OBJECTIVES: To describe the clinical course and treatment response of a case of thrombotic thrombocytopenic purpura (TTP) after a month of therapeutic plasma exchange (TPE) and immunosuppressive agents and to review related published literature regarding TTP and its response to TPE and immunosuppressive agents.
CASE AND DISCUSSION: A 64-year-old female presented with fever, bicytopenia, change in sensorium, and seizure of one day duration. Metabolic panel showed normal electrolytes with normal brain imaging. Hematologic work-up showed anemia, thrombocytopenia and leukocytosis with normal differential count. Reticulocyte was elevated. Peripheral smear showed significant schistocytes with nucleated red blood cells and marked thrombocytopenia. Thrombotic thrombocytopenic purpura was the initial consideration with the fulfilment of four out of the pentad of TTP, namely: microangiopathichaemolytic anemia, thrombocytopenia, fever and neurologic symptoms. Therapeutic plasma exchange was immediately initiated with daily platelet count and Lactate dehydrogenase (LDH) determination to assess response. However, despite daily plasma exchanges and continuous plasma infusion, there was inadequate response. In this light, immunosuppressive agents were started in the following order: high dose methylprednisolone, weekly rituximab and intravenous cyclophosphamide. On the 31st hospital day, after daily TPE and combined immunosuppression, she achieved complete response with a platelet count of 170 X 109/L to 250 X 109/L (baseline-14 X 109/L) and LDH 227U/L (baseline-1,191 U/L).
CONCLUSION: This study presented a challenging case of TTP which was successfully treated with the standard of care together with the available adjunctive treatment options.

Human ; Female ; Middle Aged ; Plasma Exchange ; Purpura, Thrombotic Thrombocytopenic ; Rituximab ; Thymidine 5'-triphosphate ; Lactate Dehydrogenase 1 ; Isoenzymes ; L-lactate Dehydrogenase ; Anemia

Disasters are frequently experienced in the Philippines with detrimental impact to hospitals and its vulnerable population. Nurses, who are front liners in hospitals during disasters, must be familiar in disaster management. This study determined the extent of familiarity on disaster preparedness of nurses in hospitals, and the significant difference when grouped according to years of experience, position and area of assignment. A quantitative descriptive method was employed, wherein the EPIQ (Emergency Preparedness Information Questionnaire) was used. Nurses with more than one year of experience were selected using simple random sampling. T-test and F-test were employed. Findings revealed that nurses were moderately familiar on disaster preparedness and there was a significant difference in all variables. Nurses in hospitals have more to learn on disaster preparedness. The need for continuing education is recommended. Future researches may be done on unaccounted for factors from this study like gender or type of institution using objective-type questionnaire.

Human ; Male ; Female ; Civil Defense ; Vulnerable Populations ; Disasters ; Hospitals ; Education, Continuing ; Surveys And Questionnaires

Herlyn Werner Wunderlich Syndrome is a rare congenital Mullerian anomaly that commonly presents with uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis. Presented here is a rare variant with contralateral dysplastic kidney with ectopic ureteral insertion instead of renal agenesis. The patient initially presented as a case of recurrent pelvic inflammatory disease who eventually underwent excision of vaginal septum with drainage of pyocolpos. Postoperatively, the patient had urinary incontinence and was eventually referred to Urology for further surgical intervention. The wide range of symptomatology and the uncommon anatomic presentation of this case led to the delay in the diagnosis and the consequent gynecologic complications.
Uterine Anomalies

It is the practice in most health care institutions in our country to have patients for elective surgery evaluated pre-operatively by Internists and Anesthesiologists. Practitioners don’t seem to agree on how this is to be carried out. Each institution has its own protocol and even individual physicians have their own preference, which they have learned either during their training or from experience. Physicians usually request for preoperative tests for patients undergoing elective surgery in order to minimize risk, and to serve as a baseline to detect subsequent changes. Several authors agree to this as the goal of pre-operative evaluation. This is being done to identify risk factors and to screen broadly for undiagnosed disease. Undiagnosed clinical conditions are correlated with the risk of complications during the perioperative period. This then allows the physician to identify patients with increased risk of morbidity and mortality, and to help them design preoperative strategies that can reduce these risks. These tests can be helpful to stratify risk and guide postoperative management; however, most of them are obtained because of protocol rather than medical necessity. Majority of surgeries performed are non-cardiac in nature. Mortality rates for these procedures can be as high as 4% depending on the patient’s risk and type of surgery. Cardiovascular complications account for half of all morbidities and mortalities in the perioperative period for patients undergoing non-cardiac surgery.
Human ; Male ; Female ; Adult ; Elective Surgical Procedures ; Preoperative Care ; Surgeons ; Universities