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Abstract Introduction: There has been a rising interest in ketamine as a promising treatment for refractory depression. Despite this, there is uncertain knowledge regarding aspects of the routinary use of ketamine for treating depression, such as optimal doses, long term toxicity, abuse potential in depressed patients, probable adverse effects associated with antidepressant drugs, the indication of ketamine in psychotic patients, and the ethical concerns of ketamine use. Clinical case: A 63 year-old woman with a psychotic depressive episode, catatonic features, cardiovascular disease (patent foramen ovale and atrial fibrillation) , and starvation risk because she refused food intake. She was sent to electroconvulsive therapy (ECT) after several weeks of oral administration of benzodiazepine, antipsychotic, and antidepressant medications; the patient presented no improvement, but she was rejected due to her cardiovascular comorbidity. Two IV Ketamine doses were used as a life-saving strategy with good clinical response, mainly in terms of the catatonic features. The ketamine treatment was not only effective but also well tolerated. Discussion: Despite the little information regarding its use in psychotic and catatonic patients, this case would suggest that it remains effective and safe, as well as a good option for patients with cardiovascular disease and those who cannot use electroconvulsive therapy.

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Leukoencephalopathy is a myelin disorder caused by multiple agents, including substance abuse. A 28-year-old man arrived at the emergency department having suffered from asthenia, dizziness, disorientation and ataxia for two months. He had a two-year history of heroin inhalation. He arrived in a normal physical condition. Brain magnetic resonance showed bilateral diffuse hypointense lesions in the white matter. At day 3 after admission, he presented neurological deterioration, stupor, haemodynamic instability, respiratory failure, and died. Toxic leukoencephalopathy symptoms start with inattention, memory and personality changes, and may eventually cause dementia and death. Heroin inhalation is a common practice and can lead to leukoencephalopathy. Leukoencephalopathy associated with heroin inhalation is a rare entity that mainly affects young adults and has a high social impact. Its aetiology is unclear, it has no effective treatment and there is a high mortality rate. Heroin consumption is on the rise in Colombia, so TL should be considered by medical staff.

La leucoencefalopatía es una patología de la mielina producida por múltiples agentes, incluidas las sustancias de abuso. Un varón de 28 años llegó urgencias por 2 meses de astenia, mareo, desorientación y ataxia. Tenía antecedentes de consumo inhalado de heroína por 2 años. Presentaba condiciones físicas regulares. La resonancia magnética cerebral mostró lesiones hipointensas difusas bilaterales en la sustancia blanca. Al tercer día presentó empeoramiento de su estado neurológico, estupor, inestabilidad hemodinámica, insuficiencia respiratoria y muerte. Los síntomas de leucoencefalopatía tóxica (LT) comienzan con falta de atención, cambios en la memoria y la personalidad, y finalmente demencia y muerte. El consumo de heroína inhalada es una práctica frecuente con riesgo de que produzca LT. La leucoencefalopatía asociada con el uso de heroína inhalada es una entidad rara que afecta principalmente a adultos jóvenes y tiene un alto impacto social. Su etiología no está clara, no tiene un tratamiento efectivo y tiene altas tasas de mortalidad. El consumo de heroína está aumentando en Colombia, por lo que el personal médico debe tener en cuenta la LT.

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BACKGROUND: Benzodiazepines have low abuse potential, but patients often develop physical dependence and neurological impairments. The objective of this study was to investigate treatment cessation and use of high doses in long-term benzodiazepine users in Colombia. METHODS: Retrospective study. Patients who used benzodiazepines for at least six months (long-term) were selected from a prescription database and followed from initiation of benzodiazepine treatment for up to 30 months. We investigated treatment duration and compared patients who received normal and high (≥2 mean prescribed daily dose) doses. RESULTS: Only 1255 (6.1 %) out of 20,567 patientsprescribed benzodiazepines became long-term users; their mean age was 60.6 years (SD=20.0) and 61.7 % were women. Mean high doses were used by 42.5 % (n=534) of the sample. Age under 20 years was a protector, whereas the long half-life benzodiazepines and use of other neurological medications were predictors of high dosage. Overall, 44.8 % (n=563) of the sample was still using benzodiazepines at the end of the study period. The use of antidepressants, antipsychotics, and anticonvulsants were negatively associated with cessation of benzodiazepine treatment. CONCLUSIONS: A low proportion of patients starting benzodiazepines became long-term users. Nearly half of them used high doses and continued the medication for up to 30 months. Use of concomitant neurological drugs was associated with higher doses and less cessation.

