We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
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Poliomyelitis is a highly contagious disease caused by any of the three human poliovirus serotypes, which are part of the enterovirus family. Europe was certified free of poliomyelitis in June 2002. Immunisation and vigilance of the disease continue to ensure the region is free of poliomyelitis. Post-polio syndrome has no defined causal mechanism but it affects between 20% and 80% of patients afflicted with poliomyelitis.
Initial symptoms are those of a influenza-like illness (fever, headache, joint and muscle pain, vomiting, among other things) and can last up to 10 days. Its most serious forms may cause respiratory paralysis leading to death. Post-polio syndrome presents a new neurological weakness that may be progressive or abrupt on muscles previously affected or unaffected. It may or may not be accompanied by new health problems such as excessive fatigue, muscle pain, pain in the joints, intolerance to cold, reduced physical stamina and function, and atrophy.
It mainly affects children and the mechanisms for its transmission may be through faecal-oral channels or a common vehicle (contaminated water or food).
Post-polio syndrome affects patients who have had poliomyelitis for 20 years or more.
Diagnosis is given clinically, supplemented with laboratory and electromyographic (EMG) tests.
Symptomatic treatment with analgaesics, a ventilator where necessary, gentle exercise and possibility of orthopaedic devices to prevent deformities or to enable function.
In acute diagnoses, studying secretions, stools and cerebrospinal fluid. EMG in acute and later stages for diagnosing post-polio syndrome.
Poliomyelitis has no cure but it can be prevent by vaccination.
A urinary tract infection is the presence of bacteria in the urinary tract, which is normally sterile. It can affect the lower urinary tract (bladder or urethra) or the kidneys, known as pyelonephritis. Common symptoms include pain during urination, frequent urination, or fever. Treatment usually involves antibiotics.
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.
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).
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).
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).
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.
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.
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.
Acute hepatitis is a sudden inflammation of the liver that can be caused by viruses, drugs, or toxins. Common symptoms include fatigue, nausea, jaundice, and dark urine, although they may go unnoticed. Diagnosis is based on laboratory tests and sometimes ultrasound. Most cases resolve spontaneously, but some types are preventable through vaccination.
Acute hepatitis consists of an acute inflammation of the liver that makes the liver not work properly. This is normally brought on by a virus, pharmaceuticals or other toxins.
The symptoms are very varied and often go unnoticed. The most common are fatigue, poor appetite, nausea, muscle pain and fever. Occasionally, a yellow tinge appears in the whites of the eyes and the skin (jaundice), and urine becomes dark in colour (choluria). Symptoms may persist for one to three months before recovery. Hepatitis B and C may become chronic.
Hepatitis A affects children and young people. Thanks to improvements in health and hygiene in our country, the disease now quite rare. It may be found in patients who have recently visited countries with greater incidence of the disease and in people who have had contact with them. As previously mentioned, the means of transmission is faecal-oral and it generally clears up with no complications.
Hepatitis B is transmitted in the majority of cases through sexual contact or by exchange of blood (drug addicts use of needles). Transmission via blood transfusion is currently very regulated and virtually never happens. In areas where the disease is very prevalent (mainly Asian countries) the most common means of transmission of hepatitis B is from mother to child during pregnancy or childbirth (vertical transmission). In these cases of vertical transmission, if adequate treatment is not administered, hepatitis B becomes chronic in more than 90% of cases.
Toxic hepatitis is caused by exposure to substances which are harmful to the liver. These toxins may be pharmaceuticals, natural products or others. In some instances the connection between the toxin and the hepatitis is very well documented and is predictable. In other instances an unexpected reaction takes place (idiosyncrasy). Finally, there are pharmaceuticals that do not produce hepatic toxicity unless they are used in much higher doses than normal (for example paracetamol).
Diagnosis is mainly clinical (observation of jaundice, dark urine) and from lab results (elevated liver enzymes and positive viral detection).
