[Are natural analgesic products safe in patients with allergy to non-steroidal anti-inflammatory drugs?] / ¿Son seguros los productos naturales analgésicos en los pacientes con alergia a los antiinflamatorios no esteroideos?

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAID)-induced hypersensitivity reactions can be clinically apparent with asthma, rhinosinusitis, anaphylaxis or rash. Although natural anti-inflammatory products can have similar components, they are not subjected to rigorous quality control standards. CASE REPORT: The case is presented of a 22-year-old female with NSAID allergy who attended with facial and laryngeal angioedema associated with pruritus in eyelids and pharynx. She developed these symptoms fifteen minutes after taking an over-the-counter (OTC) natural anti-inflammatory product. She received treatment with epinephrine, antihistamines and corticosteroids. CONCLUSION: Different natural anti-inflammatory products are freely available both OTC and online. Some contain dangerous substances that can cause important, and even lethal. side effects. Allergologists, dermatologists and general practitioners should be able to recognize that the consumption of these products, which is widely spread, can cause angioedema.

Antecedentes: Las reacciones de hipersensibilidad inducidas por antiinflamatorios no esteroideos pueden manifestarse clínicamente con asma, rinosinusitis, anafilaxia o urticaria. Aunque los productos antiinflamatorios naturales pueden tener componentes similares, no son sometidos a rigurosos estándares de control de calidad. Reporte de caso: Se describe el caso de una mujer de 22 años de edad, con alergia a los antiinflamatorios no esteroideos, quien consultó por angioedema facial y laríngeo asociado con prurito en párpados y faringe. Desarrolló los síntomas 15 minutos después del consumo de un producto antiinflamatorio natural de venta libre. Recibió tratamiento con epinefrina, antihistamínicos y corticoides. Conclusiones: Diversos productos antiinflamatorios naturales están disponibles en venta libre y en la web. Algunos contienen sustancias peligrosas que pueden causar efectos secundarios importantes e, incluso, letales. Alergólogos, dermatólogos y médicos generales deben ser capaces de reconocer que el consumo de estos productos, que se ha generalizado, puede ocasionar angioedema.

What Kind of Information and Communication Technologies Do Patients with Type 2 Diabetes Mellitus Prefer? An Ecuadorian Cross-Sectional Study.

PURPOSE: The purpose of this study is to assess the frequency of use of information and communication technologies and patterns of preference among Ecuadorian patients with diabetes. METHODS: We conducted an anonymous cross-sectional survey on type 2 diabetes mellitus. A chi-square test for association and adjusted regression analyses were performed. RESULTS: 248 patients were enrolled, with a mean sample age of 57.7 years. SMS was the most used ICT (66.0%). The Internet was used by 45.2% of patients to obtain information about diabetes. SMS and email were rated as the most useful ICTs for receiving information (64.5% and 28.1%, resp.) and asking physicians about diabetes (63.8% and 26.1%, resp.). Patients were also interested in receiving disease information (82.4%) and asking physicians about diabetes (84.7%) through WhatsApp. Adjusted logistic regressions revealed that individuals aged 55 years or younger, those with superior degree level, and those with long diabetes history preferred email for receiving information and asking physicians about diabetes compared to those above 55 years, those with low education level, and those with short diabetes history, respectively. CONCLUSION: Understanding preferences of ICTs among patients with diabetes could facilitate application development targeted towards specific requirements from patients.

Ecuadorian Cancer Patients' Preference for Information and Communication Technologies: Cross-Sectional Study.

