Deep brain stimulation', a surgery with cutting-edge technology that improves the quality of life of patients with Parkinson's

18/07/2025

Seven habits to cope with daily stress without losing your health

Who hasn't skipped meals because of unfinished work or a child who urgently needs help? Or woken up tired because they didn't sleep well or suffered from insomnia? Who hasn't spent the weekend completing a request from the boss? Or reached for a snack to stave off hunger until the end of a long Zoom call that coincided with lunch?

Our daily lives put us under pressure, and what we call 'modern life' demands a fast-paced life. And yet, "it's possible to achieve a holistic lifestyle that keeps us healthy," says internist Daniel Castillo , a physician at Metropolitan Hospital.

Habits to reduce stress

The formula is to "incorporate into your daily life—amid work, family, and other responsibilities—activities and habits that are beneficial to your health." The specialist tells us how to achieve this goal, which may seem distant:

Thinking about yourself is essential and is Dr. Castillo's first recommendation. "There's always a tendency to prioritize work; we give it our all; but what happens if you get sick and can't be there anymore?"
Find recreational activities that take us away from stress and work: sports, bike rides, a walk. The important thing: make sure they're enjoyable.
Fixed meal times and a balanced diet are ideal; but if you ever have to skip breakfast or lunch, choose quality foods: a lunch with some protein and no white flour, sugar, or processed foods.
Increasing levels of non-exercise physical activity is key. To get from one floor to another, for example, prefer the stairs; or if ordering delivery, get up to pick it up in person.
Exercise snacks are the best allies for coping with long hours in front of a screen, says the internist. It involves taking a break from work every hour to dedicate 5 to 10 minutes to physical activity such as walking or stretching. If it's every two hours, the snack should last between 10 and 15 minutes.
Don't have time to exercise or play a sport? Here's Dr. Castillo's suggestion: "At least 10 to 15 minutes of functional exercise a day—preferably for muscle building—and that will help you for a lifetime."
Get 6 to 8 hours of sleep each night, ensuring restful sleep that restores your energy. Adequate rest is key to both mental and physical health; it even prevents weight gain.

You may also be interested in: Do you suffer from migraines? The cause could be stress or depression.

With these habits, the specialist maintains, quality of life is improved; the risk of a heart attack or stroke, kidney problems, or metabolic problems such as diabetes is avoided; and healthy aging is guaranteed. All of these are possible in the midst of hectic daily life.

Dr. Daniel Castillo

INTERNAL MEDICINE

METROPOLITAN HOSPITAL

26/12/2023

Two techniques that improve the appearance of the face: botulinum toxins and fillers. Learn how they work.

Botulinum toxins and fillers are the two most used non-surgical techniques currently, worldwide, to successfully improve the facial appearance of men and women in a certain age range.

The ease of the procedures, their moderate costs in relation to those of surgical techniques and the almost general absence of side effects explain their increasingly frequent use, maintains Marcelo Gómez-Barreto, plastic surgeon at the Metropolitan Hospital.

Neither fillers nor botulinum toxins are applied indiscriminately to any person or area of the face; And to obtain the best possible result, explains the doctor, three steps are key:

Go to a doctor specialized in plastic surgery and trained in these procedures.
During the consultation, take a medical history that determines pre-existing diseases in which the use of these techniques is contraindicated.
Under the guidance of the surgeon, align personal expectations with the characteristics and results of each technique and substance.

If I have already used fillers or toxins, will I have to continue using them?

This is one of the most frequently asked questions among patients interested in the use of these non-surgical techniques, says Dr. Marcelo Gómez-Barreto and the answer is: NO.

“There is absolutely nothing wrong if the person does not use them again; It does not age any more, no more wrinkles appear and it simply returns to the state it was in before its application,” emphasizes the plastic surgeon.

These are substances that have a useful half-life; If the patient does not like the result, they should calm down: “the face returns to its previous state once that time has passed, without any side or undesirable effects.”

Dr. Gómez-Barreto makes some useful recommendations to make the right decision and understand the scope of these techniques:

Be clear that these are not products to reduce years in your physical appearance but to improve facial expression.
If your expectations are very high, it is better to opt for another alternative.
Turning to unqualified people can bring risks: in the case of toxins, their incorrect use can lead to temporary paralysis of certain facial muscles; while excess hyaluronic acid on the lips, for example, can affect facial harmony.
The use of silicone-based fillers is not permitted. Its application carries risks of granulomas (inflammations), abscesses, necrosis and lesions that deform the face.

Dr. Marcelo Gómez-Barreto

Plastic Surgeon METROPOLITAN HOSPITAL

26/12/2023

Deep brain stimulation', a surgery with cutting-edge technology that improves the quality of life of patients with Parkinson's

Deep brain stimulation (DBS) is currently the surgery with the best results on motor and non-motor symptoms in patients with Parkinson's disease who qualify for the intervention.

In Ecuador, the Metropolitan Hospital has trained professionals and cutting-edge technology to perform this surgery: a minimally invasive, highly complex and generally low-risk procedure, which allows controlling the symptom that generates the greatest discomfort in the patient.

Verónica Montilla, a clinical neurologist who is part of the medical team at the Metropolitan Hospital, explains what deep brain stimulation consists of and what happens in the brain of the person diagnosed with Parkinson's, a degenerative pathology that has no cure:

Two cables a few millimeters thick are introduced through two very small holes in the brain, until they reach deep areas known as 'base ganglia'. In a patient with Parkinson's, the neurotransmitter substances that regulate the functions of these ganglia (a complex super network where the body's movements are controlled) are not produced in the necessary quantities, causing symptoms such as tremor, rigidity and motor slowness.

These cables (electrodes), placed in the 'base ganglia', are connected to a battery that is inserted at the chest level like a pacemaker; The entire system is located inside the patient and is not visible.
The battery allows the sending of electrical current that replaces the deficient chemical stimulus due to the low production of dopamine in a patient with Parkinson's and who, despite receiving dopaminergic drugs, such as levodopa, there comes a time when the progression of the The disease makes the therapeutic effect of these medications insufficient, so it is necessary to complement this signal with continuous electrical impulses.
During most of the surgery the patient is awake and conscious, which allows us to verify “in situ” the therapeutic response generated by the stimulation of specific nuclei of the basal ganglia, observing in most cases, an immediate positive response. and being the most obvious, the improvement in rigidity.
The stimulation during surgery generates an 'edema effect or injury effect' given by a small inflammation at the stimulated site. Instead of being harmful, this effect causes a level of improvement that will last approximately 7 to 21 days, this time may vary for each patient.
When you turn on the equipment, the sustained improvement will be more evident and will even reach 70 to 80%. This percentage can vary due to different factors, however, the process of selecting the candidate as the area of the brain that will be stimulated is key. For this reason, there must be a multidisciplinary team trained in the management of patients with Parkinson's and trained in the post-surgical management of the stimulator.
When the injury effect disappears, the patient once again shows worsening of his motor symptoms, this being the signal that tells the neurologist who specializes in handling the stimulator that the time has come to turn on the device, perform a contact test to choose the best pole to stimulate, and modulate the parameters of the team.
In the first year, after the intervention, the patient has to go to their neurologist specializing in Movement Disorders at least once a month; Then, a 'neuromodulation' process begins, that is, the neurons that receive direct current try to adapt and get used to the new balance.

Does this surgery eliminate the motor symptoms of Parkinson's?

To obtain the best result, it is essential that the specialist neurologist correctly selects the 'surgical target' or 'target' within the basal ganglia, says Dr. Verónica Montilla.

To choose which area will be stimulated, you must answer the question: what is the symptom that bothers the patient the most at that moment. “We have to assess risk-benefit because we cannot target several targets at the same time in a single brain,” he adds.

And he gives two examples: if the symptom that detracts from the highest quality of life is tremor with motor slowness and rigidity, the 'surgical target' will be the subthalamic nucleus (STN); If dyskinesias prevail (sudden and repetitive movements of the head, trunk and extremities) and there is no possibility of lowering the dose of levodopa, the 'target' or objective will be the Internal Globus Palidus (GPi).

" Technology is advancing and the latest version of the electrodes that are placed inside the brain incorporates a directional and segmented system that allows greater precision and better response in the patient with fewer adverse effects. "

Dr. Verónica Montilla, clinical neurologist

What type of Parkinson's patients qualify for this surgery?

The criteria for evaluating a patient and determining whether or not they are an eligible candidate for this type of surgery have become more flexible in recent years, says Dr. Montilla and explains how they are currently applied:

Age. Although the best results of this surgery will be obtained in younger patients, there is no reason to deny this opportunity to a person between 75 and 80 years old, who exercises, has no comorbidities that are exclusion criteria, eats well and leads a healthy life. healthy. In these cases, the best option would be the Internal Pale Globus (GPi).
The Parkinson's stage. Previously, action was taken when the disease was in more advanced stages; Currently, surgery is not performed in the initial stages, but it is when the patient has begun to fluctuate and is still functional.
The levodopa test. This test works like this: the patient is withdrawn from levodopa and all dopaminergic drugs (baseline medicine) and, after 12 to 24 hours, the patient is evaluated using the unified Parkinson's scale (motor part); In a second step, the medication is reintroduced, we wait for it to take effect and the scale is passed again. The difference OFF (without medication) - ON (with medication) is then evaluated, “the percentage of improvement must exceed 30%” to qualify the surgery.

The clinical neurologist highlights the low risk of the intervention, its immediate effects on the patient's quality of life and the possibility of the person quickly returning to their daily tasks.

The non-rechargeable stimulation system lasts 7 to 10 years; and the only postoperative recommendation is to avoid blows or trauma to the head that could affect the mechanism.

Dr. Verónica Montilla

Clinical Neurologist, Movement Disorders/Parkinson's Specialist
METROPOLITAN HOSPITAL

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The specialist's recommendations to avoid depression and anxiety during December

Just as life itself is full of nuances, December celebrations bring a mix of feelings for many; In the midst of expectation, sadness, anxiety or frustration appear. There are more consultations for depression on these dates, says Monserrat Mejía, clinical psychologist at the Metropolitan Hospital.
“We always wonder why these emotions emerge in December”: and the answer lies, according to the specialist, in three characteristics of our environment:
An idealized Christmas. Advertising and social networks “sell us the practically unattainable idea of the perfect family, the perfect tree and the perfect gifts; In reality, this does not happen and we can feel bad.”
Sensitivity touches on unresolved issues. The environment becomes conducive, according to the clinical psychologist, to think about the past or about situations and emotions that have not yet been processed: a divorce, an illness, the absence of a loved one.
A very high self-demand. “When unrealistic life expectations are raised and the time comes to evaluate, we see that they have not been met.” This demand for perfection, says Dr. Mejía, does not adjust to reality.
Faced with these stimuli and risks, small strategies can help a lot. The personal goal, the clinical psychologist recommends, should be “to find oneself to discover what I feel and how I want to spend these holidays, thus rescuing my spirituality.”
These are their therapeutic recommendations:
Fall in love with imperfection. Put aside the idealized Christmas and look, with maturity, at reality: “even though there is pain or unresolved situations, it can be a beautiful Christmas.”
Learn to say 'No'. Christmas, the psychologist highlights, does not mean pleasing everyone; What if, guided by the heart and self-knowledge, “we are selective and choose where we go and where we don't.”
A list of the things that DID get done. Writing, says Dr. Mejía, is an excellent way to become aware; suggests taking paper and pencil and remembering the things that were accomplished this year to focus on the achievements.
Don't leave everything for last. Without becoming obsessed, planning the meeting with friends or family will reduce the level of anxiety; “however it turns out it will be perfect, let's not give up the ability to enjoy the celebration.”
Permission to rest. In the midst of the hustle and bustle of the holidays, says the psychologist, it is advisable to take time to relax: walk, read, listen to music...
Don't get carried away by this time. Two specific ways to achieve this are to maintain order in your diet, avoiding excesses; and continue with the habit of physical exercise.
Make a budget. In a conscious effort, “let's set a budget, stick to it without frustration, and enjoy the little things.”
And unresolved emotions? Let's listen to them as a call to resolve pending issues in the near future, emphasizes Dr. Mejía. “Let's also take a break from the differences with others to resolve them later.”
" The clinical psychologist insists, finally, on the importance of living in the present, here and now. “Let's have a curious, beginner's attitude, as if these were the first Christmas of our lives and let's enjoy them with simplicity and full awareness "

Dr. Monserrat Mejía, clinical psychologist

Dr. Monserrat Mejía
Clinical Psychologist
METROPOLITAN HOSPITAL

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Celebration time! Ten tips to enjoy without guilt

Moderation, physical exercise, planning and good hydration are the keys that will allow us this year to enjoy celebrations with family and friends without stomach problems and without excessive weight gain.
How to apply them on a daily basis, during this month, while the celebrations come one after another? Dr. Yedid Valcárcel, nutritionist at the Metropolitan Hospital, offers us useful and very practical advice so as not to fail in the attempt and enjoy this special time.
Serve food on small plates, without limiting the type of food so as not to miss the opportunity to enjoy a good lunch or a good dinner. If you are the host, do not place excessively large plates on the table.
Avoid repetitions and listen to our body's signals. “If you are full, stop eating; and if it's very delicious, you eat it in the warm-up the next day.” The extra bite will cause gas and stomach upset; no pill will take away excess food
It is not a good idea to stop eating during the day to save space before dinner; The only thing that will happen is that, when night comes, we will eat much larger portions because we will be excessively hungry.
Be selective and enjoy consciously. If you are in a buffet, prefer those foods that you do not consume regularly and that are typical of this season. Chew well and feel the satisfaction of a delicious meal in good company: the brain will receive this signal and control appetite.
Let's follow this order to eat: protein, vegetables and, lastly, starch sources such as rice or potatoes. It is possible that when we reach the carbohydrate we will be full and thus stop consuming foods with more calories in excess.
Include healthy options on the menu without sacrificing the palate. And if you are the guest, and you have agreed to bring a dessert, a salad or Christmas rice, think about how to reduce fat or sugar: fruits with dark chocolate, yogurt instead of mayonnaise, nuts or dried fruits in the rice.
Avoid sugary drinks because the menu, by itself, will already have a higher caloric load. Drink water, perhaps flavored with a few drops of lemon, it will always be the best option.
Don't stop making the toast. One or two glasses of wine or champagne usually do not cause any health problems. If you know there will be a toast, avoid other drinks with sugar; Remember that the combination of carbonated drinks and excess food causes gastrointestinal upset.
Stay well hydrated constantly and do not stop exercising: at least 30 minutes a day of some type of physical activity so that those extra calories we consume during these holidays are not excessive.
Sleep well; Following a tiring rhythm is not healthy, nor is eating dinner too late and going to bed immediately. In patients with diabetes, for example, it will cause very high sugar levels the next morning.
" You have to be realistic, says Dr. Valcárcel: December is not the time to diet. If you are following a weight control plan, perhaps an achievable goal is to maintain it. In any case, adds the nutritionist, moderation will always be the secret. Enjoy it is said !

Dr. Yedid Valcárce, nutritionist

Dr. Yedid Valcárce
Nutritionist
METROPOLITAN HOSPITAL

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Did you just sigh?: you are doing it out of necessity, your brain has ordered it

“The princess is sad... what will the princess have? The sighs escape from his strawberry mouth…”: the phrase from one of the poems by the famous Rubén Darío reminds us that we have always associated sighs with melancholy, nostalgia and, also, fatigue or worry.
But science has shown us that sighs fulfill a specific function within our respiratory system and that, in addition, they are controlled by a brain system that orders our body to do so unconsciously.
Neurologist Daniel Polo, part of the medical team at the Metropolitan Hospital, equates sighs with sneezing, yawning, hiccups or sudden coughs: “breathing is not a continuous act of taking in air and exhaling; “There are changes in our lung mechanics that occur at any time of the day, we sigh even while we sleep.”
What role do sighs play in our body?
The usual rhythm of breathing involves “a tidal amount or volume of air that we inhale and exhale.” When we sigh, two things happen, explains Dr. Polo:
The body takes a deeper breath of air that represents a greater volume of oxygen than what is regularly inhaled.
When you sigh, there is a pause that allows for greater distribution of the air that the body has inhaled.
This mechanism or action, which can be generated about 12 times per hour according to scientists, “allows us to unblock small areas of the lung that are collapsed and lose air, called atelectasis.” With the sigh, the pulmonologist details, “they are ventilated again.”
" Stress conditions, pain, the adverse effect of a drug or damage caused by a respiratory disease can alter respiratory mechanics and prevent deep inhalation of air "

Dr. Daniel Polo, pulmonologist
How to take care of our respiratory health?
Respiratory mechanics, of which sighs are a part, is a coordinated system that guarantees our health and that reacts, motivated by receptors at the nervous level, to meet its own needs.
Hence the importance of taking care of these mechanics or, in more everyday terms, of 'breathing well'. Dr. Polo explains that good breathing “meets the number of inhalations of air that we usually perform and that are necessary: between 15 and 16 times per minute.”
If this basic condition is altered, that is, 'you don't breathe well', it is important to determine the cause to assess the need or not for treatment.
Their basic recommendations to take care of lung health are the following:
Avoid exposure to unnecessary risk factors (tobacco, vaporizers or vapes, gases, smoke).
Maintain adequate physical activity and nutrition.
Submit to the recommended vaccination schedules.

Dr. Daniel Polo
Pulmonologist
METROPOLITAN HOSPITAL

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Diet and exercise to control blood sugar

Nutrition and exercise are the duo that must be included in the treatment of any of the states in which the diabetic patient finds himself; and their combination is currently the main tool to reverse prediabetes or the first warning signs of the disease.
To determine that a patient is prediabetic, explains the endocrinologist at the Metropolitan Hospital, Paola Jervis, that there are three parameters measured in the blood through laboratory tests:
Glucose level between 100 and less than 126, fasting.
Glycosylated hemoglobin (average glucose over the last three months) in the range of 5.7 to less than 6.5.
Sugar level above 140 and below 200 in oral glucose tolerance test.
" When there are alterations in glucose, without yet reaching diabetes, we could in the first instance recommend a change in lifestyle and observe how the patient is doing and then whether or not to start pharmacological treatment "

Dr. Paola Jervis, endocrinologist
However, nutrition and exercise are prescribed even when the patient is insulin dependent, such as in cases of type 1 or type 2 diabetes, and oral drugs have stopped working. Here, the positive effect is a regulation of the amount of insulin needed.
What type of nutrition helps us control glucose?
Although the nutritional plan to control blood sugar levels must be put together in a personalized way, even adapting it to the tastes of each patient, there are general guidelines that make this therapeutic strategy effective. Dr. Jervis details them:
A healthy plate is made up of 50% vegetables and legumes, 25% protein and 25% carbohydrates.
To choose foods, you must take into account their glycemic index; That is, how quickly a food will be transformed into glucose within the body.
You should prefer foods with a low glycemic index such as raw vegetables and legumes, non-starchy carbohydrates (little refined and with fiber), baked potatoes keeping the peel and unliquefied fruits, consumed in their most natural state, to avoid glucose spikes later. to eat.
Avoid foods that quickly convert to glucose such as white bread and other refined flour products.
Eliminate juices, sodas, soups, coladas and cooked oatmeal as much as possible.
What kind of exercise reduces blood sugar spikes?
To contribute to the reduction of glucose spikes in adults, explains Dr. Jervis, physical exercise must achieve the following characteristics:
At least 150 minutes of exercise a week, divided into four days; The patient should not spend more than two days without physical activity.
Aerobic exercise and routines are recommended to improve muscle mass and balance.
When exercising, active breaks should be added: if a person works sitting, they should get up every 30 minutes to do a small activity.
Exercise, the endocrinologist emphasizes, “also helps reduce insulin resistance and contributes to a better response in the body, lowering the glucose level.”
Currently, he points out, a patient with diabetes must be treated by a multidisciplinary team that includes, in addition to an endocrinologist or diabetologist, a nutritionist and even a sports doctor.

Dr. Paola Jervis
Endocrinologist
METROPOLITAN HOSPITAL

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Not all pneumonias have the same origin and not all require antibiotics

Although pneumonia is the leading cause of death due to infection worldwide, in its treatment the poor management of the diagnostic process, the choice of medication and the duration of the pharmacological regimen is still surprising, says Dr. María Belén Gallegos, pulmonologist at the Metropolitan Hospital.
Pneumonia is an inflammation of the lung structure that can have an infectious origin (bacteria or viruses) or derive from an autoimmune pathology or exposure to agents such as smoke, paints or pesticides. The first mistake, points out Dr. Gallegos, is to think that all pneumonias are identical and require antibiotics.
" "Even if the patient has a cough with phlegm, fever or sweating, the management of the disease must be personalized because the infecting agents are different." If behind pneumonia is, for example, a COVID, influenza or respiratory syncytial virus, the antibiotic is not indicated. "

Dr. María Belén Gallegos, neomologist
How to correctly treat pneumonia?
Antibiotics are used specifically to treat bacterial pneumonia. The international guidelines, specifically the pulmonologist, determine that, after suspicion and according to a patient's risk of complications, an initial antibiotic regimen should be applied that covers 80% of the most common germs.
To avoid the abuse or mismanagement of antibiotics, Dr. Gallegos makes clear the importance of the following medical protocols:
Know, suspect and value. “If the patient is stable, has no pressure problems or signs of respiratory distress or sepsis (abnormal immune response), the most prudent thing would be to confirm the diagnosis through an imaging test” before medicating.
To confirm the diagnosis of pneumonia, not only the symptoms are taken into account; An imaging test of the lungs is necessary.
If there is suspicion of pneumonia and the doctor decides to apply the initial antibiotic regimen, clinical follow-up is key and verify whether the cough and fever decrease or not, the phlegm clears, the oxygen requirement decreases or not, and the level should be measured. of white blood cells.
When the patient does not respond, cultures of secretion samples are done to determine which antibiotic the bacteria is sensitive to. In addition, blood tests are performed to identify infectious markers that cover a larger universe of bacteria or antigen tests are also performed.
Can the body become resistant to the antibiotic?

The organism does not become resistant; It is the bacteria that becomes resistant to the antibiotic. The medicine does not attack a cell in the body but instead tries to stop the bacteria. In certain types of bacteria, their genes evolve and manage to create other defense mechanisms against the antibiotic: they alter its absorption or prevent it from penetrating their wall.
What is the risk of overusing antibiotics?
Two alerts go off when there is abuse or mismanagement of antibiotics in the treatment of pneumonia; Both, according to the pulmonologist, can be avoided if the patient is evaluated well, if the diagnostic tools are used correctly and if the treatment is dynamically readjusted.
An incorrectly prescribed antibiotic regimen opens the way for the bacterial flora, which naturally exists in the respiratory tract, to become resistant to a future infection caused by its abnormal replication.
The use of stronger antibiotics has greater adverse effects: marrow depression, classic anemia or kidney failure. If its administration is not justified, unnecessary damage is caused.

Dr. María Belén Gallegos
Pulmonologist
METROPOLITAN HOSPITAL

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Everything you need to know about anesthesia myths

Anesthesia leads to a state of insensitivity or unconsciousness so that a patient can undergo surgery. As indicated by Dr. Manuel Panzeri, head of Anesthesiology at the Metropolitan Hospital, the objective of anesthesia is to avoid pain during your procedure.
In this process, the anesthesiologist monitors all vital signs such as heart rate, respiratory rate, pulse, blood pressure, pulse oximetry (oxygen levels in the blood), the depth of anesthesia (entropy), the state of muscle relaxation, among others.
In more advanced surgeries, other values are measured in real time related to the patient's clinical status. Since he cannot speak, the only way to know his status is through his vital signs.
Types of anesthesia
General: it affects the entire body and the patient is completely asleep, has no pain and the anesthesiologist will wake him up, avoiding any type of discomfort.
Regional: Used in other minor procedures to induce the absence of sensation in a specific part of the body, for example, knees, feet, arms or hands, through nerve blocking.
Local: administered in smaller procedures such as molar surgery or endoscopies. The patient is not completely anesthetized or immobile.
In adults any of these types of anesthesia can be applied, however, in children general anesthesia is usually used to avoid risks and reduce the stress of the little patient. Currently, general anesthesia is very safe, because there are more modern equipment, medicines and monitoring systems, which allow the patient to be monitored at all times.
Anesthesia myths
Myth #1 – There is no allergy to anesthesia
During surgery, the patient receives a series of medications that are considered adjuncts to anesthesia, such as antibiotics, analgesics, anti-inflammatories, corticosteroids, among others. Many times the most common allergies that occur are to antibiotics and muscle relaxants, but not to anesthesia.
Allergies in surgery are characterized by hives, redness of the skin or edema of the eyelids, and these are easily controlled with the use of anti-allergy medications and corticosteroids. A tiny percentage of patients experience true allergic shock, but there are medicines and protocols that minimize the impact of allergies and side effects.
Myth #2 – “I don't want too much anesthesia” How is your dose calculated?
Anesthesia is calculated by several factors, taking into account the patient's age, weight, height and sex. It is provided with special devices that are vaporizers and continuous intravenous infusion sets, which are also known as perfusors or intravenous pumps.
These devices administer a programmed and constant amount so that the concentration of the medication in the blood is stable and adequate. Sometimes there is suspension of operations, but the only factor for this to occur is the patients' fear of not waking up. However, it is necessary to overcome that fear.
Myth #3 – Side effects and adverse reactions
The effects and reactions are not the same and the doctor will know how to differentiate. Side effects of a medication may include upset stomach, diarrhea, loose stools, among others. While, adverse reactions are unwanted experiences in a patient associated with the use of a medical product.
" Saying that one is allergic to a medication without having an accurate diagnosis is counterproductive because we are taking away the possibility of receiving specific medicines that would allow us to cope with surgery, illness and recovery." Dr. Manuel Panzeri, head of Anesthesiology .

Dr. Manuel Panzeri, anesthesiologist
What challenges does an anesthesiologist face?
The professionals in this branch protect a patient in their greatest state of vulnerability, because they place their trust when they are in a state of unconsciousness, they even take care of their modesty, both in surgery and in recovery, that is, they ensure all integrity of the person.

