Uso de inhaladores para la enfermedad pulmonar obstructiva crónica en un grupo de pacientes colombianos

Introducción: En Colombia son escasos los datos sobre el uso de los inhaladores en pacientes con EPOC. Objetivo: Describir la técnica de uso de inhaladores de dosis medida y polvo seco en pacientes de un hospital colombiano. Materiales y métodos: Estudio descriptivo en pacientes mayores de 40 años con EPOC atendidos en un hospital en La Virginia, Risaralda, Colombia, entre el 1 de septiembre de 2019 al 31 de enero de 2020. La unidad de análisis fueron los pacientes. Se incluyeron variables sociodemográficas, clínicas y lista de chequeo para uso de inhaladores. Se aplicaron frecuencias y proporciones para variables discretas, estadísticas de tendencia central y dispersión para variables continuas. Resultados: Se incluyeron 104 pacientes con edad media de 73,6 ± 10,1 años; 57 eran mujeres (54,8 %). Además, 48 pacientes estaban clasificados como GOLD-D (46,2 %). Igualmente, 89 pacientes manifestaron haber recibido educación sobre el uso de broncodilatadores (85,6 %). Los más frecuentes fueron los inhaladores de dosis medida (DM) en 95 casos (91,3 %), seguido de los de polvo seco unidosis (7,7 %). Así mismo, 37 pacientes que usaron DM sin inhalocámara (35,6 %) no cumplieron los pasos de la lista de chequeo. En el sistema multidosis, el más realizado fue cerrar de manera adecuada el inhalador y el menos ejecutado, expulsar el aire lentamente evitando hacerlo cerca del inhalador (n = 6; 5,7 %). Discusión: Se lograron describir las características de la técnica de uso de los inhaladores en pacientes con EPOC. A pesar de que ningún paciente logró utilizar el inhalador de forma "perfecta", la mayoría han recibido educación por parte de los profesionales de la salud. Conclusión: Un alto porcentaje de pacientes usa inadecuadamente los dispositivos para suministrar los broncodilatadores. Esto puede impactar negativamente en el control de la enfermedad.

Introduction: In Colombia, there is limited data on the use of inhalers in patients with COPD. Objective: The objective was to describe the technique of using metered-dose inhalers and dry powder in patients in a Colombian hospital. Methods: Observational, descriptive study of patients over 40 years of age with COPD, treated in a hospital in La Virginia, Risaralda, Colombia, between September 1st, 2019 and January 31st, 2020. The unit of analysis were patients in consultation. Sociodemographic and clinical variables, and a checklist for use of inhalers were included. Frequencies and proportions were applied for discrete variables, statistics of central tendency and dispersion for continuous variables. Results: A total of 104 patients with an average age of 73.6 ± 10.1 years were included; 57 were women (54.8%). In addition, 48 patients were classified as GOLD-D (46.2%). Similarly, 89 patients reported having received education on the use of bronchodilators (85.6%). The most common were metered-dose (MD) inhalers in 95 cases (91.3%), followed by single-dose dry powder inhalers in eight patients (7.7%). Likewise, 37 patients who used DM without inhalochamber (35.6%) did not comply with the steps of the checklist. In the multidose system, the most performed was to properly close the inhaler and the least performed was to expel the air slowly, avoiding doing so near the inhaler (n=6; 5.7%). Discussion: The characteristics of the technique of using inhalers in patients with COPD were described. Although no patient was able to use the inhaler "perfectly", most have received education from health professionals. Conclusion: A high percentage of patients misuse the devices to deliver bronchodilators. This can negatively impact the control of the disease.

[Impact of the HEARTS Initiative in a second-level health institution in ColombiaImpacto da iniciativa HEARTS em um estabelecimento de atenção secundária à saúde na Colômbia]. / Impacto de la Iniciativa HEARTS en una institución de salud de segundo nivel en Colombia.

Objective: To identify the impact of the HEARTS initiative on patients with high blood pressure treated in a Colombian hospital. Methods: Quasi-experimental, retrospective study between 2017 and 2019 with hypertensive patients over 18 years of age included in the HEARTS strategy and treated at the Santa Mónica Hospital in the municipality of Dosquebradas, department of Risaralda. The unit of analysis was medical history. Blood pressure targets (defined in the HEARTS initiative as a patient with systolic blood pressure <140 mmHg and diastolic pressure <90 mmHg) were assessed at the time of admission to the HEARTS program and one year later. Sociodemographic, pharmacological, clinical, and blood pressure targets were included, as was compliance with the recommendations of the initiative. Descriptive analysis was performed, and binary logistic regression was applied (p <0.05). Results: A total of 372 patients were studied, of whom 262 were women (70.4%). The mean age was 66.3 ± 12.2 years. In the first consultation, 285 patients (76.6%) presented blood pressure figures within the target range; in the second consultation this was achieved by 84.1% of patients (n=313, mean difference: 7.5%, 95% CI: 1.8 to 13.1; p=0.005). After implementation of the HEARTS initiative, 77.4% of patients (n=288) continued with the initial treatment. Following HEARTS recommendations increases the likelihood of being in the target range (p=0.033; OR= 2,688; CI= 1.081 - 6.684). Conclusions: Implementation of the HEARTS initiative favorably impacted blood pressure figures in patients with hypertension and decreased cardiovascular risk.

