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.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Tuberculosis is an infection caused by the bacterium Mycobacterium tuberculosis, mainly affecting the lungs and transmitted through the air. Common symptoms include cough, fever, night sweats, and weight loss. Diagnosis uses clinical, imaging, and microbiological tests. Treatment is long (at least six months) with a drug combination and is curable if properly followed.
Infectious disease caused by the microorganism Mycobacterium tuberculosis, which mainly affects the respiratory system and requires prolonged and uninterrupted treatment to cure. If treatment is interrupted, it can become resistant to drugs, which makes it harder to cure.
The reservoir of Mycobacterium tuberculosis is humans and it is usually an airborne disease. Transmission is caused by living in close proximity to someone with pulmonary tuberculosis. It is important to be aware that we are talking about a disease that can be treated, cured and eradicated, which means that it could disappear from the human population.
At the moment, however, it is the primary cause of death from infectious disease on the planet. Factors such as resistance to first-line drugs or coinfection make it difficult to treat the disease and increase its mortality rate.
The symptoms of tuberculosis depend on the organ that is infected. In the case of pulmonary tuberculosis, the most common symptoms are chesty cough, fever, weight loss and sweating at night. A diagnosis of tuberculosis should be considered when these symptoms last for more than 3-4 weeks.
It can affect anyone who has been in contact with infected patients.
Tuberculosis is diagnosed according to the patient’s symptomatology, the findings of a physical examination and the results of complementary testing. Microbiological tests constitute an essential pillar for diagnosis. Some tests include micobacteria cultures, microscopic techniques and evidence of molecular biology.
Patients have a confirmed diagnosis when the microbiological tests are positive. If they are not positive, they are said to have a probable diagnosis.
Conducted by means of several drugs to avoid resistance. The length of treatment is prolonged (minimum six months) because many drugs acts on the dividing bacteria and this microorganism is slow growing. Where possible, all tablets are administered in one single sitting per day to make following the treatment plan easier.
Chest x-rays, general tests, cultures of biological samples.
There are no specific prevention measures to avoid infection.
Hyperthyroidism is a condition caused by an excess of thyroid hormones, which accelerate metabolism and affect body temperature and heart rate. It can occur at any age, but is more common in women. Diagnosis is made through hormone blood tests, and treatment includes medication, radioactive iodine, or other measures to control the effects of hormone excess.
The thyroid gland, which is located in the anterior part of the neck and is shaped like a butterfly, produces thyroid hormones, which regulate the metabolism of the entire human body. They therefore influence, for example, our temperature and heart rate. The main causes of hyperthyroidism are: Graves’ disease (when an antibody against the body’s own thyroids is produced), a toxic multinodular goiter (makes too much thyroid hormone), and thyroiditis (inflammation of the thyroid of unknown origin).
The most common symptoms are altered heart rate, feverish temperature, nervousness and sweating, dry skin and unexplained weight loss.
It can affect people of all ages, but particularly women from adolescence to menopause.
Hyperthyroidism is detected by finding thyroid hormones in the blood, as well as the pituitary hormones tasked with regulation of thyroid hormones.
Treatment is aimed at reducing the action of excess thyroid hormones. Drugs are used that antagonise the hormones, usually orally. Drugs are also prescribed to slow heart rate. In some cases, radioactive iodine is administered to partially deactivate the hormone-producing thyroid cells in a controlled manner.
The most common test is a blood test. Other additional tests include thyroid scintigraphy and thyroid ultrasound.
In order for the thyroid gland to function normally, moderate consumption of iodised salt is recommended, as iodine is an essential component of thyroid hormones.
Acute leukemia is a blood cancer characterized by the rapid proliferation of immature cells in the bone marrow, preventing the normal production of blood cells. It is a serious disease that requires urgent treatment with chemotherapy and often stem cell transplantation.
Acute leukaemia involves abnormal cell growth in the haematopoietic system characterised by significant proliferation and accumulation of immature cells, firstly in the bone marrow and subsequently in the blood, with a great degree of clinical and biological heterogeneity.