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INTRODUCTION: Recognizing adverse drug reactions (ADRs) is becoming more important in clinical practice.  OBJECTIVE: To determine the frequency of adverse drug reactions and ADR suspicions among the population affiliated to the Colombian health system and to describe the drugs, reactions and associated variables.  MATERIALS AND METHODS: We revised ADRs and ADRs suspicion databases from drugs dispensed by Audifarma, S.A., both for inpatient and outpatient care from 2007 to 2013. Variables included ADR report date, city, drug, drug's Anatomical Therapeutic Classification (ATC), ADR severity, ADR type, ADR classification and ADR probability according to the World Health Organization's definitions.  RESULTS: We obtained 5,342 reports for 468 different drugs. The ATC groups with the most reports were anti-infectives for systemic use (25.5%), nervous system agents (17.1%) and cardiovascular system drugs (15.0%). The drugs with the highest number of reports were metamizole (4.2%), enalapril (3.8%), clarithromycin (2.8%), warfarin (2.5%) and ciprofloxacin (2.4%). The most common ADR, classified following the World Health Organization adverse reaction terminology, were: skin and appendages disorders (35.3%), general disorders (14.2%) and gastrointestinal system disorders (11.8%). Overall, 49.4% of the ADRs were classified as "moderate" and 45.1% as "mild".  CONCLUSION: An increasing number of ADR reports were found coinciding with a worldwide tendency. Differences between inpatient and outpatient ADR reports were found when compared to scientific publications. The information on ADR reports, mainly gathered by the Instituto Nacional de Vigilancia de Medicamentos y Alimentos - Invima, should be made public for academic and institutional use.

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Introduction: Recognizing adverse drug reactions (ADRs) is becoming more important in clinical practice. Objective: To determine the frequency of adverse drug reactions and ADR suspicions among the population affiliated to the Colombian health system and to describe the drugs, reactions and associated variables. Materials and methods : We revised ADRs and ADRs suspicion databases from drugs dispensed by Audifarma, S.A., both for inpatient and outpatient care from 2007 to 2013. Variables included ADR report date, city, drug, drug´s Anatomical Therapeutic Classification (ATC), ADR severity, ADR type, ADR classification and ADR probability according to the World Health Organization´s definitions. Results : We obtained 5,342 reports for 468 different drugs. The ATC groups with the most reports were anti-infectives for systemic use (25.5%), nervous system agents (17.1%) and cardiovascular system drugs (15.0%). The drugs with the highest number of reports were metamizole (4.2%), enalapril (3.8%), clarithromycin (2.8%), warfarin (2.5%) and ciprofloxacin (2.4%). The most common ADR, classified following the World Health Organization adverse reaction terminology, were: skin and appendages disorders (35.3%), general disorders (14.2%) and gastrointestinal system disorders (11.8%). Overall, 49.4% of the ADRs were classified as "moderate" and 45.1% as "mild". Conclusion: An increasing number of ADR reports were found coinciding with a worldwide tendency. Differences between inpatient and outpatient ADR reports were found when compared to scientific publications. The information on ADR reports, mainly gathered by the Instituto Nacional de Vigilancia de Medicamentos y Alimentos - Invima , should be made public for academic and institutional use.

Introducción. La detección de las reacciones adversas a medicamentos es cada vez más importante en la práctica clínica. Objetivo. Determinar la frecuencia de reacciones adversas a medicamentos y de los casos sospechosos de tales reacciones, en la población afiliada al Sistema General de Seguridad Social en Salud de Colombia. Materiales y métodos. Se revisaron las bases de datos sistematizadas de reportes de sospecha de reacciones adversas a los medicamentos dispensados por la empresa Audifarma, S.A., para uso ambulatorio y hospitalario, entre 2007 y 2013. Las variables contempladas fueron: la fecha de radicación del reporte, la ciudad, el medicamento, la clasificación anatómica terapéutica del medicamento, la gravedad, el tipo de reacción adversa y su clasificación, así como la de su probabilidad de ocurrir, según las definiciones de la Organización Mundial de la Salud (OMS). Resultados. Se obtuvieron 5.342 reportes de sospecha de reacción adversa a 468 medicamentos diferentes. Los grupos con más reportes fueron los fármacos antiinfecciosos de uso sistémic (25,5 %) y los medicamentos para el sistema nervioso (17,1 %) y para el sistema cardiovascular (15,0 %). Los medicamentos con más reportes fueron: el metamizol (dipirona) (4,2 %), el enalapril (3,8 %), la claritromicina (2,8 %), la warfarina (2,5 %) y la ciprofloxacina (2,4 %). Las reacciones adversas a medicamentos más frecuentes, según la clasificación de la terminología sobre reacciones adversas de la OMS, fueron los trastornos de la piel y anexos (35,3 %), los trastornos generales (14,2 %) y los trastornos del sistema gastrointestinal (11,8 %). El 49,4 % de las reacciones adversas a medicamentos se catalogaron como moderadas y, el 45,1 %, como leves. Conclusiones. Se encontró un incremento de reportes de reacciones adversas a medicamentos en los últimos años, lo que concuerda con la tendencia mundial. Se evidenciaron diferencias entre los reportes hospitalarios y de consulta ambulatoria. La información sobre los reportes de reacciones adversas a medicamentos, sobre todo la recopilada por el Instituto Nacional de Vigilancia de Medicamentos y Alimentos (Invima), debería ser pública para su uso académico e institucional.

