BACKGROUND: Dengue Hemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS) occurs only in a small number of dengue fever (DF).This condition,when coupled with a form of congenital hemolytic nemia called Hereditary Spherocytosis (HS), will turn a relatively manageable case of DF into a complicated condition with very poor prognosis.

CASE PRESENTATION: Here we report a case of a 19-year-old male student from Manila who came in with fever,jaundice, and dengue warning signs. He was also diagnosed with HS. This compounding infection initiated a hemolytic crisis of his HS, causing severe bleeding and multiple organ failure on top of DHF/DSS. The progression of the disease started with bleeding, and later on with altered sensorium (encephalopathy), respiratory failure, and ultimately, demise.

CONCLUSION: DHF/DSS together with HS may cause a hemolytic crisis. High RBC turnover and heightened erythroid marrow activity in HS makes a patient vulnerable to develop aplastic crisis due to dengue virus infection. Erythroid marrow failure may result in profound anemia, heart failure, hypoxia, cardiovascular collapse, and death.

Human ; Male ; Adult ; Severe Dengue ; Patients ; Dengue ; Death

BACKGROUND: Pregnancy has been associated with differences in thyroid function.1 Maternal thyroid dysfunction has been shown to be associated with fetal and obstetric complications and prompt management is of importance. It has thus been recommended by the British and American Thyroid Association11,12 that trimester-specific thyroid function test reference ranges be used in the assessment of thyroid dysfunction. Normative values across the trimesters of pregnancy have been conducted in several countries13,17,19 and in the Philippines. Reference ranges
in the first and second trimesters of pregnancy were conducted by Patal and Hamin et al. which showed values of TSH 0.14-3.84 uIU/mL, FT4 10.44-21.58 pmol/L, FT3 2.4-5.82 pmol/L in the first trimester and TSH 0.10-4.30 uIU/mL, FT4 9.10-19.40 pmol/L, FT3 2.70- 5.190 pmol/L in the second trimester, respectively.
OBJECTIVE: To establish third trimester reference intervals for free thyroid hormones (free triiodothyronine [FT3], free thyroxine [FT4]) and thyrotropin [TSH] from thyroid peroxidase antibody [TPOAb]-negative Filipino
pregnant women.
DESIGN: This is a prospective, cross-sectional study which included consecutive 200 healthy third-trimester pregnant Filipino women attending Philippine General Hospital (PGH) out-patient services. Serum TSH, FT4, FT3, and TPOAb were measured.
MAIN OUTCOME MEASURES: Reference intervals are based on 2.5th and 97.5th percentiles for TSH, FT4, and FT3 among TPOAb-negative third-trimester pregnant Filipino patients.
ANALYSIS: All numerical data were entered in MS Excel and analyzed using STATA 12. FT3, FT4 and TSH were expressed as mean ±SD, range at 2.5th to 97.5th percentiles.
RESULTS: The reference ranges for TSH, FT4 and FT3 in TPOAb-negative third-trimester pregnant population are as follows: TSH= 0.2-3.0 uIU/mL; FT4 = 9.16-18.64 pmol/L and FT3= 2.09-3.7 pmol/L.
CONCLUSION: Reference ranges for thyroid function tests for the third trimester of TPOAb-negative pregnant Filipino women were determined in this study and are as follows: TSH= 0.2-3.0uIU/mL; FT4 = 9.16-18.64pmol/L and FT3= 2.09-3.7pmol/L.

Human ; Female ; Adult ; Thyrotropin ; Thyroxine ; Triiodothyronine ; Iodide Peroxidase ; Thyroid Function Tests ; Pregnancy Trimesters ; Thyroid Diseases ; Thyroid Hormones

