This space is dedicated to all the information that cardiology patients might find themselves in need of; this data is backed, as always, by the expertise of our team of physicians.



Aesthetic medicine: An optimal treatment for you to be liked by others and more importantly, by yourself

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 06-03-2020

0

 

Mens sana in corpore sano.The phrase comes from Satire X of the Roman poet Juvenal (usually translated as “a healthy mind in a healthy body”). The message is still powerful and can be applied nowadays, in a society where the good physical condition for a longer and better quality of life is increasingly more valued. Today, feeling good with oneself implies feeling good physically and mentally, and such an achievement may have positive effects on our self-esteem, regardless of age or gender. At Vithas Xanit International we are aware of the importance of looking ad feeling well, and for that reason, we offer our patients an aesthetic medicine of the highest quality, highlighting the doctor-patient closeness, personalised attention and the cutting-edge technology used in all individual cases.

All cutting-edge techniques and methods we offer for improving patients’ physical appearance inevitably will have a positive effect on their self-esteem, subsequently improving their inter-personal relationships. It is only natural to like to look good. However, in cases when certain aspects of our physical appearance, either congenital anomalies or those acquired over the years, are making us unhappy and with low self-esteem, aesthetic treatment is, in many cases, a way to find the desired solution.

Such operations and treatments must always be carried out by trained and board-certified specialists who meet all medical requirements. Dr Pilar Gómez Jorquera, a specialist in the area of aesthetic medicine, explains that “what sets us apart at Vithas Xanit International is that we have in a place a complete team composed of aesthetic doctors and dermatologists”. The specialist also adds that “we have a multidisciplinary team to achieve better diagnoses, together with high-quality products and appliances we use”.

Gómez Jorquera explains that Aesthetic Medicine Department at Vithas Xanit International carries out a wide range of treatments, highlighting “hyaluronic acid fillers” offering faster results, “since the volume obtained is immediate, although for the definitive result takes about two weeks, once possible inflammation and subsequent water retention are reduced.” Among the most demanded interventions aesthetic expert highlights that “there are several”, and one of them is “the use of botulinum toxin to relax the musculature of the upper third face and reduce expression wrinkles, further to preventing them”. More generally, the specialist says that “aesthetic medicine today seeks the best way to achieve maximum naturalness by improving the physical aspect”.

And who would be the person to advise us, from the aesthetic point of view, on the right type of treatment for us?  The specialist is clear: The doctor “who is going to treat you is best suited to advise on the most suitable type of treatment, depending on the patient’s needs or aspirations”, stressing that sometimes the support of a psychologist or psychologist may also be helpful.

As in any type of treatment, once it is performed, it is recommended for the person to maintain a good diet and follow healthy lifestyle habits. Also, it is essential to have “a good medical history to assess possible contraindications”, says Dr Gómez Jorquera.

Safety and optimal results are key at Vithas Xanit International.

Health check-ups: Which one is best suited for me?

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 21-02-2020

0

Any time is good to review our health and start taking charge of it accordingly. A health check-up is the best way to do it, but do you know how many types of check-ups are out there or which would be the right one for you? Today, Dr Raquel Martín, from the Health Check-ups Unit, explains some of the fundamental aspects of the selected exams and screenings.

The importance of health check-ups

The importance of undergoing a health check-up is in detecting, in asymptomatic people, risk factors that allow us to prevent and diagnose health problems early.

Here at Xanit Hospital, we have at patients’ disposition several types of health check-up that differ mainly in how extensive they are and which medical specialties they cover.

For example, a basic check-up at Vithas Xanit consists of a detailed medical history as well as a thorough physical examination, accompanied by basic laboratory analysis and simple radiological tests such as chest radiography and abdominal ultrasound.

Types of health check-ups available at Vithas Xanit International

In our hospital we have three basic types of health check-ups. All of them consist of taking a patient’s medical history, reflecting patient’s risk factors, family history, as well as a thorough physical examination (including measuring blood pressure, weight, height, body mass index, basal oxygen saturation). Besides, each of them consists of different investigations and assessments by different medical specialties:

  1. A) Basic Health Check-up:

– Laboratory analysis: Blood count, biochemical coagulation with renal function, liver function, glucose, lipid profile, ionogram, ferric profile, uric acid, thyroid hormones, urine analysis. Faecal occult blood.

– Radiology: Abdominal and pelvic ultrasound. For women, it also includes mammography or breast echography.

– Cardiology: Electrocardiogram, echocardiogram and ergometry.

– Ophthalmology.

– Gynaecology (women): Includes ultrasound and cytology.

– Urology (male).

  1. B) Premium Check-up

– Laboratory analysis: Blood count, biochemical coagulation with renal function, liver function, glucose, lipid profile, ionogram, ferric profile, uric acid, thyroid hormones, urine analysis. Faecal occult blood.

  • Total and free PSA (male).

– Radiology: Chest CT, abdominal and pelvic ultrasound. For female patients it also includes mammography or breast ultrasound, as well as bone densitometry.