Objetivo: Identificar o impacto da iniciativa HEARTS nos pacientes com hipertensão arterial atendidos em um hospital colombiano. Métodos: Estudo quase-experimental, retrospectivo entre 2017 e 2019, com pacientes hipertensos maiores de 18 anos incluídos na estratégia HEARTS, atendidos no Hospital Santa Mónica do município de Dosquebradas, departamento de Risaralda. A unidade de análise foi a história clínica. As metas de pressão arterial (definidas na iniciativa HEARTS como pressão arterial sistólica <140 mmHg e pressão diastólica <90 mmHg) foram avaliadas no momento de ingresso no programa HEARTS e um ano depois. Foram incluídas variáveis sociodemográficas, farmacológicas, clínicas, metas de pressão arterial e adesão à iniciativa. Foram realizadas análises descritivas e foi aplicada a regressão logística binária (p<0,05). Resultados: Foram analisados 372 pacientes, dos quais 262 eram mulheres (70,4%). A média de idade foi de 66,3 ± 12,2 anos. Na primeira consulta de controle, 285 pacientes (76,6%) apresentaram valores de pressão arterial dentro das metas; na segunda consulta, as metas haviam sido alcançadas por 84,1% dos pacientes (n=313 diferença média: 7,5%, IC95%: 1,8 a 13,1, p=0,005). Após a implementação da iniciativa HEARTS, 77,4% dos pacientes (n=288) continuaram com o manejo inicial. O cumprimento das recomendações da HEARTS aumenta a probabilidade de estar nas metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusões: A implementação da iniciativa HEARTS teve um impacto favorável nos valores da pressão arterial em pacientes com hipertensão e diminuiu o risco cardiovascular.

Self-medication and the 'infodemic' during mandatory preventive isolation due to the COVID-19 pandemic.

AIM: Quarantine due to the COVID-19 pandemic altered the supply and demand of health services. This, together with the 'infodemic' and generalized panic, could alter the patterns of self-medication in the population. The objective was to characterize the patterns of self-medication in four cities of Colombia during mandatory preventive isolation in 2020. METHODS: This was a cross-sectional study done in four Colombian cities during mandatory national preventive isolation between June and September 2020. A sample of 397 adults who responded to an online survey, based on the Instrument for Systematic Data Collection for Self-medication (Instrumento de Recolección Sistemática de Datos para la Automedicación-IRIS-AM), was obtained. The use of social networks (including WhatsApp) as the source of information about medications was explored. RESULTS: The 397 people surveyed had a median age of 31.0 years, and 58.2% were women. The prevalence of self-medication during lockdown was 34.3% (n = 136). Medications targeting the nervous system (n = 117; 86.0% of those participants with self-medication) and the musculoskeletal system (n = 68; 50.0%) were the most commonly used. Ten (7.4%) of the self-medicated patients reported doing so to prevent COVID-19, and 15 (11.0%) named social networks as the source of information. CONCLUSION: More than one-third of the participants reported self-medication during COVID-19 lockdown, mainly with analgesic-type nervous system medications. People who reported self-medication to prevent COVID-19 often got their information from social networks, the Internet, and WhatsApp. PLAIN LANGUAGE SUMMARY: Self-medication during mandatory COVID-19 isolation: Introduction: Self-medication refers to the use of medications to treat self-diagnosed disorders or symptoms, and it can lead to health problems. This habit is widely practiced by the people, especially in low- and middle-income countries. The objective was to characterize the patterns of self-medication in four cities of Colombia during mandatory preventive isolation in 2020 due the quarantine by COVID-19 explored pandemic. Methods: We made a cross-sectional study between June and September 2020, and a sample of 397 adults who responded to an online survey. The use of social networks (including WhatsApp) as the source of information about medications was explored. Results: The prevalence of self-medication during lockdown was 34.3% (n = 136). Medications targeting the nervous system (n = 117; 86.0% of those participants with self-medication) and the musculoskeletal system (strategies n = 68; 50.0%) were the most commonly used. Conclusion: People who reported self-medication to prevent COVID-19 often got their information from social networks, the Internet, and WhatsApp. These findings raise the possibility of designing pedagogical strategies on this topic.

Prescription of DPP4 inhibitors: Indication and effect on glycosylated hemoglobin in a primary care institution of Colombia / Prescripción de inhibidores de la DPP-4: indicación y efecto sobre la hemoglobina glicosilada en un primer nivel de Colombia

Abstract Introduction and objective: In Colombia, Dipeptidyl-Peptidase IV (DPP4) inhibitors are recommended as second-best choice for type 2 diabetes mellitus treatment. However, no evaluation of the accomplishment or impact of this recommendation was performed. The objective was to determine the prescription of the DPP4 inhibitor according to the Colombian Clinicial Practice Guide regarding type 2 diabetes mellitus treatment, and its effects on glycosylated hemoglobin (HbAlc). Materials and methods: A descriptive study that included patients with type 2 diabetes mellitus who attended a first level between 2016 and 2018, had a prescription for DPP4 inhibitor and at least two control appointments. Variables included were sociodemographic, clinics, treatment and comorbidities. The unadjusted prescription was defined as the lack of accomplishment of Colombian guidelines. Descriptive statistics and X2 test were used for the comparison of categorical variables. A binary logistic regression model was applied. Results: 112 out of 207 patients accomplished inclusion criteria, of which 77 were women (68.8%). Also, 68.8% of the patients had an unadjusted prescription of the iDPP4. There was a 0.21% total reduction in HbA1c levels, with a mean of 198.2 ± 124 days between the first and second control measurement (reduction of 0.55% when the prescription was adjusted to the guidelines and 0.05% if it was unadjusted). Conclusion: There is a limited impact of DPP4 inhibitors regarding the reduction of HbA1c and metabolic control, and there is a slight follow-up to the Colombian guidelines in patients who attend a first level.

