Claves diagnósticas de las cefaleas

La cefalea es un síntoma muy común, afecta a casi todas las personas en algún momento de su vida. Es el quinto motivo de consulta más frecuente en los servicios de urgencias y un número importante de pacientes acude a la consulta ambulatoria por cefalea crónica. La población pediátrica y adolescente también se afecta. Una adecuada historia clínica y un completo examen físico permiten el abordaje diagnóstico y terapéutico. Identificar los factores desencadenantes y antecedentes personales es fundamental. La presencia de cefalea sumada a otros signos y síntomas como alteración del estado de conciencia, focalización neurológica, convulsiones, entre otros, debe alertar al médico. El presente artículo describe las características demográficas y semiológicas de las cefaleas, además aborda los signos de alarma o banderas rojas que obligan a descartar patologías de mayor compromiso

Caracterización de las infecciones de transmisión sexual, su tratamiento farmacológico y la recurrencia en una población colombiana

Introduction: Sexually transmitted infections are a public health problem worldwide. Their inadequate antimicrobial management has been associated with a higher risk of recurrence.Objective: To characterize the main sexually transmitted infections, the adherence to clinical practice guidelines, and the factors associated with recurrence in Colombia.Materials and methods: We conducted an observational study to identify the main sexually transmitted infections, the sociodemographic variables, and the pharmacological management in a patient cohort from a population database of 6.5 million people affiliated with the Colombian health system. We made a multivariate analysis to identify the variables associated with recurrence.Results: We detected 3,158 patients with a mean age of 41.8 ± 14.5 years, of whom 63.1% were men. We found 4.030 episodes of sexually transmitted infections, predominantly urethral syndrome (27.5%). Only 13.6% of patients with urethral syndrome, ulcerative syndrome, or genital warts were managed in compliance with clinical practice guidelines and 20.6% were dispensed condoms; 16.7% of patients had recurrences and being male (OR=1.32; 95%CI 1.08-1.63), <30 years old (OR=1.72; 95%CI 1.40-2.13), being treated in municipalities other than capital cities (OR=1.43; 95%CI 1.06-1.94), and having received inadequate treatment for the first episode (OR=1.93; 95%CI 1.52-2.39) were associated with recurrence.Conclusions: The majority of patients with sexually transmitted infections were not treated in compliance with clinical practice guidelines and those who did not have adequate management had a higher risk of recurrence.Introducción. Las infecciones de transmisión sexual constituyen actualmente un problema de salud pública en el mundo. Su inadecuado tratamiento antimicrobiano se ha relacionado con un mayor riesgo de recurrencias.Objetivo. Caracterizar las principales infecciones de transmisión sexual, el cumplimiento de las guías de práctica clínica de Colombia y los factores asociados con las recurrencias.Materiales y métodos. Se hizo un estudio observacional para determinar las principales infecciones de transmisión sexual, las variables sociodemográficas y el tratamiento farmacológico en una cohorte de pacientes registrados en una base de datos poblacional de 6,5 millones de personas afiliadas al Sistema de Salud de Colombia. Se hizo un análisis multivariado para establecer las variables asociadas con las recurrencias.Resultados. Se detectaron 3.158 pacientes; su edad media era de 41,8 ±14,5 años y 63,1 % de ellos correspondía a hombres; se encontraron 4.030 episodios de infecciones de transmisión sexual con predominio del síndrome uretral (27,5 %). El 13,6 % de los pacientes con síndrome uretral, ulceroso o con verrugas genitales se manejó según las guías de práctica clínica. El 20,6 % tenía acceso a condones y el 16,7 % presentó recurrencias. Ser hombre (OR=1,32; IC95% 1,08-1,63), tener <30 años (OR=1,72; IC95% 1,40-2,13), ser tratado en municipios distintos a ciudades capitales (OR=1,43; IC95% 1,06-1,94) y haber recibido un tratamiento inadecuado en el primer episodio (OR=1,93; IC95% 1,52-2,39) fueron factores asociados con las recurrencias.Conclusiones. La mayoría de los pacientes con infecciones de transmisión sexual no fueron tratados según las guías de práctica clínica y quienes no tuvieron un manejo adecuado presentaban mayor riesgo de recurrencias

Patterns of Antibiotic Prescription in Colombia : Are There Differences between Capital Cities and Municipalities?

