Què has de tenir en compte per prevenir les infeccions de transmissió sexual?

La societat demana cada vegada més informació sobre les infeccions de transmissió sexual: l’única manera d’evitar-les és amb la prevenció, però també és important proporcionar informació sobre pràctiques de sexe segur.

Les infeccions de transmissió sexual figuren entre les cinc categories principals per les quals els adults cerquen atenció mèdica. Comprenen una sèrie de patologies, d’etiologia diversa, en les quals la transmissió sexual és rellevant des del punt de vista epidemiològic. Tot i això, de vegades pot haver-hi altres mecanismes de contagi, com ara la transmissió perinatal o parenteral.

Les intervencions d’assessorament i els enfocaments conductuals representen la prevenció primària contra les ITS, que inclouen:

• Assessorament sobre pràctiques sexuals més segures, reducció de riscos i promoció de l’ús del preservatiu
• Educació sexual integral, amb assessorament abans i després de les proves d’ITS
• Assessorament i educació sexual adaptats a les necessitats dels adolescents
• Intervencions dirigides a grups de poblacions clau, inclosos treballadors sexuals, homes que tenen sexe amb homes i consumidors de drogues injectables.

Així mateix, l’assessorament pot millorar la capacitat de les persones per reconèixer els símptomes de les ITS, amb la qual cosa augmentaran les probabilitats que aquests sol·licitin atenció i animin les seves parelles sexuals a fer-ho.

Malauradament, la manca de sensibilitat de la població i l’arrelat estigma generalitzat vers les ITS segueixen dificultant l’eficàcia de les intervencions sanitàries.

L’estudi dels contactes en les ITS és el procés pel qual les parelles sexuals d’un pacient diagnosticat amb una ITS són identificades i informades del risc de contraure aquesta infecció, i se’ls ofereix atenció i tractament per un professional sanitari. L’estudi de les parelles té beneficis clínics i de salut pública per tres raons:

• S’evita la reinfecció del pacient.
• Es diagnostica i es tracten persones infectades sense símptomes.
• Es trenca la cadena de transmissió de la infecció.

L’epidemiologia de les ITS està canviant en els últims anys i s’observa una nova emergència d’aquestes infeccions. Aquest fenomen va associat a les noves pautes de comportament: l’ús de noves tecnologies per a la cerca de parelles sexuals, l’alta mobilitat de la població, la relaxació en l’ús del preservatiu, etc.

El panorama anterior fa inqüestionable l’adopció de noves estratègies de control i prevenció, entre les quals hem d’incloure els estudis de contactes i tota la seva riquesa metodològica basada en l’evidència científica.

What do you need to bear in mind if you have complex glomerular disease or you are caring for someone who does?

On the one hand, the function of the kidneys is to eliminate impurities from the body through the urine, and regulate the amount of liquid and chemical elements that we need, such as sodium, potassium, phosphorus or calcium. 

On the other hand, the kidneys also help in regulating blood pressure by activating vitamin D, which is required to maintain healthy bones, and producing erythropoietin, which is required to produce red blood cells in the bone marrow.

When the kidneys do not work properly, the impurities we generate and the water that the kidneys cannot eliminate accumulates in the blood and the tissues, and this causes major disruptions to the patient’s general health, fluid retention and hypertension. They are also unable to properly get rid of some medications we take, which can accumulated in the body, increasing the risk of side effects. 

As the kidneys are unable to help make vitamin D, or to retain phosphorous,  the bones are weakened. The kidneys are also unable to produce erythropoietin and therefore anaemia appears.

The main types of renal replacement therapy are:

• Haemodialysis
• Peritoneal dialysis
• Kidney transplant

Where patients will not benefit from renal replacement therapy,  conservative treatment will be carried out, aimed at controlling the different disorders and symptoms that appear during evolution of the illness.

The majority of cases of glomerulonephritis cannot be prevented, although a healthy lifestyle is advised, as promoted by the Spanish National Health System:

• Keep glycaemia levels (blood sugar) and blood pressure within normal range.
• Avoid toxic habits
• Do moderate physical exercise
• Avoid obesity

In addition, the application of dietary and pharmacological measures can help prevent or decrease the progression of the illness:

Dietary measures that should be taken

Maintain a balanced diet and limit:

• Salt. As substitutes, the following items can be used to eliminate or reduce consumption:
  • Use vegetables as seasoning: celery, garlic, leek, onion, tomato, carrot.
  • Add aromatic herbs and spices: if the herb is dry, it is better to add it towards the end of cooking, as this will make the most of its flavour.
  • Flavour oil.

• Potassium. Part of the potassium in food can be removed by:
  • Water: once peeled and cut, soak foods. The longer foods are soaked for and the smaller the pieces, the more potassium will be lost. They can also be washed several times, changing water.
  • Boiling: boiling foods removes potassium, as it stays in the water. You should therefore avoid consuming cooking water. It is better to change water after 10-15 minutes of boiling foods, adding clean boiling water.
  • Frozen foods: frozen vegetables and legumes have less potassium than fresh ones, although they retain many of their other properties.
  • Preserved food: when food is preserved in liquid, the potassium remains in the liquid and the food contains less. This liquid should be poured away.

• Proteins. Although proteins are required for repairing and creating cells and tissues, as well as for the proper functioning of the immune system:
  • Dried fruits and nuts are not recommended as they have a high potassium content.

• Fluids. Fluid intake should be adjusted to each particular case:
  • Reducing the sensation of thirst.
  • Drinking only when thirsty and drinking small amounts.
  • Not getting into the habit of drinking.
  • Taking medication with the liquids in meals and using the smallest amount possible.
  • Using citrus slices to stimulate salivation and moisten the mouth.
  • Adding a few drops of vinegar to water.
  • Chewing sugar free gum.
  • Adding a few drops of lemon juice to ice cubes before putting them in the freezer.
  • Freezing fruit pieces.
  • Reducing the intake of drinks such as coke, orange juice, etc., and replacing them with ice tea and homemade lemonade.
  • Avoiding alcohol.