In addition, during the development of the disease the appearance or development of antibodies specific to each virus is detected, which determine the response of the patient and whether or not the condition becomes chronic.
An abdominal ultrasound allows us to see if there are any complications stemming from the acute hepatitis and to exclude other causes that might produce similar symptoms.
In general no specific treatment is needed for acute hepatitis except in some cases produced by hepatitis B and C viruses. Extreme personal hygiene is important to avoid contagion to others.
No specific diet is recommended (alcohol must always be avoided). Nor is total bed rest necessary (physical activity should be adapted to the patients general condition).
Basically these consist of analyses to show the status and development of the liver and how the patient is responding to treatment. Blood analyses can also reveal to what extent the condition is becoming chronic.
The best possible treatment for the A and B viruses is vaccination (included in the routine vaccination schedule). No vaccine is currently available for the C virus.
Hepatitis A is transmitted by faecal-oral contact (contaminated food and drink and from person to person). Food hygiene is fundamental here.
Barrier contraception methods (the condom) can prevent the transmission of sexually transmitted diseases (including hepatitis B and C).
In countries where the disease is very prevalent, many pregnant women may have the disease and transmit it to their child during the final phase of the pregnancy or the delivery. The use of +/- gamma globulin early vaccination against the hepatitis B virus can prevent infection in children.
Toxic hepatitis is prevented with caution to the exposure of the various toxins involved.
Skin cancer is the most common type of cancer. It appears when some skin cells undergo changes and begin to grow uncontrollably. Accumulated sun exposure is the main risk factor, although other factors such as genetic predisposition or the state of the immune system also play a role.
The main types of skin cancer are:
The dermatologist is the specialist responsible for the diagnosis, treatment and follow-up of skin cancer. Their role is essential to:
Treatment depends on the type of skin cancer and how far it has spread:
In the most serious or complex cases, treatment decisions are made by the Cutaneous Tumour Committee, which includes dermatologists, oncologists, pathologists, surgeons and other specialists.
If you are referred to the specialised skin cancer consultation, you should know that:
Once the diagnosis is confirmed, the most appropriate treatment will be explained and follow-up will be planned.
People who have received a solid organ transplant and take immunosuppressive medication have a much higher risk of developing skin cancer than the general population, and this risk increases with the years after the transplant. Although all skin tumours are more frequent in this group, squamous cell carcinoma is the most common type.
Early detection saves lives. Transplant patients should check their entire skin at least once every 3 months, in a well-lit room and with the help of a mirror or a family member.
You should examine:
Request an urgent appointment with a dermatologist if you notice:
Prevention is essential and within everyone’s reach:
Pneumonia is an infection of the lung tissue. It can be caused by many different microorganisms, although the most common causes are S. pneumoniae (pneumococcus) and Mycoplasma. Other microorganisms that can also cause pneumonia include Haemophilus, Klebsiella, Staphylococcus aureus, Legionella pneumophila, Chlamydia pneumoniae and some viruses.
Characterised by high fever, coughing, with or without sputum, and often chest pain, which may increase with respiratory movements. Sometimes, sputum has a brownish or rusty appearance, which points to pneumonia caused by pneumococcus.
The so-called atypical pneumonia, caused by Mycoplasma or Chlamydia among others, is often characterised by fever with very few respiratory symptoms.
Depending on the extent of pneumonia in the respiratory tract, different types are identified:
Pneumonia is a very common disease (350,000 cases/year in Spain) and is a significant cause of mortality in the general population. It can affect all age groups.
In previously healthy people it is a disease of mild or moderate severity. It can even be treated at home or in outpatient care, but in patients with previous pathology (immunocompromised, heart failure, previous respiratory failure), it is generally serious.
The appropriate use of antibiotics, together with occasional respiratory support measures (oxygen therapy or even intubation), contributes significantly to improving the chances of cure in the most severe cases.