Acute leukaemias are clonal proliferations (tumour cells that originate from a single initial cell and accumulate various genetic mutations that result in development of the disease) of altered blood stem cells. In normal circumstances, multipotent stem cells give rise to haematopoietic cells, which give rise to blood cells via a process of cell proliferation and differentiation mediated by the cell’s own mechanisms and by the surrounding tissues. Under normal conditions, blood cells migrate to the blood and tissues and are indispensable for the body to function correctly.
In acute leukaemias, the accumulation of different genetic and molecular alterations gives rise to the progressive accumulation of these cells, which substitute normal blood cells in a process known as "hiatus leukemicus", whereby progenitor cells (blasts) do not mature and accumulate in the bone marrow and peripheral blood. The symptomatology may be very mild and non-specific initially, resulting mainly from the lack of blood cells and sometimes from tissue infiltration. These are very serious diseases that require chemotherapy treatment to control them and often a transplant of bone marrow progenitor cells.
In many cases there are at first no major symptoms. Any symptoms there are mainly derive from the lack of blood cells and include tiredness, bleeding, infections and on rare occasions lack of appetite, bone pain, breathing difficulty or neurological symptoms. A physical examination may reveal palpitations, bruises, bleeding from mucus membranes, fever, infiltration of gums or other organs (skin, spleen, liver, etc.).
The average age for acute leukaemia is generally 67 years, but it can affect people of any age. Acute leukaemia is the most common cause of abnormal cell growth in children, with lymphoid leukaemia being the most common. Myeloid leukaemia is more common in the adult population.
A suspected diagnosis is reached in a number of ways, including clinical history, physical examination and a blood test. The diagnosis is confirmed using bone marrow aspiration in which we study neoplastic cells (blasts) under a microscope, as well as conducting multiparametric flow cytometry, cytogenetic analysis and molecular biology tests.
Based on chemotherapy. New drugs are currently being developed, such as immunotherapy or treatment against specific biological alterations (personalised treatment). If not contraindicated, a transplant of haematopoietic progenitor cells may be required once the response has been reached. Therapeutic strategies are adapted on the one hand to the patient’s situation (age, concomitant diseases, etc.) and on the other hand to the biological characteristics of the disease.
Full blood test and bone marrow aspiration.
Unfortunately, there is no way of preventing acute leukaemia from developing. The mechanisms that lead to a person developing this disease are not exactly known. We do know some factors that may be related, such as chemotherapy or radiotherapy in the past or exposure to certain toxins. A predisposition in some congenital diseases has also been observed, as well as cases where there is a family history of the disease.
The most common form is chronic myeloid leukaemia and this sheet refers exclusively to this form of leukaemia. It is a form of abnormal cell growth (neoplasia) that originates in immature multipotent blood cells (stem cells) and gives rise to red blood cells, platelets and white blood cells.
It is characterised by cellular proliferation of white blood cells with cytogenetic alteration that consists of the appearance of an abnormal chromosome known as the Philadelphia chromosome. The Philadelphia chromosome is also seen in other processes, such as acute lymphoblastic leukaemia, and diagnostic differentiation is required to distinguish which process is occurring. Chronic myeloid leukaemia may also involve red blood cell and platelet disorders, and is characterised by its chronicity. This disease serves to illustrate the revolution that has taken place in the last few years with targeted therapies in abnormal blood cell growth.
These are not very specific: Usually marked by tiredness, anaemia, loss of appetite.
This disease has a low incidence (1-1.5/100,000 pop./yr) and low mortality (more than 90% survival in the last 5 years). It mostly affects middle-aged people (40-50 years), although it can occur at any age.
A physical examination often reveals spleen growth. Blood tests show a very significant increase in white blood cells and bone marrow aspiration should be conducted to confirm. Genetic and molecular biology tests are also conducted.