  • Cardiology: Electrocardiogram, echocardiogram and ergometry.
  • Pneumology: Spirometry.
  • Otorhinolaryngology: Revision and audiometry.

– Gynaecology (women): Includes ultrasound and cytology.

– Urology (male).

  1. C) Magnum Check-up

– Laboratory analysis: Blood count, biochemical coagulation with renal function, liver function, glucose, lipid profile, ionogram, ferric profile, uric acid, thyroid hormones, urine analysis. Faecal occult blood.

  • Total and free PSA (male).
  • Tumour markers.
  • Serology hepatitis B and C.

– Radiology: Calcium Score CT, chest CT, abdomen CT, brain MRI, thyroid ultrasound, echo-doppler of supra-aortic trunk For female patients, it also includes mammography or breast echography, as well as densitometry.

  • Cardiology: Electrocardiogram, echocardiogram and ergometry.
  • Pneumology: Spirometry.
  • Otorhinolaryngology: Revision and audiometry.

– Gynaecology (women): Includes ultrasound and cytology.

  • Urology (male).
  • Dermatology: Skin cancer screening, digital dermatoscopic study of moles.

But which one is best suited for me?

In general, our patients can choose from any of the different check-ups according to their wishes and needs, although there are some general recommendations when deciding on the type of check-up:

  • Basic check-up: It is aimed at young patients, asymptomatic, with no family history of particular relevance or cardiovascular risk factors.
  • Premium check-up: Further to those examinations carried out in Basic check-up, Premium also includes chest CT and spirometry, therefore, is of particular interest in smoking patients.
  • Magnum check-up: This type of check-up is particularly useful in patients with a family history of neoplastic disease, or those with cardiovascular risk factors for the diagnosis of silent arteriosclerotic disease.

The time needed to conduct each of the check-ups varies on the type selected, ranging from 2-3 hours (the simplest check-up) or having to stay in the hospital throughout the morning, if you are to be assessed by various specialists or for more complex imagining tests.

The whole process will take place here at Xanit, you will visit different areas within the hospital, mainly outpatient’s clinics and radiology department.

Depending on the type of check-up to be performed, the time may vary until the final results are obtained. Basic check-up results can be available in 48-72 hours, while getting all the results of a Magnum checkup can take up to 7 days.

Once all the results of the various investigation tests are available, a written summary will be given to the patient with further explanation in details by an Internal Medicine Physician who coordinated and oversaw the entire check-up.

In the event that the patient is unable to present to collect the written summary, it can be managed to send the information safely and clearly.

General considerations

Regardless of the type of a health check-up you decide to go for it is essential that you present fasting for the laboratory analysis, further to allowing those radiological tests that require contrast, such as abdominal CT or coronary CT.

Also, it is recommended to wear comfortable clothes and shoes, to facilitate physical examination and to be performed some investigations such as ergometry (stress test).

Ask for more information about which health check suits your needs.

Because prevention is always better than cure.

 

All you need to know about the flu

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 15-02-2020

0

Family ill with flu at home

The flu season is already upon us like any other year during the winter months. As soon as the cold weather sets in, the circulation of respiratory viruses increases, especially among children. Of all viruses, influenza is particularly relevant because of its high-frequency occurrence, elevated impact on the health of those affected and their families, and the possible complications that it might entail. Today we spoke with Dr Conejo, Head of the Paediatrics Department at Vithas Xanit International Hospital, and we clarified some of the most frequent doubts and uncertainties regarding the flu so common during winter months.

What is the flu?

It is an infection caused by the influenza virus that periodically affects everyone, every year during the cold months, which alternate between the two hemispheres.

What is the flu virus?

It is a virus with great ability to mutate, fundamentally infecting the respiratory system and is transmitted from person to person through the air (coughing, sneezing…), hands or other objects that have become contaminated with the virus with the respiratory secretions or the hands of the infected (doorknobs, railings, toys, etc.).

How many types of viruses are there?

There are basically 2 types of viruses that infect humans: type A and type B. Although the ratio of one to the other changes in each season, in general the most common virus is the influenza A virus.

Within each type, in turn, there are many different subtypes, as it is a virus with great ability to mutate and evolve into new different viruses. Since it is a virus that varies so much annually, it is necessary that get vaccinated each year at the beginning of the flu season.

Thus, the famous influenza A (H1N1) virus that caused the 2009 pandemic was a new variety of A viruses that emerged that year and has since remained as part of the usual viruses that we are exposed to each year.

This is why we should not be alarmed when we talk about “influenza A”, as it is the most common virus, although we all can remember the 2009 pandemic.

Who does the disease affect?

Influenza is a universal infection, capable of affecting everyone, although it mostly infects children under 14 years of age. It makes the paediatric patients the most vulnerable from the flu epidemic and, also, the main transmitters of the disease to other age groups. Besides, up to 20% of hospitalised patients for severe influenza are also children under 14 years of age, the vast majority of times in previously healthy children.