Resumen Introducción y Objetivo: En Colombia se recomiendan los inhibidores de la Dipeptidil Peptidasa-IV (iDPP4) como segunda opción para el manejo de la diabetes mellitus tipo 2. No se ha evaluado el cumplimiento e impacto de esta recomendación. Como objetivo se buscó determinar la prescripción de los iDPP4 según las recomendaciones de la Guía de Práctica Clínica colombiana, y su efecto sobre la hemoglobina glicosilada (HbA1c). Materiales y métodos: Estudio descriptivo que incluyó pacientes con diabetes mellitus tipo 2 que consultaron a un primer nivel entre 2016 y 2018, y tenían formulado un iDPP4, con al menos dos consultas de seguimiento. Se incluyeron variables sociodemográficas, clínicas, tratamiento y comorbilidades. La prescripción no ajustada se definió como la falta de cumplimento de la recomendación de la guía colombiana. Se empleó estadística descriptiva y pruebas X2 para la comparación de variables categóricas. Se aplicó un modelo de regresión logística binaria. Resultados: Hubo 207 pacientes de los cuales 112 cumplieron criterios de inclusión, 77 eran mujeres (68,8%). El 68,8% de los pacientes presentaron una prescripción no ajustada del iDPP4. Hubo una reducción total de 0,21%, con una media de 198,2±124 días entre la primera y segunda medición de HbA1c de control (reducción de 0,55% cuando la prescripción se ajustaba a la guía colombiana y 0,05% cuando no). Conclusión: Hay un limitado impacto de los iDPP4 frente a la reducción de HbA1c y poco seguimiento de la guía colombiana en pacientes de primer nivel de atención.

Impacto de la Iniciativa HEARTS en una institución de salud de segundo nivel en Colombia / Impact of the HEARTS Initiative in a second-level health institution in Colombia / Impacto da iniciativa HEARTS em um estabelecimento de atenção secundária à saúde na Colômbia

RESUMEN Objetivo. Identificar el impacto de la iniciativa HEARTS en los pacientes con hipertensión arterial atendidos en un hospital colombiano. Métodos. Estudio cuasiexperimental, retrospectivo entre 2017 y 2019 con pacientes hipertensos mayores de 18 años, incluidos en la estrategia HEARTS, atendidos en el Hospital Santa Mónica del municipio de Dosquebradas, departamento de Risaralda. La unidad de análisis fue la historia clínica. Se evaluaron las metas de presión arterial (definido en la Iniciativa HEARTS como un paciente con presión arterial sistólica <140 mmHg y <90 mmHg en la presión diastólica) al momento del ingreso al programa HEARTS y un año después. Se incluyeron variables sociodemográficas, farmacológicas, clínicas, metas de presión arterial y cumplimiento de la iniciativa. Se realizaron análisis descriptivos y se aplicó regresión logística binaria (p <0.05). Resultados. Se analizaron 372 pacientes de los cuales 262 eran mujeres (70,4%). La edad media fue de 66,3 ± 12,2 años. En la primera consulta de control se reportaron 285 pacientes (76,6%) que presentaron cifras de tensión arterial en metas, en la segunda consulta este logro fue alcanzado por el 84,1% de los pacientes (n=313 diferencia media: 7,5%, IC95%: 1,8 a 13,1; p=0,005). Después de la implementación de la Iniciativa HEARTS el 77,4% en los pacientes (n=288) continuaron con el manejo inicial. Cumplir las recomendaciones HEARTS aumenta la probabilidad de estar en las metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusiones. La implementación de la Iniciativa HEARTS impactó favorablemente las cifras de tensión arterial en pacientes con hipertensión, con beneficios adicionales en variables que disminuyen el riesgo cardiovascular.

ABSTRACT Objective. To identify the impact of the HEARTS initiative on patients with high blood pressure treated in a Colombian hospital. Methods. Quasi-experimental, retrospective study between 2017 and 2019 with hypertensive patients over 18 years of age included in the HEARTS strategy and treated at the Santa Mónica Hospital in the municipality of Dosquebradas, department of Risaralda. The unit of analysis was medical history. Blood pressure targets (defined in the HEARTS initiative as a patient with systolic blood pressure <140 mmHg and diastolic pressure <90 mmHg) were assessed at the time of admission to the HEARTS program and one year later. Sociodemographic, pharmacological, clinical, and blood pressure targets were included, as was compliance with the recommendations of the initiative. Descriptive analysis was performed, and binary logistic regression was applied (p <0.05). Results. A total of 372 patients were studied, of whom 262 were women (70.4%). The mean age was 66.3 ± 12.2 years. In the first consultation, 285 patients (76.6%) presented blood pressure figures within the target range; in the second consultation this was achieved by 84.1% of patients (n=313, mean difference: 7.5%, 95% CI: 1.8 to 13.1; p=0.005). After implementation of the HEARTS initiative, 77.4% of patients (n=288) continued with the initial treatment. Following HEARTS recommendations increases the likelihood of being in the target range (p=0.033; OR= 2,688; CI= 1.081 - 6.684). Conclusions. Implementation of the HEARTS initiative favorably impacted blood pressure figures in patients with hypertension and decreased cardiovascular risk.

