Por lo que pudiéramos resumir que es de una importancia alta que el individuo posea en igual proporción un cuerpo y mente sanos, en conjunto con un entorno que le permita desarrollarse y adaptarse adecuadamente.

A casi 75 años de esta definición, diferentes autores y expertos en el tema han hecho propuestas sobre este enunciado incorporando elementos como la espiritualidad y la afectividad. La intención es poder mostrar con esto que la salud humana debe abarcar todas las dimensiones que nos representan, lo que incluye lo físico o biológico, afectivo y social, sin darle la espalda a otros aspectos como el socio-cultural y laboral, convirtiéndose en un concepto integral.

Actualmente resulta pertinente que lo enmarquemos dentro del momento histórico en que nos encontramos, donde la salud integral adquiere un significado mayor y muy singular, partiendo desde la promoción en salud y prevención de las enfermedades y complicaciones y no tanto desde la enfermedad y la curación.

Es indiscutible que el mundo cambia constantemente y conservar la armonía entre el desarrollo del ser humano y la salud se convierte en un literal reto, por lo que el conocimiento y la profundización en el tema de la salud integral mueve a cada persona a identificar, desarrollar y poner en práctica herramientas y habilidades para su conservación.

Esto hace que la salud no sea un asunto de uno, sino de tres elementos que logran armonizar. Por esta razón, al hablar de salud física nos referimos al adecuado funcionamiento de los diferentes órganos, aparatos y sistemas del organismo humano, y su correcto mecanismo depende directamente de la biología humana individual, el estilo de vida, el medio ambiente y el acceso y uso de los servicios de atención médica.

Continuando en esa misma línea, la salud mental tiene como peculiaridad que incide sobre la salud física y viceversa, viéndose ambas afectadas por las distintas alteraciones del estado de ánimo que van desde momentos de depresión y ansiedad hasta las diferentes manifestaciones de demencia. Sin restarle importancia, por último nos referimos en esta parte a la salud social, la cual se traduce cómo las condiciones en las que interactuamos en nuestro entorno para sobrevivir y cómo nos relacionamos con las personas, el trabajo y el ambiente que nos rodea.

Stress is a disorder that currently affects a large part of the population, it occurs when life events, whether physical or mental, exceed the person's ability to deal with it.

The connection that can occur in many cases between stress and eating not only conditions eating habits, but also the nutritional metabolic process and the situation of satisfaction of nutritional needs, conditioning a state of emotional hunger and the consequent overeating .

Food is essential for survival, and can be defined as the process by which living things consume food to receive the necessary nutrients. Overeating involves an excess of diet and commonly an excess of ultra-processed foods, highly addictive and poor in nutrients, causing problems of overweight, diabetes and cardiovascular diseases.

The difference between food and nutrition is that a person can eat, but is not necessarily feeding. Food is a voluntary process in which you consume food, while nutrition is a totally involuntary biological process at the cellular level.

Food should be substances that are consumed to meet a basic physiological need: hunger. But today, due to poor nutritional habits and the high prevalence of anxiety states in the population, the act of eating for the wrong reasons has become normalized, and we eat out of habit, out of sadness, because we had a bad day, to celebrate, out of boredom, out of whim, because they offered it to us, in short, that currently there is a disproportionate intake unrelated to real hunger and rather related to the desire to eat and alleviate feelings.

The purpose of our consumption is no longer usually merely nutritional, so much so that many foods lacking in nutrients are usually consumed, such as sugary soft drinks, ultra-processed products, alcoholic beverages and even diet products.

Now, we must also bear in mind that food is much more than fuel, it is part of who we are and how we express ourselves, it has great emotional value, so it should never be trivialized. However, things can get out of hand when the emotional aspect of eating turns into a way to numb painful or difficult emotions.

The important thing is that feeding is a voluntary process and therefore educable.

Said education will not only consist of food re-education and change of habits, but also at the root of the problem, working on chronic stress and bad management of emotions with psychological support.
Those with the greatest vulnerability would increase their food intake under stress conditions, would be people with obesity and people who chronically restrict their diet, so they will respond to anxiety as if they experienced “hunger”, which would really be appetite or the desire to eat .

According to the recommendations of the World Health Organization (WHO), breastfeeding should be given exclusively up to 6 months and together with complementary feeding up to 2 years or more if the mother so wishes.

