That the patient feels clear about what happens to his body gives us more guarantee that he will stick to the treatment that we are going to indicate.

Many of these treatments are aimed at changes in lifestyle, and involve teaching our patient a new way to perform their daily routines or, rather, what should be included now.

In other cases, such as when dealing with a chronic disease, a referral to another specialist is required, but keeping the accompaniment of the family doctor in order to ensure compliance with the indicated treatment. In other words, management depends on the cause; if the fatigue is due to bad habits, the treatment will be the abandonment of the same, if it is an infectious cause, the handling will be to fight the infection, etc.

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The light that hits the retina triggers a series of chemical and electrical phenomena that eventually result in nerve impulses that are sent to the brain through the optic nerve.

The retina has a complex structure. It consists basically of several layers of neurons interconnected by synapses. The only cells that are sensitive to light are cones and rods.

The human retina contains 6.5 million cones and 120 million rods. The sticks work mainly in conditions of low light and provide black and white vision, the cones, however, are adapted to situations of high brightness and provide color vision.

The vitreous can undergo changes in its molecular structure, generating small groups of gel or cells inside it, casting shadows on the retina, and you can see small spots, spots, threads or clouds that move in your field of vision, called "floaters". flies. "

They can often be seen with greater intensity when looking at a flat bottom, such as a wall or the blue sky. As we get older, the vitreous can shrink and pull the retina. When this happens, you may notice something like flashing lights, streaks of light or having the sensation of "seeing stars." This is called "flashes or photopsies." These changes produce a liquid part inside the gelatin.

These vitreous alterations may be secondary to: age, high myopia; severe eye trauma or contusions, eye surgery, inflammatory processes.

Usually, the vitreous separates from the retina without causing problems, but sometimes the vitreous pulls too hard and breaks the retina in one or more places. The fluid can pass through a tear in the retina, lifting it from the back of the eye, similar to oil paint or wallpaper on a wall; generating a detachment. The retina does not work when it comes off and the vision becomes blurry. A detached retina is a very serious problem that almost always causes blindness if it is not treated with surgery.

Symptoms of tearing and detachment of the retina may include sudden increase in the size and number of floating spots, a sudden appearance of scintillation, a shadow on the periphery (side) of the field of vision; a gray curtain moving in the middle of the field of vision or sudden decrease in vision.

The most important thing in this stage is to go immediately to an ophthalmologist to receive a complete assessment that includes pupillary dilation.

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Gynecological control is fundamental for the prevention of different pathologies in women, especially malignant ones. Approximately one out of three women suffers from cancer throughout their lives, and one in four dies of the disease, with gynecological cancers accounting for 12% of these cases.

It is estimated that only 5% of women go to the gynecologist in a preventive way, because unfortunately 95% come to consultation when a disease is latent or presents the symptoms of some ailment. This is fought with a culture of prevention that, fortunately, every day is taking more body in Dominican women.

Among the strategies established to combat cancer in the 21st century is the detection in the asymptomatic population of stages prior to malignancy and of the disease itself at the early stage. These detection strategies are based on the criteria imposed by the World Health Organization (WHO).

Undoubtedly the annual consultation with the gynecologist is an effective strategy to achieve cancer prevention. By means of a correct interrogation and physical examination it is detected which are the potentially problematic areas, which allows to derive in the most adequate complementary exams for each patient.

The routine gynecological check should be performed at least once a year to all sexually active women and / or over 18 years of age; This evaluation includes the collection of information about personal and family history that could represent risk factors related to the main malignant entities of this specialty, a thorough physical examination from head to toe with emphasis on mammary, abdominal and pelvic exams. health habits and important interventions considering the main causes of morbidity and mortality of each of the different age groups; and the accomplishment of analysis of laboratories and specialized studies to evaluate the state of all the organs of the female body: the breasts, vulva, vagina, cervix, uterine body, fallopian tubes and ovaries.
The routine preventive evaluation of the woman should be done by a gynecologist, since these exams should be done and visualized with appropriate instruments and someone skilled in the subject.

Recall that women can not self-examine in certain risky areas, such as the cervix, and that each type of gynecological cancer is different and has specific signs and symptoms, as well as different risk factors and requires different prevention strategies.
All women are at risk of gynecological cancers and the risk increases with age.

If gynecologic cancers are detected at an early stage, treatment is more effective.

What are the most frequent gynecological cancers in the Dominican Republic?

According to studies by international organizations, every year, in the Dominican Republic, 13,000 new cases of cancer are diagnosed. Breast cancer is the most frequent. It is estimated that every year around 5200 Dominican women are diagnosed with breast cancer, with the aggravating circumstance that more than 70% of cases are detected at an advanced stage.

Although breast cancer is the one that takes more victims in women in this country, it is important to remember that there are other types of cancer that affect hundreds of Dominicans, among them the Cervicouterino, in which in the Dominican Republic it registers an average of 1500 cases new cervical cancer each year and of these, there are approximately 600 deaths from this disease.

