Adherence to Inhalation Devices in Patients with Chronic Obstructive Pulmonary Disease.

Purpose: Chronic obstructive pulmonary disease (COPD) affects millions of people around the world. Poor adherence to treatment contributes to increased severity of symptoms, morbidity, and mortality. The objective of this study was to establish the adherence of patients diagnosed with COPD by their devices for inhalation in a group of patients, Colombia. Patients and Methods: This was a cross-sectional study of patients treated in the Colombian health system. Adherence to inhalation devices was evaluated with the TAI-10 instrument (Inhaler Adherence Test). A score of 50 points was considered good adherence. Results: A total of 500 patients from 84 cities were identified, with a median age of 79.0 years, and 59.2% were women. A total of 45% had GOLD B COPD, and 56.6% had good adherence. Average adherence was 47.4±5.3 points, and no significant differences were found according to inhalation devices (p=0.949). Training performed by specialist physicians (OR: 1.75; 95% CI: 1.17-2.62), use of an inhaler for less than 1 year (OR: 1.59; 95% CI: 1.04-2.43), use of short-acting ß2-adrenergic agonists (OR: 1.58; 95% CI: 1.05-2.38) and increased satisfaction with the inhalation device (OR: 1.09; 95% CI: 1.04-1.14) were associated with good adherence, while those from the central region (OR: 0.55; 95% CI: 0.36-0.83), who had a COPD evolution time of less than 5 years (OR: 0.57; 95% CI: 0.37-0.98) and had diabetes mellitus (OR: 0.60; 95% CI: 0.37-0.98) had lower adherence. Conclusion: Adherence to treatment with inhaled bronchodilators and glucocorticoids were not very high, with no significant differences by type of inhalation device. Satisfaction and training by specialists increased adherence.

Use Pattern of Ophthalmic Antiglaucoma Agents with and without Preservatives: A Cross-Sectional Study.

BACKGROUND: Different drugs have been approved to reduce the intraocular pressure. However, most of them contain preservatives to maintain sterility and these can be toxic to the ocular surface. The aim was to determine the patterns of use of antiglaucoma agents and ophthalmic preservatives in a group of patients from Colombia. METHODS: A cross-sectional study that identified ophthalmic antiglaucoma agents from a population database of 9.2 million. Sociodemographic and pharmacological variables were considered. Descriptive and bivariate analyses were performed. RESULTS: A total of 38,262 patients were identified, with a mean age of 69.2 ± 13.3 years, and 58.6% were women. A total of 98.8% were prescribed antiglaucoma drugs in multidose containers. The most widely used were prostaglandin analogs (59.9%), especially latanoprost (51.6%) and ß-blockers (59.2%). A total of 54.7% of patients received combined management, especially with fixed-dose combination (FDC) drugs (41.3%). A total of 94.1% used antiglaucoma drugs with preservatives (benzalkonium chloride, 68.4%). CONCLUSIONS: The pharmacological treatment of glaucoma was very heterogeneous, but the most commonly used therapeutic groups were in accordance with the recommendations of clinical practice guidelines but with differences by sex and age. Most of the patients were exposed to preservatives, especially benzalkonium chloride, but the wide use of FDC drugs can minimize toxicity on the ocular surface.

Use of Systemic Antibiotics in Patients with COVID-19 in Colombia: A Cross-Sectional Study.

Antibiotics are frequently prescribed to patients with COVID-19. The aim was to determine the pattern of use of systemic antibiotics in a group of patients diagnosed with COVID-19 in Colombia between 2020-2022. This was a descriptive cross-sectional study designed to identify antibiotics prescription patterns for patients diagnosed with COVID-19 treated in eight clinics in Colombia. The AWaRe tool of the World Health Organization (WHO) was used to classify the antibiotics. A total of 10,916 patients were included. The median age was 57 years, and 56.4% were male. A total of 57.5% received antibiotics, especially ampicillin/sulbactam (58.8%) and clarithromycin (47.9%). Most of the antibiotics were classified as Watch (65.1%), followed by Access (32.6%) and Reserve (2.4%). Men (OR: 1.29; 95%CI: 1.17-1.43), older adults (OR: 1.67; 95%CI: 1.48-1.88), patients with dyspnea (OR: 1.26; 95%CI: 1.13-1.41), rheumatoid arthritis (OR: 1.94; 95%CI: 1.17-3.20), and high blood pressure at admission (OR: 1.45; 95%CI: 1.29-1.63), patients treated in-hospital (OR: 5.15; 95%CI: 4.59-5.77), patients admitted to the ICU (OR: 10.48; 95%CI: 8.82-12.45), patients treated with systemic glucocorticoids (OR: 3.60; 95%CI: 3.21-4.03) and vasopressors (OR: 2.10; 95%CI: 1.60-2.75), and patients who received invasive mechanical ventilation (OR: 2.37; 95%CI: 1.82-3.09) were more likely to receive a systemic antibiotic. Most of the patients diagnosed with COVID-19 received antibiotics, despite evidence showing that bacterial coinfection is rare. Antibiotics from the Watch group predominated, a practice that goes against WHO recommendations.