There are different stages or periods in the production of human milk, among which are:

Colostrum: it is the first milk produced by the mammary glands when breastfeeding begins. It is enough and fills the baby's stomach; It is yellow in color and highly concentrated, rich in substances that help the baby to defend itself in the first days of any type of infection.

Transitional milk: is the milk that is produced between the fifth and tenth day after delivery, has a higher content of fat, lactose and vitamins, adapting to the needs of the baby.

Mature milk: is the milk that is produced around the tenth day postpartum and is the one that will be produced for the rest of the time during the breastfeeding period. It provides the baby with all the nutritional and caloric substances that he needs.

The main components of milk are 88% water, then there are proteins, carbohydrates, fats, minerals and vitamins, as well as bioactive elements, hormones and enzymes. Regarding the proteins of human or human milk, 30% is casein and 70 % is whey protein basically composed of alpha-lactalbumin, beta-lactoglobulin, immunoglobulins, lactoferrin, lysozyme.

The main carbohydrate in milk is lactose (it is composed of glucose and galactose), it provides the 40% of energy, but also other fundamental functions for the development of the nervous system, for the absorption of minerals.

As for fat, it is the most variable component of breast milk. At the beginning of the feeding the milk is light and at the end it becomes creamy, as it is 4 to 5 times more concentrated than the first. This change allows the baby to quench his thirst first and then his appetite.

The concentration of vitamins in human milk is adequate for the child, although it may vary according to the mother's intake.

As for minerals, the concentration of most of these in human milk such as calcium, iron, phosphorus, magnesium, zinc, potassium and fluoride is not significantly affected by the maternal diet.

Posted in Today newspaper.

Healthy kidneys take care of cleaning the blood and eliminating toxins, as well as excess fluid in the form of urine. In addition, they produce hormones necessary for the proper functioning of the body, regulate blood pressure, among other things.

When people develop kidney failure, in its advanced stages they need some type of replacement therapy, which can be hemodialysis, peritoneal dialysis or kidney transplant.

Hemodialysis helps manage uremic toxins and excess fluid accumulated by decreased urine formation in end-stage kidney disease.

It consists of passing the blood through an extracorporeal artificial kidney and after being filtered it returns to the patient through a vascular access.

The reluctance to start hemodialysis therapy after being indicated by the nephrologist is frequent in our health system due to different reasons raised by patients such as fear, ignorance about the therapy and taboos that have been developed in popular slang, leading the patient to seek different opinions and lose the opportunity to start therapy in the necessary time.

The late start of hemodialysis is related to important events and complications, such as acute pulmonary edema, severe anemia with cardiometabolic decompensation, encephalopathy and coma, hypertensive crisis, and arrhythmias.

The scheduled start of the same has advantages over the urgent that differ from the type of vascular access. In the emergency setting, a good caliber vein such as jugular, femoral or subclavian should be channeled to place a double-lumen catheter-type device in which high blood flow is obtained.

Procedures of this type that are performed in an emergency situation have a high rate of complications and mistreat the venous system for future access and transplantation possibilities.

Patients with catheters have a higher mortality rate from any cause, as well as a higher probability of hospitalizations and diseases associated with kidney failure. This is why a scheduled start of dialysis is recommended and under a close monitoring regimen in the prediallysis clinic.

It is important to know that there are other renal replacement treatment options, discussed throughout this article.

These include peritoneal dialysis and kidney transplantation, the latter being able to be performed in some cases, even preventively.

This is why in the first contact between the nephrologist and your chronic kidney disease, the appropriate approach is given to how, when and what options are the most appropriate in your case, to start renal replacement therapy.

How and when to start dialysis
It is an important question to be known by both the patient and his doctor.
In the first place, not all patients with advanced chronic kidney disease are aware of it, there is a growing percentage of patients who come to the nephrology consultation already in advanced and irreversible stages of kidney failure.

Where the first contact results in the terrifying phrase "you have to dialyze it."
As a general rule, and despite an apparently stable clinical situation, replacement therapy should be started when renal function is at 8-12%. Below these figures the deterioration will be very rapid and the probability of complications associated with the disease will be higher.

However, with close control there are patients who can be managed for months within this range in conditions close to normal. It is important that the patient begins therapy feeling well and not in a situation of malnutrition or with a lot of uremic symptoms.

If the patient is very ill and / or the tests are very altered, the time to start dialysis has now come. But if the analytics is not very altered and the patient can perform many activities of daily life, it could be expected.

In fact, there are situations where it can be beneficial to wait a bit. If the psychological state of the patient requires it or if the completion or maturation of a vascular or peritoneal access is pending.