Virtually all cases of this kind of pathology (99%) are related to genital infection with the human papilloma virus (HPV), which is the most common viral infection of the reproductive tract. It has been observed that more than 50% of patients who are detected this type of condition reaches the consultations when they already have metastases and, therefore, little chance of survival.

Authors: Doctors Noelia Gómez González and Kelda Rodríguez Wrispi
GINECÓLOGA- OBSTETRA- ONCÓLOGA

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Sensitivity to light and sound, visual disturbances or tiredness and insomnia may not allow you to concentrate while working. Nausea and vomiting can force you to postpone or cancel weekend plans.
20% of men and 30% of women say they lose 10% of their working hours due to migraine. And not only that, but 45% of people with migraine recognize that social and leisure activities have been lost due to this disease. Therefore, it is not a simple headache! It is a great burden that makes you less productive, both at work and in your personal life.

Each year, 3% of patients with migraine 'chronify' their disease, and 6% go from having a low-frequency episodic migraine to a high-frequency one, with more than 15 attacks per month.

Patients with chronic migraine consume four times more resources than those who have episodic migraine, consult twice more to the primary care physician and three times more to the neurologist.

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It addresses the administrative sphere and its main function is to establish the instruments that train and educate staff about the relationship between their work and the process of moralizing medical services and care provided by the center.

It makes use of the codes to regulate appropriate behaviors and is called to tune them to direct them until they coincide with the "telos" or final objectives of the health center.

It is based on instrumental values based on efficiency, effectiveness and effectiveness plus those of the institution to which sensitivity, ethics and innovation are added.

Their task will be to bring them closer to the intrinsic values of bioethics that are based on the work of health personnel consisting of curing, improving, alleviating and accompanying the patients in a respectful way.
Generally they move through deontological codes that focus more on the proper behavior of employees, interested in the generation of moral behaviors, which in this case is the hospital and the proper management of patients, which is the transverse axis and main service

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After completing the rehabilitation program (TF / TO), have the objectives been met or the doctor and / or patient want to continue working on the symptoms? Is there a contraindication for the other treatments?

These questions will give us an idea of what is happening with our patient, and we will know if it is necessary to climb a step in the complexity of the management.

Botulinum toxin is derived from the bacterium that causes botulism (Clostridium botulinum), which is a disease that produces flaccid muscular paralysis (the opposite of spasticity), so it was identified more than 30 years ago for the treatment of it. , becoming the current medicine in the first line of treatment for focal spasticity.

Being this an extremely powerful toxin, it has risks that are handled with proper training and respecting the therapeutic margins of application for each age and weight. In addition to planning clear goals, with understanding by the patient of what is pursued, and of course, accompanying coadjuvant treatments such as physical and occupational therapy, and serial splinting in cases where necessary.

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MD, MBA Senior Manager of Preventive Services HGPS. Specialist in family medicine and community expertise in Hospital Administration. Specialist in Quality Management in Health and Medical Tourism
Health systems worldwide have gradually changed their traditional approach based on the treatment of diseases in hospitals, for a preventive approach aimed at promoting healthy lifestyles and early detection of diseases.

To achieve this goal, strategies have been established such as health promotion and preventive evaluations to detect risk factors and take proactive measures to empower the population of their health care. In the same way, the primary care strategy strengthens accessibility, the community and home component of family medicine.

Family medicine is a specialty that offers continuous care, in health or illness, without distinction of group, age or gender. It is capable of solving 85% of health problems, with a comprehensive approach to the individual, the family and their environment, serving as a first contact at other levels of care.

The conventional model that consists of acting in the presence of symptoms and diseases turned out to be a strategy that is ineffective and costly in isolation, since we can now see an increase in noncommunicable diseases such as cardiovascular, endocrine-metabolic and chronic degenerative diseases, hand with a high percentage of investment in tertiary care and critical care and, on the contrary, a low investment in the first level of care and prevention.

Noncommunicable diseases, according to data from the World Health Organization (WHO), increasingly occur in young populations and a large number of them can be avoided with preventive medical evaluations and with the reduction of four risk factors: little diet healthy, inactivity, tobacco consumption and harmful consumption of alcohol and drugs.

However, living a healthy lifestyle is not part of the priorities of most individuals and families in today's society. We are bombarded with deceptive advertising, harmful products and supposedly miraculous diets. We live in a world where fast food, stress, sedentary lifestyle, self-medication and lack of time for personal care are important.

These toxic habits have a negative impact on our health, favoring the appearance of often asymptomatic diseases. It is precisely because of this that we must undergo periodic reviews and create a preventive culture in our homes, jobs and communities.
The preventive evaluations consist of a comprehensive medical check-up, in order to identify predisposition to diseases and health conditions, establishing personalized recommendations to improve the quality of life and providing tools to empower people to take care of their health and well-being.

