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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Influenza is a respiratory infection caused by the influenza virus (A, B, and C) transmitted via respiratory droplets. Symptoms include fever, cough, headache, muscle pain, and general discomfort; most recover in 7–10 days. It can be severe in vulnerable groups such as young children, adults over 60, pregnant women, or those with chronic illnesses. Treatment is symptomatic, and annual vaccination is the best prevention.
Flu is transmitted from an ill person to another person through droplets expelled when coughing and sneezing. The transmission period starts from the day before symptoms appear and persists for five days afterwards.
It is estimated that seasonal flu may affect between 5% and 20% of the general population, and that approximately 25% of febrile respiratory processes may be produced by the flu. This increased morbidity gives rise to a large number of medical consultations and absences from work as a consequence of the disease. Moreover, some people, such as older people, those with chronic illnesses, immuno-suppressed people and pregnant women, among others, may suffer more from the illness and it is common for them to experience complications during its evolution. Flu thus continues to be a major public health issue.
Flu presents heightened fever, dry cough, headache and neck ache, muscle pain and general illness. It can also cause diarrhoea, nausea and vomiting, especially in young children. In most cases, people recover in 7-10 days.
Flu may affect anyone, but the most vulnerable to suffering complications are children under the age of 2, people aged 60 or above, pregnant women, morbidly obese people and people of any age who suffer from one of the following types of illness: cardiovascular, pulmonary (including bronchopulmonary dysplasia, cystic fibrosis and asthma), neurological, neuromuscular, metabolic (including diabetes mellitus), kidney failure, immunosuppression, cancer, chronic liver diseases, asplenia and iron deficiencies.
Flu diagnosis is normally clinical and does not require laboratory tests. Despite that fact, microbiological diagnosis is fundamental to be able to obtain aetiological confirmation in patients with risk factors and those with serious illnesses. The detection of the virus in respiratory samples can be done using cultures, antigen detection techniques and molecular methods.
There is no specific treatment for flu. Treatment with analgesics and antipyretics (paracetamol) is recommended to alleviate or treat some of the symptoms associated with flu, such as fever or headache.
Antibiotics do not cure the flu. Only in cases where there is an overlying bacterial infection, such as pneumonia, or in those with chronic illnesses, may preventive antibiotic treatment be indicated to avoid complications.
Antivirals, such as oseltamivir or zanamivir, may be indicated in people at high risk of complications to reduce the duration of the flu and the possibility of complications, but they should begin to be taken within 48 hours from the outbreak of symptoms.
The best way of protecting yourself from the flu is vaccination and following good hygiene practices to prevent the spread of the virus. The purpose of anti-flu vaccination each year is to generate protection against the flu viruses that circulate in the flu season. Health authorities and scientific associations around the world unanimously recommend seasonal anti-flu vaccination for people at high risk. Anti-flu vaccinations are very safe and well-tolerated with effectiveness that ranges from 30% to 70% to prevent hospitalisation due to flu and pneumonia. In older people living in institutions, vaccinations have proven to be between 50% and 60% effective to prevent hospitalisation or pneumonia, and 80% to prevent death by flu.
It is a chronic inflammatory disease of the oesophagus caused and prolonged due to an allergic reaction.It is typified by difficulty swallowing (dysphagia) any food blockages in the oesophagus (food impaction) and rupturing of the oesophageal wall (oesophageal perforation).
The most common symptoms are:
If the inflammation of the oesophagus and related symptoms are left untreated, they will continue from childhood to adulthood. This inflammation causes structural changes to the oesophagus by remodelling the tissue. This can lead to fibrosis and oesophageal stricture. This means functional deterioration that significantly affects the patient’s quality of life.
From the first recorded case in 1993, eosinophilic oesophagitis has been found to affect 45 out of every 100,000 people, and has an incidence rate of 3.7 cases for every 100,000 people a year. This makes it the most common cause of dysphagia, spontaneous oesophageal perforation and food impaction in young patients.
For appropriate diagnosis, a gastroscopy must be carried out to take multiple biopsies from the oesophagus, since inflammatory alterations can be distributed unevenly. This technique also allows the response to treatment to be assessed.