Pharmacological measures that should be taken

• Patients many need to take the same medications as patients undergoing dialysis. Some drugs may include:
  • Hypotensors: drugs to reduce blood pressure (angiotension converting enzyme [ACE] inhibitors or angiotension receptor blockers [ACB]).
  • Corticosteroids: better known as steroids, these are anti-inflammatory medications.
  • Immunosuppressants: drugs that inhibit the immune system.

• Medication that helps patients to alleviate the symptoms,  such as itching, pain, etc., may also be taken.

• Other measures may also be adopted, such as:
  • Avoid consuming nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Avoid contact with organic solvents and polluting substances, such as mercury.

Other related health information

• Looking after the peritoneal dialysis (PD) incision and catheter.
• Looking after a tunnelled central venous catheter (CVC)
• Looking after an arteriovenous fistula (AVF)
• Training and health education for patients and carers in PD treatment.
• Recommendations on discharge for patients with nephritic syndrome
• Advice for patients undergoing immunosuppressive therapy 

What do you need to bear in mind if you have resistant osteoarticular infections?

When the patient is discharged, nursing staff will give them all the support and information they need to be able to look after the wound themselves. Most patients will be fitted with an external fixator that needs daily care, so healthcare staff will emphasise the importance of hygiene in the affected area, which should be cleaned daily and the correct dressing applied.

If patients are not independent and do not have a relative or carer to look after them, the local health authority will be contacted (through the PREALT discharge preparation unit), so that they may be provided with nursing care. If patients are being treated with intravenous medication, the Hospital at Home Unit will be contacted to follow up and provide the relevant treatment.

It is also necessary to explain the importance of taking the medication prescribed. On being discharged, most patients will receive long-term oral antibiotics (prescribed by the Infectious Diseases Unit) and they are reminded of the importance of maintaining a fixed schedule and not forgetting to take their medication.

They are also reminded of the need to maintain healthy habits, such as:

• Being well hydrated
• Eating properly (protein-based diet)
• Stopping toxic habits (should they have any), such as alcohol and tobacco

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 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.

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.

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 (normal general tests)

Clinical, analytical and screen for early detection.

Treatment (general)

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.

Other related health information

Health education for paediatric patients with hip dysplasia.

What do you need to bear in mind if you look after a child with primary immunodeficiency?

Primary immunodeficiencies are a group of genetic disorders in which the immune system functions improperly. There are more than 300 different types of primary immunodeficiency illnesses (PI), from fairly minor illnesses to other more serious ones that may prove fatal if not treated properly.

Regardless of the age at which the illness begins, it should be considered a chronic process for life. The initial symptoms resemble common illnesses (sinus infection, ear infection, fever, etc.) and this can lead to a delay in their diagnosis.

The following warning signs may cause suspicion of an immune deficiency:

1. More than two serious sinus infections in the space of a year.
2. More than two x-ray confirmed cases of pneumonia in the space of a year.
3. Serious skin infections and/or recurrent deep abscesses.
4. Stunted or delayed weight and height gain despite feeding correctly.
5. Two or more serious infections.
6. More than eight serious ear infections in the space of a year.
7. Fungal infections in the mouth after the first year of life.
8. Complications after being vaccinated and/or infections from microorganisms that normally do not cause illness.
9. Infections that do not get any better with normal treatment and require intravenous antibiotics to eradicate them.
10. Family history of illnesses in which the immune system functions improperly.

These infants are more susceptible to recurring, lingering, serious and unusual infections. At the same time, they are more likely to suffer from autoimmune diseases, allergies and abnormal tissue growth.

For this reason the necessary precautions must be taken to prevent infections. The strictness with which these measures must be applied will depend on the seriousness of picture presented and will have to be agreed with medical personnel:

• Correct hand hygiene is required, especially before eating, after going to the toilet or taking part in outdoor activities.
• Toys and personal belongings should be cleaned often.
• Avoid contact with people with infectious symptoms (fever, cough, sneezing, etc.).
• Use disposable tissues.
• Avoid crowds.
• Avoid smoking areas.
• Take precautions with pets and other animals.
• Take precautions during exposure to sunlight.
• You must ensure correct hygiene of foods to avoid poisoning.
• Avoid raw or under-cooked food.
• Avoid drinking water from an unknown source or that has been kept in the same container for a long time.
• The administration of live attenuated vaccines (rotavirus, oral polio, MMR, chicken pox, etc.) should be avoided, always following your paediatrician's advice.
• Family members should keep up to date with vaccinations.
• Follow your paediatrician’s treatment plan correctly.

The treatment chosen is up to your paediatrician and will depend on the type of PI and other factors. Most infants will, however, need the following treatment:

• Treatment with intravenous or subcutaneous gamma globulin.
• Prophylaxis with antibiotics, antivirals or antifungal medicines.
• Early and aggressive treatment of infections.

There are currently excellent collaboration channels between the biggest PI organisations, which provide optimum connections between medical staff and scientists (ESID - European Society for Immunodeficiencies), nursing staff (INGID - International Nursing Group for Immunodeficiencies) and patients (IPOPI - International Patient Organisation for Primary Immunodeficiencies).

In Catalonia, the Associació Catalana de Dèficits Immunitaris Primaris (ACADIP - Catalan Association for Primary Immunodeficiencies) aims to support patients and their families, and to campaign for the scientific community to increase research into new PI treatments. You can find further information on the association’s website: www.acadip.org.

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.
• Doingsport 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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