A new standard scoring for interstitial pneumonia based on quantitative analysis of ultrasonographic data: A study on COVID-19 patients.

OBJECTIVE: To assess the effectiveness of 3 novel lung ultrasound (LUS)-based parameters: Pneumonia Score and Lung Staging for pneumonia staging and COVID Index, indicating the probability of SARS-CoV-2 infection. METHODS: Adult patients admitted to the emergency department with symptoms potentially related to pneumonia, healthy volunteers and clinical cases from online accessible databases were evaluated. The patients underwent a clinical-epidemiological questionnaire and a LUS acquisition, following a 14-zone protocol. For each zone, a Pneumonia score from 0 to 4 was assigned by the algorithm and by an expert operator (kept blind with respect to the algorithm results) on the basis of the identified imaging signs and the patient Lung Staging was derived as the highest observed score. The output of the operator was considered as the ground truth. The algorithm calculated also the COVID Index by combining the automatically identified LUS markers with the questionnaire answers and compared with the nasopharyngeal swab results. RESULTS: Overall, 556 patients were analysed. A high agreement between the algorithm assignments and the expert operator evaluations was observed, both for Pneumonia Score and Lung Staging, with the latter having sensitivity and specificity over 92% both in the discrimination between healthy/sick patients and between sick patients with mild/severe pneumonia. Regarding the COVID Index, an area under the curve of 0.826 was observed for the classification of patients with/without SARS-CoV-2. CONCLUSION: The proposed methodology allowed the identification and staging of patients suffering from pneumonia with high accuracy. Moreover, it provided the probability of being infected by SARS-CoV-2.

Assessment of antihypertensive drug use in primary care in Ravenna, Italy, based on data collected in the PANDORA project.

BACKGROUND: In the clinical-practice setting, only a small percentage of patients treated with antihypertensive drugs become normotensive. Furthermore, the diversity of drug classes used makes comparison of treatments difficult. OBJECTIVE: The goal of this study was to characterize the types and efficacy of antihypertensive treatments used in primary care in the area of Ravenna, Italy. The study was conducted in the context of the PANDORA Project, an open-ended global outcome study. METHODS: Data were gathered from general practitioners (GPs) and were stored by the GPs or through links with national health service databases. The population of interest was patients with essential hypertension taking antihypertensive medication, each of whom was observed for 365 days. Blood pressure was measured in the morning or afternoon using an automated device, in accordance with normal clinical practice. At each office visit, the GP reviewed and made any necessary adjustments to the patient's antihypertensive treatment. Antihypertensive drug use was assessed by calculating the mean daily dose (MDD) of the prescribed drug and the duration of treatment (DT). A DT > or = 273 days constituted continuous therapy, and a DT <273 days constituted discontinuous therapy. Adverse events were not collected. RESULTS: Twenty-one GPs took part in the study. The study population included 969 patients (443 men, 526 women), all of them white, whose ages ranged from 23 to 88 years. At enrollment, 327 patients were normotensive (blood pressure <140/90 mm Hg) and 642 were hypertensive despite drug treatment. More than 25 treatment regimens were identified. Over the course of follow-up, 49 patients had discontinuous therapy and 920 had continuous therapy. Among those who had continuous therapy, 117 (12.7%) took an MDD of <0.5 tablet/d; 297 (32.3%) took > or = 0.5 and <1 tablet/d; 364 (39.6%) took > or = 1 and <2 tablets/d; and 142 (15.4%) took > or = 2 tablets/d. At the end of the observation period, the proportion of normotensive patients had increased by 5.7% (P < 0.001). CONCLUSION: Based on the findings of this study, improper use of antihypertensive drug therapy appears to be one of the reasons for the relatively small proportion of patients who attain blood pressure control with treatment.