Infections of the lower urinary tract are characterised by localised pain, which increases when urinating, and sometimes by cloudy or dark urine, usually without high temperatures.

Kidney infections (pyelonephritis) are characterised by high temperatures, acute local pain in the lower back, and pain or irritation when urinating.

Symptoms

Urinary tract infection is characterised by the presence of local pain (lower abdomen or lumbar region), which increases when urinating. The urine is often cloudy, or dark if it contains blood. There may be high fever, especially in the case of pyelonephritis (an infection of the upper urinary tract).

Who is affected by the condition?

It can affect people at any age, from early childhood to old age. It is more frequent among women and there are factors that make people vulnerable to it (pregnancy for women and enlarged prostate for men) as well as urological anomalies (pre-existing malformation or presence of kidney stones).

Diagnosis

Urinary infections are diagnosed by examining urine under the microscope (sediment) to see whether it contains white blood cells and/or bacteria, and by cultivating the bacteria in a microbiological culture to identify the strain and determine the most appropriate antibiotic for treatment (antibiotic susceptibility testing).

Standard treatment

Urinary tract infections are usually treated with antibiotics. Treatment is oral in the case of lower-tract infection.

For upper-tract infections (pyelonephritis) it is usually intravenous, although in some cases outpatient oral treatment may be administered.

Standard tests

The standard tests are urine sediment and culture (urine culture with antibiotic susceptibility testing). An ultrasound scan may be indicated for examining the kidney and urinary tract and identifying obstructions or kidney stones that may have brought about the infection.

Ultrasounds are also used to assess the state of the kidneys. A general analysis may also be indicated to see how the urinary tract infection is affecting the rest of the body, and specifically the renal function.

Prevention 

Urinary tract infection can be prevented by frequent urination (every 2 to 3 hours) and, above all, by avoiding the habit of holding in urine, and by going to the toilet whenever the bladder feels full, without waiting too long.

Medically serious suicide attempts (MSSA) or high‑lethality suicide attempts (HLSA) are defined as those involving severe organic compromise, regardless of their psychiatric severity.

Within the wide spectrum of suicidal behavior, MSSA are the closest to completed suicide, and the two groups overlap substantially, sharing common characteristics. In addition, MSSA carry a higher risk of subsequent death by suicide compared with low‑lethality suicide attempts.

An important aspect to consider is that evaluating survivors of a severe suicidal act allows direct information to be obtained from the survivor, unlike completed suicides, in which assessment is carried out indirectly through third parties (psychological autopsy). Being able to assess individuals who have come so close to suicide is of great value for understanding the psychological mechanisms behind severe suicidal behavior and for identifying warning signs to prevent suicide.

A considerable percentage of these cases show underlying psychiatric disorders, mainly affective disorders (Depression), followed by Personality Disorders and other Substance‑related Disorders. Other non‑psychiatric and socio‑environmental risk factors must also be assessed: the presence of severe or chronic medical conditions, functional limitations and their impact (such as in people with physical disabilities or older adults), and social support.

Symptoms

Most patients present depressive symptoms that do not always coincide with a recent stressful event. They often have a history of previous suicide attempts. Prior to the MSSA, they typically experience thoughts of wanting to die or a more structured suicidal ideation.

Who is affected?

People with an unstable or untreated psychiatric disorder—particularly unipolar affective disorders (Depression)—may be more predisposed to suicidal behavior.

Diagnosis

In the event of an MSSA, it is essential to assess and treat any underlying psychiatric disorder.

Typical treatment

Once the patient has recovered from the life‑threatening situation, a comprehensive approach is required, addressing both clinical and socio‑environmental aspects. Clinically, it is crucial to evaluate and treat any psychiatric condition. After medical discharge, referral to the mental health network is important, as well as activation of the Suicide Risk Code, which ensures follow‑up after hospital discharge.

Most common assessments

Medical‑psychiatric history and psychological evaluation.

Prevention

Combat myths that perpetuate the social stigma surrounding suicide and assess suicidal ideation in individuals with clinical and sociodemographic risk factors.

Symptoms

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.

Who is affected?

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

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.

Usual treatment

Legionellosis responds well to specific antibiotic treatment. Early initiation of treatment is very important.

Common tests

Chest X-ray, blood tests for antibodies against Legionella, and specific cultures to identify the bacterium.

Prevention

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.

Symptoms

Coronary artery disease can present with various symptoms, but the most characteristic is angina, or chest pain. It may also be accompanied by sweating, shortness of breath, arm pain, or palpitations.