The use of antibiotics is the most important modifiable risk factor for the development of microorganism resistance. A cross-sectional study of outpatients receiving antibiotic prescriptions registered in a population database in Colombia was conducted. The characteristics of the consumption in capital cities and small municipalities was studied and the AWaRe classification was used. AWaRe classifies antibiotics into three stewardship groups: Access, Watch and Reserve, to emphasize the importance of their optimal use and potential harms of antimicrobial resistance. A total of 182,397 patients were prescribed an antibiotic; the most common were penicillins (38.6%), cephalosporins (30.2%) and fluoroquinolones (10.9%). 'Access' antibiotics (86.4%) were the most frequently prescribed, followed by 'Watch' antibiotics (17.0%). Being 18 or older, being male, living in a municipality, having one or more comorbidities and urinary, respiratory or gastrointestinal disorders increased the probability of receiving 'Watch' or 'Reserve' antibiotics. Penicillin and urinary antiseptic prescriptions predominated in cities, while cephalosporin and fluoroquinolone prescriptions predominated in municipalities. This analysis showed that the goal set by the WHO Access of mainly using Access antibiotics is being met, although the high use of Watch antibiotics in municipalities should be carefully studied to determine if it is necessary to design specific campaigns to improve antibiotics use

Consistencia entre escalas de carga anticolinérgica y prescripciones potencialmente inapropiadas en el adulto mayor con fracturas, en tres centros de referencia, Colombia, 2018

Las fracturas en el adulto mayor son una causa frecuente de morbilidad y mortalidad, en donde están implicados múltiples factores, entre ellos la cantidad de medicamentos, las prescripciones potencialmente inapropiadas, la carga anticolinérgica y sus reacciones adversas. El objetivo fue identificar y comparar la carga anticolinérgica empleando varios instrumentos en los pacientes con fracturas evaluando las prescripciones previas al evento, durante la atención hospitalaria y posteriores al egreso en 3 centros de referencia de Colombia. Materiales y métodos: Estudio analítico de concordancia, realizado en pacientes con diagnóstico de fracturas vertebrales y no vertebrales entre el 1 de enero y 30 de junio de 2018 sobre la carga anticolinérgica presente en las formulaciones antes, durante y después de la atención hospitalaria, evaluando además polifarmacia y prescripciones potencialmente inapropiadas. Se midieron variables sociodemográficas, farmacológicas y de comedicación. Se evaluó la carga anticolinérgica utilizando las escalas ADS, ACB y ARS. Las prescripciones potencialmente inapropiadas se evaluaron mediante los criterios STOPP/START y se definió como polifarmacia 5-9 medicamentos. Se diseñó una base de datos sobre el consumo de fármacos, se utilizó la prueba ji cuadrado para el análisis de las variables categóricas y modelos de regresión logística binaria. El análisis de consistencia se realizó mediante el coeficiente kappa con ponderación cuadrática. Resultados: El estudio incluyó 220 pacientes con fracturas. La edad media fue de 75,3 ± 10,3 años y el 68,2% de pacientes correspondió a mujeres. La fractura más frecuente fue la de cadera (37,7%). La polifarmacia, las prescripciones potencialmente inapropiadas y la carga anticolinérgica fueron mayor durante la hospitalización. La escala ACB identificó la mayor carga anticolinérgica al ingreso hospitalario (35,7%), mientras que la escala ADS identificó más pacientes durante la hospitalización (77,7%) y al egreso (72,1%). La consistencia de las escalas varió en cada uno de los momentos de la prescripción, presentando la mejor correlación al ingreso con las escalas ADS y ACB (71%) mientras que durante la hospitalización y al egreso lo fueron las escalas ACB y ARS (61% y 56%, respectivamente). La prescripción de 5 o más fármacos fue factor de riesgo para recibir medicamentos anticolinérgicos y prescripciones potencialmente inapropiadas. Conclusiones: Las escalas de carga anticolinérgica en este estudio no son intercambiables y los resultados se modifican ostensiblemente en los diferentes momentos en los que se realizan las prescripciones, siendo la escala ADS la herramienta que más identificó medicamentos antimuscarínicos contrastando con la baja proporción de fármacos captada por la escala ARS.MaestríaAbogado(a

Study of Prescription-Indication of Outpatient Systemic Anti-Fungals in a Colombian Population. A Cross-Sectional Study

