Childhood cough or asthma

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on28-02-2018

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Asthma is a chronic condition of the respiratory tract which is characterised by a group of symptoms and a series of positive diagnostic tests. Generally these tests cannot be performed correctly until the age of 6 or 7, therefore the term “recurrent wheeze” is recommended when talking about children younger than this, or a nitric oxide test can be performed from the age of 4 if the patient is able to cooperate.

Today Dr Carlos Hermosos Torregrosa, Paediatric Respiratory Physician at Vithas Xanit International Hospital, answers some of our questions relating to this condition, which tends to be more complicated during the colder months.

.              What respiratory difficulties occur with asthma?

Clinically a cough and shortness of breath are typical in the asthma process. It is often episodic, and in some cases it is shown to be related to a lung allergen, always occurring at the same time of year.

When correctly controlled in children, it will appear on rare occasions throughout the year (once or twice), manifesting as a cough when exercising and at rest, usually becoming worse at night.

.              What signs should parents look out for?

A cough is the main sign that parents should look out for to predict the onset of an asthma attack. Other signs such as indrawing of the abdomen (subcostal retraction) or increased breathing rate appear when the attack is already quite advanced.

.         How is asthma diagnosed?

One of the most common and well-known tests used in the diagnosis of asthma, also used when assessing the level of control, is spirometry with the bronchodilator reversibility test. This helps to determine lung function, however sometimes use of this technique alone is not sufficient to diagnose the condition. In the last few years there has been a rise in use of the fractional exhaled nitric oxide (FeNO) test. This has the advantage that it can be performed at an earlier age than spirometry, from the age of 4 in selected patients. This test determines the nitric oxide exhaled at a proximal level (in the bronchi), as well as at a distal or alveolar level.

  • How is asthma treated? Which treatments are most effective?

There are many asthma treatments, however it is important to differentiate between the two main types: treatments focused on an acute attack, and maintenance treatments which are prescribed to correctly control the asthma and minimise the number of attacks.

The most effective treatments for asthma attacks, approved in national and international asthma guidelines, are INHALED, never oral, short acting β2-adrenergic bronchodilators: salbutamol and terbutaline.

There are also studies which show that adding corticosteroids, such as budesonide, to inhaled β2-adrenergic bronchodilators, increases their effectiveness by reducing the bronchial inflammatory component which always accompanies an acute asthma attack. When an attack is serious, these inhaled treatments are accompanied by oral corticosteroids.

With regard to maintenance treatment, there are also many options such as leukotriene receptor antagonists (montelukast), inhaled corticosteroids (budesonide/fluticasone), or combined inhaled corticosteroids and long-acting β2-adrenergic bronchodilators (formoterol/budesonide, salmeterol/fluticasone) which are prescribed depending on the patient’s clinical history.

Additionally there are some vaccines which are particularly recommended for asthmatic patients due to their higher risk of suffering from serious infections and increased risk of complications due to certain pathogens. With this in mind, it is important that providing there are no contraindications, these patients, and those they live with, have yearly flu vaccinations, preferably with a quadrivalent vaccine. As well as the flu, it is essential to vaccinate correctly against pneumococcus.

  • Can asthma be prevented?

No. If an individual is genetically predisposed to developing asthma, currently there is no way of preventing it.

However, it is possible to prevent exacerbations of asthma and improve control of the disease.  This is achieved through individual, specialist outpatient monitoring and control, where the necessary tests and required maintenance treatment is prescribed for each child, with the aim of achieving better control of the disease with as little medication possible.

The tests required for diagnosis of the condition are the respiratory function tests already discussed, using spirometry with the bronchodilator reversibility test, and FeNO tests which should be performed in all children when an allergic component is suspected.

Furthermore, both spirometry and FeNO are used for monitoring of the condition, FeNO has the advantage that it can be performed in younger children (from age 4) predicting attacks in children who are apparently well controlled.

  • Should a child with asthma change their lifestyle? (Sports, games.)

A child with asthma can lead a normal life. There are many examples of elite athletes who take part in their sport without any limitations due to their asthma.

  • Are children of parents with allergies more likely to suffer from asthma?

It is a subject still under discussion today, but it appears that children with a history of a first degree relative with asthma, or with a strong allergic component, are more likely to suffer from asthma in the future.