Endoscopic analysis of the oesophageal mucous membranes is not sufficient to reach a firm diagnosis, as 10-15% of patients will have normal results of a endoscopy.
Treatment for EoE is based on three alternative therapies:
Early diagnosis is important to prevent complications arising from EoE. Early treatment and clinical and endoscopic monitoring is also essential.
It is a chronic brain disorder that can affect people of any age. It is characterised by recurring convulsions caused by excessive electrical impulses in groups of brain cells. The consequences can be neurological, cognitive, psychological and social.
In 2005, epilepsy was defined as “a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures”. Epilepsy is therefore diagnosed when patients experience two or more seizures, separated by a period of time that can last from 24 hours to 10 years.
Epilepsy causes brief absence seizures, involuntary movements, repetitive reflexes such as sucking movements, loss of consciousness, and so on. It can originate in one area of the brain (focal seizure) or the brain as a whole (generalized seizure). Seizures are sometimes accompanied by loss of consciousness and/or loss of bowel control. Their frequency can vary from only just one over a ten year period to several per day.
Seizures (absence seizures, muscle contractions, etc.) are the main symptom and may vary depending where in the brain the epileptic seizure begins.
For example, in tonic-clonic seizures (GTCS), it is common to observe twitching, muscle contractions, jerking, etc. These movements are called “myoclonus” and may be symmetric or asymmetric and are accompanied by rolling of the eyes. They are followed by a spasm with clenching of the teeth, laboured breathing and an epileptic shout.
Epilepsy affects the entire population, regardless of age, from whilst still in the womb right up to people in their nineties. It is estimated that 8 in 1000 people have the condition.
Related factors:
In some cases the cause of epilepsy may be unknown, as although we can see an epileptic seizure occurring in the brain, current technologies do not reveal what causes them. Epilepsy may also be genetic.
It is the second most common neurological disorder (after stroke) seen in accident and emergency departments. An estimated 3,000 patients are seen in our centre every year. 3% of the population will attend a medical centre at some point during their lifetime to determine whether their symptoms are caused by epilepsy.
Diagnosis requires:
It is advisable to avoid all situations that may create:
When faced with a seizure, a series of recommendations should be followed to avoid injury to the person having the seizure.
Hypoplastic left heart syndrome (HLHS) encompasses a series of anomalies that all have a very small, or “hypoplastic”, left ventricle, which is incapable of pumping the required amount of blood to supply all the organs and tissue in the body. In this situation, the right ventricle keeps blood circulating.
Children with this type of anomaly tend to have other structures of the left side of the heart that are also smaller. Often the mitral valve, the aortic valve or the aorta itself are smaller than they should be. Hypoplasia of the left chambers is one of the most serious heart defects, although very good outcomes are achieved in centres with experience of the condition such as ours.
It is often diagnosed in the foetus during an echocardiogram. This test can identify which structures are affected by the syndrome in order to decide the best treatment.
These anomalies are usually treated with surgery during the first week of the baby’s life. This operation connects all the vessels coming out of the heart into just one, to ensure blood flows to the body. This procedure is known as “the Norwood procedure”.
In this first surgery, blood reaches the lungs via a conduit that exits the aorta (systemic-pulmonary fistula). Two further procedures will be needed. The aim of this surgery is to make the heart work solely with the oxygenated blood it receives from the lungs, and to pump it to the tissues of the body. Blood flows to the lungs through the network of veins that transport unoxygenated blood (Glenn and Fontan procedure).
Children who have had this heart defect must have their neurodevelopment closely monitored by experts in this field, to evaluate the child’s educational development and growth. Close monitoring is necessary from a cardiological point of view, above all during the first few days of a child’s life. Monitoring the patient will show when surgery is necessary, how they should be managed medically, and how to treat complications, should any arise.
Unfortunately, there are currently no measures that can be taken to prevent these anomalies.
It is a cancer found in the bones and soft tissue. Ewing's sarcoma is the second most common cancer in children, and normally occurs between ten and twenty years old. It is also more common in males than in females.
Ewing's sarcoma and primitive neuroectodermal tumours (PNET) are cancers encompassing different types of malignant tumours that share a common chromosomic abnormality. Ewing's tumours located in soft tissue are called extraskeletal Ewing’s sarcoma. They tend to be found in the thigh, pelvis, parts of the spine, the chest wall and the foot.