Dr. Manuel Panzeri
Chief of Anesthesiology
METROPOLITAN HOSPITAL

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In addition to loving them, five things we should know about caring for older adults

From the age of 65, we enter the age in which we are known as older adults. If we are not one of them, we interact with several within our family or work. Thinking that at this stage 'ailments' are normal and life begins to be limited is a big mistake.
“Nothing is further from reality than the image of the old man who forgets things, who is sitting, in pain, watching television and not eating anything,” warns Dr. Johanna Gavidia, geriatrician at the Metropolitan Hospital.
Regarding the International Day of Older Persons, this October 1, the specialist identifies five realities that we must know and understand to contribute positively to the care of an older adult.
1
Periodic reviews are mandatory
An older adult must attend periodic medical check-ups because there are many pathologies that do not present symptoms and that become quite common over the years. Hypertension, diabetes and osteoporosis, for example, do not hurt and “many times people confuse the absence of symptoms with the absence of disease,” says Dr. Gavidia.
Prevention is an objective that must be present, constantly, when addressing the needs of an older adult; Periodic check-ups, the specialist emphasizes, allow diseases to be detected in time without waiting for the consequences to occur: a hip fracture, a stroke, blindness caused by cataracts, among others.
2
Do not assume that forgetfulness, blindness, deafness are normal...
Family and surroundings usually assume it is normal that an older adult begins to forget things; also that you lose your hearing or your vision is diminished. As a society, Dr. Gavidia insists, “we must change that way of thinking”: supposedly normal situations are actually abnormal and require medical attention.
Although certain abilities are lost over time or certain alterations occur, these are mild in a healthy older adult. It is normal if you forget where you left your keys and then remember; But if you forget that you have a medical appointment, if you go out to buy bread and then don't remember what it was for, or if you get lost when going out, you need a medical evaluation or checkup.
" Unlike children, who begin to eat solids at more or less the same age or to walk around 12 months, older patients are very different from each other and need personalized attention "

Dr. Johanna Gavidia, geriatrician.
3
Mood disturbances are a warning sign
Mood disturbances are quite common at this stage of life and should draw the attention of those around the older adult. “You see patients sad, crying, locked in the house because they don't want to go out and people assume it's because of their age.”
Dr. Gavidia recommends that, when faced with these behaviors, family, friends or caregivers ask the older adult what is bothering them, what they feel, what hurts them. It is common, he says, that he prefers to remain silent or not communicate it because he feels that it may cause discomfort.
4
The diet must be personalized
In an older adult, nutrition is very important and nutritional needs vary depending on the pathologies that affect them. Diabetes, overweight or chronic kidney disease will require specific diets that must be prescribed by a nutritionist.
Patients with dementia may have difficulty swallowing (dysphagia) and cannot eat varied textures or have to follow a blended diet. In older adults, the geriatrician maintains, nutrition is an issue that must be individualized because they are very different from each other.
5
Exercising is non-negotiable
Exercise is extremely important for an older adult, says Dr. Gavidia. At least 150 minutes of cardiovascular exercise per week are needed; in addition to strength, balance and flexibility exercises.
Gait speed in older adults is related to mortality and morbidity; The slower a person walks, the more likely they are to get sick and die. It is also necessary, advises the geriatrician, to adapt the home to reduce the risk of falls.

Dr. Johanna Gavidia
Geriatrician
METROPOLITAN HOSPITAL

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What happens when we suffer a heart attack?

Our heart has arteries called coronary arteries. Blood flows with each heartbeat to deliver nutrients to the heart muscle. When there are risk factors such as tobacco consumption, excess alcohol, lack of exercise or hypertension, they cause plaques rich in cholesterol, triglycerides, calcium, among others, to form on the walls of the arteries.
Dr. María Sol Calero, cardiologist at the Metropolitan Hospital, indicates that over time these plaques begin to grow and eventually clog the artery, blocking the passage of blood to a part of the muscle (heart). This causes the person to suffer ischemia, since the muscle does not receive enough oxygenation. This is how heart attacks occur.
Risk factors in young people and adults
Unfortunately, today there is a high consumption of drugs such as cocaine and marijuana in young people. Although they are not the only substances that can damage the heart, the intake of energizers and contraceptives can cause a heart attack, says the expert.
Other risk factors such as rheumatoid arthritis, hypertension or kidney disease increase the likelihood of suffering a heart attack. Diabetes can also cause alterations in the arteries compared to a patient who does not have this disease.
In women, the most common factors are depression or emotional stress, early menopause, removal of the ovaries that suspend hormone production, preeclampsia, gestational diabetes or being overweight after pregnancy. Inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus make a person more likely to have coronary heart disease or ischemia.
However, these ischemic diseases can occur 10 years earlier in men compared to women. Men are at greater risk when they are over 45 years of age, while women enter a risk age after 55 years of age. However, when women have heart disease, their prognosis is more unfavorable compared to men.
Symptoms of a heart attack in men and women
" People who do not exercise may be asymptomatic and suddenly have a heart attack. "

Dr. María Sol Calero, cardiologist.
What to do if you think you are having a heart attack?
If you feel oppressive pain that radiates to the chest and rises to the jaw, shoulders or arms and was triggered by some physical effort such as running or lifting some weight, which is also accompanied by nausea, dizziness, cold sweats and a feeling of anxiety, you should go. immediately to a hospital.
International guidelines consider that time is crucial for care and if a heart attack is confirmed, its treatment should be immediate so that it does not exceed 120 minutes. Other chest pains may occur, but until you have an accurate diagnosis, you should go to the emergency room, even more so if you are a patient with risk factors or pre-existing diseases.

Dr. María Sol Calero Revelo
Cardiologist
METROPOLITAN HOSPITAL

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In patients with Alzheimer's, oral health should be among their priorities

Stating that oral health in a patient with Alzheimer's should be considered a priority within their daily care scheme may leave us with the question: how is dental care related to memory loss?
In fact, explains Dr. Eduardo Flores, a dentist at the Metropolitan Hospital, Alzheimer's is a brain disease that progresses progressively, destroying neurons and their connections, in a process where, in addition to losing their memory, the patient forgets their habits. One of them, dental cleaning.
By losing the habit, a person with Alzheimer's begins to experience problems with their teeth. Without the intervention of a dentist, the conditions present themselves in this way:
The first warning sign is redness of the gums.
Gingivitis, when the gums begin to bleed.
The deterioration progresses towards periodontitis and affects the tissue that holds the teeth in place.
The most serious condition occurs when the patient needs to enter an operating room for a complete healing of the oral cavity, and subsequently requires a prosthesis.
The condition becomes more complicated when the teeth begin to move and their extraction is necessary because the tissue that supports them is infected.
" The doctor in charge of the oral health of a person with Alzheimer's has to have experience because this patient will require all the time in the world to establish a personal relationship, which is the basis of treatment "

Dr. Eduardo Flores, dentist.
What to do after the diagnosis of Alzheimer's?
Statistics show that, after receiving the diagnosis, a patient with Alzheimer's lives from 8 to 20 years. A wide range that is important to manage properly to guarantee quality of life.
This is why it is important that the medical scheme to deal with this type of dementia is accompanied by an oral maintenance program, agreed upon if possible with the dentist the patient already knows.
The role played by the caregiver or the family member who accompanies the person with mental deterioration is key. He is the one who must accompany the patient in his oral cleaning schedule and observe the warning signs to decide if it is necessary to go to the specialist.
The dentist at Hospital Metropolitano makes three recommendations for successful prevention:
As soon as the patient with Alzheimer's presents redness in their gums, they should go to the specialist. This is how the disease is managed in its first stage.
It is important that the dentist in charge has a specialty in periodontics, as he will be more qualified to manage the gums and tissues around the teeth.
The person with Alzheimer's requires patience and warm attention; It must be managed responsibly to ensure your oral health for many years.

Dr. Eduardo Flores
Dentist
METROPOLITAN HOSPITAL

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Water on the skin: the most effective first aid for burns at home

Staying calm is the first step we must take when we face a burn inside the house. Immediately, it is crucial to remove the person from the source that caused the injury, observe which part of the body is injured, and expose them to plenty of cold water.
Dr. Christian Burbano, specialist dermatologist at the Metropolitan Hospital, assures that regardless of the origin of the burn (hot liquids, oils, splashing food, hot surfaces or iron), cold water reduces skin inflammation. affected.
The water does not need to be frozen nor does it need to use ice to cool it. The water that comes out of the tap is enough, explains the doctor. If the burned skin cannot be placed directly under a faucet, the person should be taken to a shower.
What can you put on a burn?
It is common that, after a domestic burn, people turn to home remedies. Dr. Burbano says that the use of butter or toothpaste is common, but he very emphatically maintains that they should not be placed on the skin. He also does not recommend other non-medicated products.
" The only thing that these home remedies cause is the formation of a paste on the skin that, at the time of healing, is very difficult to remove, a lot of friction is needed and that will hurt the person even more "

Dr. Christian Burbano, dermatologist.
The dermatologist suggests having four things at home that are useful to deal with these emergencies and that are prescribed:
A high potency topical corticosteroid.
An anti-inflammatory that the patient can take without adverse effects.
Ointment for burns containing beta-sitosterol.
Bandages to cover the skin after applying a thin layer of burn cream or corticosteroid.
If these medications are not available at home, “don't waste time going to the pharmacy to buy them.” The specialist's recommendation is clear: water to reduce inflammation and, if there is no cream or corticosteroid at that time, go to the emergency room as soon as possible.
Should blisters be burst?
The formation of blisters is the indicator of the severity of a burn and, therefore, of the need or not to seek emergency medical attention.
If a blister appears, Dr. Burbano points out, it is a superficial second-degree burn and the patient needs to receive immediate attention. “At home, the most we can handle is a first-degree (milder) burn, when the skin just turns red.”
Blisters should never be burst at home. It is a decision that the doctor will make after examining the patient and without removing the skin to avoid possible infections. Only through a small hole, made with a needle, is the fluid drained from the blister.
In the midst of an emergency of this type, the specialist recommends, it is finally important to take the following into account:
If there is a burn with chemicals, such as chlorine or liquids to unclog pipes, you should look at the instructions that these products come with in cases of contact with the skin.
If the burn affects the eyes, you should go to the emergency room immediately.
Seeking medical attention will prevent the burn from spreading and allow for faster control of the pain and burning.
Does the age of the patient matter? If a child burns, there will be a stronger reaction to the pain. Children and older adults, says the dermatologist, have more delicate skin. However, the management of the burn will be the same.

Dr. Cristian Burbano
Dermatologist
METROPOLITAN HOSPITAL

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A healthy lifestyle is the best way to prevent migraine

One in five women who live in large cities practicing a profession currently suffers from some form of migraine. On the other hand, in men the statistics are lower, since only one in 10 suffers from it. The reason women have more migraines is due to hormonal changes.
Dr. Magdalena Gómez, neurologist at the Metropolitan Hospital, shares these data to demonstrate that migraine or migraine is very common in today's societies, it can be episodic, that is, occur once every three years, or become chronic and affect a person for several years. days during the same month.
But what characterizes a migraine? It is a headache that is accompanied by one or more of these discomforts: paleness, sweating, abdominal pain, nausea, vomiting, constipation or diarrhea, low blood pressure, weakness or prostration, explains the specialist.
Does migraine have treatment?
Migraine is a disease in itself and not a symptom associated with another pathology. A clinical evaluation, an interview and only in some cases, a neurological examination will allow the doctor to obtain this conclusion and apply two types of treatment:
Prevention to prevent the attack from occurring again.
A rescue strategy to apply when pain already appears.
" Migraine can greatly interfere with quality of life. Research has shown us that it is a risk factor for cerebrovascular disease and, therefore, when it occurs in a patient, we must study it "

Dr. Magdalena Gómez, neurologist.
Prevention is in the lifestyle
Acquiring a healthy lifestyle is the most effective way to prevent migraines. Added to this change in habits is the prescription of medications. Always, tailored to each patient. “Prevention must be individualized according to the profile of comorbidities, disorders or other diseases that the person has,” says Dr. Gómez.
In addition, he highlights some examples: “If a patient is depressed; So, we give him treatment for depression that, at the same time, works for migraine. Another may be menopausal, hypertensive, allergic, suffer from sleep disorders or obesity; "He is prescribed medication for his condition that also prevents migraine."
The most recent is the use of 'monoclonal antibodies', which are injected once a month, act directly on the molecule that mediates the production of migraine and reduce the possibility of its occurrence. Its cost, however, is extremely high.

Dr. Magdalena Gómez
NEUROLOGIST
METROPOLITAN HOSPITAL

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Learn about the symptoms, causes and treatment of Guillain-Barre syndrome

The more than 200 cases of Guillain-Barre detected in Peru last July put Ecuadorians on alert. First, due to the proximity of this health emergency; and, above all, because of the little knowledge and information we have about this syndrome discovered in 1916.
Dr. Patricio Abad, neurologist at Hospital Metropolitano, describes the disease as a neurological condition that affects the peripheral nerves, which is of inflammatory and possibly autoimmune origin.
These nerves branch from the brain and spinal cord connecting to all parts of the body, including muscles and organs. They carry 'messages' that allow the person to control movement, breathing, heartbeat and digestion, among other functions.
In Guillain-Barre syndrome, the roots of the peripheral nerves begin to lose the myelin layer in which they are wrapped (as if they were wires) and stop working, producing, above all, muscle weakness.
What are the symptoms of Guillain-Barre?
Like any disease, early diagnosis is key: Dr. Abad details that, from a clinical point of view, the neurological examination performed by the specialist during the first days of symptoms is the main tool.
" We can help ourselves in the diagnosis with an electromyography to observe how the affected nerves are working or with a lumbar puncture to obtain cerebrospinal fluid and determine whether the proteins have been elevated or not "

Dr. Patricio Abad, deputy head of Neurology.
The most frequent symptoms, to which the patient should pay attention, are these:
Progressive weakness that progresses from the feet or hands upward.
Loss of muscle tone, that is, the limbs become very flaccid.
Reflexes are lost. Condition and possible paralysis of the chest muscles, including the respiratory muscles.
An early diagnosis prevents patients from reaching critical conditions, in which intubation in intensive care is even necessary.
Rehabilitation is essential in the recovery of a patient with Guillain-Barre; Unfortunately, it takes a long time because nerves slowly recover their myelin. 15% of those affected will have lifelong consequences.
The causes are not easy to identify
The causes of Guillain-Barre syndrome are related to infectious processes such as certain bacteria in the intestine; with certain respiratory viral processes; and even with parasitic diseases such as dengue.

The population that lives in inadequate sanitary conditions, in areas of high incidence such as malaria or other parasitic diseases, is therefore the most vulnerable. “It would also seem to be linked to some post-vaccine cases,” says Dr. Abad. The pathology appeared after the application of a vaccine; It happened recently during the COVID epidemic.
For the treatment of Guillain-Barre, the following measures are applied:
General support to the patient with adequate hydration and nutrition.
The use of immunoglobulin in doses according to the patient's weight.
Plasmapheresis, which refers to the extraction of blood outside the body to purify it and reverse damage.
If the diagnosis is timely, the neurologist insists, “we are almost always successful in the treatment with the majority of patients.”
If the syndrome is not treated properly, however, the person can have significant long-term consequences. Above all, muscle weakness and difficulty walking. Sometimes, conditions in the respiratory muscles that lead to pneumonia; and lack of temperature or blood pressure control.

Dr. Patricio Abad
METROPOLITAN HOSPITAL NEUROLOGIST DOCTOR

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Menopause does not have to be synonymous with osteoporosis

Menopause, a stage in a woman's life in which her ovaries stop producing the hormones called estrogen, is directly related to the loss of bone quality and, only if there is no prevention, is there the possibility of developing menopause. osteoporosis.
From the age of 33, when the quality of a woman's bones reaches its maximum peak, bone mineral density gradually decreases due to metabolic and hormonal factors; a process that accelerates in the first five years of menopause.
" With a lack of estrogen, the osteoblast or bone cell, which produces bone and allows the fixation of calcium, stops being produced in greater quantities; the osteoclast, the cell that extracts calcium from the bone, gains activity when the body needs it "

Dr. Antonio Domínguez, Gynecologist at the Metropolitan Hospital
This imbalance generates a loss of bone density in women; and the possibility of it leading to the diagnosis of osteoporosis and, therefore, a greater risk of fracture, will depend on the quality of bone that the patient has developed.
Good news: osteoporosis can be prevented
To ensure bone quality and avoid osteoporosis during menopause, the most important thing is prevention. A conscious effort that must begin in the early stages of a woman's life, highlights Dr. Domínguez.
The gynecologist details the decisions and lifestyle that will prevent the development of the disease, allowing the bone to acquire the appropriate structure to cope with the lack of estrogen:
Physical exercise is the most important form of prevention.
A healthy diet that provides calcium to the body.
Avoid medications that affect calcium absorption.
Correct intestinal problems in time that hinder the absorption of the nutrient.
Take a vitamin D supplement.
The quality of the bones is fixed until approximately 30 years of age and will determine the living conditions of women after menopause.
The first steps before a diagnosis
Densitometry is the test that measures, through radiation, the approximate amount of calcium that the bone has per square centimeter; and the values obtained will allow the doctor to determine whether or not osteoporosis exists.
If calcium loss is low and, therefore, the risk of a fracture is practically zero, we speak of osteopenia. In this case, indicates Dr. Domínguez, it is analyzed whether the woman is exposed to risk factors such as poor calcium absorption or lack of exercise, in order to act in time.
When osteoporosis has been detected, the patient must take fundamental steps:
Review your family history, lifestyle habits and daily intake of calcium to your body.
Depending on the degree of bone density loss, improve calcium intake.
Doing physical activity.
Start continuous treatment - 3 to 5 years - if the risk of fractures is very high.
Osteoporosis treatment is not aimed at restoring normal bone density; What is achieved, if well oriented and motivated, is to slow down the loss of calcium so that the bone does not weaken.

Dr. Antonio Dominguez
GYNECOLOGIST AND OBSTETRIST
METROPOLITAN HOSPITAL

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Avocado: how to take advantage of its consumption

Avocado on whole wheat toast with some added protein. Avocado in lunch salad. Avocado accompanying the soup. Avocado turned into a smoothie with some fruit. Avocado mixed with some type of seed. Avocado…
There are dozens of possibilities on the Internet and social networks to prepare the delicious fruit, but before giving in to any of them, it is necessary to clarify what their benefits are and the risks of excessive consumption.

Can avocado reduce cholesterol?
Over time, several studies have shown that the monosaturated fat contained in avocado can be beneficial for people's health, says Dr. Mónica Reyes, nutritionist at the Metropolitan Hospital.
This benefit, however, does not occur with the sole consumption of avocado. It can especially help reduce 'bad' cholesterol (LDL) and raise 'good' cholesterol (HDL) as long as, the specialist emphasizes, it is part of a healthy lifestyle.
The successful formula is as follows: “Do physical exercise, eat a healthy diet dominated by monosaturated fats such as avocado or walnuts and polyunsaturated fats such as salmon or corn or soy oils, and avoid fried carbohydrates or full-fat dairy products.” .
On the Internet, many sites present the fruit as a food that helps lose weight; They rely on the fact that its fat produces a feeling of fullness, but they forget the number of calories each avocado contains.

Be careful with the quantity

A quarter of an avocado is the recommended daily amount for consumption, indicates nutritionist Reyes. Respecting this portion will allow the person to take advantage of the composition of this ancestral fruit.
Eating avocado above this amount can cause weight gain due to excess calories, the doctor warns. A whole avocado has around 300 kilocalories, which is equivalent to 20% of the recommended daily caloric intake for an adult woman and 15% for men.
A healthy lunch, the specialist gives as an example, should include a single serving of fats. It can be a teaspoon of olive oil or about ten olives or a portion of salted nuts or a quarter of an avocado.

Other valuable components

The consumption of avocado, always respecting the recommended daily portion, is also beneficial for other reasons, maintains the nutritionist at the Metropolitan Hospital, Mónica Reyes:

• It is a good contribution of vitamin E, a nutrient with antioxidant properties.
• It is an excellent source of potassium, which the body loses with physical effort; Therefore, athletes can consume larger portions.
• Contains carotenoids, which are a type of vitamin A, useful for preventing macular degeneration (an eye disease that can cloud central vision).

Getting information from reliable sources when it comes to nutrition is another recommendation and going to a specialist when the person requires a personalized diet or putting their weight in order.

Dr. Monica Reyes
Nutritionist
METROPOLITAN HOSPITAL

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Vacation at the beach or pool: Take care of your ears to avoid bad times

When we talk about vacations, it is inevitable to think of the beach or a pool where we cool off from the heat while sharing with family or friends. In the midst of fun and if we are in contact with water, one of the organs that we must protect to avoid mishaps is the ear.
The increase in otitis externa or inflammation of the ear canal is common at this time, says the otorhinolaryngologist at the Metropolitan Hospital, Ramiro Yépez Reinhart. Adults and children frequently report this discomfort when returning from vacation.
When the ear is exposed to water for long periods, it becomes moist and predisposes it to an infection that leads to painful otitis. Its first symptom is itching, accompanied by pain and eventually a sensation of blockage or even discharge.
The use of earplugs prevents discomfort
Adults and children can use moldable earplugs to prevent the negative effects of prolonged exposure to water. It is important that the material they are made of fits the size of the user's ear to achieve adequate protection.
In addition to the use of plugs, says Dr. Yépez, another way to avoid ear inflammation is by drying it at the end of the day or when the activity in the water has finished. To do this, you must follow these instructions:
Using a hair dryer on low intensity or a thin cloth that does not damage the ear are appropriate ways to dry it.
Mixing vinegar and alcohol in equal parts and placing 4 or 5 drops of this liquid inside the ear, when the aquatic activity has finished, is another option.
Be especially scrupulous in checking the hygiene of the premises when you are going to get a tattoo.
You should never use cotton swabs to remove moisture from the ear. And lastly, do not have unprotected sex.
Avoid manipulating the ear, in an effort to dry it or as a reaction to possible itching. Frequently, we use fingers that are contaminated with bacteria and can predispose to infection.
It is the excessive humidity in the ear that can cause otitis or inflammation; There is no difference between fresh or salt water. It is important, as far as possible, not to immerse yourself in water for excessive periods of time, such as more than four hours.
Who should be more careful
People who use cotton swabs with the mistaken idea of cleaning their ears make this organ susceptible to infections, especially when they are constantly exposed to water. This is very common in summer time, when families seek the sea and the pool during their vacations.
" Those who use cotton swabs leave their ears without defense barriers; they also cause trauma that can damage the skin of the canal, opening a door to infection "
Dr. Ramiro Yépez Reinhart
The otorhinolaryngologist insists that the wax inside the ear acts as a protective layer that prevents – in this case – germs in the water from penetrating the skin and causing contamination.
There are three additional factors that increase the possibility of otitis externa:
Pre-existing skin problems, such as psoriasis or dermatitis.
Allergies that cause skin irritation problems.
The constant use of hearing aids, which affects the skin of the external ear canal and can predispose it to infections at some point.
When symptoms of ear inflammation occur, it is necessary to go to the doctor for an evaluation. Once the state of the infectious process has been determined, the most appropriate treatment can be applied.

Dr. Ramiro Yépez Reinhart
OTORHINOLARYNGOLOGY
METROPOLITAN HOSPITAL

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How much time in front of a screen to protect your eyesight?: as little as possible

The smartphone is like an umbilical cord: a technology to which adults and children are constantly connected and which is increasingly difficult to do without. Using this comparison, Dr. Javier Aguirre talks to his patients to explain the importance of limiting, as far as possible, the use of electronic devices in order to take care of the well-being and health of their eyes.

In the case of adults, explains the ophthalmologist at the Metropolitan Hospital, the use of a computer or a smartphone to carry out daily work can affect the physiological mechanism of the eyes known as convergence.

When looking closely, the muscles related to vision are permanently converging and if this process lasts for hours, the ocular system becomes fatigued and the patient may report discomfort in vision, a feeling of heaviness or the need to rub the eyes.

A second problem can arise from the blue light emitted by phone and computer screens. “During the night, exposure to this light causes the brain to act as if it were daytime and many adults who use these devices for a long time experience insomnia due to this,” says Dr. Aguirre.

The specialist makes the following recommendations for adults who already present these signs or symptoms and, in general, for those who spend long days in front of a screen:

Lubrication in case of dry eyes.
Step away from the computer or phone screen every two hours, open the curtain and look at the horizon for at least two or three minutes before resuming the activity.
The lenses used by patients with optical defects should include an anti-reflective film and a blue light filter.
Adults without optical problems who spend a lot of time in front of a screen should use glasses with a UV filter, without measure, to protect their vision.
Avoid using devices in dark environments.
Ophthalmologist Javier Aguirre maintains that, in the case of children, the physical problems generated by the excessive and uncontrolled use of electronic devices are related to myopia (seeing from a distance), visual fatigue, redness and dryness of the eyes.

“In China, for example, it has been determined that 30% of children are myopic and that myopia is growing exponentially,” exemplifies the specialist; The reality is similar throughout the world: there is a myopia induced by the use of technology. “We have children who, at 5, 6 or 7 years old, are already using glasses for distance vision on a regular and permanent basis.”

However, beyond the effects on vision, Dr. Aguirre emphasizes the social impact of the erroneous and unlimited use of these technologies. For example, parents who use the telephone to calm a crying child in a restaurant or in the waiting room of a doctor's office. "Children's dependence on technology has affected, above all, their socialization (...) and has generated anxiety and frustration in wanting life to work like a cell phone, for everything to be done quickly and at the time they want" , he emphasizes.

Their recommendations for parents are the following:
They should not give a cell phone to their children before the age of 12 as a communication instrument.
Control the use of technology, including video game consoles, to prevent children from stopping playing sports, reading or interacting with their peers.
Use systems or applications that block children's access to certain information through smartphones.
In school-age children, the use of a screen should be limited to the execution of tasks.
Ensure that the environment where children use the devices is well lit.
Seek a specialist if children have any discomfort or optical problem.
For patients of any age, adds Dr. Aguirre, it is important to attend an ophthalmological examination at least once a year. It is also essential to “stop using any device two or three hours before going to sleep” to avoid insomnia problems.

