[Quality of care in patients with exacerbation of chronic obstructive pulmonary disease in Rasool-Akram and Firoozgar hospitals, Tehran, Iran]

To assess the quality of care in patient with acute exacerbation of chronic obstructive pulmonary disease [COPD] through comparison of provided care with recommendations of an evidence-based guideline. The index of quality of care [IQC] was defined as the percent of applicable grade A, B or C recommendations of the National Institute for Health and Clinical Excellence [NICE] guideline for each case. Then we made a data check list for patients' information according to guideline. A list of cases with COPD exacerbation who admitted in Rasool Akram of Firoozgar academic hospitals was provided and 101 cases were randomly selected. One of the investigators read all clinical records and compared the provided care with recommendations of the guideline. The IQC was estimated for all cases and compared in different subgroups. The average IQC was 88.4% [standard deviation: 14.8%]. Considering applicable recommendations for each case, concordance rate between practices and recommendations was 90.7% for grade A [95%CI: 87.8-93.6%], 84.9% for grade B [95%CI: 75.3-94.5%] and 79.1% for grade C [95%CI: 71.5- 86.7%]. The IQC was statistically higher in patients who discharged alive compared to deceased cases [87.4 vs. 74.6, P<0.05]. Considering greater IQC in patients who were discharged alive, it seems using evidence-based guideline has better outcomes for patient with COPD exacerbation; using such guidelines seems to be logical in academic hospitals

Antiphospholipid antibody syndrome presenting with pulmonary embolism

Antiphospholipid antibody syndrome [APS] is a recently-diagnosed syndrome presenting with arterial and venous thrombosis, recurrent miscarriages and thrombocytopenia in the presence of antiphospholipid antibodies.A 16- year-old man referred due to right sided chest pain, dyspnea and cyanosis of two fingers presented for 2 months. After a complete workup, diagnosis of pulmonary thromboembolism was confirmed through clinical examination, spiral chest CT-scan and lower limb Doppler sonography.He had positive anticardiolipin antibody, lupus anticoagulant, ANA and anti dsDNA. Based on these findings, diagnosis of APS [probably secondary to SLE] was made. Symptoms were improved by anticoagulant, prednisolone and chloroquine therapy. In a conclusion, pulmonary embolism may be the first presentation of APS, especially in young adults.