around 6500 eV electron energy by a factor of about two above the background level. This observation is compared with calculations of the expected electron energies for the resonant Kαh emission due to the KK TR process. The observed rise as a function of the electron collision energy, which occurs in the vicinity of the predicted TR resonances, is significantly stronger and energetically much wider than the results of theoretical calculations for the TR process. However, the experimental evidence of this process is not definitive.

Introduction: Colonic lipomas are common mesenchymal tumours. They are usually asymptomatic and incidentally diagnosed during endoscopic or radiological examinations. Taking into account their typical endoscopic and radiological features and benign nature, tissue sampling, resection or follow-up are generally not required. Case Report: A 61-year-old woman with poor surgical fitness presented with colonic subocclusion and lower gastrointestinal bleeding. A colonoscopy performed 1 month earlier showed a large polypoid lesion with necrotic and ulcerated areas occupying the lumen of the proximal ascending colon with inconclusive histology. An abdominopelvic computed tomography scan with intravenous contrast was done revealing a cecal-colonic intussusception of a heterogeneous mass. The patient was successfully managed conservatively. A delayed revision colonoscopy showed a significantly smaller atypical subepithelial lesion with no necrosis or ulceration. A single, large and deep incision with a pre-cut needle-knife® allowed the direct collection of lesion tissue using standard biopsy forceps through the so-called single-incision needle-knife® (SINK) biopsy technique. Histological examination was compatible with submucosal lipoma. After 18 months of follow-up, the patient remains asymptomatic. Discussion/Conclusion: Colonic lipoma complications are rare and can lead to misdiagnosis; in general, they are surgically managed. A conservative approach and a minimally invasive endoscopic procedure allowed a definite diagnosis avoiding the morbidity and mortality of a major surgical intervention in a high-risk patient.

As technology and artificial intelligence conquer a place under the spotlight in the automotive world, driver drowsiness monitoring systems have sparked much interest as a way to increase safety and avoid sleepiness-related accidents. Such technologies, however, stumble upon the observation that each driver presents a distinct set of behavioral and physiological manifestations of drowsiness, thus rendering its objective assessment a non-trivial process. The AUTOMOTIVE project studied the application of signal processing and machine learning techniques for driver-specific drowsiness detection in smart vehicles, enabled by immersive driving simulators. More broadly, comprehensive research on biometrics using the electrocardiogram (ECG) and face enables the continuous learning of subject-specific models of drowsiness for more efficient monitoring. This paper aims to offer a holistic but comprehensive view of the research and development work conducted for the AUTOMOTIVE project across the various addressed topics and how it ultimately brings us closer to the target of improved driver drowsiness monitoring.

Various failure mechanisms have been identified in total knee arthroplasty (TKA). We hereby present one case of failure, which stands out because of its rapid and destructive progression. We report the case of a 72-year-old Caucasian female patient who developed a large bone osteolytic lesion of the femur after TKA. The patient presented to our hospital 7 years after the initial surgery, complaining of persistent knee pain. The lesion affected the distal half of the femur and, after a diagnostic workup, required a resection of 20 cm and reconstruction with a tumor prosthesis. Subsequent pathological analysis revealed a reaction to cement and prosthesis components. Periprosthetic osteolysis continues to be a major problem, and a reaction to cement and prosthesis components can be an elusive cause of TKA failure.

In rare cases of ankle fracture dislocation, the posterior tibial muscle tendon can be incarcerated in the tibio-fibular space impeding reduction. We report two cases, a 58-year-old male and a 64-year-old female who sustained a right ankle fracture-dislocation. The patients were submitted to open reduction and internal fixation. In the first case the diagnosis was made during pre-operative planning and suspected according to the fracture pattern. Arthroscopic identification and reduction of the posterior tibial tendon entrapment on the tibio-fibular space was achieved during the first surgery. In the second case, after initial fixation, post-operative radiographs showed a lateral malleolus fixation failure with a bent plate and incomplete reduction of the ankle tibio-fibular space. During revision surgery, during the arthroscopic examination, the tibialis posterior tendon was visualized between the tibia and fibula. The tendon was manipulated into its anatomical position behind the medial malleolus from a medial incision. Two years after surgery, the patient was submitted to arthroscopic ankle arthrodesis due to symptomatic ankle osteoarthritis changes. These cases show that unsatisfactory reduction of an ankle fracture may occur due tibialis posterior interposition, and that successful outcomes depends on early recognition.

