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The immune system is a defense and adaptation system of our body in relation to the external environment. It allows us to distinguish what we accept and what we do not from everything around us—foods, germs, chemical substances, our own aged or damaged cells, etc.—in order to preserve good health. All disorders caused by either an excess or a deficiency of this function are included within these diseases.
It has two fundamental components: innate immunity, which depends on the genes of our species and does not need to be trained to function, and acquired immunity, which depends on the learning process of our body through contact with infections, foods, or chemical substances. Both work together in close collaboration and in a delicate balance.
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.
Suicide is a common cause of death. Around one million people die by suicide every year worldwide. In our country, suicide has remained the leading cause of external death (INE, 2017). It is estimated that suicide attempts (SA) occur 10–20 times more frequently than suicide. Within the broad spectrum of suicidal behavior, there are high‑lethality suicide attempts (HL‑SA), which are the closest to completed suicide.
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.
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.
People with an unstable or untreated psychiatric disorder—particularly unipolar affective disorders (Depression)—may be more predisposed to suicidal behavior.
In the event of an MSSA, it is essential to assess and treat any underlying psychiatric disorder.
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.
Medical‑psychiatric history and psychological evaluation.
Combat myths that perpetuate the social stigma surrounding suicide and assess suicidal ideation in individuals with clinical and sociodemographic risk factors.
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.
Coronary artery disease includes the pathology of the coronary arteries. These arteries supply blood to the heart. Coronary artery disease affects approximately 6% of the adult population, although this prevalence has shown an increasing trend in recent years.
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.
The disease most commonly affects men over 50 years of age.
To diagnose this disease, a thorough medical history and physical examination are required; however, the key diagnostic tool is cardiac catheterization.
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.
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 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:
People who suffer from Obsessive-Compulsive Disorder are characterized by having recurrent and persistent thoughts that are generally unpleasant, which are called obsessions.
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).
Asthma is a disorder of airflow through the airways, especially the small bronchi. It causes difficulty breathing, so the patient feels short of breath and has to exert more effort to try to breathe better.
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:
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.
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.
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.
Spirometry, chest X-ray, allergy tests.
Some basic questions to help diagnose asthma include:
Treatment is based on the use of bronchodilators, in inhaler or tablet form. Anti-inflammatory medications also play an important role.
The most common diagnostic tests for asthma include:
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.
When we talk about venous thromboembolic disease, we refer to a process characterized by the formation of a thrombus (blood clot) within the deep venous system, which can grow or break apart, disrupting normal blood flow and causing various complications.
The main manifestations of venous thromboembolic disease are deep vein thrombosis (DVT) and pulmonary embolism, among others. DVT occurs when a thrombus or clot forms inside a deep vein, usually in the legs (although it can also occur in the arms, portal vein, iliac veins, or even the vena cava), obstructing normal blood circulation in the affected veins.
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).
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)
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.
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).
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.
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.
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.
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