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We aimed to identify the effects of the direction and wind speed on feeding habitat selection of wintering dunlins and little stints in an inland lake of the Iberian Peninsula. Feeding habitat (muddy surface or shallow water) and location in the lake with respect to wind direction (windward and leeward) of feeding flocks of both species were assessed on days with different wind speed (light or strong). We also performed visual counts of potential prey items (zooplankton) in mud and water habitats. In light wind conditions, wader flocks mostly selected the shallow water on the lake’s leeward shore. On the contrary, in strong wind conditions, the birds tended to forage on the windward shore, with a similar frequency in mud and shallow water habitats. The abundance of prey items in the mud and water column varied according to wind conditions, being higher in the sites preferred by waders. Our findings advance knowledge on how small–sized waders cope with environmental dynamics of wind in non–tidal lakes.

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Objective: to know the interferences of leprosy in women's lives and how they reinvent themselves in coping with the disease., Method: a descriptive study with a qualitative approach. The theoretical-methodological framework adopts an approximation to the cartographic method and some concepts of schizoanalysis, which were used to analyze the data. The tools used to produce the data were the interview and the logbook. The interviews were conducted from July to November 2019, at the participants' homes., Results: the group consisted of nine women. To display the data, we were inspired by Deleuze's ideas about difference and repetition. The results were organized in three thematic axes that address the lives of these women affected by leprosy, which accompany concerns, anxieties and worries about the effects of the disease. The transformations in the female body, the financial maintenance itself due to the comorbidities caused by leprosy and its difficulties in guaranteeing rights are elements strongly pointed out by women., Conclusion: there is overlap and interference of the female condition in a patriarchal society that still accompanies it. We bet on the strength of becoming-a-woman and the need to consider them in their singularities and in their context for producing care permeated by meetings of the affirmation of the power of life.

Objectives: To assess telemedicine satisfaction of patients from a primary health care center during COVID-19 pandemics. This work could bring information on its acceptance., Materials and Methods: Transversal study with 253 individuals. A questionnaire was performed using Likert scale (1-very unsatisfied, 5-very satisfied) on patients with diabetes, hypertension and in subjects with other pathologies, whose consultations occurred between 01/04/2020 and 01/05/2020. Collected data included sociodemographics, previous telemedicine appointments, satisfaction levels of teleconsultation and doubt clarification, and interest in further telemedicine follow-up. In addition, a comparative analysis was performed between the periods January-February and April-May of 2020 in relation to age, sex, hypertension, diabetes and the type of contact (presential or remote). Statistics were performed using SPSS® and Excel®., Results and Discussion: Diabetes follow-up appointments accounted for 34.4% of total consultations. Globally there was a high level of satisfaction and interest in future telemedicine follow-up. However, diabetic and older patients were less interested in this type of follow-up. Statistically significant differences about satisfaction were found in age, sex and presence/absence of diabetes. 70.6% of healthy patients preferred contact by e-mail over telephone. A selection bias is present because no randomization was made. The higher prevalence of diabetes consultations and the lack of adjustment for confounding factors can also affect results. Number of consults between January-February and April-May was compared and the main result was the significant reduction in the number of face-to-face consultations for diabetes (-50.1%) and hypertension (-94.1%). Presential consultations decreased by 72.6% and non-presential consultations increased by 61.9%. There was a selection bias because the sample was not random. The higher prevalence of diabetes consults and the lack of adjustment for confounders could affect results., Conclusions: This study allowed us to confirm the importance of telemedicine in primary health care, especially during pandemics. Participants recognized the usefulness of telemedicine and allowed future similar consultations., (Copyright © 2021 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Aims: To determine how often ingested foreign bodies are found and what parameters may predict their retrieval., Methods: During 1 year, we prospectively studied all patients referred to our Ear Nose and Throat Emergency Unit because of foreign body ingestion., Results: During the study, 204 (median age-42 years [10 months-84 years]) patients were admitted because of ingested foreign body. The most common was fish bone (88%). Most patients were admitted <24-hour after ingestion (72%) and complained of symptoms above the cricoid cartilage (79%). A foreign body was removed by Ear Nose and Throat team in 108 (53%) patients. Twenty-three (11%) patients were referred to Gastroenterology. In 9 (39%) of these patients, a foreign body was identified by esophagogastroscopy, always from the esophagus. Predictive variables for retrieval of foreign body by Ear Nose and Throat team were ingested fish bone (P=.000; odds ratio [OR]=17.3), short duration (<6 hours) of symptoms (P=.001; OR=2.3) and symptoms above or at the level of cricoid cartilage (P=.000; OR=8.9). In patients with symptoms below the cricoid cartilage the rate of retrieval of foreign body by Ear Nose and Throat team (11%) was significantly increased by Gastroenterology (41%; P=.03)., Conclusions: Patients with ingestion of foreign body who ingest fish bone, present within the first 6 hours or complain of symptoms at or above cricoid cartilage deserve greater investment in terms of time and resources for retrieval of ingested foreign body by Ear Nose and Throat team., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Introduction: Neuromuscular disease (NMD) patients frequently have impaired cough. Mechanical insufflation-exsufflation (MI-E) has proven efficacy in improving airway clearance, however data related to its long-term home use is lacking. The purpose of this study was to describe indications, safety and compliance of home MI-E in NMD patients., Methods: Four years observational analysis of 21 NMD patients on home MI-E. Diagnosis included bulbar and non-bulbar Amyotrophic Lateral Sclerosis (ALS) and other NMD. Median age was 58 years. Only cooperative patients with unassisted baseline Peak Cough Flow (PCF) <270 L/min were included. All patients were under continuous mechanical ventilation (6 by tracheostomy). Pulmonary function before initiation of MI-E (median): FVC=0.81 L, MIP=28cmH(2)O, MEP=22 cmH(2)O and PCF=60 L/min. MI-E was performed by previously trained non-professional caregivers, with an on-call support of a trained health care professional. Patients had pulse oximetry monitorization and applied MI-E whenever SpO(2)<95%. Median follow-up was 12 months (3-41 months)., Results: Ten patients (9 ALS) used MI-E daily. Eleven patients used MI-E intermittently, during exacerbations, and in 8 patients early application of MI-E (guided by oximetry feed-back) avoided hospitalization. All tracheostomized patients used MI-E daily and more times a day than patients under NIV. Four patients (3 bulbar ALS), were hospitalized due to secretion encumbrance. MI-E was well-tolerated and there were no complications. In general, caregivers considered MI-E effective. During this period, 4 patients died, related to disease progression., Conclusions: Home MI-E is well tolerated, effective and safe if used by well trained caregivers. MI-E should be considered as a complement to mechanical ventilation., (Copyright 2009 SEPAR. Published by Elsevier Espana. All rights reserved.)

