[Quasi-experimental study of an intervention on the pharmacological management of non-oncological chronic pain in Primary Care]. / Estudio cuasi experimental de una intervención sobre el manejo farmacológico del dolor crónico no oncológico en atención primaria.

OBJECTIVE: To analyse the impact of a formative / informative intervention on the treatment of non-oncological chronic pain in Primary Care. DESIGN: Quasi-experimental study before-after, and follow-up of the patient cohort. LOCATION: 64 Primary Care teams/centres (770 physicians). PARTICIPANTS: Patients≥14 years without an oncological diagnosis on: 1) fentanyl citrate, 2) major opioids and≥2 anxiolytics-hypnotics, 3) long-term major and minor opioids, 4) transdermal lidocaine, out of indication. INTERVENTION: Dissemination of recommendations for the treatment of non-oncological chronic pain and the reporting of the incidents of their patients to each doctor. MAIN MEASUREMENTS: Number of incidents in 2 cross sections (June 2017 and June 2018). Number of incidents in June 2017, which were maintained in June 2018 (prospective cohort). RESULTS: Of the 2,465 incidents detected in 2017, there was a 21.1% reduction after the intervention. The reduction was higher (61.8%, p<.001) in the prospective cohort. In absolute values, the most important reduction was in incidences of lidocaine patches outside of indication (1,032 incidences). The approved indication was found in less than 8% of the treated patients. CONCLUSIONS: The intervention reduced the number of patients with incidences, and this reduction was higher in the prospective cohort, confirming the efficacy of sending information about patients with incidences to their physicians. The incorporation of new treatments during the follow-up year was significant, so these interventions should be perpetuated over time.

[Adequacy of treatment for osteoporosis in primary prevention. Quantitative and qualitative study]. / Adecuación del tratamiento de la osteoporosis en prevención primaria. Estudio cuantitativo y cualitativo.

OBJECTIVE: Quantitative study: To assess the prevalence of inadequacy of treatment for osteoporosis in primary prevention (OPP) in women aged 60-74years. Qualitative study: To evaluate the diagnostic and treatment criteria of the OPP and it's variability in primary care physicians (PC) and specialists. MATERIAL AND METHODS: Quantitative study: observational, cross-sectional and retrospective study. POPULATION: women aged 60-74years with active treatment for OPP (n=424) in May 2012. Inadequacy if they had ≤2 risk factors with a DXA or DXA T-score ≥-2.4. Qualitative study: Delphi technique (15items) and two rounds of consultation. PERIOD: March-April 2014. POPULATION: PC physicians, rheumatologists and orthopaedic surgeons (n=251). Random sampling. RESULTS: Quantitative study: degree of inadequacy is 63.4%. In 43.2% isn't mention a diagnosis of osteoporosis. In 82.3% there isn't mention of risk factors. TREATMENT: bisphosphonate 40.3% and calcium +vitaminD 47.9%. Qualitative study: 23% respond to the first round, and of these 67% the second round. Items with higher agreement were the important of the evaluation of risk factors for diagnosis and bisphosphonates for treatment. Items with fewer consensuses were using the FRAX and densitometry and treatment with only calcium +vitaminD. CONCLUSIONS: The percentage of inadequacy is high. The degree of registration in medical history is low. The Delphi method is useful for detecting discrepancies between recommendations of clinical practice guidelines and results.

[Experiencia en la vacunación frente a la COVID-19 en personas con antecedentes de alergia.] / Experience in vaccination against covid-19 in people with a history of allergy.

OBJECTIVE: A common consultation since the beginning of the vaccination campaign against COVID-19 was related to people with a history of allergy to drugs or other vaccines. The objective of the study was to describe what happened after the administration of the vaccine against COVID-19 in people with a history of moderate and severe allergy, vaccinated against COVID-19 in a Primary Care Emergency Center (PCEC). METHODS: Observational descriptive study with sixty-four people with a history of moderate and severe allergy was carried out, vaccinated in PCEP, between May and October 2021, in the Barcelonés Nord and Maresme (Barcelona province), after assessment by primary care pharmacologists and pharmacists. The percentage of people with adverse events that occurred after vaccination during their stay in the PCEP, the types detected and severity were calculated. Subsequently, a telephone survey was conducted to determine patient satisfaction. A descriptive analysis (calculation of proportions) was performed. RESULTS: The mean age of 49.7 years (from twelve to ninety-four years) and 90.6% were women. 87.5% of the administered vaccines were Comirnaty®. Adverse events occurring after vaccination were detected in fifteen patients (23.4%), of whom four (6.25%) were manifestations of hypersensitivity, all classified as mild. The reasons for vaccination were a history of allergy to NSAIDs (45.3%), antibiotics (32.8%), analgesics (17.2%), vaccines (28.1%), other substances (40.6%) and anaphylaxis (26.6%). The degree of general satisfaction was 9.11 (out of 10). CONCLUSIONS: The percentage of patients with a history of anaphylaxis and allergic drug reactions who present hypersensitivity reactions to COVID-19 vaccines is 6.25% and all are mild.