INTRODUCTION: Ferbile neutropenia is considered a medical emergency and remains a major cause of morbidity and mortality among cancer patients. In this population, infections are often characterized by the lack of significant clinical findings during physical examination and a clear focus of infection, perhaps because of the inability to mount an adequate inflammatory response. It has long been recognized that any delay in treatment may result in a higher risk of mortality especially when caused by highly virulent pathogens such as Pseudomonas aeruginosa.
OBJECTIVE: To determine the clinical profile and disease outcome of the various infections an adult patient with leukemia who developed febrile neutropenia admitted at the University of Santo Tomas Hospital from January 1,2010 to July 31,2013.
METHODOLOGY: This is a three and a half year retrospective descriptive study. Medical records of all patients >18 old with leukemia, who were admitted and assessed to have infection which developed at the time of the neutropenia were included.
RESULTS: A total of 44 cases of leukemia with febrile neutropenia were reviewed. There was equal distribution between genders. Mean age was 39.64 years. Majority of patients had acute myelogenous leukemia (AML) [72.7%, (32/44)]. All patients had sepsis, where two, (4.5%) manifested with shock. Co-morbidities included hyperthyroidism (9.15%), diabetes milletus (DM) (6.8%), and hypertension (6.8%). Cefepime [40.9% (18/44)] and meropenem [31.8%, (14/44)] were the most coon antimicrobial agents used to treat neutropenic patients.
All of the patients had blood cultures, however, only 12, (27.3%) yielded positive results. Among those with negative culture results, 18.8% received antibiotics prior to collection of blood. Other specimens tested sputum and urine. Among those with positive results, the most common organisms isolated were E. coli [33.3%, (4/12)] followed by Enterobacter cloacae [16.7%, (2/12)]. Other organisms isolated include Aeromonas hydrophilia , Pseudomonas aeruginosa , Stenotrophomonas maltophilia , coagulase-negative straphylococci (CoNS), and viridans streptococci.
Nineteen (43.2%) patients had pneumonia, while five (11.4%) patients had urinary tract infection. Seventeen (38.6%) patients had no known focus of infection despite aggressive search. Culture positivity was observed more frequently among those with profound neutropenia [91.7% (11/12)] and those with Multinational Association for Supportive Care in Cancer (MASCC) score of less than 21 [100%, (6/6)].
Thirty seven (84%) of patients were discharged improved, (six 14%) died due to infection and one patients was discharged against medical advice. Mortality was high among those with profound neutropenia, (6/6, 100%) and those with MASCC score of less than 21 [100%, (6/6)].
CONCLUSION: Acute myelogenous leukemia cases comprised majority of febrile neutropenic patients. All patients had sepsis commonly involving the lungs. Co-morbidities included hyperthyroidism, DM and hypertension and few patients had prior use of antibiotics. Blood culture was positive in more than one fourth of the population. The most common organisms isolated were E. coli followed by Enterobacter cloacae. Mortality was high among patients with profound neutropenia and MASCC score of less than 21.

 

 

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Aeromonas ; Anti-bacterial Agents ; Cephalosporins ; Coagulase ; Diabetes Mellitus ; Enterobacter Cloacae ; Escherichia Coli ; Fever ; Hypertension ; Hyperthyroidism ; Leukemia, Myeloid, Acute ; Stenotrophomonas Maltophilia ;

Initial Planning: Statement 1: Develop a Family-focused Care Plan that contains tasks and activities related to the family structure, home environment and processes in order to mitigate the effect of the COVID-19 epidemic Adjustment in the Family Structure and Home Environment: Statement 2: Identify a Family Caregiver who will remind the family to follow and implement the plan. Make sure this person is supported by all the members of the family. Statement 3: Identify a room or area that can be used for isolation in the event that a family member will be exposed to a diagnosed COVID-19 patient. Statement 4: Identify those who are at risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition and advice to take extra precaution. Statement 5: During the declared community quarantine period, all family members should stay at home, limit family celebrations, avoid home parties with outside guests, cancel travels as much as possible and be ready to have more members staying at home Performance of Routine Tasks and Activities : Statement 6: Practice personal hygiene that includes regular and appropriate hand washing, daily bath, cough and sneezing etiquette, minimize hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. Statement 7: Daily cleaning of frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol What to Do When a Member is Exposed Statement 8: Advice an exposed family member to stay home and in the room or area allocated for isolation, wear mask and maintain at least 2 meters physical distance from the other family members. Make sure their clothing, personal belongings and other things that they usually hold is cleaned regularly and not touch by other members. Statement 9: Watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person exposed is low risk and there is difficulty of breathing or worsening of symptoms, consult your family doctor. If the person is high risk i.e. elderly or with exiting chronic disease and symptoms appear, consult your family doctor right away. Call first before going to the clinic or hospital. Statement 10: If the symptoms are mild, continue home quarantine, take over-the-counter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Other family members are encouraged to provide psychological and social support to an exposed and isolated member. Statement 11: Symptoms usually resolved within 14 days, after which home quarantine can be discontinued between 14-21 days. If symptoms persist beyond 14 days consult your family doctor for advice
COVID-19 ; Family

