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A common condition in people over 50 years of age Introduction Knee crepitation—also referred to as joint crepitus —is a frequent clinical finding, characterized by an audible or palpable grinding, cracking, or crunching sensation during joint movement. It may be heard, felt, or both, and does not always present with pain. However, in patients over 50, it is common for crepitation to coexist with pain , which can be localized to the anterior, lateral, or posterior knee (popliteal fossa). Popliteal pain associated with crepitation should not be considered trivial, as it can indicate degenerative, inflammatory, traumatic, or even vascular pathology. Appropriate diagnostic work-up and early treatment are essential to prevent functional deterioration. Main causes of knee crepitation 1. Articular cartilage degeneration Hyaline cartilage  covers the joint surfaces and allows smooth, frictionless movement. With age, cartilage undergoes progressive wear ( chondropathy ), losing thickness and elasticity. This leads to surface irregularities  that produce mechanical friction and crepitation. Risk factors: aging, obesity, repetitive microtrauma, previous injuries. 2. Osteoarthritis Chronic degenerative joint disease with cartilage loss, bone remodeling, and secondary synovitis. Crepitation is associated with mechanical pain , morning stiffness lasting <30 minutes, and functional limitation. More common in postmenopausal women and individuals with a history of knee trauma. 3. Meniscal injuries Menisci distribute loads and stabilize the joint. A meniscus tear  may cause clicking or grinding sensations, localized pain, and joint effusion. Chronic or degenerative tears are common in people over 50. The medial meniscus is most frequently affected. 4. Ligament injuries Injuries to the anterior cruciate ligament (ACL)  or posterior cruciate ligament (PCL)  may result in chronic instability. Irregular joint mechanics due to laxity and fibrotic scar tissue cause crepitation during movement. 5. Overuse and repetitive strain Repetitive activities (stairs, squatting) accelerate cartilage wear. Excessive friction between bone and tendon structures increases the risk of pain and joint noise. 6. Bursitis Inflammation of bursae  (synovial sacs) causes localized swelling, warmth, and soft crepitation. In the knee, the prepatellar bursa  and pes anserine bursa  are most often affected. 7. Sequelae of trauma Past fractures, dislocations, or contusions can leave bony irregularities. These mechanical changes perpetuate joint friction. 8. Iliotibial band friction syndrome Repeated friction of the iliotibial band over the lateral femoral condyle. Causes lateral pain and occasionally crepitation. Popliteal pain with concurrent crepitation: key causes Although crepitation is often perceived anteriorly or laterally, some patients report posterior knee pain . Common causes include: Baker’s cyst (popliteal cyst) Dilation of the gastrocnemius-semimembranosus bursa. Often associated with osteoarthritis or meniscal tears. Produces dull resting pain, a sensation of tightness, and occasionally mechanical crepitation. Posterior meniscus tear Tears in the posterior horn (especially medial) may radiate pain to the popliteal fossa. Crepitation occurs with flexion-extension movements. PCL injury Posterior pain, instability, and occasional crepitation from degenerative changes. Popliteal bursitis Inflammation of the posterior bursa producing focal pain and, in chronic cases, soft crepitation. Vascular or neurological conditions  (differential diagnosis) Popliteal artery aneurysm, deep vein thrombosis, tibial nerve entrapment. These do not cause mechanical crepitation but may coexist with joint pathology. Diagnosis A structured diagnostic approach includes: Medical history : onset, progression, aggravating factors, prior trauma. Physical examination : inspection, palpation, meniscus tests (McMurray, Apley), ligament tests, palpation for popliteal masses. Imaging : X-ray : detects osteoarthritis, osteophytes, and bony irregularities. MRI : assesses menisci, cartilage, ligaments, and Baker’s cysts. Ultrasound : useful for bursitis and cysts. Laboratory tests : in cases of suspected inflammatory or infectious disease, analysis of synovial fluid. Evidence-based management 1. Conservative treatment Relative rest and activity modification : avoid movements that exacerbate symptoms. Physical therapy : Strengthening of quadriceps and hamstrings. Proprioceptive training. Stretching to relieve tendon tension and improve range of motion. Cryotherapy  for acute inflammation; heat therapy  for chronic cases. NSAIDs  (ibuprofen, naproxen) for short-term pain and inflammation control. Weight reduction  in overweight patients. Orthotics and braces  to unload and align the joint. 2. Injections Intra-articular corticosteroids : temporary pain and inflammation relief, indicated in marked synovitis. Hyaluronic acid : viscosupplementation to improve joint lubrication. Platelet-rich plasma (PRP) : growing evidence for mild-to-moderate degenerative changes. 3. Surgical options Arthroscopy : meniscal repair or debridement, removal of loose bodies, synovectomy. Corrective osteotomies  for malalignment. Partial or total knee arthroplasty  in advanced osteoarthritis. Patellar prosthesis  for isolated severe chondropathy. Prevention and prognosis Prognosis : depends on the underlying cause—degenerative conditions tend to progress, while traumatic injuries may recover fully with timely treatment. Prevention : Maintain healthy body weight. Engage in low-impact exercise (swimming, cycling, walking on flat surfaces). Strengthen periarticular muscles. Avoid prolonged deep knee flexion positions. References Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet . 2019;393(10182):1745–1759. Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med . 2009;43(4):247–252. Englund M, et al. Meniscus tear in middle-aged and elderly persons: prevalence and relation to osteoarthritis. Ann Intern Med . 2008;148(10):724–732. van der List JP, DiFelice GS. Arthroscopic primary repair of the anterior cruciate ligament: a systematic review. Arthroscopy . 2017;33(8):1583–1593. Cho W, et al. Popliteal cyst: a current review. Knee Surg Relat Res . 2014;26(3):125–134. Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage . 2019;27(11):1578–1589. Migliore A, et al. Intra-articular injectables in knee osteoarthritis: a literature review. RMD Open . 2021;7(3):e001720. Papalia R, et al. Management of degenerative meniscus tears: a critical review. Br Med Bull . 2019;130(1):105–119.

