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Mistakes in gastrostomy insertion and how to avoid them

Tom Welbank

Summary

AI Generated

This article combines author opinion with evidence to address management and patient selection for long-term gastrostomy feeding, topics less extensively covered in the published literature despite clear clinical guidelines and numerous studies on the intervention itself.

  • Long-term enteral nutrition via gastrostomy is a relatively common intervention for patients at risk of malnutrition who have an accessible and functioning gastrointestinal tract
  • Clear clinical guidelines exist describing principles of practice, supported by numerous retrospective and non-randomised controlled studies and case series
  • Fewer publications offer advice and guidance specifically on management and patient selection for gastrostomy interventions
  • The article presents a combination of the author's views alongside the available evidence base
  • Clinicians involved in gastrostomy decision-making or management would benefit from this perspective on patient selection
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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7
1.
Westaby D, Young A, O’Toole P, et al. The provision of a percutaneously placed enteral tube feeding service. Gut 2010; 59: 1592–1605. [Link]
2.
National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Collaborating Centre for Acute Care (UK), 2006. [Link]
3.
Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40: 4745–4761. [Link]
4.
Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe Practices for Enteral Nutrition Therapy. J Parenter Enter Nutr 2017; 41: 15–103. [Link]
5.
Chang C-M, Yin W-Y, Wei C-K, et al. Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery. PLOS ONE 2016; 11: e0148076. [Link]
6.
Cullinane M, Gray AJG, Hargraves CMK, et al. ‘Scoping our practice’. The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death. United Kingdom: NCEPOD, 13 October 2004. [Link]
7.
Lim JH, Choi SH, Lee C, et al. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis. Intest Res 2016; 14: 333–342. [Link]
8.
Zettervall SL, Holzmacher JL, Radomski M, et al. Comparison of Complications Following Laparoscopic and Endoscopic Gastrostomy Placements. J Gastrointest Surg 2017; 21: 1396–1403. [Link]
9.
Sutcliffe J, Wigham A, Mceniff N, et al. CIRSE Standards of Practice Guidelines on Gastrostomy. Cardiovasc Intervent Radiol 2016; 39: 973–987. [Link]
10.
Partovi S, Li X, Moon E, et al. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26: 383–392. [Link]
11.
Sandquist M, Davenport T, Monaco J, et al. The Transition to Adulthood for Youth Living with Rare Diseases. Children 2022; 9: 710. [Link]
12.
Di Lorenzo C, Colletti RB, Lehmann HP, et al. Chronic Abdominal Pain In Children: A Technical Report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: AAP Subcommittee and NASPGHAN Committee on Chronic Abdominal Pain. J Pediatr Gastroenterol Nutr 2005; 40: 249. [Link]
13.
Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr Edinb Scotl 2020; 39: 5–22. [Link]
14.
Hvas CL, Farrer K, Blackett B, et al. Reduced 30-day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study. J Hum Nutr Diet 2018; 31: 413–421. [Link]
15.
Gaspar R, Ramalho R, Coelho R, et al. Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure. GE - Port J Gastroenterol 2023; 30: 61–67. [Link]
16.
Menni A, Tzikos G, Chatziantoniou G, et al. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc 2023; 15: 44–55. [Link]
17.
Yuan Y, Zhao Y, Xie T, et al. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev 2016; 2016: CD009198. [Link]
18.
Fugazza A, Capogreco A, Cappello A, et al. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques. World J Gastrointest Endosc 2022; 14: 250. [Link]
19.
McCulloch A, Roy O, Massey D, et al. Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates. Frontline Gastroenterol 2018; 9: 105–109. [Link]
20.
Serrano Aguayo P, Herguido N, Campos J, et al. New laparoscopic assisted percutaneous gastrostomy. Description and comparison with others gastrostomy types. Clin Nutr ESPEN 2016; 16: 24–29. [Link]
21.
Bhambani S, Phan TH, Brown L, et al. Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department. West J Emerg Med 2017; 18: 770–774. [Link]
22.
Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th ed. Oxford University Press, 2001. [Link]
23.
Arvanitakis M, Gkolfakis P, Despott EJ, et al. Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 81–92. [Link]
24.
Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev 2009; 2009: CD007209. [Link]
25.
Welbank T, Kurien M. To PEG or not to PEG that is the question. Proc Nutr Soc 2021; 80: 1–8. [Link]
26.
Chisholm J, Burton S, Campbell R, et al. Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent: Guidance for decision-making in England and Wales. United Kingdom: British Medical Association, Royal College of Physicians, 2018. [Link]
27.
Mental Capacity Act 2005. legislation.gov.uk, https://www.legislation.gov.uk/ukpga/2005/9/contents (2005, accessed 19 February 2024). [Link]

Abstract

Long-term enteral nutrition via gastrostomy is a relatively common medical intervention for patients at risk of malnutrition who have an accessible and functioning gastrointestinal tract. There are clear clinical guidelines describing the principles of practice as well as numerous retrospective and non-randomised controlled studies and case series. However, fewer publications impart advice and guidance regarding the management and ‘patient selection’ for these interventions. The following article provides a combination of the author’s views and the evidence base.

