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Find out everything you need to know about atopic dermatitis

Posted by Xanit Internacional Xanit Internacional | Posted in dermatology | Posted on 30-05-2019

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Atopic dermatitis is a common skin condition, especially in paediatrics, currently affecting almost 20% of children. Although it’s symptoms usually disappear as the patient gets older, there are also adults affected by this pathology. Today, Dr Enrique Herrera Acosta, explains what atopic dermatitis is and offers us some practical advice on its treatment, prevention and how to act when faced with this condition.

What is atopic dermatitis?

It is a chronic skin pathology that causes itching and inflammation of the affected areas and gives rise to eczema of different consideration, which, also, leads to other lesions as a result of scratching. After a while, it can be translated into thickening and chronic dryness of the skin. It also psychologically affects the patient, with increased irritability, nervousness and difficulties in having adequate physical rest. It is, therefore, a significant problem for the quality of life of those who suffer it.

What are its main causes?

It is mainly a genetic disease, with the patients showing an individual predisposition to it, meaning they often have a family history of atopic dermatitis. However, whether the genetic factor is triggered or not depends on some external factors, such as very cold and dry environmental conditions. The existence of food or textile allergies further aggravates the situation.

Who does it affect? Does it affect everyone equally?

The initial outbreaks usually appear in the first months of life. Almost 20 per cent of children suffer from it. It is usually diagnosed in childhood and in most cases, tends to disappear as the patient is approaching adulthood; however, there are also reported instances of debutant adults with atopic dermatitis.

Is there a way to prevent atopic dermatitis?

There is no cure, nor unique treatment. However, the effectiveness of preventive measures and good personal care of atopic skin is proven. The personalised diagnosis by a dermatologist is essential, so when outbreaks or significant lesions occur, the patient can receive the appropriate treatment and specific pharmacological prescription with the correct dosage.

What treatments or recommendations would you give to prevent its occurrence?

Indoor places with dry air should be avoided by those suffering from atopic dermatitis. That is why it is important to maintain proper hydration of the skin. Atopic dermatitis entails a weakened skin barrier, which is why the lack of moisture in the air favours the extreme dryness of the skin, which tends to crack and increases the likelihood of eczema and skin lesions typical of the disease.

Too low temperatures are also not good, because it also reduces hydration, reduces the generation of skin fat and further weakens such vulnerable skin. Cold also increases the feeling of itching, the patient scratches more, and secondary injuries worsen.

People who suffer from atopic dermatitis should wear 100% cotton garments, avoid sudden changes in temperature and use specific hygiene products, which the dermatologist recommends in each case.

The showers or baths can not be very long and the water should be warm. The shower gel should be mild, it is also advised to use shower oils. Do not exfoliate or use abrasive products. The skin should be dried without rubbing it with the towel, rather pat drying it.

Another thing to bear on mind is, as silly as it might seem, to keep your nails short and trimmed; the idea is to avoid scratching at all cost, but sometimes it happens unconsciously, for example, while you sleep, and the shorter the nails are, the less aggression will be produced over the affected area.

How should atopic skin be treated?

Using ointments or creams with corticosteroids is the general treatment in cases of mild-moderate outbreaks. As for maintenance and topical corticosteroid creams, there are inhibitors of Calcineurin, Tacrolimus and Pimecrolimus, which dermatologists use extensively during in-between outbreak periods.

When the extent of eczema is considerable, treatment resorts to cycles of oral corticosteroids. If the patient requires several cycles per year or stops responding to corticosteroids, it is necessary to consider choosing immunomodulatory drugs, other than corticosteroids, such as cyclosporine, mofetil mycophenolate, azathioprine, methotrexate…

Currently, there are also very encouraging results with biological drugs, such as Dupilumab, Omalizumab or Ustekinumab, which are used for other skin pathologies and could be effective in patients with severe atopic dermatitis.

What are the differences with other types of dermatitis, such as seborrheic or contact dermatitis?

Seborrheic dermatitis – is a skin disease also with a genetic predisposition, but can also be caused by fungi or excess of sebaceous glands. The lesions appear on the scalp and face, with noticeable redness and flaking. This fact makes a big difference from atopic dermatitis which can affect the whole body: the face, the flexion areas of the neck, arms and legs, meaning the folds of elbows and knees, and, in adults, damage appears in almost any area of the body.

Contact dermatitis. It is the skin’s response to contact with a particular substance, whether in food, textile or object… It does not have to be an allergy, but it can be a clue that there is an allergy.

Now in summer, what special recommendations should be given during hot months?

First of all plenty of moisturising, the more the better, but not over the areas affected by an outbreak of dermatitis. Moisturising is a preventive measure, to avoid irritations. When there are outbreaks, skincare will depend on the specific recommendations of the dermatologist.

When it comes to showers and baths, the recommendation is to do it in moderation. They should not be too long, in very cold or very hot waters.

Sun exposure is often a good ally in the treatment of eczema, so we sometimes use artificial narrowband ultraviolet radiation to control outbreaks. Still, always in moderation and without getting burned.