The inappropriate use of antifungals is associated with greater antimicrobial resistance, costs, adverse events, and worse clinical outcomes. The aim of this study was to determine prescription patterns and approved and unapproved indications for systemic antifungals in a group of patients in Colombia. This was a cross-sectional study on indications for the use of systemic antifungals in outpatients from a drug dispensing database of approximately 9.2 million people affiliated with the Colombian Health System. Sociodemographic, pharmacological, and clinical variables were considered. Descriptive, bivariate, and multivariate analyses were performed. A total of 74,603 patients with antifungal prescriptions were identified; they had a median age of 36.0 years (interquartile range: 22.0–53.0 years), and 67.3% of patients were women. Fluconazole (66.5%) was the most prescribed antifungal for indications such as vaginitis, vulvitis, and vulvovaginitis (35.0%). A total of 29.3% of the prescriptions were used in unapproved indications. A total of 96.3% of ketoconazole users used the medication in unapproved indications. Men (OR: 1.91; CI95%: 1.79–2.04), <18 years of age (OR: 1.20; CI95%: 1.11–1.31), from the Caribbean region (OR: 1.26; CI95%: 1.18–1.34), with chronic obstructive pulmonary disease (OR: 1.80; CI95%: 1.27–2.54), prescriptions made by a general practitioner (OR: 1.17; CI95%: 1.04–1.31), receiving comedications (OR: 1.58; CI95%: 1.48–1.69), and the concomitant use of other antimicrobials (OR: 1.77; CI95%: 1.66–1.88) were associated with a higher probability that the antifungal was used for unapproved indications; deep mycosis (OR: 0.49; CI95%: 0.41–0.58), prescribing fluconazole (OR: 0.06; CI95%: 0.06–0.06), and having diabetes mellitus (OR: 0.33; CI95%: 0.29–0.37), cancer (OR: 0.13; CI95%: 0.11–0.16), or HIV (OR: 0.07; CI95%: 0.04–0.09) reduced this risk. Systemic antifungals were mostly used for the management of superficial mycoses, especially at the gynecological level. In addition, more than a quarter of patients received these medications in unapproved indications, and there was broad inappropriate use of ketoconazole

Prescription Patterns of Drugs Given to Hospitalized COVID-19 Patients: A Cross-Sectional Study in Colombia

The impact of COVID-19 prompted a race to find a treatment that would reduce its mortality. Most studies have not shown favorable results for many of these drugs, but they are still used. The aim as to determine the differences and similarities in the hospital pharmacological management of patients with COVID-19 according to sex, age group, and geographical region of Colombia, 2020–2021. Descriptive cross-sectional study was conducted on the prescription patterns of the medications given to patients diagnosed with COVID-19 treated in eight clinics in Colombia between 6 March 2020 and 31 May 2021. We performed a descriptive analysis of the sociodemographic, clinical, and pharmacological variables of the patients. A total of 8596 patients from 170 cities were identified, with a median age of 53.0 years and 53.3% of them men. A total of 24.3% required care in the intensive care unit, and 18.7% required invasive mechanical ventilation. The most commonly used drugs for the treatment of COVID-19 were systemic corticosteroids (63.6%), followed by colchicine (12.8%), azithromycin (8.9%), and ivermectin (6.4%). Corticosteroids, anticoagulants, colchicine, azithromycin, ivermectin, and hydroxychloroquine were prescribed more frequently in men, and their overall use increased with age. There were differences in prescriptions between geographic regions. The majority of patients were managed with medications included in the management guidelines. There were differences between sexes, age groups, and geographical regions

Pharmacological Treatment of Herpes Zoster and Factors Associated with Its Recurrence

The burden of herpes zoster disease is significant worldwide, with millions affected and an increasing incidence. Increased age and immunosuppression due to disease or drugs have been related to its recurrence. The aim of this work was to determine the pharmacological management of herpes zoster and identify factors associated with recurrence, representing a longitudinal retrospective study identifying the pharmacological management of patients with herpes zoster and the factors related to the first recurrence using a population database. Follow-up was carried out for up to 2 years, and descriptive analysis and Cox proportional hazards regression were performed. A total of 2978 patients with herpes zoster were identified, with a median age of 58.9 years and 65.2% being women. The treatment mainly involved acyclovir (98.3%), acetaminophen (36.0%), and non-steroidal anti-inflammatory drugs (33.9%). A total of 2.3% of patients had a first recurrence. Corticosteroids were used in a greater proportion for recurrence than for the initial herpes episode (18.8% vs. 9.8%, respectively). Being female (HR:2.68;95%CI:1.39–5.17), age ≥60 years (HR:1.74;95%CI:1.02–2.96), having liver cirrhosis (HR:7.10;95%CI:1.69–29.80), and having hypothyroidism (HR:1.99;95%CI:1.16–3.40) were associated with greater probability of a first recurrence. The vast majority of patients were managed with acyclovir, and the use of acetaminophen or non-steroidal anti-inflammatory drugs for pain management was frequent. Several conditions were found that increased the probability of presenting a first recurrence of herpes zoster, such as age over 60 years, being a woman, suffering from hypothyroidism, and liver cirrhosis