BACKGROUND: The instantaneous spread of information, low costs, and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, patient communication, and medical interventions in cancer treatment. There is little information available in Latin America about the level of usage of ICTs for and by cancer patients. Our study attempts to fill this gap. OBJECTIVE: The aim of this study was to assess the level of ICT use and patterns of preferences among cancer patients. METHODS: We conducted an anonymous cross-sectional survey study in 500 Ecuadorian cancer patients. This questionnaire consisted of 22 items about demographic and clinical data, together with the preferences of people who use ICTs. Chi-square, crude, and adjusted logistic regressions were performed. RESULTS: Of the total, 43.2% (216/500) of participants reported that they had access to the Internet, and 25.4% (127/500) reported that they neither owned a cell phone nor did they have access to the Internet. The Internet constituted the highest usage rate as a source of information about malignant diseases (74.3%, 162/218) regardless of age (P<.001). With regard to the preferences on how patients would like to use ICTs to receive information about diseases, WhatsApp (66.5%, 145/218) and short message service (SMS) text messaging (61.0%, 133/218) were widely reported as interesting communication channels. Similarly, WhatsApp (72.0%, 157/218) followed by SMS (63.8%, 139/218) were reported as the preferred ICTs through which patients would like to ask physicians about diseases. Adjusted regression analysis showed that patients aged between 40 and 64 years were more likely to be interested in receiving information through SMS (odds ratio, OR 5.09, 95% CI 1.92-13.32), as well as for asking questions to physicians through this same media (OR 9.78, CI 3.45-27.67) than the oldest group. CONCLUSIONS: WhatsApp, SMS, and email are effective and widely used ICTs that can promote communication between cancer patients and physicians. According to age range, new ICTs such as Facebook are still emerging. Future studies should investigate how to develop and promote ICT-based resources more effectively to engage the outcomes of cancer patients. The widespread use of ICTs narrows the gap between cancer patients with restricted socioeconomic conditions and those with wealth and easily available technological means, thereby opening up new possibilities in low-income countries.

Management and attitudes about IPF (Idiopathic Pulmonary Fibrosis) among physicians from Latin America.

BACKGROUND: The aim of our study was to assess current practice patterns and attitudes towards diagnosis and management of idiopathic pulmonary fibrosis (IPF) patients in Latin America. METHODS: A Cross-sectional survey was developed and up to 455 physicians were enrolled. We used a rigorous method of validation using the translated version of the AIR Survey. RESULTS: Mean age was 47.5 years (SD 12.6) with 20.4 years (SD 12.3) of practice. In around 30% of physicians were reported access to radiologist, pathologist and multidisciplinary team. Despite almost all physicians reported that (ATS/ERS/JRS/ALAT) guidelines are useful, half of them prescribed corticoids for treatment of disease. Most respondents (69.9%) reported cough as the presenting symptom. Around 80% considered IPF to be an important clinical disorder, and felt that identifying patients at risk for IPF was important or extremely important. However, only 59.7% felt confident in managing patients with IPF, and similar numbers (60.8%) felt confident about their knowledge. Pulmonologist have more confidence and management of IPF that no pulmonologist. CONCLUSION: The results of this survey of Latin American physicians could help to fill gaps regarding awareness, management and treatment of IPF and improve earlier diagnosis of IPF.

[Does Ecuadorians with asthma has preferences in the use of information and communication technologies? Pilot study]. / ¿Los ecuatorianos con asma tienen preferencias en el uso de tecnologías de la información y comunicación? Estudio piloto.

BACKGROUND: Inadequate communication between asthmatic patients and their physicians may interfere directly with asthma control. In the last years, the use of information and communication technologies (ICTs) it has increased in Latin-America. This technology seems to be a good tool to improve communication and management of the asthmatic patient. OBJECTIVE: We evaluated the frequency and preference patterns of communication and information technologies in Ecuadorian patients with bronchial asthma. METHODS: We conducted a pilot cross-sectional study to identify the frequency and preferences of ICT in patients with asthma. The Spanish version of the Michigan questionnaire was used. Age and educational level were categorized into 3 groups. We used logistic regression between these groups regarding the frequency of use, interest in seeking and receiving information related to their asthma for the age and educational level of the patients. RESULTS: A total of 222 patients participated in our study. The mean age was 45.6 years (SD 17.4), the most common sex was female with 89.25 %. Almost all patients had a cell phone (87.5 %) and internet access (62.7 %). The three ICTs most likely to be used to search for or receive information about their illness were WhatsApp, Facebook and email (p <0.05). CONCLUSION: Information and communication technologies improve the care of asthmatic patients. In our pilot study email and text messages are the most preferred ICT among patients however WhatsApp and Facebook may be appropriate for certain ages especially young asthmatic. Knowledge of preferences can help the development of ICT in a personalized way and improve the outcomes in patients with asthma.