However, most severe cases occur in people over 65 years of age or those with some risk factors (lung disease, heart disease, etc.).

What are the symptoms of the flu? How is it different from a normal cold?

In many cases, the symptoms of influenza and the common cold are indistinguishable, as most influenza syndromes are mild in children.

In general, the main symptom of influenza is elevated fever over 39º C), which is usually accompanied by muscle aches and headaches. These symptoms generate great general malaise and a major feeling of weakness, which is often a source of concern on behalf of child’s parents (the child is usually very down, with a loss of appetite or desire to play, etc.). It is usually accompanied by cough, phlegm, sore throat, nasal congestion and sneezing, although in general, the symptoms are less intense than in common cold. Most often, symptoms resolve themselves within 5-8 days, although coughing and tiredness can last for several weeks.

On the other side, the symptoms of common cold and other viral infections usually start progressively over several days (first cough and phlegm and then fever or the rest of the symptoms may appear), the fever is usually less intense, although it can also be high, and is usually accompanied by less affectation of the general condition and less headache. In the case of common cold, the predominant symptoms are the affectation of the upper respiratory tract, with more phlegm, nasal congestion and more intense cough. Finally, the duration of the fever is usually shorter in these cases, between 3 and 5 days most of the time, although the rest of the symptoms (cough, phlegm…) can take up to 2-3 weeks to completely disappear and some infections usually overlap with others.

How is the flu treated?

As it is a viral infection, and although some antivirals are available that could be used in very specific cases, there is no curative treatment capable of shortening the duration of symptoms that can be applied to the general population. As the popular saying goes, the flu “lasts 7 days without treatment and a week with treatment.”

The only thing we can do is control the symptoms so that the patient is as comfortable as possible for the duration of the infection. If there is fever or discomfort, the usual painkillers (paracetamol, ibuprofen) can be used, avoiding the use of aspirin or influenza compounds containing it. It is also important to maintain good hydration and avoid other toxic irritating agents, such as tobacco smoke. It is not recommended to force food intake. It is recommended to rest at home, at least up to 24 hours after fever stops.

For paediatric patients, it is not recommended to use anti-catarrhal drugs, anti-cough medication, mucolytics, influenza compounds, anti congestive drugs, antihistamines, vitamins, etc., since their effectiveness is not proven and can be associated with adverse effects. Antibiotics have no beneficial effect and should be avoided in the absence of complications.

When is a consultation with the paediatrician recommended?

In the vast majority of cases, the flu behaves like a mild illness, from which the child will eventually recover smoothly. However, you should consult your paediatrician if:

  • The fever is very high and persistent.
  • The child is very irritable or sleepy.
  • The child looks bad or has shortness of breath.
  • If the child has a rash on the skin.

How can it be prevented?

The flu is very contagious and it is impossible to completely avoid infection in epidemic times. However, some means may minimise the risk of infection. General hygiene measures focusing on proper hand hygiene, have been shown to reduce transmission of the virus partially and are universally recommended, as are other measures such as the use of disposable handkerchiefs, covering the mouth with the inside of the elbow rather than by hand when coughing or sneezing or using masks in certain environments.

The most effective measure we have today to prevent serious cases is the influenza vaccine. Although it does not have a 100% efficacy (no vaccine has it), it has been useful to avoid up to 60% of severe cases, depending on the degree of concordance between the viruses included in the vaccine each year and the viruses that eventually circulate in each season.

The Vaccine Advisory Committee of the Spanish Association of Paediatrics recommends influenza vaccination in the following cases:

  • Risk groups: children from 6 months of age and adolescents in certain situations or those with basic diseases (diabetes, asthma, etc.).
  • Healthy children from 6 months of age, adolescents and healthy adults living together with patients at risk.
  • Members of the family with infants younger than 6 months of age and with risk factors, since the infants cannot receive the flu vaccine.
  • Pregnant women, regardless of the weeks of gestation.
  • All healthcare professionals.

Vaccination of children without risk factors (universal vaccination) can also be assessed, as it is common in many developed countries (United Kingdom, USA). USA, Australia, etc.).

But also to be vaccinated are:

  • People over 65 years of age or those of any age who have long-term health problems.

Who should not be vaccinated?

  • People who have had a severe allergic reaction to previous vaccination with a flu vaccine.
  • Children under 6 months.
  • If a person has an acute illness with a high fever, we should wait until the underlying condition is resolved first.

 

The 10 commandments to prevent drowning of children on beaches and in swimming pools

Posted by Xanit Internacional Xanit Internacional | Posted in Miscellaneous, Pediatrics | Posted on 10-07-2019

0

Every year, a significant number of children die in Spain from drowning in the sea and swimming pools. To make sure that the number of casualties from previous years will not repeat, Vithas and ojopequealagua.com offer you ten recommendations to make your and your child’s holiday as fun and safe as possible.

Besides, these recommendations are tailored not only for children but for the elderly members of the family too, given that there is an elevated risk for their security when it comes to swimming in the sea or swimming pools.