The Preventive Health Unit of the General Hospital of the Plaza de la Salud promotes an integral medicine based on the prevention and early detection of diseases. For these purposes, it has developed a model of patient-centric care and a priority care modality, with specialists from different areas of medicine and with a space where all the equipment required to carry out executive, corporate and medical check-ups is available. international community.

Domiciliary Medicine (HGPS in Your Home)

Sometimes, some patients find it difficult to go to the doctor for reasons of disability, lack of time, transportation or simply for privacy and convenience.

Because of this, the demand for ambulatory services grows at a global level, which at a personal, family and corporate level become an intelligent and cost-effective alternative.

Having the availability of medical care at home, at work or while enjoying a vacation in a hotel, results in an attraction that allows you to have professionals and diagnostic and treatment equipment within reach of a call, without having to travel.

That is why the General Hospital of the Plaza de la Salud has an innovative program of home health care called 'HGPS in Your Home', which provides services with a mobile unit of specialized consultations, physical therapy, nursing, laboratory, vaccines, administration of medications, placement of probes, channeling and studies such as electrocardiogram, sonography of abdomen, pelvis, thyroid, Doppler and pain clinic.

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STIs contribute to the spread of HIV / AIDS, which is why people with any of these diseases (gonorrhea, chlamydia, syphilis, chancroid and trichomoniasis), who are exposed to HIV, are more likely to be infected with the virus and a Once they become infected, they increase the chances of transmitting it.

Circumcision can be accepted as an effective intervention to reduce heterosexual infections in herpes virus and human papillomavirus in men and adolescents.

Circumcision reduces the risk of bacterial vaginosis, vaginal ulcers and trichomoniasis, as well as decreasing the presence of cervical cancer in the female partner.

The practice of safe sex should be promoted, since the protection of circumcision is only partial. Although studies in Africa have shown that circumcision can decrease the spread of HIV in heterosexuals, it would not be very effective in preventing infections in homosexual and bisexual men. In some research conducted in African regions it was found that circumcised heterosexuals were 60% less likely to contract HIV.

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On July 28 of each year, the WHO commemorates the World Day against Hepatitis, with the aim of raising awareness and educating the population about viral hepatitis.

There are several types of acute and chronic hepatitis, this time we refer to the chronicles, particularly hepatitis C (HVC) because it is the most prevalent worldwide.

Hepatitis C is a disease caused by the virus of the same name; capable of causing inflammation of the liver, and its clinical manifestations can range from very mild symptoms to severe or complicated forms of the disease.

The hepatitis C virus (HCV) causes acute and chronic infection. In general, acute infection is asymptomatic and rarely (if at all) is associated with a life-threatening disease. Approximately 15-45% of infected people eliminate the virus spontaneously within a period of six months, without the need for treatment. The remaining 60-80% will develop chronic infection, and in these cases the risk of liver cirrhosis at 20 years is 15-30%.

The natural history of the disease is very variable, it is not known what this is due to, but factors related to the host, the virus and the environment are involved. Chronic HVC infection can lead to liver cirrhosis and hepatocellular carcinoma. The incidence of these complications has been significant in the last two decades, however, it is expected to decrease this incidence by 2030. Complications secondary to HVC are the main cause of liver transplantation in the United States and Europe, as well as in the Republic. Dominican Republic where it represents 58% of the transplanted until the year 2017.

Chronic hepatitis C is the only hepatitis that is cured with antiviral treatment.

Successful antiviral treatment prevents complications in the short and long term, however, when they are present they do not disappear, but they are easier to handle and their evolution is slowed down.

Hepatitis C is prevalent throughout the world, it is estimated that there are more than 200 million people infected, in the United States there are more than five million people with the virus.

The most affected regions of the WHO are those of the Eastern Mediterranean and Europe, with a prevalence of 2.3% and 1.5% respectively. The prevalence of HCV infection in other WHO regions ranges between 0.5% and 1.0%. Depending on the country, infection with the hepatitis C virus can be concentrated in some populations (for example, among users of injectable drugs), and / or in the general population.

There are numerous strains (or genotypes) of HCV, the distribution of which varies according to the region. It is more common in men than in women and more frequent in African-Americans than in Caucasians.

Treatment 

The treatment of hepatitis C has evolved significantly in recent years, reaching the era of direct-acting antivirals such as sofosbuvir, daclatasvir, ledipasvir, among others, capable of achieving total healing of the virus, something that years was impossible. These medications are much more effective and safe, and better tolerated than the old treatments; however, access is limited due to the high costs they still have. To choose the treatment, the degree of liver damage (fibrosis or cirrhosis) must be evaluated, by liver biopsy or FibroScan. In addition, a laboratory test should be performed to identify the genotype of the virus. There are six genotypes of HCV, and their response to treatment is different. On the other hand, the same person may be infected by more than one genotype. The degree of liver damage and the genotype of the virus are used to guide therapeutic decisions and clinical behavior.

In the Dominican Republic we have these treatments subsidized by the Ministry of Public Health, with some limitations that prevent total access.