On the other hand, during outbreaks, you have to be careful with swimming pools because chlorine dries the skin very much, and for that reason, it is necessary to rinse your skin well after bathing — it is a good recommendation for everyone, but much more for people with atopic dermatitis. On the contrary, seawater is recommended because it enhances the beneficial effects of the sun.

Can atopic dermatitis be cured?

As it is a genetic disease, the answer is no. The medication can alleviate symptoms, depending on the severity of the cases. However, symptoms can disappear by itself with the progress of each individual, or attenuate with time, but there is no treatment to cure it.

Technology: Learn about calcium score

Posted by Xanit Internacional Xanit Internacional | Posted in cardiology with heart | Posted on 24-05-2019

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The Cardiology Department at Vithas Xanit Hospital incorporates all the diagnostic and therapeutic procedures available today. It allows us to offer personalised care for any cardiovascular disease using the latest technology.

Within this framework, the Score Calcium technique is used to detect the presence, location and extent of calcium in the coronary arteries. Accumulation of calcium in the arteries can lead to atherosclerosis (buildup of fat in the arteries) and exposes the patient to an increased risk of a heart attack.

With this technology, we obtain markers that allow us to evaluate the cardiovascular risk of the patient and subsequently determine the most appropriate treatment plan according to the results.

What does Calcium Score consist of?

It is a technique used to determine whether coronary arteries are blocked or narrowed by the accumulation of plaque. It is performed by cardiac computed tomography (CT) using special X-ray equipment to create photographs of arteries that allow quantification of coronary calcium.

What do we diagnose with Calcium Score?

Information obtained through this system can help assess whether the patient is at risk of a heart attack. It is an exploratory study that may be recommended to patients who have risk factors for coronary artery disease but who have no clinical symptoms.

How is it carried out?

Once the patient is laid on the examination table, electrodes (small “sticky” discs) are placed on the patient’s chest and connected to an electrocardiograph (ECG) machine that records the electrical activity of the heart.

The table moves quickly through the scanning device to determine the correct starting position for scanning, and then the table moves slowly through the machine while scanning is performed.

Patients are asked to hold their breath for a time of 10-20 seconds while the images are recorded.

What benefits does it have?

This technology is a practical, non-invasive way to assess whether the patient is at increased risk of a heart attack. The examination is performed in a short time, does not cause pain and does not require the injection of contrast. It also does not leave traces of radiation in the body, nor does it usually have side effects.

Cardiac surgery, from its beginning until today: how has it evolved?

Posted by Xanit Internacional Xanit Internacional | Posted in cardiology with heart | Posted on 09-05-2019

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The heart has been one of the most mysterious organs throughout the history of medicine.

It took us 2,000 years to walk the 3 centimetres that separate the skin from the pericardium. Here is a brief review of the history of cardiac surgery.

The first cardiac intervention was performed in 1815 by the Spaniard Francisco Romero, who successfully performed the first thoracotomy followed by pericardiectomy.

Despite the lack of support from the scientific community of the time, cardiac surgery continued to advance and in 1896, Dr L. Rehn, a surgeon from Frankfurt, performed the first direct suture of the heart. In America, Dr L. Hill was the first to report the surgical repair of a heart wound in a 13-year-old male. In 1923, E. Cutler performed the first mitral valvulotomy in Boston.

The first major achievements of cardiac surgery took place in the 40s. Among all the surgeons who contributed to the advancement of cardiac interventions, outstanding was the role of Dr D. Harken, a surgeon of the U.S. Navy who, during World War II, extracted 134 projectiles from the mediastinum, 55 from the pericardium and 13 from the heart cavities, without any patient dying.

Until now, only interventions to correct external lesions of the heart had been possible. It was necessary to obtain devices that would allow the blood to be pumped and oxygenated out of the body so that the heart could be temporarily stopped.

During the 40’s and early ’50s, all interventions in this field had not yielded good results. In 1953, Dr J. Gibbon was the first surgeon to perform an “open heart” surgery successfully and we started to see an emergence of other devices that replaced the function of the heart, but they were still very rudimentary and their use entailed high mortality.

Appeared techniques such as cross circulation, for which it was necessary the participation of a relative or volunteer, whose heart and lungs were connected in parallel through femoral arteries exercising as an aid during the intervention.

Also emerged the heart-lung machines, a system thanks to which it was possible to perform the first valve replacements and be able to open the heart, obtaining a direct view of the mitral valve.

At the end of the 60s, a new device emerged that allowed correcting electrical defects of the heart. It was the heart pacemaker, invented by J. Reynolds. Undoubtedly, one of the most revolutionary techniques of the twentieth century was heart transplantation and the development of an artificial heart.

Cardiac surgery is still a science in development. We have been able to see how for thousands of years the heart was an unknown and untouchable organ, and how in just 50 years cardiac surgery developed at a rapid speed. It is sensible to think that in the coming decades’ cardiac surgery will continue to evolve and provide new techniques to deal with other types of heart disease that even today continue to shorten life expectancy.