Manejo de secreciones no invasivo en un paciente con Esclerosis Lateral Amiotrófica no colaborador, ¿dónde está el límite? A propósito de un caso / Non invasive mucus drainage in a non-collaborate Amyotrophic Lateral Sclerosis patient. Where the limit is? A case report

Las complicaciones respiratorias son una de las causas de hospitalización más frecuente, e incluso de muerte, en pacientes con enfermedad neuromuscular. El seguimiento multidisciplinar tiene efectos positivos sobre la supervivencia y la calidad de vida en estos pacientes. Este caso supuso un reto terapéutico para el manejo de secreciones bronquiales, por ser un paciente con Esclerosis Lateral Amiotrófica no colaborador y que rechazaba las medidas invasivas. Tras un primer intento fallido de adaptación al sistema mecánico de tos convencional, se modificó la interfase usando una boquilla de tipo buzo invertida, introducida entre los dientes durante la aplicación del equipo con mascarilla nasobucal. Se consiguieron muestras de esputo, lo que nos permitió tratar las infecciones respiratorias con el antibiótico específico. Además, el seguimiento se realizó por videollamada, sin necesidad de desplazar al paciente hasta el hospital. El equipo multidisciplinar se adaptó a las necesidades del paciente tratando de forma novedosa y eficaz las infecciones respiratorias. Además, el uso de nuevas tecnologías evitó ingresos hospitalarios, a pesar de ser un paciente gran dependiente.(AU)

Respiratory complications are one of the most frequent causes of hospitalization and even death in patients with neuromuscular diseases. Multidisciplinary follow-up has been shown to have positive effects on survival and quality of life in these patients. The present case represented a therapeutic challenge in order to manage respiratory secretions in a non-collaborate Amyotrophic Lateral Sclerosis patient due to the negative to accept invasive strategies to cope with respiratory infections. Despite a first failed approach in the adaptation to a mechanical assisted cough device, then a modification in the interfase allowed to mobilize secretions and it was also possible to analyze them and use the correct antibiotic treatment. Moreover, a remotely follow-up was done to handle situations, like respiratory tract infections, whenever possible, without requesting the patient to move to the hospital. The multidisciplinary unit team adapted to his needs offering a newest and efficacy strategy to cope with respiratory infections. Indeed, the use of new technologies avoided in a high dependent patient to require hospitalizations.(AU)

Sedimentation assessment and effects in Venda Nova dam reservoir (Portugal).

Sediment quantity and quality in dam reservoirs is often neglected and usually only water quality is monitored in many countries, such as in Portugal. Nevertheless, there are risks associated to sedimentation in dam reservoirs, particularly considering that many dams in the world are ageing into an overextended lifetime. The present study was conducted with the goal to understand how sedimentation monitoring in Portuguese dam reservoirs could be attained, as that information is essential to tackle any sedimentation effects that may have occurred. A dam reservoir in the north of Portugal, the Venda Nova reservoir, was selected for the study. First, historical relevant data was compiled and then new data for sediment and water quality analysis was collected. The results show that since the reservoir was filled, after the dam construction conclusion in 1951, the reservoir morphology has been affected by the sedimentation at different rates and underwent multiple transformations from 1946 (before the dam construction) to 2004 (last topobathymetric survey). An expressive morphology transformation detected in 1984 led to an intervention to remove some of the accumulated material. It was verified, as well, that the asymmetrical contamination of the sediments and water is still strongly influenced by a nearby mine even if now inactive. The methodology applied, if periodically used, will be helpful to understand the sedimentation phenomena in Portuguese and other European dam reservoirs where reservoir sedimentation has been overlooked, and can play a key role to improve river continuity and to comply with the Environmental Quality Standards under the EU Water Framework Directive (2000/60/EC).

Computer eyestrain.

Main ocular mechanisms probably underlying eyestrain symptoms in computer users-diminished aqueous tears, extraocular muscle fatigue, color fatigue and decreased amplitude of accommodation induced by monochromatic light--are discussed. With this background, some practical consequences are drawn to avoid or reduce eyestrain.