Human ; Family Practice ; Medicine ; Case Reports

Human ; Primary Health Care ; Review

The growing population of senior citizens in the Philippines faces increased vulnerability to co-existence of two or more chronic diseases, highlighting the complex interplay of health, socioeconomic, and healthcare access challenges in this age group. This case report presents a 71-year-old Filipino female from Barangay Bunuanan, Catbalogan City, Samar, diagnosed with hypertension, gout, and diabetes mellitus. The patient experiences difficulties common to elderly individuals in the Philippines, including financial limitations and managing multiple chronic illnesses. Laboratory tests revealed elevated blood uric acid, borderline high lipid profile, and an HbA1c level indicative of poor glycemic control. The case highlights the complexity of multimorbidity in the elderly and the impact of socioeconomic factors on disease management.

A 26-year-old Filipino woman, gravida 4 para 0 (G4P0), with systemic lupus erythematosus (SLE) and lupus nephritis (LN), presented at 7 weeks of gestation. Her history included three previous pregnancy losses, including a stillbirth due to eclampsia. Following pregnancy confirmation, medications were adjusted to pregnancy-compatible immunosuppressants and antihypertensives. At 13 weeks, her disease remained quiescent, with persistent proteinuria and stable platelets. The patient remains under outpatient surveillance with plans for referral to tertiary maternal-fetal medicine (MFM) care. This case illustrates management challenges in lupus nephritis during pregnancy, emphasizing early risk stratification, safe pharmacotherapy, and coordinated multidisciplinary care in a low-resource setting.

Stroke remains a leading cause of long-term disability worldwide, demanding extensive and often prolonged rehabilitation. This case report describes the recovery of Mr. Julio, a 60-year-old male, who suffered an ischemic stroke at age 58, resulting in left-sided hemiparesis and balance issues. Even with delays in formal rehabilitation, he made a remarkable recovery over nearly three years. This is because of his strong intrinsic motivation, sustained adherence to therapy, and family support. His symptoms included left-sided weakness, numbness, vertigo, vomiting, and critically high blood pressure. Crucially, his diagnosis was confirmed by MRI only three months later and formal physical therapy started only after six months. Treatment included an emergency TPA, blood pressure control, antiplatelets, and a sustained home- based physical therapy regimen. This case highlights how patient-driven factors can lead to significant recovery even in resource-limited settings, emphasizing the role of motivation and adherence in long-term stroke rehabilitation.

This case study describes Mrs. CS, a 57-year-old grandmother with a 3-year history of Type 2 Diabetes Mellitus (T2DM), who came from a diabetic family and presented with blurry vision and fatigue. She was also diagnosed as hypertensive last year. She reported discontinuing all prescribed medications for five months, relying instead on decoctions of the Philippine serpentina plant (Andrographis paniculata) and the insulin plant (Chamaecostus cuspidatus) for blood pressure and glycemic control due to budget constraints. An HbA1c test revealed hyperglycemia (7.5%). This case highlights the critical public health challenge of medication non-adherence in T2DM patients, particularly those influenced by traditional herbal remedies. It emphasizes the significant risks of relying on unproven therapies, the resulting poor glycemic control, and the potential for severe microvascular complications like diabetic retinopathy. The report emphasizes the urgent need for comprehensive patient and family education regarding evidence-based T2DM management, the dangers of unsupervised medication cessation, and the importance of professional medical consultation to integrate any complementary therapies safely.

Dropped head syndrome is a rare condition characterized by the inability to maintain an upright head posture. It is commonly associated with neuromuscular disorders and is more frequently observed among the elderly population. While the exact cause of dropped head syndrome can vary, one potential cause is electrolyte imbalance, specifically hypokalemia, which can be induced by chronic alcoholism. Chronic alcohol use disorder could be traced back from psychosocial factors which can be identified by using various family assessment tools.

This is a case of a 40-year-old male who presented with a sudden inability to lift his head after a two-week long alcoholic beverage intake.

The case highlights the importance of the biopsychosocial approach in primary care, which offers holistic management by addressing not only medical problems but also the psychosocial factors that contribute to the patient’s clinical presentation.

Empyema Necessitans is a rare complication of Empyema Thoracis that is caused by a longstanding pleural infection such as persistent pleural effusion. It is caused by an extension of pus to nearby structures including the chest wall and is usually caused by Mycobacterium tuberculosis infection. It is difficult to diagnose since its features are similar to those of other disease entities such as malignancies; therefore, imaging tests such as a chest CT scan are helpful in establishing the diagnosis. In addition, other diagnostic tests such as acid-fast stain and GeneXpert may be falsely negative due to inadequate or incorrect sampling location. One such case is this 30-year-old female with chronic cough and recurrent pleural effusion that progressed to Empyema Necessitans presenting as an abdominal mass where sputum GeneXpert was negative, but aspirate of the abdominal mass showedMycobacterium tuberculosis. Prompt initiation of anti-tuberculosis treatment once diagnosis is confirmed as well as emphasizing its completion is imperative for definitive treatment. As such, family physicians have a vital role in navigating patients for further workup and necessary referrals for a multidisciplinary management especially in persistent disease processes as well as screening and treatment of the family for holistic care.

Low back pain is one of the most common reasons for consultation encountered in the primary care setting. The majority of cases are due to mechanical low back pain; however, proper evaluation is needed to identify patients who have secondary causes. This can be done through a focused history and physical examination using the Look-Move-Feel Approach as a guide. Identification of red flags suggests underlying pathology. The mnemonic BACK PAINS (Bladder/bowel incontinence, Age extremes, Chronic infection, Known Malignancy, Pain worse at night, Acute trauma, IV drug/Immunosuppression, Neurologic findings, and Systemic symptoms) can be used to remember red flags of low back pain. In general, patients with non-specific low back pain often require no imaging or work-up, while those with red flags warrant diagnostic investigation and possible referral.

Headaches are among the top reasons for consultation in primary care clinics and can be classified either as primary or secondary. Primary headaches are unrelated to any medical condition and usually benign in nature. Secondary headaches are caused by an underlying pathology or condition. The mnemonic “HEADACHES” may be used to remember the red flags and it includes: Headache of sudden onset, Elderly onset, Altered mental status or neurologic deficits, Different or new pattern, Associated systemic symptoms, Cancer or immunocompromised state, Headache with exertion or position change, Eye findings and Secondary risk factors. Patients presenting with red flags are suggested to have underlying causes or secondary headaches and presence of which warrants diagnostic investigation or referral to specialists. Diagnostic imaging is not routinely recommended for patients with headache unless presenting with red flags or with suspected underlying pathology.