And although so far no serious problems have arisen from the use of these technologies, their development continues to be rapid and the dependency they generate in adults and children is growing. “For me,” Aguirre insists, “the most serious problem is the social order.”
Dr. Javier Aguirre
OPHTHALMOLOGIST
METROPOLITAN HOSPITAL

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In the face of hepatitis, vaccination is key

Getting vaccinated and having safe sexual relations are the two practices that generally prevent hepatitis, that state of inflammation of the liver that if not diagnosed in time - and, sometimes, even doing so - can lead to the death of the patient.

It is not a single-origin disease; There are three types of hepatitis, explains Ricardo Chong, hepatologist at the Metropolitan Hospital: those caused by viruses, those of autoimmune origin and the toxic ones derived from the consumption of drugs or medicinal infusions of natural origin.
Hepatitis A, B, C, D and E are viral; They differ from each other in their origin, their evolution and the results of their treatment. The viruses that cause hepatitis A and E are found in contaminated food and, therefore, enter the body through the fecal-oral route.
Due to its symptoms and evolution, hepatitis A has the best prognosis; Generally, the doctor explains, it affects the child population and the patient recovers in about a week. However, the hepatologist clarifies, 1% of those infected with this virus in adulthood can develop fulminant liver failure.

In these exceptional cases, which can also occur in sexually transmitted hepatitis, what happens is the following: “instead of reacting progressively to stop the virus little by little, the immune system triggers all its 'soldiers' against the virus. "which is in the liver and ends up destroying the organ in about 72 hours."

Hepatitis B, on the other hand, is very difficult to cure. If the body does not resolve the disease within three months, indicates Dr. Chong, the patient has to take a daily pill for life to control the virus with a chance of 'cure' of less than 10% of cases. .

The hepatitis B virus is incorporated into the liver cells and, therefore, does not disappear; In the best of cases, the patient develops a specific antibody that stops the virus, producing a 'functional cure'. The virus can reactivate if the infected person subsequently takes some immunosuppressive medication or undergoes chemotherapy.

For hepatitis C, also sexually transmitted or blood-borne, there is - meanwhile - a curative treatment that is administered orally for three months. As there is no vaccine, says the hepatologist, the most effective way to prevent it is to avoid unprotected sexual relations and contact with sharp objects or needles that are not discarded after use.

The specialist emphasizes four particularities of this disease:
For all hepatitis viruses, the symptoms are quite similar: headache, general malaise, a flu-like illness and yellowing of the skin.
Hepatitis B and C may not cause symptoms; If there is no diagnosis and treatment, the patient will develop cirrhosis within 10 to 15 years.
Health workers - in contact with sharp material -, the homosexual population or those who have unprotected sexual relations with several partners should frequently be tested for hepatitis B and C. The rest, at least once in their life.
In hepatitis, there is no genetic factor involved.
Dr. Chong recommends liver screening at least once a year to identify autoimmune hepatitis in time. This occurs when “the body generates antibodies that recognize its liver as foreign and chronically inflame it; "When the patient comes to the consultation, he is already cirrhotic - the final state of any inflammatory liver disease."

Elevated levels of liver enzymes are not always related to fatty liver. If they are detected, it is essential to consult a specialist to rule out autoimmune hepatitis.

For the hepatologist, finally, it is key that the population avoids the consumption of natural medicines without first consulting a doctor. “We have had many cases of fulminant liver failure related to these products and there are even reports of patients with toxic hepatitis related to medicinal infusions.”

Dr. Ricardo Chong
HEPATOLOGIST
METROPOLITAN HOSPITAL

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Vaccines: Since no one sees the enemy, no one appreciates what they do to stop it

“If every person who, thanks to a vaccine, is saved from infection or death had a doorbell, there would be a continuous swarm of sounds all over the world.” But since the benefit is silent, laments pediatric neurologist Gonzalo Baquero, “no one pays enough attention to vaccines and, what's more, there are people who go against them, creating a situation that puts the elimination and eradication of preventable diseases at risk.”
Eradicating a virus, the specialist insists, “is a difficult task because no one sees the enemy; and not only that, but no one appreciates what the vaccine does against the enemy.”
As president of the Certification Commission for the Eradication of Polio in Ecuador, Baquero highlights that not a single case of this disease has occurred in the country since 1990, but at the same time explains the efforts being made to keep the population free of the virus.
The Commission meets weekly to assess eradication programmes, to review - if necessary - the contingency plan to be applied in the event of a polio outbreak and to keep a watchful eye on possible cases.
Of the three strains of the virus, strains 2 and 3 have been eradicated from the country and the region; strain 1 is in the eradication phase and Ecuador will soon receive certification, says the pediatric neurologist at the Metropolitan Hospital, because no cases have been registered. However, he warns, “the wild strain 1 – as it is called – is still in Pakistan, Afghanistan and Africa.”
What happened with Covid-19 has shown that human mobility and the interconnection between different regions of the planet facilitate the circulation of viruses. Therefore, and although polio has already been eradicated in the country, it cannot be ruled out - stresses Dr. Baquero - that the virus could arrive from other latitudes, putting the unvaccinated population at very high risk.
“Until polio is eradicated globally, children remain vulnerable,” he added. And within the pediatric population, children with weakened immune systems, cancer or degenerative diseases who are receiving medication, or malnourished infants are even more vulnerable.
Following the pandemic, this vulnerability has increased. In virtually all countries, vaccine coverage – in general – was reduced due to restrictions and lockdowns; and in the specific case of polio, it dropped to around 50% in the region – including Ecuador. According to the standards established by the World Health Organization (WHO), the coverage level must be at least 95% to ensure eradication.
Hence the importance of the vaccination campaign that public health authorities in Ecuador have launched with the support of the Commission.
It is the only way, says Dr. Baquero, to reach children with vaccines who –during the pandemic- did not follow the regular schedule and were left without protection. “It gives us the opportunity to achieve 95% vaccination against polio and other diseases that are on the way to elimination, such as measles and rubella.”
Addressing parents, the specialist emphasizes the following recommendations:
There are countless vaccine-preventable diseases and it is essential that children are protected from all of them, from birth. Children must be between 18 and 65 years of age.
Unvaccinated children are potential carriers of viruses; they are not only at risk of getting sick but also of infecting others.
Parents should ensure that their children comply with the regular vaccination schedule, but also take them to any vaccination campaigns.
Every vaccine counts, “not only for your child, who will be protected, but for all the children who unfortunately are not vaccinated or who are immunodeficient and can become infected.”
Regarding vaccines, everything is planned and regulated at regional and global levels.
Yes, vaccines have moderate side effects, but the benefit is exponentially greater.
Finally, the pediatric neurologist emphasizes that communication is crucial in epidemiological issues; it must be based, he says, on “truthfulness, ethics and science.” And he issues a warning to families: “the Internet does not tell the whole truth.”

Dr. Gonzalo Baquero
PEDIATRIC NEUROLOGIST
METROPOLITAN HOSPITAL

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20 questions (and their answers) about how to take good care of our facial skin

The skin of the face, along perhaps with that of the hands, is without fear of being mistaken the one that is most exposed to external factors: solar radiation, air pollution, wind, poor quality water, blue light from computer screens. electronics devices…
How we should then take care of it; What should we take into account when choosing one product or another. How to prevent the damage that these factors cause; It is possible or not to reverse it. Carmen Elena Sánchez, dermatologist at the Metropolitan Hospital, resolves all doubts regarding the health, protection and treatment of facial skin.
1. What characteristics does facial skin have?

First, there is the skin phototype, which is the color type and goes from 1 - the lightest - to 6 which is the darkest; The way in which melanocytes or skin cells capture solar radiation varies according to phototype. Then, there is the thickness of the skin; The one on the face or the eyelids is more delicate and different from the rest of the body.
2. Are there different skin types on the same face?

The most delicate are the periocular parts (around the eyes) and the perioral parts (around the mouth) and also the nasolabial fold (between the nose and the cheek) which is usually inflamed by seborrhea, for example. In addition, let's not forget that we also have dry, oily, combination, seborrheic skin and skin that tends to become stained due to a hereditary burden.
3. Does age affect skin condition?

More than age, genetics and the care we have given to the skin of our face matter. If a person has passed the age of 50 and has received, throughout their life, a lot of solar radiation, this will have consequences.
4. What are the general and fundamental care for all skin types?

Face wash in the morning and at night. During the night, we generate impurities and fat; and during the day, the skin is exposed to pollution. We keep that in every pore of the skin and, therefore, washing is important. Then, moisturizing: both in the morning and at night with serums and a moisturizing cream (at night, a more fluid one). And during the day, sunscreen.
5. What product should we wash our face with?

With soap substitutes; detergent-free products, known as syndets. If it is oily skin, we need a soap substitute that cuts the fatty acid or contains salicylic acid for a better effect of destroying that sebum. No antibacterial soaps. And for dry skin, a rather simple syndet, with a neutral pH and that does not cause peeling or dryness.
6. Is it important to remove makeup at night?

You should always remove your makeup at night to avoid leaving all those pores clogged and allowing your skin to stay healthy. Makeup does not damage the skin; The important thing is to remove it. If it is not done, we will see ourselves with aged and dull skin all the time.
7. How to protect our face from solar radiation?

The best protection will always be a cap, a hat, and long sleeves; Solar radiation is systemic - any part of the body can capture it - and already within our system it damages cells. If we have not protected ourselves throughout our lives, we will have as a consequence freckles, moles, melasma - dark spots -, carcinomas or actinic keratosis that warns of cancer. Photoprotection is important, but physical protection is the best.
8. What type of sunscreen should I use for my face?

If I have oily skin, a fluid protector; and if I have dry skin, one that is more concentrated, more moisturizing, with hyaluronic acid perhaps. A good sunscreen should have filters for UVA and UVB rays; and a sun protection factor greater than 35. It must be reapplied during the day, three times. Children should use protectors made for that age.
9. How do I know if I have blemish-prone skin?

It is revealed little by little over the years; We know that in the family my mother, my sister, my brother, my aunt have spots, it comes a lot with genetics. It must be explained to the patient that the spots are difficult to treat, that they will not go away overnight and that what is achieved is to attenuate them.
10. Is there a way to prevent stains?

Yes, avoiding sun exposure; but we also have depigmentants that are gentle, that are used when the spots are mild and have just appeared, and that will not worsen the skin condition over time. Before, we used strong products to give the patient peace of mind that the stain was gone, but then it would return and it would be worse.
11. How to deal with wrinkles and sagging facial skin?

As time goes by, from the age of 25, we lose ceramides, proteins, and hyaluronic acid and we have to restore them depending on our age. The years and gravity cause the loss of our tissue after the age of 40. Creams help us, but in general the most effective is the laser, injectable products such as hyaluronic acid or botulinum toxin, radiofrequency with needles is very good at preventing sagging skin and does not have many adverse effects. And also the exercises: facial yoga and massages.
12. Are these products and treatments safe and reliable?

Very safe, but you have to find a specialist who applies them and follow their recommendations. We must handle the issue of facial harmonization, its anatomy; It is not about puncturing here and there, you have to know the route of the arteries, veins and nerves to avoid causing damage.
13. What does the selection and application of these products depend on?

Botulinum toxin – or Botox – serves to relax the muscle and hyaluronic acid to lift tissue, fill in furrows and hydrate the entire face. It depends on the condition of the skin. It is not advisable to wait until you turn 60 to look for a specialist and ask for a treatment of this type because we are going to need a lot of product and it is expensive.
14. Does collagen work to delay the appearance of wrinkles or reduce them?

The collagen that is ingested, and which now comes in so many brands, is not absorbed; It is a large molecule and we would have to make it very small so that our body absorbs it as if it were natural collagen. Until now, there is no such thing on the market. We achieve more by consuming gelatin than by ingesting collagen.
15. What other products are in fashion and do not work for facial skin?

There are many masks. There is something for everything, for acne, for blemishes, for oily skin, for dry skin. Between the one and the other, there is no difference. What I have seen is patients who, at 12 or 13 years old, put on masks and live with dermatitis. The recommendation is not to put anything on your face that is not recommended by a doctor or has been tested.
16. Do treatments with natural products work?
Yes they can serve. Cucumber and oats are anti-inflammatory; Avocado is a moisturizer because it has fatty acids. Strawberries mixed with natural yogurt and placed on the face also help. If we want a little exfoliation, papaya is good. Lemon is not recommended; It is irritating and stains.
17. How to act against acne?

You have to act in time. If I already see a little seborrhea in an 11 or 12 year old girl, we can start with soap substitutes that cut grease. If he does not respond, we move on to a cream that serves to destroy that fatty acid; then we go with glycolic acid or clindamycin. We move up the steps depending on how the person responds. The only foods that cause more damage or worsen the condition are sweets and dairy.
18. Can psychological state affect skin condition?

Quite a lot, a lot. There are many psychodermatoses caused by the person's mood; Itching, acne, everything worsens with our emotional state. It is a factor that is always taken into account when choosing one treatment or another.
19. Should we protect ourselves from the light emitted by certain screens and office light?

Blue light can affect the skin, making it more prone to spots, but not as intense as solar radiation. You must reapply sunscreen three times a day between 9 in the morning and 4 in the afternoon, even if you do not go outside.
20. Does advice or 'word of mouth' from friends and family work on skin care issues?

A professional guide is always needed. Conversation between friends is typical, but it is not useful. Each person has their own skin type and needs their own particular treatment. What feels good to someone, doesn't feel good to another.

Dr. Carmen Elena Sánchez
DERMATOLOGIST
METROPOLITAN HOSPITAL

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Donating blood brings us closer to altruism and also has physical benefits

The satisfaction of having saved human lives is the main benefit that the blood donor receives, whose World Day is celebrated every June 14, says hematologist Johanna Rojas, part of the medical team at the Metropolitan Hospital.
With each donation, he explains, three lives are saved. “Donated blood is divided into red blood cell, plasma and platelet concentrates, which are its components and contribute to three needs.”
The benefits are also physical and knowing them can help make blood donation a voluntary, regular and conscious act.
Blood extraction, the specialist details, “stimulates the marrow and the regeneration of cells; With each donation you can burn about 650 calories; and the donor has access to a free check of vital signs (blood pressure, pulse, oxygen saturation) and a hemoglobin measurement, in addition to free tests for HIV, hepatitis B and C, syphilis and Chagas disease.”
In Ecuador, says Dr. Rojas, more than 60% of blood donations are directed; That is, they occur when a person requests it for the surgery or treatment of a family member or friend. Only four out of ten donors are volunteers.
This reality makes it difficult for cancer patients - those most in need - to have access to this product that cannot be manufactured and, therefore, has donations as its only source.
Who can donate blood?
The question has been answered on multiple occasions, but it is still relevant to insist on what are the requirements or characteristics that the donor must meet:
Weigh more than 50 kilos (110 pounds).
Be between 18 and 65 years of age.
Generally enjoy a good state of health.
Not have any active urinary tract, respiratory or gastrointestinal infection.
Not having had tattoos, piercings or acupuncture in the last year.
Not having undergone any major surgery in the last year
People who have had cancer cannot donate.
Not have any autoimmune disease.
Not having been exposed to any dental procedure in the last three months.
Have a stable sexual partner.
Women can donate every four months; the men, every three.
The periods that must elapse between certain aesthetic or medical procedures and the moment of donation are related to the risks that the person has been infected with a disease or carries a hidden infection.
There are several factors that, according to Dr. Rojas, explain the reduced level of voluntary donations in Ecuador. The first is logistical: “we are not a country with enough donation points and those that work serve during office hours, which makes the decision difficult.”
And then there is a group of beliefs and myths that discourage blood donation. Despite the information that is constantly disseminated, there are people who still think that by donating they can catch diseases such as HIV or hepatitis, or sometimes faint.
For this reason, the hematologist and director of the blood bank at the Metropolitan Hospital emphasizes the following:
All supplies used for a donation are opened at that moment, are single-use and completely sterile.
In each donation, only the allowed volume of blood is extracted: 450 milliliters, which is equivalent to less than 10% of the total blood circulatory volume.
As a general principle, the risk of contagion applies to those who receive the blood and not to those who donate it.
All the necessary tests are carried out on the donated blood to guarantee its quality.
“Identify the place where it is easy for you to donate; There are several blood banks in public hospitals, in the Red Cross and one in the Metropolitan Hospital. There is no need to wait for someone to become ill or at risk of death to donate; “As a society,” Dr. Rojas concludes, “we have to transform it into a habit.”

Dr. Johanna Rojas
HEMATOLOGIST
METROPOLITAN HOSPITAL

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Regular check-ups starting at age 50 are the only way to detect prostate cancer in time.

Without presenting symptoms in the earliest stage, prostate cancer is the most common among Ecuadorian men and, within this population, the second one that generates the highest mortality.
Although it is characterized by a slower evolution in relation to other types of tumors, its diagnosis usually occurs in late stages when the symptoms only become present: swelling of the legs, bone pain, back pain or changes in the kidney due to metastasis.
“The only way to detect it in time is to have a regular prostate checkup,” says Francisco Coronel, a urologist at the Metropolitan Hospital. This is an examination or review that all men without close relatives with this type of cancer or free of risk factors must attend from the age of 50; and that it should be brought forward to 45 years for those who have a family history and for the Afro-descendant population.
The fears and myths that still surround prostate screening are one of the factors that explain its high incidence in the country, says the specialist. "Although it is losing more and more space, there is still the mistaken belief that rectal examination could have consequences on virility or that it is 'not for men' to perform it."
Among the population with limited economic resources and less access to education, it is - in addition - a medical examination that is not among their priorities.
Hence the importance, Dr. Coronel emphasizes, that the population knows and becomes aware of the following:
1. The rectal examination - part of the prostate check-up - lasts a few seconds, it does not cause pain or discomfort.
2. Regular prostate checkup does not always include a digital rectal examination.
3. If the doctor previously orders a blood test to measure the level of prostate antigen and it shows normal numbers, a digital rectal examination may not be necessary.
4. The prostate antigen rises when there is inflammation or alterations in said organ, but it does not confirm the presence of a tumor or its malignancy.
5. If the prostate antigen is located at abnormal levels, a rectal examination becomes essential to determine if there is a tumor and additional studies to rule out cancer.
6. If no warning signs are detected, the next prostate checkup can be performed after two to five years, depending on the patient's age.
Among the factors associated with the development of prostate cancer are cigarette smoking, obesity, family history and ethnicity; Afro-Ecuadorians are more likely to develop this pathology.
When prostate cancer has been diagnosed, “treatment with curative intentions is the first option for patients in whom the tumor is localized,” says urologist Francisco Coronel.
In these cases, prostate surgery or radiotherapy is used. The surgical technique with the best results, explains the specialist, is the 'robotic radical prostatectomy'; that is, the total removal of the prostate using the precision of the robot.
At the Metropolitan Hospital, Da Vinci robot technology and its most updated version are used, which, in the case of the prostate, when a tumor is low risk or slow progression, it is possible to opt for active medical monitoring or surveillance. , without surgery, to decide over time whether to operate or not. In case of metastasis, the only objective is to stop the progression of the tumor. This specific surgery guarantees greater precision, the conservation of certain organic structures related to erection and urinary continence, and a faster recovery of the patient.
In the case of the prostate, when a tumor is low risk or slow progression, it is possible to opt for active medical monitoring or surveillance, without surgery, to decide over time whether to operate or not. In case of metastasis, the only objective is to stop the progression of the tumor.
The decisions made in conjunction with the urologist, Dr. Coronel emphasizes, will allow the patient to receive the best possible treatment.

Dr. Francisco Coronel
Urologist
Metropolitan Hospital

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World No Tobacco Day: a new threat gains space in society

Although campaigns, regulations and state policies to discourage cigarette consumption have had a relative effect in most countries, the medical community continues to send a clear message: “we cannot let our guard down in the face of this addiction, which is preventable.” ”says the pulmonologist at the Metropolitan Hospital, Daniel Polo.
The message becomes even more relevant due to the manufacturing and strong presence in the electronic cigarette market. Its consumption is affecting, Dr. Polo warns, younger people. And among the population there is still not enough information about its components.
Unlike the traditional cigarette, the electronic cigarette does not combust the tobacco and the substances that are added to make the nicotine level higher. However, says the specialist, this new product requires a battery that heats a liquid until it evaporates and that heating is linked to a metal that releases substances: "we don't know what injuries it can cause." The liquid also contains not only nicotine but other elements that can be harmful.
“In the future, when ongoing research offers decisive results, the effects of its consumption will be clearly known,” says the pulmonologist.
The electronic cigarette has been on the market for about two decades and still little is known. What is proven is that it is not harmless either. Its consumption is less harmful than that of traditional cigarettes, but it also contains nicotine at levels that the industry seeks to increase due to its addictive effect.
While this market advances, with few limitations and regulations worldwide, it is important - points out the doctor from the Metropolitan Hospital - to remember that smoking is not only associated with lung cancer and other diseases of this organ but also with cardiovascular pathologies, gastrointestinal, dermatological and even autoimmune diseases such as rheumatoid arthritis.
Tobacco, adds Dr. Polo, also increases the risk of diabetes, high blood pressure, kidney or bladder cancer. In Ecuador, between 5% and 7% of the population smokes.
The specialist insists on the warning: “if you can choose between breathing air and vaping – as the action of consuming an electronic cigarette is known –, choose air; If you have to choose between vaping and smoking a traditional cigarette, vaping may be best. But if you put the three things before you, avoid smoking and also avoid vaping.”
And he sends a recommendation to parents: “their role is fundamental because there are children who think that the electronic cigarette is not harmful; "Young people are clear that smoking is bad and they reject it, but they have - on the other hand - the conception that 'it's just vapor' and perhaps not addictive."

Dr. Daniel Polo
PNEUMOLOGIST
METROPOLITAN HOSPITAL

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It is the 'silent killer', but with timely diagnosis and treatment the risk disappears

'The silent killer' is the name that the medical community has given to high blood pressure around the world, says Christian Fierro, cardiologist at Hospital Metropolitano. And it is because it does not present symptoms, it does not cause pain, it does not warn and the only way to diagnose it - says the specialist - is to look for it.
Fierro rules out that headaches, dizziness, unusual fatigue or palpitations are signs of high blood pressure in the patient. For this reason, he insists, the only way to identify it is through medical check-ups that every person must undergo annually once they reach the age of majority.
The first alert occurs when, during a medical appointment or a routine check-up, the patient registers high blood pressure. If at that moment the measurement is greater than 180/110, you are already suffering from hypertension and treatment should begin.
But if a patient has not yet broken that limit, says the cardiologist, it is necessary to undergo monitoring to identify the frequency of that high pressure over time.
For a definitive diagnosis, Dr. Fierro suggests the use of one of these two tools:
Pressure monitoring through a professional and automatic machine that -well calibrated- is located around the patient's arm and takes their pressure every 30 minutes for 24 hours, without the need to enter a clinic or hospital.
Monitoring pressure through manual measurement. The patient must measure it twice a day, for seven days, sitting, mid-morning and mid-afternoon; and write down the values.
The criteria used to diagnose high blood pressure are the following:
A patient is hypertensive if, for more than 25% of the time monitored automatically, he or she registers values above 135/85 (during the day) or above 120/70 (at night).
In the case of manual monitoring for seven days, hypertension is confirmed if the pressure - on average - is above 135/85.
Can hypertension be prevented?
No, answers the specialist doctor. “We don't know the cause of hypertension; What we do know is that, more or less from the age of 45 or 50, it is already detected in men and women. And we also know that there are factors that increase the risk of developing it: hypertensive close family, obesity, lack of physical exercise, excessive salt consumption."
However, Dr. Fierro emphasizes, “not all children of hypertensive patients will be hypertensive; nor are all the obese or all those who do not exercise or all those who eat salty.” The tendency to develop hypertension is already in every person, no matter what they do.
Can its appearance be postponed?
If possible. Studies with hypertensive patients, says the cardiologist, have shown that losing weight, reducing salt consumption and exercising regularly push blood pressure values down. “If you do these things and you have a tendency to develop the disease, you might put it off a little bit.”
If I am diagnosed with hypertension, is my only option to take medication?
Hypertension can be diagnosed as Mild, moderate, or severe. Hypertension can be diagnosed as mild, moderate, or severe. For mild hypertensive patients, who are not diabetic, the first choice of treatment is to change habits; You can avoid the medicine with diet, exercise, and low salt intake. These are cases in which the pressure does not exceed 145/95 and in which “an hour of daily exercise is more effective than medicine.”
For moderate and severe cases, lifestyle change is necessary, but not sufficient to reach the goal of any treatment: an average blood pressure below 135/85.
The Framingham Study - the largest investigation to date on high blood pressure - showed that the disease increases the risk of stroke, heart failure or attack, and kidney damage resulting from dialysis. With treatment that lowers the pressure to normal levels, the risk disappears.
Dr. Fierro offers four key messages around high blood pressure; Taking them into account can save anyone's life:
After the age of 45, the possibility of having high blood pressure cannot be ignored.
High cholesterol, diabetes and smoking increase the risk of hypertension.
Hypertension, being common, can be treated by any doctor.
Treatment of hypertension is preventive medicine; Even if they do not feel it, the patient must continue their treatment and undergo periodic check-ups.
Dr. Francisco Benítez was the principal investigator for Ecuador of one of the most important studies on the prevalence of hypertension in seven capitals of Latin America, the CARMELA study. The results in all of them are very similar, a fifth of the adult population between 25 and 65 years old is hypertensive. I think the prevalence will be higher in older people.
Recommendations:
Hypertension itself is the fifth cause of death. So, it's a serious thing; It is a public health problem. You have to pay close attention to it.
It is not curable. It's forever.