It is performed based on the patient's clinical history (age, previous pathology, evolution time and type of symptoms), auscultation, chest radiography and blood and sputum cultures to identify the causative organism.
Antigens can also be detected in urine for pneumococcus and Legionella.
The treatment is antibiotic, based on a clinical estimate of the possibility of it being caused by one germ or another (in many cases treatment is started immediately without knowing the causal organism). Treatment is later maintained or changed according to the cultures and the patient's evolution.
The criterion for inpatient or outpatient treatment depends on the estimation of the risks that may occur (older age, previous pathology, impairment of respiratory function).
In a previously healthy patient, treatment may be in outpatient care.
Chest x-ray, blood and sputum or respiratory secretion cultures and determination of antigens in urine.
Infective endocarditis is the presence of a microbial infection on the endocardial surface (the inner surface of the heart). It is the most common cardiovascular infection and is highly significant due to its potential severity and the fact that it can present in different clinical forms.
Infective endocarditis primarily affects the heart valves, whether natural or artificial, although it can sometimes involve other structures of the heart. It is classified according to the duration of the infection (days, weeks, or months) and the type of causative microorganism (bacteria, yeast, or fungi).
The characteristic lesion of infective endocarditis is the endocardial vegetation. This consists of an abnormal aggregate of platelets, fibrin, bacteria, and inflammatory cells that adheres to the inner surface of the heart—typically a heart valve—and can detach, causing infectious emboli in distant organs such as the skin, nervous system, or extremities.
It is considered a serious disease. Although most cases are curable, it carries significant complications and mortality even with treatment. In many cases, achieving a definitive cure requires surgical intervention to remove affected tissue and replace the valve with an artificial one.
In the acute form, infective endocarditis may cause high fever, chills, prostration, and rapid deterioration of general condition over hours or days.
In subacute forms, with progression over weeks or months, the main symptoms are fatigue, loss of appetite, and mild fever. In these cases, characteristic skin lesions, such as nodules or spots, may also occur, although not always.
In patients with severe valve involvement, valvular dysfunction may develop, resulting in heart failure symptoms, such as significant shortness of breath and edema in the lower limbs.
Infective endocarditis has a global incidence of 2–3 cases per 100,000 people per year. In Catalonia, around 200 new cases are diagnosed annually. Its incidence increases significantly with age, reaching 15–30 cases per 100,000 people per year in individuals over 65—about 10 times higher than in younger populations.
The causative agents have changed over recent decades. Previously, streptococci, particularly viridans streptococci, were the most common. Currently, the most frequent pathogens are staphylococci, followed by streptococci and enterococci. However, any microorganism present in the blood can adhere to a heart valve, especially if it is previously damaged or artificial.
Diagnosis is primarily based on:
-blood cultures: to identify the causative microorganism and guide selection of the appropriate antibiotic therapy.
-echocardiography: to locate endocardial vegetations, assess valve function, and determine the need for surgery in certain patients.
In some cases, additional imaging (CT scans, nuclear medicine scans) is necessary to detect peripheral emboli, which are common at diagnosis or during treatment.
Treatment of infective endocarditis is antibiotic therapy, specifically targeted at the causative microorganism. Doses are high and prolonged, because vegetations are poorly vascularized and the antibiotic must penetrate by diffusion from circulating blood.
Patients who do not respond adequately to antibiotic therapy, or who develop significant valvular damage, may require valve replacement surgery.
Blood cultures and echocardiography, both at diagnosis and during follow-up, to monitor disease progression.
In individuals with known valvular abnormalities, antibiotic prophylaxis is recommended before dental procedures or gum surgery, following specialist guidance.
Preventive measures should also be taken during endoscopic procedures, especially upper gastrointestinal endoscopy (gastroscopy), according to the prescribed antibiotic regimen.
This prevention is crucial because the presence of bacteria in the bloodstream during such procedures significantly increases the risk of infective endocarditis.