Autoimmune Idiopathic Inflammatory Myopathies: Pharmacological Differences and Similarities by Type of Myositis and by Sociodemographic Variables.

Objective: Autoimmune idiopathic inflammatory myopathies (IIMs) are a group of pathologies that are generally characterized by muscle weakness. Their treatment involves glucocorticoids and immunosuppressants. The aim was to identify differences and similarities in the pharmacological management of a group of patients with autoimmune IIMs according to the type of disease, sex, age group, and city of residence in Colombia from 2020 to 2021. Methods: This cross-sectional study identified medication prescription patterns for outpatient use in patients with autoimmune IIMs between 2020 and 2021 based on a population database of 8.5 million Colombians affiliated with the Colombian health system. Sociodemographic and pharmacological variables were considered. Results: A total of 671 patients with autoimmune IIMs were identified, with a median age of 57 years, and 70.9% were women. Overlap myositis was the most frequent disease (31.4%). A total of 91.5% of the patients received pharmacological treatment, mainly systemic glucocorticoids (78.5%), conventional disease-modifying antirheumatic drugs (DMARDs) (74.1%), immunosuppressants (9.1%), and biological DMARDs (3.7%). Pharmacological management predominated among patients with overlap myositis, those who lived in cities, and those affiliated with the contributory regime of the Colombian health system. Conventional DMARDs were prescribed mainly to women and to those older than 65 years. Conclusions: Patients with autoimmune IIMs are not treated homogeneously. The pattern of drug use varies according to the type of IIM, sex, age group, city, and health system regime affiliation.

Mixoma auricular izquierdo gigante como causa de obstrucción de la válvula mitral e hipertensión pulmonar severa

Resumen: Los tumores cardíacos primarios son raros, representan el 0.0017-0.03% en grandes series de autopsias, ocurren con mayor frecuencia entre mujeres en la quinta o sexta década de la vida y generalmente se desarrollan en las aurículas. Se presenta el caso clínico de una paciente de sexo femenino de 74 años que consulta a urgencias con sospecha de síndrome coronario agudo sin elevación del segmento ST y troponinas positivas. El ecocardiograma transtorácico evidenció la presencia de un mixoma auricular gigante con área de 11 cm2, que protruye a través de la válvula mitral, una presión sistólica de la arteria pulmonar de 110 mmHg y un resultado de dímero D positivo dando como diagnóstico un mixoma auricular izquierdo gigante que causa obstrucción mitral e hipertensión pulmonar, el cual fue remitido a otra institución para manejo quirúrgico.

Abstract: Primary cardiac tumors are rare, accounting for 0.0017-0.03% in autopsy series, occur more frequently among women between the fifth and sixth decade of life. A 74-year-old female patient presented with symptoms of acute coronary syndrome without ST segment elevation and positive troponins. The transthoracic echocardiogram showed the presence of a giant atrial myxoma with an area of 11 cm2, protruding through the mitral valve, a systolic pressure of the pulmonary artery of 110 mmHg and a positive D-dimer result, yielding a diagnosis of a giant left atrial myxoma that causes mitral obstruction and pulmonary hypertension, being referred to another institution for surgical management.

Resumo: Os tumores cardíacos primários são raros, representam o 0,0017-0,03% em grandes séries de autópsias, ocorrem mais frequentemente entre mulheres na quinta ou sexta década de vida e geralmente se formam nos átrios. Apresentamos o caso de uma paciente do sexo feminino de 74 anos, que apresentou sintomas de síndrome coronário agudo sem elevação do segmento ST e troponinas positivas. O ecocardiograma transtorácico revelou a presença de um mixoma atrial gigante com área de 11 cm2 projetando-se através da válvula mitral, uma pressão sistólica de artéria pulmonar de 110 mmHg e um resultado de D-dímero positivo, dando o diagnóstico de um mixoma atrial esquerdo gigante causando obstrução mitral e hipertensão pulmonar, que foi encaminhado para outra instituição para manejo cirúrgico.