Chronic pain and continuity of analgesic treatment during the COVID-19 pandemic.

INTRODUCTION: Chronic pain can trigger both physical and mental health complications. During the COVID-19 pandemic, patients with chronic diseases have had reduced access to some medications. OBJECTIVE: To determine the pharmacological management of patients with chronic pain and its continuity during the COVID-19 pandemic. METHODS: This was a retrospective longitudinal study of the continuity of analgesic use in patients with chronic pain between September 1, 2019 and February 28, 2021 based on a drug dispensing database. Survival analysis was performed until the discontinuation of chronic analgesics. RESULTS: A total of 12,701 patients who were being treated for chronic pain were identified. Their median age was 70.3 years, and 74.4% were women. The pain of rheumatological origin was the most frequent etiology (46.1%); the most used medications were nonopioid analgesics (78.9%), pain modulators (24.8%) and opioid analgesics (23.3%). A total of 76.1% of the patients experienced interruptions in their management during the study period. The median time to the first interruption of treatment was 5.0 months (95% CI: 4.8-5.2). Those who were treated for oncological pain experienced a greater number of interruptions in their management. CONCLUSIONS: The pharmacological management of patients with chronic pain is heterogeneous, and this real-world study showed that a high proportion of patients experienced an interruption of pain management during the 12 months following the onset of the COVID-19 pandemic.

Incidence and factors related to SARS-CoV-2 infection in a cohort of patients with rheumatoid arthritis from a health service provider in Colombia during the COVID-19 pandemic.

Background: Patients with rheumatoid arthritis (RA) have an increased risk of SARS-CoV-2 infection due to intrinsic characteristics of the pathology and the medications used to treat it. The aim was to evaluate the incidence of and factors related to SARS-CoV-2 infection in patients with RA in Colombia. Methods: This was an observational study of patients diagnosed with RA who were treated at a health care institution in Colombia. The study evaluated whether the patients presented SARS-CoV-2 infection and other clinical variables. Variables associated with the risk of SARS-CoV-2 infection were identified. Results: A total of 2566 patients with RA were identified. They had a median age of 61.9 years, and 81.1% were women. They were mainly treated with synthetic disease-modifying antirheumatic drugs (DMARDs) (85.3%), glucocorticoids (52.2%), and biological DMARDs (26.8%). The incidence of SARS-CoV-2 infection was 5.1%, and the factors that increased the risk included treatment with synthetic DMARDs with or without biological DMARDs but with concomitant systemic glucocorticoids [odds ratio (OR): 2.18, 95% confidence interval (CI): 1.21-3.93 and OR: 1.69, 95% CI: 1.05-2.74, respectively] and receiving antidiabetic drugs (OR: 2.24, 95% CI: 1.27-3.94). A total of 20.8% of patients with COVID-19 required hospitalization and 3.8% died. Conclusion: The incidence of COVID-19 is higher among patients with RA who receive DMARDs and glucocorticoids simultaneously or who have diabetes mellitus than among patients with RA not receiving these drug combinations, which should guide treatment strategies.

Use of Drugs Associated with QT Interval Prolongation at the Hospital Level during the COVID-19 Pandemic in Colombia

Background Many of the therapeutic proposals for COVID-19 have been associated with adverse effects, including the risk of QT interval prolongation and torsades de pointes (TdP). The objective was to determine the use of drugs with a risk of QT interval prolongation in 21 clinics/hospitals in Colombia from January to December 2020. Methods This cross-sectional study identified drug use according to pharmacological groups with potential risk of QT interval prolongation according to a risk classification: conditional, possible, and known risk of TdP. Descriptive analyses were performed. Results A total of 355,574 patients who received QT-prolonging drugs were identified (equivalent to 51.4% of all inpatients treated during the study period). Of the group of patients on QT drugs, 54.4% used at least one drug with conditional risk, 52.6% with possible risk, and 40.3% with known risk. The most commonly used belonged to the group of drugs for the nervous system (63.0%), alimentary tract and metabolism (56.8%), anti-infectives for systemic use (13.0%), and the cardiovascular system (11.7%). On average, patients received 2.0 ± 1.5 risk drugs. Regarding drugs initially considered against COVID-19, 2,120 patients (0.6%) received azithromycin, 802 (0.2%) received chloroquine, 517 received hydroxychloroquine (0.1%), and 265 received lopinavir/ritonavir (0.1%). Conclusion The high proportion of patients treated at the hospital level who receive drugs with risk of prolonging the QT interval should alert those responsible for their care to avoid fatal outcomes, especially during the COVID-19 epidemic, when some QT drugs are being used more frequently.