🔬 Where does its active ingredient come from? Batana oil is extracted from the fruit of the palm Elaeis oleifera , an American species of oil palm native to Honduras, especially from the La Mosquitia region. The oil is obtained through an artisanal process: the nuts are roasted and ground, then boiled to extract the dense, dark oil. No specific single “active ingredient” with proven pharmacological action has been identified. Its composition includes: Essential fatty acids (oleic, linoleic) Vitamin E (tocopherols) Phenols and natural antioxidants Beta-carotenes 🎯 What is its real use? Traditionally used by indigenous peoples to: Moisturize dry or damaged hair Repair split ends Add shine and strengthen hair Treat dry or itchy scalp In modern cosmetics: Used as a nourishing hair treatment, similar to argan or castor oil. 🧬 Can it regenerate hair in androgenetic alopecia? No. Androgenetic alopecia is a genetic and hormonal condition (caused by the action of DHT – dihydrotestosterone) that leads to progressive miniaturization of the hair follicle. There is no  published scientific evidence or clinical trials proving that batana oil: Blocks DHT Revives fully atrophied follicles Is comparable to approved treatments like minoxidil or finasteride It may improve the appearance of existing hair, but it does not reverse advanced genetic baldness. ✅ Realistic and possible benefits: Improves hydration and elasticity of dry hair Protects against mechanical hair breakage Adds shine and softness May slightly reduce scalp flaking Has a conditioning effect ⚠️ Risks and side effects: Generally safe for topical use, but: May cause allergic reactions or contact dermatitis in sensitive individuals Excessive use can clog scalp pores Should not be used on infected scalp, active psoriasis, or open wounds 🕐 How long can it be used? As a cosmetic treatment: 2–3 times per week, applying for 20–30 minutes before washing hair Can be used continuously as long as no adverse effects occur Not recommended for daily use on oily or acne-prone scalps 🤔 Is it worth using? Yes, if: You want a natural product to nourish hair You have damaged, curly, afro-textured, or dry hair You use it as a complement, not a substitute for medical treatments in alopecia cases No, if: You expect it to regrow hair in bald areas caused by androgenetic alopecia You have an oily or sensitive scalp You dislike dense textures or oils in your hair routine Is Batana Oil recognized or approved by the FDA? No. To date, the FDA ( Food and Drug Administration ) has not approved Batana Oil as a medical treatment for hair loss or as a medication for any condition. ❗ Important distinction: The FDA regulates drugs and medical products that claim to treat diseases such as androgenetic alopecia It also oversees cosmetics but does not require prior approval for their sale as long as no medical claims are made 🧴 Therefore: If marketed as a cosmetic product (to hydrate, add shine, improve appearance), Batana Oil can be legally sold in the U.S. without prior approval If it claims to regrow hair or cure baldness, it would require FDA approval as a drug, which it does not have 🕵️ What does this mean for the consumer? You can buy it as a cosmetic hair oil, but it should not be considered a clinically approved treatment Brands claiming it “cures baldness” or “grows new hair” are making unsupported statements and could face warnings or penalties for misleading advertising in the U.S. ✅ Final recommendation Before using any product claiming to “stop baldness” or “grow hair,” check if it is approved by agencies such as the FDA or EMA (in Europe) and look for clinical support.Batana Oil can be a good cosmetic complement but does not replace approved medical treatments. 🧾 CONCLUSION Batana Oil is an excellent natural product to nourish and beautify existing hair, but it is not a medical solution for baldness .Its benefits are comparable to those of other vegetable oils.There is no scientific evidence supporting its ability to regenerate follicles destroyed by androgenetic alopecia.It can be part of a hair care routine, but it should not create false therapeutic expectations. 🧠 FINAL SLOGAN: “The only thing that stops hair from falling… is the ground.” References: U.S. Food and Drug Administration (FDA). Cosmetics Laws & Regulations . Available at: https://www.fda.gov/cosmetics/cosmetics-laws-regulations European Medicines Agency (EMA). Human Regulatory: Medicines . Available at: https://www.ema.europa.eu/en/human-regulatory/overview/medicines Katta R, Kramer MJ. Skin and Hair Care Products in Dermatology . Journal of Clinical and Aesthetic Dermatology . 2018;11(2):21–26. Trueb RM. Medical treatment of hair loss . Clinics in Dermatology . 2001;19(2):149–158. Gavazzoni Dias MFR. Hair cosmetics: an overview . International Journal of Trichology . 2015;7(1):2–15. Publications and reports on Elaeis oleifera  in: PROSEA ( Plant Resources of South-East Asia ). Available at: https://uses.plantnet-project.org/en/Elaeis_oleifera_(PROSEA)

🧴 What is Aceclidine (VIZZ) and Who Develops It? Aceclidine is a muscarinic cholinergic agonist formulated as a 1.44% ophthalmic solution under the brand name VIZZ, developed by the pharmaceutical company LENZ Therapeutics, Inc. It is a new chemical entity in the United States and the first aceclidine-based eye drop globally approved for the treatment of presbyopia. Although aceclidine has historical use as a glaucoma eye drop in Europe during the 1970s, it had never been approved for presbyopia until now. ⚗️ Chemical Composition The active ingredient is aceclidine at 1.44%, in a preservative-free single-dose ophthalmic solution. The detailed chemical formula has not been publicly disclosed, but its mechanism of action is known: it acts as a muscarinic agonist targeting iris receptors, producing a precise miotic effect. 👁️ What Is It Used For? VIZZ is indicated for the treatment of presbyopia in adults, aiming to improve near vision without glasses or reading lenses. It offers a non-invasive, fast, and easy-to-apply solution that provides visual clarity for hours, useful for everyday activities like reading or using electronic devices. ⚙️ Mechanism of Action, Efficacy, and Duration Mechanism of Action VIZZ acts as a selective miotic agent for the pupil, without significantly affecting the ciliary muscle. It stimulates the iris sphincter, causing pupillary constriction that creates a pinhole effect, reducing the pupil to less than 2 mm. This increases depth of focus and improves near vision without inducing significant refractive changes. Clinical Efficacy VIZZ’s efficacy has been demonstrated in three Phase 3 clinical trials. In the CLARITY 1 and CLARITY 2 studies, involving over 460 participants, near vision improvement was observed within 30 minutes of application, lasting up to 10 hours. These results were consistent and reproducible. The CLARITY 3 trial evaluated long-term safety over 6 months, confirming sustained tolerance without serious adverse events. Over 75% of participants achieved at least one line of improvement in near visual acuity, and over 60% achieved two or more lines, with effects lasting between 8 and 10 hours. ⚠️ Adverse Reactions and Safety Profile Common Adverse Events Most side effects were mild, transient, and self-limiting. The most frequent were: Ocular irritation at the instillation site Temporary or mild blurred vision Mild headache Conjunctival hyperemia Specific Warnings Temporary dimmed vision may occur after instillation, so caution is advised before driving or operating machinery. Rare cases of retinal detachment or tears have been reported. Contact lenses should be removed before application and reinserted at least 10 minutes afterward. Each single-dose container must be discarded after use. ✅ FDA Recognition The FDA approved VIZZ on July 31, 2025, as the first and only aceclidine eye drop authorized in the U.S. for presbyopia. Approval was based on clinical evidence supporting its rapid onset, prolonged duration, and favorable safety profile. Initial samples are expected to be available starting October 2025, with full commercial launch anticipated by the end of Q4 2025. 🇪🇺 When Will It Arrive in Europe? As of August 2025, there are no official data regarding its approval or launch in Europe. The company has expressed its intent to pursue international licensing, but no specific dates have been announced. Although aceclidine was historically used in Europe for glaucoma treatment, its indication for presbyopia has not yet been approved by the European Medicines Agency. 🧪 Clinical Summary Aspect Summary Composition Aceclidine 1.44%; preservative-free single-dose ophthalmic solution Mechanism Selective miotic → pinhole effect → increased depth of focus Efficacy Onset: 30 minutes; duration: up to 10 hours Safety Well tolerated; mild, transient side effects; retinal monitoring FDA Approved July 31, 2025; available in U.S. from Q4 2025 Europe No approval or expected launch date 🔍 Conclusion VIZZ (aceclidine 1.44%) represents a significant advancement in the management of presbyopia, with a precise mechanism, rapid onset, prolonged effect, and proven safety. It is already approved in the United States, but its availability in Europe remains subject to regulatory review. If you'd like this translated into a press release, infographic, or presentation format, I can help with that too.