The treatment most used is tyrosine-kinase inhibitors. It is an oral, chronic and relatively well tolerated treatment, including Imatinib: it is the first drug that was described, and the most commonly used. Side effects include submalar skin pigmentation (aesthetic problems), nausea and vomiting, which are often mild.
As there is some resistance to this drug, new drugs need to be developed to stop the other proliferation pathways of the affected cells.
Physical examination, blood test, bone marrow aspiration.
Hiatal hernia occurs when the upper part of the stomach moves into the chest through the diaphragm, allowing stomach acid to irritate the esophagus. It can cause heartburn, abdominal discomfort, difficulty swallowing, or dry cough. Diagnosis is made via imaging and endoscopy, and treatment can be medical or surgical depending on severity.
A hiatal hernia is when the upper part of the stomach moves from the abdomen to the thorax above the diaphragm muscle.
This means that the acidic content of the stomach can easily go up into the oesophagus, leading to a chemical irritation known as oesophagitis.
This condition affects approximately 20% of the population, although knowing exactly how many people suffer from it is difficult because some of them do not present any symptoms at all. Those that experience symptoms usually suffer from acidity, abdominal discomfort, difficulty swallowing, bad breath or a dry cough.
We do not really know why hiatal hernias occur.
The diaphragm is the muscle that separates the thorax from the abdomen. The diaphragm's hiatus is one of the anatomic structures that help to keep the oesophagus (intrathoracic) and the stomach (intraabdominal) in position. If the stomach is displaced towards the thorax, its gastric content, which is very acidic, can easily go back up the oesophagus. The existence of a hiatal hernia is one of the causes of acid reflux, but not the only cause.
When suffering from a hiatal hernia, a patient may have acid reflux, with the consequence being a chemical irritation from the stomach acid on the lining of the oesophagus. This leads to a form of inflammation, known as oesophagitis, which is very painful.
Such pain is located close to the heart, which is why it needs to be distinguished from the pain caused by angina or pericarditis.
There may also be no symptoms of a hiatal hernia.
Hiatal hernias are very common and can affect 20% of the population at some point in their lives. It can also be an incidental x-ray finding in >40% of the asymptomatic population. Incidence increases with age and is most common in the over-50s.
Diagnosis of a hiatal hernia is based on demonstrating the abnormal position of the stomach and almost always the presence of acid reflux.
Oesophagogram:
The oesophagus and the stomach can be X-rayed, as can the swallowing process and reflux. A substance must be taken that shows up as opaque on X-ray images in order to be able to see the aforementioned structures.
Digestive endoscopy:
A flexible tube is inserted into the mouth, containing a camera for imaging the oesophagus and the stomach. This enables the position of the oesophagus and the stomach to be observed and the degree of inflammation detected.
Oesophageal manometry:
During this test, a probe is inserted through the nose that allows pressure changes in the oesophagus to be observed during swallowing and detects abnormalities in the way it is functioning.
24-hour pH (acid) monitoring
Acid monitoring with a probe that is inserted through the nose and assesses the amount of acid reflux from the stomach to the oesophagus over a 24-hour period.
Hiatal hernias are treated if there is severe acid reflux or excessive compression (strangulation) in the part of the stomach that is displaced.
Medical treatment of the hiatal hernia is done using hygienic-dietetic measures, such as lifting the head of the bed, not eating copious amounts of food, light dinners and medications that counteract or decrease stomach acidity.
If the patient does not respond to medical treatment, surgical correction of the hiatal hernia can be performed to reposition the stomach intraabdominally.
Surgery can be performed by laparoscopy.
Pericarditis is an inflammation of the pericardium, the membrane covering the heart. Pericardial inflammation can come about for lots of different reasons: infection (viral, bacterial, fungal or parasite) or due to multiple non-infectious causes.
The pericardium facilitates contraction of the heart, and can contain a small amount of fluid under normal conditions. When it becomes inflamed, it can cause friction during contractions of the heart, or accumulate fluid, since the pericardium is a double membrane that can be filled with fluid in cases of inflammation.
