What do you need to bear in mind if you have hereditary angioedema?

It is advisable, as far as possible, to avoid possible triggers or aggravators of attacks:

• Pregnancy and hyperoestrogenic periods: if you are trying to conceive, either naturally or with in vitro fertilisation, you should consult your doctor with a view to adjusting your medication. In general, pregnancy does not affect the evolution of the disease, but it is advisable to undergo regular check-ups throughout this period. You should also inform your gynaecologist about your disease and provide them with an up-to-date clinical report. During pregnancy, angioedema attacks can be treated with C1-INH plasma concentrate, specifically Berinert® or Cinryze®. Prophylaxis can be provided with C1-INH plasma concentrate.
• Oral contraceptives with oestrogens: in general, treatments with oestrogens should be avoided. Progestogens can be used. In an emergency situation (morning-after pill) it is only advisable to use drugs with progestogens: levonorgestrel (Norlevo®, Postinor®).
• Stress or states of anxiety: in certain cases these may trigger an attack. You should ask your doctor or specialist whether you need to take measures or medication to control your anxiety.
• Injuries: although the recommendation is to lead a normal life, some patients suffer inflammation in certain parts of the body as a result of knocks and bangs or playing contact sports. It is therefore a good idea to consult your doctor about physical activity and, where applicable, adapt your background treatment.
• Dental visits and oral surgery: it is advisable to inform your dentist about your disease. Simple procedures such as cleaning do not require any additional precautions, but extractions and other procedures should only be performed after treatment with C1-INH plasma concentrate administered one to six hours in advance or with an increase in the intake of attenuated androgens for a few days before and after the appointment. It is advisable to have a full dose of emergency treatment with you at all times.
• Infections: infections should be treated quickly in order to prevent possible angioedema attacks, especially those that affect the mouth and pharynx. Your doctor will indicate the most suitable treatment in each case.
• High blood pressure medication: ACE inhibitors (angiotensin-converting-enzyme inhibitors), such as enalapril, captopril, lisinopril and imidapril, are formally contraindicated. Due to the introduction of new drugs with new brand names, you should ask your doctor to determine whether a particular medication is included in one of these groups.
• Oral diabetes medication: it is not advisable to take DPP-4 (or DPP-IV) inhibitors (inhibitors of dipeptidyl peptidase 4): vildagliptin, sitagliptin, saxagliptin, linagliptin and alogliptin. These drugs are used to treat type 2 diabetes mellitus.

How can you quickly recognise an abdominal attack?

The following symptoms indicate a suspected case:

• Recurrent colicky abdominal pain
• Abdominal distension with or without nausea, vomiting, constipation or diarrhoea
• Arterial hypotension (low blood pressure) with dehydration
• An increase in normal waist circumference

The doctor must make a correct differential diagnosis in order to rule out other causes, such as appendicitis.

How can you quickly recognise a throat or larynx attack?

The following symptoms indicate a suspected case:

• Tightness or a foreign body sensation in the throat or larynx.
• Evident inflammation of the tongue
• Voice changes, such as hoarseness or partial loss of voice
• Difficulty swallowing
• Strange respiratory sounds, such as a strident sound or an acute, rough sound

In this case it is important to remain calm and follow the doctor’s instructions. Here is some general advice:

What should you do in the case of a major attack (affecting the throat or larynx or difficulty breathing)?

1. Ask someone to help you explain what is happening to you.

2. Have the clinical report issued to you by your doctor at the ready.

3. If you have rescue or emergency medication (intravenous Berinert® or Cinryze®, or subcutaneous Firazyr®):

a) If you have been taught how, self-administer it in accordance with the instructions.

b) If you cannot administer it yourself, take it with you to the health centre.

4. Go to your nearest health centre for emergency treatment.

5. Make an appointment with your specialist once the immediate crisis has been dealt with.

In the case of a significant symptom burden in type I and II angioedemas, C1-INH may be administered as a prophylaxis.

Other recommendations and possible doubts 

TRANSFUSIONS – CAN I GIVE BLOOD?

It is not advisable for patients with hereditary angioedema of any type or acquired C1-inhibitor deficiency to donate blood.

LONG OR FOREIGN TRIPS

We recommend you take an up-to-date copy of the clinical report issued by your doctor with you. It is a good idea to have the report translated into the language of your destination or English.

Find out where the nearest healthcare centre is.

Always carry rescue or emergency medication with you and make sure it has not expired. Have your medical report to hand at security controls at airports or railway stations to avoid problems.

DIET

You do not have a follow a special diet because it is not an allergic oedema and it is not caused or triggered by a food allergy.

Diet does not have any impact on the evolution of the disease. You should, of course, follow the healthy diet recommendations issued to everyone.

Exercise and a diet rich in fibre encourage healthy bowel and bladder movements and improve kidney function. In terms of related conditions, often diabetes, good metabolic control of the diabetes is essential to preserve good kidney function. Controlling arterial pressure, which often has an unknown cause, is also vital to maintain good kidney function.

What do you need to bear in mind if you have meningitis?

The risk of contracting meningitis increases if you come into close contact with someone who has it (if you sleep in the same room, live in the same house, kiss on the cheek, etc.), but there is no need to disinfect objects or areas because meningococcus bacteria do not live long outside of the human body.

The measures to prevent this illness are:

• Chemoprophylaxis (antibiotic treatment)
• Vaccination 

With meningitis, the appropriate measure is to administer antibiotics to the family and other people who live with the affected person.

If the illness was caused by meningococcal group B, the only preventive measure, and the most common in Spain,  is chemoprophylaxis, which aims to eliminate the microorganism from the pharynx. This stops it from spreading, in the space of a few days, between the people who have taken the medication.

If the illness was caused by meningococcal group C, as well as administering chemoprophylaxis, people close to the affected person will be vaccinated if they have not already been so.

If there is evidence that someone has had intimate contact with the patient in the ten days prior to the occurrence of the disease and they have not been administered chemoprophylaxis, healthcare staff must be informed.

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 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 to prevent Ebola virus?

Although there is currently no commercially available vaccine against the virus, the results of studies conducted so far show that the vaccine could be very effective. In Spain the risk of infection is very low, but: 

• Try not to travel to affected countries.
• Should you find yourself in one of these countries, avoid trips to affected areas. 

If you find yourself in an area affected by Ebola virus:

• Avoid direct contact with blood or bodily fluids from a patient or a corpse, and with objects that may be contaminated.
• Reduce contact with wild animals and do not eat raw meat.
• Wash your hands regularly.
• Avoid having unprotected sex.

If you travel to one of the affected areas and a few weeks after your return you notice the following symptoms, you need to seek medical attention urgently and tell the doctor about the trip:

• Fever
• Tiredness for an unknown reason
• Diarrhoea
• Other serious symptoms 

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

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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