We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Human papillomavirus (HPV) is generally spread through sexual intercourse and mainly infects the skin (penis, vulva, anus) or mucous membranes (vagina, cervix and rectum) of the genitals in both men and women. Likewise, it can also appear in the mouth and the pharynx and tonsils.
This is a frequently transmitted disease and in most cases it does not result in any pathology. It can, however, release a benign disease in the form of warts, or less commonly, different types of cancer. In women, HPV can cause cervical cancer.
HPV is spread via direct skin to skin contact during sex, and not through fluids. In around 90% of cases it disappears spontaneously, but it can be transmitted whilst the virus is present.
HPV is classified in terms of whether or not there is a risk of cancer developing:
It should be said that it is possible to be infected with more than one type of HPV. In addition, persistent infection can result in developing cancer of the cervix, vulva, penis, anus or oropharynx.
Specifically, the virus initiates dysplastic changes in the epithelial cells which continue to evolve until they produce an invasive cancer. This is a progressive process and the time from infection until developing the disease can be up to twenty years.
Genital warts or small protuberances or groups of different sizes and shapes may appear in the area of the genitals.
In the case of cancer, there are no symptoms until it is very advanced. In the case of cervical cancer, symptoms show up as:
In Catalonia, cancer of the womb occurs in 7.2 out of every 100,000 women per year (2003-2007). This represents 2.8% of all female cancers. Between the ages of 35-64 this figure rises to 16.1 cases for every 100,000 women. Furthermore, the risk of developing this disease for women who live to 75 is one in 106.
Anal cancer has an annual incidence rate of 1.8 cases for every 100,000 people, but in the case of men engaging in same-sex relations and infected with HIV, this rises to 70 or 128 cases for every 100,000.
When there is evidence of warts, diagnosis is usually clinical or by biopsy. Cancer is detected by cytology tests, which allow anomalous changes in the cells to be seen before they develop. If the test comes back anomalous it can be complemented by a colposcopy that allows magnified examination of the cervix and samples to be taken.
HPV detection is the main component of a preventative strategy to detect the virus before it reaches the point of disease.
There is no specific antiviral treatment for HPV.
In the case of warts, in most cases they can be eliminated through surgery, ointments or other treatments.
If cancer does develop, treatment will depend on the stage at which it is diagnosed. For example, if it is detected early in the cervix this can involve removing the damaged tissue, whilst in more advanced stages it may require a hysterectomy, radiotherapy or chemotherapy.
The use of condoms is essential to prevent HPV. There is also highly effective vaccine used as a way to prevent cervical cancer. Regular cervical smear tests (Papanicolau test) are also carried out as a form of screening. This strategy, however, is changing due to the techniques used to detect the virus which, together with the smear test, are enabling the different stages of the disease to be monitored (acquisition, persistence, progression to precancerous lesions and invasion).
Migraine is a type of chronic headache characterised by repeated episodes of intense pain that can prevent those affected from going about their daily life.
According to the WHO, it ranks 7th in the list of most debilitating illnesses as it can result in years of inactivity, in suffering and a lack of productivity.
Migraine is the result of activation or irritation of the trigeminal nerve fibres. This nerve has three branches that transmit sensation in the head. The fibres of the first branch surround the blood vessels found in the membranes known as the meninges.
The meninges are made up of different layers of tissue that lie over the brain and it is in these structures where we feel the pain. It is the membrane covering it, not the brain itself, where the pain is felt.
During a migraine, the meninges become inflamed as a consequence of inflammatory substances being released from the trigeminal fibres. This inflammation, or non-infectious “meningitis” is responsible for producing the pain and means that it increases or worsens when upon moving the head. For this reason, resting and staying still brings relief.
A migraine attack may last from 4 to 72 hours. This type of headache may occur any number of times, from once a year to several times in succession.
This condition is three times more common in women than men. It generally starts before thirty years of age and no later than fifty.
There is often a family history of migraine. It can be triggered by various stimuli such as food and drink (cheese, red wine, chocolate), intense odours, bright lights, changes in the weather, changes in sleep patterns, hormonal changes and stress.
The symptoms a patient describes must be taken into account when making a diagnosis. A detailed physical and neurological examination should then be carried out, which should be normal in a person with migraine.
After this first stage, the health professional will decide whether additional examinations are necessary to confirm it is migraine and not another illness.
Certain conditions require further medical investigation such as when:
Although there is no cure for migraine, the right treatment can relieve the pain and prevent it occurring.
The first group includes anti-inflammatories, paracetamol, ergotamine and its derivatives, and drugs generically known as triptans. Preventative treatment is advisable when migraines are very frequent and do not respond well to symptomatic treatment.