In electron–ion collisions, recombination processes play a very important role. Recently, multielectron recombination processes have been highly investigated, as they carry information about electron–electron interaction. Among them, the most basic process is dielectronic recombination (DR). The research presented here was conducted using an EBIT at Jagiellonian University. Using X-ray spectroscopy, we conducted research into K-LL, K-LM, K-LN, K-LO and K-MM resonances. The aim of this study was to investigate the contribution of the intershell higher-order recombination processes in collected spectra. A good resolution for the K-LL DR spectrum made it possible to distinguish structures for He- up to C-like Ar ions.

Background and study aims The European Colonoscopy Quality Investigation (ECQI) Group comprises expert colonoscopists and investigators with the aim of raising colonoscopy standards. We assessed the levels of monitoring and achievement of European Society of Gastrointestinal Endoscopy (ESGE) performance measures (PMs) across Europe using responses to the ECQI questionnaires. Methods The questionnaire comprises three forms: institution and practitioner questionnaires are completed once; a procedure questionnaire is completed on multiple occasions for individual total colonoscopies. ESGE PMs were approximated as closely as possible from the data collected via the procedure questionnaire. Procedure data could provide rate of adequate bowel preparation, cecal intubation rate (CIR), withdrawal time, polyp detection rate (PDR), and tattooing resection sites. Results We evaluated ECQI questionnaire data collected between June 2016 and April 2018, comprising 91 practitioner and 52 institution questionnaires. A total of 6445 completed procedure forms were received. Institution and practitioner responses indicate that routine recording of PMs is not widespread: adenoma detection rate (ADR) is routinely recorded in 29 % of institutions and by 34 % of practitioners; PDR by 42 % and 47 %, CIR by 62 % and 64 %, bowel preparation quality by 56 % and 76 %, respectively. Procedure data showed a rate of adequate bowel preparation of 84.2 %, CIR 73.4 %, PDR 40.5 %, mean withdrawal time 7.8 minutes and 12.2 % of procedures with possible removal of a non-pedunculated lesion ≥ 20 mm reporting tattooing. Conclusions Our findings clearly show areas in need of quality improvement and the importance of promoting quality monitoring throughout the colonoscopy procedure.

Most patients with familial adenomatous polyposis (FAP) will develop duodenal polyps and 5% progress to cancer. Those with Spigelman stage IV have a 36% risk of cancer at 10 years. Endoscopic surveillance is necessary with local ablation for early disease. Unresectable duodenal disease and severe dysplasia are an indication for prophylactic radical surgery by pancreaticoduodenectomy or pancreas-sparing duodenectomy. Some preliminary results have shown better outcomes with duodenectomy. A 45-year-old female with FAP had restorative proctocolectomy at 24 years, desmoid of the mesentery with regression after sulindac, two pregnancies, and at the age of 37 years had duodenal polyposis stage III carpeting the periampullary region. Endoscopic papillectomy and extensive piecemeal mucosectomy was performed but was unsuccessful due to recurrence. After 7 years of regular endoscopic surveillance, focal high-grade dysplasia was diagnosed at the last evaluation. Some diminutive polyps were seen in the small-bowel capsule endoscopy. MRCP showed a normal biliary and pancreatic duct without visualization of the Santorini duct. A pancreas and pylorus-preserving duodenectomy was performed with 3 main steps: (1) duodenectomy with preservation of the pancreas and the pylorus; (2) reconstruction with an advanced jejunal limb and duodenojejunostomy; (3) reimplantation of the biliary and pancreatic duct in the jejunal loop. The patient was discharged on the 11th postoperative day without complications. In conclusion, pancreas- and pylorus-preserving duodenectomy is a promising alternative to pancreaticoduodenectomy for advanced duodenal polyposis that allows complete endoscopic surveillance.