 

Measures to prevent drowning in swimming pools   

  1. Continuous monitoring: The child must be monitored at all times by an adult who, if absent, must have another trusted guardian.
  2. Rule 10” 20”: The adult must look at the child every 10 seconds and stay at such a distance as to allow him to reach the child in 20 seconds, should that be necessary.
  3. Detecting risks: It is important to check if there is any way for the child to reach the pool alone and if so, to know how to prevent it.
  4. Protection: Incorporate safety devices that prevent the child from getting into the water in an oversight.
  5. Learning: Before the summer and from quite an early age, children should learn to float first and then to swim. In any case, the child also must be monitored while learning to float.
  6. Rescue device: Have on hand life-jacket, pole and phone to contact emergency services.
  7. Orderliness: Keep away from the pool toys or objects that attract the child’s attention, making them get closer to the water.
  8. Drainage: Make sure the drainage systems are off, and the children are away from them.
  9. Safety: Have fences, winter covers, perimeter or immersion alarms, flotation elements adapted to each child.
  10. Emergency: Learn the cardiopulmonary resuscitation sequence (CPR) and the emergency phone number (112).

 

Measures to prevent drowning in the sea    

  1. Always accompanied: Never let children go to the beach alone. They do not have the same perception of danger as we do and can belittle it.
  2. Better with lifeguard: Choose beaches with lifeguard service. Respect and follow their indications.
  3. Swim Vest: It is better if a child knows how to swim, but if not, in the sea, better to wear on a swim vest than swim floaties or water wings.
  4. Avoid jumps: Tell children not to jump from rocks or any elevated platform and teach them by example.
  5. Be wary of inflatables: Inflatable rubber or plastic mattresses and floaties give a false sense of security.
  6. After eating: Children should slowly enter the water as there is a risk of hydrocution in the face of sudden changes in temperature.
  7. Watch constantly: There are a lot of people on the beach. Do not leave them alone for a minute.
  8. Trust the lifeguard: If you have to do a rescue, always follow the lifeguard’s instructions.
  9. CPR saves lives: Learn the cardiopulmonary resuscitation sequence (CPR) and the emergency phone number (112).
  10. Protect children from the sun: Apply SPF 50 sun cream frequently, make sure they wear a cap, sunglasses, light clothing, sunscreen lip balm. Heat strokes can be fatal in the water.

*These recommendations are extendable to swamps, water reservoirs or ponds that form on some beaches when the low tide.

By following these recommendations you and your family will enjoy a refreshing and safe holiday.

Happy summer!

Infectious meningitis in children

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics, Xanit salud | Posted on 24-04-2019

0

What is meningitis?

Meninges are membranes covering the Central Nervous System (CNS: brain, cerebellum and spinal cord) that have protective functions, among others. Between meninges, there is cerebrospinal fluid (CSF), which surrounds the CNS, also helping in its protection. When a pathogen germ penetrates these membranes and reaches the Central Nervous System, inflammation of the meninges (“meningitis”) occurs as a result of both the pathogenic activity of the germ and the body’s defensive response to the invasion. Some patients may also have particular risk factors that make them especially prone to certain types of meningitis.

Further to infectious meningitis, which is the most common type of meningeal inflammation, other diseases can cause inflammation by abnormal activation of the immune system in the absence of infection (autoimmune meningitis).

On some occasions meningitis can be accompanied by a very severe generalised disorder known as sepsis.

 

How many types of infectious meningitis are there?

Classification of meningitis can be made based on different parameters. In general, the most common classification differentiates meningitis according to the germ that causes the infection. Thus, we can distinguish:

  1. Viral meningitis: Caused by many different viruses. It is the most frequent type of meningeal inflammation.
  2. Bacterial meningitis: Produced by different bacteria. It is the most severe type of meningitis. The most common bacteria in our environment today are meningococcus and pneumococcus. In the case of meningococcus, there are several different subtypes (serogroups) (A, C, Y, W, B), each with some specific characteristics. In newborns, the most common are germs related to the birth canal.
  3. Tuberculous meningitis: Provoked by the bacteria that causes tuberculosis. This type of meningitis is also serious, although it is rare in our environment in the absence of risk factors.

 

Is meningitis common?

We should mention that, despite the potential severity of the disease, the meningitis is rare in Spain at present, with the majority of cases occurring in children under five years of age, especially children under one year of age and adults over 65.

Talking about meningitis/meningococcal sepsis, which is the most frequent among bacterial types, the incidence has decreased progressively over the last 15-20 years. The causes of this decline are little known, although there is evidence that these microorganisms usually have periods of activity oscillating over time that can be unpredictable, further to causing outbreaks in some closed communities (universities, etc.). In fact, in the last 2-3 years, it seems that in Spain we had more cases as a result of the increase in some emerging serogroups.

In this respect, there are great differences between the various serogroups. The most common in Europe and Spain is meningococcus B, responsible for more than 40% of all cases of meningitis in children. On the other hand, although they are less frequent in children, it is worrying the already mentioned rapid rise evidenced worldwide of different serotypes such as W and Y, responsible for around 12 — 13% of cases in children, being more frequent in young adults and over 65 years old.