Complete Guide for Patients and Healthcare Professionals Meta Description (SEO):  Cervical pain (cervicalgia) is a common reason for medical visits. Learn about causes, symptoms, diagnosis, treatment, and emergency care. Introduction Cervical pain, also known as cervicalgia , refers to discomfort in the neck area that may radiate to the shoulders, back, or arms. It is among the most frequent causes of visits to primary care and emergency services. Most cases are benign, but recognizing red flags  is essential to act promptly and prevent complications. Common Causes of Cervical Pain The most frequent causes include: Muscle strain : poor posture, prolonged desk work, inadequate sleeping position. Degenerative changes : cervical osteoarthritis, disc wear. Trauma : whiplash, falls, accidents. Radicular compression : herniated disc, osteophytes. Inflammatory or systemic diseases : rheumatoid arthritis, spondyloarthritis. Rare serious causes : spinal infections, cervical tumors. Symptoms and Red Flags Localized neck pain, possibly radiating to shoulders or arms. Muscle stiffness and limited range of motion. Occipital headache  (pain at the back of the head). Tingling, numbness, or weakness in the upper limbs  (if nerve involvement exists). Red flags : Progressive neurological deficits. Fever. Unintentional weight loss. Severe nocturnal pain without relief. Diagnosis Diagnosis is mainly based on history  and physical examination . Physical examination : mobility assessment, muscle palpation, neurological evaluation. Imaging : Cervical spine X-ray: useful in trauma or degenerative changes. MRI: indicated for neurological deficits or suspected serious pathology. CT: for bone injuries or complex trauma. Laboratory tests : only if infection, systemic inflammation, or tumor is suspected. General Treatment Initial measures : relative rest, avoiding prolonged static positions, posture optimization. Pharmacologic treatment : Analgesics: acetaminophen, NSAIDs (as tolerated). Muscle relaxants: for significant muscle tension, short-term use. Oral corticosteroids: in selected cases of acute radiculopathy. Physical therapy : local heat, targeted physiotherapy. Interventional options : facet or epidural injections for refractory cases. Prevention and Patient Recommendations Ergonomic posture  at work and during sleep. Strengthening exercises  for neck and shoulder muscles. Avoid sudden movements  and repetitive strain. Adjust screen and seating height  to prevent neck strain. Therapeutic Approach in the Emergency Department In the emergency setting, the priority is to rule out serious pathology and control pain: Initial assessment Look for red flags: neurological deficits, fever, trauma, severe nocturnal pain. Immediate symptomatic treatment IV or IM analgesics (acetaminophen, NSAIDs if not contraindicated). Muscle relaxants for severe tension. IV or oral corticosteroids for acute radiculopathy with mild recent deficit (case-dependent). Immobilization Soft cervical collar only in selected cases and for short-term use (48–72 h). Referral Urgent neurosurgery referral: progressive motor deficits, myelopathy, unstable fracture. Outpatient rehabilitation or orthopedics: persistent pain without red flags. Summary of References Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. BMJ . 2015;350:h1225. Guzman J et al. Clinical guidelines for the management of neck pain. Eur Spine J . 2009;18(3):355–375. Blanpied PR et al. Neck pain: revision of the 2017 clinical practice guidelines. J Orthop Sports Phys Ther . 2017;47(7):A1–A83. Childress MA, Stuek SJ. Neck pain: initial evaluation and management. Am Fam Physician . 2020;102(3):150–156.

Recommendations and Therapeutic Measures Low back pain is one of the most common reasons for medical consultation, both in primary care and emergency services. Its management requires a comprehensive approach that combines pharmacological and non-pharmacological strategies, aiming to relieve pain, improve function, and prevent recurrence. 1️⃣ General Measures and Initial Recommendations Relative Rest    In acute episodes, relative rest for 24 to 48 hours is recommended. Prolonged absolute bed rest is not advised, as it may lead to muscle weakness and delay recovery. Heat or Cold Application Local cold  (first 48 hours) can reduce inflammation and muscle spasms. Local heat  (after the initial phase) improves circulation, relaxes muscles, and relieves pain. Posture Correction    Postural hygiene is key: Keep your back straight when sitting. Avoid excessive loads and sudden twisting movements. Bend your knees when lifting objects. Elastic Support Belt    May be considered for short periods and during intense physical activity. Prolonged use is not recommended to avoid muscle atrophy. 2️⃣ Complementary Non-Pharmacological Measures Early Mobilization and Exercise    Progressive physical activity reduces the risk of chronicity: Gentle walks. Abdominal and lumbar strengthening exercises. Posterior chain stretching. Physical Therapy    A physiotherapist may apply: Mobilization techniques. Personalized exercises. Postural education. Therapeutic Massage    Useful in subacute or chronic phases to reduce muscle tension and improve mobility. Spinal Manipulation    Performed by trained professionals, it may provide relief in selected cases, especially without severe neurological signs. Acupuncture    Moderate evidence supports its use as an adjunct therapy for chronic low back pain relief. 3️⃣ Pharmacological Management in Emergency Settings For patients presenting to the emergency room with acute disabling low back pain, the goal is rapid pain relief and early functional recovery. 📋 Analgesic Management for Acute Low Back Pain (Emergency)    (In the absence of red flags: neurological deficit, cauda equina syndrome, infection, fracture, tumor) Intensity First Line If Pain Persists Optional / Rescue Mild Paracetamol 1 g IV/PO every 6–8 h (max. 4 g/day) + Dexketoprofen 50 mg IV/IM every 8 h (or Ibuprofen 600–800 mg IV every 8 h) Local heat / gentle mobilization Moderate Paracetamol 1 g IV + Dexketoprofen 50 mg IV every 8 h + Metamizole 2 g IV slowly every 8 h (monitor for hypotension) Muscle relaxant: Cyclobenzaprine 5–10 mg PO at night or Tizanidine 2–4 mg PO every 8 h (max. 2–3 weeks) Severe Paracetamol 1 g IV + Dexketoprofen 50 mg IV + Metamizole 2 g IV + Tramadol 50–100 mg IV slowly (repeat every 8 h if needed, max. 400 mg/day) Consider adding Diazepam 2–5 mg PO at night for intense spasms (max. 3–5 days) 4️⃣ Follow-Up and Review Criteria Reassess in 48–72 hours. Refer for imaging studies if intense pain persists or alarm signs are present. Prevent chronicity through education, exercise, and control of predisposing factors. 💊 Medication Therapy for Persistent Low Back Pain A  – Tramadol + Metamizole + Metoclopramide daily for 72 hours IM or IV B – Metamizole + Methylprednisolone + Diazepam as a single dose within 24 hours IM or IV ⚠️ If you are allergic to any of the medications suggested here, do not use them. In case of any reasonable doubt, consult your physician.