Topics

Small Intestine & Nutrition Stomach & H. Pylori

Citation

Welbank T, Mistakes in gastrostomy insertion ingestion and how to avoid them. UEG Education 2024; 24: 8-11.

Published

2024

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Abstract

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Mistakes in abdominal distension and how to avoid them

Elizabeth Barba Orozco, Alberto Ezquerra-Durán

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7
1.
Westaby D, Young A, O’Toole P, et al. The provision of a percutaneously placed enteral tube feeding service. Gut 2010; 59: 1592–1605. [Link]
2.
National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Collaborating Centre for Acute Care (UK), 2006. [Link]
3.
Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40: 4745–4761. [Link]
4.
Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe Practices for Enteral Nutrition Therapy. J Parenter Enter Nutr 2017; 41: 15–103. [Link]
5.
Chang C-M, Yin W-Y, Wei C-K, et al. Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery. PLOS ONE 2016; 11: e0148076. [Link]
6.
Cullinane M, Gray AJG, Hargraves CMK, et al. ‘Scoping our practice’. The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death. United Kingdom: NCEPOD, 13 October 2004. [Link]
7.
Lim JH, Choi SH, Lee C, et al. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis. Intest Res 2016; 14: 333–342. [Link]
8.
Zettervall SL, Holzmacher JL, Radomski M, et al. Comparison of Complications Following Laparoscopic and Endoscopic Gastrostomy Placements. J Gastrointest Surg 2017; 21: 1396–1403. [Link]
9.
Sutcliffe J, Wigham A, Mceniff N, et al. CIRSE Standards of Practice Guidelines on Gastrostomy. Cardiovasc Intervent Radiol 2016; 39: 973–987. [Link]
10.
Partovi S, Li X, Moon E, et al. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26: 383–392. [Link]
11.
Sandquist M, Davenport T, Monaco J, et al. The Transition to Adulthood for Youth Living with Rare Diseases. Children 2022; 9: 710. [Link]
12.
Di Lorenzo C, Colletti RB, Lehmann HP, et al. Chronic Abdominal Pain In Children: A Technical Report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: AAP Subcommittee and NASPGHAN Committee on Chronic Abdominal Pain. J Pediatr Gastroenterol Nutr 2005; 40: 249. [Link]
13.
Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr Edinb Scotl 2020; 39: 5–22. [Link]
14.
Hvas CL, Farrer K, Blackett B, et al. Reduced 30-day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study. J Hum Nutr Diet 2018; 31: 413–421. [Link]
15.
Gaspar R, Ramalho R, Coelho R, et al. Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure. GE - Port J Gastroenterol 2023; 30: 61–67. [Link]
16.
Menni A, Tzikos G, Chatziantoniou G, et al. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc 2023; 15: 44–55. [Link]
17.
Yuan Y, Zhao Y, Xie T, et al. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev 2016; 2016: CD009198. [Link]
18.
Fugazza A, Capogreco A, Cappello A, et al. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques. World J Gastrointest Endosc 2022; 14: 250. [Link]
19.
McCulloch A, Roy O, Massey D, et al. Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates. Frontline Gastroenterol 2018; 9: 105–109. [Link]
20.
Serrano Aguayo P, Herguido N, Campos J, et al. New laparoscopic assisted percutaneous gastrostomy. Description and comparison with others gastrostomy types. Clin Nutr ESPEN 2016; 16: 24–29. [Link]
21.
Bhambani S, Phan TH, Brown L, et al. Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department. West J Emerg Med 2017; 18: 770–774. [Link]
22.
Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th ed. Oxford University Press, 2001. [Link]
23.
Arvanitakis M, Gkolfakis P, Despott EJ, et al. Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 81–92. [Link]
24.
Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev 2009; 2009: CD007209. [Link]
25.
Welbank T, Kurien M. To PEG or not to PEG that is the question. Proc Nutr Soc 2021; 80: 1–8. [Link]
26.
Chisholm J, Burton S, Campbell R, et al. Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent: Guidance for decision-making in England and Wales. United Kingdom: British Medical Association, Royal College of Physicians, 2018. [Link]
27.
Mental Capacity Act 2005. legislation.gov.uk, https://www.legislation.gov.uk/ukpga/2005/9/contents (2005, accessed 19 February 2024). [Link]

Abstract

Abdominal distension and bloating are among the most frequently misunderstood complaints in gastroenterology. They are often used as interchangeable terms, a conceptual mistake that continues to drive diagnostic errors and ineffective treatment. According to Rome IV, bloating and distension may represent either a primary disorder of gut–brain interaction (DGBI) or occur as symptoms with other DGBIs, such as irritable bowel syndrome (IBS), functional dyspepsia (FD) or functional constipation (FC).