RESUMO Objetivo. Identificar o impacto da iniciativa HEARTS nos pacientes com hipertensão arterial atendidos em um hospital colombiano. Métodos. Estudo quase-experimental, retrospectivo entre 2017 e 2019, com pacientes hipertensos maiores de 18 anos incluídos na estratégia HEARTS, atendidos no Hospital Santa Mónica do município de Dosquebradas, departamento de Risaralda. A unidade de análise foi a história clínica. As metas de pressão arterial (definidas na iniciativa HEARTS como pressão arterial sistólica <140 mmHg e pressão diastólica <90 mmHg) foram avaliadas no momento de ingresso no programa HEARTS e um ano depois. Foram incluídas variáveis sociodemográficas, farmacológicas, clínicas, metas de pressão arterial e adesão à iniciativa. Foram realizadas análises descritivas e foi aplicada a regressão logística binária (p<0,05). Resultados. Foram analisados 372 pacientes, dos quais 262 eram mulheres (70,4%). A média de idade foi de 66,3 ± 12,2 anos. Na primeira consulta de controle, 285 pacientes (76,6%) apresentaram valores de pressão arterial dentro das metas; na segunda consulta, as metas haviam sido alcançadas por 84,1% dos pacientes (n=313 diferença média: 7,5%, IC95%: 1,8 a 13,1, p=0,005). Após a implementação da iniciativa HEARTS, 77,4% dos pacientes (n=288) continuaram com o manejo inicial. O cumprimento das recomendações da HEARTS aumenta a probabilidade de estar nas metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684). Conclusões. A implementação da iniciativa HEARTS teve um impacto favorável nos valores da pressão arterial em pacientes com hipertensão e diminuiu o risco cardiovascular.

Clínica y tratamiento de la diabetes tipo 2 en adultos jóvenes en un hospital colombiano / Clinical presentation and treatment of type 2 diabetes in young adults in a Colombian hospital

Resumen Introducción: la diabetes mellitus tipo 2 (DM2) es el tipo más común de diabetes la cual ocurre generalmente en adultos, sin embargo, hay reportes que la describen en adolescentes y adultos jóvenes. Objetivo: describir las características clínicas y el tratamiento de la diabetes tipo 2 en adultos jóvenes en un hospital colombiano. Material y métodos: estudio de corte transversal entre el 2017 y 2019, que incluyó pacientes adultos jóvenes entre 18 y 40 años con DM2, que fueron atendidos en el Hospital Santa Mónica de Dosquebradas, Colombia. La unidad de análisis fueron las historias clínicas. Se incluyeron variables sociodemográficas, clínicas, farmacológicas y control metabólico (HbAlc < 7.0%). Se realizaron análisis descriptivos y se aplicó una regresión logística binaria (p< 0.05). Resultados: se identificaron 124 pacientes de los cuales 83 (70.0%) cumplieron criterios de inclusión, con una edad media de 33.7 ± 5.3 años. Unos 28 pacientes eran obesos (33.7%). Además, 21 pacientes (25.3%) presentaron control metabólico. Los fármacos más usados fueron metformina en 64 pacientes (77.1%), seguido de las insulinas en 46 pacientes (55.4%). Se estableció que 51 de estos (61.4%) presentaron adherencia al tratamiento. No hubo pacientes con terapia triple como estrategia terapéutica. Los pacientes con retinopatía diabética presentaban una probable asociación con tener control de la enfermedad en el momento del estudio (P=0.048, OR:0.130; IC95%:0.017-0.987). Conclusiones: los pacientes adultos jóvenes presentan pobre control metabólico y uso frecuente de insulinas. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1902).

Abstract Introduction: type 2 diabetes mellitus (T2DM) is the most common type of diabetes, generally occurring in adults. However, there are reports which describe it in adolescents and young adults. Objective: to describe the clinical characteristics and treatment of type 2 diabetes in young adults in a Colombian hospital. Materials and methods: a cross-sectional study from 2017 to 2019 which included young adult patients between 18 and 40 years old with T2DM who were seen at Hospital Santa Mónica in Dosquebradas, Colombia. The unit of analysis was the medical charts. Sociodemographic, clinical, pharmacological and metabolic control (HbA1c < 7.0%) variables were included. Descriptive analyses were performed, and binary logistic regression was applied (p<0.05). Results: 124 patients were identified, 83 (70.0%) of whom met the inclusion criteria, with a mean age of 33.7 ± 5.3 years. Some 28 patients were obese (33.7%). In addition, 21 patients (25.3%) had metabolic control. The most frequently used medications were metformin in 64 patients (77.1%), followed by insulin in 46 patients (55.4%). It was determined that 51 of these patients (61.4%) were compliant with treatment. No patients received triple therapy as a therapeutic strategy. Patients with diabetic retinopathy had a probable association with having the disease controlled at the time of the study (P=0.048, OR:0.130; 95%CI:0.017-0.987). Conclusions: young adult patients have poor metabolic control and frequent use of insulins. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1902).

Zika virus: clinical manifestations and treatment at a primary care institution in Colombia / Virus del Zika: manifestaciones clínicas y tratamiento en una institución de primer nivel en Colombia

Abstract Introduction: Although Zika virus cases have been reported in Colombia since 2015, its clinical and pharmacological characteristics have not yet been described. Objective: To describe the main clinical manifestations and sociodemographic characteristics of patients diagnosed with Zika and the treatment provided to them at a primary care hospital in a municipality of Colombia. Materials and methods: Descriptive cross-sectional study. The study population consisted of patients diagnosed with Zika between January 1 and July 25, 2016 at a primary care hospital. Sociodemographic, clinical, and pharmacological variables, as well as adverse clinical outcomes associated with the infection were included. Descriptive statistics were performed. A x2 test was used for categorical variables, and a multivariate analysis was conducted using Epi info 7.1 software. Results: 254 individuals infected with Zika virus during the study period were identified, and Zika diagnosis was more frequent in women (68.5%). Regarding treatment, 90.9% of the cases were treated using acetaminophen. The most commonly reported symptoms were rash (81.1%) and pruritus (55.9%). In addition, antihistamines were the most frequent comedication (31.9%). Factors such as being a woman, being pregnant and inpatient treatment were associated with adverse clinical outcomes. Conclusion: The clinical manifestations described here are similar to those reported in other populations. Furthermore, inappropriate pharmacological management practices that can lead to complications in this population, such as bleeding, were observed in some cases. Thus, educational interventions on the proper prescription of medications for treating this disease aimed at general physicians working in Zika affected areas must be implemented to improve the prognosis of these patients.