The choice of a symptomatic or preventative treatment should be decided and monitored by a doctor. It is very important not to self-medicate to avoid chronic headaches that may be triggered by abusing analgesic medication. If used often or in large doses, both prescription and non-prescription medications can cause other problems.
One way to prevent migraine is to try to avoid the things that trigger it. However, some trigger factors are outside our control, such as migraine caused by menstruation or certain weather conditions.
Keeping a regular schedule and avoiding certain food and drink that may cause migraine, as well as getting enough sleep, are important to prevent it. It is important to have a balanced lifestyle with regular mealtimes and bedtimes.
Frequent and gentle exercise also helps reduce the illness.
You can find more information on the blog Midolordecabeza.org
Crohn's disease is a chronic inflammatory intestinal disease that causes recurring lesions anywhere in the gastrointestinal tract. It particularly affects young people who present episodes of stomach symptoms such as diarrhoea, abdominal pain, fever, blood in faeces or fistulas. Crohn's disease can cause various health problems that may result in changes to the patient's personal, social and family life.
Changes in health directly depend on:
All these changes may make the patient feel their quality of life is getting worse and that they should see their doctor often.
Caring for patients with this disease requires a multidisciplinary approach centred around their needs in order to avoid repeat visits. For this reason patients are treated in specialised unit, such as the Crohn’s-Colitis Unit at Vall d’Hebron Hospital.
The disease manifests as flare-ups. In other words, there are periods when symptoms are active and the patient feels unwell (“flare-ups”) and others when the disease calms down (“periods of remission”).
The most common symptoms during a flare-up are:
The incidence rate of Crohn's disease is 1-10 patients/100,000 people a year and its prevalence is 300 per every 100,000 people. It can appear at any age, but is most common in young adults aged 20-40. It affects men and women equally, and factors leading to a predisposition to the disease include smoking, first degree family members with the disease or changes to the faecal microbiota.
Diagnosis is based on the doctor's assessment of the combined symptoms and subsequent complementary tests that identify and locate lesions in the intestine.
The most important test is the colonoscopy, which consists of inserting a flexible tube into the rectum to see inside the intestine, and through which biopsies can be obtained. Radiological tests can also be used such as MRI or CT scans. The results of the biopsies are used to confirm diagnosis.
Recovery begins with pharmacological treatment, which has vastly improved in recent years, and adopting a healthy lifestyle.
There are several treatment options such as corticosteroids, immunosuppressants, and biological agents, which are used depending on the activity and location of the disease, and taking into account any complications that may arise. Once treatment is agreed it is very important not to stop it, as this would result in a relapse and lack of control over the disease.
Diphtheria is an acute infectious disease caused by the Corynebacterium diphtheriae bacteria and which only affects humans. It may show up as a condition of the upper respiratory tract (tonsils, pharynx and nasal mucosa). The bacteria produces an exotoxin that is responsible for the clinical symptoms of the disease. In adults, it can be fatal in 5-10% of cases, and in children this rises to 20%.
The characteristic symptom of respiratory diphtheria is a greyish white membrane (pseudomembrane) covering the tonsils and pharynx. The membrane tends to be difficult to remove and in doing so the area bleeds easily.
The most common symptoms are:
Thanks to vaccination, there have been no cases diagnosed in Spain for over thirty years. In 2015, however, there was one case in a child who had not been vaccinated.
Diphtheria is transmitted through respiration or close physical contact with an infected person or a healthy person carrying the bacteria but who has never shown symptoms.
The incubation period is two to seven days and it can be spread from seven days before symptoms appear up to two or three weeks afterwards.
Diagnosis is confirmed via microbial culture of clinical samples (swabs from the nasal mucosa, pharynx or pseudomembranes).
Diphtheria antitoxin medication and an antibiotic such as penicillin G procaine must be given as soon as possible (in the first 48 hours after showing symptoms, without waiting for the laboratory diagnosis).
Vaccination is the main measure to prevent diphtheria and is effective in 95% of cases. It must be periodically boosted as the effects of the vaccination do not last for ever.
Epidemiological monitoring and prophylaxis are essential to control the bacteria and to avoid secondary cases.
Diabetes is a chronic disease brought about by the body’s inability to process sugar effectively. It occurs when the pancreas cannot produce insulin, or when the body cannot put it to use. This means there are high levels of glucose in the blood, which can damage organs, tissues and limbs if it remains high for a long time.
There are two types of diabetes: 1 and 2. Type 1 can only be treated with insulin, whereas type 2 can be prevented through doing sport, taking exercise and diet.