Dr. Christian Fierro
Cardiologist
METROPOLITAN HOSPITAL

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Lupus: a 'sleeping lion' that can be controlled to avoid serious conditions

Also known as 'the disease of a thousand faces', lupus can present in many forms, at various levels of intensity and affecting a wide variety of organs.
It is not a type of cancer, says Rosa Ventura, a rheumatologist at the Metropolitan Hospital. It is an inflammatory disease that occurs when the person's immune system attacks or affects the same tissues or systems of the body. Inflammation, he adds, arises as a defense response, but it does not subside easily, it continues in one way or another and is deactivated little by little according to its own mechanisms.
You are not born with lupus, highlights the specialist. There is a hereditary predisposition, which is 'awakened' by factors such as viruses, stress or excessive sun; Inflammation is then unleashed and can appear - from the beginning - with mild symptoms or with serious effects that put the patient at risk.
It is common, according to Dr. Ventura, that it initially affects, for example, the joints, leading the patient to think about possible arthritis.
But it is also common for it to begin on the skin through multiple manifestations: 'butterfly wings' (facial flushing that resembles the open wings of an insect) are a typical expression of lupus.
The first diagnosis has to be suspected by the doctor. Laboratory tests confirm and support this. In the case of lupus, a complete blood count (blood test), globular segmentation and C-reactive protein (which indicate inflammation) are used, as well as kidney tests and antinuclear antibodies.
“Lupus is a systemic disease,” says the rheumatologist. And therefore, it can also affect many organs at different times or at a single point in the disease. In the blood, it can cause anemia, low white blood cells and platelets. In certain patients, kidney damage becomes serious; A sick person can give way to cardiovascular problems.
Therefore, the specialist highlights, it is important to act as soon as possible. Although lupus can start very aggressively, “there are cases in which we are not very sure and time confirms the diagnosis.” This is what is known as 'lupus-like' or undifferentiated disease: signs that point to inflammation and that are not yet definitive, but that require - as a first step - treatment of the symptoms.
“We must prevent the disease from waking up and developing more serious complications,” says Dr. Ventura.
Very mild anti-inflammatories or a type of corticosteroids in low doses can be used. Also seek support from a dermatologist to face skin problems. Excessive fatigue, pericarditis (inflation of the thin tissue surrounding the heart) or a small pleural effusion (accumulation of fluid in the pulmonary system) are also manifestations of lupus.
Once the disease is diagnosed, “what we can never forget is plaquinol or hydroxychloroquine,” says the doctor. “It is an immunomodulator that, in some way, modulates these diseases that are determined by alterations in the immune system.”
Modern medicine has gained time in the detection of lupus and, therefore, a better quality of life for the patient. It is clear, the rheumatologist emphasizes, that as it is a disease that 'turns on' and 'off' - that is, it has periods of exacerbation and remission -, it is essential that doctors manage to "keep it well asleep" through appropriate treatments.
The recommendations come from the patient's lifestyle and attitude towards the disease:
Avoid the sun.
Perform physical exercise at levels that are tolerated.
Psychological support to avoid stress and anxiety.
Eat a balanced diet that includes varied proteins.
A woman with lupus can get pregnant; You must take advantage of the periods of remission of the disease. Do not present serious exacerbations for at least six months before pregnancy.
Medical follow-up, the close relationship between patient and doctor to deal with the disease and the peace of mind that the specialist can convey, play in favor of people with lupus, emphasizes Dr. Rosa Ventura.
Without knowing exactly the reasons, although the suspicion is on the hormonal side, it is a disease that attacks -especially- young women; However, there are cases recorded in patients of different ages, including children.

Dr. Rosa Ventura
RHEUMATOLOGIST
METROPOLITAN HOSPITAL

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Correct information, prevention and timely decisions are the spearhead to confront ovarian cancer.

The first symptoms of ovarian cancer are not directly related to the pelvis or the organ itself. They are indirect and, therefore, can confuse the patient and delay an adequate diagnosis that saves time for the disease.
One of the main signs of this type of gynecological cancer comes from the gastrointestinal side, indicates clinical oncologist Amparito Basantes, specialist at the Metropolitan Hospital. Women with stomach disorders - bloating, gas, altered bowel movements or chronic constipation - for more than three months, without obvious improvement, should think that something else is happening and find out.
When experiencing these discomforts, many women go first to a general practitioner, then to a gastroenterologist and, only after a while, when symptoms such as weight loss or greater abdominal distention appear, to a specialist in the correct area. “The disease is diagnosed when there is already a lot of data and the masses or tumors are very large.”
For this reason, Dr. Basantes emphasizes the need for an annual gynecological check-up as a prevention mechanism.
Ovarian cysts are common in childbearing age and there is no direct risk of developing cancer. If there is a complex cyst, that is, with a denser component inside or with multiple septa and it grows, it should be studied in greater depth.
There is no tumor marker for the diagnosis of cancer, in ovarian cancer the ca 125 is a test that is detected in the blood and, if it is significantly elevated, it can add to the diagnosis of the disease.
It is essential to look at cancer as a chronic disease, with which the patient can learn to live and which will not necessarily kill them. Diagnosed early, cancer can be controlled; and even when it is detected in an advanced stage, it can be treated in several ways to improve the patient's quality of life.
Dr. Basantes maintains that adequate information and timely decisions are key when facing this gynecological pathology. In the path of diagnosis and treatment of ovarian cancer, it is essential -he says- to take into account the following:
“If you are diagnosed with cancer, don't be afraid; Get informed from specialists.”
Treatment depends on the stage of the cancer, its molecular and genetic characteristics.
Chemotherapy should not be scary; It is applied according to the type of tumor and in doses that are calculated according to the person's size and weight.
Not all ovarian cancers need chemotherapy. A stage 1-A cancer – when the tumor has been confined to a single ovary and has not ruptured its capsule – only requires surgery to remove several organs and tissues; and the remission is complete.
Ovarian cancer when the capsule has ruptured or gives a positive peritoneal fluid in surgery, which is called a stage and in other stages of the disease it needs treatment with chemotherapy to reduce the risk of the disease returning.
In metastatic states, treatments that act on various intracellular proteins are currently used - in addition to chemotherapy. This is what is known as 'target therapy'.
Within the 'target therapy', there is a molecule that blocks the production of new blood vessels that feed the tumor and that must be administered together with chemotherapy.
At the moment, in certain cases of ovarian cancer, a specific mutation is analyzed, which is called a BRCA 1 and 2 test, because there are drugs that act directly on this mutation and can constitute another tool that adds to the treatment of the disease.
The risk factors for this cancer are not fully identified, they may be the indiscriminate use of contraceptives without medical supervision, obesity, not having had children, a family history of cancer, but they are risk factors, they are not conditions. absolutes for the possible presence of cancer, the specialist clarifies.
“Take care of yourself, no one is going to do it for you; and keep your annual check-up with the gynecologist as a habit”: is the advice - perhaps the most important - that Dr. Basantes leaves on the table.

Dr. Amparito Basantes
MEDICAL ONCOLOGIST
METROPOLITAN HOSPITAL

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Message to parents: asthma is the most common respiratory disease in childhood.

Very common, little recognized, complicated to diagnose and difficult to accept by the family, asthma is the most common respiratory disease in childhood and its treatment determines not only the present quality of life of children but also what they will have in their adulthood. .
It is essential to understand that asthma is not necessarily an allergic disease, highlights Yazmina Lascano, pediatric pulmonologist at the Metropolitan Hospital. Although the one related to allergic components predominates in childhood, it is “a multifactorial pathology”; that is, triggered or also produced by other situations or conditions.
Respiratory syncytial virus (RSV) and rhinovirus can also cause asthma. “After the child has been infected, there may be a greater predisposition to recurrent wheezing,” says Lascano. Wheezing is that high-pitched, squeaky sound you hear during breathing because your breathing passages have narrowed.
Finally, genetics and what is known as “the theory of hygiene” weigh in. The latter, the specialist details, has determined that the lack of exposure to germs and certain infections makes infants more allergic when there is a genetic predisposition.
How to improve the quality of life of a child with asthma?
The first thing, Lascano answers, is to identify the degree of the infant's asthma. With less than one asthmatic episode every two months, the illness may be mild; with one per week, it is moderate; and if there are hospitalizations or admissions to intensive care, it is severe.
Once the level of the disease is determined, it is key to apply the most appropriate and effective treatment. Since 2019, the specialist indicates, the GINA guide for the management of asthma - accepted worldwide - recommends the combined use of salbutamol (which relieves bronchospasm) with an inhaled corticosteroid for cases of mild asthma. While for moderate asthmatics, a permanent inhaled corticosteroid is recommended.
In the search for quality of life for an asthmatic child, says the pediatric pulmonologist, it is also important to identify allergens; that is, those 'triggers' of the allergic condition. You have to eliminate them. They can be dust, humidity, some food, stuffed animals...
Pets?
The pediatrician affirms that there are very well-conducted studies with scientific support that show that if a pet is introduced into the life of a family before, during or immediately after the mother's pregnancy, a 'desensitization' of the newborn occurs and it will not develop allergy.
“If a family with a history of allergies wants to have a pet and decides to do so after a year after the child is born, it would not be advisable,” he adds.
Can asthma be cured?
At the moment there is no cure and it can persist into adulthood. We must remember, says Dr. Lascano, that asthma is a chronic disease and is characterized by reactivation and healing periods.
It is essential to accept “that treatment with inhaled corticosteroid is the only one that prevents airway remodeling”; That is, the disease causes damage. If five or six years are allowed to pass before starting the use of corticosteroids, “the airway may already have been affected and this, in adult life, could give way to chronic bronchitis” or more complex pathologies.
The pediatric pulmonologist emphatically points out: The use of corticosteroids does not have undesirable or adverse effects in adequate pediatric doses for a long time. And it does not produce dependency.

Dr. Yazmina Lascano
Pediatric Pulmonologist
METROPOLITAN HOSPITAL

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Eight factors that allow us to keep our immune system balanced

What we commonly call 'defences' do not go up or down; Many times, behind recurrent or prolonged flu, as well as chronic ailments, are underlying problems that must be resolved.
Israel Narváez, an internist at the Metropolitan Hospital, explains that comments and beliefs like these are based on a general lack of knowledge about what the immune system is and how it works. “It is not a thing, a muscle, something that can be observed; "The defenses, as we call them, are a set of thousands of cells that work in the body."
'I get the flu all the time,' says someone during a gathering of friends. And the comment that is usually heard is: 'your defenses are down'. Immediately, within the group, multiple pieces of advice arise to 'raise them': 'take vitamin C', 'I know a great supplement to boost your defenses', 'have you heard of this latest product?'.
Upload them? It sounds ironic, but if leukocytes, neutrophils and lymphocytes – the blood components that express the state of the immune system – are elevated, “we are talking about leukemias.” Narváez further explains: “do you want to 'boost' your immune system?; “When there is an overexpression of this system, we are facing autoimmune diseases in which this defense mechanism is not working well.”
So, the specialist emphasizes, there is no 'up and down' in the functioning of the immune system; The right thing and what adults should maintain is “a balance of their system.” And to achieve this - says Narváez - there are eight key factors on which, worldwide, experts and academics in medical science agree:
Correct weight according to each person.
Regular physical activity.
Adequate sleep according to age range; in adults, 7 to 8 hours.
Reduction of stress and anxiety.
Balance diet.
Complete vaccination schedule according to age.
Adequate control of comorbidities, such as diabetes or hypertension.
Do not smoke or consume alcohol in excess.
All these actions add up and have their importance, but the greatest risk factor for the immune system not working well is obesity, says the internist, as it is a condition that affects the entire body.
Narváez maintains that the biggest myth surrounding the body's defenses is that they improve or are elevated thanks to the supply of vitamins. Its consumption, he categorically insists, does not make a difference when it comes to keeping the immune system balanced.
In fact, be warned, its consumption, even in excess, can cause unwanted side effects; “The majority need a medical prescription, control and monitoring.”
Bombarded by an enormous supply of vitamins and compounds, “which vary according to the time and fashion,” adults are convinced that their consumption will make them feel better and get sick less. And what is called the placebo effect occurs, says the internist. It has been proven that 30% of the result obtained through a drug corresponds to this effect.
Vitamins are in foods and a balanced diet is part of the factors that allow a balance of the immune system. There are only four cases in which the consumption of vitamin supplements is recommended: pregnant women, children under five years of age, older adults without good nutrition, and people who have had bariatric surgery.
What then does a patient do who - for example - gets sick with the flu and who, after the normal period of 5 to 7 days, is left with a cough for 15 to 20 more days? “A little more research should be done; Possibly, something is happening with your bronchi,” says internist Fernando Narváez.
For this reason, it is essential to look for the underlying problem that makes an adult more prone to certain ailments.

The patient wants quick solutions and that does not exist, the doctor emphasizes. If a patient is already over 50 years old and has led a sedentary life, they cannot think that taking collagen will improve knee pain, for example. Hence the importance of taking care of our health permanently and thinking in the long term.

Dr. Israel Narváez
INTERNAL MEDICINE
METROPOLITAN HOSPITAL

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To avoid the consequences of childhood meningitis, parental commitment is key.

As World Meningitis Day arrives, dated every April 24, we want to emphasize the importance of taking care of our children. Complete vaccination schedules and pediatric surveillance are essential.
As it is the main cause of cognitive disability in children in the country, it is essential that parents and caregivers know the origin, symptoms and treatment of childhood meningitis. It is in your hands to prevent this disease from leaving serious consequences in the little ones.
“Children who do not treat meningitis well can end up with deafness, cerebral palsy or some behavioral disorder and can even lead to epilepsy,” says Francisco Espinel, a neuropediatrician at the Metropolitan Hospital.
Before delving into symptoms and care, the specialist explains that encephalitis is an inflammation of the brain coverings - called meninges - caused by two factors: infectious factors, that is, bacteria, viruses, fungi or parasites; and immune-mediated, which occur when some immunological mechanism attacks the brain and produces an infection.
SYMPTOMS
The neuropediatrician describes the symptoms and warns that some of them could lead parents and caregivers to confuse meningitis with some poisoning, a drop in glucose or a strong flu. Hence, the importance of going to the doctor if the child has the following:
Alteration of consciousness and cognitive functions.
Drowsiness and lethargy.
Alteration of memory, judgment or personality.
Alteration of the pupils and reflexes – which may be increased.
Fever ranging between 39 and 40 degrees.
Seizures.
Alteration of consciousness and cognitive functions.
In the newborn, breathing difficulties, skin rash, conjunctivitis, altered state of consciousness, high fever and seizures.
In an infant, the fontanelle - called the 'nose' - is bulging, there is irritability, vomiting, the pupils do not react, there is increased pressure in the skull and stiffness in the neck.
When laboratory tests are performed to confirm meningitis, Dr. Espinel maintains, an increase in leukocytes and a decrease in blood glucose is observed. If a study of the cerebrospinal fluid is carried out, an alteration is evident at the level of proteins and defense cells.
Through an electroencephalogram, “we see that the electroencephalogram is slow – that is, the electrical activity of the brain is decreased – and there are epileptic alterations”; and, finally, an imaging study may reveal involvement of the temporal lobes.
Yes. Meningitis is serious, highlights the specialist. However, timely diagnosis and treatment (combination of antibiotics and antivirals) is curable and children can return to a normal life.
RECOMMENDATIONS
Many times, it is the decisions of adults that compromise the health of infants; Therefore, the neuropediatrician makes the following recommendations:
Maintain the child's complete vaccination schedule; including, in this case, those directed at meningococcus and pneumococcus bacteria.
Avoid home or homeopathic treatments.
Ensure adequate nutrition for infants and adequately treat gastrointestinal infections.
Do not neglect child care; Children who suffer strong falls or are in very close contact with animals - cats and rodents - could develop meningitis.
Take greater care with immunosuppressed children; are exposed to greater risks.
Go to regular pediatric checkups. .
In up to 60% of cases of meningitis, says Espinel, “the agent that caused it cannot be identified with certainty: what virus, bacteria, fungus or parasite (...); Even the rabies virus, Zika virus, coronavirus and tuberculosis can cause inflammation of the coverings of the brain.”
In this scenario, the neuropediatrician emphasizes again, access to correct information and making timely decisions can preserve children's health.

Dr. Francisco Espinel
PEDIATRIC NEUROLOGIST
METROPOLITAN HOSPITAL

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After more than two centuries, hemophilia is still surrounded by myths

Hemophilia is a disorder that prevents blood from clotting normally when there is a wound or injury; If it is not well treated, it damages the large joints - ankles, knees, elbows - where bleeding generally occurs.
Although it is a disease discovered more than 200 years ago, hemophilia is still shrouded in myths and ignorance due to its low incidence among the population worldwide and, therefore, also in Ecuador.
“It is a hemorrhagic pathology, its origin is genetic, recessive and linked to the X chromosome,” indicates Dr. Marcela Zamora, specialist in Hematology and Hemotherapy at the Metropolitan Hospital. And to understand this description it is essential to resort to percentages and probabilities.
To begin with, let us remember that women genetically have two X chromosomes and men, one X and one Y chromosome. In the case of women, the double X chromosome protects them from the development of hereditary hemophilia; If there are cases of the disease within a family, they will generally be the carriers and those who transmit it to their children.

“When the mother is a carrier, there is a 50% chance that she will have a hemophiliac son and a 50% chance that she will bring a carrier or healthy daughter into the world,” explains Zamora.

So only men can develop this disease? No. It's a myth. The specialist clarifies that, although it is an ailment linked to sex, "70% of cases are hereditary and 30% are due to genetic mutations" that occur even when there are no sick relatives and, there, women with hemophilia can also be registered. .

Another belief that is distorted by these data is that which attributes one hundred percent of the cases of this disease to hereditary factor.
There are mild, moderate or severe hemophilias. In the latter, which are diagnosed during the first months of life, the hemorrhages are repetitive - even spontaneous - and damage the joints, making the patient's mobility difficult.
RECOMMENDATIONS FOR EVERYDAY LIFE
Perhaps driven by ideas that have been transmitted for generations, we also think that a person with hemophilia has a reduced life expectancy and cannot, in addition, perform any physical activity due to the risk of bleeding.
They are erroneous ideas, says Zamora. If the person receives good treatment upon diagnosis and correct medical follow-up, “hemophilia does not have to take years away”; If these conditions do not exist, what does happen is that the patient loses quality of life.

Perhaps driven by ideas that have been transmitted for generations, we also think that a person with hemophilia has a reduced life expectancy and cannot, in addition, perform any physical activity due to the risk of bleeding.

They are erroneous ideas, says Zamora. If the person receives good treatment upon diagnosis and correct medical follow-up, “hemophilia does not have to take years away”; If these conditions do not exist, what does happen is that the patient loses quality of life.

The specialist therefore makes several recommendations aimed at families with cases of hemophilia and also at those who have been diagnosed:
Perform physical exercise to maintain the patient's health, avoiding contact sports in which blows or injuries occur. Swimming, walking or jogging are ideal.
Maintain a proper diet and avoid being overweight; This increases the load on the joints, which can cause spontaneous bleeding.
Take care of oral health at the level of the mucous membranes, such as the gums, as bleeding may occur and these should be avoided at all costs in people with hemophilia.
Obtain information about the public health program that, at the national level, welcomes all patients with hemophilia to facilitate their access to treatment. In the country, the disease is considered catastrophic.
Go for genetic studies if there is already a family member with hemophilia and you want to have children.
With the advancement of science, Marcela Zamora maintains, there have been improvements in the treatments of the pathology. The first is the use of concentrates of the coagulation factor that is missing in the sick person's body; The percentage of deficiency of factors or proteins 8 and 9 -related to the disorder- determines whether hemophilia is mild, moderate or severe.

Recently, “therapies without replacement factor have been developed that mimic the function of factor 8 and thus prevent or reduce bleeding events,” explains the hematologist. In November of last year, a drug that 'orders' certain cells in the body to produce factor 9 was approved; Due to the scientific leap it represents, its cost is still very high.

Dr. Marcela Zamora
HEMATOLOGIST
METROPOLITAN HOSPITAL

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In the face of Parkinson's, the goal of treatment is to maintain quality of life

April 11 is World Day for this neurodegenerative disease that afflicts, according to updated statistics, 1% of people over 60 years of age globally.
When faced with a diagnosis of Parkinson's disease, the neurodegenerative disorder that affects a person's movements, there are three scientific confirmations that are essential to take into account today.
The first is that although there is no cure or any way to stop its progression, all the treatments that are now available aim to maintain the patient's quality of life for as long as possible, says Magdalena Gómez, an adult clinical neurologist at the Metropolitan Hospital. .
The second verification, the specialist emphasizes, is that physical exercise as a habit of life from youth “delays the appearance of neurodegenerative conditions such as Parkinson's and Alzheimer's”; and in the case of the first, it is the only way to modify the natural progression of the disease. Something that medications do not achieve.
It has also been identified, adds Gómez, that smoking, consuming alcohol or drugs, and receiving blows to the head repeatedly - for example, while practicing boxing - are risk factors for the development of Parkinson's. In addition to exposure to pesticides, fungicides and herbicides without following technical standards, or the consumption of contaminated well water.
And the third reality is linked to the diagnosis and the types of treatment. In patients suffering from this disease, both issues are addressed individually: it is “precision medicine,” says the clinical neurologist.
Science has shown that by the time a patient shows the first signs of Parkinson's, between 60% and 80% of the neurons that produce dopamine have already been lost. It is precisely the lack of this substance that affects the nervous system and explains the symptoms.
The diagnosis of Parkinson's is based, says Dr. Gómez, on the patient's clinical history and physical examination. Imaging tests – such as MRIs or CT scans – are necessary only to rule out similar syndromes whose origin is different.
The neurologist details the main symptoms of the disease:
Rest tremor; That is, the arms or legs tremble when the muscle is relaxed.
Asymmetries in tremors: the right and left limbs are not affected equally
Stiffness and loss of manual dexterity
Slow mobility and gait; the person has a hard time starting a movement
Sometimes, sleep disorders, depression, cognitive disorders, constipation, slowness in eating and swallowing and/or apparent excess saliva production.
To the treatments commonly used to control the signs of Parkinson's, such as the supply of dopamine, the development of new surgical techniques is being added.
Neurostimulation through electrodes placed at precise sites within the brain and neuroablation to destroy the area that causes tremor are among the options that require surgical intervention. The first, says Magdalena Gómez, is applied at the Metropolitan Hospital through multidisciplinary teams and in cases of Parkinson's that are difficult to manage, that respond to medication or that present uncontrollable tremors.
The clinical neurologist finally places emphasis on two things: the importance of the patient relying on a physiatry and physical rehabilitation team that offers individualized therapy and the awareness that, currently, "there is almost always some alternative to manage Parkinson's." and manage to maintain a good quality of life.”

Dr. Magdalena Gómez
NEUROLOGIST
METROPOLITAN HOSPITAL

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How to take care of our kidneys: the eight golden rules

Worldwide, medical societies recommend adequate and not excessive fluid intake, reducing salt and red meat consumption, and taking medications under supervision, among other actions to prevent chronic kidney disease.
Maintaining healthy kidneys to prevent chronic kidney disease is in our hands and becoming aware of this medical reality is the main objective pursued by the International Society of Nephrology.
For Fernando Jiménez, a nephrologist at the Metropolitan Hospital, prevention is crucial because it is a condition that does not present symptoms in the early stages, which affects 11% of the population in the country and requires high costs for its treatment through dialysis.
The first thing to take into account, maintains the specialist, are the main causes of chronic kidney disease: diabetes, high blood pressure, immunological kidney diseases, medication abuse and, in children, - in addition to the immunological factor - congenital diseases.
“If the person has one or more of these risk factors, they should go to the doctor to have their kidney function monitored at least once a year.”
In addition to taking blood pressure, Jiménez details, there are laboratory tests whose results raise the first alerts: blood biometry to rule out anemia - a characteristic in this ailment - and blood and urine tests that measure levels of urea, albumin and creatinine. (including filtration rate, which reveals how well the kidneys are functioning), uric acid, and electrolytes such as sodium and potassium. Depending on the findings, an ultrasound may also be necessary.
Periodic review of the state of the kidneys is, precisely, one of the eight golden rules promoted by medical societies linked to Nephrology, comments the doctor. Each rule is a recommendation about the lifestyle, the type of diet and the decisions that a person can make to take care of the health of this organ.
Stay active and play sports to avoid obesity, a condition that predisposes to chronic kidney disease; monitor blood glucose levels, at least once a year, to stop diabetes in time; monitor blood pressure monthly and, if you already have hypertension, verify that the medication is working.
Added to these three are fundamental tips: eat healthy and keep your weight under control; maintain adequate fluid intake (two liters daily, depending on the person's build); do not smoke and do not self-medicate.
Jiménez explains the reasons behind these golden rules. "In the diet, the two enemies of the kidney are animal protein - especially red meat, because it generates waste that requires more work - and salt." Drinking liquids, he adds, should become a habit, not a reaction to the feeling of thirst; However, we must also take into account “that excess water can alter electrolytes and affect the kidney because it has to work harder.”
The nephrologist draws attention to the consumption, without medical supervision, of medications such as anti-inflammatories - used long term -, antibiotics, diuretics as a mechanism to lose weight and omeprazole, which is administered to protect the stomach from acidity problems. Medicines for cancer treatment also need monitoring because many of them, Jiménez warns, affect the kidneys.
Yes it's correct. “We can live with only one kidney after losing the other due to kidney stones, a kidney tumor or congenital malformations,” says the specialist from the Metropolitan Hospital; But when there is chronic kidney disease - he warns - “both kidneys are lost” and, although dialysis works like a prosthesis when a leg is missing, the patient who has lost kidney function reduces their quality of life.

Dr. Fernando Jiménez
NEPHROLOGIST
METROPOLITAN HOSPITAL

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What do we know about epilepsy. The first thing: it is not one but dozens of epilepsies.

