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Internal Medicine, General Hospital
Immunological diseases can impair the body’s defense system or cause an inappropriate immune response. Proper medical follow-up, adherence to treatment, and healthy lifestyle habits are essential to prevent infections, manage symptoms, and improve quality of life.
A person’s immune status depends on their overall health: proper nutrition and avoiding exposure to tobacco smoke and chemicals whenever possible. In early childhood, the vaccines and immunizations recommended in the vaccination schedule help build a competent immune system.
In primary immunodeficiencies, early detection is important, usually indicated by the presence of frequent infectious diseases. Secondary immunodeficiencies occur during treatment for neoplasms or in transplant patients who must take lifelong immunosuppressive medication.
In autoimmune diseases, it is essential to follow the prescribed medication, often for life, and to avoid excessive cold and sun exposure, which can trigger disease manifestations. To maintain the functionality of joints and muscles, following specific rehabilitation guidelines is important.
In immune deficiency, administering immunoglobulins (blood proteins responsible for our defense) can play an important role. When the deficiency affects immune cells, immunoglobulins are not effective; in such cases, antibiotics can prevent or reduce infections.
In diseases caused by excessive or poorly regulated immune responses, anti-inflammatory drugs and medications that modulate immunity are used, such as corticosteroids and biologics, which block specific inflammatory pathways. Other drugs may also have beneficial effects through less well-understood mechanisms, such as some medications used to treat malaria.
Immunological diseases are disorders in which the immune system does not function properly, either due to overactivity or deficiency. This imbalance can cause inappropriate responses to external agents or damage the body’s own tissues.
Immune System Diseases
There are immune system disorders caused by:
a) Loss of function: Primary immunodeficiencies, acquired immunodeficiencies.
b) Excess of function: Autoimmune diseases, in which the body, through an excessive exercise of its defenses, attacks itself due to the loss of a fundamental function: self-tolerance. This means that under normal conditions, a body’s own cell will never attack another of its own cells.
In the first case, immunodeficiencies are indicated by the repeated occurrence of infections, which is the key sign for detection. These can appear early in life due to a genetic alteration, in adulthood as a result of treatments for other diseases such as cancer, or can be acquired through viral infections, with HIV (human immunodeficiency virus) being one of the most significant.
In the second case, autoimmune diseases are suggested by the appearance of inflammation without apparent cause in joints, lungs, kidneys, liver, or other organs.
Symptoms primarily depend on whether they are due to a loss of function (recurrent infections) or an excess of function (inflammatory disease affecting one or more organs).
Immune diseases can affect anyone throughout their life. In general, immunodeficiencies are more common in early childhood, while autoimmune diseases usually affect young adults, more frequently women.
The body’s defense capacity is assessed in two ways:
Basal state: in the patient’s ordinary condition.
After stimulation: the immune cells are stimulated in the laboratory to evaluate their function.
For autoimmune diseases, factors present in the blood are analyzed; elevated levels may indicate abnormal activity against the body itself.
Diagnostic evaluations include:a) Study of innate immunityb) Study of acquired immunityc) Study of the functional capacity of the immune systemd) Study of factors characterizing autoimmune disease
Assessing immune competence can be done in several ways:
Detection and counting of immune cells, specifically lymphocytes.
Laboratory stimulation of lymphocytes to test their functionality.
Analysis of blood or biopsy samples for factors causing self-attack, such as autoantibodies (defense proteins with abnormal self-aggressive function).
Study of elevated cellular messengers indicating the activity of these cells against the body.
Immunodeficiency: restoration of the immune system’s functional capacity.
Autoimmunity: modulation or inhibition of the immune system’s self-aggressive capacity.
Laboratory tests to assess immune system functionality are standard. Genetic tests are also used to assist in diagnosis.
In addition to general recommendations for a healthy diet, regular exercise, and abstaining from smoking, adherence to the childhood vaccination schedule is essential. Vaccinations not only protect against specific infections but also help improve overall immune defense.
Legionellosis is a lung infection caused by Legionella pneumophila, found in contaminated water. It spreads through inhaling contaminated water or vapor, causing fever, pneumonia, muscle pain, and general malaise. It mainly affects older or immunocompromised people. Diagnosis involves cultures, antibody detection, or chest X-ray. Treatment is early antibiotics, and prevention relies on monitoring and disinfecting water systems.
