What do you need to bear in mind to prevent Zika virus?

The advice to prevent infection with Zika virus is particularly aimed at pregnant women or those thinking of becoming pregnant in the short to medium term. The possibility of transmitting the infection to the foetus means that pregnant women are the most vulnerable group. For this reason, you are advised to:

• Avoid travelling to countries where there is a risk of being infected while you are pregnant.
• Inform a healthcare professional if you have already travelled to any the affected areas.
• Use a condom for the entire pregnancy if your sexual partner has travelled to countries affected by Zika virus.

Mosquito bite prevention

• Dress in clothes that cover most of your body and wear a hat all day to protect your skin as much as possible from exposure to mosquitoes.
• Use authorised repellents, following the manufacturer’s instructions for their use and reapplication indicated on the product.
• Avoid being outside unnecessarily during the most active times of day for mosquitoes (first thing in the morning and late afternoon).
• Sleep in air-conditioned accommodation, as mosquitoes tend to avoid the cold, or place mosquito nets around the bed, doors and windows.

Mosquito proliferation prevention

Another way of preventing mosquito bites is to avoid proliferation of mosquitoes, which you can do by finding out and periodically checking the areas where these insects reproduce. Once breeding points are located, the measures should focus, as appropriate, on:

• Avoiding and/or draining any accumulation of water there may be in the subsoil of accommodation.
• Emptying or covering objects that may accumulate water.
• Emptying or refreshing water weekly in the case of fixed objects or containers that may accumulate water and covering, with a lid or mosquito screen, those that cannot be emptied.
• Keeping swimming pools, ponds and other bodies of water in correct hygiene conditions.

What do you need to bear in mind if you have acute bronchiolitis?

Acute bronchiolitis is a respiratory tract infection common in infants under two. This infection, caused by RSV, manifests itself in mild or moderate catarrhal symptoms, although if it is not treated, it may progress and cause serious bronchiolitis or pneumonia.

The symptoms of acute bronchiolitis may vary depending on the patient’s age:

• In adults and the majority of healthy infants: upper respiratory symptoms (rhinitis, mild cough, minor wheezing)
• In breastfeeding and premature babies: normally, lower respiratory symptoms (bronchiolitis, pneumonia)

This virus may be transmitted in two ways:

• Directly: through contact with secretions from an infected individual (wet mode)
• Indirectly: through contact with surfaces, such as furniture (for example, those that have been exposed to infectious secretions)

The preventive measures to avoid transmission of the virus are:

• Hand hygiene: hands should be washed before touching the child.
• Toys should be cleaned, especially after having been used by other infected children or adults.
• Personal utensils (plates and feeding bottles) should be washed properly, and specific utensils used for the infant that are different to those used by adults.
• (Paper) disposable tissues should be used and immediately disposed of (not re-used).
• Physical contact with the infant should be avoided by people with respiratory symptoms or fever. Infection can be avoided if a distance of 1.8 m is maintained from the person with symptoms.
• Enclosed environments and crowds should be avoided.
• Avoid exposure to tobacco smoke.
• Breastfeeding should be encouraged, as it protects against infections.

Admission to hospital is more likely in infants belonging to high risk groups:

• Children born premature
• Children with chronic pulmonary illnesses
• Children with congenital heart disease

In the above cases, administering prophylaxis with palivizumab is recommended, as it is proven to reduce hospital admissions for RSV.

Palivizumab

• Palivizumab is a passive immunisation that prevents infections due to RSV (it is not a vaccine).
• It does not normally have adverse effects, and it does not interfere with the vaccination schedule.
• Care must be taken to ensure that the doses are correctly given, since each dose last approximately 30 days.
• It must be administered by a healthcare professional in a hospital clinic (it cannot be administered in a primary care centre).
• The dose given will depend on the child’s weight, and will be administered once a month during an epidemic period (five doses in total) and by intramuscular injection to the face and/or outside thigh.

What do you need to bear in mind if you have human papillomavirus?

HPV infection can cause, in many cases:

• Benign lesions: such as skin and genital warts
• Malignant lesions: such as some types of cancer, including uterine, cervical, prostate, vulvar or anal cancer. These are some of the less frequent lesions.

It is possible for people not to know that they have the virus because they have no lesions or because they have damage that is difficult to see. Plus, the majority of lesions disappear completely without having any affect.

Generally, HPV is transmitted through unprotected sex (oral, anal or vaginal), with or without penetration, with someone who is infected, even if that person does not have any symptoms.

Therefore, it is essential to use a condom properly during sex. This does not offer complete protection, as areas that cannot be covered with a condom will remain unprotected. It is also worth noting that it could be months between being infected and the appearance of symptoms, so it is very difficult to tell when the infection occurred.