Hemorrhoidal disease (HD) is a frequent health problem with considerable repercussions on patients’ quality of life. However, much of the clinical practice related to HD is based on knowledge without scientific evidence and supported largely by empirical experience of the physician who deals with this pathology. As in other countries, the goal of this consensus is to establish statements supported by solid scientific evidence and whose purpose will be to standardize and guide the diagnosis and management of HD both in the general population and in some particular groups of patients.

The detection of gravitational waves and electromagnetic signals from the neutron star merger GW170817 has provided evidence that these astrophysical events are sites where the r-process nucleosynthesis operates. The electromagnetic signal, commonly known as kilonova, is powered by the radioactive decay of freshly synthesized nuclei. However, its luminosity, colour and spectra depend on the atomic opacities of the produced elements. In particular, opacities of lanthanides and actinides elements, due to their large density of bound–bound transitions, are fundamental. The current work focuses on atomic structure calculations for lanthanide and actinide ions, which are important in kilonovae modelling of ejecta spectra. Calculations for Nd III and U III, two representative rare-earth ions, were achieved. Our aim is to provide valuable insights for future opacity calculations for all heavy elements. We noticed that the opacity of U III is about an order of magnitude greater than the opacity of Nd III due to a higher density of levels in the case of the actinide.

The European Colonoscopy Quality Investigation (ECQI) Group aims to raise awareness for improvement in colonoscopy standards across Europe. We analyzed data collected on a sample of procedures conducted across Europe to evaluate the achievement of the European Society of Gastrointestinal Endoscopy (ESGE) mean withdrawal time (WT) target. We also investigated factors associated with WT, in the hope of establishing areas that could lead to a quality improvement. Methods: 6445 form completions from 12 countries between 2 June 2016 and 30 April 2018 were considered for this analysis. We performed an exploratory analysis looking at WT according to the ESGE definition. Stepwise multivariable logistic regression analysis was conducted to determine the most influential associated factors after adjusting for the other pre-specified variables. Results: In 1150 qualifying colonoscopies, the mean WT was 7.8 min. Stepwise analysis, including 587 procedures where all inputs were known, found that the variables most associated with mean WT were a previous total colonoscopy in the last five years (p = 0.0011) and the time of day the colonoscopy was performed (p = 0.0192). The main factor associated with a WT < 6 min was the time of day that a colonoscopy was performed. Use of sedation was the main factor associated with a higher proportion of WT > 10 min, along with a previous colonoscopy. Conclusions: On average, the sample of European practice captured by the ECQI survey met the minimum standard set by the ESGE. However, there was variation and potential for improvement.

We present relativistic ab initio calculations of fundamental parameters for atomic selenium, based on the Multiconfiguration Dirac-Fock method. In detail, fluorescence yields and subshell linewidths, both of K shell, as well as Kβ to Kα intensity ratio are provided, showing overall agreement with previous theoretical calculations and experimental values. Relative intensities were evaluated assuming the same ionization cross-section for the K-shell hole states, leading to a statistical distribution of these initial states. A method for estimating theoretical linewidths of X-ray lines, where the lines are composed by a multiplet of fine-structure levels that are spread in energy, is proposed. This method provides results that are closer to Kα1,2 experimental width values than the usual method, although slightly higher discrepancies occur for the Kβ1,3 lines. This indicates some inaccuracies in the calculation of Auger rates that have a higher contribution for partial linewidths of the subshells involved in the Kβ1,3 profile. Apart from this, the calculated value of Kβ to Kα intensity ratio, which is less sensitive to Auger rates issues, is in excellent agreement with recommended values.