Resumen Introducción. Aunque el virus del Zika está presente en Colombia desde el 2015, sus características clínicas y farmacológicas aún no han sido descritas. Objetivo. Describir las principales manifestaciones clínicas y características sociodemográficas de pacientes diagnosticados con zika, así como el tratamiento que recibieron en un hospital de primer nivel. Materiales y métodos. Estudio descriptivo de corte transversal. La población estuvo constituida por los pacientes diagnosticados con zika entre el 1 de enero y el 25 de julio de 2016 en un hospital de primer nivel. Se incluyeron variables sociodemográficas, clínicas y farmacológicas, además de los resultados adversos clínicos y paraclínicos asociados a la infección. Se realizó estadística descriptiva; para las variables categóricas se usó la prueba x2 y el análisis multivariado se realizó a través del programa Epi Info 7.0. Resultados. Se identificaron 254 pacientes con zika, siendo más frecuente en mujeres (68.5%). El 90.9% de la población recibió tratamiento con acetaminofén. Los síntomas más comunes fueron sarpullido (81.1%) y prurito (55.9%). Además, los antihistamínicos fueron la comedicación más frecuente (31.9%). Los factores asociados con resultados clínicos y paraclínicos adversos fueron ser mujer, estar embarazada y tener manejo intrahospitalario. Conclusión. Las manifestaciones clínicas encontradas fueron similares a las reportadas en otras poblaciones. En algunos casos se observó un manejo farmacológico no recomendado, lo que puede generar complicaciones como sangrados; en consecuencia, se deben implementar intervenciones educativas sobre la prescripción adecuada de medicamentos para tratar esta enfermedad, dirigidas a médicos generales que trabajen en regiones afectadas por el zika para, así, mejorar el pronóstico de estos pacientes.

Etiología y perfil de resistencia antimicrobiana en pacientes con infección urinaria / Etiology and antimicrobial resistance profile in patients with urinary infection

Introducción: La infección de vías urinarias (IVU) es una de las enfermedades más prevalentes en la práctica clínica Objetivo: Identificar los principales agentes etiológicos y la frecuencia de resistencia a antibióticos por parte de microorganismos aislados por urocultivos en pa cientes con IVU en un hospital de primer nivel de atención. Materiales y Métodos: Estudio descriptivo de corte transversal, a partir de una muestra aleatoria de pacientes con IVU en La Virginia, Risaralda, entre el 1 de abril de 2014 a 31 de marzo de 2015. Se evaluaron las bacterias aisladas en la totalidad de urocultivos procesados y los resultados de los antibiogramas. Se establecieron frecuencias y proporciones. Para el análisis de datos, se utilizó SPSS Statistics 22. Se hizo análisis multivariado. Resultados: Se realizaron 1563 urocultivos en el periodo de estudio, de los cuales 329 (21,0%) mostraron crecimiento mayor a 100.000 UFC. Las frecuencias más altas de resistencia para E. coli se observaron para cefalotina (75,8%), ampicilina (72,6%) y trimetoprim/sulfametoxazol (55,3%). De 296 pacientes seleccionados aleatoriamente se halló que la cistitis era la IVU más frecuente (70,3%) y al 50,7% no se les prescribió ningún antimicrobiano. El uso de antiulcerosos se asoció con mayor probabilidad de uso inadecuado del antibiótico (OR:4,28; IC95%:1,070-17,153; p=0,04). Conclusiones: Existe una elevada resistencia bacteriana a los antibióticos de primera línea para el tratamiento de las IVUs, lo que sugiere la importancia de identi ficar los microorganismos y sus perfiles de sensibilidad a antimicrobianos para seleccionar con mejor criterio cual emplear.

Introduction: Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice. Objective: To identify the main etiologic agents and the frequency of antibiotic resistance by microorganisms isolated from urine culture and sensitivity in patients with IVU in a hospital primary care. Materials and Methods. Descriptive cross-sectional study, from a random sample of patients with UTI in La Virginia, Risaralda, from April 1, 2014 to March 31, 2015. Bacteria isolated from all processed urine cultures and the results of susceptibility were evaluated. Frequencies and proportions were established. For data analysis was used SPSS Statistics 22. Results: A total of 1563 urine cultures were performed in the study period, of which 329 (21.0%) showed further growth to 100,000 UFC. Higher frequencies of resis tance were observed for E. coli to cephalothin (75.8%), ampicillin (72.6%) and trimethoprim/sulfamethoxazole (55.3%). In the 296 randomized patients it was found that the most common UTI was cystitis (70.3%) and 50.7% were not prescribed any antimicrobial. The use of anti-ulcer is associated with increased probability of inappropriate use of antibiotics (OR:4.28; 95% CI:1.070-17.153; p=0.04). Conclusions: There is a high bacterial resistance to first-line antibiotics for treatment of UTIs, suggesting the importance of identifying microorganisms and their antimicrobial susceptibility profiles to select which use better approach.

