Integration of transthoracic focused cardiac ultrasound in the diagnostic algorithm for suspected acute aortic syndromes.

AIMS: The diagnosis of acute aortic syndromes (AASs) is challenging and requires integrated strategies. Transthoracic focused cardiac ultrasound (FoCUS) is endorsed by guidelines as a first-line/triage tool allowing rapid bedside assessment of the aorta. However, the performance of FoCUS in the European Society of Cardiology-recommended workup of AASs awaits validation. METHODS AND RESULTS: This was a prespecified subanalysis of the ADvISED multicentre prospective study. Patients with suspected AAS underwent FoCUS for detection of direct/indirect signs of AAS. Clinical probability assessment was performed with the aortic dissection detection risk score (ADD-RS). Case adjudication was based on advanced imaging, surgery, autopsy, or 14-day follow-up. An AAS was diagnosed in 146 (17.4%) of 839 patients. Presence of direct FoCUS signs had a sensitivity and specificity of 45.2% [95% confidence interval (CI) 37-53.6%] and 97.4% (95% CI 95.9-98.4%), while presence of any FoCUS sign had a sensitivity and specificity of 89% (95% CI 82.8-93.6%) and 74.5% (95% CI 71-77.7%) for AAS. The additive value of FoCUS was most evident within low clinical probability (ADD-RS ≤1). Herein, direct FoCUS signs were identified in 40 (4.8%) patients (P < 0.001), including 29 with AAS. ADD-RS ≤1 plus negative FoCUS for AAS rule-out had a sensitivity of 93.8% (95% CI 88.6-97.1%) and a failure rate of 1.9% (95% CI 0.9-3.6%). Addition of negative D-dimer led to a failure rate of 0% (95% CI 0-1.2%). CONCLUSION: FoCUS has additive value in the workup of AASs. Direct FoCUS signs can rapidly identify patients requiring advanced imaging despite low clinical probability. In integrated bundles, negative FoCUS is useful for rule-out of AASs.

Estadio clínico del cáncer de mama y nivel socioeconómico en el partido de General Pueyrredón, Argentina, 2013 / Clinical stage of breast cancer and socioeconomic status in General Pueyrredón, Argentina,2013

INTRODUCCIÓN: el acceso a los servicios de salud y laarticulación entre diagnóstico y tratamiento pueden explicar diferenciasen la supervivencia por cáncer de mama (CM) en las regionescon bajos indicadores socioeconómicos. OBJETIVOS: Identificardiferencias clínico-epidemiológicas al diagnóstico de CM según sectorde atención de la salud (público o privado) en el Partido de GeneralPueyrredón (PGP), Buenos Aires, durante 2013. MÉTODOS: Serealizó un estudio transversal de casos incidentes de CM infiltrante enmujeres residentes en PGP. Las variables fueron: sector de atención,estadio clínico y edad. Se ajustó un modelo de regresión logística:estadio (variable dependiente) agrupado como avanzado/tempranoy sector de atención público/privado (variable independiente), concontrol por edad. RESULTADOS: Se identificaron 413 casos: 11,4% delsector público (SPb) y 88,6% del privado (SPr). El 63% se diagnosticóen estadios tempranos. En el SPb se observó 4,4 (OR) veces másriesgo de estadio avanzado (p=0,001) y menor promedio de edadque en el SPr (p<0,05). CONCLUSIONES: El mayor riesgo de estadioavanzado en el SPb podría relacionarse con múltiples causas (entreellas, obstáculos al diagnóstico precoz y factores conductuales). Lamenor edad observada en el SPb podría deberse, en parte, al menorporcentaje de mujeres mayores y al subdiagnóstico. Este trabajo aportavaliosa información de base poblacional para conocer desigualdadessociales que influyen en la atención del CM.

INTRODUCTION: differences in survival of women withbreast cancer (BC) in regions with bad socioeconomic (SE) indicatorsmay be explained through the access to health services andthe coordination between diagnosis and treatment. OBJECTIVES:To identify epidemiological and clinical differences for BC diagnosisaccording to public (PU) or private (PR) health care sector in GeneralPueyrredón (PGP), Buenos Aires, during 2013. METHODS: Across-sectional study was performed, focusing on invasive BC casesdiagnosed in 2013 in women living in PGP. The variables were: healthcare sector, clinical stage and age at diagnosis. A logistic regressionmodel was adjusted with stage at diagnosis as dependent variable(grouped as early and advanced) and PU or PR health care sectoras independent variable, controlling by age. RESULTS: A total of 413cases were identified: 11.4% PU and 88.6% PR. Of them, 63% werediagnosed in early stages. The PU sector showed a risk of advancedstage 4.4 (OR) times higher (p=0.001) and lower average agethan the PR sector (p<0.05). CONCLUSIONS: The increased risk ofadvanced stage in PU sector could be related to multiple causesincluding barriers to early diagnosis and behavioral factors. Thelower average age in PU sector women could be partly attributed tothe lower percentage of old women and to under-diagnosis in thisgroup. This study provides valuable population-based informationto understand social inequalities that affect the attention of BC.