Primitive neuroectodermal tumours in bones and soft tissue are the least common type of Ewing’s sarcoma. They are made up of immature nerve cells.
The most common symptoms of Ewing’s sarcoma are:
There may also be a lump or swelling around the affected bone or tissue. During diagnosis it is very common to discover a pathological fracture (a non-traumatic fracture) due the fact that the tumour has weakened the bone. Weight loss and fever are other very common symptoms of this kind of tumour.
Malignant neoplasms in children and teenagers are rare, but they are one of the most important causes of morbidity and mortality in these age groups. Ewing’s sarcoma represents 3 % of cancers diagnosed in children throughout Spain. Every year there are around 30 new cases in children under 14 years of age.
If a child shows symptoms of this sarcoma, the doctor will carry out several diagnostic tests which may include:
These tests will help to determine the size and location of the tumour and whether it has spread to other parts of the body.
Three kinds of treatment are often used to treat Ewing’s tumours. Chemotherapy is always used. In addition, surgery (whether to save or amputate the limb) and radiotherapy are used for local control of the tumour. The type of treatment depends on the child's age, the location of the tumour and whether it has spread to other parts of the body.
There are currently no measures to prevent this kind of tumour.
The ductus arteriosus is a blood vessel connecting the aorta to the pulmonary artery. It spontaneously closes after birth in the majority of infants born at full term, and this is essential in order for the baby to survive. However, in premature babies, closure of the ductus arteriosus is often delayed until more than a week after being born.
The most common clinical sign is the onset of a murmur under the left collar bone. Patent ductus arteriosus may be accompanied by a high heart rate and rapid breathing and also increased pulmonary flow. This increase produces congestion which prevents development of the lungs in premature babies.
It principally affects premature babies. Patent ductus arteriosus affects 30% of premature babies weighing under 1500g.
Patent ductus arteriosus is detected via echocardiogram.
When the patent ductus arteriosus affects the new-born’s health, initial treatment is medical and pharmacological.
Indometacin is the standard treatment for closing the ductus arteriosus with medication. Ibuprofen can also be used as this anti-inflammatory gives good results in these cases.
The usual treatment would be closure via catheterization. This means inserting a catheter into the ductus arteriosus to close it. This type of closure would normally be used for babies with ductus arteriosus under 3 mm diameter and who are of a suitable weight.
Surgical treatment is reserved for patients where pharmacological treatment has failed, or where it is not advisable, and for cases where catheterization is not recommended.
Prognosis is excellent both for closure through catheterization and surgery. The recanalization rate of patent ductus arteriosus is estimated at 0-3 %.
Epidermolysis bullosa (EB) encompasses a range of genetic diseases characterised by excessive fragility of the skin and mucous membranes when subjected to minimal trauma. The disease appears at birth or during the first few years of life, and lasts a lifetime. Prognosis is variable, but tends to be serious. Life expectancy is 50 years, and the disease brings with it complications related to infections, nutrition and neoplastic complications. There is currently no effective treatment available.
Depending on the area of skin where blistering occurs, the disease can be divided into four main groups, and subsequently 32 subgroups.
The most common cutaneous symptoms are blisters in the areas of greatest friction such as on the hands and feet. They are skin lesions that bleed and may form scabs that are easily infected and that itch constantly. Scratching contributes to new lesions and secondary infections of already affected areas.
Once blisters have healed, millium cysts appear, atrophic or hypertrophic scars that produce webbed hands and feet, joint contractures, as well as aesthetic and functionally limiting deformities in the hands or that affect walking. All this leads to loss of independence.
In addition, the chronic wounds may produce highly aggressive skin carcinoma.
Aside from this, extracutaneous manifestations may result, such as involvement of the skin annexes, teeth and the gastrointestinal systems, the urinary tract and the respiratory epithelium.
The disease has a low prevalence rate and affects one in every 17,000 live births worldwide.
The main method of diagnosis is mapping using immunofluorescence and electron microscopy techniques. In addition, genetic diagnosis is mandatory for these patients as the disease may have different evolutions and prognoses.