A detailed clinical history during a specialist consultation gives the asthma predictive index (API), which is a very useful tool in determining the type of treatment and monitoring which the patient is going to require.

What is clear today is that a child under the age of 3 who starts with repeated bronchial episodes, and who has a family history of asthma, must be observed and strictly monitored until the age that the necessary tests to diagnose asthma can be performed.

Dr. Carlos Hermoso Torregrosa (Paediatric Respiratory Physician),

Chronic Hepatitis C. New direct-acting antiviral treatments

Posted by Xanit Internacional Xanit Internacional | Posted in Various, Xanit salud | Posted on28-02-2018

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The hepatitis C virus is a small RNA virus which has a special affinity for infecting liver cells. It is an infectious disease which, the majority of the time, is transmitted by exposure to blood contaminated with the virus.

In this post Dr. Juan Carlos Gavilan, from the Department of General Internal Medicine, explains about the new direct-acting antiviral treatments for chronic hepatitis C infection.

How is this virus transmitted?

In the past, before there was a blood test available to test blood donors, contaminated blood transfusion or the use of syringes and/or contaminated material in patients who were drug users was the most common method of transmission. Nowadays transmission through transfusion is highly unlikely. The risk of sexual transmission of the virus is low, although not impossible. However, a high percentage of patients who have the infection do not have any of the risk factors mentioned, therefore they very probably acquired it as a result of “unnoticed” exposure to blood or material contaminated with infected blood. 

 

How does the hepatitis C virus act?

Once in the body the virus multiplies leading to acute hepatitis, but in many cases the patient does not become jaundiced and the symptoms present as tiredness and weakness which are attributed to other factors, the infection passing unnoticed.

In approximately 20% of cases, the body’s defence system is able to effectively eliminate the infection, with it resolving spontaneously, but in 80% of cases this does not happen, and CHRONIC HEPATITIS develops. In other words it persists long term, causing continuous inflammation of the liver, which in a third of patients can lead to liver cirrhosis years later, and with it complications such as liver failure or liver cancer.

During the chronic phase, the infection presents few symptoms and frequently passes unnoticed until it is found incidentally on blood tests, or when donating blood. Spontaneous elimination during the chronic phase is very unlikely. Between 1 and 2% of the Spanish population may be affected, with a percentage of infected patients being unaware, precisely because of the lack of symptoms presented.

Possible treatment for hepatitis C

For years there was no effective treatment available to eliminate the virus; subsequently there were treatments such as interferon and ribavirin which had many side effects with low rates of recovery.

Nowadays however we have a wide range of direct-acting antiviral drugs, in tablet form. In more than 95% of cases these are capable of eliminating the infection with less than 12 weeks of treatment, and with few side effects.  Elimination of the virus during the chronic hepatitis phase, before the virus has caused significant damage to the structure of the liver, particularly in relation to the degree of fibrosis caused in the organ, makes the final prognosis after treatment excellent.

In cases where effective elimination of the virus takes place, but the liver already has a significant degree of fibrosis at the time of treatment, particularly if there is established cirrhosis, prognosis also improves. However elimination of the virus does not reduce possible future complications to zero as the liver can be affected by the consequences of cirrhosis, in these cases special monitoring is therefore recommended.

Detection of undiagnosed cases and their treatment will allow future eradication of the infection and of the complications which could result from the risk of progression to cirrhosis in many of these patients.

Advice for a healthy star to the new year

Posted by Xanit Internacional Xanit Internacional | Posted in Various, Xanit salud | Posted on31-01-2018

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Cycles are a feature of in nature, some as a result of the environment and human development. Others are as a result of the calendar, key dates which, for society as a whole, signify promising beginnings, a new start.

One of the most important is the start of a new year. Inevitably we take advantage of the opportunity to start from scratch to achieve any goal that we have previously set without success.

2018 has already begun and it is never too late to improve any aspect of your life, regardless of your age, especially when related to health.

At Vithas we are health experts and we would like to pass on a few tips for the new year, to help you take care of the important things: your physical and mental health.

Health advice for 2018

  1. Take proper care of your digestive system.

Forget miracle diets. From a certain age, around the age of 50, symptoms may be more significant and require more active investigation by doctors. Good nutrition containing all the food groups (carbohydrates, fats, proteins) in the correct amounts is the healthiest diet to follow. To prevent overeating, avoid going for long periods without food and eat 5 times a day. Not smoking and avoiding abuse of alcohol can of course also help to keep your digestive system healthy. 