Prevention and Symptomatic Treatment The common cold is a self-limiting viral infection, most frequently caused by rhinoviruses, seasonal coronaviruses, and other respiratory viruses. Although generally mild, its high frequency and transmissibility justify preventive measures and appropriate symptomatic treatment. Hygiene Measures Hand Hygiene Wash hands with soap and water for at least 20 seconds , especially after blowing the nose, coughing, sneezing, or touching commonly used surfaces (door handles, light switches, railings). If soap and water are not available, use alcohol-based hand sanitizers with at least 60% alcohol . This measure significantly reduces rhinovirus and other respiratory virus transmission. Respiratory Hygiene Cover mouth and nose when coughing or sneezing with disposable tissues or the elbow crease. Dispose of used tissues immediately and wash hands. Avoid coughing into the air without protection to reduce airborne viral particles. Avoid Touching the Face Eyes, nose, and mouth are entry points for viruses. Clean hands and avoiding contact with mucous membranes reduce the risk of infection. Social Distancing Maintain at least 1 meter (3 feet)  distance from individuals with symptoms of respiratory infections. Avoid sharing utensils, glasses, towels, or bedding. Masks Wear surgical masks when having respiratory symptoms to reduce droplet spread. In healthy individuals, routine use is not necessary unless in crowded settings or close contact with ill persons. Surface Cleaning and Disinfection Regularly disinfect frequently touched surfaces (phones, keyboards, light switches, door handles, toys). Use common household disinfectants (solutions containing sodium hypochlorite, quaternary ammonium compounds, or ≥70% alcohol). Healthy Diet and Rest Maintain a varied diet with fruits, vegetables, lean protein, and healthy fats. Sleep 7–8 hours daily to support immune function. Chronic stress and sleep deprivation increase susceptibility to viral infections. Avoid Contact with Sick Individuals Maintain physical distance and do not share personal items. Wash hands after indirect contact. Adequate Ventilation Ventilate rooms regularly to dilute airborne viral particles. Open windows several times a day. Vaccination No specific vaccine exists for the common cold, but influenza vaccination reduces co-infections and respiratory complications. In individuals with chronic conditions, influenza and COVID-19 vaccines reduce the risk of severe illness. Specific Treatment The common cold has no specific cure . Treatment focuses on relieving symptoms and supporting natural recovery. Antibiotics are not indicated , except in documented bacterial complications (bacterial sinusitis, otitis media, pneumonia). 1. Rest Allows the body to focus energy on the immune response. Avoid strenuous activity during the symptomatic phase. 2. Hydration Drink plenty of fluids (water, broth, herbal teas, natural juices). Keeps mucous membranes moist and helps thin secretions. 3. Humidification Use humidifiers or vaporizers to avoid dry indoor air. Hot showers can provide temporary nasal congestion relief. 4. Symptomatic Medication Fever and Pain : Paracetamol (Acetaminophen) 500–1000 mg orally every 6–8 hours  as needed (max 4 g/day). Alternative: Ibuprofen 400 mg orally every 8 hours , if no contraindications (GI, renal, cardiovascular). Cough : Dry cough: Dextromethorphan or Levodropropizine may be effective short-term. Productive cough: Expectorants (Guaifenesin) can help with mucus clearance. Nasal Congestion : Nasal irrigation with isotonic or hypertonic saline several times daily. Topical decongestants (Oxymetazoline, Xylometazoline) maximum 3–5 days  to avoid rebound congestion. Sore Throat : Lozenges containing local anesthetics or anti-inflammatory agents (Flurbiprofen, Benzocaine). Gargling with warm salt water several times daily. 5. Salt Water Gargles Solution: ½ teaspoon salt in 200 ml warm water. Reduces pharyngeal inflammation and soothes discomfort. 6. Lozenges or Hard Candies Keep throat mucosa moist. Examples: Strefen, Lizipaina  every 6–8 hours as needed. 7. Avoid Irritants Tobacco smoke and air pollution irritate the airways and delay recovery. 8. Inhalation Improves sensation of nasal congestion. Caution in children (risk of burns). 9. Healthy Diet Diet rich in vitamins A, C, D, E, zinc, and antioxidants supports immune function. Routine supplementation is not recommended unless a deficiency is documented. Summary Table – Symptomatic Medication Symptom Medication / Measure Dosage and Administration Major Contraindications Fever / Pain Paracetamol (Acetaminophen) 500–1000 mg p.o. every 6–8h Severe liver disease Ibuprofen 400 mg p.o. every 8h Peptic ulcer, renal impairment, heart disease Nasal Congestion Nasal irrigation as needed None Oxymetazoline / Xylometazoline 1–2 sprays every 8h (≤5d) Rhinitis medicamentosa if prolonged use Dry Cough Dextromethorphan 10–20 mg p.o. every 6–8h Children <6 y, SSRI interaction Productive Cough Guaifenesin 200–400 mg p.o. every 4h Children <6 y unless prescribed Sore Throat Flurbiprofen lozenges 8.75 mg p.o. every 3–6h Peptic ulcer, NSAID allergy Throat Irritation Salt water gargles several times daily None Immune Support Healthy diet, rest daily None References CDC . Common Cold: Protect Yourself and Others. Centers for Disease Control and Prevention. Updated 2024. WHO . Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections. World Health Organization, 2023. UpToDate . Treatment of the common cold in adults and children. Updated 2025. Cochrane Database of Systematic Reviews . Decongestants, antihistamines, and analgesics for the common cold. 2024. Eccles R. Understanding the symptoms of the common cold and influenza. Lancet Infect Dis . 2023;23(2):e49-e58. Fashner J, Ericson K. Treatment of the Common Cold in Adults. Am Fam Physician . 2024;109(5):443-450.

Staying informed remains the most effective tool at this time.  In a global context where reliable information can make the difference between prevention and unnecessary exposure, this post aims to provide clear, accessible, and useful guidance to all visitors seeking help and orientation regarding the SARS-CoV-2 virus (the cause of COVID-19). The COVID-19 pandemic has radically changed the way we live, work, and interact socially. Despite scientific progress, it remains crucial to follow prevention measures and to understand risk factors, symptoms, and transmission routes. WHO IS MOST AT RISK? While no one is completely exempt  from acquiring the infection or transmitting the virus, certain groups are more vulnerable  and require special attention: Immunocompromised individuals : including those with cancer, HIV, transplant recipients, or those under immunosuppressive treatment. Elderly people : advanced age is associated with a weakened immune system and multiple comorbidities. Newborns and small children : due to immature or developing immune systems. Patients with chronic diseases : such as hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), cardiovascular disease, or obesity. TRANSMISSION MECHANISMS The primary mode of COVID-19 transmission is via respiratory droplets  expelled when a person talks, coughs, or sneezes. These droplets can settle on surfaces or directly enter another person’s mucous membranes (eyes, nose, or mouth). Aerosol transmission  in poorly ventilated environments has also been confirmed. The virus can remain active on surfaces for hours or even days , depending on the material, temperature, and humidity. CLINICAL PRESENTATION: COMMON SYMPTOMS The clinical presentation of COVID-19 is highly variable , which has posed a diagnostic challenge for healthcare professionals, particularly in high-volume clinical settings. The most common symptoms  include: Fever Dry cough Rhinorrhea  (clear nasal discharge) General malaise Headache Muscle aches Sore throat Shortness of breath , especially in more severe cases Other less common but reported symptoms include: Anosmia  (loss of smell) Ageusia  (loss of taste) Gastrointestinal symptoms : nausea, diarrhea, vomiting Conjunctivitis Skin rashes In some patients, disease progression may be rapid and severe , leading to bilateral pneumonia, acute respiratory distress syndrome (ARDS), pulmonary embolism, sepsis, or multiorgan failure, with a risk of death. DIAGNOSIS AND CLINICAL EVALUATION Due to the nonspecific nature of symptoms, a detailed epidemiological history  is essential. Key factors to assess include: Contact with confirmed or suspected COVID-19 cases Origin from areas with high viral circulation Participation in mass gatherings Symptoms in close contacts or cohabitants Health authorities place great emphasis on the epidemiological component  when guiding clinical decisions, especially in airports, transit areas, or nursing homes. When COVID-19 is suspected, specific diagnostic tests  should be performed: RT-PCR : the gold standard molecular test Rapid antigen tests : faster but less sensitive Serology : useful for retrospective or epidemiological studies PREVENTIVE AND CONTROL MEASURES Prevention remains the cornerstone for containing the spread of the virus. The following measures are recommended for both the community and healthcare settings: 1. Use of face masks Mandatory in indoor public spaces and when caring for respiratory patients. Proper use covers both the nose and mouth; avoid touching the front of the mask. 2. Frequent handwashing Use soap and water for at least 20 seconds. If unavailable, use hand sanitizer with at least 60% alcohol. 