Rupture of pseudoaneurysms is rare but can be life-threatening complications of acute or chronic pancreatitis, usually due to enzymatic digestion of vessel walls crossing peripancreatic fluid collections. We report the case of a 40 year-old female, with multisystemic lupus and anticoagulated for prior thrombotic events, admitted for probable cyclosporine-induced acute pancreatitis. Hemodynamic instability occurred due to abdominal hemorrhage from two pseudoaneurysms inside an acute peri-pancreatic collection. Selective angiography successfully embolized the gastroduodenal and pancreatoduodenal arteries. The hemorrhage recurred two weeks later and another successful embolization was performed and the patient remains well to date. The decision to restart anticoagulants and to suspend cyclosporine was challenging and required a multidisciplinary approach. Despite rare, bleeding from a pseudoaneurysm should be considered when facing a patient with pancreatitis and sudden signs of hemodynamic instability.

Introduction: The risk of iatrogenic perforations in colonoscopy is not negligible. Experience with endoscopic closure of perforations is increasing and new devices for this purpose are being released, making endoscopy a therapeutic option. National data regarding iatrogenic perforations is scarce and the burden of iatrogenic perforations in out-hospital procedures is poorly characterized in the literature. Objective: Evaluation of iatrogenic perforations rate during colonoscopy, their characteristics, management and prognosis. Methods: Retrospective study of all patients with perforations secondary to in-hospital and non-hospital colonoscopies treated in a tertiary hospital between 01-01-2006 and 01-10-2014. Demographic, endoscopic, radiological and therapeutic data were analyzed. Results: Fifty-three perforations were identified, 20 occurring in colonoscopies performed in non-hospital environment (45% with therapeutic procedures) and 33 occurring in-hospital procedures (73% in therapeutic colonoscopies; representing 0.12% of all colonoscopies carried out in-hospital). Patients: male in 56%, average age of 71 years, history of previous abdominopelvic surgery in 31% and diverticulosis in 10%. Colonoscopy: elective in 93%, under deep sedation in 21%, with less than excellent/good bowel preparation in 56%. A resident was the first performer in 10 cases. Perforations: average size of 21 mm (4–130 mm), diagnosed during the procedure in 51% of cases and occurred in rectum-sigmoid transition in 58.5%. Regarding therapeutics, all patients with perforation occurring in non-hospital colonoscopies were managed by surgery. Concerning treatment of those in our unit: 2-conservative, 12-endoscopic (10 successfully), 21-surgical (including the 2 cases with failure of the endoscopic approach). Comparing endoscopic treatment (n = 10, G1) versus surgery (n = 21; G2): perforation size – 9 mm (G1) versus 28 mm (G2); perforation location – 7/10 in rectum-sigmoid (G1) versus 8/21 in rectum-sigmoid and 10/21 transverse/ascending colon/hepatic angle (G2). Morbidity: 1 infection in G1 and 13 complications in G2 (infection, hemorrhage, fistula). Mortality: no deaths in G1 and 2 deaths at 30 days due to septic shock in G2. Conclusion: Perforations in colonoscopy are rare in our clinical practice. Endoscopic closure was effective, though limited to perforations found during the procedure. The mortality was relatively low and endoscopic management did not seem to worsen it. An additional effort is necessary in order to detect perforations during colonoscopy.

Refractory celiac disease is an uncommon but serious complication of celiac disease. We describe a case of a severe refractory celiac disease type II, complicated with ulcerative jejunoileitis, in a 68 years old female, unresponsive to consecutive treatments with budesonide, prednisolone, cladribine and autologous stem cell transplantation. The patient maintained severe malnutrition, advanced osteoporosis, anaemia, vitamin deficiencies and hydro-electrolytic imbalances, necessitating consecutive hospitalizations for total parenteral nutrition. The patient also developed life-threatening complications, namely respiratory and urinary septic shock and also episodes of haemorrhagic shock secondary to ulcerative jejunoileitis. The progression to enteropathy associated T-cell lymphoma was never demonstrated, but the patient died 7 years after the diagnosis due to a septic shock secondary to a nosocomial pneumonia and osteomyelitis related to a spontaneous hip fracture. This case highlights the difficulties in the diagnostic process, therapeutic management and surveillance of this rare condition associated with very poor prognosis.