  1. Participate in regular exercise

Even if it is low intensity exercise. However joining the gym in January and leaving in February does not produce results. The most important thing is to find a balance, participate in a sport you enjoy and which you can practice consistently, even if it’s only for 30 minutes a day. 

  1. Take care of your mind 

Taking care of your psyche is also important. Seeing a psychologist to resolve emotional conflicts improves mental health, and a healthy mind is the beginning of a healthy body. Therefore see specialists who can help you to focus on what is really important and leave stress behind. 

  1. Have regular dental and eye checks

Don’t neglect ophthalmic and dental check-ups in the medium term.

Periodic check-ups are key, gum disease is a silent condition which does not manifest itself until it has become a serious and chronic problem. It is therefore important to treat it in the acute phase, with early detection and monitoring from the start.

To maintain good oral health (which is demonstrated by clean, pink gums, with no bleeding or tartar, monitored by a professional) it is important to have check-ups every 6 months to a year. As well as brushing regularly, the spaces between the teeth and the area where the teeth meet the gums should also be cleaned using dental floss, oral irrigators and interdental brushes.

Eyesight is one of the senses most affected by age. Conditions of varying magnitude and significance can develop. Many patients do not realise they have a problem until sight becomes blurred, or visual disturbances appear such as metamorphorpsia. There are several tests such as the Amsler grid test, FAG, OCT or Fundoscopy which can be performed.

There are people who must spend long periods of time in front of a screen for work or other reasons. For these people it is advisable to develop a routine, taking a couple of minutes rest every 45 minutes.

Artificial tears may also be recommended to reduce eye irritation.

 

  1. Eliminate bad habits from your life. 

The start of a new year is usually a time of high motivation to deal with addictions such as smoking, alcohol and other drugs. 

Smoking is responsible for 17% of deaths in Spain and kills 124 people each day. 30% of the adult population are smokers. After 5 years, only 3% of patients who do not see a specialist for help manage to still be smoke-free. For this reason our advice is to ask for individual help from the start, to choose an intensive, personalised treatment.

  1. A general check-up at the start of the year is a good idea. 

Finally, start the year with a general health check, nothing is better than knowing your current state of health to be able to set yourself realistic goals for the rest of the year.

Regular consultations with individualised treatment are essential to keeping completely healthy and motivated.

The number of compulsive shoppers has dramatically increased, with the disorder now affecting 7% of the population

Posted by Xanit Internacional Xanit Internacional | Posted in Xanit salud | Posted on31-01-2018

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Christmas is coming, a time for singing carols, family gatherings, meals and shopping, lots of shopping. The month of December is typically a season of frantic purchases on a large scale. Those who suffer from a shopping addiction have a greater risk of compulsive shopping at this time of year. During the holidays it is easier for their behaviour to pass unnoticed, or to be justified, but, how can we recognise a compulsive shopper? Specialists in psychology at Vithas Xanit International Hospital, belonging to the Vithas Healthcare Group, explain what to look out for to detect this disorder, which affects 7% of the population, and which is increasing year on year, especially after the introduction of the internet into our lives.

“Compulsive shopping is associated with impulse control, its features include excessive worry related to purchases made, the irresistible urge to buy superfluous objects on a massive scale with accompanying feelings of anxiety, irritability or discomfort, and adverse consequences such as debt,” explains Dr Vanesa Tejon, Psychologist at Vithas Xanit International Hospital, adding, “The problem in itself drives these purchases to be made, control is lost in the pursuit of satisfying what is experienced as a vital need. After momentary relief on performing the addictive behaviour, the person then experiences feelings of guilt.”

According to reports from specialists, the incidence of people with this problem continues to increase, currently affecting 7% of the population. “The influence of advertising, the increase in materialism as an indicator of social success, or even as a sign of identity, and the increasingly available opportunities to shop, are factors which favour the number of patients with this disorder. In the last few years, the internet has become a powerful risk factor in the development of this condition. Additionally, when the sales are on, as will happen shortly, fear of losing a good deal directly influences our behaviour, encouraging the shopper to buy as quickly as possible,” clarifies Dr Tejon.