HPV that may lead to cancer may not at first show any symptoms or obvious injury, but it may be detected using specific tests (such as a Pap test or cervical and vaginal cytology).

HPV infection of the cervix and anus can be serious and, therefore, it should be diagnosed and treated as early as possible to prevent it from evolving and becoming a cervical or rectal cancer. A routine HPV test is not recommended.

Some measures to prevent the spread of warts to other parts of the body and to other people are:

• If an injury appears in the area, see a specialised health care professional.
• Do not scratch lesions; if you have touched this area of your body, make sure you wash your hands thoroughly.
• Maintain a good level of hygiene and avoid dampness.
• If someone has warts, it is important that they let their sexual partner or partners know, so that they can take protective measures during sex and so that the partner can be tested by a professional and receive the appropriate treatment if required.

The infection of some types of HPV may be prevented using vaccinations (these should be administered before having sex). Currently, the vaccine is funded under the systematic vaccination programme for 11/12-year-old girls (sixth grade).

Despite vaccination, the recommended screening protocol for cervical cancer should be followed. The aim is to prevent malignant lesions in the genital tract associated with the virus. The vaccine protects against infections due to the virus, which cause 70% of cervical cancers and 90% of genital warts.

Other related health information

• http://canalsalut.gencat.cat/ca/detalls/article/Papilloma_huma
• http://www.geosalud.com/vph/vacunas-virus-papiloma-humano.html

What do you need to bear in mind if you have sarcoma or other musculoskeletal tumours or you are caring for someone who does?

It is important to follow a series of advice related to lifestyle and treatment. The most important advice is:

• Diet and hydration: follow a healthy and balanced diet, ensuring it includes the necessary foods, proteins and calories.
• Control over passing urine and faeces: there is a tendency to constipation caused by pain medication (morphine or derivatives), which is why a diet rich in fibre is recommended.
• Unhealthy habits: avoid habits such as smoking, drinking or taking other toxins.
• Hydration and skin awareness: the skin normally becomes very delicate and deteriorates due to the effects of aggressive treatment.
• Control of post-surgical wounds: wash using less aggressive soaps and keep your skin well hydrated.
• Side effects (localised and systemic) of medication: watch for and avoid effects such as nausea, vomiting, diarrhoea, skin peeling, itchy skin, etc.).
• Education and keeping extremities mobile: sometimes there are cases of amputation and phantom limb syndrome.
• Maximum empowerment of the patient’s independence in the new situation and provide the necessary tools: crutches, walkers, wheelchairs, etc.
• Pain management: medication, relaxation techniques, breathing control, mobility techniques and energy saving.
• Education in injury and fall prevention: wearing appropriate footwear, adapting the home (removing barriers), walking safely, wearing comfortable clothing, etc.
• Infection control: keep an eye on temperature and symptoms. It is worth remembering that this is an immunosuppressant condition.
• Insistence on the importance of oral hygiene.
• Information and assessment of correctly taking medication.
• Vigilance and control of port-a-cath, if the patient has one.
• Sleeping at night and resting during the day to enable proper rest at night time.
• More direct professional support for the patient, their family or carer: necessary, adequate and understandable information should be provided about the illness and treatment. Support must be provided in paper format and other types of professionals can also give their support.
• Respect the patient’s independence and the decisions they make.
• Information about patient’s wishes.

Health education in patients with psoriasis should, first and foremost, consist of informing them about its chronic nature. It is also essential that they are aware of the possible increase or decrease in irritation and the factors that predispose or trigger them.

Likewise, it is important to know the healthy lifestyle options that help alleviate or improve it, as well as the personalised alternatives available for treatment (topical treatments, systemic treatments, phototherapy and photochemotherapy).

Recommendations

To contribute to the welfare of patients with psoriasis, it is important that they are aware of a series of tips and recommendations:

Correct application of treatments

• Topical, systemic and phototherapy.
• It is important to follow the treatment prescribed.

Treatment

• The patient should be aware that treatment might not always be effective and there are other alternatives, on an individual basis.

Hygiene for patients with psoriasis

• Avoid aggressive gels or shampoos.
• Eliminate sponges from your personal hygiene routine.
• Apply moisturisers as usual.
• Skin treatments should be used daily.

Scalp treatment

• It is important to wet hair with warm water.
• Shampoos with a pH between 4 and 4.5 are recommended.

Factors that should be avoided

To keep this illness under control and reduce symptoms:

• Follow a balanced diet, rich in fresh food, keeping saturated animal fats in check and eating plenty of foods containing antioxidants.
• Avoid toxic products as much as possible (alcohol, tobacco and other drugs).
• Avoid stress and learn to live with the illness: both of these are important factors in controlling psoriasis outbreaks.