Posted in Newspaper Today.

The epidemic of infection by the new coronavirus associated with Severe Acute Respiratory Syndrome (SARS] -CoV-2) has spread rapidly around the world. Today it continues to spread throughout the planet and has already infected more than 18.3 million people, and the global death toll now exceeds 696,000.

The most affected country is the United States, with more than 4.7 million infections and more than 156,000 deaths. It is followed by Brazil, which exceeds 2.7 million cases and more than 94,000 deaths; India, with 1.8 million infections and almost 39,000 deaths.

Until today, in the Dominican Republic we have 74,295 confirmed cases and 1,243 deaths. In much of the world's population, we continue in confinement, physical distancing and paralyzed displacement, as well as economic activity, causing a very serious recession throughout the planet.

Both the new virus and the covid-19 disease were unknown.
Coronaviruses are an extensive and ancient family of viruses, perhaps 10,000 years old, that can cause disease in both animals and humans. Within the coronaviruses or "CoVs" there are four main groups and they have names of Greek letters: alpha, beta, gamma and delta.

The alpha and beta CoVs largely infect mammals and probably originated in bats, while the gamma and delta CoVs largely infect and originate from birds. In humans, there are 7 known types of coronaviruses that can infect us, the so-called HCovs.

Four of them (HCoV-229E, HCoV NL63, HCoV-HKU1 and HCoV-OC43) usually cause a cold and the remaining three: SARS-CoV-1 (2002-2003), produce acute and severe respiratory syndrome; MERS-CoV produces Middle East Respiratory Syndrome and now SARS-CoV-2 which is the latest addition.

SARS-CoV-2 is the name of the virus that causes the disease called COVID-19.
COVID-19 is the name that comes from the English phrase “coronavirus disease of 2019” (coronavirus disease of 2019).

Coronavirus gets its name from the presence of S proteins on its surface, which gives rise to the protruding spikes or spikes similar to a crown.
These are the proteins responsible for adhesion to the host cell. Once attached to the cell, it enters through a receptor called ACE2, which is found in many parts of the human body: in the lungs, heart, kidneys, and intestine.

The main mission of the virus once it enters the body is to create copies of itself. For this, it uses the machinery of the cell where it enters, like a factory to make copies of itself and its genetic material. It leaves the cell with its thousands of copies, ready to start infecting other cells.

One of the main differences between SARS-CoV-2 and other coronaviruses is that it attaches to more cell receptors and thus reproduces faster, even before the patient had symptoms. This means that a person can begin to infect others before symptoms appear.

Se calcula que a nivel mundial el asma afecta a 300 millones de personas. Según la OMS, es la enfermedad crónica más común en niños, aunque constituye un grave problema de salud a nivel mundial en todas las edades, con una prevalencia que va en aumento en muchos países en desarrollo.

Hoy en día continúa siendo una carga para el sistema de salud y para la sociedad, como consecuencia de la pérdida de la productividad laboral, el alto costo de los medicamentos, alteraciones en la vida familiar y el hecho de que aún mantiene una mortalidad alta a nivel mundial incluyendo los pacientes jóvenes.

El asma es una enfermedad crónica frecuente y potencialmente grave.

Provoca síntomas respiratorios, limitación de la actividad física y crisis que requieren atención médica urgente y pueden tener un desenlace fatal.

Hoy en día el asma se puede tratar de manera efectiva y el paciente puede llevar un buen control de su enfermedad, llegando a necesitar poca o ninguna medicación, no presentando síntomas nocturnos, llevando una vida productiva y físicamente activa y evitando las crisis, hasta el punto de mantener una función pulmonar normal o casi normal.

Los síntomas característicos de asma son: sensación de falta de aire, opresión torácica (en el pecho), tos y sibilantes (sensación de silbido en el pecho).

Estas manifestaciones pueden variar con el tiempo en su aparición, frecuencia e intensidad, llegando esto a tal punto de que un paciente puede pasar varios años sin tener manifestaciones y este entender que está curado, lo cual es un error, ya que si es asma como ya hemos dicho es una enfermedad crónica y no se cura, aunque se controla.

El paciente presentará dificultad para expulsar el aire de sus pulmones, lo cual está dado por una estrechez de la vía respiratoria, engrosamiento de la pared y aumento de la mucosidad.
Ciertos factores pueden desencadenar una crisis de asma o empeorar los síntomas, incluyendo las infecciones virales, alérgenos (ácaros del polvo, cucarachas, polen), humo, el ejercicio, estrés e incluso algunos fármacos.