 

What are the symptoms of meningitis?

Symptoms depend on the age of the patient, as in almost any infection in children. In general, the younger the child, the more non-specific are the symptoms, although fever is present in virtually all cases. In newborns and small children, irritability or drowsiness may also occur. In older children more common are headache, vomiting, stiff neck, or sleep tendency. In all cases, seizures or other signs of neurological involvement may occur. The range of possibilities is very wide.

We should not forget that these symptoms can be non-specific and could be a part any other banal infectious process, so when in doubt, it is crucial to assess the patient by a paediatrician.

 

How is meningitis diagnosed?

First, the complete medical history is taken and analysed, and a detailed physical examination is performed to establish the diagnosis of suspected acute meningitis. A blood test is usually required to check certain parameters that help the diagnosis and allow to differentiate one type of meningitis from another.

However, in order to confirm or rule out suspected meningitis, a lumbar puncture is the definitive and necessary test to be performed.

Further to lumbar puncture, imaging tests, such as cranial ultrasound or computed tomography (CT), are sometimes performed at the discretion of the paediatrician.

 

What does lumbar puncture consist of?

Cerebrospinal fluid sampling is a technique in which a sample is removed through a puncture in the lower back. It is also used to administer epidural anaesthesia used in childbirth and some surgeries.

We usually perform it under topical anaesthesia in the form of cream over the puncture site, although depending on the age and the specific case, it can also be performed under sedation with systemic mediation, generally, but not exclusively, intravenously.

It is the only test that can confirm or rule out the diagnosis of meningitis and identify the germ causing the infection, so it should always be carried out if meningitis is suspected and in the absence of any contraindications.

 

What complications does lumbar puncture have?

In expert hands, it is a straightforward safe technique. With this technique, complications are infrequent and almost always local (pain after the puncture, local bleeding, etc.). In children, pain or stiffness in the back after the puncture is much less common than in adults. In some children, especially newborns and small infants (because of their small size) the technique may be somewhat more complicated and more than one attempt may be needed to obtain a valid sample (it may even be that no sample is obtained at all).

 

What is the treatment of infectious meningitis?

Viral meningitis requires almost no specific treatment. Like many other viral infections, these are banal processes that heal themselves after a few days, so the only treatment is the usual analgesics to control possible symptoms (headache, a general feeling of weakness, etc.). Many of the patients affected by viral meningitis do not even need hospital admission and can be treated at home. A notable exception is the case of infection with the herpes virus (herpetic meningoencephalitis), which is a severe condition that requires hospital admission, often in paediatric ICU, and prolonged intravenous antiviral treatment.

On the other hand, bacterial meningitis requires hospital admission in all cases and intravenous antibiotic treatment, sometimes with more than one antibiotic until the causal germ is identified. It is a serious condition that may need admission to the ICU and aggressive support measures, such as mechanical ventilation, etc.

Other treatments, such as corticosteroids, anti-epileptics or intravenous fluids, may also be necessary.

 

What is the prognosis for infectious meningitis?

Viral meningitis heals itself, and the possibility of complications or sequelae is extraordinarily rare, except in the case of herpetic meningoencephalitis, which is associated with a high percentage of neurological sequelae and mortality, even with the correct treatment.

Bacterial meningitis/sepsis has a mortality of practically 100% of the cases without adequate antibiotic therapy, although with a correct treatment patient clinical progress is usually good. However, even with early and correct treatment, approximately 1 in 10 patients die and, of those who survive, 2-3 out of 10 have severe and chronic sequelae.

The actual prognosis depends on many factors (age of the patient, progress period, the presence of other risk factors, causal germ). These are cases that, although rare, are potentially very serious and have a great impact not only on the patient and his family but on the whole community in which they develop.

 

How can we prevent infectious meningitis?

Viral meningitis cannot be prevented. The viruses that cause it are multiple, and of constant circulation between humans, so it is impossible to avoid contact. The exception is herpetic meningoencephalitis, which does have some measures to avoid infection in the birth canal in newborns, although there is no real prevention option at a later age.

Most bacterial meningitis can be prevented by using vaccines. Severe meningitis caused by some bacteria very common a few years ago, such as those produced by Haemophilus influenza type B or meningococcus C, have decreased drastically today (they have almost disappeared in the case of Haemophilus) thanks to the vaccination of the entire population against these germs included in the vaccination calendar financed by the Public Health System. Another bacterium that causes many cases of meningitis is pneumococcus, whose vaccine (Prevenar ®) has also recently been included in vaccination programs throughout Spain.