3. Physical distancing Maintain at least 1.5 meters (6 feet) between individuals. Avoid crowded places, especially indoors. 4. Proper ventilation Especially important in homes, clinics, offices, and shared spaces. 5. Surface disinfection Use disinfectants such as 0.1% sodium hypochlorite or 70% alcohol on frequently touched surfaces (doorknobs, keyboards, desks). 6. Temperature checks Implemented in airports, stations, and health facilities as part of active surveillance. RECOMMENDATIONS FOR HEALTHCARE PROFESSIONALS Personal Protective Equipment (PPE) : including FFP2 or N95 respirators, protective gowns, gloves, and face shields or goggles. Active epidemiological surveillance  of patients and healthcare personnel. Mandatory reporting  of suspected or confirmed cases to public health authorities. Avoid unnecessary staff rotations  and maintain separate circuits for respiratory patients. DISEASE PROGRESSION AND COMPLICATIONS COVID-19 can present in three major clinical forms: Mild : nonspecific respiratory symptoms without pneumonia. Moderate : pneumonia evident on imaging, but no severe respiratory distress. Severe : dyspnea, hypoxia (SpO₂ < 92%), need for oxygen therapy or ICU admission. Major complications  include: Severe viral pneumonia ARDS (acute respiratory distress syndrome) Deep vein thrombosis and pulmonary embolism Myocarditis and arrhythmias Encephalopathy and stroke Secondary bacterial infections Sudden death from silent hypoxia CONCLUSION COVID-19 has demonstrated that health education is a critical tool  for empowering the population. Understanding how the virus spreads, how to protect oneself, and when to seek medical care can be decisive. As healthcare professionals, our duty is to communicate clearly, act based on scientific evidence, and stay continuously updated  to face the challenges this virus poses. REFERENCES World Health Organization (WHO). Coronavirus Disease (COVID-19) Pandemic . https://www.who.int Centers for Disease Control and Prevention (CDC). COVID-19 Information for Healthcare Professionals . https://www.cdc.gov/coronavirus Ministerio de Sanidad, Gobierno de España. Gestión de la crisis sanitaria COVID-19 . https://www.mscbs.gob.es Guan, WJ., et al. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China . N Engl J Med, 382:1708–1720. doi:10.1056/NEJMoa2002032 Huang C, Wang Y, Li X, et al. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China . Lancet. 395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5 Sadoff J, Le Gars M, Shukarev G, et al. (2021). Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against COVID-19 . N Engl J Med, 384:2187–2201.

Mediterranean Diet. On many occasions, we have advocated for its usefulness when developing a dietary plan aimed at protecting individuals from developing chronic illnesses or preventing the worsening of existing ones. We believe that certain dietary patterns should not be sacrificed lightly, unless there is a structural incompatibility or medical necessity. On our blog dedicated to nutrition and health, we have tackled this subject with the seriousness it deserves. We prefer to highlight which foods are beneficial or harmful depending on the disease to prevent or manage, so that people can make informed choices. The ultimate goal is for the average citizen to become the true protagonist of their own health, building a conscious and personalized diet without giving up taste or food enjoyment. A Healthy Heart In our recent clinical and epidemiological reviews, we confirm—without hesitation—that a healthy diet is practically synonymous with the Mediterranean Diet. This is not a rhetorical claim: it is supported by high-quality scientific evidence. Its effectiveness in preventing cardiovascular diseases has been extensively documented through randomized clinical trials and large-scale meta-analyses. Considering that cardiovascular conditions remain among the leading causes of death worldwide, it would be unwise to ignore the therapeutic and preventive power of this dietary pattern. Our duty as healthcare professionals is not only to treat disease once it has developed, but to promote long-term healthy habits. That’s why we strongly recommend adopting Mediterranean dietary principles, especially in individuals who have already experienced a cardiovascular event. Experience shows that patients who adapt to new eating habits have a significantly higher chance of improving their clinical condition and reducing the risk of recurrence than those who stick to lifelong habits acquired during early life stages. Mediterranean Diet: Science, Taste and Tradition What makes the Mediterranean Diet unique is not only its proven health benefits, but also the fact that it doesn’t sacrifice taste or variety. This pattern emphasizes fresh plant-based foods (fruits, vegetables, legumes, whole grains), healthy fats (especially extra virgin olive oil), oily fish, nuts, and moderate consumption of white meats and dairy. Moderate intake of red wine in healthy adults is also part of the traditional model, due to its polyphenol content. Unlike restrictive diets, the Mediterranean Diet is not absolutist. It allows flexibility and focuses on incorporating foods that contribute positively to our health. Therefore, our approach is to provide practical and accessible information about which nutrients are found in everyday foods and how to integrate them into a tasty, sustainable lifestyle. Our goal is to elevate food literacy so that each person can create their own healthy menu based on availability, cultural preferences, and individual needs. Diet and Cardiovascular Prevention Lowering LDL cholesterol, improving insulin sensitivity, controlling blood pressure, and reducing low-grade chronic inflammation are all well-documented effects of the Mediterranean Diet. Numerous studies have confirmed these benefits. Cultural change takes time, but it begins with awareness. Hence, we insist: Your Food Culture Is Your Health. Key Nutrients and Their Food Sources Nutrient / Compound Food Sources Vitamin A Fish, fish oils, eggs Vitamin B6 Nuts, legumes, liver Vitamin B12 Animal-based foods, fermented soy, algae Vitamin C Fruits (guava, citrus), vegetables, leafy greens Vitamin E Nuts, vegetable oils (especially olive oil) Magnesium Vegetables, fruits, legumes, nuts Selenium Animal-based products, whole grains Copper Seafood, liver, nuts, whole grains Zinc Lean red meats, legumes, shellfish (especially oysters) Soluble Fiber Vegetables, legumes, fruits, whole grains Insoluble Fiber Whole grains, cereals, vegetables, legumes Polyphenols Extra virgin olive oil, grapes, red wine, dark chocolate Flavonoids Tea, cocoa, fruits, vegetables, nuts Phytosterols Vegetable oils (corn, sunflower, olive), legumes, fruits, nuts Monounsaturated Fats Olive oil, avocado, nuts, Iberian pork Polyunsaturated Fats Seed oils (soy, corn, sunflower), nuts Omega-3 Fatty Acids Oily fish (mackerel, sardines, tuna), flaxseed, chia, algae Lecithin & Choline Eggs, lean meats, legumes, dairy Sulfur Compounds Garlic, onions, leeks 📚 Scientific References – Mediterranean Diet Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med. 2013;368(14):1279–1290. DOI: 10.1056/NEJMoa1200303 Martínez-González MA, Gea A, Ruiz-Canela M. The Mediterranean diet and cardiovascular health: a critical review. Circ Res. 2019;124(5):779–798. DOI: 10.1161/CIRCRESAHA.118.313348 Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344. DOI: 10.1136/bmj.a1344 Schwingshackl L, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: a systematic review and meta-analysis. Nutrients. 2015;7(6):4210–4229. DOI: 10.3390/nu7064210 Tosti V, Bertozzi B, Fontana L. Health benefits of the Mediterranean diet: metabolic and molecular mechanisms. J Gerontol A Biol Sci Med Sci. 2018;73(3):318–326. DOI: 10.1093/gerona/glx227 World Health Organization (WHO). Healthy Diet: Fact Sheet No. 394. URL: https://www.who.int/news-room/fact-sheets/detail/healthy-diet American Heart Association (AHA). 2021 Dietary Guidance to Improve Cardiovascular Health. Circulation. 2021;144(23):e472–e487. DOI: 10.1161/CIR.0000000000001031 Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61(6 Suppl):1402S–1406S. Fito M, et al. Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Arch Intern Med. 2007;167(11):1195–1203. UNESCO. Mediterranean Diet – Intangible Cultural Heritage of Humanity. https://ich.unesco.org/en/RL/mediterranean-diet-00884