It is important for this condition to be diagnosed so that you can see a specialist who will help to treat the problem. Some signs which may indicate that you have a compulsive shopping disorder are: feeling sad, depressed or angry, with shopping being the only thing which stops these feelings; shopping frequently for things of little use and regretting it afterwards; having the house full of articles which have never been used; feeling rushed when shopping due to being unable to control impulses; being criticised by friends and family due to your love of shopping; feeling unsatisfied despite buying lots of expensive things; uncontrolled spending which at times even surprises  you or preferring to dedicate any free time to visiting shopping centres. “If any of these symptoms continue and occur regularly you should see a specialist to determine the status of your condition,” explains the psychologist.

“That said, there are guidelines to prevent someone from reaching this point so that shopping does not become a problem. You should for example plan your shopping by making a list of what you need to buy, consciously reflecting on what you really require. Allocate a specific budget for shopping to prevent overspending, take payment in cash and leave your credit card at home. When you go to the sales it’s important to compare prices beforehand to find true offers, but still wait a few minutes before buying anything. Avoid shopping via the internet, if necessary block all advertising, email promotions and discount coupons, this can help to prevent compulsive shopping. Finally, avoid shopping when upset, preferably distract your mind with other things, perform a physical activity or meet with friends and family and keep away from shopping centres. These are a few simple tricks to make sure shopping doesn’t become an obsession,” she advises.

The time change and its effects on our body

Posted by Xanit Internacional Xanit Internacional | Posted in Various, Xanit salud | Posted on23-01-2018

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This Saturday night, 28th October, the clocks go back from 3 am to 2 am. Daylight Saving Time finishes, it has been practised throughout Europe since 1981. The time change was devised to adapt to the hours of daylight, meaning we are less dependent on electricity. However, the time change also causes changes in our body, including sleep problems and difficulty adapting.

Autumn is a time of year when the body’s defences are diminished due to the drop in temperatures. Many people suffer feelings of sadness, tiredness, apathy, lack of energy, drowsiness and difficult concentrating. Food and sleep are vital in combating these feelings.

With the arrival of the bad weather and night falling early, we stop taking part in some of the activities we enjoy (sport, the beach, day trips, shopping, walking…) and don’t replace them with other things. A drop in the level of personal enjoyment can predispose to low mood or depression.

Today, we talk to Dr Vanesa Tejon, psychologist at Vithas Xanit International Hospital, about how the time change and change in daylight hours can affect us.

How does daylight affect the body’s internal clock?

Our body has a time regulator which is in the centre of the brain, it is regulated by sunlight and environmental stimuli. It regulates the daily cycle which affects hormone levels and cellular activity, therefore when the light cycle or routine changes, it can become disorientating.

The time change can cause mild sleep disruption, as well as issues with our meal routines, mood swings, increased tiredness, irritability and lack of concentration, although these problems disappear after around 3-4 days.

Children and the elderly are the groups of the population more sensitive to these changes, as they tend to have an established timetable for meals and sleeping.

The time change also affects our digestive system, as meals times change. Lack of appetite at meal times or feeling hungry at other times of the day can be a problem, continuing with regular mealtimes is recommended.

How to deal with the time change

Sleep well, make the most of daylight hours, take part in outdoor activities and follow an appropriate diet, this will help you to face autumn and the cold with the required energy.

  • Increase the amount of light in the home, place of work, etc.: use curtains made of light or translucent fabrics, decorate walls and floors with light colours (if they are high gloss even better as they will reflect the light). Have glass doors, white reflective furniture, mirrors (they increase the amount of light).

 

Healthy routines which help to keep levels of serotonin high, promoting a feeling of well-being:

  • Dark chocolate: stimulates the release of endorphins and serotonin (but always in moderation).
  • Physical exercise: as well as being healthy, makes us feel good, reducing anxiety, increasing endorphins, regulating breathing, etc. as well as contributing to high serotonin levels. Outdoor aerobic exercise is recommended.
  • Meditation: Helps with relaxation and breathing control.
  • Relaxation: when under stress we breathe more rapidly and serotonin drops. Relaxation induces release of this hormone.
  • Omega 3: helps with synthesis of neurotransmitters such as serotonin. Eating trout, sardines and nuts is recommended.
  • Spend time in the sun.
  • Adopt a regular sleep cycle.
  • Perform enjoyable activities.
  • Relive happy memories. 

