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.

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 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.

Symptoms

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.

Prevention

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.

Treatment

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.

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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The lack of effective removal of mucus initiates and exacerbates the lung disease cystic fibrosis and gives rise to the inability to prevent and eradicate the bacterial infection effectively.

In cystic fibrosis, inhalation therapy improves:

• The properties and mobility of the mucus
• The hydration of the airway surface
• Mucociliary clearance and pulmonary function

Aerosol therapy

Aerosol therapy is a treatment method based on administering substances in aerosol form by inhalation. An aerosol is a stable suspension of solid or liquid particles in the air, like oxygen.

The main advantage of aerosol therapy is that the aerosol is deposited directly on the respiratory tract, which allows greater concentrations of the substance converted into aerosol form to reach the bronchi and lungs, and with fewer side effects than if the blood stream is used.

Types of nebuliser therapy most used in cystic fibrosis

A nebuliser is a device used to administer drug solutions or suspensions, in liquid form, via inhalation through a mask or a pipette (depending on the patient’s personal preferences and the indications of medical personnel).

Nebulisers may be classified according to the type of compressor that they use to generate the particles to be inhaled. Models that are easy to assemble and disassemble for patients are preferable.

There are currently three types of nebuliser:

• Pneumatic or jet nebulisers are the ones that are most used in clinical practice and come in different sizes. The nebuliser generally functions using compressed air or oxygen that enters through a small hole. The increased speed of the air causes a fall in pressure, which sucks the liquid to be nebulised through a feeding tube towards the outlet at great speed and in small drops.
• Ultrasonic nebulisers. Their function is based on applying a high frequency electric current to a quartz glass, which gives rise to a vibration that is transmitted to a liquid medium, which then transmits it to the substance to be nebulised and thus is able to produce steam or mist. Once the aerosol has been produced, it is pushed by a flow of air towards the patient.
• Mesh nebulisers. In these devices, the aerosol is created by passing the liquid through a mesh.

Using nebulisers

Nebulisers comprise a nebulisation chamber, where the liquid to be nebulised is introduced, and the aerosol created, and an energy source to allow the nebuliser to function.

• One of the risks associated with using nebulisers is pulmonary infection, so the reservoir needs to be cleaned properly each time it is used.
• Once nebulisation is complete, all the pieces need to be disassembled in order to clean them with hot water and soap. They must then be cleared, dried completely by air and stored in a dry place.
• It is recommended that the first dose of a new drug is administered at the hospital to check that it has no adverse effects.
• Nebuliser therapy is given to patients and caregivers, and they are educated in handling, use, cleaning and maintenance of different devices, as well as in how to prepare the medication, focusing on and emphasising correctly following the treatment plan.

Steps to follow to administer nebulised medication

• Wash your hands
• Prepare and administer the medication correctly and safely: dose, drug, day, expiry date.
• Prepare and check the nebuliser.
• Fast-acting bronchodilator (salbutamol inhaler with spacer chamber). Bronchospasm should be avoided.
• Wait 15 minutes and then inhale the prescribed medication.
• Once the therapy is finished, good hygiene should be followed and the mouth rinsed to avoid infections and bad breath.

What do you need to bear in mind if you look after a child with pulmonary hypertension?

It is important to take into account the following:

• Being familiar with the symptoms
• Having a balanced diet
• Adapting to physical activity
• Preventing infections

Pulmonary hypertension requires highly specialised treatment, therefore, each case needs to be treated in reference units with a multidisciplinary team.

Nursing staff equip the child’s main carers and, depending on their age, the child, with the knowledge, skills and aptitudes they need to manage and treat the condition at home.

Possible signs and symptoms

Although the main symptom is difficulty breathing, initially following exercise and later when resting, the symptoms in paediatrics are non-specific and depend on the age of the child and the evolution of the illness:

• Breastfeeding babies: they may show signs of tiredness when feeding, frequent vomiting, irritability, slow growth and weight gain, quicker breathing and heart beating faster than normal; chest pain may manifest in crying fits and bluish discolouration of skin, mucous membranes and fingers (cyanosis).
• Pre-school children: the most common symptoms are fatigue with ease and lack of breath during physical effort; the skin and lips may have bluish discolouration,
• In children older than ten years and advanced cases: swelling may appear on the ankles and legs, the liver is enlarged and swelling of the finger and toe tips (acropachy).