Breast examination is becoming increasingly important in breast cancer prevention. This disease does not differentiate between young and older women, regardless of age or reproductive status, and can also occur without a family history. Although there is a genetic predisposition in some cases, numerous modifiable risk factors should not be overlooked, such as tobacco consumption, excessive alcohol consumption, an unhealthy diet, and long-term exposure to ionizing radiation  – we will discuss the latter separately. Breast examination is not a minor measure, but an active tool for self-care and early detection. This text is primarily addressed to you, woman, to empower you to correctly apply this method, which can make a decisive difference for your future health. Observation in front of the Mirror Stand in front of a well-lit mirror  where you can see both breasts completely. Carefully observe their shape, size, symmetry, and general characteristics . Slight asymmetry can be normal, but significant differences or new changes warrant medical clarification. Raise your arms behind your head and observe whether both breasts move freely, without indentations or fixations. The nipples  should be evenly aligned and free of indentations, spontaneous secretions, or noticeable color changes. The skin  should be smooth and continuous, without redness, flaking, or lesions. Any deviation from these characteristics can be an initial warning sign. Breast Palpation Technique Mentally divide each breast into four quadrants : upper inner, upper outer, lower inner, and lower outer quadrant. Place one hand behind your head and systematically palpate the opposite breast  with the other hand. Use your fingertips , making circular movements clockwise, and palpate at different depths  – superficial, medium, and deep. The goal is to detect lumps, thickenings, hard areas, or painful spots  that do not belong to the normal structure of your breast. If you feel anything unusual, note its exact position by quadrant for later comparison. Examination of the Armpit and Clavicle Area After the breast examination, palpate the adjacent areas: the armpits  and the supraclavicular and infraclavicular regions . These areas contain lymph nodes that can react in inflammatory or malignant processes. Gently feel for lumps, hard, or immobile structures , even if they are not painful. Such findings should always be medically evaluated. Benefits of Breast Self-Examination Breast self-examination is simple, safe, and risk-free. It does not replace medical examination or imaging procedures, but it offers important advantages: It promotes understanding of one's own normal anatomy. It can reveal early changes. It facilitates continuous self-observation. It strengthens awareness and responsibility for one's own health. It's important to perform it regularly with correct technique, in a quiet environment with sufficient light and privacy. Regarding Mammography Mammography is a very accurate imaging procedure, especially in women over 40  or those with an increased risk. It can detect lesions before they become palpable and has demonstrably reduced mortality in screening programs. However, it also has limitations: It uses ionizing radiation , which poses a cumulative risk with frequent use. Its informative value is also limited in dense breasts  – often found in younger women. The recommendation for mammography should be individualized. Current guidelines recommend examinations between 40 and 69 years of age every one to two years . For women under 40, it should only be done if there is a clear family or clinical indication. Digital mammography provides better images for dense breast tissue, but should still only be used when truly necessary. Warning Signs for Breast Cancer If any of the following symptoms occur, you should seek immediate medical attention : Change in breast size, shape, or volume . Appearance of new, firm lumps that are increasing in size . Nipple discharge , especially bloody or unilateral. Increase in temperature or local swelling  without an obvious reason. Persistent breast pain  not related to the cycle and not responding to pain medication. Skin changes : indentations, hardening, flaking, or "orange peel" skin. These signs should never be ignored. Concluding Recommendations Perform breast self-examination at least twice a month , preferably about a week after menstruation when the breast is less sensitive. Document any unusual findings with a drawing or map for later comparison. If you notice anything unusual, be sure to consult your doctor . Avoid mammograms without a medical indication. A negative finding does not mean that you cannot develop a lesion in the following weeks. True prevention is active, regular, and based on knowledge. Knowledge of your body is one of your strongest tools. Early detection can be crucial.  Don't waste time – act with knowledge, calmness, and determination. References Used World Health Organization (WHO) - Breast Cancer – Fact Sheet. Updated 2024. Available at: https://www.who.int/de/news-room/fact-sheets/detail/breast-cancer Guideline for Breast Cancer Screening in General Practice. Spanish Ministry of Health, updated 2022. Source: https://portal.guiasalud.es National Comprehensive Cancer Network (NCCN) - Guidelines for Breast Cancer Diagnosis and Prevention, Version 2.2024. Source: https://www.nccn.org American Cancer Society - Breast Cancer Screening Recommendations, 2023. Source: https://www.cancer.org Spanish Society of Senology and Breast Pathology (SESPM) - Guide for Early Detection of Breast Cancer, 2023. Source: https://www.sespm.es National Cancer Institute (USA) - PDQ® Guidelines for Breast Cancer Screening – for Healthcare Professionals, Version 2024. Source: https://www.cancer.gov European Society of Breast Imaging (EUSOBI) - Recommendations for Informing Women about Breast Screening, 2022. Source: https://www.eusobi.org Silva da Rosa P, et al. Accuracy of clinical breast examination for breast cancer detection: systematic review and meta-analysis. BMC Women’s Health. 2022;22(1):219. doi:10.1186/s12905-022-01841-1