Legionellosis is a disease caused by the bacterium Legionella pneumophila, which typically lives in contaminated water systems, such as water pipes, ponds, cooling towers, swimming pools, or hot tubs.
It is acquired through inhalation after contact with contaminated water, either by bathing in it or being in nearby areas, as the bacteria can spread from the water into the surrounding air.
It generally causes a lung infection in the form of pneumonia, which, if not diagnosed and treated promptly, can become severe and life-threatening.
Legionellosis produces the typical symptoms of pneumonia—fever, chest pain, and difficulty breathing—along with severe muscle pain and a significant overall decline in health, with pronounced malaise.
Legionellosis can affect anyone who comes into contact with the causative bacterium, but it is more common in elderly or immunocompromised individuals who have been exposed to contaminated water or inhaled vapor from such water.
Diagnosis is made by detecting the bacterium or antibodies against it in the blood, once suspected based on clinical characteristics (age of onset, fever, severe general malaise, muscle pain) or radiographic findings (pneumonia affecting large areas of the lungs). Isolation of the bacterium is relatively recent, as it requires special culture media.
In fact, Legionella was not identified as a cause of pulmonary disease until 1976, during a pneumonia outbreak at an American Legion convention in Philadelphia, from which it gets its name.
Legionellosis responds well to specific antibiotic treatment. Early initiation of treatment is very important.
Chest X-ray, blood tests for antibodies against Legionella, and specific cultures to identify the bacterium.
Epidemiological surveillance of detected cases (water pipes, air-conditioning towers, pools, or hot tubs involved) is crucial to disinfect them.
When a case of legionellosis is detected, public health authorities conduct an investigation to locate and eliminate the source.
Legionella does not tolerate high temperatures well and is usually eliminated by temporarily raising the temperature of the water systems. To ensure the bacterium is fully eradicated, these measures should be carried out by specialized professionals.
Fibromyalgia is a chronic condition related to an altered pain perception in the central nervous system. It is mainly characterized by widespread pain, often accompanied by fatigue and sleep disturbances. It can affect people of all ages, especially women. Treatment combines patient education, physical exercise, psychological support, and sometimes medication.
Fibromyalgia is a common condition, affecting 2.4 % of the general population, and is part of the so-called central sensitization syndromes. It is mainly characterized by widespread pain. There is hyperexcitation of the central nervous system with a lowered pain threshold, causing pain to appear earlier and be more intense, longer-lasting, and more diffuse. There is an exaggerated response to painful stimuli (hyperalgesia) and pain in response to normally non-painful stimuli (allodynia). Its cause is unknown, but sometimes there are clear triggers such as physical or emotional trauma or infections.
It is a chronic condition with a fluctuating course, with periods of improvement and others of clinical worsening.
The main symptom is widespread pain, but it is often accompanied by other symptoms such as fatigue, insomnia, tingling in the limbs, headache, dizziness, memory and concentration problems, anxiety, or depression.
It usually affects middle-aged women, with a peak between 40 and 49 years, but it can affect people of all sexes and ages.
Diagnosis is based on criteria that rely on the patient’s clinical presentation, according to the presence of characteristic symptoms and signs.
There is no specific medical test.
Laboratory tests and sometimes imaging studies help rule out other conditions that are often concomitant (present at the same time).
Treatment of fibromyalgia should be based on four pillars: patient education (general information about the disease and attitude toward it), physical exercise according to tolerance, cognitive-behavioral therapy if appropriate, and pharmacological treatment.
1. Patient education and attitude toward the disease
The disease should be explained, providing general advice to improve well-being.
2. Physical exercise according to tolerance
There is evidence of its effectiveness on pain, well-being, and physical function.
It is recommended to start with low-impact aerobic exercise: walking, swimming, stationary cycling, aquagym, tai chi, or pilates.
Exercise should be performed regularly and progressively.
It is recommended to do 20–50 minutes per session, at least three days per week.
In cases of lower tolerance, start with ten minutes per session, four to six days per week, and gradually increase duration, frequency, and intensity, if possible, each month.
3. Cognitive-behavioral therapy
Provided by clinical psychologists in cases of accompanying anxiety or depression.
Although fibromyalgia is not a psychological condition, anxiety and depression can trigger and perpetuate symptoms.