Who is affected?

The disease most commonly affects men over 50 years of age.

Diagnosis

To diagnose this disease, a thorough medical history and physical examination are required; however, the key diagnostic tool is cardiac catheterization.

Usual treatment

There are essentially three pillars in the treatment of coronary artery disease. First, medical treatment, which is reserved for mild cases; second, coronary intervention; and third, coronary surgery. Different severity scales are used to decide when a patient requires percutaneous treatment or is a candidate for coronary revascularization surgery.

Most common tests

The first test performed on patients presenting with chest pain is an electrocardiogram. From there, depending on the severity of the case, a stress test may be done in stable cases, or cardiac catheterization may be performed directly in clear-cut cases. Catheterization provides the definitive diagnosis.

Prevention

Prevention plays a very important role in this disease. Although there are isolated cases with few risk factors, the vast majority of patients have cardiovascular risk factors.

The most important measures to adopt for both primary and secondary prevention are:

• Quit smoking.
• Control blood pressure.
• Manage diabetes.
• Control weight and abdominal circumference.
• Avoid a sedentary lifestyle.
• Stop drinking alcohol.

In addition, these thoughts trigger repeated actions or rituals that serve to “cope with” the aforementioned obsessions, called compulsions. Some examples of compulsions include: washing hands, religious behaviors (such as praying a written prayer exactly 15 times to prevent something bad from happening), and counting or checking things (e.g., making sure the door is locked, the gas is off, etc.).

Very often, they feel that “something bad” will happen if they do not carry out the compulsions, so they feel “forced” to perform them. This generates a lot of anxiety and distress, as they feel responsible for a possible misfortune.

They may become detached from daily life activities or avoid them completely due to fear of the obsessions or compulsive behaviors.

They may also experience difficulties with everyday tasks (cooking, cleaning, bathing, etc.) and suffer higher levels of anxiety.

Following some recommendations can help you “live with” or overcome Obsessive-Compulsive Disorder.

However, if recommendations are not enough and the disorder becomes more severe, you should see a psychologist or psychiatrist to complement these tips with other types of treatment (cognitive-behavioral therapy, pharmacological treatment).

Recommendations to help cope with or overcome your obsessions and compulsions:

• You must believe that you can overcome it and be determined to tackle your problem.
• You should learn to lose fear of your obsessive thoughts and allow your mind to think “silly” things without getting scared, as they pose no real danger.
• Regarding your rituals, you should change the way you perform them and be clear that the ultimate goal is to eliminate them.
• When you think that something bad will happen to you or a loved one if you don’t perform a ritual, realize that it is a completely irrational and false worry.
• You will experience anxiety for a while, but it will then decrease as if you had performed the ritual.
• Be aware that nothing bad happens when you feel the urge to perform the ritual and do not do it.
• Part of your brain recognizes that all this is “absurd” and that nothing bad can happen if you do not perform your rituals.
• Rituals calm you at the moment, but increase the problem in the medium and long term. Use distraction (call someone, go for a walk, relaxation techniques…) to reduce anxiety.
• Accept your irrational thoughts and leave them there without fighting them, seeing them as what they are —unpleasant thoughts— but understanding they pose no danger and will weaken until disappearing.
• Tell yourself: “It’s okay if I have obsessions; no matter how silly my thoughts are, nothing bad will happen.”
• Write down and record your “absurd” thoughts so you can listen to them repeatedly and realize they are completely false and harmless.
• Focus on your normal life; as you do so, unpleasant thoughts will gradually disappear.
• Do not feel guilty for having the obsession; accept it.

To help reduce or even eliminate compulsions or rituals:

• Postpone or delay the ritual; in the meantime, distract yourself with interesting things and pleasant activities (such as talking to someone, listening to your favorite music, playing with your pet, exercising…).
• Perform the ritual more slowly; you can help yourself by doing several slow diaphragmatic breaths.
• Change some aspect of the ritual: for example, if you used a particular soap, change the brand; if you repeatedly touched an object, touch another; if you performed the ritual in one room, do it in another; if you did it standing, do it sitting.
• Add a consequence of the ritual: each time you perform a ritual, you must complete an additional task unrelated to your compulsions. It should be something time- and effort-consuming to help you avoid performing the ritual. For example: if you perform the ritual, afterward you must drive for an hour, clean the house, take a 30-minute walk, or do 10 push-ups, etc.
• Exercise regularly, as it reduces anxiety and will help you have fewer obsessions and compulsions.