Study of the indications for macrolide prescriptions in a Colombian population / Indicación y prescripción de macrólidos en una población colombiana

Introduction: The inappropriate use of antibiotics is associated with a greater risk for antimicrobial resistance, high health care costs, adverse events, and worse clinical outcomes. Objective: To determine the prescription patterns and approved and nonapproved indications for macrolides in a group of patients from Colombia. Materials and methods: This was a cross-sectional study on the indications for the use of macrolides in outpatients registered in a drug-dispensing database of approximately 8.5 million people affiliated with the Colombian health system. Sociodemographic, pharmacological, and clinical variables were considered. Results: A total of 9.344 patients had received a macrolide prescription; their median age was 40.1 years (interquartile range: 27.1-53.3 years) and 58.3% were women. The most commonly prescribed macrolide was azithromycin (38.8%) most frequently for Helicobacter pylori infection (15.9%) and pneumonia treatment (15.8%). A total of 31.3% of the prescriptions were used for unapproved indications: common cold (7.8%), COVID-19 (4.0%), and acute bronchitis (3.5%). Residence in the Caribbean region (OR=1.17; 95%CI 1.05-1.31), dental prescriptions (OR=2.75; 95%CI 1.91-3.96), presence of chronic respiratory comorbidities (OR=1.30; 95%CI 1.08-1.56), and prescription of erythromycin (OR=3.66; 95%CI 3.24-4.14) or azithromycin (OR=2.15; 95%CI 1,92-2.41) were associated with a higher probability of macrolide use for unapproved indications while being 18-64 years old (OR=0.81; 95%CI 0.71-0.93) or 65 years or older (OR=0.77; 95%CI 0.63-0.94) and residing in Bogotá-Cundinamarca (OR=0.74; 95%CI 0.65-0.85) were associated with reduced risk. Conclusions: Most patients received macrolides for respiratory tract infections; erythromycin and azithromycin were used for unapproved indications in people under 18 years of age and those with chronic respiratory diseases.

Introducción. El uso inadecuado de antibióticos se asocia con aumento de la resistencia antimicrobiana, mayores costos de atención médica, más efectos adversos y peores resultados clínicos. Objetivo. Determinar los patrones de prescripción y las indicaciones aprobadas y no aprobadas para macrólidos en un grupo de pacientes en Colombia. Materiales y métodos. Se hizo un estudio de corte transversal sobre las indicaciones de uso de macrólidos en pacientes ambulatorios a partir de una base de datos de dispensación de medicamentos de 8,5 millones, aproximadamente, de personas afiliadas al sistema de salud de Colombia. Se consideraron variables sociodemográficas, farmacológicas y clínicas. Resultados. Se encontraron 9.344 pacientes que habían recibido prescripción de macrólidos; su mediana de edad era de 40,1 años (rango intercuartílico: 27,1-53,3 años) y el 58,3 % correspondía a mujeres. El macrólido más prescrito fue la azitromicina (38,8 %) y los usos más frecuentes fueron el tratamiento de la infección por Helicobacter pylori (15,9 %) y la neumonía (15,8 %). El 31,3 % de las prescripciones correspondía a indicaciones no aprobadas, destacándose el resfriado común (7,8 %), la Covid-19 (4,0 %) y la bronquitis aguda (3,5 %). La residencia en la región Caribe (OR=1,17; IC95% 1,05-1,31), las prescripciones odontológicas (OR=2,75; IC95% 1,91-3,96), las comorbilidades respiratorias crónicas (OR=1,30; IC95% 1,08-1,56), y la prescripción de eritromicina (OR=3,66; IC95% 3,24-4,14) o azitromicina (OR=2,15; IC95% 1,92-2,41), se asociaron con una mayor probabilidad de recibir macrólidos para indicaciones no aprobadas, en tanto que tener entre 18 y 64 años (OR=0,81; IC95% 0,71-0,93), 65 o más años (OR=0,77; IC95% 0,63-0,94) y residir en Bogotá-Cundinamarca (OR=0,74; IC95% 0,65-0,85) reducían dicho riesgo. Conclusiones. La mayoría de los pacientes recibieron macrólidos para infecciones del sistema respiratorio; la eritromicina y la azitromicina se prescribieron en indicaciones no aprobadas en menores de 18 años y en quienes presentaban enfermedades respiratorias crónicas.

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.

Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, and several sociodemographic variables, comorbidities and care variables have been associated with complications and mortality. OBJECTIVE: To identify the factors associated with admission to intensive care units (ICUs) and mortality in patients with COVID-19 from 4 clinics in Colombia. METHODS: This was a follow-up study of a cohort of patients diagnosed with COVID-19 between March and August 2020. Sociodemographic, clinical (Charlson comorbidity index and NEWS 2 score) and pharmacological variables were identified. Multivariate analyses were performed to identify variables associated with the risk of admission to the ICU and death (p<0.05). RESULTS: A total of 780 patients were analyzed, with a median age of 57.0 years; 61.2% were male. On admission, 54.9% were classified as severely ill, 65.3% were diagnosed with acute respiratory distress syndrome, 32.4% were admitted to the ICU, and 26.0% died. The factors associated with a greater likelihood of ICU admission were severe pneumonia (OR: 9.86; 95%CI:5.99-16.23), each 1-point increase in the NEWS 2 score (OR:1.09; 95%CI:1.002-1.19), history of ischemic heart disease (OR:3.24; 95%CI:1.16-9.00), and chronic obstructive pulmonary disease (OR:2.07; 95%CI:1.09-3.90). The risk of dying increased in those older than 65 years (OR:3.08; 95%CI:1.66-5.71), in patients with acute renal failure (OR:6.96; 95%CI:4.41-11.78), admitted to the ICU (OR:6.31; 95%CI:3.63-10.95), and for each 1-point increase in the Charlson comorbidity index (OR:1.16; 95%CI:1.002-1.35). CONCLUSIONS: Factors related to increasing the probability of requiring ICU care or dying in patients with COVID-19 were identified, facilitating the development of anticipatory intervention measures that favor comprehensive care and improve patient prognosis.