Alternatively these factors can have a negative impact on serotonin levels and should be avoided:

  • Sleep deprivation.
  • Sugar and refined flour.
  • Energy drinks or drinks with caffeine.
  • Stopping enjoyable activities (going for a walk, a day out…) and not replacing them with others.

 

In the final analysis regular, physical activity, enjoying time in the sun or outdoors and dealing with the time change with a sense of humour are all sound recommendations. Think of the positives that the time change brings (it is more pleasant to get up early in the morning after dawn has broken) and follow a regular routine (important for good eating and sleeping habits), etc.

How to deal with a wasp or bee sting

Posted by Xanit Internacional Xanit Internacional | Posted in Various, Xanit salud | Posted on23-01-2018

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In September it’s often still hot, and when we are enjoying the outdoors or the last few days at the pool, they are always lurking… Wasps sting both the young and old, with no section of the population safe. In some cases these stings don’t simply cause pain but can in fact be life threatening.

Dr Clara Isabel Perez Padilla, from the Allergy Service at our hospital, explains the most significant symptoms of a bee or wasp sting, so you will know how to react when faced with one, she also explains the difference between having an allergy, or not, to these insects.

Firstly it’s important to distinguish between the two most common stinging insects: wasps and bees. Bees tend to be found around areas such as flower beds, whereas wasps are everywhere, making their nests wherever they like. As a result they appear where we might least expect them. Being around us in the garden, the countryside, at the beach or the pool, it is much easier for a wasp to sting us, unlike the bee which we are much less likely to come across. Once a bee has stung, it loses its sting and dies, a wasp on the other hand does not. Wasps are also more aggressive and more easily irritated. Another very annoying insect which is more prevalent in summer is the mosquito, although it doesn’t usually cause an allergic reaction, other than a local reaction to the bite.

It is important to be aware of how dangerous wasps can be, however it should be made clear that a wasp sting is only very serious if a person is allergic to it, otherwise it simply causes itching, pain etc., These reactions are not pleasant and are the result of the skin reaction the sting causes, but they do not have major implications.

What happens if I am stung by a bee or a wasp?

When stung by these insects, the usual result is simply a local reaction in the area of the sting which manifests as mild swelling, pain and/or itching. In this case the best thing to do is apply something cold, such as ice or similar.

When someone is stung by a wasp or bee, it causes an inflammatory reaction in the area of the sting, a reaction known as a local reaction. This reaction, including reddening, swelling and pain, is normal. It can be quite large and extend to several centimetres around the sting. The reaction may be bigger or smaller, the individual response differing from person to person. Despite the pain and discomfort that might occur, it is not life threatening.

But, what happens if a bee or wasp stings me and I have an allergy?

When someone has an allergy it is a different matter altogether, systemic symptoms will be produced which can be very serious, even fatal. If the sting occurs on the arm for example the person may develop generalised urticaria, hives on different areas of the body, shortness of breath and difficulty breathing, sneezing, repetitive cough, low blood pressure, nausea, etc. When a person experiences symptoms of this type, they should see a doctor straight away, so that an adrenaline injection can be given. This reaction starts to appear after a short period of time, generally in less than 20-30 minutes after the sting.

For those who have this type of allergy, and have already been diagnosed, carrying a self-injectable adrenaline pen is recommended, in preparation for a situation of this kind, at least in the first few years until the corresponding treatment has been given. The pen is very easy to use and can even be employed without removing clothes, it can save lives. Ideally you should inject the adrenaline and go straight to a hospital Emergency Department, where your condition can be assessed by specialists.

In order not to generate confusion, it is important that the general public are clear that to be allergic to something, including a wasp sting, you firstly have to have had contact with the allergen. The first time that a wasp stings anyone it rarely produces a reaction as serious as death, as the allergy has not yet developed. Antibodies against the allergen appear following the first sting. For the peace of mind of everyone, especially mothers, a person has to have been stung several times to develop a wasp sting allergy.

General measures for preventing wasp and bee stings

Long term treatment of a real bee or wasp sting allergy is immunotherapy, or allergy vaccination. This vaccine is the most effective of all the allergy vaccines. Tolerance of insect venom is achieved, so that the allergic person reacts in the same way as someone who has never had an allergy. Until this effect is achieved, the affected person has to continue with the aforementioned precautions. The specialist will decide for which patients the vaccination is indicated, the length of time it should be given and when it should be stopped.

