الملخص
Introduction: urticaria has a high impact on the quality of life of patients with this condition. While there are multiple evidence-based guidelines, these tend to be aimed at providing management recommendations for specialists rather than primary care physicians, who are usually the first to care for patients with urticaria. Objective: to develop a consensus document aimed at presenting evidence-based recommendations to help general practitioners, family doctors, pediatricians, internists and emergency physicians provide timely care for patients with urticaria, facilitating its diagnosis and timely care, and thus avoiding delays for the patients. Methods: international urticaria guidelines with recommendations based on the GRADE system were used as the source of information. Delegates of the interested scientific societies were convened, and, through structured meetings, treatment barriers and possible solutions for the application of the recommendations in primary care were identified. Results: the main barriers for primary care physicians in applying the guidelines were identified: confusion in the diagnosis, proper timing of treatment, first-line medications, and management of special situations. Possible consensus solutions were proposed for each identified barrier. Conclusion: this consensus document contains recommendations for the management and treatment of acute and chronic urticaria which help primary care physicians provide timely and effective treatment for patients with this disease. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2722).
الملخص
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Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.