Although it is being researched, at the moment there is no cure for this disease, but preventative and symptomatic treatment of skin lesions can be carried out, as well as treatment for systemic complications. When the disease appears it is vital to act quickly as patients’ life expectancy and quality of life depends on it.
Currently, new cellular and molecular therapies are being researched to combat the disease.
Human papillomavirus (HPV) is generally spread through sexual intercourse and mainly infects the skin (penis, vulva, anus) or mucous membranes (vagina, cervix and rectum) of the genitals in both men and women. Likewise, it can also appear in the mouth and the pharynx and tonsils.
This is a frequently transmitted disease and in most cases it does not result in any pathology. It can, however, release a benign disease in the form of warts, or less commonly, different types of cancer. In women, HPV can cause cervical cancer.
HPV is spread via direct skin to skin contact during sex, and not through fluids. In around 90% of cases it disappears spontaneously, but it can be transmitted whilst the virus is present.
HPV is classified in terms of whether or not there is a risk of cancer developing:
It should be said that it is possible to be infected with more than one type of HPV. In addition, persistent infection can result in developing cancer of the cervix, vulva, penis, anus or oropharynx.
Specifically, the virus initiates dysplastic changes in the epithelial cells which continue to evolve until they produce an invasive cancer. This is a progressive process and the time from infection until developing the disease can be up to twenty years.
Genital warts or small protuberances or groups of different sizes and shapes may appear in the area of the genitals.
In the case of cancer, there are no symptoms until it is very advanced. In the case of cervical cancer, symptoms show up as:
In Catalonia, cancer of the womb occurs in 7.2 out of every 100,000 women per year (2003-2007). This represents 2.8% of all female cancers. Between the ages of 35-64 this figure rises to 16.1 cases for every 100,000 women. Furthermore, the risk of developing this disease for women who live to 75 is one in 106.
Anal cancer has an annual incidence rate of 1.8 cases for every 100,000 people, but in the case of men engaging in same-sex relations and infected with HIV, this rises to 70 or 128 cases for every 100,000.
When there is evidence of warts, diagnosis is usually clinical or by biopsy. Cancer is detected by cytology tests, which allow anomalous changes in the cells to be seen before they develop. If the test comes back anomalous it can be complemented by a colposcopy that allows magnified examination of the cervix and samples to be taken.
HPV detection is the main component of a preventative strategy to detect the virus before it reaches the point of disease.
There is no specific antiviral treatment for HPV.
In the case of warts, in most cases they can be eliminated through surgery, ointments or other treatments.
If cancer does develop, treatment will depend on the stage at which it is diagnosed. For example, if it is detected early in the cervix this can involve removing the damaged tissue, whilst in more advanced stages it may require a hysterectomy, radiotherapy or chemotherapy.
The use of condoms is essential to prevent HPV. There is also highly effective vaccine used as a way to prevent cervical cancer. Regular cervical smear tests (Papanicolau test) are also carried out as a form of screening. This strategy, however, is changing due to the techniques used to detect the virus which, together with the smear test, are enabling the different stages of the disease to be monitored (acquisition, persistence, progression to precancerous lesions and invasion).
This disease consists of a hole in the partition that separates the right and left chambers of the heart, and a malformation of the mitral valve.
Patients with an atrioventricular septal defect have a hole in the wall between the left and right sides of the heart and a malformation of the mitral valve, which is the valve that regulates blood flow from the left side of the heart.
In the case of a partial atrioventricular septal defect, the upper part (atrial) or lower part (ventricular) part of the partition may be affected. In the case of a complete atrioventricular septal defect, the hole affects both the atrial and the ventricular chambers of the partition.
This heart condition may or may not present symptoms, depending on the size of the interatrial hole and the insufficiency of the mitral valve.
Where there are symptoms, the most common are those related to heart failure:
This is carried out through an echocardiogram to identify the presence of a defect and the degree of mitral insufficiency.
This heart disorder is corrected through surgery, during which a patch is used to close the atrial septal defect and the mitral valve is repaired by closing the hole. The ideal age to repair a partial AV defect is from 1 to 4 years old.
The vast majority of patients with a repaired defect of this type have a similar life expectancy and quality of life to the general population. If it is not corrected, patients may develop pulmonary hypertension, a disease with drastically reduced survival rates from around thirty or forty years old.
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