Without a public health policy to confront this pathology, the gaps in diagnosis and treatment are enormous in the country. “The prognosis is not good as long as epilepsy is not elevated to the category of catastrophic disease,” says neurologist Patricio Abad.
Erroneous beliefs and harsh realities revolve around the diagnosis and treatment of epilepsy in Ecuador, where it is estimated that more than 300 thousand people suffer from this disease.
Thinking that that image of a person convulsing on the floor is the only evidence of this pathology, in Ecuador there is a great task still pending to raise awareness among the population about the scope and impacts of epilepsy.
“The international classification considers more than 50 types of epilepsy; "The one that involves large seizures, with generalized shaking of the body, corresponds to approximately 20% of cases, but there are others that present as disconnections or with the movement of an arm or a leg," says Patricio Abad, a neurologist specialized in epilepsy. .
In Ecuador, maintains the specialist from the Metropolitan Hospital; “many are not diagnosed and very few have access to health systems.” To the small group that receives private medical care - 10% to 15% of patients nationwide - is added to a majority that cannot access medication.
And epilepsy has a higher incidence among the most vulnerable population. In situations of poverty, explains Abad, children are more exposed to infections that do not cure adequately, to frequent falls and traumas, to parasitic diseases - such as neurocysticercosis - that derive from poor water quality; The lack of adequate care during childbirth makes neurological problems more common in neonates.
70% of types of epilepsy are explained by these risk factors, while 30% could, according to Abad, have a genetic origin.
The neurologist believes that, when talking about this disease, it is important to also consider the following data: with a good diagnosis and treatment, 70% of epilepsies can be controlled; The disease can occur at any age, although 6 out of 10 patients are children and young people up to 17 years old; and early diagnosis is essential because any epilepsy that is not treated will always have neurological consequences.
Thanks to technological advances, Abad comments, it is now possible to study isolated seizures that are not necessarily epilepsy to discover abnormal circuits inside the brain very early. Prolonged electroencephalograms, video monitoring, advanced magnetic resonance imaging and genetic studies that confirm the mutation associated with the disease, among others, are high-tech equipment that supports the diagnosis.
The Metropolitan Hospital has the capacity to carry out these studies to treat patients with difficult-to-control epilepsies, "We have the option of studying them in greater depth through prolonged video monitoring, to capture seizures and, if applicable, offer the patient the possibility of epilepsy surgery.”
From diagnosis to possible surgery, patients are cared for by around 15 people who make up the team that is dedicated to the study of these cases within the Neurophysiology Unit of the Metropolitan Hospital. -Abad details- that within the operating room "we can place electrode templates directly on the brain to - through a stimulator - produce seizures, identify where they come from and, eventually, extract that little piece of the brain that produces the abnormal discharge called epilepsy.

Dr. Patricio Abad
NEUROLOGIST
METROPOLITAN HOSPITAL

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Reducing the frequency of colon cancer is still a pending goal

Attention! At age 45, you should have your first preventive colonoscopy if there is no family history or warning signs. Regarding World Colon Cancer Day, we review the risk factors and advances in diagnosis and therapy
A greater frequency of cases of colon cancer and its detection at younger ages has reduced by five years the recommended age for the first colonoscopy: the procedure that allows us to observe in detail the interior of this section of the digestive tract.
“At 45 years of age, for men and women, we should currently have a preventive colonoscopic study,” says Jaysoom Abarca, Head of the Gastroenterology Service at the Metropolitan Hospital.
Until a few years ago, the indicated age was 50 years; However, diets that include processed foods, with GMOs or carcinogenic ingredients, in addition to the poor quality of water that contaminates products since they are planted, have increased – at a global level – the incidence of colon cancer and have reduced the age at that is already diagnosed.
In Ecuador, Abarca points out, this type of cancer occupies fourth place among the most detected, after those of the breast, prostate and cervix. In the world, it is the third.
And although this trend is not encouraging, the specialist instead highlights the positive impact of current methods of detecting the disease and its treatments. The advances, in both cases, have allowed the percentage of deaths from colon cancer to decrease and the life span of sick patients to increase.
Colonoscopy remains the main and most successful medical examination to diagnose this cancer in early stages; It allows, according to the specialist, to detect polyps, remove them and, with this, “cut the sequence that can cause the development of the disease; also taking biopsies and treating the lesion”
Technology plays in favor of a more precise colonoscopy. At the Metropolitan Hospital, explains Abarca, a team that incorporates artificial intelligence has been operating for two months. “It's like it's a third eye; “We have the nurse, the specialist examiner and the team called CADEYE that detects lesions in the colon and issues alerts.” It also helps the doctor define whether it is a benign lesion or a higher risk to make surgical decisions.
This recent acquisition adds to the advanced technology of the Hospital's endoscopic equipment. These have chromaendoscopy, which uses different types of light to evaluate the surface and vascularity of lesions in the colon; and with magnification, which significantly increases the image to look at the lesion in greater detail and define its structure.
An accurate colonoscopy is key in the treatment of colon cancer; “It is the base therapeutic.” Based on the study, once the disease is confirmed, a series of tools are applied and combined. According to Abarca, medications based on antibodies directed at the factor that produces tumor growth and those treatments that start from the genetic origin of cancer, to select specific therapies, currently contribute to prolonging the life of patients.
The challenge remains in prevention. Avoiding processed foods, reducing the intake of red meat, consuming fruits, vegetables and yogurt with probiotics (regardless of age), doing physical exercise and taking care of mental health, are among the decisions we can make in favor of our health. colon.

Dr. Jaysoom Abarca
GASTROENTEROLOGIST
METROPOLITAN HOSPITAL

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War is only won in battle: children need to get sick to train their immunity.

Self-medication with antibiotics “does lower the immune system because it prevents the child from learning to defend himself; When the antibiotic is really needed, it will no longer have the effect we want,” says pediatrician Hugo Bardellini.
What can I do to raise my children's defenses so they don't get so sick? The constant question from mothers and fathers, concerned in this time of high number of infections with respiratory viruses, has a medical answer based on science.
“No vitamin or jelly or supplement, nothing, raises children's defenses; "They have to get sick so that they acquire defenses against the viruses and bacteria that come from outside," states – categorically – the pediatrician at the Metropolitan Hospital, Hugo Bardellini.
Just as an athlete needs to practice for a competition, the child's immune system – and that of humans in general – requires training. “And how we train the system: boys and girls have to get sick, especially from viruses.”
Bardellini explains that the constant chains of infections in schools, colleges or daycare centers have, precisely, an explanation in this scientific finding. “We had two years of lockdown or physical contact restrictions, during which our children never got sick, and now they go out and we have children sick with two, three, four or five viruses at the same time.”
The immune system is making up for lost training time. It is not, the specialist insists, an immune deficiency or low defenses.
Under normal conditions, he explains, a boy or girl around three years old gets sick with the flu 6 to 12 times each year. The defenses work very well because the body goes through the different cycles: three days of fever, 5 to 7 days of respiratory process, and then it passes on its own.
In the post-pandemic, Bardellini comments, today it is common for five-year-olds to continue getting sick with that level of frequency when, for their age, the number of annual infections should have been reduced to one or two.
And although nothing raises the defenses in the body of children, their lifestyle and diet can contribute to good immunity. For example, the pediatrician details, physical exercise, good nutrition, sun, countryside, fewer artificial products in the diet, less processed and more foods without dyes are factors that “help a lot because they allow the children's body to respond better to viral processes.
Consuming a tangerine, an apple, an orange or a kiwi, instead of vitamin C - in pill or jelly - which has a lot of flavoring and coloring, is the recommendation that Bardellini makes to his patients. Accompanied by another very important one: antibiotics should be given only in two situations; when there is bacterial otitis media or rhinosinusitis.
"Parents must be reassured, told that these diseases are normal, they have their cycle, that mucus and cough are defense mechanisms that should not be stopped because, in this way, our body develops immunity." And very important, the specialist emphasizes: that good communication with the pediatrician is necessary.

Dr. Hugo Bardellini
PEDIATRICIAN
METROPOLITAN HOSPITAL

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Probiotics: where to find them?

In recent years the word probiotic has become fashionable, but what is it? According to the World Health Organization, probiotics are live microorganisms that in adequate quantities provide great health benefits. These can support the immune system and help prevent diseases such as: diarrhea, ulcers, irritable colon, among others.
Dr. Jayson Abarca, gastroenterologist at Hospital Metropolitano, mentions that the intestine can host up to 1,000 different species of bacteria and that these keep its microbiome in balance. Probiotics and prebiotics are essential microorganisms for the proper functioning of the digestive system.
“Probiotics are frequently prescribed for recovery from stomach and intestinal diseases since they help balance the intestinal flora and support digestion. However, in some recent studies it has been found that these can also provide great benefits in respiratory and allergic diseases,” says Dr. Abarca.
One of the main functions of probiotics is to collaborate in the formation of essential nutrients such as vitamins, enzymes and fatty acids, in addition to promoting the absorption of calcium, iron and magnesium.
Foods rich in probiotics
Although today the pharmaceutical industry has developed supplements in order to increase probiotics in the body, Dr. Abarca always recommends consulting your trusted doctor to make sure they are suitable for each person. However, regarding the intake of probiotics in natural foods, there are no contraindications and we can find them in yogurt, kimchi, sauerkraut, kefir, kombucha, among other fermented foods.
In addition, the body also needs prebiotics, these are what provide energy to probiotics and we find them in foods such as: grains, bananas, green leafy vegetables, onions, garlic, soy and artichokes.
It is important to remember that in addition to consuming probiotics in foods rich in these bacteria, it is also valuable to maintain a healthy diet rich in fiber, fruits and vegetables. Always good nutrition will keep our body healthy.
Dr. Jaysoom Abarca
GASTROENTEROLOGY
METROPOLITAN HOSPITAL

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Monkeypox: what you need to know!

Monkeypox is not a new disease; it has been circulating for decades in some countries including parts of western and central Africa. However, at the beginning of May 2022, a new outbreak was detected in Spain, Portugal, the United States and Canada.
Monkeypox is not a new disease; it has been circulating for decades in some countries including parts of western and central Africa.
However, at the beginning of May 2022, a new outbreak was detected in Spain, Portugal, the United States and Canada.
Although its symptoms are similar to common smallpox, there are many concerns in the world's population. That's why we went to Dr. Joanna Acebo, pediatric infectious disease specialist, from the Metropolitan Hospital, to answer some of those questions.
What is monkeypox?
Monkeypox or monkeypox is a zoonosis or an infection that occurs in animals, in this case it is a virus that affects monkeys and has managed to be transferred to humans.
Who is most at risk of contracting monkeypox?
It is not known exactly who in the general population is at greatest risk of contracting this infection since there have been outbreaks in people of all ages. There is still no information on whether there is a more vulnerable population for this infection.
Transmission is general, it can affect both children and adults. Contagion will depend on the contact that people have with the virus.
How is monkeypox transmitted?
The current transmission from person to person is through direct or indirect contact of contaminated respiratory secretions such as blood, saliva, urine; also due to contact with contaminated skin lesions or with contaminated fomite-type material (sheets, clothing, etc.).
What are the symptoms of this disease?
This disease has an incubation period, which ranges from 5 days to 21 days and during this period various symptoms may appear. Generally, in the initial period, before the lesions appear, the person will have a fever greater than 38.5° Celsius, headache, swollen glands throughout the body, a lot of muscle pain called myalgia, and a lot of weakness, these as main symptoms. From the third day after the fever appears, lesions begin to appear on the skin, which initially look like rosettes or papules as doctors call them, and then they become vesicles and finally scabs appear. The illness in total can last up to 4 weeks.
How can we protect ourselves?
There is currently no vaccine for this disease. Previously, until 1980 when smallpox was eradicated, the vaccine for this disease worked for this type, but now in Ecuador we no longer have smallpox, so there is no vaccine. However, we can protect ourselves from this disease by maintaining good hand hygiene, avoiding contact with sick people, and avoiding traveling to endemic places where one may have contact with sick people.
How serious can this disease be?
This disease is considered a mild disease, not serious, from the point of view of lethality.
If I have the disease, how do I take care of myself?
If there is a suspected or confirmed case, the first thing you need is respiratory isolation and care in handling the scabs or vesicles. Special care must be taken when handling the infected person's clothing and sheets. Also, it is important to avoid scratching as it can cause marks on the skin, and of course to immediately contact your primary doctor so that he or she can provide you with appropriate treatment based on your medical history.

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You may have Glaucoma and not know it

Glaucoma is known as “the silent thief of sight”, since it often goes unnoticed in its early stages, does not present warning signs such as pain or discomfort and has almost imperceptible visual symptoms at the beginning of the disease, since the loss of Vision occurs in the peripheral areas of vision, but since our binocular vision system is effective, it allows the less affected eye to compensate for the defects of the other and we do not notice any changes until it is too late.
How is glaucoma diagnosed?
Dr. Javier Aguirre, ophthalmologist at Hospital Metropolitano, tells us that this pathology is usually detected in a routine ophthalmological examination and not necessarily because the patient has noticed any symptoms that indicate it.
“An ophthalmological check-up should include a measurement of intraocular pressure, as well as an evaluation of the optic nerve, especially when there are risk factors such as age or family history,” comments Dr. Aguirre.
There is no single test to determine if you have glaucoma or are at risk for developing it. There are several tests, however, the two most frequent and routine are: tonometry and ophthalmoscopy.
Controls and checkups should be done depending on age and whether or not you have genetic or hereditary factors. Due to the pandemic, in the last two years, these checks have been carried out to a lesser extent. Mammography, Colonoscopy and Pap smears are studies that have been stopped during the pandemic and that is why in recent times we are seeing patients with advanced disease.
How to prepare for your eye checkup?
Routine eye exams are not uncomfortable or painful. It is important that if you wear glasses you take them with you to know if they are working well. In addition, Dr. Aguirre recommends that if you are going to undergo the checkup for the first time, you be accompanied by a person, since some of these exams require drops to dilate the pupil, in order to evaluate the fundus of the eye, the retina, the optic nerve, among others; and this may hinder visibility for some time until the pupil returns to normal.
It must also be taken into account that before having a tonometry, some anesthetic drops are applied to the eyes. For an accurate measurement, take several calm breaths before resting your chin and forehead on the tonometer. Breathe normally. Do not hold your breath, as this may produce a higher measurement than the actual pressure.
After your exam…
Remember that it is important to ask your ophthalmologist about the findings, possible treatments and how to prevent future diseases.
The Metropolitan Hospital's Medical Checkup service is complete and has evaluations in more than 4 specialties, including ophthalmology. In addition, the Metropolitan Hospital has the latest generation equipment for precise diagnosis of your vision.

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5 facts you should know about cancer

The word cancer often tends to be synonymous with tragedy, pain or even death, but it does not always have to be that way, although each cancer is a dangerous and very careful disease, it can be controlled and even overcome if it is detected in time. Today, as World Cancer Day is commemorated, we spoke with Dr. Verónica Patricia Pérez Encalada, Clinical Oncologist at the Metropolitan Hospital, and she tells us 5 important facts that we should know about cancer.
1. The most common and aggressive
Dr. Pérez points out that, in Ecuador, the most common cancers are cervical, breast cancer, colorectal cancer, gastric, prostate and thyroid cancer. “Among the most aggressive we can highlight gastric cancer, pancreatic cancer, lung cancer, melanoma, colorectal and cervical cancer because they are generally diagnosed late,” says the expert.
2. Time to treat cancer
The idea is to act with prevention. One third of cancer cases can be avoided by reducing risk factors. "Among those that we can avoid, we highlight cervical, breast and colon cancer, which are tumors that can be acted upon by reducing risk factors and detected early through screening and in this way, allow the patient to be cured," indicates the Dr. Pérez.
Controls and checkups should be done depending on age and whether or not you have genetic or hereditary factors. Due to the pandemic, in the last two years, these checks have been carried out to a lesser extent. Mammography, Colonoscopy and Pap smears are studies that have been stopped during the pandemic and that is why in recent times we are seeing patients with advanced disease.
3. Stages of cancer
Cancer is staged from 'stage one to stage four', with 'clinical stage one' being the earliest, and stage four being that which is already advanced or metastatic. Depending on that, the best treatment for the patient is decided.
Nowadays, combinations of chemotherapy, radiotherapy, surgery and associated immunotherapy are made, and palliative care is promoted to improve the quality of life of the patient and their families throughout the entire transition of the disease.
4. How we take care of ourselves to avoid cancer
There are many factors that we can modify to try to avoid the disease, according to Dr. Pérez. “We must avoid the consumption of alcohol, tobacco, drugs, we must have a healthy diet and do physical activity, exercise. We must avoid obesity, avoid exposure to radiation and perform preventive checkups.
5. A second chance at life
We know that approximately one in two men will have cancer and one in three women will suffer from this disease. Knowing this, it is very likely that we ourselves or someone in our family will have cancer at some point in their lives. The idea is to raise awareness on this special day to try to get people to appreciate the importance of avoiding having this disease, knowing that we can prevent it with checkups and avoiding the risk factors already indicated.

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Reasons to have a medical checkup

We are all starting a year in which we want to take great care of our health. To achieve this fundamental objective, Dr. Álex Hernán Almeida Robalino , internist at the Metropolitan Hospital and postgraduate director of Internal Medicine at the International University, reminds us of the importance of starting the year 2022 with a general medical check-up of our body.
Dr. Almeida indicates that every month is a good time to do a checkup. “Many people do them in January, due to the psychological factor of starting a year with great health.”
The general medical checkup should be directed by an internist who will examine all of the person's organs. “After the complete clinical examination, it is complemented with laboratory and imaging tests, to confirm that the organs that have been examined are fine,” says the doctor.
In this Medical Checkup process, the heart, lungs, abdomen, and extremities are evaluated, the results of office tests are reviewed, and a final report is prepared with diagnoses and recommendations.
More frequently, according to the expert, metabolic disorders may occur. Basically they are alterations in lipids (cholesterol), glucose or high blood pressure. “There are patients who enter apparently healthy and, through the medical check-up, several problems are detected: whether simple or major.” Among them are visual, auditory and even more important problems such as cardiological, pulmonary, or gastrointestinal problems.
Checkups are carried out at all ages, and preferably begin at school age. Internists basically observe adult patients, but the check-ups are aimed at each age group. It is not the same to perform a checkup on a 60 or 70 year old patient as on a 30 year old one. Complementary exams are planned differently depending on the age group.
To maintain perfect health throughout the year
First you have to do a medical check-up with our private doctor and then a laboratory and imaging evaluation, to accordingly see how the metabolic profile, cardiovascular risk factors , weight (body mass index) is and make a plan effective. nutrition and physical activity.
“Based on the diagnoses obtained, we suggest whether it is necessary to maintain or make changes in lifestyle: diet, and exercise that is more appropriate for each person,” says Dr. Almeida.
The results of the Medical Checkup also lead us to plan activities that reduce our stress or anxiety load. You can plan both physical and psychological activity through meditation, but everything depends on the data obtained from an initial general medical check-up.

Dr. Álex Almeida
METROPOLITAN HOSPITAL
INTERNAL MEDICINE

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A proper diet helps reduce migraines

Headache is an illness that we have all suffered at some point in our lives, however, it is important to recognize the difference between a simple headache and a migraine.
Migraine comes from the Greek word hemikrania or "hemi-cranial", which means half of the head, that is, it is a pain that occurs in a single cerebral hemisphere. One of the most common symptoms of migraine is that it is pulsatile and that its intensity increases progressively. It may also be accompanied by nausea, vomiting, sensitivity to light, noise, and a heavy head. Migraine attacks can last from hours to days and be so intense that they interfere with daily activities.
Dr. Patricio Abad, neurologist at the Metropolitan Hospital, tells us that there are more than 40 subtypes of migraines. “This type of headache can be so severe that it can only be treated by going to the Emergency Department. Clinical diagnosis is important to rule out a brain tumor, an aneurysm or some brain pathology.”
The precipitants
Migraines occur in people with a more sensitive nervous system. In these people, nerve cells in the brain are easily stimulated, producing higher than normal electrical activity, affecting the trigeminal nerve, which in turn releases substances that cause painful inflammation in the brain blood vessels.
There are several precipitants that can cause this imbalance such as red wine, chocolate, foods that contain nitrates, such as hot dogs and processed meats (deli meats or sausages), there are also foods that contain tyramine such as aged cheeses, dairy products. soybeans, beans, among others. However, this does not mean that all this food causes migraines, it is crucial to recognize what things can trigger it in our own body (and it is not just food) to control or reduce the likelihood of it appearing.
Healthy food
To relieve the symptoms of chronic migraine, it is advisable to adopt a diet based on vegetables, such as dark green leafy vegetables, such as spinach, kale and watercress, as they have nutrients and anti-inflammatory and antioxidant properties.
Recent research suggests that the LIFE (Low Inflammatory Foods Everyday) diet offers an effective alternative to this ailment. This diet is rich in dark green leafy vegetables and limits the intake of whole grains, starchy vegetables, oils and animal proteins, especially dairy and red meat, which in some way can precipitate a migraine.
Positive changes
Making changes to your lifestyle is important. Increasing the hours of sleep and drastically reducing stress is essential to combat migraines. Likewise, practicing yoga, meditating and exposing yourself to white noise can be good allies. We must also not forget to exercise or walk at least 30 minutes a day. It is crucial to always consult your trusted doctor so that you can follow appropriate treatment and not self-medicate.

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5 ways to take care of your eyesight

For many of us, the sense of sight is one of the most valuable, however, what importance do we give it? Studies reveal that more than half of the world's population has not undergone a comprehensive vision examination in the last year.
It is worth remembering that 50% of the information we receive is visual and that an image can say more than a thousand words. For this reason it is important to take proper care of our eyesight. Dr. Delia Landázuri, ophthalmologist at the Metropolitan Hospital, shares the best tips to protect your eyes .
1. Use glasses with a UV filter: The sun's rays produce two types of light, the one that we see and illuminate and another that is ultraviolet light. The latter can be very harmful to the eyes. That is why it is essential to use a visual protector with a UV filter, such as glasses. In addition, this object will also protect you from other environmental agents that are aggressive to the eyes such as wind or smoke.
2. Do not self-medicate: Many medications, in their side effects, can cause blindness, so it is important to always consult with your doctor before taking any type of medicine.
3. Maintain adequate hygiene: Hygiene is important to keep your eyes healthy, so when washing your face you should clean the area around them. You should not touch or rub them with your hands as you could expose them to infections.
4. Reduce the use of screens: Currently, screens such as television, cell phone, computer, among other devices, have become essential tools in our daily environment. However, you should try to reduce exposure as they can cause blurred vision , dry eyes, difficulty focusing at a distance and headaches.
5. Visit the ophthalmologist at least once a year: More than one billion people in the world have visual problems , 80% of which can be avoided if we had good control of the health of our vision. If you currently wear glasses, it is important to keep a periodic review of your measurement.
At the Metropolitan Hospital we have all the latest technology equipment, always being a reference for visual health with our Metrolaser area. Check out our packages.
Dr. Delia Landázuri
OPHTHALMOLOGIST
METROPOLITAN HOSPITAL

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Consuming coffee has benefits for fatty liver

Nonalcoholic fatty liver is a general term for a variety of liver conditions. These occur when a lot of fat accumulates in the cells of this organ. The most important cause of this accumulation is an inadequate diet, high in carbohydrates, processed sugars and fats.
Dr. Verónica Ayala, gastroenterologist at the Metropolitan Hospital, tells us: “fatty liver is a silent disease that does not have specific symptoms; But if you notice fatigue, have dizziness and high cholesterol, it is important to have a medical check-up, since you may suffer from fatty liver and if it is not controlled in time it can turn into a more severe liver disease such as cirrhosis or cancer .
Currently, research on this organ focuses precisely on how to prevent the appearance of fatty liver, with the most suggested recommendation always being to maintain a healthy weight and exercise. However, in recent years, scientists have found that consuming the equivalent of three cups of coffee can be beneficial in preventing the progression of fatty liver.
Dr. Ayala recognizes these studies, but mentions that it is important not to self-medicate, and also emphasizes that any type of treatment must be accompanied by a correct diagnosis . “Non-soluble stale coffee is rich in antioxidants, which makes it good for fatty liver, but consuming too much of it can cause harmful effects on the body, so it is important to always consult your doctor.”

Dr. Veronica Ayala
GASTROENTEROLOGY/INTERNAL MEDICINE
METROPOLITAN HOSPITAL

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9 reasons why your heart can get sick. You can prevent them.

Heart diseases are, in the world, one of the main causes of death, however it is important to remember that many of them are preventable.
Dr. Francisco Benítez, cardiologist at the Metropolitan Hospital, indicates that high blood pressure, coronary artery diseases, heart attack and angina pectoris have increased their incidence in the world. "These have non-preventable and preventable causes, the former are related to age and genetics such as hereditary diseases, but the latter involve factors that we can modify with the simple act of changing our lifestyle."
Below, together with Dr. Benítez, we tell you the 9 risk factors that you must change in your lifestyle to keep your heart healthy:
1. Blood pressure: it is important that you check your pressure once a year. High blood pressure usually does not present symptoms, it is a silent disease that without proper care can cause death. Although it can be hereditary, it is also caused by being overweight. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. Which brings us to the second factor.
2. Overweight and obesity: Excess weight, especially around the waist, can lead to conditions that increase the chance of developing heart disease, including high blood pressure, high cholesterol, and type 2 diabetes. The best way to know if you are in An adequate weight is through body mass index (BMI), which uses your height and weight to determine whether or not you have a healthy percentage of body fat.
. Use our BMI calculator
3. Sedentary lifestyle: perform isotonic activity such as walking, dancing, swimming, among others, to avoid inactivity. It is recommended to do 150 minutes a week, which can be divided into 30 minutes over 5 days.
4. Elevated cholesterol and triglycerides: these are waxy substances found in the blood, but in excess causes fatty deposits to form in the blood vessels and this in turn makes it more difficult for enough blood to flow through of the arteries, causing heart attacks or strokes.
5. Smoking: The chemicals in tobacco damage the heart and blood vessels. Additionally, cigarette smoke reduces oxygen in the blood and makes the heart work harder to supply oxygen to the body, and the extra work causes blood pressure and heart rate to increase.
6. Excess alcohol: its consumption is toxic, its substances damage the heart muscle, weaken it and cause a disease called dilated cardiomyopathy, causing symptoms of heart failure in the patient.
7. Diabetes: it is important to lower the level of glucose in the blood, high blood sugar levels can damage the blood vessels and nerves that control the heart.
8. Poor diet: not eating well is the main cause of all the aforementioned diseases. A highly recommended diet is the Mediterranean, well known since ancient times, ideal for people who want to eat healthy due to its flexibility.
9. Excess stress: improper management of emotions can put extra pressure on the heart, causing it to beat out of rhythm.
The most important thing is prevention through an annual medical check-up. Regular screening can tell you what your numbers are and whether you need to take action.
Learn about our medical checkup packages.