Finally, vaccines against the rest of the meningococcal serogroups are also available on the private market. In this respect, it is worth noting:

  • Vaccines against meningococcus B: there are currently two vaccines in pharmacies, Bexsero® and Trumenba®. The first can be used from 6 weeks of age, and the second – from 10 to 25 years. These vaccines are recommended for all children, especially under the age of 5, when the disease is most common. Fortunately, some autonomous communities have begun to include them in their funded vaccination schedules and it is expected that this practice will be extended progressively to the rest of Spain.
  • Vaccines against meningococcus ACWY: there are also two vaccines in pharmacies against these four germs, Nimenrix® and Menveo®. Recently, the Public Health Commission has reported that this vaccine will become funded throughout the country soon, replacing the meningococcal C vaccine that is currently administered at the age of 12. However, the Vaccine Advisory Committee of the Spanish Association of Paediatrics recommends starting vaccination during the lactation period, as some autonomous communities have already put in practice.

In some specific cases, such as patients with risk factors, under current outbreaks of the disease or laboratory personnel, these vaccines may be financed by Social Security.

Further to vaccines, preventive antibiotic treatment is recommended when in close contact with confirmed cases of bacterial meningitis, which, in the event of school outbreaks, can be extended to all staff and students at the centre.

 

António J. Conejo Fernández.

Childhood cough or asthma

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 28-02-2018

0

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),

Childhood vaccination? A response from the experts

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 23-10-2017

0

Vaccination yes, no…? When? How many? The vaccination process poses many questions for parents. For this reason we are talking to Dr Conejo, Paediatrician at Vithas Xanit International Hospital, who is going to help dispel some of the most common myths surrounding the subject.

Firstly, the big question:

What are vaccines?

To explain: they are biological products given with the objective of producing a controlled immune response, similar to that produced by a natural infection, but with practically no risk. They are therefore a way of providing protection against certain microorganisms in case of future exposure.

It is important to bear in mind that vaccines are not 100% effective; in some cases, depending on the type of vaccine, it is possible to have an infection from a microorganism even after a vaccine has been given. In such cases vaccination usually achieves development of much milder symptoms than if the disease had been caught without prior vaccination.

Why do children have to be vaccinated?

The development of vaccines has made it possible to absolutely control many of the infectious diseases that have been responsible for the greatest mortality throughout history, including measles, chickenpox, diphtheria, rabies, tetanus… Nowadays all these infectious diseases have been relegated to isolated cases, the majority occurring in countries with weak vaccination policies and vaccine coverage. Smallpox is notably an infection which it has been possible to completely eradicate from the planet. Others, such as poliomyelitis, are now also very close to being eradicated.

It is known that there are many viruses which are strongly implicated in some types of cancer, therefore vaccination against these can protect against the development of associated tumours. For example the hepatitis B virus is related to the development of liver cancer, and the human papilloma virus is related to many cervical, penile, anal and ENT cancers.

Additionally the protective effect of the vaccine can extend to unvaccinated people as a result of the decreased circulation of the microorganism amongst the vaccinated population. This is known as community or herd immunity, and can benefit individuals who cannot be vaccinated directly due to specific circumstances.

Do vaccines have side effects?

As with all biological or pharmaceutical products, vaccines can have adverse effects, however they are generally mild and well tolerated, on very rare occasions they can be serious.

The most common are pain and swelling at the site where the vaccine has been given. Systemic adverse reactions are much less frequent and are often milder. Amongst the most common are general malaise, anorexia (loss of appetite) and fever.

When should I vaccinate my child?

There are different established vaccination schedules which clearly specify the ideal ages for the administration of each vaccine. The most comprehensive calendar in our country is that developed annually by the Spanish Paediatric Association’s Vaccine Advisory Committee.

However, in practice the calendar which is applied and funded throughout Spain, and recommended by the different Spanish autonomous communities, is based on the schedule presented by the Interterritorial Council.  Both schedules, that of the Advisory Committee (ideal) and of the Interterritorial Council (financed), have become increasingly similar thanks to a great joint effort in recent years, although there are still some vaccines recommended by the Advisory Committee which are not recognised in official schedules.

Is there any reason not to vaccinate my child?

Vaccines, like other medical products, have permanent, absolute contraindications to their administration in some people. However there are only two absolute contraindications: allergy to any of the vaccine components (or anaphylactic reaction to a previous dose) and encephalopathy of unknown origin, developed in the 7 days following administration of any vaccine with a whooping cough component. In this last case, the contraindication only affects vaccines with the whooping cough component, all other vaccines can be given as usual.

There are also some temporary contraindications which mean the vaccine should not be given during a determined period of time, although it can be given once the situation in question has been resolved. Included in this temporary group are pregnancy and temporary immunosuppression in the case of live attenuated vaccines. There is also a contraindication in those suffering from moderate or serious intercurrent illness. Mild illnesses such as common colds, mild bronchitis or low grade febrile illnesses, viral in origin, do not constitute a contraindication to the administration of any vaccine, therefore vaccination should not be delayed in respect to the established schedule.

What happens if vaccination is delayed?

Except for a few, specific vaccines which are given under exceptional circumstances, there is no maximum interval for the different doses of the same vaccine, applying the general principle that if a dose has been given the dose is counted. According to the age of the patient and the type of vaccine, vaccination should be completed with a determined number of doses, the doses administered should always be considered as such under any circumstances.