OBJETIVO: Una consulta habitual desde el inicio de la campaña de vacunación frente a la COVID-19 fue la relacionada con personas que tienen antecedentes de alergia a fármacos u otras vacunas. El objetivo del estudio fue describir lo ocurrido tras la administración de la vacuna frente a la COVID-19 en personas con antecedentes de alergia moderada y grave, en un Centro de Urgencias de Atención Primaria (CUAP). METODOS: Se realizó un estudio observacional descriptivo con sesenta y cuatro personas que tenían antecedentes de alergia moderada y grave, vacunadas en CUAP, entre mayo y octubre de 2021, en el Barcelonés Nord i Maresme (provincia de Barcelona), previa valoración por farmacólogos y farmacéuticos de Atención Primaria. Se calculó el porcentaje de personas con acontecimientos adversos ocurridos tras la vacunación en el transcurso de su estancia en el CUAP, los tipos detectados y la gravedad. Posteriormente, se realizó una encuesta telefónica para conocer la satisfacción de los pacientes. Se realizó un análisis descriptivo (cálculo de proporciones). RESULTADOS: La media de edad de las personas participantes fue de 49,7 años (de doce a noventa y cuatro años) y el 90,6% fueron mujeres. El 87,5% de las vacunas administradas fue Comirnaty®. Se detectaron acontecimientos adversos ocurridos tras la vacunación en quince pacientes (23,4%), de los que en cuatro casos (6,25%) fueron manifestaciones de hipersensibilidad, todas catalogadas como leves. Los motivos de vacunación fueron antecedentes de alergia a AINE (45,3%), antibióticos (32,8%), analgésicos (17,2%), vacunas (28,1%), otras sustancias (40,6%) y anafilaxia (26,6%). El grado de satisfacción general fue de 9,11 (sobre 10). CONCLUSIONES: El porcentaje de pacientes con antecedentes de anafilaxia y reacciones alérgicas a medicamentos que presentan reacciones de hipersensibilidad a las vacunas frente a la COVID-19 es del 6,25% y todas son leves.

Antidepressant Drugs and COVID-19: A Review of Basic and Clinical Evidence.

The COVID-19 pandemic has encouraged the repurposing of existing drugs as a shorter development strategy in order to support clinicians with this difficult therapeutic dilemma. There is evidence to support the theory that some antidepressants can reduce concentrations of different cytokines in humans and animals and, recently, the antiviral activity of some antidepressants against SARS-CoV-2 has been reported. The aims of this narrative review are to evaluate the possible role of antidepressants in the treatment of COVID-19 infection and the possible benefits and risks of patients taking antidepressants for mental disorders and COVID-19 infection. A review was performed to analyse the current literature to identify the role of antidepressant medication in the treatment of COVID-19 patients. The electronic search was completed in MEDLINE and MedRxiv/BioRxiv for published literature and in ClinicalTrials.gov for ongoing clinical trials. The results show some evidence from preclinical data and observational studies about the possible efficacy of some specific antidepressants for treating COVID-19 infection. In addition, two published phase II studies testing fluvoxamine showed positive results for clinical deterioration and hospitalization rate versus a placebo. Seven ongoing clinical trials testing fluvoxamine, fluoxetine, and tramadol (as per its anti-inflammatory and antidepressant effect) are still in the early phases. Although the available evidence is limited, the sum of the antiviral and anti-inflammatory preclinical studies and the results from several observational studies and two phase II clinical trials provide the basis for ongoing clinical trials evaluating the possible use of antidepressants for COVID-19 infection in humans. Further investigations will be needed to support the possible use of antidepressants for this application.