How does lack of daylight affect our state of mind and daily routine?

Posted by Xanit Internacional Xanit Internacional | Posted in Various, Xanit salud | Posted on23-01-2018

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This is a good question to ask at this time of year. Especially when you bear in mind that we live in an area where we are used to enjoying so many hours of sunshine. Conventional wisdom has always been that light provides our body and mind with many benefits. In fact it has been recently demonstrated that vitamin D, which we get from the sun, exerts a protective effect on our body against some diseases such as breast and colon cancer.

But apart from this, do we really know how much we benefit from sunlight?

Dr Vanesa Tejon, psychologist at Vithas Xanit International Hospital, helps us to find out.

What does sunlight provide, both physically and psychologically?

The main advantages for our health are:

  • Protection against different types of cancer

This is very important, vitamin D has a protective effect against tumours. Recent studies have discovered that sunlight helps to protect us from some of the most common cancers such as breast and colon cancer, as well as others such as ovarian, bladder, uterine, stomach, lymphoma and prostate.

  • It strengthens teeth and bones.

UV rays help vitamin D production in the skin, which is vital for the process of mineralisation of bones and teeth.

  • It improves the skin’s appearance

It helps to combat some very conspicuous conditions such as acne and psoriasis.

  • It activates defences against many diseases.

The sun increases the number of white blood cells or lymphocytes, which are the cells responsible for protecting us against infection.

  • It balances cholesterol

UV light is required for the metabolism of cholesterol generated by our body.

  • It decreases blood pressure

The sun causes vasodilation of superficial blood vessels and increases circulation of blood in the skin, this in turn lowers blood pressure.

  • It improves mood at the same time as preventing the development of stress, anxiety and depression.

Radiation from the sun (UV rays) promotes serotonin synthesis (the neurotransmitter related to emotional well-being).

Amongst other functions serotonin is also involved in the regulation of sleep, body temperature and sexual behaviour.

  • It helps to regulate sleep.

The levels of melatonin (sleep hormone) decrease with natural light. When night falls and it becomes dark, this causes the pineal gland to secrete melatonin in larger quantities, encouraging better sleep.

How are blood melatonin levels affected? They are higher during the night, when it’s dark. When it’s light, melatonin drops and we feel more awake and active.

  • It keeps the nervous system in shape

It increases perception, improving decision making.

  • It improves sex life.

It has been proven that the sun, taken in moderation, increases levels of testosterone in the blood (one of the hormones responsible for sexual appetite).

As you can see, natural light from the sun can be very beneficial for our body. However, this does not mean we should start to spend long periods in the sun, especially in summer.

Above all, be sensible!

Pacemakers: Technology to take care of our heart

Posted by Xanit Internacional Xanit Internacional | Posted in cardiology with heart | Posted on23-01-2018

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An artificial pacemaker is an electronic device designed to produce electrical impulses to stimulate the heart when there is a failure of normal or physiological stimulation. These impulses, once generated, require a conduction lead from the device to the heart to achieve its goal. Thus, a cardiac stimulation system consists of an electrical impulse generator and a lead.

After many years improving this technique, pacemakers have become safe and reliable systems. A modern pacemaker has an estimated, average life of between 9 and 10 years. After implantation it requires maintenance, in the same way as any other electronic device.

Dr Gomez Doblas, Head of the Heart Centre at Vithas Xanit, answers some of the most frequently asked questions on implantation and life span and provides information on this technology, which has managed to lengthen, and save, the life of millions since its invention.

Pacemakers are generally implanted in patients who have a very low heart rate due to an abnormal electrical system in the heart. Especially when this heart rate is related to symptoms which are not attributable to other causes and where there is no capacity to increase the heart rate with exercise.

 

How is a pacemaker implanted?

Surgery for pacemaker implantation is very straight forward. A lead is implanted which is taken right up to the heart from the chest wall through a small puncture, a small-sized battery is left inserted underneath the pectoral skin. It is performed under local anaesthetic, the procedure only takes a short time and has a low complication rate.