The presence of columnar epithelium in the esophagus is associated with two conditions: Barrett's esophagus and heterotopic gastric mucosa. The former results from the metaplastic replacement of the normal distal squamous esophageal lining, is associated with gastroesophageal reflux and is a pre-neoplastic condition. The second is thought as a congenital condition, resulting from the incomplete squamous epithelialization of the esophagus during embryologic development. It is found mainly in the cervical esophagus. Histologically, Barrett's esophagus is composed of an admixture of cardiac mucosa, oxintocardiac mucosa and intestinal metaplasia. Most of heterotopic gastric mucosa consists of oxyntic mucosa where the mucosal glands are straight and composed of parietal and chief cells. There are few reports of heterotopic gastric mucosa in the lower esophagus, generally presenting as small islands. In the present report, a series of four cases of large lower esophageal heterotopic gastric mucosa is described. All patients were initially misdiagnosed with Barrett's esophagus and referred for surveillance. The correct diagnosis was based in endoscopic and histological features. In all, a circular tiny strip of squamous mucosa was observed at endoscopy between the lower end of the columnar-lined esophagus and the esophagogastric junction, defined as the proximal end of the gastric folds. Biopsy samples taken from the columnar-lined segments of the four patients showed pure oxyntic mucosa. When columnar-lined esophagus is observed in the distal esophagus not in continuity with gastric mucosa, the diagnosis of heterotopic gastric mucosa must be thought and confirmed histologically by the presence of pure oxyntic mucosa.

Introduction: Lynch syndrome (LS), the most common hereditary colorectal cancer syndrome, is characterized by mutations in mismatch repair (MMR) genes leading to an increased cancer risk, namely colorectal cancer. Case: In the context of surveillance colonoscopy, a 40-mm flat lesion (0-IIa+b, Paris classification) was identified and submitted to piecemeal mucosal endoscopic resection in a 64-year-old LS patient with an MLH1 germline mutation (262delATC) and two previous segmental resections due to metachronous colorectal cancer. Pathology raised the suspicion of superficial submucosal invasive carcinoma with poor differentiation. Immunochemistry showed heterogeneous MLH1 expression and PMS2 loss. In a short-term follow-up colonoscopy, another 30-mm advanced carcinoma was identified. The patient was referred to surgery. Conclusion: This case raises several issues: (1) the potentially fast tumorigenesis and progression to carcinoma in LS and implications for endoscopic screening and surveillance; (2) pitfalls in the interpretation of MMR proteins immunochemistry; (3) the role of endoscopic resection in LS.

The authors report the case of a 41-year-old woman with a colonic perforation due to a ventriculoperitoneal shunt (VPS) catheter. Left-sided colonic perforation was diagnosed by abdominal computed tomography 28 years after shunt placement, following acute meningitis caused by Escherichia coli. The proximal end of the VPS was exteriorized and it was decided to remove the distal end by colonoscopy. After pulling out the catheter with a polypectomy snare, it broke at the site where it was entering the colon, leaving a small perforation in the colonic wall which was closed with 2 endoclips. The endoluminal fragment of the catheter, being 20 cm in length, was removed through the rectum. The patient is asymptomatic at the 12-month follow-up. A review of the literature regarding 9 endoscopically managed cases of digestive tract perforation caused by VPS is presented.

Introduction: The Over-The-Scope Clip (OTSC®) is a device with promising applications in endoscopic closure of perforations/dehiscence/fistulas, endoscopic hemostasis and NOTES. Aims: To evaluate the clinical effectiveness and safety of OTSC. Methods: Between September 2011 and September 2013, 6 consecutive patients underwent OTSC placement by two experienced endoscopists. In three patients OTSC was used in the closure of surgical dehiscences, both in upper digestive tract (after esofagojejunostomy and gastric sleeve) and in lower digestive tract (blind loop dehiscence after colorectal anastomosis). Two patients had esophageal fistulas with several weeks’ duration (one to the bronchial tree and other to the pleura). Furthermore, OTSC was used to close an iatrogenic perforation following colonic polipectomy. Results: All procedures experienced technically immediate success and there were no complications related to the placement of the OTSC (1 clip). It was well tolerated and patients were hospitalized on average 15 days (5–53 days). However, during follow-up (mean = 12.4; 5–22 months) permanent closure of chronic esophageal-bronchial fistula could not be achieved in one patient. Conclusion: In our experience, OTSC shows efficacy in solving gastrointestinal leaks.