Antecedentes: La comunicación inadecuada entre los pacientes y sus médicos puede interferir directamente con el control del asma. En los últimos años, el uso de tecnologías de la información y comunicación se ha incrementado en Latinoamérica y parece ser un recurso útil para mejorar la comunicación, adherencia y control del paciente con asma. Objetivo: evaluar la frecuencia y patrones de preferencia de las tecnologías de comunicación e información en pacientes ecuatorianos con asma bronquial. Métodos: estudio transversal en el que se utilizó la versión en español del cuestionario Michigan. La edad y el nivel educacional fueron categorizados en tres grupos. Se utilizó regresión logística entre los grupos respecto a la frecuencia de uso e interés en buscar y recibir información relacionada con el asma, según la edad y nivel educativo. Resultados: en nuestro estudio participaron 222 pacientes. La edad media fue de 45.6 ± 17.4 años y el sexo más común fue el femenino, con 89.25 %. Casi todos los pacientes tenían teléfono celular (87.5 %) y acceso a internet (62.7 %). Las tres tecnologías de la información y comunicación con mayor probabilidad de ser usadas con fines de buscar o recibir información acerca de la enfermedad fueron WhatsApp, Facebook y correo electrónico (p < 0.05). Conclusión: el correo electrónico y los mensajes de texto fueron preferidos por los pacientes, sin embargo, WhatsApp y Facebook pueden ser apropiados para ciertos grupos, especialmente para los jóvenes. La selección de TIC adecuadas para la comunicación médico-paciente podría mejorar la adherencia y el control de los pacientes con asma.

[Is it possible for chronic urticaria diagnostic approach to be simplified? A clinical data checklist]. / ¿Es posible simplificar el abordaje diagnóstico de urticaria crónica? Una lista de verificación de información clínica.

BACKGROUND: Existing clinical guidelines do not offer an efficient alternative for the collection of data on relevant clinical traits during history and physical of the patient with chronic urticaria. OBJECTIVE: Our aim was to provide a clinical data checklist together with its guide to allow for thorough information to be obtained and for a physical exam that identifies the main features and triggering factors of the disease to be carried out. METHODS: A search was conducted for relevant literature on chronic urticaria in Medline, the Cochrane library and PubMed. RESULTS: We developed an easy-to-use clinical data checklist with its corresponding clinical guide, comprised by 42 items based on two components: essential clues for history taking and chronic urticaria diagnosis (typical symptoms according to subgroups, etiology and laboratory results). Some components are the time of disease onset, wheals' duration, shape, size, color and distribution, associated angioedema, atopy, triggering factors and others. CONCLUSION: The clinical data checklist and its guide constitute a tool to focus, guide and save time in medical consultation, with the main purpose to aid physicians in providing better diagnosis and management of the disease.

Antecedentes: Las guías clínicas existentes no ofrecen una alternativa eficiente para la recolección de rasgos clínicos relevantes durante la anamnesis y el examen físico del paciente con urticaria crónica. Objetivo: Proporcionar una lista de verificación de información clínica y una guía que permitan obtener información completa y realizar un examen físico que identifique las características principales de la enfermedad y los factores desencadenantes. Métodos: Se realizó una búsqueda de literatura relevante sobre urticaria crónica en Medline, la Biblioteca Cochrane y PubMed. Resultados: Desarrollamos una lista de verificación de información clínica fácil de usar, con su respectiva guía clínica, integrada por 42 elementos basados en 2 componentes: pistas esenciales para la anamnesis y el diagnóstico de la urticaria crónica (síntomas típicos según sus subtipos, etiología y resultados de laboratorio). Algunos componentes son el tiempo de aparición de la enfermedad, duración, forma, tamaño, color y distribución de las erupciones; angioedema aso-ciado, atopia, factores desencadenantes y otros. Conclusiones: La lista de verificación de información clínica y su guía constituyen una herramien-ta para enfocar, orientar y ahorrar tiempo en la consulta médica, con el fin principal de que los médicos realicen un mejor diagnóstico y manejo de la enfermedad.

Checklist for a complete chronic urticaria medical history: an easy tool.

BACKGROUND: Existing guidelines do not offer a quick, efficient alternative to the patient's recollection of relevant clinical features during anamnesis and physical examination for chronic urticaria (CU). This study aimed to identify specific items reflecting the main characteristics of CU that should be included in a comprehensive medical history for patients with CU. We also aimed to clarify possible eliciting factors for CU to support accurate diagnosis of the disease. METHODS: A panel of postgraduate dermatologists conducted a literature search for relevant studies on CU using Medline, the Cochrane database, and PubMed. RESULTS: We identified82 articles from which we drew a collection of items to inform development of an easy-to-use checklist and collection of items that should be included in a correct medical history. The final version of the checklist included42 items across two areas: essential clues for anamnesis and diagnosis of CU; and typical symptoms/parameters or characteristics according to subtype, etiology, and laboratory findings. Items included time of disease onset; duration, shape, size, color, and distribution of wheals; associated angioedema; atopy; and triggering factors. CONCLUSIONS: Our guide provides an easy-to-use tool to support clinicians to focus, orient themselves, and save time in medical consultations for CU, allowing better diagnosis and management of this disease.