Prescripción-indicación de los inhibidores de la bomba de protones. Costo de la prescripción inadecuada en un primer nivel en Colombia / Prescription-indication of proton pump inhibitors. Cost of inadequate prescription in a first level institution in Colombia

Resumen Introducción: los inhibidores de la bomba de protones (IBP) son medicamentos antiulcerosos que han presentado patrones de uso diferentes a los autorizados, por lo cual se buscó determinar la prescripción-indicación de los IBP en una institución de primer nivel de La Virginia, Risaralda, y el costo de la prescripción inadecuada. Diseño: estudio de prescripción-indicación de medicamentos. Métodos: estudio de prescripción-indicación en pacientes mayores de 18 años con formulación de un IBP atendidos en el Hospital San Pedro y San Pablo de La Virginia, Risaralda, entre el 1 de julio de 2016 al 31 de julio de 2017. Se obtuvo una muestra aleatoria simple proporcional. Se utilizaron las historias clínicas como unidad de análisis. Se incluyeron variables sociodemográficas, comorbilidades, patrones de prescripción-indicación y polifarmacia. Se definió prescripción-indicación adecuada de IBP según la última evidencia científica disponible. Se usó Epi info 7.2 para realizar estadística descriptiva, X2 y una regresión logística binaria (P<0.05). Para el análisis de costos se definió costo de referencia por unidad de IBP y DHD x 1000 habitantes/día. Se contó con aprobación bioética. Resultados: se analizaron 317 pacientes de los cuales 65.6% eran mujeres. El omeprazol fue el IBP más frecuente prescrito (93.7%). Se presentó una prescripción inadecuada en el 46.3% de los pacientes, siendo el servicio de urgencias el que mayor prescripción inadecuada presentó (53.1%). Los principales diagnósticos asociados a la indicación no adecuada de IBP fueron la hipertensión arterial (10%) seguido de la diabetes (6.0%). Siete variables se asociaron con una mayor probabilidad de presentar una prescripción adecuada de un IBP. El costo anual estimado por prescripción inadecuada de IBP fue de COP $446 602 606 DHD x 1000 habitantes/año. Conclusiones: se describe una elevada proporción de prescripción inadecuada de los IBP en la población de un primer nivel de atención, representando un elevado costo para el centro hospitalario. (Acta Med Colomb 2018; 43: 183-191).

Abstract Introduction: Proton Pump Inhibitors (PPIs) are anti-ulcer drugs that have presented patterns of use different from those authorized, which is why it was sought to determine the prescription-indication of PPIs in a first-level institution in La Virginia, Risaralda as well as the cost of inadequate prescription. Design: prescription-indication study of medication. Methods: study of prescription-indication in patients older than 18 years with formulation of a PPI attended at the San Pedro and San Pablo Hospital of La Virginia, Risaralda, between July 1, 2016 and July 31, 2017. A proportional simple random sample was obtained. The clinical histories were used as a unit of analysis. Sociodemographic variables, comorbidities, prescription-indication patterns and polypharmacy were included. Adequate prescription-indication of PPI was defined according to the latest available scientific evidence. Epiinfo 7.2 was used to perform descriptive statistics, X2 and a binary logistic regression (P <0.05). For the cost analysis, reference cost per unit of IBP and DHD x 1000 inhabitants/day was defined. It had bioethical approval. Results: 317 patients were analyzed, of which 65.6% were women. Omeprazole was the most frequent PPI prescribed (93.7%). An inadequate prescription was presented in 46.3% of the patients, being the emergency service the one with the highest inadequate prescription presented (53.1%). The main diagnoses associated with the inappropriate indication of PPI were arterial hypertension (10%) followed by diabetes (6.0%). Seven variables were associated with a higher probability of presenting an adequate prescription of a PPI. The estimated annual cost for inadequate prescription of PPI was COP $446 602 606 DHD x1000 inhabitants/year. Conclusions: a high proportion of inadequate prescription of PPIs is described in the population of a first level of care, representing a high cost for the hospital center. (Acta Med Colomb 2018; 43: 183-191).

[Prescribing patterns of antiparkinson drugs in a group of Colombian patients, 2015].

INTRODUCTION: Parkinson's disease, whose prevalence in Colombia is 4.7 per 1,000 inhabitants, is a public health problem and a therapeutic challenge for health professionals. OBJECTIVE: To determine the prescribing patterns of antiparkinson drugs and the variables associated with its use in a population from Colombia. MATERIALS AND METHODS: We conducted a descriptive cross-sectional study. We selected patients who had been given antiparkinson drugs uninterruptedly between January 1st and March 31st, 2015 from a systematized database of approximately 3.5 million people affiliated to the Colombian health system. We included sociodemographic, pharmacologic and comedication variables. For the multivariate analysis, we used the IBM SPSS™-22 software. RESULTS: A total of 2,898 patients was included; the mean age was 65.1years, and 50.7% were men; 69.4% (n=2010) of people received monotherapy and 30.6% combination therapy with two to five antiparkinson drugs. The most frequently prescribed drugs were: levodopa 45.5% (n=1,318 patients), biperiden 23.1% (670), amantadine 18.3% (531) and pramipexole 16.3% (471). The most commonly used association was levodopa/carbidopa + entacapone (n=311; 10.7%). Multivariate analysis showed that being male (OR=1.56; 95%CI: 1.321-1.837), over 60 years (OR=1.41; 95%CI 1.112-1.782) and receiving treatment in the city of Barranquilla (OR=2.23; 95%CI 1.675-2.975) were statistically associated with a greater risk of using combination therapy; 68.2% (n=1,977) patients were given concomitant treatment with other drugs. CONCLUSIONS: Prescribing habits of drugs with high therapeutic value predominated, mainly in antiparkinson drugs monotherapy. Most were employed in the usual recommended doses. It is necessary to explore the clinical effectiveness of the medications studied and differentiate between disease and parkinsonian syndromes subtypes.