It is a simple procedure to perform. As it is carried out under local anaesthetic, and is not a prolonged operation, it is a low risk procedure. A pacemaker can be implanted in very elderly patients, in fact the majority of patients are elderly, as the electrical system of the heart degenerates at an advanced age and as a result this is when these problems most commonly occur.

 

Once the pacemaker is in place, how is the patient’s life affected? 

The effect of pacemaker implantation on the patient’s life is minimal. With a pacemaker in situ care should be taken not to pass through the magnetic security scanners such as those found in airports, the second inconvenience is that people with a pacemaker in situ are unable to have an MRI scan. Although we do now have some pacemaker models which are compatible with this diagnostic test.

There are no risks or restrictions with the magnetic devices in shops or with mobile phones or microwaves, to name but a few of the devices that patients often ask about.

 

Pacemaker maintenance and review

As discussed at the start, the first pacemakers had a limited life but current technology allows pacemaker batteries to last an average of 9 to 10 years. When the battery runs out, we only have to remove the pacemaker generator or battery, it is not necessary to replace the lead which is inside the heart. In reality it is the same as changing any battery.

Pacemaker reviews are performed annually except at the start, when an early review is recommended to ensure that all is functioning well. However when the pacemaker battery starts to run out, checks will take place every 6 months until replacement.

Pacemaker reviews are performed using a computer, with an extension which is positioned over the skin where the pacemaker is. With this simple procedure we can check its programming, function, battery life, etc… This process can also now be carried out from home, if the pacemaker has this function available. The majority of pacemakers now possess this technology. The patient has a device which is placed next to their phone. The pacemaker connects through this device to the computer where we can check all the parameters of the pacemaker’s function.

Multidisciplinary Treatment of Breast Cancer

Posted by Xanit Internacional Xanit Internacional | Posted in ALL ABOUT CANCER, women's health | Posted on09-01-2018

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Breast cancer is the most common malignant tumour in women and is occurring more frequently at a younger age.

Throughout history there have been many changes in the management of this condition, both in terms of diagnosis and treatment. Developments have led to recovery being achieved in close to 85% of cases. But one of the most significant developments has been the multidisciplinary approach to this condition, which guarantees the most appropriate treatment for each patient according to current scientific standards. Breast cancer should be treated by a multidisciplinary team, specialised in the breast, offering individually tailored treatment in each case.

 

Multidisciplinary team in the treatment of breast cancer

Dr Fran Fernandez, from the Breast Unit at Vithas Xanit International, explains in this post the role of each of the professionals involved in the multidisciplinary treatment of breast cancer, a key part in the patient’s recovery process.

  • Radiologists, they are fundamental to the whole process as they are “the gateway,” they initiate the whole process of breast cancer diagnosis, performing the necessary tests to arrive at a more accurate diagnosis. They not only play a part, they are essential in the marking of the majority of lesions for later removal in theatre.
  • Pathologists have acquired a distinct role in the last few years, no longer being simply those who confirm malignant disease, but those who perform diagnostic tests and provide reports with the great amount of information required to offer the most appropriate treatment for each patient.
  • Nuclear medicine physicians play a major role in our theatres for important sentinel node localisation, a technique which has prevented innumerable cases of axillary emptying and its subsequent problems. They work with the radiologists using other investigations focused on diagnosis, of great use in the management of breast cancer.
  • Gynaecologists are active participants at the very beginning of the process with screening of asymptomatic patients, detecting possible abnormalities during their examination.
  • Medical oncologists and radiation oncologists are another critical link in the chain. They are responsible for administering chemotherapy treatment or prescribing radiotherapy, both before and after surgery, to help shrink tumours and promote a higher cure rate with comprehensive treatment of the disease. They are also those responsible for research and better understanding of the disease, participating in the multiple research studies required to learn more about the disease and therefore improve treatment where possible.
  • The plastic surgeon, aesthetic appearance is also crucial, participation of the plastic surgeon is therefore essential to improve results.
  • The general surgeon, who in this case serves as a common link to the whole team, manages the patient’s journey in the agreed manner from the moment presented at the committee, deciding on technical aspects of the surgery when required.

 

Vithas Xanit Oncology Committee

The cases of patients who are newly diagnosed with breast cancer are presented weekly at the Oncology Committee. The committee’s radiologists, pathologists, medical and radiation oncologists, nuclear medicine physicians and surgeons decide together on the best treatment option for each, individual patient. From that point on, a multidisciplinary decision is taken in the same Oncology Committee regarding any new circumstance that may patient may develop. Thus, results following surgery, the end of treatment or any other incident result in further discussion of the case to ensure the best decision is made.