Claves diagnósticas de las cefaleas

La cefalea es un síntoma muy común, afecta a casi todas las personas en algún momento de su vida. Es el quinto motivo de consulta más frecuente en los servicios de urgencias y un número importante de pacientes acude a la consulta ambulatoria por cefalea crónica. La población pediátrica y adolescente también se afecta. Una adecuada historia clínica y un completo examen físico permiten el abordaje diagnóstico y terapéutico. Identificar los factores desencadenantes y antecedentes personales es fundamental. La presencia de cefalea sumada a otros signos y síntomas como alteración del estado de conciencia, focalización neurológica, convulsiones, entre otros, debe alertar al médico. El presente artículo describe las características demográficas y semiológicas de las cefaleas, además aborda los signos de alarma o banderas rojas que obligan a descartar patologías de mayor compromiso.http://revistas.utp.edu.co/index.php/revistamedicaHeadache is a very common symptom, affecting nearly everyone at some point in their lives. In fact it is the fifth most common reason for consultation in the emergency room and a significant number of patients demand assistance at the ambulatory care clinic for chronic headache. The pediatric and adolescent population is also affected. An adequate medical history and physical examination allow a full diagnosis and therapeutic approach. Identifying the triggering facts and personal history is essential. The presence of sick headache combined with other signs and symptoms such as altered state of consciousness, neurological focalization, and seizures, among others, should alert physicians. This article describes the demographic and semiological features of headaches; it also addresses the warning signs or red flags that force dismissal of more serious pathologies

Consistency between anticholinergic burden scales in the elderly with fractures.

OBJECTIVE:Falls and bone fractures are important causes of morbidity and mortality in the elderly. The objective of this study was to identify the degree of consistency between the anticholinergic scales used for patients diagnosed with fractures. METHODS:This was an analytical agreement study conducted in patients diagnosed with vertebral and nonvertebral fractures in Colombia. The quadratic-weighted kappa coefficient was used to identify the consistency between the Anticholinergic Drug Scale-ADS, Anticholinergic Cognitive Burden Scale-ACB and Anticholinergic Risk Scale-ARS in assessing the prescriptions of fracture patients during the month prior to the fracture, during their stay as an inpatient and at discharge, according to Landis criteria. RESULTS:220 patients with fractures were included, with a mean age of 75.3±10.3 years, and 68.2% were women. The ACB scale identified the highest anticholinergic burden (26.8%) in prescriptions made the month before the fracture, and the highest agreement was between ACB and ADS (0.717); during hospitalization and at discharge, the cholinergic antagonists were best identified with ADS (77.7% and 72.1%, respectively), with the best agreement between ACB and ARS (0.613 and 0.568, respectively). The prescription of tramadol was found in 64.1% of hospitalized patients and in 61.4% of patients at the time of discharge. CONCLUSIONS:The scales evaluated show marked discrepancies between them, with highly variable frequencies of anticholinergic drugs identified at the different prescription times, and with low agreement among them, which is why the scales are not interchangeable in patients with bone fractures

Síndrome Carcinoide: reporte de caso y revisión de la literatura

Se presenta el caso de una mujer de 63 años de edad, con cuadro clínico crónico de un año de evolución caracterizado por diarrea esteatorreica, asociado a episodios de dolor abdominal difuso, tipo cólico y “sensación de bochornos”, además enrojecimiento en cara y tronco superior. El abordaje diagnóstico de la diarrea crónica es un reto para los médicos generales y especialistas, más aún, cuando se acompaña de manifestaciones inespecíficas como dolor abdominal y la presencia de “bochornos”. La coexistencia de varios de los anteriores síntomas, obliga a descartar diversas patologías que representan alta morbimortalidad para el paciente. El síndrome de intestino irritable, el feocromocitoma, el hipertiroidismo, el síndrome carcinoide, entre otras, son patologías a excluir en todo caso. El presente artículo pretende brindar el diagnóstico diferencial de las patologías que presentan dichos síntomas, buscando conducir al lector hasta el diagnóstico definitivo de la paciente