However, the recommended intervals between vaccines should be adhered to whenever possible, having been well researched.

Any special measures for premature babies?

Premature children are especially vulnerable to infection as a consequence of their immature immune system, therefore optimisation of vaccination in this population is of paramount importance.

As a general rule, the same vaccines should be administered and with the same prescription as for full-term infants, always taking into account the chronological age and not the corrected age of the child. The only exception is Hepatitis B vaccination in children under 2000 g born to a mother with Hepatitis B, these babies need to have an extra dose of the vaccine during the first 12 hours of life, together with the specific immunoglobulin, with the objective of preventing the infection.

With regard to vaccines not included in the funded schedule, the rotavirus vaccine particularly is recommended (from 25 weeks of gestational age) and the influenza vaccination from 6 months of chronological age.

Which vaccines does my child need? Paediatrician’s recommendations

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 02-03-2017

Tags:

0

 

We understand the importance of your child’s health, as parents it is what worries us the most. Disease prevention is essential for your child to be able to lead a healthy life and the most effective way of protecting children from possible infectious diseases is vaccination.

In this post we will review all the vaccines that your child will need including those which are in the Spanish Association of Paediatrics’ vaccination schedule 2017 as well as those that are not.

This schedule establishes the age and the dose for each vaccine. In it we can see that the recommended vaccines are divided into funded and non-funded.

Let’s have a look at the vaccination chart:

  • Funded Vaccines. These are those which all children in Spain receive and they are free. They include the following: hepatitis B, diphtheria, tetanus, whooping cough, polio, Haemophilus influenzae type B, meningococcus C, pneumococcus, mumps, measles and rubella, chicken pox and human papilloma virus (for girls only).

In addition to these, children in Catalonia, Ceuta and Melilla are also vaccinated against hepatitis A.

 

  • Non-funded vaccines. These are those which are not included in the public health schedule, therefore they are not free and must be paid for by the patient. However the Spanish Association of Paediatrics’ Advisory Committee on Vaccines (CAV-AEP) considers it appropriate that all children receive them. The vaccines which qualify include the rotavirus and meningococcus B for babies and tetravalent meningitis vaccine in adolescents.

 

Remember that the paediatrician is the expert who should assess each case, therefore in addition to these general recommendations, there are many situations in which the schedule should be individualised due to personal circumstances.

 

The non-funded vaccines are discussed below in detail. Which are they and what are they for?

  • Rotavirus vaccine:

Rotavirus is the main cause of childhood gastroenteritis. It is also the cause of more serious symptoms, which can cause dehydration and other associated disorders in babies and young children.

This vaccine has shown to be extraordinarily effective in reducing the number and seriousness of infections due to the rotavirus, therefore avoiding hospitalisation, days of absenteeism from work and school etc, as well as preventing other pathological conditions in which this virus is implicated.

 

  • Meningococcus B vaccine:

Meningococcus B is a bacteria which causes very serious infections such as meningitis and sepsis (blood infection).

Despite the low incidence of this disease in our country in the last few years, the Advisory Committee for Vaccines recommends vaccination against meningococcus B for all children over the age of 2 months.

 

  • Quadrivalent conjugate vaccine against meningococcus ACWY:

In addition to the most common meningococcal strains in Europe named earlier: B (not funded) and C (funded), there are other serotypes which are less frequent but which have become relevant in the last few years, such as meningococcus serotypes Y and W.

 

The Spanish Advisory Committee on Vaccines recommends administration of this vaccine at the start of adolescence, in place of the monovalent vaccine against meningococcus C.

 

At the moment this vaccine is not available in pharmacies, although it is foreseen that it will be within the next few months.

 

  • Human papilloma virus (HPV) vaccine in males:

Males are involved in the transmission of the virus, however genital (penis, anus) cancer as well as more significantly cancer of the head and neck have also been described in men as a result of HPV.  Genital warts, which are much more frequent, are suffered equally by both sexes.

 

The two vaccines currently available against HPV protect against the types of the virus most commonly associated with these tumours. The quadrivalent vaccine also protects against the viruses involved in genital warts.

 

Although in some countries both sexes are already vaccinated against HPV, in Spain at the moment the Advisory Committee for Vaccines recommends informing parents on the possibility of male vaccination and taking an agreed decision.

 

Dr. Conejo, Paediatrician del Hospital Vithas Xanit Internacional

A day in the Accident & Emergency Unit at Vithas Xanit International

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 26-01-2017

Tags:

0

Today we shall be going inside Vithas Xanit International Hospital to see how it functions and to learn more from the doctors and staff about the day to day running of the Emergency Unit

We shall go inside the most interesting parts of Vithas Xanit that we know little about. SHALL WE BEGIN?

In any one day there are approximately 23 professionals in the A&E Unit. 23 people who attend to the running of the Unit and give the maximum care to each patient.