Infection control

• Any type of infection must be treated from the onset.

Healthy habits

• Skin wounds or lesions reduce the body’s ability to face external aggressions and worsen the symptoms of psoriasis.
• You should be careful not to put on weight.
• Traumas and injuries, along with aesthetic aggressions to the skin, may worsen the state of psoriasis plaques.
• You should avoid wearing very tight clothes and rapid temperature changes.

Exposure to sunlight

• A brief period of exposure to sunlight may be beneficial for psoriasis. However, always avoid burns and use adequate protection.
• Avoid exposure to sunlight between 12 noon and 4 pm.

Psychological effects:

• Self-esteem and self perception should be dealt with on an individual basis with each patient.

Evolution of the illness

• Concomitant and co-morbid illnesses (arterial hypertension, obesity and arthritis) are common. These will also need to be treated, and the patient will need to know how to avoid them.

What do you need to bear in mind to prevent Ebola virus?

If you find yourself in an area affected by Ebola virus:

• Avoid direct contact with blood or bodily fluids from a patient or a corpse, and with objects that may be contaminated.
• Reduce contact with wild animals and do not eat raw meat.
• Wash your hands regularly.
• Avoid having unprotected sex.

Treatment

Although there is currently no commercially available vaccine against the virus, the results of studies conducted so far show that the vaccine could be very effective. In Spain the risk of infection is very low, but:

• Try not to travel to affected countries.
• Should you find yourself in one of these countries, avoid trips to affected areas.

When should you go to the ER?

If you travel to one of the affected areas and a few weeks after your return you notice the following symptoms, you need to seek medical attention urgently and tell the doctor about the trip:

• Fever
• Tiredness for an unknown reason
• Diarrhoea
• Other serious symptoms

What do you need to bear in mind if you have diabetic foot?

The complications of diabetes mellitus with high blood sugar and/or poor metabolic control may end up causing injuries to small vessels, such as diabetic retinopathy and diabetic nephropathy, or large vessels, such as diabetic arteriopathy.

This affectation also extends to protective sensitivity to injuries, and causes signs of peripheral nerve damage. It may present as sensory, motor or autonomic nerve damage.

The most frequent form is sensory/motor and one of the serious complications is Charcot foot and ankle. The combination of nerve and artery damage with foot infection may be considered a serious complication.

Symptoms

Although it may start more severely, the main symptoms of diabetes are:

• Being very thirsty
• Being very hungry
• Needing to urinate a lot

And the symptoms that may indicate the beginning of diabetic foot are:

• Loss of feeling in the feet
• Pain at night
• Intolerance to bed sheet friction
• Dry skin that may lead to cracking
• Changes in the points of support on the feet
• Appearance of hard skin and ulcers that may lead to amputation

Epidemiological data

Around 15% of patients diagnosed with diabetes get diabetic foot. Between 40% and 50% of diabetics will have an ulcer and 20% will need an amputation. More than 50% of non-traumatic leg amputations are performed in diabetics.

Diagnosis

Clinical, analytical and screen for early detection.

Treatment

Depending on symptoms and preventive.

Prevention

Prevention of diabetic foot includes good metabolic control alongside a healthy lifestyle and professional foot care

What do you need to bear in mind if you need periacetabular osteotomy surgery?

In the months running up to the operation patients are advised to follow an iron-rich diet. In addition, three doses of intravenous iron will be administered and, in some cases, a dose of erythropoietin glycoprotein to stimulate the production of red blood cells.

So that patients are able to be independent, they will be taught to walk with no pressure (without putting weight on the operated leg) and with partial pressure (only putting weight on the tips of their toes) using crutches so that they can walk on their own.

After the operation, patients will have their blood pressure, heart rate and temperature monitored, and they will have a finger prick done to check for anaemia.

Where possible, younger patients will not be given blood transfusions. By correctly tolerating low haemoglobin levels, this patient group is able to more easily trigger the body’s physiological mechanisms without complications to try to compensate for the blood lost during surgery. For this reason it is very important to rigorously monitor vital signs.

Once in the hospital, the person and their family should be informed about the exercises to be performed:

• Maintenance of the anti-rotation leg box, if required.
• Internal rotation exercises.
• Attempt to sit up on their own 24 hours after surgery.
• Doing mobility exercises with a pillow between their legs for the patient’s comfort.
• Training for the person’s family on how to carry out pumps, flexoextension, passive abduction and triple extension exercises so that they can help the patient.