Topics

Neurogastroenterology & Motility

Citation

Barba E and Ezquerra-Durán A. Mistakes in abdominal distension and bloating and how to avoid them. UEG Education 2026; 26: 5-9.

Published

2026

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Summary

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

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Summary

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Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7
1.
Westaby D, Young A, O’Toole P, et al. The provision of a percutaneously placed enteral tube feeding service. Gut 2010; 59: 1592–1605. [Link]
2.
National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Collaborating Centre for Acute Care (UK), 2006. [Link]
3.
Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40: 4745–4761. [Link]
4.
Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe Practices for Enteral Nutrition Therapy. J Parenter Enter Nutr 2017; 41: 15–103. [Link]
5.
Chang C-M, Yin W-Y, Wei C-K, et al. Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery. PLOS ONE 2016; 11: e0148076. [Link]
6.
Cullinane M, Gray AJG, Hargraves CMK, et al. ‘Scoping our practice’. The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death. United Kingdom: NCEPOD, 13 October 2004. [Link]
7.
Lim JH, Choi SH, Lee C, et al. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis. Intest Res 2016; 14: 333–342. [Link]
8.
Zettervall SL, Holzmacher JL, Radomski M, et al. Comparison of Complications Following Laparoscopic and Endoscopic Gastrostomy Placements. J Gastrointest Surg 2017; 21: 1396–1403. [Link]
9.
Sutcliffe J, Wigham A, Mceniff N, et al. CIRSE Standards of Practice Guidelines on Gastrostomy. Cardiovasc Intervent Radiol 2016; 39: 973–987. [Link]
10.
Partovi S, Li X, Moon E, et al. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26: 383–392. [Link]
11.
Sandquist M, Davenport T, Monaco J, et al. The Transition to Adulthood for Youth Living with Rare Diseases. Children 2022; 9: 710. [Link]
12.
Di Lorenzo C, Colletti RB, Lehmann HP, et al. Chronic Abdominal Pain In Children: A Technical Report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: AAP Subcommittee and NASPGHAN Committee on Chronic Abdominal Pain. J Pediatr Gastroenterol Nutr 2005; 40: 249. [Link]
13.
Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr Edinb Scotl 2020; 39: 5–22. [Link]
14.
Hvas CL, Farrer K, Blackett B, et al. Reduced 30-day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study. J Hum Nutr Diet 2018; 31: 413–421. [Link]
15.
Gaspar R, Ramalho R, Coelho R, et al. Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure. GE - Port J Gastroenterol 2023; 30: 61–67. [Link]
16.
Menni A, Tzikos G, Chatziantoniou G, et al. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc 2023; 15: 44–55. [Link]
17.
Yuan Y, Zhao Y, Xie T, et al. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev 2016; 2016: CD009198. [Link]
18.
Fugazza A, Capogreco A, Cappello A, et al. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques. World J Gastrointest Endosc 2022; 14: 250. [Link]
19.
McCulloch A, Roy O, Massey D, et al. Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates. Frontline Gastroenterol 2018; 9: 105–109. [Link]
20.
Serrano Aguayo P, Herguido N, Campos J, et al. New laparoscopic assisted percutaneous gastrostomy. Description and comparison with others gastrostomy types. Clin Nutr ESPEN 2016; 16: 24–29. [Link]
21.
Bhambani S, Phan TH, Brown L, et al. Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department. West J Emerg Med 2017; 18: 770–774. [Link]
22.
Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th ed. Oxford University Press, 2001. [Link]
23.
Arvanitakis M, Gkolfakis P, Despott EJ, et al. Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 81–92. [Link]
24.
Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev 2009; 2009: CD007209. [Link]
25.
Welbank T, Kurien M. To PEG or not to PEG that is the question. Proc Nutr Soc 2021; 80: 1–8. [Link]
26.
Chisholm J, Burton S, Campbell R, et al. Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent: Guidance for decision-making in England and Wales. United Kingdom: British Medical Association, Royal College of Physicians, 2018. [Link]
27.
Mental Capacity Act 2005. legislation.gov.uk, https://www.legislation.gov.uk/ukpga/2005/9/contents (2005, accessed 19 February 2024). [Link]

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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Episode 6: UEG Journal October Spotlight

Mohsan Subhani, Maria Manuela Estevinho

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Abstract

Topics

Endoscopy Hepatobiliary IBD Pancreas

Published

2025

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Pradeep Mundre Pradeep Mundre, David S. Sanders

Mistakes in abdominal distension and how to avoid them

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Alberto Ezquerra-Durán Alberto Ezquerra-Durán, Elizabeth Barba Orozco

Oesophageal cancer with Massimiliano di Pietro (Part 2)

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Gonçalo Alexandrino Gonçalo Alexandrino, Ana Catarina Garcia

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Maria Manuela Estevinho Maria Manuela Estevinho, Mohsan Subhani

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