标签： Dominican Republic

For many patients facing an upcoming surgical procedure, the long list of pre-operative instructions often feels like unnecessary red tape, with little understanding of why each rule exists. To demystify these critical protocols, Dominican newspaper Listín Diario interviewed experienced surgeon José Barriento, who walked through the reasoning behind every precaution and why skipping even one step can put patients in serious danger.

Dr. Barriento stresses that patient understanding of pre-surgery rules is the foundation of a successful procedure. When patients follow guidelines correctly, they enter the operating room in the best possible physiological condition, cutting the risk of life-threatening complications during and after the operation.

Pre-operative evaluations are not just routine box-ticking, the surgeon explains. Care teams first conduct a full cardiovascular assessment to confirm a patient’s vascular system is strong enough to tolerate the physical stress of surgery. Providers also test lung function and evaluate liver health, since all patients will be exposed to anesthetic gases and medications during the procedure. These screenings catch underlying issues early that could raise risk levels if left unaddressed.

It is also completely normal for patients to experience anxiety or fear in the lead-up to surgery, Dr. Barriento notes. Entering an operating room, an unfamiliar and high-stakes environment, naturally triggers these feelings. To manage this anxiety, he encourages patients to remember that surgery is a targeted solution to an existing health problem, and thorough pre-operative preparation — including multi-specialist evaluations, full medical history reviews, and prehabilitation — is designed to set the procedure and recovery up for success.

One of the most non-negotiable pre-surgical requirements is fasting, though modern guidelines have updated the old 8-hour rule. Dr. Barriento explains that current standards call for 2 to 4 hours of fasting from solid foods, with the exact timeline adjusted to the type of procedure being performed. The core risk of eating too close to surgery is aspiration: when patients are under general anesthesia with a breathing tube in place, a full stomach raises the chance of gastroesophageal reflux, which can push food particles into the airways and lungs. This complication can lead to dangerous aspiration pneumonia, or even death in the most severe cases. Clear liquids move through the digestive system far faster than solids, the surgeon adds, so a small sip of water just 1 to 2 hours before surgery rarely causes issues.

For patients with chronic conditions like hypertension that require daily medication, Dr. Barriento confirms it is usually safe to take routine doses before entering the operating room. The one non-negotiable rule here is full honesty: patients must disclose all food, drink, and medication they have consumed before surgery, even if they forgot the fasting rule. “It is always better to postpone the procedure by two to four hours than to put the patient at unnecessary risk,” he says. He emphasizes that safe surgery is a shared responsibility: while clinical teams bear part of the burden for preventing complications, patients also play a critical role by following guidelines and being transparent about their habits and health.

Dr. Barriento also addressed the common requirement to pause certain medications in the days before surgery. Anticoagulants such as aspirin, for example, increase the risk of uncontrolled, massive bleeding during a procedure, so patients must stop taking these medications 5 to 7 days before their operation. Tobacco use must also be paused at least four weeks before surgery, he says: smoking impairs post-operative tissue healing, raising the risk of complications by 40% compared to non-smoking patients. Alcohol is also restricted in the pre-operative period, as it causes dehydration and interferes with the liver’s ability to process anesthetic and other surgical medications. Dr. Barriento recommends full abstention from tobacco and alcohol before, during, and after any surgical procedure to support optimal outcomes.

Pre-operative hygiene is another often-overlooked step that makes a big difference in preventing post-surgical infections. Most hospitals require patients to bathe or wash the surgical site with chlorhexidine, a powerful antiseptic that reduces harmful bacteria on the skin before the incision. Patients are also asked to remove all jewelry and accessories, and to remove acrylic nails or nail polish before entering the operating room. This rule exists because pulse oximetry, a key tool for monitoring oxygen levels and heart function during surgery, is clipped to a patient’s finger. Artificial nails and polish block the sensor, leading to inaccurate vital sign readings that can compromise patient safety during the procedure.

In closing, Dr. Barriento reiterates that the most important actions a patient can take are approaching surgery with a positive, open attitude and being fully honest with their care team about every detail of their health, including medical history, medication use, substance use, and recent food or drink intake. No detail is too small to hide, he stresses: providers need full information to keep patients safe. Even when pre-operative tests and protocols feel excessive or tedious, following every instruction cuts complication risk dramatically and improves the chances of a successful procedure and smooth recovery.

Dr. Barriento also added a key warning for patients in the Dominican Republic: amid a growing number of unqualified practitioners offering surgical services, patients must verify that their operating surgeon is properly certified, registered with the Dominican Medical Association, and affiliated with the national College of Surgeons or a relevant legitimate professional collegiate body before agreeing to any procedure.