Dr. Francisco José Benitez Saa
CARDIOLOGY / HEMODYNAMICS
METROPOLITAN HOSPITAL

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Your lifestyle influences the appearance of Alzheimer's by 40%

Alzheimer's is a type of dementia that is characterized by the progressive deterioration of higher mental functions such as memory and reasoning. Although there is currently no cure, its appearance can be prevented or delayed by adopting different healthy lifestyle habits.
For Dr. Johanna Gavidia, geriatrician at the Metropolitan Hospital , the most important risk factors in this disease are age and genetic inheritance, however she mentions that there is new evidence that suggests that there could be other factors that influence up to 40%. in the appearance of dementia , some of them include high blood pressure, diabetes, physical inactivity, obesity, sedentary lifestyle, head trauma and depression, among some others.
This is where nutrition and dietary habits become the key to the clinical care of people with neurodegenerative diseases. Some vitamins and minerals have important antioxidant and anti-inflammatory properties that can protect against oxidative damage , neuroinflammation and subsequent cognitive decline, in addition to their influence on intestinal microbial flora.
Some vegetables such as broccoli, cabbage, spinach, beets, eggplants or peppers are ideal for improving preventive capacity. Among the fruits, plums, blackberries, grapes, strawberries, cherries and blueberries stand out.
That is why it is important to increase the consumption of natural foods of plant origin and reduce the consumption of foods of animal origin and with a high content of saturated fats.
Scientific research has also shown that both the MIND diet and the Mediterranean diet reduce the risk of Alzheimer's to a similar level, with the former being the easiest to follow due to its flexibility. At this point it is important to emphasize that it is not essential to follow the diet perfectly to obtain benefits, but rather to focus on improving your lifestyle.
Dr. Johanna Gavidia
METROPOLITAN HOSPITAL

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5 ways to strengthen the immune system in children

The immune system is that part of the body that defends and protects us from germs and microorganisms. While vaccination is underway, the coronavirus pandemic continues and children may be the last group to be inoculated. That is why it is important that we do not let our guard down and ensure that our children are protected, with their immune system strengthened to prevent possible respiratory infections or any other type.
“It is important to remember that 90% of diseases in children are viral and therefore their immune system recognizes these diseases and creates defenses that will work throughout their life,” comments Dr. Hugo Bardellini, pediatrician at the Hospital. Metropolitan. For him, medical check-ups for children are very important to keep them healthy. In addition to complying with the vaccination schedule, Dr. Bardellini gives us five tips that will help us in this task:
A healthy environment
Children are like sponges and absorb everything around them, from behaviors to chemicals. In the second case, it is important to have an environment free of cigarette smoke, free of smog, since these are the cause of allergies and respiratory diseases in children. When we talk about a healthy environment we mean going out into nature and receiving the sun, maintaining an active life. We must also remember that the sun generates vitamin D, essential for children's defenses. In fact, a deficiency of this vitamin increases the risk of contracting respiratory infectious diseases.
Improve nutrition
Natural foods are the best food we can provide our children, especially fruits and vegetables, these have the vitamins that our children's bodies need while they are growing. Zinc, for example, is a mineral that has a lot to do with immunity. Other vitamins that can contribute to the immune system are vitamin A, B and C, but that does not mean that we are going to dose children with synthetic products, but rather that one orange or tangerine a day should be included in the daily diet, among other fruits.
It is also important to minimize junk food and sugar as these can alter the child's body.
Comply with sleep hours
Many times on vacation, children alter their sleeping hours, since their routine is different. However, in the current situation it is important for a child to sleep between 8 to 10 hours a day uninterrupted, in order to help the development of defenses. A well-rested child has a body better prepared to fight and protect itself from bacteria.
Physical activity
Regular moderate physical exercise reduces the risk of suffering from infections and helps eliminate bacteria from the lungs and respiratory tract and therefore reduces the chances of contracting a cold, flu or other respiratory illness.
Visit to the doctor
Medical check-ups are important to be able to detect any discomfort or illness in time before it becomes serious. Changes during the childhood stage occur frequently, what must be controlled is that they are in the correct parameters. During the first year of life, see your pediatrician every month. From one year to 5 years old, a visit is made every 6 months; and from the age of 5, at least one annual check-up in a healthy child.

Dr. Hugo Bardellini
PEDIATRICIAN
METROPOLITAN HOSPITAL

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6 measures you can take to prevent hepatitis

Hepatitis is a common disease that inflames the liver. Currently, it is known that there are five viruses that cause this pathology that affects this organ acutely or chronically.
According to data from the World Health Organization (WHO), in 2017 there were a total of 257 million people affected by a chronic infection caused by these viruses.
Types of hepatitis
Each strain is different and affects the population in different ways. There are currently hepatitis A, B, C, D and E, although the most common are the first three. Dr. Ricardo Chong explains to us how this disease is transmitted and how this disease can be prevented.
Knowing how it is transmitted and what the symptoms are is the key
Generally, hepatitis A and hepatitis E are spread through contact with food or water contaminated with the feces of an infected person. You can also get hepatitis E by eating undercooked pork or seafood. Hepatitis B, C and D are transmitted through contact with the blood of a person with the disease. B and D can also be spread through contact with other body fluids and can happen in many ways, such as sharing injection needles or having unprotected sex.
Some people do not know they are infected, but for the most part the most common symptoms of this disease can include: jaundice (a yellowing of the skin and eyes), fever, fatigue, loss of appetite, nausea and/or vomiting, pain abdominal pain, dark urine, whitish stools and joint pain. If the infection is more acute, symptoms may appear between 2 weeks and 6 months after being infected and in chronic cases up to years later.
It can be prevented
There are different ways to prevent or reduce the risk of becoming infected with hepatitis, depending on the type of condition. Here we share the top 5:
Vaccination is the best way to prevent. Currently there are vaccines for types of hepatitis A and B, immunization being an effective weapon against this disease.
Always wash your hands as well as all food before starting to cook. Especially vegetables, but also meat.
Do not share your toothbrush or razor or hair removal blades. Also do not share injection needles and always verify that the material that has had contact with fluids is correctly sterilized.
Be especially scrupulous in checking the hygiene of the premises when you are going to get a tattoo.
Annual medical checkups can help early detect any pathology that may exist in the liver.
And lastly, don't have unprotected sex.
In the best of cases, our defenses can solve the problem and the liver regenerates completely without the infected person even knowing about it. However, if you experience any of the above symptoms, see your doctor immediately.

Dr. Ricardo Chong
GASTROENTEROLOGIST/HEPATOLOGIST
METROPOLITAN HOSPITAL

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Don't get confused between hypothyroidism and hyperthyroidism

It is easy to confuse both diseases, because although they are caused by the same gland, they both represent two sides of the coin. Here we share the response from Dr. Mauricio Pérez, Endocrinologist at the Metropolitan Hospital.
What is the difference between hypothyroidism and hyperthyroidism?
The thyroid is an organ that produces a unique hormone that acts throughout the body and when we have a dysfunction of this organ we witness a rise or fall in this hormone. That is to say, “when we have an overproduction of this hormone it is called hyperthyroidism , while when it is not produced enough it is called hypothyroidism .”
And why is this hormone so important?
As I mentioned before, the thyroid gland affects virtually every part of the body. The hormone it secretes regulates metabolism and the ability to tolerate heat or cold. It can change energy levels and mood and, if you are a woman, menstrual periods.
What are the symptoms of hypothyroidism?
The symptoms of hypothyroidism are mainly fatigue, since the person is always tired because their metabolism works at a lower rate than normal and they barely obtain the necessary energy from food. It also shows an increased sensitivity to cold as it is difficult for it to regulate body temperature. Other symptoms include constipation, dry skin, or weight gain when activity decreases.
And in hyperthyroidism?
In the second case, hyperthyroidism, the opposite occurs: the gland works too much and fills the blood with thyroid hormones. In this case, the metabolism accelerates excessively, increasing hyperactivity and anxiety in the person, as well as their heart rate with the logical risk for the patient. It can be caused by the existence of benign tumors in the thyroid gland, an excess of iodine in the diet, a viral infection or being treated with thyroid hormones.
Any final recommendations?
It is vital to make sure your thyroid is working well. If you experience any of these symptoms, or if you just don't feel like yourself, tell your doctor.
It is important to mention if you have a family history with thyroid problems because you could have a greater predisposition to this type of disease.
Dr. Mauricio Pérez
ENDOCRINOLOGIST
METROPOLITAN HOSPITAL

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Can people who have been vaccinated or who have had COVID-19 donate blood?

Like every year on World Blood Donor Day, campaigns are activated around the world that encourage people to carry out this altruistic act. But this year, unlike others, the question arises: can I donate blood if I have been vaccinated or have had COVID-19? The answer is yes. Dr. Johanna Rojas, Hematologist at the Metropolitan Hospital, tells us that patients who have been vaccinated can immediately make a donation. “There is no history of this virus being transmitted through blood. In the case of a person who had COVID-19, it is important to wait about 28 days after the illness to donate, so that the donor's body is healthy and strong.”
Furthermore, according to the Pan American Health Organization (PAHO), the transmission of COVID-19 does not occur through blood transfusions or other blood components, so donating does not represent any danger.
Donating blood is to donate life
We must remember that every time we donate blood we are saving four lives, since there are four blood components that can be extracted from blood and used for different purposes in different patients. Unfortunately, due to the pandemic, there has been a worldwide reduction in donations. “Currently, most donations are compensatory, which is not optimal, since blood components are needed all the time for patient care,” says Dr. Rojas.
It is also important to know that those who benefit the most from blood donations are cancer patients. “34% of the donated blood goes to patients with different types of cancer compared to the 2% used for patients who come from accidents or 4% for obstetric patients,” Rojas emphasizes.
3 Benefits of donating blood
But this altruistic act not only benefits those who receive it, it also benefits those who donate.
Rejuvenates the body: by extracting blood from the body, we are forcing our marrow to produce new red blood cells.
By donating you burn 650 calories: donating blood also helps you lose weight and saves you a day at the gym.
You have a medical check-up: before donating blood, doctors subject the volunteer to certain rigorous check-ups (pulse, pressure, hemoglobin levels, etc.), so that you can take advantage of the opportunity to check your health.
But this altruistic act not only benefits those who receive it, it also benefits those who donate.

Dr. Johanna Rojas
HEMATOLOGIST
METROPOLITAN HOSPITAL

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Hydration: the basis of correct nutrition

Since we were children we have been taught that the human body is made up of 70% water, and more than once we have heard that we must drink this liquid daily, but it is not very common to hear that hydration is the basis of good nutrition. Dr. Yedid Valcárcel, nutritionist at the Metropolitan Hospital, explains why. Our body is like a car, gasoline is like our daily diet, and water, just like in the car engine, is the liquid that we must ingest. We must understand that no matter how much we put gasoline in the car, it will never work well without water, in fact, we can burn the engine if we do not put this vital liquid in it.
That is why it is important to consume water every day of our lives. Consuming between 6 to 8 glasses a day depending on the constitution of each person, can improve our health.
It must be recognized that although water is not the most exciting drink that exists, we cannot live without it.
Foods that should not be missing from your daily diet
For Dr. Valcárcel, in addition to keeping our body hydrated, there are also essential foods that we must eat in adequate portions every day. These foods provide vitamins, minerals, among other substances, that are essential for the body, that is, for the body to work correctly. Lastly, it is important not to overwhelm yourself by indulging from time to time, if you eat what you should 80% of the time, you are doing a pretty good job of nourishing yourself.
“To achieve a correct balance in your diet, you must include foods that provide protein, such as fish, chicken, turkey, eggs, cheese, beans, lentils, among others. We must also incorporate foods that provide energy such as carbohydrates, but preferably those that also provide us with fiber, such as whole grains or fruit. Of the latter you should consume at least 3 servings a day. In addition, healthy fats such as avocado, vegetable oils and nuts should be included.”

Dr. Yedid Valcárcel
NUTRIOLOGY
METROPOLITAN HOSPITAL

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Contraceptive use may reduce ovarian cancer risk

Ovarian cancer is a disease that has a high mortality rate. It constitutes the seventh cause of death from malignant tumors in Ecuador. Although it most frequently affects women between 45 and 75 years old, many young women are currently seen with this condition. 23% of women who suffer from this disease have a genetic history, however the majority of patients who contract ovarian cancer do not have a known specific cause.
Risk factor's
Dr. Danilo Salazar, gynecologist at the Metropolitan Hospital, says that it is important to know that there are risk factors that can predispose a woman to having this cancer, such as age, not having had children (there are several studies that show that women who have been mothers several times are less likely to suffer from ovarian cancer), family history and obesity.
contraceptives
The use of birth control pills, patches or rings containing estrogen and progestin, was associated with a lower risk of ovarian cancer in women of reproductive age. "The ovary is an organ that has constant, monthly cell renewal. This seems to have something to do with it, since every cell that reproduces actively and quickly has a greater risk of at some point changing its reproduction code and generating a pathology." malignant The use of contraceptives allows the ovary to enter a period of rest, which can reduce the possibility of contracting ovarian cancer,” says Salazar. In 2018, a study was published in the medical journal BMJ, which found that “the risk of ovarian cancer was highest in women who had never used hormonal contraceptives, and lowest among women who had used the method at some point.” .”
However, it is important to remember that birth control pills come with some risks and serious side effects. Patients should talk to their gynecologists about the possible risks and benefits before taking them.
Visit your doctor
Only 20% of patients are diagnosed in the initial stages of the disease. For this reason, Dr. Salazar calls on women to undergo periodic examinations and visit their gynecologist at least once a year in order to prevent and detect any disease in time.

Dr. Danilo Salazar
GYNECOLOGIST
METROPOLITAN HOSPITAL

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5 habits that can help you fight hypertension

High blood pressure is a chronic disease, which is characterized by an increase in tension in the body's blood vessels (arteries), which can damage them and cause serious damage to the heart, brain, kidneys and eyes.
High blood pressure is generally suffered by people over the age of 40 who are overweight, have diabetes, and have high cholesterol. They also tend to have a very high stress load, smoke and consume alcohol.
Dr. Vladimir Ullauri, cardiologist at the Metropolitan Hospital, comments “that it is important to carry out periodic blood pressure checks from an early age to avoid complications over time. In young people between 20 and 40 years old, it is recommended that every three to five years they have a general evaluation and after the age of 40, an annual evaluation, if possible.
Habits that can save our lives
Making small changes in our daily lives can mean a lot when fighting high blood pressure or preventing it.
Reduce salt intake
This is a fundamental step to keep hypertension at bay. This condiment in small doses can add flavor to food, but in high quantities it can increase our blood pressure.
One dose of exercise a day
It is important to exercise at least 30 minutes a day or 150 a week. This exercise should be of moderate intensity, that is, a brisk walk, bicycle, elliptical, among others. Studies have proven that exercising can reduce blood pressure by approximately 5 mm Hg and 8 mm Hg if you have high blood pressure.
Improve your diet
Reducing the consumption of fats and sugars in the diet is essential to improve blood pressure. These types of foods not only increase tension in the blood vessels but also cause blockage in them, which can cause severe damage to the heart.
There are also foods that you can increase in your meals to reduce pressure. The consumption of garlic and onion promotes the dilation of blood vessels and good circulation. Cinnamon helps control blood sugar levels and celery improves the elimination of sodium through urine.
Quit smoking and consuming alcohol
This may be a difficult habit to break, but it is essential if you want to win the war against hypertension. It has been shown that the relationship between alcohol and tobacco consumption and increased blood pressure is close.
Try not to stress so much
We know that today's lifestyle demands that we do more and more things in less time and we can continually end up thinking about work, finances, problems, but we will have to ask ourselves at what cost. Chronic stress can contribute to high blood pressure. That is why it is important to take time to analyze what causes this stress and thus work on it to improve our quality of life.
Don't forget that the best way to prevent any disease is to consult your doctor and have routine check-ups.

Dr. Vladimir Ullauri
CARDIOLOGIST
METROPOLITAN HOSPITAL

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5 myths about asthma that we should know

Asthma is a disease characterized by obstruction of the airways, mainly the bronchi. The word asthma comes from the Greek meaning 'panting or shortness of breath'.
According to a study by AIRLA (Asthma Insights and Reality in Latin America), it is estimated that asthma affects 10.9% of the child population in Ecuador. For this reason it is important to know the myths and truths around this disease.
Dr. Byron Canelos, pulmonologist at the Metropolitan Hospital, resolves some concerns about this inflammatory disease of the bronchi that occurs more in childhood.
Myth: Mites in mattresses can cause asthma.
Answer: In the first stages of children's lives, what is called allergic march can develop, this being a reaction that produces broncho-inflammatory substances within the body. The proteins that mites have, as well as the proteins present in pollen and cat fur, among others, cause children's bodies to react in this way.
Myth: Cow's milk causes asthma.
Answer: No. An allergy to a specific food rarely causes asthma alone. However, there are children who are hyperreactive to certain foods and if a patient is allergic to a food and is exposed to it, they may suffer a generalized allergic reaction that usually causes hives, general discomfort and triggers an asthma attack. It is also important to take into account that one of the causes of respiratory symptoms in babies is gastroesophageal reflux, which in turn causes vomiting and cough in children.
Myth: Children who grow up with asthma are cured.
Answer: It is not feasible to say that a person stops having asthma when they grow up. However, you can go a long period without having a crisis. The body's conditions to generate inflammatory reactions are less intense as age progresses and with adequate treatment the bronchi lose this reactivity, until it becomes so mild that people hardly notice it.
Myth: Asthma goes away in hot, dry weather.
Answer: Not necessarily. However, we do see that there are more asthmatic children in a warm-humid climate and this is related since in this type of climate we find a greater presence of biological particles such as fungi.
Myth: Obesity predisposes to asthma.
Answer: Obesity is a risk factor for many diseases. It is currently known that this is a disease that aggravates asthma but does not cause it. For this reason, asthmatic patients are always recommended to regulate their weight because obesity greatly alters lung mechanics.
It is important to remind parents that most asthmatic children can lead normal lives, like other children their age. Communication with your doctor is essential to resolve all doubts surrounding this disease so that optimal treatment can be provided that improves the quality of life of patients who have asthma.

Dr. Byron Canelos
PNEUMOLOGIST
METROPOLITAN HOSPITAL

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Micra, a capsule-sized pacemaker arrives in Ecuador

In Ecuador, cardiovascular diseases are the leading cause of death, in 2019 it reached 26.49% of total deaths, according to the Ministry of Health. Although not all of these diseases are treated in the same way, some have a solution, implanting a pacemaker, this being one of the most common procedures each year.
“A pacemaker is a device that is responsible for sending a signal to the heart that makes it beat at the correct rhythm. Currently, this device is the size of two 50-cent coins and is traditionally inserted under the skin of the chest, which can represent more short- and long-term risks for the patient,” says Dr. Diego Egas, cardiologist at the Hospital. Metropolitan.
A great medical advance
Micra is the evolution of a traditional pacemaker, this new device is the size of a capsule, ten times smaller than traditional ones, it has no cables and its implantation drastically reduces the hours of the procedure in the operating room.
The Metropolitan Hospital, at the forefront of medical advances, is a pioneer in Ecuador and one of the first hospitals in Latin America to begin implanting Micra pacemakers, thus being a reference in cardiology at the national level.
“Ecuador is one of the pioneer countries in Latin America in using this technology and it is projected that this type of implants will begin to grow, in this way, Ecuador can be a reference to teach this technique to other Latin American countries that are interested in learning” commented Egas.
5 advantages of Micra
The Micra pacemaker is implanted directly into the heart so it does not require cables or implants in the skin, which reduces complications over time.
The Micra pacemaker is implanted directly into the heart so it does not require cables or implants in the skin, which reduces complications over time. Micra also reduces the risk of endocarditis, one of the most common infections in patients with pacemakers.
Micra is a device that is implanted through a catheter inserted through the femoral vein, a procedure that can take between 10 to 15 minutes, reducing the time in the operating room and being less invasive.
It lasts longer than traditional pacemakers (between 10 and 12 years).
At the end of its useful life it is not necessary to remove it, it is designed to live in the heart and its small size allows another one to be implanted if necessary.
It is important to take into account that Micra is for patients who have atrioventricular block. If you want to know if you are a candidate for this type of pacemaker, consult your cardiologist.
Dr. Diego Egas
CARDIOLOGIST
METROPOLITAN HOSPITAL

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Vaccination is the best defense against meningitis

Meningitis is a very contagious disease and, although it is very rare, it puts parents and medical personnel on alert due to its high mortality rate and the serious consequences it can leave in people who suffer from it.
Four out of five cases of meningitis are caused by a virus while the other percentage is caused by bacteria. Although the exact cause that causes a virus or bacteria to act in a certain way in the body is not known, it is possible to prevent certain types of meningitis with immunization.
“Vaccines that protect against bacterial diseases such as Haemophilus influenzae type b, meningococcal and pneumococcal diseases, as well as mumps, the main cause of bacterial meningitis, reduce the risk of children contracting this disease by almost 100%. %”, indicates Dr. Álvaro Calero, pediatrician at the Metropolitan Hospital.
Unfortunately, due to the pandemic, confinement and fear of going to health centers, many parents have chosen to delay vaccination in their children, which puts the health of many children at risk and raises health alarms due to the possible growth of cases of meningitis.
The serious consequences
Meningitis is a disease that can erode the quality of life after the illness. Approximately 25% of patients who recover from meningitis develop some injuries such as deafness, blindness, brain damage, spinal cord injuries, among others.
For this reason, it is important to detect and define treatment in time for this disease. “Children with meningitis must be hospitalized so that they can receive their treatment and it is constantly monitored by doctors,” says Dr. Calero.
The Metropolitan Hospital has a multidisciplinary team of pediatricians, neurologists, infectologists and nurses, fully trained to care for all types of meningitis cases and within its infrastructure it has the Pediatric and Neonatal Intensive Care Unit, to provide children with the best possible treatment.
A call to parents
Vaccination is the most effective weapon that parents have to prevent many diseases in their children. It is important that children attend their appointments with pediatricians, with all biosafety measures, to prevent their immunization schedule from being discontinued and in this way they are protected and healthy.
Vaccination is the most effective weapon that parents have to prevent many diseases in their children. It is important that children attend their appointments with pediatricians, with all biosafety measures, to prevent their immunization schedule from being discontinued and in this way they are protected and healthy.

Dr. Álvaro Calero
Pediatrician
METROPOLITAN HOSPITAL

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Deep Brain Stimulation, a surgery that improves Parkinson's symptoms

Parkinson's disease is a disease that, after Alzheimer's, is the second most recurrent neurodegenerative disorder; approximately 7 million people in the world suffer from it.
This disease is characterized by producing the degeneration and death of dopaminergic neurons, which causes a disorder in the motor system and leads to slowing of movements, causing rigidity and, frequently, tremor.
But what are these dopaminergic neurons?
The neurologist, Dr. Patricio Abad, a doctor at the Metropolitan Hospital, helps us answer this question: “They are neurons that produce dopamine and have the function of helping to coordinate movement in the body.”
Dr. Abad also mentions that dopamine is produced in the brain stem, but we also have it present at the nasal level, which is why one of the premonitory symptoms in patients with Parkinson's is anosmia or loss of smell. “There are several studies that confirm that the majority of people who suffered from this disease had stopped perceiving odors ten or fifteen years before Parkinson's was detected,” says Abad.
Causes
Among the most common causes of Parkinson's is genetics, that is, having a family history with a cerebrovascular disease. But it has also been seen that poor circulation, hypertension, diabetes, metabolic disorders, among others, can be risk factors for contracting the disease.
A hope for quality of life
Two hundred years ago, Parkinson's disease was first detected. Since then, research has made great progress in order to find a cure, or at least help these patients improve their quality of life.
Although Parkinson's is initially treated with medications, this is a degenerative disease, so at some point, these medications lose their effect and that is when Neurosurgery comes into play.
Deep Brain Stimulation (DBS) surgery consists of placing part of a neurostimulator system in the parts of the brain where the control of body movements occurs. This surgery has improved the quality of life of patients with Parkinson's by 80%.
The Neurology service of the Metropolitan Hospital has professionals specialized in Parkinson's disease and have vast experience in cases of deep brain stimulation.

Dr. Patricio Abad
NEUROLOGIST
METROPOLITAN HOSPITAL

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Video monitoring can help detect an epileptic seizure.