The contractility and function of the heart are generally not compromised by the effect of pericarditis. Aside from infectious causes, pericarditis may be a secondary manifestation of myocardial infarction, kidney failure, a tumour or hypothyroidism. Autoimmune diseases such as lupus or scleroderma can also cause pericarditis.
The main symptom is chest pain, which should be differentiated from angina or the pain caused by a hiatal hernia.
It affects all age groups, and in younger patients (under 40 years old) it is usually caused by a virus.
It can be done by auscultation (a friction noise can be heard when the heart contracts), by electrocardiogram (specific alterations) or echocardiogram
It depends on the cause, since it is the cause that needs to be treated. In the case of viral pericarditis, the treatment is usually anti-inflammatory, usually with a very good outcome.
Heart auscultation, electrocardiogram, echocardiogram.
There is no specific prevention because pericarditis is a secondary manifestation of an uncontrollable infection or another illness.
Angina pectoris is characterised by strong, oppressive pain in the chest that spreads to the neck and left arm. It is a sign of lack of oxygen in the heart. It is normally caused by a condition in the coronary arteries, which are the arteries responsible for carrying oxygen to the heart tissue.
Intense pain that appears quickly and intensifies over the course of a few minutes in the chest. It is accompanied by sweating, nausea, vomiting and can spread across the whole chest, the left arm, the neck, and the bottom part of the face.
Angina should be differentiated from the pain that can be caused by pericarditis (inflammation of the membrane surrounding the heart), from hiatal hernia (stomach hernia) and from musculoskeletal pain. It can also be confused with indigestion.
It can affect any age group in adulthood. It is very rare in children. There is a correlation with age (the risk increases as age increases), and there is a slight predominance in males.
Based on clinical observation, electrocardiogram and on determining different blood parameters that show changes in the heart muscle. Diagnosis can be made during an episode of pain, or through a stress test to highlight it, under strict medical control.
The definitive diagnostic test is cardiac catheterisation, which shows blocked areas and often allows the blockage to be cleared with the same catheter.
Electrocardiogram, echocardiogram, nuclear magnetic resonance of the heart, and also cardiac catheterisation which has a diagnostic and therapeutic aim as it can improve blockages in the coronary arteries.
Treatment is aimed at reducing the risk factors, especially tobacco, and improving blood flow in the heart, with the use of various vasodilators.
Health education is essential for those suffering from angina, in order to avoid triggers (quick and intense exercise without warming up) and risk factors (tobacco and alteration of fat content in the blood).
There are numerous coronary vasodilators and various pharmacological families. One thing they all have in common is that they improve coronary blood flow. Controlling arterial hypertension is essential to reduce cardiac effort and overloading of the surrounding vessels.
Cardiac catheterisation consists of inserting a catheter via the arm or leg that reaches the heart and uses contrast to detect coronary obstruction. It thus allows the blockage to be cleared using a dilator or by inserting a stent (an artificial object that allows the flow of blood along the coronary artery to remain open).
Cardiac surgery allows coronary reconstruction with the heart in hand, using artificial arteries or the patient's own vein, which can be taken out of other parts of the body, such as the legs. The advantage is that the reconstruction is better and the disadvantage is that it entails open surgery with the use of extracorporeal circulation.
Tobacco is a big risk factor for developing angina. It should be completed avoided. Controlling fats in the blood and moderate, constant physical exercise are very important.
It is also important to have a healthy diet and regular light or moderate exercise continued over time.
Another important aspect for those who suffer from angina is information relating to how to lead a normal life, over many years, with close monitoring of medication and the relevant tests. Many people have a long life with very few issues after having had angina, as long as the condition is closely controlled.
Cardiology, Cardiac surgery, Haemodynamics and cardiac catheterisation, Intensive care.
Delirium is an acute disorder of attention and cognition, particularly common in hospitalized older adults, but it can occur in severely ill patients of any age. Early recognition and intervention help reduce complications and support recovery.