Prescribing patterns of antiparkinson drugs in a group of Colombian patients, 2015 / Patrones de prescripción de fármacos antiparkinsonianos en un grupo de pacientes de Colombia, 2015

Introduction: Parkinson's disease, whose prevalence in Colombia is 4.7 per 1,000 inhabitants, is a public health problem and a therapeutic challenge for health professionals. Objective: To determine the prescribing patterns of antiparkinson drugs and the variables associated with its use in a population from Colombia. Materials and methods: We conducted a descriptive cross-sectional study. We selected patients who had been given antiparkinson drugs uninterruptedly between January 1st and March 31st, 2015 from a systematized database of approximately 3.5 million people affiliated to the Colombian health system. We included sociodemographic, pharmacologic and comedication variables. For the multivariate analysis, we used the IBM SPSS™-22 software. Results: A total of 2,898 patients was included; the mean age was 65.1years, and 50.7% were men; 69.4% (n=2010) of people received monotherapy and 30.6% combination therapy with two to five antiparkinson drugs. The most frequently prescribed drugs were: levodopa 45.5% (n=1,318 patients), biperiden 23.1% (670), amantadine 18.3% (531) and pramipexole 16.3% (471). The most commonly used association was levodopa/carbidopa + entacapone (n=311; 10.7%). Multivariate analysis showed that being male (OR=1.56; 95%CI: 1.321-1.837), over 60 years (OR=1.41; 95%CI 1.112-1.782) and receiving treatment in the city of Barranquilla (OR=2.23; 95%CI 1.675-2.975) were statistically associated with a greater risk of using combination therapy; 68.2% (n=1,977) patients were given concomitant treatment with other drugs. Conclusions: Prescribing habits of drugs with high therapeutic value predominated, mainly in antiparkinson drugs monotherapy. Most were employed in the usual recommended doses. It is necessary to explore the clinical effectiveness of the medications studied and differentiate between disease and parkinsonian syndromes subtypes.

Introducción. La enfermedad de Parkinson, cuya prevalencia en Colombia es de 4,7 por 1.000 habitantes, constituye un problema de salud pública y un reto terapéutico para los profesionales de la salud. Objetivo. Determinar los patrones de prescripción de fármacos antiparkinsonianos y las variables asociadas con su utilización en una población colombiana. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal. A partir de una base de datos de 3,5 millones de afiliados al sistema de salud, se seleccionaron pacientes con prescripción de medicamentos antiparkinsonianos de manera ininterrumpida entre el 1º de enero y el 31 de marzo de 2015. Se incluyeron variables sociodemográficas, farmacológicas y de medicación concomitante. El análisis multivariado se hizo con el programa IBM SPSS™-22. Resultados. Se hallaron 2.898 pacientes, con una edad media de 65,1 años, de los cuales el 50,7 % correspondía a hombres. El 69,4 % (n=2.010) de las personas recibía monoterapia y el 30,6 %, tratamiento combinado con dos a cinco medicamentos antiparkinsonianos. Los más prescritos eran la levodopa (45,5 %; n=1.318 pacientes), el biperideno (23,1 %; n=670), la amantadina (18,3 %; n=531) y el pramipexol (16,3 %; n=471). La asociación más utilizada fue la de levodopa-carbidopa y entacapone (n=311; 10,7 %). En el análisis multivariado se encontró que ser hombre (odds ratio, OR=1,56; IC95% 1,321-1,837), ser mayor de 60 años (OR=1,41; IC95% 1,112-1,782) y recibir tratamiento en Barranquilla (OR=2,23; IC95% 1,675-2,975), se asociaban con una mayor probabilidad de emplear el tratamiento combinado. Al 68,2 % (n=1.977) de los pacientes se les había prescrito tratamiento concomitante con otros medicamentos. Conclusión. Predominaron los hábitos de prescripción de medicamentos con gran valor terapéutico, principalmente en la monoterapia, la mayoría en las dosis usuales recomendadas. Es necesario explorar la efectividad clínica de las prescripciones estudiadas, y diferenciar entre la enfermedad y los subtipos de síndromes parkinsonianos.

Utilización de fármacos antihipertensivos, efectividad e inercia clínica en pacientes / Antihypertensive drug use, efficacy, and clinical inertia in patients

Resumen Introducción: la hipertensión arterial es una de las principales causas de enfermedad cardiovascular. Se encuentra una limitada caracterización local de su tratamiento en nuestra población. Metodología: estudio de corte transversal sobre la prescripción de fármacos antihipertensivos, la efectividad del tratamiento y la inercia clínica en pacientes atendidos en 2014. Se estableció la efectividad según el Sevent Report of the Joint National Committee y se definió inercia clínica como la falta de modificaciones para alcanzar la meta terapéutica. Se incluyeron variables sociodemográficas y farmacológicas. Se aplicaron modelos de regresión logística. Resultados: de un total de 4.195 pacientes, se obtuvo una muestra aleatoria de 309, el 54,7% eran mujeres y 52,8% tenían más de 60 años. Los antihipertensivos más utilizados fueron losartán e hidroclorotiazida (20,8% cada uno). Se halló un control de cifras tensionales en el 75,3% de un total de 675 consultas y de las 167 visitas que no presentaron control tensional se evidenció inercia clínica en 47,9%. Tener prescrito concomitantemente un antidiabético se asoció con menor probabilidad de que se presentara inercia clínica (p=0,032; OR: 0,21; IC95%: 0,051-0,879). Conclusión: la proporción de pacientes que no logran las metas de control de tensión arterial y la frecuencia de inercia clínica es menor que en otras series de pacientes.