Initial Planning: Statement 1: A Community-oriented Health Care Plan that contains tasks and activities related to the community organization, environment, health care and social processes in order to mitigate the effect of the COVID-19 epidemic on the community should be developed. Statement 2: The plan should also include adjustments needed to continue the delivery of other health services i.e. maternal and child health, immunization, treatment of other communicable and non-communicable disease but with strict COVID-19 transmission precautions. Adjustment in the Community Organization and Environment: Statement 3: A local task force should be organized to develop and implement the community health plan. The task force should be recognized and supported by the whole community. Statement 4: A facility in the barangay that can be used for isolation in case that a member will be diagnosed to have mild COVID-19. A hospital facility for referral of high-risk cases should also be identified and an emergency referral and transport plan should be established. Statement 5: All community health workers should wear appropriate personal protective equipment in the process of performing their community health work. Statement 6: Households in the community who have members at high-risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition should be identified and advised to take extra precautions i.e. personal hygiene, wearing mask and physical distancing. Statement 7: During the declared community quarantine period by the community or higher-level authority, all community members and household should be advised to stay at home, limit celebrations and community gatherings Performance of Routine Tasks and Activities: Statement 8: A community-directed information, education and communication (IEC) plan should be developed and implemented for the following: a) Informing every household in the community on the basic and accurate information about COVID-19 and the community plan. b) Encouraging everyone to practice personal hygiene that includes regular and appropriate hand washing, daily bath, coughing and sneezing etiquette, wearing of mask, minimizing hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. c) Encouraging everyone to clean everyday frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol. d) Encouraging everyone to report and seek help to the community health worker if a household member is exposed and developed mild symptoms of COVID-19 What to Do When a Member or Household is Exposed or Diagnosed COVID-19: Statement 9: If there is a household whose member is exposed to a COVID-19, the person should be encouraged to stay home preferably in a room or area adequate for isolation, wear mask and maintain at least 2 meters physical distance from other family members. Statement 10: Other household members should be advised to watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person is low risk but there is difficulty of breathing or worsening of symptoms or if the person is high risk i.e. elderly or with existing chronic disease and symptoms appear, they encouraged to inform the community health worker and facilitate the necessary referral and transport arrangement to the hospital. Call first before going. Statement 11: If the symptoms are mild, continue home isolation or in the isolation facility identified by the community, take over-thecounter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Family members and community health workers are encouraged to provide psychological and social support to isolated patients. Discontinuation of isolation can be done if symptoms resolve within 14-21 days Epidemiology and Surveillance Statement 12: The municipal or city health office should be provided daily with a situation report of the implementation of communityoriented health care for COVID-19. Situation report should include: a) The number of exposed, number of diagnosed cases, number of mild cases, number of cases referred to the hospital and number of cases recovered or died in the community. b) Brief description of best practices
COVID-19 ; Noncommunicable Diseases ; Quarantine

Background: The interpretation of thyroid hormone function during pregnancy is difficult due to its physiologic changes. Differences in iodine status in previous studies led to different intervals; therefore the use of trimester-specific, method-specific and probably country-specific reference values is advocated. Objective: To establish trimester-specific reference interval for thyroid function tests in pregnant Filipino women. Methodology: Six hundred sixteen pregnant patients (5–40 weeks gestation) attending a tertiary center were recruited. Level of serum thyroid stimulating hormone (TSH) was measured using immunoradiometric assay while free thyroxine (FT4), free triiodothyronine (FT3) and thyroid peroxidase antibodies (TPOAb) were measured by radioimmunoassay method. Main outcome measures are trimester-specific reference interval based on 2.5th and 97.5th percentiles for TSH, FT4 and FT3 among TPOAb-negative pregnant patients. Results: The reference intervals for each trimester were as follows: TSH (0.05-4.24, 0.13-3.95, and 0.20-3.00 uIU/mL); FT4 (9.80-21.88, 9.10-18.95 and 9.16-18.64 pmol/L) and FT3 (2.40-6.20, 2.77-5.00 and 2.09-3.70 pmol/L). FT4 and FT3 are strongly and negatively correlated with age of gestation (p=<0.01and <0.01 respectively). No correlation is found with TSH and age of gestation (p=0.52). Conclusions Trimester-specific intervals among pregnant Filipino women are different from their non-pregnant counterparts and laboratory cutoffs. Thus, these reference values should be used in the country.
Thyroid Function Tests