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Los trastornos de la conducta alimentaria (TCA) son la tercera enfermedad crónica más prevalente en adolescentes, por lo que se consideran un problema de salud pública.Objetivo: Determinar la prevalencia de trastornos de la conducta alimentariaen estudiantes de media académica de colegios públicos de la zona urbana dela ciudad de Pereira Métodos: Se realizó un estudio descriptivo con muestreo aleatorio mediante distribución proporcional entre los colegios públicos de la zona urbana de Pereira agrupados por sectores según su ubicación. Se aplicó la Encuesta de Comportamiento Alimentario (ECA).Resultados: Se encuestaron 382 estudiantes, 58,9% hombres. La ECA fue positiva en el 24,3% de los encuestados. Según el Índice de Masa Corporal el 9,7% de la población se encontraba en rangos de delgadez, 5,8% sobrepeso y 1,6% obesidad. Se encontró relación (p<0,05) entre el género femenino y la ECA positiva (RM=3,83), realización de dietas (RM=1,55), alteración de la auto imagen (RM=1,79), uso de laxantes (RM=2,58) e inducción del vómito (RM=4,41). El 33,4% reportó tener con alguna frecuencia episodios de consumo de grandes cantidades de alimentos acompañados de sensación de culpa.Discusión: Existen alteraciones comportamentales relacionadas con trastornos de la conducta alimentaria en esta población, por lo que es necesariogenerar programas de prevención y promoción de los TCA enfocados paraadolescentes...

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Malaria remains endemic in 21 countries of the American continent with an estimated 427,000 cases per year. Approximately 10% of these occur in the Mesoamerican and Caribbean regions. During the last decade, malaria transmission in Mesoamerica showed a decrease of ~85%; whereas, in the Caribbean region, Hispaniola (comprising the Dominican Republic [DR] and Haiti) presented an overall rise in malaria transmission, primarily due to a steady increase in Haiti, while DR experienced a significant transmission decrease in this period. The significant malaria reduction observed recently in the region prompted the launch of an initiative for Malaria Elimination in Mesoamerica and Hispaniola (EMMIE) with the active involvement of the National Malaria Control Programs (NMCPs) of nine countries, the Regional Coordination Mechanism (RCM) for Mesoamerica, and the Council of Health Ministries of Central America and Dominican Republic (COMISCA). The EMMIE initiative is supported by the Global Fund for Aids, Tuberculosis and Malaria (GFATM) with active participation of multiple partners including Ministries of Health, bilateral and multilateral agencies, as well as research centers. EMMIE's main goal is to achieve elimination of malaria transmission in the region by 2020. Here we discuss the prospects, challenges, and research needs associated with this initiative that, if successful, could represent a paradigm for other malaria-affected regions.

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INTRODUCTION: Self-medication is an increasingly frequent phenomenon worldwide; some studies suggest that there is a relationship with socio-economic and cultural factors. OBJECTIVE: To determine the prevalence of self-medication and its related factors in a Colombian city. MATERIALS AND METHODS: Cross-sectional descriptive study, in Pereira, Colombia. We selected 414 adults using simple randomization sampling with houses used as the observational unit. The IRIS-AM instrument was used to collect the information required. RESULTS: Four hundred and fourteen (414) people were interviewed, 62.6% were females, and mean age was 44 years; 77.5% of the sample had self-medicated at least once in their life and 31.9% during the last month. The most commonly used medications were: analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs and anti-rheumatic medication (36.4%), and anti-histamine medication (8.5%). The most commonly self-medicated symptoms were: headache (55.7%), cold (16.2%) and muscular pain (13.2%). Multivariate analysis revealed an association between self-medication throughout life and storing medications at home, and between a high level of education and having a favorable opinion of self-medication. Storing medications at home and recommending them to others were associated with self-medication during the previous 30 days. CONCLUSION: Self-medication rates were found to be similar to those reported globally, but there is not an established pattern for this practice. Associations were found between social and demographic variables and self-medication, which require further characterization. Intention to self-medicate has not been well-described in other studies, and may be an important indicator which will contribute to future understanding of this phenomenon.