Abstract Introduction: Arterial hypertension is one of the main causes of cardiovascular disease. The characteristics of its treatment in the population at a local level are relatively unknown. Methods: A cross-sectional study was conducted on the prescribing of antihypertensive drugs, the efficacy of the treatment, as well as the clinical inertia in patients seen in the year 2014. The efficacy was established according to the Seventh Report of the Joint National Committee, and clinical inertia was defined as lack of modifications to achieve the therapeutic aim. Sociodemographic and pharmacological variables were included in the logistical regression models. Results: Out of a total sample of 4,195 patients, a randomised sample of 309 patients was obtained, of which 54.7% were women, and 52.8% were over 60 years of age. The antihypertensive drugs most used were losartan and hydrochlorothiazide (20.8% each). Blood pressure control was observed in 75.3% of a total of 675 clinical visits, and of the 167 visits where the blood pressure was not controlled, there was evidence of clinical inertia in 47.9%. To have a concomitant antidiabetic drug prescribed was associated with a lower possibility of there being clinical inertia (P=.032; OR: 0.21; 95% CI: 0.051-0.879). Conclusion: The proportion of patients that do not achieve the targets of blood pressure control, as well as the frequency of clinical inertia, are lower than those found in other patient series.

Prescripción de antibióticos en infecciones de piel y tejidos blandos en una institución de primer nivel / Prescription of antibiotics in infections of the skin and soft tissues

Resumen Introducción: En la práctica clínica las infecciones de piel y tejidos blandos son frecuentes y pueden ser responsables de sepsis y complicaciones graves. Objetivo: Determinar las variables asociadas con la prescripción de antimicrobianos en pacientes con diagnóstico de infecciones de piel y tejidos blandos en un hospital de primer nivel de atención. Métodos: Estudio de corte transversal, en pacientes hospitalizados por infecciones de piel entre el 1 enero y 31 diciembre de 2014 en Hospital de La Virginia, Risaralda. Se realizó un muestreo aleatorio simple. Se incluyeron variables sociodemográficas, clínicas, farmacológicas a partir de las historias clínicas. Se definió que el tratamiento era adecuado cuando había correlación entre el diagnóstico de cada paciente registrado según la Clasificación Internacional de las Enfermedades -10 como infección purulenta o no purulenta, severidad y el medicamento prescrito. Se realizó análisis multivariado. Resultados: Se identificaron 309 pacientes en quienes las penicilinas fueron los antibióticos iniciales más formulados (81,7 %); el 74,8 % recibió tratamiento antibiótico indicado. La comedicación más frecuentemente encontrada fue con antiinflamatorios no esteroideos (61,2 %). Recibir el primer antibiótico por vía oral tuvo menor probabilidad de que la prescripción fuese inadecuada (OR: 0,2; IC95 %:0,1-0,4). Conclusión: Los datos obtenidos deben ser destinados para mejorar las prescripciones y permitir la implementación de planes de capacitación que contribuyan a que la terapia sea más efectiva y segura.

Abstract Introduction: Infections of skin and soft tissues are common in clinical practice, which may even be responsible for sepsis and severe complications. Objective: To describe the prescription of antimicrobials and variables associated with their use in patients with diagnosis of infections of skin and soft tissues in a primary care hospital. Materials and Methods: Cross-sectional study in patients hospitalized for infections of the skin between 1 January and 31 December 2014. A simple random sampling was performed. Were included sociodemographic, clinical and pharmacological variables from medical records. Treatment was defined as adequate when there was a correlation between the diagnosis of each patient according to the International Classification of Diseases (ICD-10) as purulent or non-purulent infection, severity (mild, moderate or severe) and prescribed medication. Multivariate analysis using. SPSS 22.0. Results: A total of 309 patients were included, and the penicillins corresponded to the initial most formulated antibiotics (81.7 % of cases); 231patients (74.8 %) had well indicated antibiotic treatment. Comorbid conditions most frequently found in patients of this cohort were antiinflammatory drugs (NSAIDs) (61.2 %). Receiving the first oral antibiotic was less likely that the prescription was inadequate (OR:0.215;IC95 %:0.115-0.400). Conclusion: The data obtained should be aim to improving prescriptions and should allow implement training plans that contribute to therapy more effective and safe.

An economic analysis of inadequate prescription of antiulcer medications for in-hospital patients at a third level institution in Colombia.

INTRODUCTION: The prescription and costs of antiulcer medications for in-hospital use have increased during recent years with reported inadequate use and underused. AIM: To determine the patterns of prescription-indication and also perform an economic analysis of the overcost caused by the non-justified use of antiulcer medications in a third level hospital in Colombia. MATERIALS AND METHODS: Cross-sectional study of prescription-indication of antiulcer medications for patients hospitalized in "Hospital Universitario San Jorge" of Pereira during July of 2012. Adequate or inadequate prescription of the first antiulcer medication prescribed was determined as well as for others prescribed during the hospital stay, supported by clinical practice guidelines from the Zaragoza I sector workgroup, clinical guidelines from the Australian Health Department, and finally the American College of Gastroenterology Criteria for stress ulcer prophylaxis. Daily defined dose per bed/day was used, as well as the cost for 100 beds/day and the cost of each bed/drug. A multivariate analysis was carried out using SPSS 21.0. RESULTS: 778 patients were analyzed, 435 men (55.9 %) and 343 women, mean age 56.6 +/- 20.1 years. The number of patients without justification for the prescription of the first antiulcer medication was 377 (48.5 %), and during the whole in-hospital time it was 336 (43.2 %). Ranitidine was the most used medication, in 438 patients (56.3 %). The cost/month for poorly justified antiulcer medications was € 3,335.6. The annual estimated cost for inadequate prescriptions of antiulcer medications was € 16,770.0 per 100 beds. CONCLUSION: A lower inadequate prescription rate of antiulcer medications was identified compared with other studies; however it was still high and is troubling because of the major costs that these inadequate prescriptions generates for the institution.