To improve the signs and symptoms, we recommend

• Having a balanced diet
  • Both being overweight and being under-nourished can affect the control of this illness, limit daily activities and increase breathing and heart complications and infections.
  • Diet should be varied, low in salt and saturated fats and high in fibre, prevent constipation to avoid over exertion.
• Adapting to physical activity
  • Intense physical activity may increase pulmonary artery pressure. Activities that bring on symptoms should therefore be avoided, and you should look out for signs of fatigue.
  • Adaptation to exercise should be slow and gradual. Increase frequency and intensity from slight to moderate, depending on how the infant tolerates it.
  • Any activity that causes dizziness or shortness of breath should be immediately stopped.
• Preventing infections
  • Infections worsen the child’s general condition and aggravate the symptoms of the illness:
    • Hand hygiene: hands should be washed regularly.
    • Oral hygiene: clean teeth after every meal.
    • Vaccinations: respiratory infections are poorly tolerated and must be treated early. Seasonal vaccinations of flu and pneumococcal pneumonia are recommended for both the patient and their cohabiting family.

Look out for the following warning signs and, if they appear, see a doctor:

• Difficulty breathing which leads to frequent interruptions during intake of breath.
• Unexplained weight gain (900 g a day or > 2 kg a week)
• Increased swelling of the ankles, feet, legs or abdomen
• Extreme fatigue or decreased tolerance of physical activity
• Shortness of breath that does not improve with rest

What do you need to bear in mind if you have multiple sclerosis or you are caring for someone who does?

Current evidence is insufficient to give advice on preventing multiple sclerosis. It is, however, advised that your have a healthy lifestyle and carry out activities as normal. Multiple sclerosis affects women more than men, often appears in young adults and is the second biggest cause of non-traumatic disability.

When agreeing with the patient to start them on a drug to treat symptoms or multiple sclerosis itself:

• They should be given very specific education about the action of the medication, the possible side effects, as well as how to administer and store it in order to guarantee that the treatment plan is followed and stuck to.
• Although the establishment of background treatment as soon as possible allows good control of the evolution of the illness, sometimes outbreaks sometimes occur that need to be assessed and, where required, treated at a day hospital for three days, completing the appropriate follow-up to check recovery.

Symptoms

The symptoms of multiple sclerosis can vary greatly, so you are advised to consult specialists when you feel:

• Fatigue. If it appears, it is a good idea to plan moments of activity with moments of rest.
• Sensitivity to temperature changes.You are advised to avoid extreme temperatures and, if you get a fever, lower it as soon as possible.

Although there is no scientific evidence that allows us to make concrete recommendations to prevent or change the course of the illness, there is a whole host of advice about diet, habits and physical exercise that patients and, in general, the entire population, should bear in mind:

• You need to have a healthy lifestyle.
• You should have a balanced and varied diet.
• Exercise.
• Do not smoke, as tobacco is associated with worsening in the progression of the illness.

You are also advised, should you suffer fatigue, to continue daily activity and stay active, combining moments of activity with moments of relaxation as well as to seek energy-saving strategies.

Vitamin D has an important role to play in relation to the illness, which is being researched intensively. Often, people affected present a deficiency of this vitamin, so you are advised to take a supplement under instructions and supervision by your specialist.

Multiple sclerosis is a complex and chronic illness, so it is recommended that those around the person affected are given adequate and comprehensive information. It is also a good idea to have access to ongoing advice whenever necessary.

The family or professional carer, where necessary, may need training and practical advice on topics such as diet, hygiene and the patient’s mobility.

Other related health information

Health education in the diagnosis, at the beginning of the treatment and for the mobilisation of the disabled patient.