Hidradenitis Suppurativa (HS), commonly referred to as “golondrinos” in some regions, is a chronic, inflammatory, recurrent, and often debilitating skin condition that affects apocrine sweat glands and hair follicles. While the overall prevalence is low, its impact on physical and emotional well-being can be considerable, and it is often underestimated by both healthcare professionals and patients. What Is Hidradenitis Suppurativa? HS is a chronic inflammatory skin disorder of the hair follicle that primarily affects intertriginous areas such as the axillae, groin, buttocks, and perianal region. It presents with painful nodules, abscesses, draining sinus tracts, and scarring. The disease follows a recurrent course, often with unpredictable flares, causing chronic pain, emotional distress, and a significant reduction in quality of life. Pathogenesis: Why Does It Occur? The disease process begins with follicular occlusion, followed by rupture of the follicular unit and subsequent inflammatory response. Secondary bacterial colonization often occurs, and in advanced stages, abscesses and sinus tracts may develop. HS is considered a multifactorial disease, with the following key contributing elements: Local immune dysregulation Exaggerated inflammatory response Alteration of the cutaneous microbiome Genetic predisposition Hormonal and metabolic factors Contrary to popular belief, HS is not simply a bacterial infection or a result of poor hygiene. Predisposing Factors Obesity : Increases friction and moisture in affected areas. Smoking : Strongly associated with HS. Diabetes mellitus and metabolic syndrome Hyperandrogenism : Such as in polycystic ovary syndrome. Genetic predisposition : Up to 35% report a family history. Aggressive deodorants and antiperspirants Acidic sweat and hyperhidrosis : Facilitate maceration and inflammation. Clinical Staging (Hurley Classification) Hurley I : Single or multiple abscesses without sinus tracts or scarring. Hurley II : Recurrent lesions with sinus tract formation and scarring. Hurley III : Diffuse or near-total involvement with multiple interconnected sinus tracts and scarring. Diagnosis Diagnosis is clinical and based on three essential criteria: Presence of typical lesions (nodules, abscesses, sinus tracts) Typical anatomical locations Recurrent episodes (at least two in six months) Differential diagnosis includes: furuncles, simple abscesses, cutaneous Crohn’s disease, inverse acne, and carbuncles. Evidence-Based Treatment Management should be individualized according to disease severity, associated comorbidities, and the patient’s quality of life. A stepwise, multimodal approach is recommended. 1. General Measures Gentle hygiene with neutral soaps. Avoidance of friction and tight clothing. Healthy diet and weight loss if applicable. Smoking cessation. Control of associated conditions (e.g., diabetes, dyslipidemia). 2. Medical Treatment Topical antibiotics : Clindamycin 1% in Hurley I. Systemic antibiotics : Doxycycline 100 mg every 12 hours for mild to moderate disease. Clindamycin + rifampicin (300 mg/12 h each) for 10–12 weeks in Hurley II. Hormonal and antiandrogenic treatments : Cyproterone acetate with ethinyl estradiol for hormonal imbalance. Spironolactone has shown benefit in select cases. Oral retinoids : Isotretinoin (less effective than in acne vulgaris). Immunosuppressants : For refractory cases. Biologics : Adalimumab  (anti-TNF): The only biologic specifically approved for moderate to severe HS. Other biologics (infliximab, ustekinumab) are under investigation. 3. Surgical Treatment Incision and drainage : Only for temporary relief; not curative. Wide surgical excision : Useful for Hurley II and III stages. CO2 or Nd:YAG laser therapy : Reduces lesions, especially in recurrent axillary cases. Psychosocial Impact and Support HS has a significant effect on body image, self-esteem, sexuality, and social life. Essential components of care include: Validating the patient’s suffering. Screening for depression and anxiety. Multidisciplinary support (dermatology, surgery, psychology, endocrinology). Practical Advice for Patients Do not self-medicate with antibiotics or attempt to drain lesions at home. Avoid tight clothing and excessive moisture in the affected areas. Use cool compresses to reduce acute pain. Strictly follow prescribed treatments. Seek medical attention for new or worsening symptoms. Conclusion Hidradenitis Suppurativa is a complex, chronic inflammatory disease with significant physical and emotional impact. Early diagnosis, patient education, and a personalized, structured treatment plan are critical to improving outcomes. Successful management lies not only in treating the active lesions but also in identifying and addressing the underlying risk factors, providing psychological support, and maintaining long-term follow-up. References Alikhan A, Lynch PJ, Eisen DB. “Hidradenitis suppurativa: a comprehensive review.” J Am Acad Dermatol. 2009;60(4):539–561. Jemec GBE. “Clinical practice. Hidradenitis suppurativa.” N Engl J Med. 2012;366(2):158–164. Zouboulis CC, et al. “European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa.” J Eur Acad Dermatol Venereol. 2015;29(4):619–644. Gulliver W, et al. “Management of patients with hidradenitis suppurativa: Canadian guidelines.” J Cutan Med Surg. 2016;20(3S):10S–27S. Ingram JR, et al. “Interventions for hidradenitis suppurativa: updated Cochrane systematic review.” Br J Dermatol. 2021;185(6):1220–1228. Martorell A, et al. “Hidradenitis suppurativa: a review of current diagnostic and treatment options.” Actas Dermosifiliogr. 2015;106(7):551–566.

Acute tonsillitis is an inflammatory infectious disease of the palatine tonsils, lymphoid structures that are part of Waldeyer’s ring and play an essential immunological role in protecting the upper respiratory tract. It is a frequent reason for consultation both in primary care and emergency departments, especially among pediatric patients. Although most cases resolve without major consequences, some can become complicated and potentially life-threatening if not properly managed. This document aims to provide a clear, evidence-based and up-to-date guide for the identification, classification, etiology, management, and prevention of tonsillitis, emphasizing key risks and relevant complications. It also promotes health education and improved patient quality of life. 1. Anatomy and Immune Function of the Tonsils The tonsils are composed of lymphatic tissue and are located in the oropharynx. Their primary function is immunological defense against inhaled or ingested pathogens. They contribute to the production of secretory immunoglobulin A (IgA) and activation of T and B lymphocytes. However, under persistent exposure or chronic infection, they may become inflamed and serve as sites of infection. 2. Etiology of Acute Tonsillitis a) Viral Causes (most common): Adenoviruses Influenza and Parainfluenza viruses Epstein-Barr virus (EBV) Enteroviruses Coronaviruses Respiratory Syncytial Virus (RSV) Viral tonsillitis is usually self-limiting and accompanied by catarrhal symptoms such as rhinorrhea, cough, moderate fever, and sore throat. b) Bacterial Causes: Streptococcus pyogenes (Group A β-hemolytic streptococcus)  – main bacterial cause. Staphylococcus aureus Haemophilus influenzae Neisseria gonorrhoeae  (in sexually active adolescents) Mycoplasma pneumoniae Bacterial tonsillitis usually presents with high fever, purulent tonsillar exudates, painful cervical lymphadenopathy, and absence of cough. c) Chemical Irritants: Less commonly, tonsillitis can result from chemical or caustic exposure (e.g., ingestion of household disinfectants). A noteworthy clinical case involves a 4-year-old child who developed severe tonsillar inflammation after ingesting a disinfectant—a medical emergency requiring immediate intervention. 3. Clinical Classification a) Acute Tonsillitis: Sudden onset High fever, intense odynophagia Tonsillar redness and swelling Purulent exudates or plaques Tender cervical lymphadenopathy Duration: 3–7 days b) Chronic Tonsillitis: Recurrent inflammation (≥7 episodes/year or ≥5 per year for two consecutive years) Persistent halitosis and general malaise Tonsillar hypertrophy Chronic pharyngitis, intermittent sore throat May require tonsillectomy if quality of life is impaired 4. Risk Factors Pediatric age (5–10 years) Close contact with infected individuals Poor oral hygiene Exposure to tobacco smoke (passive smoking) Immunosuppression (congenital or acquired) Overcrowded settings (schools, daycares) Untreated dental caries Ingestion of contaminated food or water 5. Complications of Acute Tonsillitis a) Local Complications: Peritonsillar abscess : uvula deviation, trismus, muffled “hot-potato” voice Retropharyngeal abscess : mostly in children <5 years; risk of airway obstruction Otitis media, sinusitis Cervical cellulitis b) Systemic Complications: Rheumatic fever  (if Group A Streptococcus is not adequately treated) Post-streptococcal glomerulonephritis Streptococcal toxic shock syndrome c) Critical Complication: Ludwig’s Angina A rapidly progressing cellulitis of the submandibular space that can lead to airway obstruction. This is a life-threatening emergency requiring intensive care and surgical intervention. 