RESUMEN

Objective: Acne is a chronic inflammatory disease that involves the pilosebaceous follicle. Its pharmacological treatment involves topical and systemic medications, but a heterogeneous group of drugs may exacerbate or induce skin lesions. The aim of this study was to identify the pharmacological management and medications related to the exacerbation of skin lesions in patients diagnosed with acne. Methods: This was a cross-sectional study that identified the outpatient medication prescription patterns of patients with acne from a dispensing database of 8.5 million members of the Colombian Health System. Sociodemographic and pharmacological variables and the identification of prescriptions that were potentially inappropriate due to the risk of worsening acne were considered. Results: A total of 21,604 patients with acne were identified. Median age was 20.8 years (interquartile range: 17.3-27.3 years), and 60.7 percent were female. Treatment mainly involved antibiotics (79.9% of patients), especially doxycycline (66.0%), and retinoids (55.7%). A total of 17.2 percent of patients had potentially inappropriate prescriptions, predominantly progestogens with androgenic properties (8.9%). Female patients (odds ratio [OR]: 3.55; 95% confidence interval [CI]:3.24-3.90) and patients with pathologies such as systemic lupus erythematosus (OR: 18.61; 95% CI: 7.23-47.93) and rheumatoid arthritis (OR: 10.80; 95% CI: 5.02-23.23) were more likely to receive inappropriate prescriptions, and the risk increased with each year of life (OR: 1.02; 95% CI: 1.02-1.03). Limitations: Access to medical records was not obtained to verify clinical characteristics of acne. Conclusion: Patients with acne are excessively treated with systemic antibiotics, counter to clinical practice guidelines. Approximately one-fifth of these patients received some potentially inappropriate medication that could exacerbate their skin lesions.

RESUMEN

Suicide is considered a Public Health issue. In 2019 the Colombian suicide rate was 5.8 per-100.000 inhabitant. Likewise, the Colombian Coffee Region has doubled the national average on these rates. On the other hand, the Pandemic COVID 19 socio-economic consequences are aggravating the risk factors that we've known about suicide. Objective: To evaluate the suicidal trend in the population of the Colombian Coffee Region during the COVID-19 pandemic and compare it with a non-pandemic period. Methods: The data were taken from the National Institute of Legal Medicine and Forensic Science for the suicidal events during the 2016-2020 period in the Colombian Coffee Region, and the Montecarlo Regression was applied using the JoinPoint Regression Program. Results: We found 1022 cases, most of them were men. The mean age was 34 years. The most used method was hanging in both sexes. Half of them had at least a high school degree. Half of the suicides were committed by single people. One-third of the cases had a previous mental illness. There are significant differences in the suicidal trend between the lockdown period and the non-lockdown period with a P value < 0.05. Conclusions: We found most suicidal cases between older men and an inversely proportional relationship between education and suicidal rate. Is interesting that the most applied method for suicide for both sexes was hanging. The suicidal trend was increasing until 2020, although in the lockdown we found a decrease. In the post-lockdown period for men was a posterior increase and for women the trend has a continued decrease.

RESUMEN

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.