Leading Dominican cardiologist and electrophysiologist Fernando Vidal Bett has issued a stark public health warning: sudden cardiac death has overtaken all forms of cancer to become the number one cause of death in the Dominican Republic. As director of the Arrhythmia, Electrophysiology and Pacemaker Unit at the country’s Cedimat Cardiovascular Center, Vidal Bett shared detailed insights on this public health crisis in an interview with local outlet Listín Diario.

Sudden cardiac death is defined as an unexpected fatal event triggered by malignant cardiac arrhythmias — abnormal, irregular heart rhythms — that claims a patient’s life within 24 hours of symptom onset. Vidal Bett explained that half of all deaths linked to cardiovascular disease in the country are sudden cardiac deaths, making the condition one of the most pressing ongoing challenges for the Dominican public health system. Contrary to common misconception, however, he stressed that not all patients diagnosed with heart disease will experience sudden cardiac death, noting that the highest risk is concentrated among patients with pre-existing conditions. These high-risk groups include individuals who have already suffered a heart attack, those living with dilated cardiomyopathy (an enlarged heart), and patients with diagnosed heart failure.

Vidal Bett outlined a wide range of modifiable and non-modifiable risk factors that contribute to elevated rates of cardiovascular disease and subsequent sudden cardiac death. Non-modifiable risks include a family history of cardiac conditions, while key preventable risks include tobacco use, chronic hypertension, obesity, a sedentary lifestyle, diabetes, and excessive alcohol consumption. He explained that tobacco and heavy alcohol use directly contribute to the development of ischemic cardiovascular disease, a condition marked by blocked coronary arteries. When a coronary artery becomes obstructed, a section of heart tissue dies and forms scar tissue, which is prone to generating dangerous arrhythmias that act like “short circuits” within the heart, often resulting in sudden death.

Beyond traditional risk factors, the cardiologist highlighted lesser-known contributors to poor cardiac health: chronic stress, anxiety, and untreated sleep disorders. All three conditions often drive elevated blood pressure and trigger life-threatening arrhythmias. He also issued a specific warning to young Dominican people about the dangerous combination of alcohol and energy drinks, which research has linked to a sharp increase in sudden cardiac events and ischemic heart disease among younger populations.

While cardiovascular disease does not have an inherent gender bias, Vidal Bett noted that the condition typically affects men a decade or more earlier than women, due to the cardioprotective effects of female hormones until menopause. After that life stage, however, the risk of sudden cardiac death equalizes between men and women.

Though sudden cardiac death can occur without obvious pre-warning signs, Vidal Bett identified key red flags that individuals should not ignore. These include a family history of sudden cardiac death before age 40, recurring chest pain, unexplained shortness of breath, dizziness, lightheadedness, unexpected fainting, and persistent heart palpitations. He specifically emphasized that any patient who experiences loss of consciousness leading to a head injury should be categorized as high-risk and receive immediate cardiac evaluation.

To combat the growing burden of sudden cardiac death, Vidal Bett stressed that proactive intervention remains the most effective strategy. The gold standard for prevention among high-risk patients, he confirmed, is the implantable cardioverter-defibrillator (ICD), the only medical device proven to prevent fatal sudden cardiac events. Describing the device as similar to a standard implanted pacemaker, he explained that an ICD continuously monitors heart rhythm, automatically detects malignant, potentially lethal arrhythmias, and delivers immediate targeted treatment — either through rate-adjusting stimulation or a controlled defibrillation shock to restore normal rhythm.

Despite the device’s proven effectiveness, Vidal Bett noted that a core challenge remains accurately identifying patients who qualify for ICD implantation. Eligible high-risk groups include patients with hypertrophic cardiomyopathy, individuals who have suffered a heart attack and have residual heart function below 35%, and patients who have already survived a sudden cardiac arrest. He clarified that ICDs are not implanted in terminally ill patients with poor prognosis; the procedure is only performed on stable patients with a life expectancy of more than one year, with the dual goal of extending lifespan and improving quality of life. Currently, an ICD costs between $10,000 and $15,000, has a 7 to 10 year battery life, and improves patient outcomes up to 80% for qualifying individuals.