6. Diagnosis Diagnosis is primarily clinical. The modified Centor criteria are useful: Fever >38 °C Absence of cough Tonsillar exudates Tender anterior cervical lymphadenopathy Age 3–14 years (+1 point) If ≥3 points: perform a rapid antigen detection test (RADT) or throat culture. If Epstein-Barr virus infection (mononucleosis) is suspected: order serologic testing (EBV IgM) and a CBC showing atypical lymphocytes. Differential Diagnoses: Viral pharyngitis Mononucleosis Oral candidiasis Diphtheria (rare but serious) Oropharyngeal tumors (in adults) 7. Treatment a) Viral Tonsillitis: Symptomatic management: Paracetamol or ibuprofen Adequate hydration Warm saline gargles Relative rest b) Bacterial Tonsillitis: First-line therapy:  Amoxicillin 500–1000 mg every 8 hours for 10 days Children: 50 mg/kg/day Alternatives: Cefadroxil, cephalexin In penicillin allergy: azithromycin or clindamycin Crucial:  Complete the full antibiotic course to prevent immunologic complications c) Chronic or Recurrent Tonsillitis: Referral to ENT Tonsillectomy indications: ≥7 episodes/year ≥5 episodes/year for two consecutive years Recurrent peritonsillar abscesses Suspicion of malignancy 8. Preventive Measures and Health Education Maintain proper oral hygiene (brushing teeth 2–3 times/day) Avoid sharing utensils, glasses, or towels Address active dental caries Regular hand hygiene Isolate symptomatic individuals when possible Smoke-free environments Use of face masks during peak respiratory infection seasons Close monitoring of immunocompromised patients 9. Conclusion Acute tonsillitis is a common and generally manageable condition. Most cases are viral and self-limited. Accurate diagnosis is essential to identify bacterial cases that require antibiotic therapy. Early recognition of warning signs, integrated management, and patient follow-up are crucial to avoid complications. Promoting preventive habits, hygiene, and timely medical evaluation enhances patient outcomes and quality of life. 10. References Shulman ST, Bisno AL, Clegg HW, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update . Clin Infect Dis. 2012;55(10):1279-1282. NICE (National Institute for Health and Care Excellence). Sore throat (acute): antimicrobial prescribing.  London: NICE; 2018. ESCMID. Guidelines for diagnosis and management of sore throat.  Clin Microbiol Infect. 2012. Mayo Clinic. Tonsillitis. https://www.mayoclinic.org/diseases-conditions/tonsillitis UpToDate. Treatment and prevention of streptococcal pharyngitis in adults and children. Asociación Española de Pediatría. Acute Tonsillopharyngitis Protocol. 2023. CDC – Group A Streptococcal (GAS) Disease . https://www.cdc.gov/groupastrep/index.html

Hyperemesis Gravidarum: an obstetric emergency requiring early intervention During pregnancy—especially in the first trimester—many women experience nausea and vomiting. In most cases, these symptoms are mild and temporary (known as nausea and vomiting of pregnancy, NVP ). However, in some women, they can become severe and debilitating, leading to a condition known as Hyperemesis Gravidarum (HG) . If not recognized and managed promptly, HG can affect both maternal and fetal health with potentially serious consequences. It is therefore essential to understand its warning signs, causes, and safe treatment options. What is Hyperemesis Gravidarum? Hyperemesis Gravidarum is a severe form of pregnancy-related vomiting characterized by significant weight loss (>5% of pre-pregnancy weight), dehydration, electrolyte imbalance, and ketosis . It typically occurs during weeks 12–16  of gestation, but may extend beyond the first trimester. It affects approximately 0.3–2%  of pregnancies and often requires hospitalization if symptoms do not respond to outpatient management. Major Complications If untreated, HG may lead to two major clinical issues: 1. Dehydration Persistent vomiting can result in hypovolemia , impaired renal perfusion, and electrolyte disturbances (hypokalemia, hyponatremia, metabolic alkalosis, or ketoacidosis). In severe cases, there is risk of renal injury, syncope, or even Wernicke’s encephalopathy if thiamine (B1) is deficient. 2. Malnutrition (Depauperation) Failure to maintain adequate caloric and protein intake can lead to muscle wasting , vitamin deficiencies (especially B vitamins and folate), and an unfavorable metabolic environment for the fetus. This can result in low birth weight, preterm birth, and intrauterine growth restriction. What Causes Hyperemesis Gravidarum? The exact etiology is not fully understood; however, HG is known to be multifactorial . Key contributing factors include: High levels of human chorionic gonadotropin (β‑hCG) : Associated with higher HG rates, especially in multiple pregnancies or molar gestation. Hormonal fluctuations : Increased estrogen and progesterone affecting gastric motility. Genetic predisposition  and family history. Psychosocial stress factors . Enhanced smell and taste sensitivity . Mechanical factors : Uterine compression of the stomach. No single theory explains all cases, so a comprehensive approach is required. Clinical Diagnosis Diagnosis is mainly clinical , based on: History of persistent nausea and vomiting  before 20 weeks’ gestation. Weight loss >5%  of pre-pregnancy weight. Signs of dehydration, ketonuria , and abnormal electrolytes (from blood/urine tests). Exclusion of other causes such as infections, appendicitis, gastroenteritis, biliary disease, hepatitis, or metabolic disorders. Therapeutic Approach Treatment should be personalized based on the severity of symptoms  and risks to mother and fetus . Non-medical measures: Dietary modifications : Small, frequent meals, avoiding long fasts. Avoid fatty, spicy foods and strong odors. Moderate rest and gentle posture changes : Avoid lying down immediately after eating. Keep a well-ventilated environment. Maintain oral hydration  by sipping cool fluids. Pharmacological treatment (per clinical guidelines): Note : All medications should be used under medical guidance, especially considering pregnancy safety categories. Pyridoxine (Vitamin B6) : First-line for mild nausea (25 mg every 8 hours). Doxylamine (H1 antihistamine) : Often combined with B6; safe in pregnancy. Metoclopramide : Prokinetic antiemetic for moderate nausea. Ondansetron : Effective, but used cautiously in the first trimester due to debated congenital risk (follow local guidelines). Other antihistamines  (meclizine, dimenhydrinate): Safe and useful. Corticosteroids  (hydrocortisone or methylprednisolone): For severe/refractory cases, after first trimester and other causes ruled out. Inpatient Management: Indications for hospital admission: Weight loss >5–10% Persistent ketosis Moderate to severe dehydration Failure of outpatient therapy Hospital treatment includes: Intravenous hydration  with isotonic fluids. Electrolyte replacement . Intravenous thiamine  prior to glucose administration to prevent Wernicke’s encephalopathy. Parenteral nutrition  or nasogastric feeding if oral intake is not possible for several days. Key Recommendations from Dr. Jr Avoid prolonged fasting ; eat 5–6 small meals daily. Gentle walking or light activity  improves gut motility. Start prenatal vitamins early , especially B1, B6, and folate—particularly if there's a history of HG. Avoid triggering odors  or environments. Sleep on the left side  after meals to enhance uteroplacental perfusion. VIDEOS EDUCATIVOS... Conclusion Hyperemesis Gravidarum is more than intense nausea; it’s a potentially serious condition that can threaten maternal-fetal health if not recognized and treated early. Careful, evidence-based medical management significantly improves outcomes. Any pregnant woman with persistent vomiting should be evaluated—never underestimated. References Niebyl JR. Nausea and vomiting in pregnancy. N Engl J Med . 2010;363(16):1544–1550. American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy. Obstet Gynecol . 2018;131:e15–e30. Fiaschi L, Nelson-Piercy C, et al. Clinical management of nausea and vomiting in pregnancy. BMJ . 2019;364:l523. McCarthy FP, Khashan AS, North RA, et al. A prospective cohort study investigating associations between hyperemesis gravidarum and cognitive, behavioural and emotional well-being in pregnancy. PLoS One . 2011;6(11):e27678. Tan PC, Khine PP, Vallikkannu N, Omar SZ. Promethazine compared with metoclopramide for hyperemesis gravidarum: A randomized controlled trial. Obstet Gynecol . 2010;115(5):975–981. Boelig RC, Barton SJ, Saccone G, Kelly AJ, Edwards SJ, Berghella V. Interventions for treating hyperemesis gravidarum. Cochrane Database Syst Rev . 2016;(5):CD010607.