Las crisis a estos factores son más probables cuando el paciente no lleva una adecuada medicación de base.

Las crisis de asma en ocasiones pueden presentarse en pacientes que mantengan su mediación, por lo que es requerido un plan de acción coordinado con su médico de base de cómo el paciente deberá manejarse en esos casos.

El asma es una enfermedad muy variable de un individuo a otro, por lo que es necesaria una adecuada valoración y descartar cualquier otra posibilidad. En este paciente será importante la evaluación por un médico especialista en el área, el neumólogo, quien junto a una adecuada historia clínica, examen físico y estudios especiales determinará si el diagnóstico es asma y el tratamiento que más se adecúe al paciente según la gravedad de su asma, así como las medidas preventivas y el manejo adecuado del paciente ante una crisis.

Todo esto nos dará un paciente con un asma controlado, activo y productivo a pesar de su enfermedad.

Posted in Today newspaper.

Se define la alimentación complementaria tanto por la Organización Mundial de la Salud (OMS) como por la Sociedad Europea de Gastroenterología, Hepatología y Nutrición Pediátrica (ESPGHAN) a cualquier bebida/alimento que complemente la leche materna, incluyendo sustitutos de leche (formulas infantiles y de seguimiento), como una forma de enfatizar y fomentar la lactancia materna.

Las recomendaciones actuales son de iniciarla no antes de los 4 meses ni después de los 6 meses.
A nivel internacional, se utilizan otros términos para referirse a la alimentación complementaria, tales como Beikost en alemán, Weaning en inglés. La palabra ablactación, actualmente no es reconocida por el diccionario de la Real Academia Española.

Etimológicamente proviene del latín “ablactatio”, que significa destete, término que actualmente se encuentra en desuso, ya que este proceso no implica una supresión de la leche materna o de las fórmulas lácteas infantiles.

¿Por qué iniciar la alimentación complementaria? ¿Cuál es su finalidad?

El niño durante su etapa de crecimiento y desarrollo adquiere y desenvuelve un sin número de habilidades, al mismo tiempo que incrementa sus requerimientos energéticos y nutricionales, por lo que la alimentación exclusiva con leche humana o artificial no puede ser igual en estas etapas de la edad pediátrica. Entre los objetivos que se persiguen con la introducción de la alimentación complementaria están:

• Promover un adecuado crecimiento y desarrollo neurológico, cognitivo, del tracto digestivo y el sistema neuromuscular.
• Proveer nutrientes que son insuficientes en la leche materna, tales como: hierro, zinc, selenio, vitamina D.
• Enseñar al niño a distinguir sabores, colores, texturas y temperaturas diferentes, como a fomentar la aceptación de nuevos alimentos.
• Promover y desarrollar hábitos de alimentación saludable.
• Favorecer el desarrollo psicosocial, e interrelación correcta entre padres e hijos.
• Conducir a la integración de la dieta familiar siempre y cuando sea saludable.
• Promover una alimentación complementaria que permita prevenir factores de riesgo para alergias, obesidad, desnutrición, hipertensión arterial, síndrome metabólico, entre otras.
• Evitar la presencia o el desarrollo de enfermedades alérgicas. históricamente para ello se ha tratado de eliminar o retrasar la introducción de ciertos alimentos con alto potencial alergénico, como el huevo, el pescado, el cacahuate o las nueces.

Posted in Today newspaper.

Source: Newspaper Today

They have changed the way we live. Current events have led humanity to make radical decisions regarding the way of doing things.

Although we live in a common framework, the truth is that there are many scenarios that individualize the approach with which we assume this situation, so we have a diversity of realities.

In the health context, there is a great demand for services from those patients who live with chronic diseases and who depend on follow-up with their doctor. Thus, we have a pending task, in addition to the one that came to us without notice and came to revolutionize everything.

Today, the provision of solutions in health services has two large groups, patients who need support in relation to COVID-19, whether for education, counseling or disease management purposes, and patients who have other conditions. acute or chronic, which also require support. So, we have a significant increase in demand, but we cannot give the traditional response to it due to the limitations imposed by the measures taken to contain the virus.
Thus, we use strategies that allow us to be present and accompany those who need us.

One of these tools is remote medical assistance, also known as telemedicine, which basically constitutes any means that allows for face-to-face interaction between the patient and their doctor, with the intention of identifying and, as far as possible, treating the conditions that are presenting.