Otitis is an inflammation of the ear that can affect either the external ear canal or the middle ear. It is common in children and is often linked to swimming or respiratory infections. Pain is the main symptom, and treatment depends on the type and cause.
There are two very different types of otitis, both of which children can suffer from: external otitis and middle ear infection.
External otitis affects the auditory canal and is above all related to exposure to swimming pool, bath and fresh water in general. It is most common in summer.
Middle ear infection is related to infections in the upper respiratory tracts, and can be self-limiting (it resolves itself in most cases) or purulent requiring antibiotic treatment It is most common in winter.
In both cases, diagnosis is clinical: medical history, assessing symptomatology and exploration using an otoscope.
Otoscope exam. Occasionally, if there is suppuration, cultivation of the pus.
Scleroderma is a rare autoimmune disease that causes excess collagen production and hardening of the skin. It can also affect organs such as the lungs, heart, kidneys, or digestive system. One of the most characteristic symptoms is Raynaud’s phenomenon, with color changes in the fingers triggered by cold. Treatment focuses on controlling symptoms and complications depending on the organs involved.
Raynaud syndrome: one of the most characteristic manifestations of the condition (97% of cases), it is the first clinical expression in most patients. It is caused by vasoconstriction of the capillaries. Patients report that with the cold their fingers change colour and turn pale (like wax) first, then turn blue after a while and finally turn reddish. The presence of Raynaud syndrome is not always an indication of scleroderma. In reality, only 5% of people with Raynaud syndrome later develop the condition. Almost half of sufferers may have digital ulcers, as an expression of a severe microcirculatory injury.
The most peculiar manifestation of the disease is the way it affects the skin. It is hard, tight and wrinkle-free (hard to pinch). The extent of the skin condition varies and is related to the prognosis. Two clinical forms are distinguished: limited (distal skin condition to elbows and knees) and diffuse (distal and proximal skin condition to elbows and knees, and torso). The face can be affected equally in both clinical forms. The limited subtype has a better prognosis than the diffuse one. Reduced aperture of the mouth (microstomy) may also be seen. In the skin there are hyperpigmented and coloured areas, telangiectasia (accumulation of small blood vessels) and sometimes subcutaneous calcium deposits can be felt (calcinosis).
Most patients experience joint and muscle pain, and in extreme cases contraction and retraction of the fingers are observed. When the digestive tract is affected, which often happens, the patient complains of a burning sensation and difficulty swallowing, as the oesophagus has lost its ability to move food towards the stomach. Pulmonary disease is the leading cause of death and may occur in the form of fibrosis or pulmonary hypertension; coughing, choking and heart failure are the main manifestations of lung involvement. When the heart is affected, heart rhythm disturbances and in some cases symptoms of angina pectoris are detected, due to the involvement of the small coronary vessels. In a small percentage (about 5%) scleroderma alters the kidney (scleroderma renal crisis) and manifests itself as malignant arterial hypertension and kidney failure.
It should be noted that not all patients with scleroderma present all the manifestations described above. It can also be concluded that there is great, almost individual, variability in the clinical expression of the disease.
Scleroderma is a rare disease with an incidence of 4-18.7/million/year and a prevalence of 31-286/million. It is more common in females, with a variable ratio, depending on the series, ranging from 3:1 to 14:1 (female/male). The age at which it presents is around 30-40 years.
When the above symptomatology is clear, the diagnosis does not offer too much room for doubt. Various complementary tests are helpful in confirming diagnosis and in assessing the degree of involvement of the various organs that may be affected.
“An incurable, but not untreatable condition”. There is currently no treatment for scleroderma that has satisfactory results, but this does not mean that it cannot be treated. Treatment is symptomatic, depending on the organ affected. For Raynaud syndrome: vasodilators, antiplatelets; gastro-oesophageal reflux: proton pump inhibitors; renal crisis: angiotensin converting enzyme inhibitors/dialysis; pulmonary fibrosis: immunosuppressants/lung transplant; pulmonary hypertension: vasodilators/lung transplant. In patients with the diffuse form and less than three years of evolution, immune modulators such as mycophenolate sodium (or mycophenolate mofetil) or methotrexate may be indicated as a basic treatment.