Epilepsy is a brain disease characterized by recurrent seizures. These seizures are episodes or crises caused by excessive and abnormal activity of a group of neurons.
Epilepsy is a brain disease characterized by recurrent seizures. These seizures are episodes or crises caused by excessive and abnormal activity of a group of neurons.
There are many types of epilepsy and seizure symptoms can vary widely. There are people who stare for a few seconds during a seizure, there are other patients who repeatedly move their arms or legs, sometimes seizures can manifest themselves in the form of laughter (are you sure??) or in a moment known as déjà vu That is, a crisis can be discharged (do you mean manifest?) in any human impulse, but it is repetitive and uncontrolled.
It is important to note that at least two unprovoked seizures are required to determine a diagnosis of epilepsy.
Technology to save lives
Dr. Magdalena Gómez, neurologist at the Metropolitan Hospital, tells us that currently there is a video-monitoring technique that consists of recording the patient for a period of time to know how the crises appear. That is, this technique allows the patient to be observed during a seizure episode and, together with the data emitted by the electroencephalogram, which records the electrical activity of the brain, provides the doctor with a more specific diagnosis.
What to do in case of a seizure
It is important to mention that with appropriate treatment, most patients can recover completely and lead a relatively normal and active life. However, if you have epilepsy or know someone who suffers from this disease, it is very important to know what to do in the event of a seizure or seizure.
Lie the person down and turn them on their side very carefully.
Make sure you protect your head
Do not put anything in your mouth during the crisis
Make sure there are no sharp or other objects around the person that could endanger their physical integrity while the seizure occurs.
If the episode lasts more than three minutes, ask for help and call 911.
After the attack, check that he is breathing normally
Dr. Magdalena Gómez
NEUROLOGIST
METROPOLITAN HOSPITAL

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Don't lose sight of your vision. World Glaucoma Week

Every year, in March, World Glaucoma Week is commemorated, in order to raise awareness in the population about this silent disease and the importance of visiting an ophthalmologist preventively.
Let's start with the basics
Glaucoma is a degenerative disease that affects the optic nerve, which generates vision from the eye to the brain to interpret images. That is, this condition occurs due to damage caused by intraocular pressure and the progressive deterioration of the nerve fibers.
This disease is considered the second cause of blindness in the world.
According to the WHO, it is estimated that there are 80 million people worldwide with this condition, and most importantly, many of them are unaware that they suffer from it until the damage is irreversible. Generally this disease is detected when there is already 40% visual loss.
Normal Vision
With Glaucoma
The most common risk factors
Glaucoma can affect people of all races and genders, but the risk increases with age. African Americans and Latinos are much more likely to get glaucoma than other races and tend to develop the disease earlier in life.
Another risk factor is diabetes; people with this condition are twice as likely to develop glaucoma. There are also people with a family history of this disease, they have ten times the risk than the general population.
Among other factors are:
severe myopia
Farsightedness
High blood pressure (hypertension)
Long-term use of corticosteroids
Previous eye surgery or injury.
Prevention
Dr. Ana María Vásquez, ophthalmologist at the Metropolitan Hospital, tells us that it is important to know that although glaucoma is a chronic disease, early diagnosis is important, so the best way to prevent and stop its progression is to visit the ophthalmologist on average. once a year starting at age 55 and once every two to four years starting at age 35.
Additionally, to have good eye health he recommends:
Perform physical exercise, as this helps internal eye pressure
Maintain a healthy diet rich in green vegetables and red fruits
Taking a multivitamin support containing vitamins C, E and B3
Do not expose yourself to the sun without glasses or a hat
Do not consume excessive tobacco or coffee.
Treatment
Although there is no cure for glaucoma, this is a disease that with proper treatment can slow vision loss and also slow the disease.
These treatments may consist of eye drops and medications that help decrease fluid and increase drainage to relieve eye pressure.
It is important to recommend that if any type of discomfort occurs in your vision or optical field, you should immediately consult an ophthalmologist.
Dr. Ana María Vásquez
Ophthalmology
Metropolitan Hospital

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Self-medication could damage your kidneys

Knowing about the diseases that can affect the kidneys is important and as every year on March 12, World Kidney Day is commemorated, precisely with that same premise.
Currently, more than 2 million people around the world receive treatment with dialysis or a kidney transplant, a number that could grow if there is no awareness of the risk factors that can cause a condition.
Among the most common risk factors are:
Diabetes
High blood pressure (hypertension)
Self-medication
Do you take medication without a prescription?
Currently, one of the causes that can lead to acute kidney damage or a serious condition is self-medication with common anti-inflammatories, which we buy in any pharmacy without the need for a prescription.
Dr. Washintgon Osorio, nephrologist at the Metropolitan Hospital, tells us that in certain scenarios, such as dehydration due to sports or stomach upset, among others; Where we feel sore and take an anti-inflammatory without a prescription, that is when we can cause lethal damage to the kidneys.
It is important to remember that this organ is the great purifier of the body, thanks to it we free ourselves from toxins, so oversaturating the kidneys with the inappropriate use of anti-inflammatories such as ibuprofen, aspirin or diclofenac, can lead to damage. acute renal failure and consequently produce the need for permanent dialysis and kidney transplant.
Hydration is the key!
But not everything is bad, there is always a proper way to take care of our kidneys. Among the most important things is reducing salt in meals, reducing the consumption of red meat, not smoking or drinking alcohol, not taking medications without prior medical consultation, and of course hydrating with pure water, consuming at least 1.5 liters. daily, in order to help the kidneys eliminate toxins from the body.
Of course, don't forget to visit a nephrologist at least once a year if you have risk factors or are over 50 years old, and from age 35 onwards, go to your doctor's office at least every two to four years.
Dr. Washington Osorio
NEPHROLOGIST
METROPOLITAN HOSPITAL

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For your health

Dr. Patricia Durán mentions that medical checkups are done on healthy people who do not have symptoms and just want to know how their general health is.
First, an interview is done with the internist and that is where they indicate what tests must be done to verify a good state of health.
When the person goes to the doctor with an illness, that is no longer a check-up; The conditions are not appropriate because the expert will focus on the patient's ailment or complaint directly.
In adolescents, the medical check-up focuses on looking at their nutritional status, functional status, and digestive system. The hormonal part is also essential. In all of these exams, we assess whether there is anemia through biometry, whether there are parasites with a stool test, and whether there are thyroid disorders with blood tests.
In young adults who are between approximately 18 and 40 years old, there are disorders more related to nutrition and weight. In other words, you have to see how your glucose is, or whether you have anemia or not, how your cholesterol is, how your triglycerides are, if you have a fatty liver or hepatitis. It is even observed if there are problems related to the consumption of fats or liquors.

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Anesthesiologist's Day: The management of anesthesia in a surgical intervention

Today, October 16, marks Anesthesiologist's Day. The head of the Anesthesiology Service and Medical Head of the Surgical Unit is Dr. Manuel Panzeri Piras. He points out that anesthesia is a controlled state of unconsciousness in which the body does not feel, in this state it is not perceived and therefore it is allowed. perform surgical procedures.
Anesthesia is composed of different medications through which a dose is delivered to the body to interrupt or reduce its ability to perceive it. Dr. Manuel Panzeri Piras points out that “For a surgical procedure to be safe, a pre-anesthetic evaluation must be done, which is a consultation in which the doctor gets to know the patient, delving into his or her health history. The cause of the disease, laboratory tests or if there are other diseases such as hypertension, diabetes or a previous neurological disorder.
Today, October 16, marks Anesthesiologist's Day. The head of the Anesthesiology Service and Medical Head of the Surgical Unit is Dr. Manuel Panzeri Piras. He points out that anesthesia is a controlled state of unconsciousness in which the body does not feel, in this state it is not perceived and therefore it is allowed. perform surgical procedures.
At that point, the history of allergies, medication consumption or abuse of any substance is appreciated. On the other hand, the anesthetic plan is essential since the patient's family understands the risks of the operation and the safety regulations that will be used in the process. At the end, the family and the patient give their consent to perform the surgery, as does the surgeon who meets with the patient to inform him or her what will happen during the surgery and its risks.
The different types of anesthesia used depend on the place in the body where it will be performed. “In surgery, we monitor all biological and vital signs. It means that we monitor all the behavior of vital signs or all their changes to minimize the impact of surgery on the body. Heart rate, respiratory rate, temperature, electrocardiogram, blood pressure, gas and oxygen levels are monitored. In addition, the patient's hemodynamic status is controlled so that he or she does not have postoperative pain, or has as little pain as possible."
Finally, not all patients are the same and depend on factors such as age, weight, height, sex and clinical conditions of the person to administer a dose of anesthetic. At the Metropolitan Hospital, several anesthetic techniques are used, such as: Balanced General Anesthesia, General Inhalation Anesthesia, Total Intravenous Anesthesia or Neuroaxial Anesthesia that includes Epidural and Spinal Anesthesia. After the operation, the patient must take their analgesics orally with pills since anesthesia is managed in three periods: preoperative, intraoperative and postoperative.

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World Heart Day

Heart disease can be prevented with timely diagnosis of risk factors.
Every September 29, World Heart Day is celebrated, the aim is to raise awareness among citizens about cardiovascular diseases that are latent in Ecuador.
Around the world, heart disease is the leading cause of death, as are heart attacks, cerebrovascular diseases, heart failure and diabetes. In the country this is reflected in 25% of deaths from cardiovascular diseases.
Vladimir Ullauri, Cardiologist at the Metropolitan Hospital and President of the Ecuadorian Society of Cardiology Núcleo Pichincha, shares with us that the most common diseases in Ecuadorians are: acute myocardial infarction, heart failure and cerebrovascular diseases. Ullauri explains that these diseases are the product of multiple risk factors or conditions throughout our lives.
These conditions can be high blood pressure, diabetes, cholesterol disorders, triglycerides, smoking, sedentary lifestyle, overweight and stress that may not be diagnosed or poorly controlled in daily life. For this reason, Ullauri recommends that a diagnosis is necessary to prevent these diseases and control them ideally if necessary. He points out that "the fundamental thing is to have a periodic evaluation and from an early age, especially if there is a family history, in terms of the population over 40 years of age, a cardiovascular evaluation is necessary, which consists of determining the presence or absence of risk factors. risk, such as high blood pressure, high cholesterol, altered glucose levels, smoking, weight changes, abdominal obesity and psychosocial factors such as a poor eating style and emotional stress", in the same way the pandemic we are currently experiencing has influenced the decompensation in health and the appearance of cardiovascular diseases that have had a higher risk of complications or even death.
In conclusion, it is important to keep in mind that all existing types of cardiovascular diseases are preventable and therefore it is key to lead a healthy lifestyle, along with an adequate diet in which we must eliminate excess fat and carbohydrates. Daily exercise also helps to lead an ideal lifestyle and it is advisable to do it three to five days a week, 30 to 60 minutes per day. What is sought through medical evaluations is to reduce mortality from heart diseases and lead an optimal life.

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World Alzheimer's Day

September 21 marks World Alzheimer's Day, which is the most common type of dementia.
Dr. Johanna Gavidia Banegas, Deputy Head of the Geriatrics Service at the Metropolitan Hospital, explains that dementia is a neurodegenerative disorder that is characterized by the progressive deterioration of higher mental functions (memory, orientation, reasoning and judgment, among others) with an intensity sufficient to interfere with people's daily lives, both socially and at work and at home. Around 50-70% of dementias are due to Alzheimer's Disease, which has a prevalence of 2.8-3.9% between 75 and 79 years of age and between 7.2 and 34.1% in older people. 85 years old.
According to the expert, there are clearly identified risk factors. “First we will talk about modifiable risk factors. In those under 45 years of age, less education increases the risk by 7%. In the range of 45-65 years, hearing loss has an 8% influence; head trauma up to 3%; high blood pressure 2%; and alcohol intake (more than 21 units per week) and obesity increase by 1% respectively. In those over 65 years of age, smoking increases the risk by 5%, depression by 4%, infrequent social contact by 4%, physical inactivity by 2%, environmental pollution by 2% and diabetes. in 1%".
Other risk factors include sleep disturbances and Atrial Fibrillation, and it is believed that there are more that continue to be studied.
There are also non-modifiable risk factors, the main one being age. The older a person is, the greater the risk of having dementia due to Alzheimer's disease. In addition to this, female sex and the APOE haplotype are also non-modifiable factors.
“Memory loss is not a normal part of aging. If the patient shows any symptoms of dementia, they should be evaluated by a doctor specializing in the subject to carry out a complete and adequate assessment that allows a diagnosis to be made and decisions to be made,” says Dr. Gavidia. The diagnostic process also allows us to rule out other treatable causes of dementia. An adequate diagnosis of the disease allows the patient to make decisions about their future and plan care together with their family.
There are no treatments that cure or stop the progression of dementia, but there are treatments that can help slow the deterioration. In addition to pharmacological treatment, cognitive stimulation is also important. In the initial stages of the disease, the patient perceives his alterations and may develop depressive symptoms, which also require medical evaluation and the evaluation of a specific treatment.
Hereditary Alzheimer's disease accounts for less than 1% of all cases of the disease, mainly related to forms of onset at an early age. Signs and symptoms of this type usually appear between 30 and 60 years of age. “Forgetting where we put the keys and then finding them is common, but if a person forgets that a child has visited them, it is a sign of alarm. If the person completely forgets an event or repeats the same story several times, these are symptoms that require evaluation.”
If the ability to plan tasks has been noticeably reduced, this is also a clear warning message. If a person, for example, when going out to the neighborhood store becomes disoriented and cannot return home, it is a sign to take into account or if he or she presents a decrease or lack of judgment when making decisions.
Care planning will depend on the severity of the disease. In the severe stage the patient has lost the ability to speak, walk, and control his sphincters and requires a permanent caregiver.
"In the initial phases, to improve communication, it is recommended to use short and simple sentences, speak slowly, use a low tone of voice, eliminate background noises, do not answer the patient's questions, do not speak as if our family member were not there. present and treat him like an adult,” he concludes.
It is also important to care for and support the main caregiver to prevent them from becoming fatigued.

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Myths, truths and recommendations about the COVID-19 disease caused by the SARS CoV-2 virus

Does the coronavirus travel long distances through the air?
NO. In an experimental study published by the journal NEJM, experiments were done with fogging machines that simulated the transmission and suspension of the coronavirus in the air and various surfaces. In that study, it was found that SARS-CoV-2 remained viable in aerosols for the duration of the experiment for three hours.
Droplets that are very small could float longer in the air, but this is unlikely because of aerodynamics. In general the droplets will move in the air around the body and clothing. The majority will fall to the ground, this being a very low risk, especially if social distancing is practiced and we only make occasional trips to the supermarket or pharmacy, with little exposure time. In these cases it is not necessary to shower or change clothes, but hand hygiene is always mandatory.
This same principle applies to hair or beard where it is very unlikely that droplets will remain when sneezing, coughing or talking and this of course does not happen if we use the mask properly, covering the nose and mouth completely.
Should I separate my laundry if I have been exposed in the community?
This will depend on whether the routine clothing is the clothing of a sick person:
Clothes that are used on a daily basis should be washed normally without concern with a normal detergent.
In the case of washing clothes of sick people, the clothes should not be shaken. To handle this clothing, gloves must be worn and not mixed with other clothing.
Is the virus immortal on surfaces?
NO. The virus is not immortal, but it can last from hours to days on surfaces.
A study revealed that the virus can survive, under ideal conditions, up to three days on metal and plastic surfaces and up to 24 hours on cardboard and fabric.
The risk of getting sick from handling mail or packages is extremely low. At the moment there is no documented case of someone getting sick from opening a package or reading a newspaper.
Am I at high risk of getting infected when walking the dog or exercising outdoors?
NO. The chances of catching the virus outdoors are extremely low, as long as you maintain a safe distance of at least two meters from other people.
Should I take off my shoes and clean them when I get home?
No. Shoes harbor bacteria and viruses, but they are not a common source of infections.
The shoes that should be changed are those that have been in hospitals and critical areas since infected patients are there.
If at home there are children who crawl or play on the floor or people with allergies or altered immune systems, it is recommended not to wear shoes as a good hygiene practice in general.
Do pets spread the virus?
There is no proof of this, but hand washing is insisted upon after touching them.
Is COVID-19 spread through coins and/or bills?
Although it can remain on surfaces for a while, the risk of contagion occurs if after touching them we touch our eyes, nose or mouth.
Should we all use N95 masks?
The N95 mask is indicated only to protect health professionals performing procedures on patients with COVID-19. The community must use a surgical mask or other anti-fluid fabric type.
Do hand dryers kill the virus?
Hand dryers do not eliminate the virus. It is recommended after washing your hands to dry with a clean or paper towel.
Does vitamin C prevent disease?
Vitamin C does not prevent disease.
Are antibiotics useful in fighting the virus?
Antibiotics are not useful to combat the virus. Antibiotics destroy bacteria.
Is ibuprofen contraindicated in COVID-19 disease?
There is NO scientific evidence that indicates that ibuprofen is counterproductive in case of coronavirus infection.
Can children go out to playgrounds?
The Spanish Society of Pediatrics suggests that children can go out for an hour to open spaces where they can walk, run and carry their toys, but NOT go where there are children's games such as houses, swings, slides, etc.
Social distancing should be explained to children and the use of masks should be practiced with them before departure.
Compiled by Dr. Joanna Acebo Arcentales
PEDIATRIC INFECTOLOGY
METROPOLITAN HOSPITAL

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Donating blood can save lives

In Ecuador, citizens still do not have a culture in blood donation. One of the myths that leads people to have certain fears when donating blood is that they can catch something. Dr. Johanna Rojas, a Hematologist at the Metropolitan Hospital, explains to us that donations are made with sterile materials and there is a unique contact with the blood. blood from the donor, therefore, it is impossible for there to be contagion of any disease. In addition, they are processes that are carried out under strict security measures.
When a person decides to make a donation, the following precautions are taken: the patient's blood pressure, vital signs, temperature, and an exam is done to see how the hemoglobin is. The act of drawing blood allows the marrow to renew itself and all of this benefits the person's health.
To donate blood, a person must be between 18 and 65 years of age. You must also weigh more than 50 kilos, be healthy and not have had any recent illness. On the other hand, the donor must not have undergone recent surgeries or have had tattoos or piercings in the last year before donating blood.
The Metropolitan Hospital has its own blood bank that operates from Monday to Friday from 08:00 to 16:00 and on weekends from 08:00 to 13:00. Nowadays, due to the health emergency, we receive donors whenever they can come. The process to donate lasts a maximum of one hour because a short interview is done with the person and the data is taken as a first step before the donation. Men can donate every three months and women every four months.
The Metropolitan Hospital manages a plasma collection program that has given positive results, it is working with patients who have already been through the coronavirus, in this way the blood of these people is obtained to put the plasma in patients who are fighting against the illness. This process is known as passive immunity and teaches that the antibodies that are created in the plasma of a recovered person are defense proteins for the body. Those who have already overcome the disease have created those antibodies in their blood plasma and that plasma is very good to donate to people who are with Covid-19.
Dr. Johanna Rojas
HEMATOLOGIST
METROPOLITAN HOSPITAL

◀ Myths, truths and recommendations about the COVID-19 disease caused by the SARS CoV-2 virus Donate your plasma ▶

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Donate your plasma

◀ Donating blood can save lives Robotic Hysterectomy - Dr. Jijón ▶

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Robotic Hysterectomy - Dr. Jijón

Some gynecological pathologies require surgery. Thanks to the advancement of technology, the use of minimally invasive surgery, such as robotic surgery, is now possible. One of the gynecological surgeries where robotics can be used is hysterectomy (removal of the uterus). This procedure can be performed with the assistance of a robot that allows the surgeon to intervene with greater precision.
Dr. Alfredo Jijón Chiriboga, an expert in robotic and laparoscopic gynecological surgery, trained at the Mayo Clinic, and member of the Metropolitan Hospital, tells us that there is “a widespread misconception that organs are removed in a hysterectomy. In hysterectomy itself, the uterus is removed, not the ovaries, so the patient will not have hormonal alterations . "
The specialist emphasizes that this type of surgical procedure must be performed after a comprehensive and complete study of the patient's clinical condition. He tells us that among the most common reasons for performing the intervention are abnormal and/or excessive uterine bleeding (usually caused by fibroids), chronic pelvic pain, endometriosis, uterine prolapse, malignancy of the uterus or cervix, among other causes.
Robotic surgery and patient recovery
The most common procedure in hysterectomy has been the traditional one, that is, open surgery. This method is more invasive and carries greater risks, as well as a prolonged recovery time compared to minimally invasive surgery.
With the development of technology, surgical techniques such as laparoscopic or robotic surgery allow the uterus to be removed in a less invasive way, meaning the patient will have a significantly smaller scar and will be able to return to normal activities in less time. “Some patients could go home the same day as the procedure,” says Dr. Jijón.
With the development of technology, surgical techniques such as laparoscopic or robotic surgery allow the uterus to be removed in a less invasive way, meaning the patient will have a significantly smaller scar and will be able to return to normal activities in less time. “Some patients could go home the same day as the procedure,” says Dr. Jijón.
The expert explains that this type of procedure, in which Da Vinci robotic technology is used, provides 360-degree mobility of the instruments (similar to hand movements), 3D vision that allows for surgery with greater precision, Less bleeding, shorter surgical intervention time and therefore safer surgery for the patient. The surgeon tells us that "this technology can also be useful in patients who have other types of gynecological problems such as infertility, endometriosis or for the extraction of fibroids." This type of surgery is already frequently carried out at the Metropolitan Hospital with very satisfactory results.
Dr. Alfredo Jijón Chiriboga
GYNECOLOGIST
METROPOLITAN HOSPITAL

◀ Donate your plasma HM Safe Care - Dr. Ullauri ▶

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HM Safe Care - Dr. Ullauri

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Chronic diseases require strict controls and patients must continue with their treatments to avoid complications. Come with confidence, we have redoubled biosecurity measures for your peace of mind. We transform for you.
#2Hospitals1complex
#SafeAttentionHM

◀ Robotic Hysterectomy - Dr. Jijón Safe care HM - Dr. Felipe ▶

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Safe care HM - Dr. Felipe

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We have two hospitals that treat respiratory conditions separately from the rest of the pathologies. Our operating rooms have, as always, all biosafety measures to provide the best care to our patients. We transform for you.
#2Hospitals1complex
#SafeAttentionHM

◀ HM Safe Care - Dr. Ullauri Safe Care HM - Dr. Córdova ▶

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Safe Care HM - Dr. Córdova

Today more than ever we take care of you, that is why we have the most complete biosafety standards, come with confidence. AT HM WE TRANSFORM FOR YOU.
#2Hospitals1complex
#SafeAttentionHM

◀ Safe care HM - Dr. Felipe We are two hospitals in a single medical complex. ▶

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We are two hospitals in a single medical complex.

In the evolution of this pandemic, COVID-19 has proven to be an incredibly cunning enemy due to its rapid spread among humans.
In this tough battle, defeating him is a complex task, but one of the most powerful weapons we have is to stay away from each other. That is why, honoring our commitment to take care of you and your family as always, providing excellent care to our patients, we have designated all the facilities of the Hospital del Día for the exclusive care of patients with respiratory conditions and with redoubled biosafety standards. , about which we have proven experience.
We have a great infrastructure that gives us the advantage of implementing this solution. We have two different hospitals in a single medical complex. Our Hospital of the Day has autonomous and exclusive operation for patients with respiratory conditions / Covid 19; and the Metropolitan Hospital cares for all our patients with other pathologies.
2 image areas
2 hospitalization areas
2 operating room areas
2 intensive care units
We have 200 meters of separation between the Metropolitan Hospital and the Hospital del Día. This means that a patient with respiratory conditions will not have physical contact with a patient caring for other pathologies.
Each person, through social distancing, has the historic opportunity to stop the transmission of the virus in their circle. Metropolitan Hospital, as a leader in the provision of health services, honors this opportunity by doubling efforts to provide safe care.
#2Hospitals1complex
METROPOLITAN HOSPITAL

◀ Safe Care HM - Dr. Córdova MAXIMUM SAFETY FOR OUR PATIENTS! ▶

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MAXIMUM SAFETY FOR OUR PATIENTS!

Our responsibility as an icon of private medicine in Ecuador motivates us to demand ourselves every day, even more so when the country and the world face an unprecedented pandemic whose expansion depends, to a large extent, on how disciplined and demanding we are with ourselves. .
The Metropolitan Hospital, as a healthcare home, is fully aligned with the guidelines issued by the Ministry of Public Health. Every day, we welcome new regulations that allow us to fight the spread of COVID-19.
In addition to the guidelines of national authorities, the Metropolitan Hospital is guided by international regulations from PAHO (Pan American Health Organization) and CDC, “Center for Disease Control and Prevention” in Atlanta, and regulations from other hospitals such as the John Hopkins in Maryland.
We have worked on a contingency plan that, with proven international strategies, will direct us to work towards better control of the spread of the virus. In relation to the management of patient flow, we have designed, from the Emergency area, a triage whose objective is to differentiate the location of patients with respiratory problems to separate them from those with other pathologies.
We have proceeded in the same way with the hospitalization of patients and strengthened this strategy. Patients with suspected or confirmed COVID 19 are not admitted to the hospitalization floors. These patients have been transferred to an exclusive area located in another building, where the Hospital del Día is located.
Our teams of professionals, made up of doctors, nurses, assistants, technologists, cleaning and disinfection personnel, comply with strict care and disinfection protocols for the safe care of our patients. They also receive constant training in the correct use of personal protective equipment that is used to treat patients with respiratory diseases.
Likewise, we have implemented security standards in visitor control. Most high-traffic areas of the Hospital have been equipped with special antibacterial mats, normally used at the entrance to operating rooms, which eliminate the microorganisms that we can bring on the soles of our shoes; and they can be moved through stretcher wheels and wheelchair wheels.
For the treatment of other pathologies and medical care in other types of diseases, both in the Operating Rooms, Emergency, Laboratory and Imaging areas, the Metropolitan Hospital has redoubled its biosafety measures to be able to provide safe care to patients and the entire interdisciplinary team. that intervenes in it.
At this time we ask our patients to avoid receiving visitors unless they are absolutely necessary. We want to ensure that the social distancing required to stop the spread of the virus is met.
#Stay at home
METROPOLITAN HOSPITAL

◀ We are two hospitals in a single medical complex. Keys to act against Covid-19 ▶

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Keys to act against Covid-19

Ecuador and the world are fighting these days against the coronavirus. Dr. César Marcelo Delgado Viteri, Head of the Pulmonology Service at the Metropolitan Hospital, informs us more about the disease and invites us to remain calm, in addition to taking care of his life and that of his family.
Prevention.

The specialist points out that the only way to prevent contagion is by staying at home and respecting social distancing.
“The disease debuts like a common cold, with a sore throat, headache, there may be nasal congestion and a feeling of lack of smell. Digestive symptoms such as abdominal pain and diarrhea may occur 10% of the time,” says the doctor.
It also mentions that the symptoms that raise the alarm to visit a hospital are high fever, a lot of dry cough and severe difficulty breathing. “If you have a little headache, a little cough and a little general discomfort, you may have the infection, but it is mild. If you are a young person and do not take medicine, if you do not have pre-existing diseases, you should only consult the doctor by phone,” he indicates.
The specialist asks to leave emergency rooms to patients with serious symptoms such as agitation or persistent fever, and to people at higher risk of having a serious illness. This group refers to people over 60 years of age and who have a history of high blood pressure, heart disease, lung disease or a history of cancer. They are at risk of their situation getting worse.
How should people with mild symptoms be treated?

