Lung ultrasonography in patients with COVID-19: comparison with CT.

AIM: To determine whether findings from lung ultrasound and chest high-resolution computed tomography (HRCT) correlate when evaluating COVID-19 pulmonary involvement. MATERIALS AND METHODS: The present prospective single-centre study included consecutive symptomatic patients with reverse transcription polymerase chain reaction (RT-PCR)-proven COVID-19 who were not in the intensive care unit. All patients were assessed using HRCT and ultrasound of the lungs by distinct operators blinded to each other's findings. The number of areas (0-12) with B-lines and/or consolidations was evaluated using ultrasound and compared to the percentage and classification (absent or limited, <10%; moderate, 10-25%; extensive, 25-50%; severe, 50-75%; critical, >75%) of lung involvement on chest HRCT. RESULTS: Data were analysed for 21 patients with COVID-19 (median [range] age 65 [37-90] years, 76% male) and excellent correlation was found between the ultrasound score for B-lines and the classification (p<0.01) and percentage of lung involvement on chest HRCT (r=0.935, p<0.001). In addition, the ultrasound score correlated positively with supplemental oxygen therapy (r=0.45, p=0.041) and negatively with minimal oxygen saturation at ambient air (r=-0.652, p<0.01). CONCLUSION: The present study suggests that among COVID-19 patients, lung ultrasound and HRCT findings agree in quantifying lung involvement and oxygen parameters. In the context of the COVID-19 pandemic, lung ultrasound could be a relevant alternative to chest HRCT.

Patient and provider perspectives on quality and health system effectiveness in a transition economy: evidence from Ukraine.

Facing a severe population health crisis due to noncommunicable diseases, Ukraine and other former Soviet republics and Eastern European countries have a pressing need for more effective health systems. Policies to enhance health system effectiveness should consider the perspectives of different stakeholder groups, including providers as well as patients. In addition, policies that directly target the quality of clinical care should be based on objective performance measures. In 2009 and 2010 we conducted a coordinated series of household and facility-level surveys to capture the perspectives of Ukrainian household members, outpatient clinic patients, and physicians regarding the country's health system overall, as well as the quality, access, and affordability of health care. We objectively measured the quality of care for heart failure and chronic obstructive pulmonary disease using CPV(®) vignettes. There was broad agreement among household respondents (79%) and physicians (95%) that Ukraine's health system should be reformed. CPV(®) results indicate that the quality of care for common noncommunicable diseases is poor in all regions of the country and in hospitals as well as polyclinics. However, perspectives about the quality of care differ, with household respondents seeing quality as a serious concern, clinic patients having more positive perceptions, and physicians not viewing quality as a reform priority. All stakeholder groups viewed affordability as a problem. These findings have several implications for policies to enhance health system effectiveness. The shared desire for health system reform among all stakeholder groups provides a basis for action in Ukraine. Improving quality, strengthening primary care, and enhancing affordability should be major goals of new health policies. Policies to improve quality directly, such as pay-for-performance, would be mutually reinforcing with purchasing reforms such as transparent payment mechanisms. Such policies would align the incentives of physicians with the desires of the population they serve.

Characteristics of lung cancer in elderly patients.

In order to assist in the definition of the natural history of lung cancer in the elderly population, a number of biological characteristics were studied, retrospectively, by comparing previously abstracted data from a cancer registry for three cohorts of patients: young (ages 40 to 50, n = 364), middle-aged (ages 51 to 69, n = 822), and elderly (ages 70 and above, n = 209). Compared to the younger cohort, the elderly cohort demonstrated more presenting symptoms of dyspnea, fewer symptoms of chest pain but a similar frequency of weight loss as a presenting sign. The elderly cohort contained more chronic, comorbid diseases but demonstrated more localized cancer and less metastatic disease compared to the younger cohorts. More than 80% of both groups did not undergo surgical resection. We conclude that elderly patients may be a relevant subgroup of lung cancer patients who must be included in studies of new strategies for disease detection, treatment, and management, and the identification of biological characteristics that could further define this high-risk subset of cancer patients.

Detection of bacterial cytotoxic activities from water-damaged ceiling tile material following incubation on blood agar.

Samples of ceiling tiles with high levels of bacteria exhibited cytotoxic activities on a HEP-2 tissue culture assay. Ceiling tiles containing low levels of bacterial colonization did not show cytotoxic activities on the HEP-2 tissue culture assay. Using a spread plate procedure on blood agar plates, the levels of bacteria colonizing portions of cellulosic indoor ceiling tiles were easily identified. Levels of bacteria measured by this simple procedure may be a good indicator of microbial colonization of indoor building materials especially in the case of water damage. We suggest that bacterial levels above 150 CFU g(-1) of ceiling tile material indicate colonization has occurred.

Quality of care in family planning services in Morocco.

This study was conducted to heighten awareness of quality of care as a programmatic issue in the Moroccan governmental family planning program and to test modified Situation Analysis instruments for measuring quality of care. Data were collected from 50 service-delivery points in five provinces to measure six elements of quality in accordance with the Bruce/Jain framework. A procedure for calculating quality-indicator scores is presented. Although facilities varied by province and within provinces, most had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service-delivery points scored well on mechanisms to ensure continuity of use. Notable shortcomings included a dearth of materials for counseling and a widespread unavailability of the Ovrette pill. This study raises issues regarding the complexity of measuring quality, the ownership of results, and the appropriateness of a centralized study of quality in a decentralized program.

PIP: The objective was to heighten the awareness of quality of care in the Moroccan government's family planning program and to test modified situation analysis instruments for its measurement. Data were collected from 50 service delivery points (SDPs) in 5 provinces to measure 6 elements of quality in accordance with the Bruce/Jain framework of quality of care. The 4 modules in the study were: 1) the inventory of each SDP (infrastructure, equipment, and supplies); 2) the observation guide for interaction between family planning clients and service providers; 3) the exit interview with clients attending the SDP; and 4) the interview with providers at the SDP. The data were collected for the provinces of Rabat, El Jadida, El Kalaa, and Tetouan in November and December 1992 and for Taroudant in January 1993. 80% of the 293 clients participating in the exit interviews were continuing users of family planning, while the remainder were either new users (15%) or discontinuers who returned (5%). The mean age of the clients was 32 years; 97% were in a monogamous marriage; 73% had no formal education, 12% had attained primary level, and 13% had secondary or university education. Housework was the principal activity of 75% of clients. The mean number of children reported was 3.4. The oral contraceptive Lo-Femenal was universally available in the facilities; and condoms were also widely available (90%). Only 49% of the SDPs offered IUDs. Ovrette pills were seldom available (22%), even though 1/3 of clients were breastfeeding. 70-100% of clients were able to obtain their selected contraceptive at the same facility. Most facilities had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; and the SDPs scored well on mechanisms to ensure continuity of use.

Chlorine inactivation of spores of Encephalitozoon spp.

This report is an extension of a preliminary investigation on the use of chlorine to inactivate spores of Encephalitozoon intestinalis and to investigate the effect of chlorine on two other species, E cuniculi and E. hellem, associated with human infection. The 50% tissue culture infective doses of these three species were also determined. On the basis of the results obtained, it appears that chlorination of water is an effective means of controlling spores of these organisms in the aquatic environment.