The most common tests to confirm and/or assess the degree of involvement of the various organs are: general analyses and immunological data (specific antinuclear antibodies); capillaroscopy, high-resolution computerised axial tomography scan of the chest, respiratory functional tests, oesophageal manometry and echocardiogram. In the follow-up for these patients, respiratory functional tests and an echocardiogram should be performed annually.
Chronic obstructive pulmonary disease or COPD is a respiratory disease that leads to obstruction of airways. The main symptoms are coughing, hawking and difficulty breathing, requiring particular effort. Although it can be due to other reasons, it is mainly caused by exposure to tobacco smoke. The main treatment is bronchodilators administered using an inhaler.
COPD is a respiratory disease that mainly appears in smokers or ex-smokers and causes the airway to become obstructed or blocked.
The main symptoms are coughing, hawking and difficulty breathing, requiring particular effort. Patients with COPD can also present with infection or worsening of symptoms, known as exacerbation.
The illness mainly affects smokers and ex-smokers. It is also associated with exposure to other sources of smoke, such as biomass smoke. In a small proportion of cases it may be due to genetic causes. The prevalence of COPD is up to 10% of the adult population aged over 40 in Spain.
Diagnosis of COPD is confirmed using a respiratory test: spirometry. This is a very simple test that can be conducted in a primary care centre (CAP). This test should be performed on all individuals over the age of 40 with a history of smoking who have respiratory symptoms such as breathlessness or coughing.
Typical treatment for COPD involves using bronchodilators administered via an inhaler. There are two different types of bronchodilator that may be administered together or separately, depending on each patient’s needs. The aim of this treatment is to reduce the sensation of breathlessness and the number of exacerbations and improve lung capacity. In some patients, administering corticosteroids via inhaler may also be necessary. The best treatment for COPD is stopping smoking.
As well as spirometry, other tests that may be required include chest x-ray, CAT scan, sputum culture or other more complete breathing tests. A blood test is normally performed to rule out genetic causes.
As tobacco is the main risk factor, the best prevention for COPD is not smoking. Exposure to environmental pollution and passive smoking should also be avoided.
Rare factor deficiencies are a group of inherited clotting disorders caused by a deficiency of one or more clotting factors. Clotting factors are involved in a series of reactions to prevent bleeding. Within this set of deficits, factors I, II, V, V + VIII, VII, X, XI or XIII are considered to be affected.
Although in general they do not usually produce spontaneous bleeding, surgery or invasive procedures require prior evaluation of the patient and consideration should be given to administering the appropriate treatment according to the type of procedure and the type of deficit.
It should be noted that most factors usually have a good correlation between factor levels and clinical signs, for example, in factor deficits FI, FII, combined deficit of FV and FVIII, deficit of FX and deficit of FXIII. In the case of VF and VII, however, the correlation is not so clear and with FXI there is usually no correlation between levels and clinical signs.
In general, there is usually bleeding after invasive procedures such as tooth extraction, caesarean section, surgery, epidural anaesthesia, etc. Patients may also present with mucosal bleeding, nosebleeds, heavy-flow menstrual periods, intestinal bleeding, etc.
As it is a genetic disorder, it can appear at all ages. Generally, with a factor level of >20%, haemostasis is ensured in order to conduct a normal daily life, although it is necessary to personalise treatment according to the deficit factor and the characteristics of each patient.
Diagnosis is made in the haemostasis laboratory:
Treatment will depend on the patient’s clinical signs and symptoms, the haemostatic levels required to perform surgery, etc. In mild cases, administration of antifibrinolytics may be sufficient, and in others administration of recombinant factor if available; otherwise plasma or APCC may be used.
The aforementioned laboratory tests.
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