The concept of telemedicine is not new and, in fact, there are countries where it constitutes a common practice, being of special value for the assistance of communities that have little or no access to physical care centers.
In 1924, an article titled “Doctor on Radio” appears in the magazine “Radio News”; in 1951, the first demonstration covering several of the states of the United States was given, using lines and television studios.

In Montreal, in the year 1955, Dr. Albert Jutras carried out tele-radiology, and in order to avoid the high doses of radiation that affected fluoroscopy, a conventional intercom was used.
In 1959, in Nebraska, Cecil Wittson began his first tele-education and tele-psychiatry courses, between his hospital and the state hospital in Norfolk, Virginia, 180 kilometers away.

The doctor-patient connection defines the foundations of disease control and prevention. Today's circumstances call for alternatives that help sustain this link.
Today, more than ever, health education makes a vital difference for individuals. Therefore, it should be assumed as an integral part of the interventions in the consultation.

In 1991, the Unesco Chair in Telemedicine carried out the first remote DNA quantification in the world, applied to image analysis of prognostic factors in breast cancer.
The interaction of health with communication technology has become the best combination for the massification of information, contributing to health promotion, education and prevention strategies.

An ethical, efficient and effective professional orientation can calm a person who feels overwhelmed. There is a significant difference in the provision of this service, ranging from informal conversation to the use of complex platforms that maintain formality and professionalism, preserving the legal medical framework that must support the provision of medical care.

Source: Newspaper Today

Source: Newspaper Today

As a specialist in physical medicine and rehabilitation, it is necessary to manage the effects of physical deconditioning and detraining in all our patients. We see it daily in patients who have medical conditions that alter the level of physical activity they can perform (for example, prolonged hospitalization, postoperative periods, chronic non-communicable diseases or chronic rheumatic diseases, among others). Then the services of the multidisciplinary rehabilitation team are required for the evaluation, prevention and treatment of the harmful effects of said limitation.
In the specific case of confinement due to the COVID-19 pandemic, the general population has had an abrupt decrease in the level of physical activity and that exercise specifically aimed at physical conditioning.
One of the most specific recommendations of the World Health Organization and international sports organizations, through their medical commissions, has been to keep doing some kind of physical activity at home to combat the effects of deconditioning; The beneficial effect that regular exercise can have on the immune response is also validated. What is difficult to comply with the measure has been the particularity of each individual in terms of the availability of equipment at home, the advice of certified personnel and adherence to the exercise program. Likewise, in the de-escalation process in different countries, the regulations of each country on outdoor activity have also played an important role.
Physical fitness refers to the ability of an individual to perform physical activity. In a broad way, it is necessary to mention the different elements that make it up, such as muscular strength and endurance, cardiorespiratory capacity, flexibility and speed, among other aspects that allow a detailed assessment of how fit a person is at any given time. given for physical activity. The bad news is that these elements, particularly strength and endurance, are gained with time and effort, slowly, and are lost relatively quickly.
An example has been evidenced in a study published by Pedersen and Cols. in the Journal of the American Medical Association, where a patient with a similar body mass index was taken as a reference, and a decrease in daily step count from 6200 to 1300 daily steps for three weeks. They saw how insulin resistance and abdominal fat increased and muscle mass decreased at the level of the legs in the different sub-groups of their research.
Similar results have been seen even in young adult patients (mean age: 24 years), which could also be accentuated by the sarcopenia process that begins to be seen from the age of 30-35 years according to most authors.
If we additionally take into account the variations in diet and sleep hours that have also been evidenced during this period, we should note that habituation to the training program must respect those physiological and structural changes that can be verified in the literature.

Competition planning

Athletes participating in competitive events may have an additional feeling related to the desire to compete at this time. At present, international and local federations are preparing to prepare the logistics related to sporting events, although there are no confirmed events yet. The postponement of the Tokyo 2020 Olympic Games marked the world sports community, and although for many it will serve as a second wind to prepare, for others it could represent the end of the race. At the recreational level, many mass events, such as iconic marathons, triathlons and “masters” events, still remain without a definitive date, but with protocols under development to be carried out safely. This will allow all these athletes to take the time to prepare, without rushing the process. In addition, it is important to note that once the competitions are published, there should be at least 8-12 weeks of preparation for less demanding events and with previous experience, and longer periods for those events in which there is no experience or that are More demanding