Information and communication technology use in asthmatic patients: a cross-sectional study in Latin America.

Rapid diffusion, low cost and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, communication and interventions in asthma. There is little information in Latin America about usage frequency of ICTs in asthmatic patients. The analysis undertaken consisted of an observational, cross-sectional study that aimed to identify the frequency and type of ICTs most often used by asthmatics. The Spanish version of the Michigan questionnaire was employed in five Latin American countries. Age and educational level was categorised. Logistic regression was performed among these groups concerning the frequency of ICT usage and the level of interest shown in seeking and receiving information about asthma. In total, 673 asthma patients were surveyed. The mean age was 43.44 years. Over two-thirds of the participants were female (68.4%). The most used ICT was the short message service (SMS) (69.9%). SMS and E-mail are useful tools for communicating (i.e. receiving and seeking information) with all asthma patients, irrespective of their age. WhatsApp (61.5%) and Facebook (32.0%) were rated as being the most interesting channels of communication for receiving information. Regression analysis showed that younger asthmatics and asthmatics with higher educational levels were most likely to use almost all forms of ICTs. ICTs are generally an attractive platform for managing care, communication and interventions to improve asthma care. SMS and E-mail were found to be the preferred ICT forms among users. However, social media forms such as WhatsApp and Facebook may also be appropriate for certain types of patient.

[Knowledge and attitudes about aspirin exacerbated respiratory disease among Ecuadorian physicians]. / Conocimiento y actitudes en médicos ecuatorianos sobre enfermedades respiratorias exacerbadas por aspirina.

BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) is an asthma phenotype that involves high costs and significant burden for health systems. OBJECTIVE: To determine the level of knowledge and attitudes towards AERD among Ecuadorian physicians. METHODS: Descriptive, observational study. A questionnaire about knowledge on the disease and attitude towards it (confidence in the treatment and importance of AERD, measured with a Likert scale) was developed. The answers about knowledge were dichotomized into right and wrong; attitude was rated as high or low. Means and percentages were obtained; the answers of doctors with or without specialty were compared using the chi-square test. RESULTS: One-hundred eighteen physicians participated. The age was 41.3 ± 11.7 years; 48.3 % were specialists. Less than 50% answered correctly the questions about knowledge. Specialist physicians obtained more correct answers regarding first symptoms, prevalence and leukotriene overproduction (67.9 %, 46.3% and 90.7 %), when compared with general practitioners (45.0 %, 25% and 74.6 %) (p < 0.05). More than 70 % of physicians indicated high confidence in the identification of patients with AERD. There were no significant differences in attitudes (p > 0.05). CONCLUSION: Medical education programs should be developed in order to improve the level of knowledge about AERD.

Antecedentes: La enfermedad respiratoria exacerbada por aspirina (EREA) es un fenotipo de asma que conlleva un alto costo e importante carga para los sistemas de salud. Objetivo: Determinar los conocimientos y actitudes hacia la EREA en médicos ecuatorianos. Métodos: Estudio observacional descriptivo. Se elaboró un cuestionario acerca de los conocimientos sobre la enfermedad y la actitud hacia ella (confianza en el tratamiento e importancia de la EREA, medidas con una escala de Likert). Las respuestas sobre conocimiento se dicotomizaron en correctas e incorrectas; la actitud se calificó como alta o baja. Se obtuvo media y porcentaje; con c2 se compararon las respuestas de los médicos con o sin especialidad. Resultados: Participaron 118 médicos. La edad fue de 41.3 ± 11.7 años; 48.3 % era especialista. Menos de 50 % contestó correctamente las preguntas sobre conocimiento. Los especialistas obtuvieron más respuestas correctas respecto a los primeros síntomas, prevalencia y sobreproducción de leucotrienos (67.9, 46.3 y 90.7 %), al compararlos con los médicos generales (45, 25 y 74.6 %) (p < 0.05). Más de 70 % de los médicos indicó alta confianza en la identificación de pacientes con EREA. No hubo diferencias significativas en las actitudes (p > 0.05). Conclusión: Se deben desarrollar programas de educación médica para mejorar el conocimiento acerca de la EREA.