There are different types of diabetes depending on the harm they cause:
There are several symptoms which may or may not appear. The most common are:
In the case of type 1 diabetes, these symptoms may appear suddenly or over time, and may significantly affect general well-being.
Between 1980 and 2014, diabetes in adults rose from 4.7 % to 8.5 %. In addition, it has been found to be on the increase in countries with low and middle incomes.
It can be detected with a blood test analysed in the laboratory to measure glucose levels. Diabetes is confirmed if the level is equal to or higher than 126 mg/dL on two occasions. A normal glucose level would be between 110 and 125 mg/dL.
In the case of type 2 diabetes, it can be in the body for many years without detection. For this reason, it is often diagnosed when a complication arises or as the result of a routine blood test.
There are several types of medication that lower blood glucose levels. Each type of diabetes requires different treatment.
Type 1 diabetes cannot be prevented, but environmental factors leading to the process that destroys insulin producing cells in the pancreas are being studied.
On the other hand, a balanced diet and increased physical exercise can help prevent type 2 diabetes. In other words, obesity should be avoided.
Meningitis is an inflammation of the meninges, which are the membranes covering the brain and spinal cord. This is generally caused by an infection that is bacterial, viral or fungal.
Meningitis may also have various non-infectious origins such as trauma and tumours.
There are two types of meningitis:
Bacterial meningitis is a serious disease requiring immediate medical attention. Three microorganisms are the cause of the disease. They are naturally present in the pharynx, where they are commensal, or “friendly”, bacteria. The disease can progress very quickly. This happens when these microorganisms invade the blood stream. Bacterial meningitis is spread through respiratory secretions, for example when we cough or kiss. People sharing a home are likely to be infected.
Meningitis may also include nausea and vomiting, sensitivity to bright light, drowsiness, falling into a coma or convulsions.
The first symptoms of bacterial and viral meningitis are similar. However, bacterial meningitis is generally severe and can cause serious complications such as brain damage or learning difficulties.
In bacterial meningitis, the bacteria in the blood can give rise to another serious disease, septicaemia, which is the body’s generalized reaction to infection and which may have various consequences such as:
In the most serious cases it can be fatal. In this case, the appearance of small spots on the skin is cause for alarm.
Bacterial meningitis can be contracted by any age group but the elderly and young children are most at risk. In the last twenty years its epidemiology has changed significantly with the introduction of new vaccines linked to child vaccination programmes.
Whilst meningococcus is the main cause of bacterial meningitis around the world, in Spain meningococcal disease is not endemic, with an annual rate of fewer than 5 cases for every 100,000 people. Meningococcal meningitis may lead to death in 3-15 % of cases.
Many of the viruses that cause the disease are present worldwide and others are specific to particular regions.
If meningitis is suspected, blood and cerebrospinal fluid (the liquid around the spinal cord and brain) samples will be analysed. Cerebrospinal fluid is obtained via lumbar puncture. Analysis will help confirm the disease and will identify the microorganism causing it.
Most cases of infectious or viral meningitis improve without treatment in 7-10 days. However, it is very important that people with symptoms of meningitis receive immediate medical care to make a correct diagnosis of the disease, to determine the type of meningitis and to receive the right treatment.
In the case of bacterial meningitis, antibiotic treatment must be administered intravenously as soon as possible. Anti-inflammatories may also be used to treat any complications that may arise.
It is a hole that may be found in any part of the partition dividing the ventricles, and may be one hole or multiple, and of varying sizes and shapes. VSD may be associated with more complex heart defects such as tetralogy of Fallot, transposition of the great arteries or atrioventricular canal.
Small ventricular septal defects reduce in size over time and in many cases may close up by themselves, particularly during the first two years of a child’s life. The overall rate of spontaneous closure is 30-35% of cases.
In general, children with small VSD do not show any symptoms and So their eating habits, growth and development are all normal. This hole is detected via the presence of a murmur during the first weeks of life.
Children with a medium or large VSD develop symptoms in the first few weeks after being born. These may be:
VSD is one of the most common heart defects, if we do not include bicuspid aortic valve. It represents around 20% of all heart defects.
VSD is detected by an echocardiogram, which can confirm the number, size, location and functional repercussions.
Babies with small VSD do not need surgical treatment.
Those with medium to large VSD who develop cardiac insufficiency, on the other hand, must undergo medical treatment. If symptoms persist, early corrective surgery will be carried out, which consists of closing the hole with a patch, or a device implanted by cardiac catheterization.
If there are no other defects associated with the VSD, surgical mortality is 0%. After the operation, patients can lead a normal life the same as the rest of the population.