“Patients with confirmed virus and mild symptoms should not take specific medicines, but only symptomatic treatment; That is, if I have general discomfort, I will take Paracetamol, if I have phlegm I will take an expectorant. "You should not self-medicate with antibiotics," says Dr. Delgado and adds that "all people should avoid the use of corticosteroids and anti-inflammatories such as Ibuprofen or Diclofenac."
What does coronavirus do to the lungs?

“The virus enters the body and has a special affinity for lung cells and when it binds to these cells called 'Type 2 Pneumocytes', there is an inflammatory response that causes lung damage. This inflammatory response ends up damaging the lung.”
Whoever is cured of coronavirus... Do they have consequences in their lungs?
“This disease is new, it has only been in the world for three months. People who recover from a mild coronavirus have small pulmonary sequelae, but those who develop a severe disease with the inflammatory response that we already mentioned can have significant lung damage.
What is the return home like for someone who has already recovered?

We send the patient who no longer has warning signs or symptoms home with a home isolation order, in which they must comply with a protocol and notify if another warning symptom occurs.
14 days after the onset of symptoms, it is necessary to perform a control test. The same 'test' that confirmed the positive coronavirus status will determine that the coronavirus is negative. “If this comes out negative, it must be repeated to reconfirm; By having two negative results on day 14 and day 15, we will have a patient with an epidemiological discharge, that is, recovered.”
The transfer of these patients after discharge is carried out under strict biosafety protocols. In addition, the family receives detailed instructions for their care while they are monitored and monitored through telemedicine.
Dr. Cesar Delgado
HEAD OF THE PNEUMOLOGY SERVICE
METROPOLITAN HOSPITAL

◀ MAXIMUM SAFETY FOR OUR PATIENTS! A united couple overcomes the crisis. ▶

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A united couple overcomes the crisis.

In Ecuador and the world we are going through difficult times. We are quarantining without leaving home to prevent the spread of Covid-19, but that task can have its difficulties. In this second part, Dr. Adriana Oñate Coronel, Head of the Psychology Service at the Metropolitan Hospital, shares some advice focused on managing these complex days with our partner without the relationship suffering any deterioration.
In China during the quarantine there was an increasing divorce rate. Studies show that domestic violence can increase by 30%. If we want this to not happen in our country we have to be aware and try to better manage the differences within the home.
“The proper functioning of our immune system is directly related to the way we deal with stress. The moment we realize that we are thinking a lot about the coronavirus, the economic problems of the future and the social consequences, let's try to change our thoughts," the expert mentions.
Healthy relationship.
The specialist emphasizes that you have to try to agree with your couple to talk about the crisis only as much as is necessary. The rest of the time you can listen to music, enjoy a movie together, exercise or prepare a different dinner. “Talk with your partner, communicate and do activities that unite you, that lead to interaction. “In these times is when the most affection should be shown.”
For the doctor, the time we invest in ourselves is also key. “There is always a time of day when we can be alone in a place in the house that we like and do a few minutes of yoga, meditation exercises, mindfulness practices and practicing gratitude. That is very helpful to connect with the present and overcome uncertainty. “Working time can also be perfect to be alone.”
A time to relax.
You can be well without having to resort to psychiatric medications and self-medicate, and he indicates “just giving ourselves about 10 minutes of slow breathing each day helps to radically reduce anxiety. Let's not forget that sleeping well and eating healthy helps regulate emotions. It is very important to understand that those people who take psychiatric medication DO NOT stop the prescribed medication and consult the Psychiatrist regularly online or by phone.”
Don't forget your family.
Psychologists agree that it is correct to use social networks and the telephone to see how the family is doing, however, it is not necessary to call family members several times a day because that can become an obsession and generate anxiety.
“Calling our family once a day is enough, there are other ways to support and show affection. Respecting all the safety and hygiene parameters requested by our authorities, we can make purchases for our mother or our grandmother and leave them at the door of their homes, that is another way of supporting.”
Dr. Adriana Oñate Coronel
CLINICAL PSYCHOLOGIST
METROPOLITAN HOSPITAL

◀ Keys to act against Covid-19 COVID - 19: Disease that leaves its mark ▶

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COVID - 19: Disease that leaves its mark

SARS COV 2 is the name of the virus that the world is currently facing. How to act against it or defend ourselves from contagion? Dr. Cristina Moreno, expert infectious disease specialist, explains what we should do to protect ourselves.

“We knew that this coronavirus could be very transmissible and contagious, SARS COV 2 produces a disease called COVID-19, a new severe pneumonia that can kill. The specialist indicates that, given the latest evidence from autopsies in countries like China (the first country where this virus emerged), this disease, even if it presents mild symptoms in some cases, leaves consequences on the lung.
“The evidence says that patients who have been infected with this type of coronavirus present changes in the lung. Having this disease is complicated,” he says. And this new virus that affects humans is transmitted by inhalation, like influenza, paramyxovirus, parainfluenza, etc., but unlike them, SARS COV 2 does not just cause a common cold, but severe pneumonia.

The recommendations to protect ourselves are:
Wash your hands with soap and water, especially between your fingers because that is where most of the dirt stays. Complement hand cleaning with alcohol gel.
Constant cleaning of the surfaces where we work or places of family coexistence, with 70% alcohol, disinfectants, even the sun (under the indicated conditions).
At the population level, staying home is the measure that has worked the most in countries like China that has slowed the spread of the virus.
If you must leave the home and have contact with other people, it is essential to use a mask and gloves. When you get home, the gloves and mask should be discarded. The surgical mask is a double-edged sword if you don't know how to use it, you should not manipulate the front part of it and you should use it for a maximum of 4 hours, and then throw it away.
Maintaining physical distance between humans is important. The specialist explains that this virus, SARS COV 2, has a certain size, so after a sneeze or cough, it does not have the capacity to reach beyond one or half meters. “The virus needs proximity or close contact to continue its contagion, which is why it is recommended to maintain that distance between people,” he points out.
This type of coronavirus can remain on smooth surfaces if weather conditions allow it. The sun can kill the virus if the exposed surface reaches a temperature of 56° C within half an hour. In air it lasts less than 4 hours, and in wood, up to 24 hours. In steel or metal it can stay up to 48 hours. It can stay on clothing for less than 8 hours, so when you get home, the exposed person can change before entering your home.
Dr. Cristina Moreno
INFECTOLOGIST INTERNIST
METROPOLITAN HOSPITAL.
Find a specialist

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These days get to know your children better

In Ecuador and the world, there are days of uncertainty and confusion due to the coronavirus, but his family will undoubtedly help him get ahead. In this time destined to be at home, we must each do our part to bring out the best in the people around us and live in an environment that is as harmonious as possible.

Dr. Adriana Oñate Coronel, Head of the Psychology Service, guides us on the best way to spend these days at home without falling into depression. The specialist recommends avoiding excessive information that pushes us towards a state of anxiety. “It is better to watch or listen to just one news item a day, one that is very reliable. For the rest of the day, don't think about the news and share it with your family."
The positive thoughts that we parents transmit to our children fill young people with good energy and we make them enjoy their time at home and are aware that these days it is not correct to go out. These days you have to stay active, exercise at home and not be connected to the networks all the time because we can fall into stress. It is important to make a “peace agreement” with the family, collaborate with each other and encourage each other to be united in days of uncertainty.
It is key that children know that fear of getting infected is not the reason for not leaving the house. The real reason is to take care of grandparents or people with weaker health.
If we have small children at home, it is important to maintain routines and schedules and teach them the importance of following those routines. “In the morning we do the online homework that the schools send, then we enjoy a delicious meal and then we watch a movie or play, but everything is in order.” We cannot forget that they should sleep well, eat well and do manual and physical activities that prevent them from spending the day in front of a screen.
Dr. Adriana Oñate Coronel
CLINICAL PSYCHOLOGIST
METROPOLITAN HOSPITAL

◀ COVID - 19: Disease that leaves its mark Kidney care ▶

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Kidney care

Dr. Fernando Jiménez, Head of the Nephrology Service at the Metropolitan Hospital, tells us how to take care of the kidneys and thus avoid costly future treatments such as dialysis.

The specialist points out that the kidney performs important functions such as regulating blood pressure, eliminating waste from the body and regulating the amount of certain elements in the blood such as water, sodium, potassium, bicarbonate. "These elements are normal in the blood, but their excess or deficiency brings alterations." The kidney also has functions such as helping in the generation of blood and regulating the metabolism of calcium, phosphorus and bones.
The expert mentions that the kidneys normally do not show symptoms early: "when the kidneys show symptoms, there may already be an advanced disease. That is why we must prevent it," he says. The negative thing about all this is that many people expect pain in the kidney. to see the doctor and this is a rare symptom of kidney disease.
Normally, the earliest symptoms of chronic kidney disease (kidney damage) or as people know it "kidney failure" can be: high blood pressure, presence of protein in the urine, which manifests itself as foam in it, presence of of blood in the urine and, in advanced cases, anemia and swelling. “Not all of us are at risk of entering dialysis. With advancing age, it is normal for kidney function to decrease, but if the person does not take care of themselves in their daily life, they may have to face dialysis, especially if they have risk factors or a diet with excessive consumption of salt and proteins" indicates the doctor.
Normally, the earliest symptoms of chronic kidney disease (kidney damage) or as people know it "kidney failure" can be: high blood pressure, presence of protein in the urine, which manifests itself as foam in it, presence of of blood in the urine and, in advanced cases, anemia and swelling. “Not all of us are at risk of entering dialysis. With advancing age, it is normal for kidney function to decrease, but if the person does not take care of themselves in their daily life, they may have to face dialysis, especially if they have risk factors or a diet with excessive consumption of salt and proteins" indicates the doctor.
The people most predisposed to kidney disease are diabetics, patients with high blood pressure, people with autoimmune diseases and those who take a lot of pain relievers.
Today 850 million people are affected by kidney disease. It is currently the fifth most common cause of premature death with a projection to the year 2040. People who undergo dialysis or transplant require a high cost to maintain their health.
Dr. Fernando Jimenez
NEPHROLOGIST
METROPOLITAN HOSPITAL

◀ These days get to know your children better Plastic surgery ▶

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Plastic surgery

Nose Surgery or Rhinoseptumplasty
This is the most common and most complex surgical procedure in plastic surgery, lasting approximately 1 hour under general anesthesia.
It is an outpatient procedure, with quick recovery, with mild discomfort and little inflammation. The aim is to quickly reincorporate the patient into their daily activities and obtain natural and lasting results. The less noticeable the surgery is, the more successful our work is.

Absence of the ear or microtia
The absence of an ear represents a catastrophe for the patient and his family environment.
Reconstruction of the pinna or ear is one of the most complex reconstructive procedures in plastic surgery and requires a lot of experience, skill and skill. It can be done from 7 years of age with excellent results. I use the cartilage from the patient's own chest and we create the new ear similar to the one on the opposite side.
Dr. Pedro Polo Barzallo
PLASTIC SURGEON
METROPOLITAN HOSPITAL

◀ Kidney care Medical Checkups ▶

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Medical Checkups

Medical check-ups should be done once a year to take care of our health. The Metropolitan Hospital has several check-up alternatives: pediatric, executive, outpatient, geriatric, among others. Executive exams are for people between 18 and 70 years old. When the patient's age is over 70 years, a 'Senior' check-up is performed in the hands of a geriatric doctor, and for those under 18 years of age, a pediatric check-up is performed, says Dr. Fernando Terán Vélez, an internist.
People under 30 years old will need a basic laboratory study that contains their cholesterol profile, their liver enzymes, uric acid, a look at their kidney functions. A blood count is also performed to see how the blood cells are doing. It is also advisable to do urine and stool tests along with an evaluation of the thyroid gland.
The specialist indicates that in women, a gynecological evaluation should be part of the check-up. “In patients between 30 and 70 years old, stress tests are added to know their cardiological status and imaging studies such as abdominal echoes. Endoscopic studies are also performed. In this case, he comments that: “there are upper digestive endoscopy and lower digestive endoscopy.” In this checkup package you can add an examination by the ophthalmologist, an audiometry checkup with the otorhinolaryngologist and you can visit the areas of Physiatry, Traumatology and Dermatology. In male patients over 40 years of age, it is necessary to evaluate the prostate gland.
Medical checkups are generally performed within a few hours, but there are patients who want more in-depth checkups such as a lower gastrointestinal endoscopy. In that case, the person stays hospitalized for a day to complete the hydration process.
If we find something irregular in the patient's health, something that has not caused an illness, but is there, we refer him to the specialty that needs to do all the required tests.
Dr. Fernando Terán Vélez
INTERNIST
METROPOLITAN HOSPITAL

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HM Doctor's Day 2020.

Read more

◀ Medical Checkups 34 years taking care of you! Metropolitan Hospital Anniversary. ▶

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34 years taking care of you! Metropolitan Hospital Anniversary.

34 years Metropolitan Hospital
Metropolitan Hospital 2019

◀ HM Doctor's Day 2020. Say goodbye to your glasses. The best alternative in eye surgery. ▶

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Say goodbye to your glasses. The best alternative in eye surgery.

General terms and conditions of the "Metrolaser HM" promotion.
DURATION: the validity of the Metrolaser HM promotion will end on June 30, 2021. Hospital Metropolitano reserves the right to change the start and end dates of the promotion, and to modify these terms and conditions in the event of unforeseeable circumstances, outside of their control or beyond their control.
ELIGIBILITY: Clients suitable for eye surgery will be eligible, after free medical evaluation with the list of specialists defined by the Metropolitan Hospital.
CONDITIONS: conditions of the “Metrolaser HM” promotion:
The credit cards participating in the promotion are the Produbanco and Diners Credit Cards.
The fee of $65 per month applies for the “2-eye deferred personalized laser excimer” surgery, with a final price of $1,560. It can be deferred to 24 months with Diners or Produbanco cards.
Additionally, there are other surgical alternatives shown in the Table below:
PACKAGE NAME GENERAL TOTAL PACKAGE
EXCIMER EST. DEFERRED 1 EYE $855
EXCIMER EST. DEFERRED 2 EYES $1,300
EXCIMER PERS. DEFERRED 1 EYE $1,050
EXCIMER PERS. DEFERRED 2 EYES $1,560
The patient may contact Metrolaser (02 399 8000 extension 2706 - 2617) to request information and resolve concerns about having this surgery and the available packages.
If the patient accepts, Metrolaser will assign appointments with the ophthalmologists enrolled in the program (Dr. José Pitarque, Dr. Xavier Rodríguez, Dr. Jorge Estrella, Dr. Galo Guerra, Dr. Andres Rodríguez, Dr. Renato Zambrano, Dr. Xavier Cabezas, Dr. Sandra Larco), the Metropolitan Hospital will inform you in a timely manner when more specialists join the program. The initial consultation has no cost to the patient.
To attend the initial consultation, the patient must have previously coordinated the details with Metrlaser. In addition, they must bring their Pentacam exam previously performed at Oftalmotec, said exam is included in the value of the package. (The patient does not have to pay for this exam, which will help them know if they are suitable or not).
The patient and the doctor will agree on the optimal package depending on each particular case and if necessary, a wavescan or an idesgin will be performed, the value of which is included in the package.
If you are a collaborator of the Metropolitan Hospital, we suggest contacting Human Talent for details related to the packages, their values and payment alternatives.
The packages mentioned in the previous table can also be paid in cash or with a credit card in current payment.
The values for cash payments are shown in the table below:
Insert your custom code here
PACKAGE NAME GENERAL TOTAL PACKAGE
EX STANDARD LASER 1 EYE $735
EX STANDARD LASER 2 EYES $1,145
EX LASER PERS 1 EYE $895
EX LASER PERS 2 EYES $1,355
For more information, contact (02) 399 8000 ext. 2706 - 2617 or 1800 HMETER (463 876)
Insert your custom code here

◀ 34 years taking care of you! Metropolitan Hospital Anniversary. Be the hero of your heart! International heart day. ▶

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Be the hero of your heart! International heart day.

Dr. Arcos | Prevention heart month
Dr. Bermeo | Prevention heart month
Dr. Fierro | Prevention heart month
Dr. Gaibor | Prevention heart month
Dr. Mancero | Prevention heart month
Dr. Ullauri | Prevention heart month
Dr. Vicuña | Prevention heart month
Patient Frisch | Prevention heart month

◀ Say goodbye to your glasses. The best alternative in eye surgery. Preventive culture against hypertension ▶

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Preventive culture against hypertension

Preventive culture against hypertension
High blood pressure is a chronic disease that involves an interaction of blood vessels with the heart. Often called the “silent killer,” this is a disease that most of the time does not cause symptoms. “A small percentage of patients may experience headaches, nosebleeds, or subconjunctival hemorrhage. Sometimes the patient feels the blood pressure only when it is at alarming levels,” says Dr. Egas.

Hypertension is due to several causes such as poor lifestyle, lack of daily exercise and a poor diet rich in salt. Other risk factors such as overweight, cholesterol, high blood triglycerides, genetic load, age, race and the functions of other organs also predetermine whether the patient may develop hypertension. The most vulnerable group are people over 65 years of age, as well as diabetics and smokers. In terms of gender, men have a greater predisposition in relation to women who have a type of protection that is the hormonal basis until the age of 65.
Hypertension and heart
There is a direct relationship between high blood pressure and heart problems. Ischemic heart disease, myocardial infarction and heart failure are perhaps the most common heart diseases that are directly related to hypertension.
Prevention culture
According to the specialist, the essential thing is to adopt a lifestyle that includes daily aerobic exercise and healthy eating. Dr. Egas emphasizes that more than the intensity of exercise, regularity and no less than 30 minutes a day are important.
Another aspect of preventive culture has to do with discarding the idea that you should go to the doctor when you are sick; Periodic preventive checkups are a great tool.

The Cardiology Institute of the Metropolitan Hospital promotes campaigns to promote preventive health and heart care
Dr. Diego Egas
CARDIOLOGIST
METROPOLITAN HOSPITAL

◀ Be the hero of your heart! International heart day. Metropolitan Hospital | Teamwork with excellent results. ▶

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Metropolitan Hospital | Teamwork with excellent results.

2018 was a great year for the Metropolitan Hospital, having achieved very good results despite the widespread problems in the macroeconomic and health scenario, in particular. The Metropolitan Hospital reported a growth of 8.2% in income. This encouraging growth figure is the result of continuous teamwork and the diverse perspectives that coexist constructively in our hospital community.

On the other hand, we have started a new challenge towards digital transformation, because in the 21st century, technology impacts the most important aspects of life and, therefore, also the evolution and development of the Hospital. This is how “Atenea”, Conclina's digital transformation project, has arrived as a great opportunity to continue reinventing ourselves. This Brazilian technological platform “Soul MV”, which is part of the operation in several of the best hospitals in the world and now in ours, will allow its users, both doctors and patients, access to more efficient hospital processes, so that we continue to guarantee patient safety and increase their level of satisfaction in the different stages of care.

We will continue to differentiate ourselves within the health sector and continue to execute our strategic vision of leading the transformation of health in Ecuador.
ING. JAVIER CONTRERAS

◀ Preventive culture against hypertension ATENEA begins a new digital culture ▶

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ATENEA begins a new digital culture

The Metropolitan Hospital (HM) begins this 2019 with the implementation of a new technological platform that will digitally link the administrative, financial and accounting areas with all hospital and medical processes to support the efficiency of the institution, continue guaranteeing patient safety and elevate their level of satisfaction in the different stages of care.

This platform called 'Soul MV' was acquired in September 2018 from the Brazilian company MV, a pioneer in the region in hospital system developments.

The automation of all processes will take the Metropolitan Hospital to a new and higher level of efficiency in patient care, in managing the safety of all those who work to offer the best possible care, in the application of medications, in the speed with which doctors access information about their patients and, in general, throughout clinical practice.

Therefore, this system will above all support medical management and the patient. We want our doctors to benefit from all these changes; We are taking a big leap, we are an entity accredited by the Joint Commission International (JCI) and now automation will allow us to obtain new accreditations and certifications.

The HM's next goal is to become a paperless institution; The digital platform is an advance in that direction and will allow the Metropolitan Hospital to work to reduce the impact of its activity on the environment.

◀ Metropolitan Hospital | Teamwork with excellent results. The big change in 2019 will be the digital platform ▶

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The big change in 2019 will be the digital platform

One of the changes that will take place in 2019 is the implementation of a new technological platform, SOUL MV, which will lead us to digitalization. This is a shift that will break paradigms at all levels and will involve significant efforts from our doctors.

The new platform will have great benefits: access to all types of information about what is happening in the Hospital, management of a 100% digitalized clinical history that will avoid errors and data duplication, and the possibility of quickly knowing what is happening with each patient in the different hospital areas.

The transformation will make the work of doctors more comfortable and efficient, as they will have centralized information at hand on their smartphone or computer. It will also allow us, as an organization, to cooperate in caring for the environment by reaching the desired situation of 'zero paper'. The statistical data that can be obtained through the new platform will also provide us with a better understanding of our internal epidemiological reality in medicine.
Dr. Raul Jervis Simmons

◀ ATENEA begins a new digital culture How do I register? Registration steps and possible drawbacks ▶

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How do I register? Registration steps and possible drawbacks

Step 1
Login
Go to the "Sign in" section located at the top right of the web page.
Login here
Step 2
Identification data entry
Enter your ID number or identification document.
Click on "Validate".
Step 3
Email selection
The email account(s) associated or registered in our database will be displayed.
The user must select an email account for access.
Step 4
Password creation
The user must generate a password.
Once the email account has been selected and the password has been generated, an email will be sent to the address indicated for validation.
We suggest also checking your spam folder.
Possible drawbacks
Cases:
1) I am not registered
If when you enter your identification number, a message is displayed inviting you to contact our Call Center. The user must contact 1800 HMETRO to continue the data validation/update process and user creation.
2) Invalid password
If after generating the password, problems persist in logging in. The user can recover the password as many times as necessary by clicking on the "Recover password" option.
3) I can't log in
If there are problems when starting the session, the user must immediately contact 1800 HMETRO and request assistance.

◀ The big change in 2019 will be the digital platform

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Categories

Metromaternity

Is everything going well with my pregnancy?: How to check the health of a baby on the way
Fever after vaccinating the baby: what to do to control it in the rare cases in which it occurs
What care should a premature baby have for proper development?
There are emotions that can be associated with breast cancer and other diseases
Security and trust, keys to successful breastfeeding
3 facts you need to know if you have a premature baby
5 recommendations to take care of yourself during the postpartum period
5 breastfeeding myths
9 questions you should ask yourself to choose where to give birth
What vaccines are safe during pregnancy?

Robotic Surgery

In prostate cancer, robotic surgery improves quality of life
We added another milestone: the first hepatectomy with the most advanced Da Vinci Robot in the world.
Robotic surgery, a precise and safe technological advance
Robotic Bariatric Surgery: a new and beneficial alternative for patients with morbid obesity
Robotic Surgery | Da Vinci

Bariatric Surgery

Safe bariatric surgery: the steps the patient must follow to guarantee a long-term result
Overweight and obesity: when bariatric surgery is the indicated procedure
My life before and after bariatric surgery
Robotic surgery prevents erectile dysfunction in prostate cancer

News

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The specialist's recommendations to avoid depression and anxiety during December
Celebration time! Ten tips to enjoy without guilt
Did you just sigh?: you are doing it out of necessity, your brain has ordered it
Diet and exercise to control blood sugar
Not all pneumonias have the same origin and not all require antibiotics
Everything you need to know about anesthesia myths
In addition to loving them, five things we should know about caring for older adults

Present

Oncology

What is immunotherapy and which patients benefit from it?
Prostate cancer: the first step to early detection is to overcome the taboo
Cáncer de cuello uterino: el más prevenible, pero en Ecuador, todavía es mortal.
Ovarian cancer: three ways to prevent and detect the disease early

PACKAGE NAME	GENERAL TOTAL PACKAGE
EXCIMER EST. DEFERRED 1 EYE	$855
EXCIMER EST. DEFERRED 2 EYES	$1,300
EXCIMER PERS. DEFERRED 1 EYE	$1,050
EXCIMER PERS. DEFERRED 2 EYES	$1,560

PACKAGE NAME	GENERAL TOTAL PACKAGE
EX STANDARD LASER 1 EYE	$735
EX STANDARD LASER 2 EYES	$1,145
EX LASER PERS 1 EYE	$895
EX LASER PERS 2 EYES	$1,355

Deep brain stimulation&#39;, a surgery with cutting-edge technology that improves the quality of life of patients with Parkinson&#39;s

If I have already used fillers or toxins, will I have to continue using them?

Does this surgery eliminate the motor symptoms of Parkinson's?

What type of Parkinson's patients qualify for this surgery?

What role do sighs play in our body?

How to take care of our respiratory health?

What type of nutrition helps us control glucose?

What kind of exercise reduces blood sugar spikes?

How to correctly treat pneumonia?

What is the risk of overusing antibiotics?

Types of anesthesia

Anesthesia myths

Myth #1 – There is no allergy to anesthesia

Myth #2 – “I don't want too much anesthesia” How is your dose calculated?

Myth #3 – Side effects and adverse reactions

What challenges does an anesthesiologist face?

Periodic reviews are mandatory

Do not assume that forgetfulness, blindness, deafness are normal...

Mood disturbances are a warning sign

The diet must be personalized

Exercising is non-negotiable

Risk factors in young people and adults

Symptoms of a heart attack in men and women

What to do if you think you are having a heart attack?

What to do after the diagnosis of Alzheimer's?

What can you put on a burn?

Should blisters be burst?

Does migraine have treatment?

Prevention is in the lifestyle

What are the symptoms of Guillain-Barre?

The causes are not easy to identify

Good news: osteoporosis can be prevented

The first steps before a diagnosis

Can avocado reduce cholesterol?

Be careful with the quantity

Other valuable components

The use of earplugs prevents discomfort

Who should be more careful

Deep brain stimulation', a surgery with cutting-edge technology that improves the quality of life of patients with Parkinson's