4. Pharmacological treatment
Can help manage some symptoms such as pain, fatigue, or sleep disturbances, although its effectiveness is limited in a large percentage of patients.
Currently, analgesics, muscle relaxants, anticonvulsants, and some groups of antidepressants are used.
The risk/benefit and potential side effects of any medications should be carefully evaluated.
A healthy lifestyle is recommended, maintaining weight with aerobic exercise according to tolerance and a balanced diet, organizing and prioritizing daily tasks with short breaks, and avoiding physically and emotionally stressful activities.
Health advice for people with fibromyalgia is provided.
Hip fractures involve a change in the autonomy of elderly patients, negatively affecting their quality of life and altering their family and social environment, as it causes a change in their prior functional capacities, with a high risk of complications.
The femur is the longest bone in the human body. It should be stated that a femoral fracture in elderly people basically affects the end nearest the hip joint. For this reason, the best-known name for this type of fracture is hip fracture. We should not understand this health problem as a fracture of a long bone that affects an elderly person, but rather as a gateway leading to their physiological and functional situation, and their underlying conditions, becoming decompensated.
The classic symptoms are pain in the hip area, reported by the patient themselves, when they can, along with the associated functional impotence. Furthermore, the affected limb tends to be shorter and presents external rotation (with the lateral side of the foot touching the bed). In patients with cognitive deterioration, who cannot communicate the level of pain they are suffering, a decrease in their functional situation can be a symptom that should make us suspect a “hidden” fracture.
The population incidence of hip fractures in Catalonia for patients aged > 65 is around 600 cases / 100,000 inhabitants per year. The perspective is that this figure will increase in coming years, due to the increase in life expectancy and an increasing population.
At Hospital Vall d'Hebron in 2020, the year of the Covid-19 pandemic, we operated on a total of 693 hip fractures. In 2019, surgery was performed on 720 fractures. In other words, these are fractures that occur under normal circumstances of patients falling over.
The average age where this occurs is 85 years old, and it affects women in 75% of the cases. Some of the risk factors for women may be early menopause and hormonal treatment. A prior fracture (radius or spine are the most frequent), obesity, smoking and a sedentary lifestyle are risk factors in general.
The suspected diagnosis can be made from typical clinical signs and symptoms, as stated above.
In regard to treatment, it has been demonstrated that surgery on hip fractures in the elderly population increases survival, when compared to a non-surgical treatment, as it permits the patient's early movement without pain, thereby avoiding added complications. For this reason, at present, the treatment of choice is surgical treatment. However, there are some exceptions.
A multi-disciplinary approach is important, with the collaboration of specialists in geriatrics, internal medicine and anaesthesiology for the preoperative optimisation of the patient and early surgery, as a rule within the first 48 hours.
It is essential to classify the fractures according to their location, in order to decide on the type of surgical treatment. Intracapsular fractures seriously affect the vascularisation of the femoral head, and for this reason, the most popular option for treatment is to replace it with an artificial head, in the form of a hip prosthesis, especially in displaced fractures. Depending on the patient's age and functional situation, we may opt for a partial or total prosthesis, reserving the second option for younger patients with a better quality of life. Some non-displaced intracapsular fractures can be treated percutaneously, using screws. Extracapsular fractures, of which pertrochanteric fractures are the most common, do not compromise the vascularisation of the femoral head, and for this reason it is not necessary to replace it with a prosthesis. Percutaneous treatment with intramedullary nailing is usually the treatment of choice.
The postoperative period is also very important. Close collaboration with rehabilitation and physiotherapy services is established so that patients do not lose their prior functional capacity. Furthermore, social workers assess the social situation of each patient, in order to ensure an appropriate hospital discharge.
Diagnosis confirmation is usually carried out with a simple x-ray of the pelvis. In cases where the x-ray does not show a fracture, as may occur in the case of some non-displaced intracapsular fractures, tomography (CAT) is usually the technique of choice.
Hip fracture prevention is based on the adoption of healthy habits, such as a balanced diet that is rich in calcium and vitamin D, doing physical activity every day, within the person's functional capacities, and avoiding tobacco and alcohol.
It is also important to prevent falls, by means of appropriate closed footwear with a non-slip sole, standing up slowly, without haste, programming visits to the toilet to avoid rushing, wearing glasses and hearing aids, not walking in the dark or on went floors, etc.
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