Background: prognostic scores have been validated in cirrhotic patients admitted to general Intensive Care Units. No assessment of these scores was performed in cirrhotics admitted to specialized Gastroenterology Intensive Care Units (GICUs). Aim: to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), Model for End-stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) in predicting GICU mortality in cirrhotic patients. Methods: the study involved 124 consecutive cirrhotic admissions to a GICU. Clinical data, prognostic scores and mortality were recorded. Discrimination was evaluated with area under receiver operating characteristic curves (AUC). Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. Results: GICU mortality was 9.7%. Mean APACHE II, SAPS II, SOFA, MELD and CPT scores for survivors (13.6, 25.4, 3.5, 18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5, respectively) (p < 0.001). All the prognostic systems showed good discrimination, with AUC = 0.860, 0.911, 0.868, 0.897 and 0.914 for APACHE II, SAPS II, SOFA, MELD and CPT, respectively. Similarly, APACHE II, SAPS II, SOFA, MELD and CPT scores achieved good calibration, with p = 0.146, 0.120, 0.686, 0.267 and 0.120, respectively. The overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the APACHE II, SAPS II, SOFA, MELD and CPT scores, respectively. Conclusions: in cirrhotics admitted to a GICU, all the tested scores have good prognostic accuracy, with SOFA and MELD showing the greatest overall correctness of prediction.

A redução da mortalidade das abelhas pelos pesticidas exige: o conhecimento da sua Classificação Toxicológica (CT) para permitir a selecção dos menos perigosos; e a adopção de Frases de Segurança (FS), como as referidas em SPe8, por exemplo Evitar os tratamentos nas épocas de floração das culturas e das infestantes, já recomendadas pelo Laboratório de Fitofarmacologia, em 1965, há quase 50 anos. As graves deficiências da informação oficial e das empresas de pesticidas foram avaliadas pela análise de 66 rótulos e 80 Fichas de Dados de Segurança (FDS),acessíveis no conjunto de 115 p.f. de 40 s.a., e evidenciam ser muito elevada a probabilidade de mortalidade das abelhas pelos pesticidas.To reduce bee poisoning by pesticides it is very important: to know the hazard classification (HC)to allow the selection of the less dangerous pesticides; and the adoption of the safety precautions (SP), as SPe8, namely Do not apply to crops in flower or when flowering weeds are present, already recommended by the Laboratório de Fitofarmacologia in 1965, almost 50 years. The graves official and pesticides suppliers informations' deficiencies were evaluated by the analysis of 66 labels and 80 Safety Data Sheet (SDS), accessible in the set of 115 products of 40 active ingredients, that allows the conclusion of a very high probability mortality of honey bees by pesticides.

O risco do uso dos pesticidas agrícolas ser aceitável depende da adopção de rigorosas medidas de segurança definidas pela UE. Esta problemática, em Portugal, é muito preocupante em consequência de graves ilegalidades, como o não funcionamento da CATPF há 5 anos e da sistemática prática, a nível oficial (ex: DGPC/DGADR e Serviços de Avisos) e das empresas de pesticidas, da política de esconder a informação essencial para: a selecção dos pesticidas menos perigosos; o conhecimento das indispensáveis medidas de mitigação do risco; e a adequada formação de técnicos e de agricultores.The pesticide risk could be acceptable if mitigation measures decided by EU are adopted. In Portugal that problematic is quite difficult in consequence of graves illegalities, as the CATPF 5 years not working and the systematic practice, at official level (ex: DGPC/DGADR and Warning Service) and at pesticides suppliers, of a political to hide the information that is essential to: the pesticides selection of the less dangerous to human health and the environment; the knowledge of indispensable and appropriate measures to reduce those risks as much as possible; and the level of education and training of technicians and farmers.