Nursing staff and physiotherapists can teach the patient how to carry out deep breathing exercises, which:

• Prevent blood pressure from dropping, and help to oxygenate because rest reduces oxygenation of tissues
• Supply a large amount of oxygen to the lungs
• Ventilate and clean the lungs
• Activate the body’s relaxation response
• Stimulate the heart
• Promote bowel movements
• Massage the organs

Patients will move about and walk in the following three stages, depending on x-ray exams:

• First four weeks: leaning on the tips of the toes so as not to lose balance
• Partial pressure: from four weeks on
• Total pressure: from six weeks on

Pain will be controlled using intravenous drugs for the first few days and, after that, oral medication. In order to alleviate pain, a cold compress will need to be applied on the area for twenty minutes three times a day.

To prevent thromboembolism, patients will be treated with subcutaneous heparin injections. The hospital admissions unit’s nursing staff will show them how to administer this.

Remember

• Exercises must always be assisted (by a family member).
• The patient will walk or move from their chair to the bed without putting their weight on the operated leg.
• If the articular capsule has been operated on, the leg should not be rotated towards the exterior.

What do you need to bear in mind if you have mucositis?

Good prevention and early detection are fundamental to avoid complications. To reduce the symptoms of mucositis it is important to follow the following advice:

Before receiving your first cancer treatment

Have a dentist check-up to detect possible conditions and reduce the risk of complications during treatment.

During treatment:

• Clean your teeth, tongue and gums after each meal with a soft brush and gentle fluoride toothpaste.
• Rinse your mouth out with a thyme or chamomile infusion or even water with a small spoonful of bicarbonate of soda after oral hygiene. Do not use mouthwash containing alcohol.
• Keep your lips well hydrated, with olive oil or lip balm.
• Drink plenty of fluids
• Avoid acidic, spicy, very salty or seasoned foods.
• Avoid very hot foods.
• Avoid substances that will irritate your mucous membranes, such as tobacco and alcohol.
• If you wear false teeth, keep them clean and soak them every night in a glass of disinfectant water and rinse them well before you put them back in.

When should you go to the ER?

If you notice ulcers in your mouth or any other change (redness, burning sensation, white spots, etc.) that cause pain or stop you from eating properly, consult your nurse and/or day hospital.

If you have a fever which develops call the immediate care line or go to A&E.

Proper control of risk factors, coupled with recommendations for lifestyle changes, can prevent up to 90% of stroke cases. These elements, together with the pharmacological treatments prescribed by the specialist, can also reduce the risk of recurrence and first episodes of other cardiovascular diseases with common risk factors.

These measures also benefit other aspects of health if followed in your daily life.

Modifiable risk factors

• Proper monitoring of tension lowers the chances of suffering a stroke and other cardiovascular diseases. Hypertension is, in fact, the main risk factor for stroke after age (it is estimated to be the cause in between 25 and 50% of cases).
• Follow a healthy diet, limiting salt and fats, processed meats, and industrial pastries. The Mediterranean diet is a good choice because, as well as being balanced and providing the necessary nutrients, it has a low content of saturated fatty acids, is rich in antioxidants and reduces the possibility of obesity, bad cholesterol (a risk factor for stroke) and diabetes. It is also advisable to eat fish, legumes, fibre, fruit and vegetables on a regular basis.
• Doing sport on a regular basis helps avoid obesity and diabetes and prevents cardiovascular disease. Everyone is advised, where possible, to do 30-60 minutes of moderate (walking quickly) or intense (running) aerobic physical exercise five days a week.
• Proper monitoring and treatment of diseases such as diabetes may decrease the risk of stroke and other vascular diseases. While chronic microvascular complications involved in diabetes (retinopathy, nephropathy, and neuropathy) are associated with poor long-term glycaemic control, macrovascular complications (ischemic heart disease and stroke) are determined mainly by other cardiovascular risk factors. We also need to monitor weight and obesity, which promotes high blood pressure, dyslipidaemia and diabetes.
• Nicotine causes cholesterol plaques in the arteries and can cause them to clog, so it is recommended to give up smoking.
• Excessive alcohol consumption is also harmful: it causes hypertension and cardiovascular disease. This is why you are also advised to limit alcoholic beverages.
• Controlling heart disease, specifically atrial fibrillation: changes in heart rate, as is the case in atrial fibrillation, may cause thromboembolism in the brain (a type of stroke) or in other organs.
• Take your pulse is a campaign run by the Department for Health of the Generalitat de Catalunya, la Fundació Ictus (Stroke Foundation) and the Consell de Col·legis de Farmacèutics de Catalunya (Council of Associations of Pharmacists of Catalonia). If you feel strong, rapid palpitations without having done any previous physical activity, you are recommended to go to the doctor.

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