Recently, the Dominican Society of Cardiology’s Electrophysiology Council took a major step forward in addressing the sudden cardiac death crisis by issuing an official position statement supporting the responsible use of ICDs for prevention across the country. The document is rooted in the latest international scientific evidence, adapted specifically to the Dominican public health context, and outlines clear clinical recommendations for ICD use, highlights the importance of specialized cardiac evaluation, and addresses pathways for long-term economic sustainability of ICD access. The statement marks a key milestone for public education and clinical training initiatives focused on cardiovascular health in the nation.

One ongoing gap in addressing the crisis, Vidal Bett acknowledged, is the lack of a national sudden cardiac death registry in the Dominican Republic. Currently, death certificates rarely specify sudden cardiac death as a cause of death, making it difficult to track exact prevalence and allocate public health resources effectively. However, he confirmed that the Dominican Society of Cardiology is already taking active steps to develop and launch the first national registry to address this data gap.

Against a backdrop of rising temperatures driven by climate change that are expanding the active season for disease-transmitting insects, the United States has launched its first ever residential pilot program deploying non-biting male mosquitoes infected with the naturally occurring bacterium Wolbachia to curb mosquito-borne disease spread.

On a recent afternoon just outside of Washington D.C., Todd Montgomery, 32-year-old founder of the private firm Bee Safe Mosquito Control, twisted open the cap of a small tube and released hundreds of specially modified mosquitoes into a suburban residential yard.

Unlike common pest control methods that rely on pesticide spraying, this approach targets the Aedes albopictus, or tiger mosquito, an invasive species that acts as a vector for dangerous diseases including dengue. The tactic leverages a unique biological mechanism: the released males carry a specific strain of Wolbachia that naturally occurs in some insects, and when they mate with wild, uninfected female tiger mosquitoes, their eggs fail to hatch, gradually suppressing the local population over time. The service, branded “ZAP Males,” is the first initiative of its kind offered to private residential homeowners across the country. By the end of the summer, the company plans to release a total of 600,000 modified mosquitoes across the region.

Montgomery, a former electrical engineer who launched the company in 2023, framed the effort as a critical response to growing risks tied to climate change. “With climate change, we are facing a ticking time bomb,” he told AFP. Rising average temperatures across most of the U.S. have extended the stretch of warm, humid conditions that disease-carrying mosquitoes need to thrive, lengthening their active season and increasing public exposure to mosquito-borne illness. The urgency of the issue has been amplified locally by the recent confirmation of the first locally acquired case of dengue in Northern Virginia.

The pesticide-free approach fills a growing demand from homeowners who are wary of chemical fumigation, which many avoid due to links between some common pesticides and increased cancer risk. For 67-year-old breast cancer survivor Sandra Marquardt, the program offered a solution to a dilemma: she refused to spray chemicals on her lush property, but was frustrated by constant mosquito infestations that left her unable to enjoy the large garden she tends each year. Marquardt told reporters she has been impressed with the results, calling the Wolbachia mosquito intervention “surprisingly effective.”

So far, 25 residential customers have signed up for the program. Each participating property receives 1,500 modified males per week over 16 weeks, adding up to the full 600,000 mosquitoes the company will release by the end of the pilot. The method has already been deployed at large scale in other parts of the world: Singapore runs the world’s largest public sector Wolbachia program, which launched in 2016 and now releases more than 10 million modified mosquitoes weekly. A peer-reviewed study published in the *New England Journal of Medicine* found that the approach reduced the Aedes mosquito population by a substantial margin, cutting the risk of dengue transmission by more than 70%.

Still, results have varied for early participants in the U.S. pilot. April Chunko, a 44-year-old mother of a young child from Silver Spring who joined the program immediately due to her distrust of harsh chemicals around her son’s backyard sandbox, says she has not yet noticed a major reduction in biting mosquitoes. Chunko noted her property sits adjacent to a dense stretch of trees, which may complicate the program’s local effectiveness.

Experts note that outcomes of the Wolbachia suppression method do depend on local geographic and environmental conditions. Marcelo Jacobs-Lorena, an emeritus professor at Johns Hopkins University who specializes in mosquito-borne disease research, explained that wild mosquitoes can travel with wind currents, meaning results vary based on local landscape features.

Jacobs-Lorena also highlighted an alternative approach to leveraging Wolbachia that focuses on disease blocking rather than population reduction. Instead of only releasing infected males to suppress populations, this method releases both males and females that carry the same Wolbachia strain. This allows eggs to hatch normally, leading the bacteria to spread through the entire local mosquito population. Since Wolbachia naturally blocks the replication and transmission of viruses that cause dengue, Zika, and chikungunya, mosquitoes can still bite humans but no longer spread these dangerous diseases.