Delirium is an acute attention and cognitive disorder that frequently appears in elderly hospitalised patients, although it can affect anyone with a severe illness, including children.
Presentation of this mental state alteration is both acute (its onset can be quite precisely recognised) and fluctuating (there are moments in the day when the person has more manifestations). However, with appropriate interventions, it can be fully or partially reversible and even prevented.
Delirium usually involves multiple factors, but the main causes that can trigger it during hospitalisation are:
They may present with one or several of the following symptoms:
Inform the healthcare staff if you detect any of these manifestations in the person you are accompanying. In addition, bear in mind that the episode of delirium may last from hours to days in most cases, but it can also last for weeks or months.
In 40% of cases, delirium can be prevented if you follow these recommendations:
As well as implementing non-pharmaceutical measures, the medical team and nurses will analyse the possible causes of the delirium and adopt the most appropriate measures for each patient, such as diagnosing and treating infections, controlling pain, correcting dehydration, and reviewing treatment and catheter use, among other measures.
On some occasions, it will be necessary to administer medication to help control the delirium, calm the person and make them more collaborative to remove the risk of accidents and injury.
People who suffer episodes of delirium during their hospitalisation may suffer falls, bronchospasms and loss of autonomy in activities for daily living, possibly requiring more help than before hospitalisation; they may even need to stay in hospital or another centre for longer to recover their lifestyle.
In some cases, patients with delirium require subsequent follow-up due to the risk of developing cognitive impairment.
Collaboration with the family is essential, as they know the patient best and can best help to prevent some of the associated complications.
Whenever possible, it is important for the person to be accompanied by a family member or close friend, especially in their first 48 hours of admission. This will calm and reassure them.
If the companion has to go and leave the person alone, the nurses should be informed so they can supervise the necessary care.
You can follow the prevention recommendations and also bear in mind the following:
Myalgic encephalomyelitis or chronic fatigue syndrome is a chronic, complex and multisystemic disease that can significantly affect functional capacity and daily life. It is characterised by debilitating fatigue that does not improve significantly with rest, post-exertional malaise, sleep disturbances and cognitive difficulties.
The cause of chronic fatigue syndrome is not yet fully understood, and its pathophysiology remains the subject of ongoing research. Possible mechanisms and predisposing factors are being investigated, including neurological, metabolic and immune system abnormalities, as well as a possible genetic contribution. Available genetic studies have produced preliminary findings and do not yet allow a definitive genetic basis for the condition to be established. Infections have also been linked to the onset of some cases, although the mechanisms involved are not yet fully understood.
Clinical assessment should take into account the full range of symptoms and how they develop over time, including post-exertional malaise, sleep disturbances, cognitive difficulties, pain and possible autonomic and immune system manifestations. Management aims to provide individualised care, control symptoms and improve quality of life, taking into account each person's needs and abilities.
Chronic fatigue syndrome is characterised by a range of symptoms that can vary in intensity and frequency between affected individuals and over time. The main symptoms include debilitating fatigue that does not improve substantially with rest and significantly reduces the ability to carry out everyday activities, post-exertional malaise, unrefreshing sleep and cognitive difficulties.
Post-exertional malaise is the worsening of symptoms following physical, cognitive, emotional or social activities that were previously better tolerated. This worsening may be disproportionate to the activity undertaken, may be delayed (occurring hours or even days afterwards) and may last for days or longer.
Other symptoms may include:
The condition can affect people of any age, including children, adolescents and adults. In adults, it is diagnosed more frequently in women than in men, although it can affect people of any sex.
The prevalence of the condition varies depending on the diagnostic criteria used and the methodology of epidemiological studies. It is also thought to be significantly underdiagnosed, meaning that prevalence estimates may not reflect the actual number of people affected. When interpreting these figures, it is important to take into account the population studied and the criteria used in each study.
Diagnosis is clinical and is based on an assessment of the symptoms, how they develop over time and their impact on functional capacity. There is currently no laboratory or imaging test that can, on its own, confirm the condition.
