RESUMEN
Pulmonary embolism is considered as a great masquerader due to its frequent nonspecific signs and symptoms. Typically pulmonary embolism is under-diagnosed or over-diagnosed. In this study a patient with pulmonary embolism is reported in which the patient exhibited two unusual manifestations namely; right upper quadrant abdominal pain and ST-T elevation in anterior precordial leads. Due to the fact that the patient did not display typical pulmonary embolism symptoms and its major risk factors, extensive workup to discern the cause was carried out. The examination included abdominal sonography, kidney ureter and bladder Computed Tomography scan [CT-scan] and coronary angiography. Eventually after a six-day delay, pulmonary embolism was diagnosed by spiral chest CT scan. This case and several other similar reports underlines the fact that while various other common causes may exist for right upper abdominal pain, one should always consider pulmonary embolism as a possible cause especially when backed up with ECG finding
RESUMEN
To assess compliance with the American Society of Health-System Pharmacists [ASHP] guidelines of prophylactic antibiotic use in private hospitals in Shiraz, Iran. This cross-sectional study was performed using prospective data gathered from April to September 2010 in the surgical wards of all private hospitals in Shiraz. Administrative data, patient characteristics, and antibiotic prophylaxis criteria were collected. Adherence to five criteria according to ASHP guidelines was evaluated: justification of the use of prophylactic antibiotics, appropriateness of the agent, dose, initiation time, and duration of the agent's effect. Only if all of the above criteria were fulfilled would the individual be labeled as completely compliant. We used descriptive analysis, including frequencies, to evaluate the results. From April to September 2010, 365 patients from 63 surgical wards of eleven private hospitals were enrolled in our study. Prophylactic antibiotics were inappropriately given to 64.6% of patients. Twenty out of 26 patients did not receive an appropriate course of antibiotics. In cases requiring antibiotic prophylaxis per ASHP guidelines, antibiotic choice was concordant in 32 [25.4%] out of 126 procedures. In cases that required and received prophylactic antibiotics, the duration and initiation time of prophylaxis were concordant with the guidelines for 37 [29.4%] and 77 [61.1%] cases, respectively. The overall compliance with ASHP guidelines was 10.13%.Our study revealed that in private hospitals in Shiraz, Iran, approximately 90% of patients received inappropriate surgical prophylaxis. Practical measures to improve the implementation of guidelines are urgently needed