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Introduction: Self-medication is an increasingly frequent phenomenon worldwide; some studies suggest that there is a relationship with socio-economic and cultural factors. Objective: To determine the prevalence of self-medication and its related factors in a Colombian city. Materials and methods: Cross-sectional descriptive study, in Pereira, Colombia. We selected 414 adults using simple randomization sampling with houses used as the observational unit. The IRIS-AM instrument was used to collect the information required. Results: Four hundred and fourteen (414) people were interviewed, 62.6% were females, and mean age was 44 years; 77.5% of the sample had self-medicated at least once in their life and 31.9% during the last month. The most commonly used medications were: analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs and anti-rheumatic medication (36.4%), and anti-histamine medication (8.5%). The most commonly self-medicated symptoms were: headache (55.7%), cold (16.2%) and muscular pain (13.2%). Multivariate analysis revealed an association between self-medication throughout life and storing medications at home, and between a high level of education and having a favorable opinion of self-medication. Storing medications at home and recommending them to others were associated with self-medication during the previous 30 days. Conclusion: Self-medication rates were found to be similar to those reported globally, but there is not an established pattern for this practice. Associations were found between social and demographic variables and self-medication, which require further characterization. Intention to self-medicate has not been well-described in other studies, and may be an important indicator which will contribute to future understanding of this phenomenon.

Introducción. La automedicación es un fenómeno cada vez más frecuente a nivel mundial. Los estudios en este campo sugieren que hay una relación entre la automedicación y diversos factores sociodemográficos y económicos. Objetivo. Determinar la prevalencia de la automedicación y los factores relacionados en Pereira, Colombia. Materiales y métodos. Estudio descriptivo de corte transversal llevado a cabo en la población de Pereira. Se hizo un muestreo aleatorio por afijación proporcional en 414 adultos, y se desarrolló y aplicó la encuesta IRIS-AM ( Instrument for Systematic Data Collection of Self-Medication ). Resultados. Se encuestaron 414 personas, 62,6 % de las cuales eran mujeres; el promedio de edad fue de 44 años. La prevalencia de la automedicación fue de 77,5 % a lo largo de la vida y de 31,9 % en los 30 días previos. Los medicamentos más comúnmente utilizados fueron los analgésicos y antipiréticos (44,3 %), los antiinflamatorios no esteroideos (36,4 %), y los antihistamínicos (8,5 %). Los síntomas que llevaron a la automedicación con mayor frecuencia fueron la cefalea (55,7 %), el resfriado (16,2 %) y el dolor muscular (13,2 %). Los análisis multivariados mostraron asociación entre la automedicación a lo largo de la vida y guardar medicamentos en casa, así como entre tener un nivel superior de escolaridad y estar a favor de la automedicación. Los factores referentes a almacenar medicamentos y recomendarlos a otros se asociaron con la automedicación en los 30 días previos. Conclusiones. La prevalencia de la automedicación hallada en este estudio fue similar a la reportada previamente a nivel mundial; aun así, no existe un patrón establecido para esta práctica. Se evidenciaron las variables sociodemográficas asociadas con la automedicación, las cuales requieren una mejor caracterización. La intención de recurrir a la automedicación ha sido poco estudiada y podría ser un indicador importante para la medición y comprensión de este fenómeno.

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INTRODUCTION: The prescription and costs of antiulcer medications for in-hospital use have increased during recent years with reported inadequate use and underused. AIM: To determine the patterns of prescription-indication and also perform an economic analysis of the overcost caused by the non-justified use of antiulcer medications in a third level hospital in Colombia. MATERIALS AND METHODS: Cross-sectional study of prescription-indication of antiulcer medications for patients hospitalized in "Hospital Universitario San Jorge" of Pereira during July of 2012. Adequate or inadequate prescription of the first antiulcer medication prescribed was determined as well as for others prescribed during the hospital stay, supported by clinical practice guidelines from the Zaragoza I sector workgroup, clinical guidelines from the Australian Health Department, and finally the American College of Gastroenterology Criteria for stress ulcer prophylaxis. Daily defined dose per bed/day was used, as well as the cost for 100 beds/day and the cost of each bed/drug. A multivariate analysis was carried out using SPSS 21.0. RESULTS: 778 patients were analyzed, 435 men (55.9 %) and 343 women, mean age 56.6 +/- 20.1 years. The number of patients without justification for the prescription of the first antiulcer medication was 377 (48.5 %), and during the whole in-hospital time it was 336 (43.2 %). Ranitidine was the most used medication, in 438 patients (56.3 %). The cost/month for poorly justified antiulcer medications was € 3,335.6. The annual estimated cost for inadequate prescriptions of antiulcer medications was € 16,770.0 per 100 beds. CONCLUSION: A lower inadequate prescription rate of antiulcer medications was identified compared with other studies; however it was still high and is troubling because of the major costs that these inadequate prescriptions generates for the institution.

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