This syndrome is one of the most frequently treated gastrointestinal disorders in gastroenterology. It is characterized by chronic abdominal pain accompanied by changes in bowel movements in the form of diarrhoea or constipation. It is common in young women and can have a significant impact on the patient’s personal life, health, and economic and social welfare.
Scientific evidence from recent years suggests there are many different factors involved in developing this disease:
It is currently considered to be a disorder caused by an imbalance in the gut-brain-microbe axis This imbalance negatively affects the functioning of the intestinal barrier and activates the digestive system’s immune and nervous system. This creates visceral hypersensitivity and motor disturbances.
It is classified according to consistency:
It affects 7.8% of the population in Spain and twice the number of women compared to men: 1. IBS is the reason for 10-15 % of primary care appointments and 25-30 % of gastroenterology consultations. Over 50 % of patients are affected by other pain conditions such as fibromyalgia, headache or pelvic pain, and also by other gastrointestinal disorders such as dyspepsia or by anxiety disorders and depression.
IBS is diagnosed by fulfilling a set of clinical criteria based on symptoms and on the exclusion of other organic causes that may act in a similar way.
Diagnostic criteria known as the Rome IV criteria have been established by medical consensus by committees of experts. The following are required for diagnosis:
When determining treatment, it is important patients understand the chronic and fluctuating nature of the disease. To draw up an appropriate treatment plan, the doctor must identify the dietary and psychic-social causes of the illness.
Specific treatments are beginning to be introduced for IBS, such as linaclotide, eluxadoline and lubiprostone, but not all are available in Spain. There are also many treatments designed to control symptoms, such as anti-spasmodic drugs, laxatives and anti-diarrhoeals.
It is a hole in the partition that separates the two atria and that causes the right side of the heart to be overloaded. Children with ASD do not show symptoms, even though the right side of the body has to work with a much larger volume of blood.
Depending on the position of the atrial septal defect, ASD is classified into three types:
“Ostium Primum” is considered a different defect due to the damage associated with it.
ASD is one of the most common heart defects (6-10%) and is more common in women.
In most cases, children with ASD show no symptoms. For this reason, it is detected when listening to the heart during a routine examination detects a heart murmur. In that case, an echocardiogram should be carried out on the patient to identify the defect and determine treatment options.
When the defect is small with no significant blood flow no procedure may be necessary. On the other hand, if this is significant, the characteristics of the ASD must be assessed to decide if it is necessary to close it via catheterization or surgery.
Closure via catheterization consists of inserting a device to close the defect and stop blood passing from one chamber of the heart to the other.
When the defect is large or its shape prevents the percutaneous device entering, this closure must be performed through surgery. The procedure consists of fitting a patch over the hole in the partition, made either from synthetic material or tissue taken from the patient themselves.
Children who have undergone ASD closure have a similar life expectancy and quality of life to healthy patients. In fact, the survival rate is over 99.7%. In contrast, patients with ASD who do not undergo surgery see a decline in their life expectancy after forty years old.
Chagas disease is an infection caused by the “Trypanosoma cruzi” parasite which is transmitted through the bites of an insect (the “kissing bug”). The disease can also be spread from mother to child (vertical transmission), through blood transfusion, organ donation from people infected with the disease or from eating food contaminated with the parasite. For the moment, the number of new cases has been reduced thanks to policies to eliminate the insect in countries where it is endemic, as well as thanks to screening programmes aimed at blood and organ donors and pregnant women. The future challenges to cure this disease are maintaining and increasing these measures in addition to developing new treatment evolution and response markers for patients in the chronic phase, and new drugs to treat the disease.
Chagas disease is endemic to Latin America and is a global health challenge due to migration from countries in the region. Transmission via insect is mainly found in Bolivia, which has the highest number of cases. There are also infections in north-west Argentina, Peru, Paraguay, Ecuador, Nicaragua and southern Mexico. Outside these areas it is more commonly transmitted from mother to child.
Most patients with Chagas disease do not show any symptoms, which makes it difficult to detect. The disease develops in two phases:
This disease affects six to seven million people, but 60 million are estimated to be at risk of infection. There are 11,000 cases in Catalonia.
There are currently two drugs that are used to treat Chagas disease: Benznidazole and Nifurtimox. Specific treatment is needed to address any cardiac and/or gastrointestinal complications that may arise.
Since 2011, Catalonia has implemented the “Protocol for screening and diagnosing Chagas disease in pregnant Latin American women and their babies”. This programme allows possible congenital cases to be detected, and at the same time actively screens blood and organ donations from donors.
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