Each day we can find 5 doctors, 7 nurses, 1 auxiliary, 2 porters, and 2 X-ray technicians. This department counts upon the support of 5 staff in the reception, 2 cleaners, and a welfare person to care for International patients.

Over the course of the year on average the A&E Unit attends to 230 people per day, 100 of which are pedeatric cases, and 130 are adults. This amounts to an approximate total of 83.950 people per year.

What kind of emergencies do we see in Xanit?

The type of emergency depends on the time of year. At the moment, and around Christmas time, we see a lot of respiratory cases; catarrh, colds and flu.

Furthermore, we also see cases related to traumatology, along with many pedeatric cases.

The average profile of patients visiting the A&E Unit is adults between the age of 40 and 50, and the majority are women and children.

Working 24 hours a day

The Emergency staff at Vithas Xanit International care for patients 24 hours a day, 365 days a year.

We have spent an entire day in the hospital and have seen that the busiest hours of the day in the Accident & Emergency Unit are between the hours of10:30 -13:00, and 17:30 -21:00. Although during the summer months this can be later.

Football versus Accident & Emergency

And now for the celebrity news….

Have you ever wondered if a footballer under the influence has come to the A&E Unit? Well the answer is YES.

 

Back to school: smoothing the transition

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 20-09-2016

0

 consejos-de-seguridad-vuelta-al-cole

Going back to school after the holidays is a big change in daily routine, making it a good time to introduce healthy habits into children’s lives. To make the transition easier for children and parents, it is worth keeping a few thing in mind:

Sleep

A good night’s sleep is the first step. School age children need to sleep for between 9 and 11 hours a day. A good sleep pattern supports learning and helps recuperation and growth.

It’s a good idea for children to start going to bed early a few days before returning to school to help them adapt to their new timetable.

 

School bags

Backpacks should be lightweight, have two shoulder straps and not be too heavy. The recommendation is that they should not weigh more than 10 to 15 % of the child’s weight.

 

Getting to and from school

Walking or cycling is recommended when distances allow, encouraging physical activity. Please see the following advice for children when using different methods of transport:

On the school bus.

  • Wait until the bus stops before approaching it from the kerb.
  • Do not walk about inside the bus.
  • Before crossing the street check that no cars are coming.
  • Make sure you stay in sight of the bus driver.

 

In the car:

  • All passengers should use the appropriate seat belts/booster seats.

 

By bicycle:

  • Always use a helmet for cycling, however long or short the journey maybe.
  • Know the rules of the road and follow them.

 

Walking:

  • Make sure children use a safe route and know the rules for staying safe.
  • Ensure a child is old enough to be safe travelling without an adult before going to school alone.

 

Diet

Breakfast is the most important meal of the day. As well as improving performance in school, it helps children to maintain an appropriate weight.  The ideal breakfast for a child consists of between 20 and 35% of their daily energy intake. It should include milk or dairy produce, cereals and fresh fruit or natural fruit juice to provide energy, protein and vitamins. Paediatricians recommend that the family should eat breakfast together in an unhurried, stress free environment. With this in mind it is a good idea to wake children early, leaving them plenty of time to be able to finish their breakfast calmly.

It is also useful for parents to make a note of school lunch menus when preparing dinner, making sure that children have a varied, balanced diet which includes fruit and vegetables every day. It is better to opt for seasonal fruit and vegetables, they taste better, they help to vary the menu and they encourage children to eat different types of foods.  Reduction of salt consumption is also important, up to 3 grams a day for those under the age of 7, 4 g a day for those aged between 7 and 10 and up to 5 g a day for adults.

Prevention: schools and spread of infection

Enclosed spaces, such as classrooms, encourage the spread of those illnesses transmitted by contact or breathing (coughing, sneezing, etc.) as well as common infections such as gastroenteritis, colds and conjunctivitis. Other infections such as whooping cough, measles or meningitis can also be spread. With this in mind it is a good time to review children’s vaccinations and update them if necessary, avoiding preventable diseases through vaccination. For those conditions where a vaccine does not exist, hygiene measures such as frequent hand washing, adequate ventilation of enclosed spaces and cleaning of materials used by everyone in the classroom, are important.

All parents of children with chronic conditions such as asthma, diabetes, coeliac disease etc, and of those children who suffer from allergies or other health problems which may affect them, should inform the teachers or school head of the problem and any measures which may need to be taken.

 

After school

 

On arriving home from school, children need to be supervised. A responsible adult should be available when they return home.

Many children take part in after school activities. It is important that activities are appropriate for the age group, do not prevent children from having free time or time to rest, and that they do not become a daily chore.

Exercise: At least one sporting activity outside school

As school age children ought to do at least one hour of moderate-intense physical exercise a day, when planning timetables and extracurricular activities it is advisable that at least one of them is related to sport. This also establishes a routine which helps to prevent the development of obesity as well as improving school performance and the child’s state of mind.

We should remember that when children take part in sports, they need to have the correct clothing and footwear, as well as the appropriate safety equipment.

 

Dr Marta García Ramírez

Paediatric Department Vithas Xanit International Hospital