Introduction: Perinasal sinus infections is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the gravity of this condition, because late recognition and delay in treatment can increase mortality and morbidity. The authors made a retrospective study of pediatric patients admitted to Garcia de Orta Hospital between 1996 and 2001 with the diagnosis of subdural empyema and sinusitis., Case Reports: Four patients were identified, with ages between 9 and 13 years. Prodromal manifestations of sinusitis were present in all, followed several days later by headaches, fever, vomiting and neurological abnormalities. Two patients presented in the emergency department with an acute confusional state and a non convulsive status epilepticus. The other two patients had a longer duration of disease, severe deterioration of consciousness and focal neurologic signs. Medical treatment was started in all cases at admission, but none improved significantly before being submitted to surgical intervention, which was repeated several times in two patients. Streptococcus milleri and anaerobic organisms were isolated. There was no mortality and global evolution was favorable, with a median follow up of 32 months., Conclusions: Clinical presentation of subdural empyema can be relatively inespecific, requiring a high degree of suspicion. Facing a young adolescent with fever of unknown origin associated with any neurological abnormality and previous history of sinusitis, neuroradiological investigation shoul be asked. Early diagnosis and treatment are the mainstays of successful outcome.

Background and Objective: Percutaneous coronary angioscopy (CAG) provides in vivo visual information about the luminal aspect of the vessel. In this report we describe our initial experience with CAG during coronary angioplasty (PTCA)., Methods: Fifty-five patients (age 60 +/- 9 years), 8 female, were included. Most patients, 42 (76%) were treated for unstable angina., Results: In 49 patients (89%) CAG was performed prior to PTCA, and in all cases the intraluminal material responsible of the stenosis was recognized. This included plaque associated to thrombus in 29 patients (59%), isolated plaque in 15 (31%) and isolated thrombus in 5 (10%). Of these plaques, 25 (57%) were yellow, 14 (32%) were yellow and white and 5 (11%) were white. Of the 34 thrombi, 23 (68%) were mural and 11 (32%) protruding. CAG post-PTCA was performed in 43 patients (78%). CAG visualized residual plaque in 41 patients (95%) and residual thrombus in 34 (79%). In addition, CAG recognized dissections in 30 patients (70%). CAG was more sensitive than angiography for the detection of thrombus (pre-PTCA 34 [69%] vs 11 [22%]; p < 0.05, and post-PTCA 34 [79%] vs 5 [12%]; p < 0.05]) and coronary dissections (post-PTCA 30 [70%] vs 19 [44%]; p < 0.05). CAG before intervention caused angina in 39 patients (80%), ventricular fibrillation (successfully managed with DC cardioversion) in 1, and AV block in another patient. The angiographic result deteriorated in 4 patients (9%) immediately after the CAG performed following PTCA. A repeat balloon PTCA was required in these patients., Conclusions: CAG provides unique information on coronary lumen surface that complements angiographic data. As compared with angiography, CAG is more sensitive in the detection of intracoronary thrombi and dissections. Further studies are required to determine whether the additional information provided by CAG may be used, to select coronary interventions according to specific lesion characteristics, to optimize dilation results and, eventually, to improve the clinical outcome of these patients.