Further investigations are selected on an individual basis according to each person's clinical presentation. Their purpose is to support the diagnostic assessment, investigate other conditions that may explain the symptoms and identify any coexisting conditions.
Myalgic encephalomyelitis should be suspected in people who experience debilitating fatigue that does not improve substantially with rest, a significant reduction in their ability to carry out everyday activities, post-exertional malaise, unrefreshing sleep or other sleep disturbances, and cognitive difficulties. The diagnosis can be confirmed when symptoms have persisted for three months, established diagnostic criteria are met and no other clinical explanation for the symptoms is identified.
The assessment should include a detailed medical history, a physical examination and an assessment of mental state when clinically indicated. It is important to establish when the symptoms began and how they have developed, their impact on everyday life, whether post-exertional malaise is present and whether there are other associated symptoms, as well as to identify any possible coexisting conditions.
Treatment
There is currently no curative treatment for this condition. Management should be individualised and, where possible, interdisciplinary. It should focus on controlling the main symptoms, preventing them from worsening and improving quality of life, taking into account the severity of the condition and each person's needs.
The main care measures include:
Clinical follow-up should be adapted to the severity and progression of the condition, with decisions made jointly by the person and their healthcare professionals.
Graded exercise therapy based on fixed, predetermined increases in physical activity is not recommended.
Prevention
No effective measures have currently been shown to prevent the onset of the condition. However, it is important to recognise its symptoms, ensure appropriate clinical assessment and establish an early diagnosis. Once the condition has been diagnosed, individualised follow-up and adapting activities to each person's capacity may help manage symptoms and reduce the risk of post-exertional malaise.
General recommendations
Follow-up should be adapted to the severity and progression of the condition. Decisions about care and treatment should be made jointly by the person and their healthcare professionals, taking into account their needs, preferences and priorities.
Kidney diseases affect the ability of the kidneys to filter blood, regulate minerals and blood pressure, and produce red blood cells. Early detection, medical monitoring, and appropriate treatments can slow progression and prevent serious complications.
Kidney disease encompasses a wide range of conditions that compromise the normal functioning of the kidneys. Their main purpose is to purify the blood of different composites, regulate their composition of mineral salts and acidity and contribute to the normal formation and maintenance of bones. They also support the creation of red blood cells and regulate arterial pressure.
Is measured by the stage of renal insufficiency, which increases from 1 to 5; the most advanced stage at which the kidneys have ceased to function. During stages 1 to 4 there are different medical treatments that can slow or compensate for renal insufficiency. At stage 5, patients have to undertake extrarenal purification techniques such as haemodialysis or peritoneal dialysis. In this case, the possibility of a kidney transplant will always be considered, which would allow a normal life free from dialysis but would require taking immunosuppressant medication to prevent rejection of the transplanted organ.
The treatment of kidney failure has four fundamental pillars: controlling high blood pressure when present, managing elevated urea levels, addressing mineral salt imbalances (sodium, potassium, calcium, phosphorus, magnesium), and controlling acidosis and anemia.
Renal insufficiency is usually detected with a simple blood test. Symptoms tend to be tiredness and generally feeling unwell caused by a build-up of urea, anaemia or both factors together. The patient may also have a headache if their arterial pressure is high.
All age groups. In childhood, there is often a genetic cause. In adults, it may be due to other illness such as diabetes, immune diseases or infectious diseases. It may also manifest due to the late appearance of genetic diseases in adults.
Renal insufficiency is diagnosed with a simple blood test. Establishing the cause of the renal insufficiency is more complicated. Often, a kidney biopsy and genetic testing will be needed.
Typical tests include blood tests, ultrasound, nuclear magnetic resonance imaging, kidney biopsy and genetic testing.
Initial treatment consists of substituting or compensating for the aforementioned alterations. During later stages, haemodialysis or peritoneal dialysis may be used, and in the case of terminal renal insufficiency, a kidney transplant may be carried out; from a deceased or a living donor.
Drinking a reasonable amount of water a day contributes to good kidney function.
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