A multidisciplinary team provided for the patient, it achieves its objective: the complete recovery and rehabilitation of the patient, in 85% of cases. Prevention and regular mammograms are also an essential part of effective treatment.

AMD Age-Related Macular Degeneration

Posted by Xanit Internacional Xanit Internacional | Posted in Ophthalmology | Posted on09-01-2018

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Sight is the sense that most deteriorates with age. Conditions of varying magnitudes and importance start to appear, including those which are quite common among the population such as age-related blurred near vision, presbyopia and cataracts, as well as other more serious ones such as Age-related Macular Degeneration (AMD).

Dr. Cilveti, Head of the Ophthalmology Department talks to us about this disease which affects around 700,000 people in Spain (1.5% of the population). It is expected to be one of the conditions associated with blindness that will increase most over the coming years.

AMD is a degenerative eye condition which affects the central area of the retina (called the macula) in people over the age of 50. The macula is responsible for central vision and fixation and therefore enables common activities such as reading, watching the television or driving. The main risk factor is age, the condition only affects people over the age of 50 with the risk significantly increasing after the age of 65.

It is one of the current challenges in ophthalmology as it can seriously affect central vision, that is to say, it can leave us unable to read or see details, it is becoming more and more common and does not have a definitive cure. However, we shouldn’t give up hope, we should learn to understand it, prevent it as much as possible, and above all, detect it in time to be able to treat it.

 

What symptoms does AMD cause?

The symptoms of macular affectation can include, from greater to lesser frequency:

  • Blurred central vision, preserving peripheral vision.
  • Alteration in the shape of images (metamorphopsia).
  • Alteration in the size of images: bigger (macropsia) or smaller (micropsia).

The causes are not understood in any depth, although we know many factors which encourage it. Firstly there is a genetic factor, we therefore see families where there are multiple cases, it appears more in patients with blue eyes and in those with greater exposure to the sun, it is also more common in those who are long sighted. It can be induced by mechanisms associated with poor nutrition, smoking, hypertension, hypercholesterolaemia and others.

It is clear that not all patients in whom these factors occur develop the disease, but they do have a greater disposition. 

What types of AMD are there?

Dry or atrophic AMD: is the most common form of the disease (90% of cases). Progression of the disease is slow (years) and severe loss of central vision can take decades. Initially it may not cause any symptoms and be diagnosed at ophthalmological check-ups. It causes a progressive loss of nerve cells in the macula.

Wet or exudative AMD: although this form is less frequent (10% of cases), it is more aggressive and leads to loss of central vision in a short time (weeks, months). New tissue appears under the deepest layers of the retina which grows, produces exudate and may bleed.

 

Diagnosis of Age Related Macular Degeneration

Many patients do not notice they have a problem until their vision has become blurred or visual disturbances such as metamorphopsia have appeared. With testing the ophthalmologist can detect the disease at its earliest stages, performing a series of tests, which depending on the degree of affectation, normally include: 

  • Amsler Grid Test: the patient looks at a gridded page to determine the degree of affectation or metamorphopsia. 
  • Fundoscopy: minute examination of the macular zone, to observe the degree of affectation, as well as to determine which one the two types is the problem.
  • Fluorescein Angiography (FA), generally used in wet AMD, it defines the location, extent and degree of activity of the neovascular membrane which fills with contrast.
  • Optical coherence tomography (OCT), displays virtual, microscopic slices of the macula and provides a lot of information to the ophthalmologist, in both the dry and wet forms of AMD. Indispensable for assessing the response to treatment in the wet form.

 

If you are over the age of 55 and you are affected by some or all of the previously described risk factors you should undergo an ophthalmological review at least once a year, even if you don’t notice anything unusual with your sight.

If you are over the age of 55, whether you have any of the other risk factors or not, if you notice a loss of visual acuity, images becoming deformed or difficulty reading, you should request an appointment with your ophthalmologist as soon as possible.

The Ophthalmology Department at Vithas Xanit International Hospital can provide the different treatments and diagnostic procedures recommended for patients over the age of 55.