Impacto sanitario de la prohibición total de publicidades de tabaco en argentina.

Health impact of the total ban on advertising of tobacco productsThe objective was to estimate the health impact of the total ban on advertising of tobacco products in terms of avoided cardiovascular events in those over 35 years of age in Argentina.The Cardiovascular Disease Policy Model (CVDPM) was used, which is a Markov simulation model used to represent and project mortality and morbidity due to cardiovascular disease (CVD) in the population aged 35 or over. It constitutes a demographic-epidemiological model, which represents the population between 35 and 95 years of age and uses a logistic regression model based on the Framingham equation to estimate the annual incidence of cardiovascular disease. We assumed that implementing a complete ban on the advertising of tobacco products would lead to a 9% reduction in tobacco consumption.The complete ban on advertising could prevent 15,164 deaths over a period of 10 years, of which 2610 would be the result of coronary heart disease and 747 due to stroke. These reductions would mean an annual decrease of 0.46% of total deaths, 0.60% of deaths from coronary heart disease and 0.33% in deaths from stroke. In addition, during the same period, it would avoid 6630 acute myocardial infarctions and 2851 strokes (reductions of 1.35% and 0.40%, respectively).We hope that these findings might contribute to the strengthening of sanitary tobacco control policies in Argentina based on the remarkable benefits of banning the advertising of tobacco products in full and in line with current global recommendations.

Ecografía para la evaluación inicial de pacientes con sospecha de hidatidosis hepática / Ultrasound for the initial evaluation of patients with suspected hepatic hydatidosis

La hidatidosis o equinococosis quística es una infección endémica en varias regiones de Argentina. Su forma más frecuente, la hidatidosis hepática, suele ser asintomática por largos periodos de tiempo y, de presentar síntomas, los mismos suelen ser solapados, inespecíficos y crónicos. Por este motivo, los métodos complementarios de diagnóstico resultan indispensables en la valoración de estos pacientes. Entre ellos, la ecografía continúa siendo el método de elección con el que iniciar la evaluación ante la sospecha de hidatidosis hepática; otros métodos, como la serología, la tomografía computada o la resonancia magnética, pueden resultar de utilidad en casos específicos y siempre contextualizados por la clínica, epidemiología, y los hallazgos ecográficos. (AU)

Hydatidosis or cystic echinococcosis is an endemic infection in several regions of Argentina. Its most frequent form, hepatic hydatidosis, is usually asymptomatic for long periods of time and, if symptoms occur, they are usually overlapping, non-specific and chronic. For this reason, complementary diagnostic methods are essential in the evaluation of these patients. Among them, ultrasound remains the method of choice to initiate the evaluation of suspected hepatic hydatidosis; other methods, such as serology, computed tomography or magnetic resonance imaging, may be useful in specific cases and always contextualised by the clinical, epidemiology and ultrasound findings. (AU)

Sobreuso de mamografía para rastreo en un hospital académico de Buenos Aires / Overuse of screening mammography at an academic medical center in Buenos Aires

INTRODUCCIÓN: el rastreo de cáncer de mama en lapoblación general asintomática no está recomendado en mujeresmenores de 40 años y es controvertido en las de 40 a 49 años. Eluso inadecuado de mamografía con fines de rastreo (sobreuso) y suconsecuencia, el sobrediagnóstico, pueden conducir a tratamientosagresivos. OBJETIVO: Reportar la proporción de mamografíasinapropiadamente realizadas en mujeres menores de 50 añosafiliadas a un plan de salud de un proveedor de medicina prepaga.MÉTODOS: Se efectuó un estudio observacional de corte transversal.Se identificó a las mujeres de 18-39 y de 40-49 años afiliadas al plande salud del Hospital Italiano de Buenos Aires que se habían realizadoal menos una mamografía en 2012. Se revisaron las historiasclínicas de 200 pacientes en cada grupo de edad para determinarsi la mamografía había sido solicitada para rastreo de cáncer demama. RESULTADOS: Durante 2012, 1 533 mujeres de 18-39 añosse realizaron una mamografía. En 96 de las 200 historias revisadas,esta prueba había sido solicitada con fines de rastreo (48%; IC 95%:40,9-55,2%). Entre las mujeres de 40-49 años, 4 432 tenían unamamografía efectuada ese año. Se revisaron 199 historias clínicas;en 105 casos, el estudio había sido solicitado con fines de rastreo(52,8%; IC 95%: 45,6-59,9%). No se realizó ningún diagnóstico decáncer de mama como consecuencia de esta estrategia de rastreo.CONCLUSIONES: La alta proporción de sobreuso de mamografíapara rastreo es especialmente preocupante entre las mujeres másjóvenes y revela la dificultad que los médicos pueden tener paraadoptar las guías de práctica clínica más actualizadas.

INTRODUCTION: breast cancer screening in the generalasymptomatic population is not recommended in women youngerthan 40 years old, and it is controversial among women aged 40 to49 years. Overuse of screening mammography and its consequence,overdiagnosis, can lead to aggressive treatments. OBJECTIVE: To reportthe proportion of mammograms that were performed for breast cancerscreening among women younger than 50 years old enrolled in aprivate Health Insurance Plan in Buenos Aires, Argentina. METHODS:A cross-sectional observational study was performed. Among womenaged 18 to 39 and 40 to 49 years old enrolled in a private health plan(Hospital Italiano de Buenos Aires), those with a mammogram conductedin 2012 were identified. Of them, 200 in each age group wererandomly selected. Their medical charts were reviewed to determine ifthe mammography had been performed for breast cancer screeningpurposes. RESULTS: During 2012, 1533 women aged 18 to 39 years oldhad a mammogram conducted. Of them, 200 charts were reviewed, 96of which were determined to have a screening mammography (overuseproportion: 48%; 95% CI: 40.9-55.2%). Among women aged 40 to49, 4 432 had a mammography performed during 2012. The chartsof 199 of these women were reviewed. The mammogram had beenconducted for screening purposes in 105 cases (overuse proportion:52.8%; 95% CI: 45.6-59.9%). There was no diagnosis of breast canceras a result of these screening mammograms. CONCLUSIONS: Thishigh overuse of screening mammography is particularly concerningamong the younger women and highlights the difficulty physiciansmay have to adopt the most updated guidelines.