Nos últimos 17 anos foi intensificado, pela Autoridade Fitossanitária Nacional e pelas empresas de pesticidas, o tabu da classificação toxicológica dos pesticidas com efeitos específicos na saúde humana e o das frases de risco. Já há três anos que, sem resultados positivos, se alerta para os inconvenientes deste último tabu em relação à saúde humana e ao ambiente, em virtude da muito provável ocorrência de riscos inaceitáveis dos pesticidas.During the last 17 years was intensified, by the Nacional Pesticides Authority and the pesticides industry, the pesticide designation tabu and the tabu concerning, the hazard classification of pesticides with specific effects on human health and the risk phrases. The warning about the inconvenients of the last tabu concerning the high probability of occurrence of unacceptable risk to human health was insufficient to obtain any results.

Para proceder à comunicação do risco dos pesticidas, relativa a novos conhecimentos toxicológicos, ecotoxicológicos e ambientais decorrentes das exigências da Directiva 91/414/CEE, é indispensável assegurar a sua divulgação nos Guias de Pesticidas da DGPC e das empresas dos pesticidas, ultrapassando o actual SILÊNCIO, quase generalizado, dessas entidades sobre estas matérias. Com esta comunicação procura-se proporcionar essa informação relativamente aos pesticidas homologados, em Portugal, para a cultura da macieira, para permitir a tão importante selecção dos pesticidas.To perform pesticide risk communication, namely concerning new toxicological, ecotoxicological and environmental knowledge, consequence of the Directive 91/414/ CEE, it is indispensable to secure the convenient divulgation, in the Pesticide Guides of DGPC and of Pesticide Companies, overtaking their actual SILENCE, almost generalized about these problems. With this paper we seek to give that information concerning the authorized pesticides, in Portugal, in apple crop, in order to allow pesticide selection.

Obscure gastrointestinal bleeding is responsible for 2–10% of the cases of digestive bleeding. Angiodysplasia is the most common cause. The authors report a case of a 70-year-old female patient admitted to our Gastrointestinal Intensive Care Unit with a significant digestive bleeding. Standard upper and lower endoscopy showed no abnormalities, and we decided to perform a capsule enteroscopy that revealed a submucosal nodule with active bleeding in the jejunum. An intraoperative enteroscopy confirmed the presence of a small submucosal lesion with a central ulceration, and subsequently a segmental enterectomy was performed. Surprisingly, the histopathological diagnosis was angiodysplasia. The patient remains well after a two-year period of follow-up. We present this case of obscure/overt gastrointestinal bleeding to emphasize the role of capsule and intraoperative enteroscopy in the evaluation of these situations, and because of the unusual endoscopic appearance of the angiodysplasia responsible for the hemorrhage.

Introduction: Several factors are used to stratify the probability of polyp recurrence. However, there are no studies correlating the location of the initial polyps and the recurrent ones. The aim of this study was to verify whether the polyp location at the surveillance colonoscopy was correlated with the location of the previously excised polyps at the baseline colonoscopy. Methods: A retrospective study of patients submitted to colonoscopy with presence and excision of all polyps, followed by a surveillance colonoscopy. Polyp location was divided into proximal/distal to splenic flexure and rectum. Characteristics and recurrent rates at the same colon location were also evaluated. Results: Out of the 346 patients who underwent repeated colonoscopy, 268 (77.4%) had at least 1 polyp detected. For all the segments there was an increased risk of recurrent polyps in the same location and it was about four times higher in proximal (OR 3.5; CI 2.1-6.0) and distal colon segments (OR 3.8; CI 2.1-6.8), followed by three times higher in the rectum (OR 2.6; CI 1.5-4.6). No difference was found between the rates of recurrence at the same segment, taking into consideration the polyp morphology, size, polypectomy technique employed and histological classification. Conclusion: There seems to be a significant association between polyp location at baseline and surveillance colonoscopy.