Asthma is a chronic inflammatory disorder of the airways that causes a variable obstruction of airflow. It usually changes throughout the day (it may worsen at night) and improves with the established treatment, although it can reappear later.

It is a disease primarily caused by an inflammatory mechanism.

In the airways of patients with asthma, three phenomena occur:

1. Reduction of the bronchial diameter, which hinders airflow.
2. Inflammation, with thickening of the bronchial wall, which also contributes to obstructing airflow.
3. Increased activity of mucus-producing glands, so that the rise in secretions further contributes to breathing difficulty.

There is a set of cells circulating in the blood involved in the local inflammation observed in asthma: T lymphocytes, mast cells, and eosinophils. These cells are responsible for the normal defense of the body and show increased activity in asthma, which is regulated with the administered medication.

Symptoms

Depending on the degree of obstruction, the affected person may experience difficulty breathing and a feeling of shortness of breath. Wheezing is also characteristic of asthma; it is a high-pitched sound produced by air passing through smaller airways and also by increased bronchial secretions.

Who is affected?

Asthma can affect all age groups and sometimes coincides with bronchitis. In some cases, it may have an allergic origin or result from exposure to environmental or chemical agents.

Diagnosis

Spirometry, chest X-ray, allergy tests.

Some basic questions to help diagnose asthma include:

1. Have you ever had “wheezing” in your chest?
2. Have you had a cough, especially at night?
3. Have you had cough, wheezing, or difficulty breathing at certain times of the year or when in contact with animals, plants, tobacco, at work, or after exercise?
4. Have you had colds lasting more than 10 days or that “go down to your chest”?
5. Have you used inhaled medications?

Usual Treatment

Treatment is based on the use of bronchodilators, in inhaler or tablet form. Anti-inflammatory medications also play an important role.

Most common tests

The most common diagnostic tests for asthma include:

1. Spirometry: Measures airflow during inhalation and exhalation and detects airway obstruction, a key feature of asthma.
2. Bronchodilator test: Determines whether spirometry improves with medications that dilate the airways.
3. Bronchial provocation test: The opposite test, using medications that cause slight airway obstruction, detected by spirometry.

Prevention

To prevent asthma, it is essential not to smoke and to avoid exposure to allergens that trigger it, which can be identified through allergy testing as part of the asthma evaluation.

A thrombus that forms in a deep vein can fragment or break off and become detached. The resulting embolus then travels through the veins toward the heart and reaches the lungs via the pulmonary arteries. In the lungs, the embolus lodges and obstructs one or more pulmonary arteries, preventing normal blood flow. This process is called a pulmonary embolism or thromboembolism (PE).

Symptoms

Deep vein thrombosis (DVT):

- Swelling or inflammation of the affected leg

- Pain or tenderness in the leg, often starting in the calf

- Increased warmth in the leg

- Changes in skin color (redness or bluish and shiny appearance)

Pulmonary embolism (PE):

- Sudden shortness of breath or difficulty breathing (dyspnea)

- Increased respiratory rate

- Increased heart rate

- Sharp chest pain

- Dry cough, sometimes with blood

- Fainting (syncope)

Who it affects

The incidence of venous thromboembolic disease in the general population, including any of its manifestations, is estimated at 1–2 cases per 1,000 inhabitants per year. In Spain, this translates to more than 80,000 cases annually. About 70 % of cases are deep vein thromboses, with the remainder being pulmonary embolisms.

Diagnosis

DVT:
Diagnosis involves assessing patient symptoms, blood tests, and imaging. The preferred imaging method is Doppler ultrasound (eco-Doppler), which allows visualization of the deep veins and confirms or rules out the diagnosis.

PE:
If a pulmonary embolism is suspected, diagnosis is confirmed using tests such as a chest CT scan or a lung scan (ventilation-perfusion scintigraphy).

Usual treatment

The main goal in any type of thrombosis is to dissolve the thrombus and restore blood flow to prevent further complications.

Anticoagulation is the treatment of choice for venous thromboembolic disease. Anticoagulants are medications that alter blood clotting to prevent new thrombi from forming and help dissolve existing clots.

Common tests

Laboratory tests, such as D-dimer Imaging tests, including Doppler ultrasound, CT scans, and lung scintigraphy.

THROMBOPHILIA STUDY: In some cases, a blood test is performed to determine if the patient has abnormalities in clotting proteins that predispose them to thrombosis.

Prevention

Knowing the risk factors for venous thromboembolic disease is key to managing and reducing risk. One of the simplest and most effective preventive measures is walking, as movement helps prevent thrombus formation.