BACKGROUND<p style="text-align: justify;" data-mce-style="text-align: justify;">Pulmonary aspergilloma is the most common pulmonary involvement due to Aspergillus. It usually develops in a pre-existing cavity in the lung, most often due to tuberculosis. Hemoptysis occurs secondary to local invasion of the blood vessels lining the cavity. Recurrence of which, is an indication to do surgery, lobectomy in particular. Antifungals like amphotecin B given intravenously and itraconazole given orally, have been the traditional management. But with the emergence of newer antifungals, Echinocandins in particular, which functions to inhibit the β-(1,3) p-glucan synthase, an enzyme necessary for the synthesis of an essential component of the cell wall of fungi, one may need not undergo surgery. The most common antifungal medication for Aspergillus is voriconazole, a second-generation triazole. This case demonstrates the efficient utilization of Voriconazole along with Anidulafungin, which is necessary for the fungal cell wall integrity. For immunocompromised patients with pulmonary aspergilloma, this dual therapy presents a viable substitute for surgical intervention and an efficient treatment approach.p>CASE<p style="text-align: justify;" data-mce-style="text-align: justify;">We present a case of a 54-year-old married patient, who presented with massive hemoptysis four days before consulting a private physician. She had ten episodes of hemoptysis four hours before admission and was rushed to the hospital. The patient had multiple comorbidities, including diabetes, hypertension, and asthma, contributing to an immunocompromised state. She had a history of anti-tuberculosis treatment in 2000, which was discontinued due to an allergic reaction. During her hospital stay, she experienced febrile episodes, and capillary glucose monitoring was beyond acceptable levels, prompting antibiotic initiation. A chest CT scan revealed pulmonary tuberculosis with cicatricial atelectasis of the lingular segment and infected cavitary formation. A bronchoscopy and biopsy of the cavitary lesion were scheduled. Surgical intervention, particularly lobectomy, was not pursued due to multiple factors, including the patient's immunocompromised status, her underlying comorbidities, and the response to antifungal therapy. After eight to 14 fourteen (8-14) hospital days, no episodes of hemoptysis were noted, and the biopsy result revealed fungal colonization consistent with Aspergillus species. The patient was discharged with oral Voriconazole and other maintenance medications. A repeat chest CT scan after five months of antifungal therapy showed regression of the fungus ball.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">In this case, pulmonary aspergilloma in an immunocompromised patient was successfully treated with a combination antifungal therapy utilizing anidulafungin and voriconazole. The favorable clinical response to dual antifungal therapy provides a feasible non-surgical alternative to surgical intervention, which has historically been the preferred option for treating recurrent hemoptysis, particularly in high-risk patients. The fungus ball's regression and the fungal infection's resolution support the growing role of more recent antifungal medications in the treatment of complicated pulmonary infections. This case suggests that echinocandins combined with triazole therapy are a viable less invasive treatment option for pulmonary aspergilloma than surgery.

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Human ; Female ; Middle Aged: 45-64 Yrs Old ; Anidulafungin ; Immunocompromised Host ; Patients ; Therapeutics ; Voriconazole

BACKGROUND<p style="text-align: justify;" data-mce-style="text-align: justify;">Myiasis is a parasitic infestation of humans caused by dipteran flies' larvae, which feed on the host's tissue. It affects various body parts, including the skin, eyes, ears, nose, mouth, and gastrointestinal tract. Cutaneous myiasis is the most common clinical form, while wound myiasis is the main manifestation. Myiasis can be caused by various fly families, including blowflies, flesh flies, and botflies, with different types depending on the site and infestation type. A rare occurrence rarely reported in medical literature, Sarcophaga species infestation within a tracheostomy tube in a patient with laryngeal carcinoma, is presented in this case. Given that the airway is protected and has built-in barriers against external contamination, the presence of flesh flies (Sarcophaga spp.) at a tracheostomy site is extremely uncommon. By showing how weakened respiratory structures, along with particular environmental and patient factors, may make people more susceptible to this uncommon parasitic complication, this report adds to our understanding of the condition. Recognizing such atypical infestations is crucial for clinicians in early diagnosis, prevention, and effective management of similar cases.p>CASE PRESENTATION<p style="text-align: justify;" data-mce-style="text-align: justify;">The study details a rare instance of Sarcophaga species myiasis in a tracheostomy tube in a patient who Had laryngeal carcinoma after radiation therapy. The 71-year-old farmer patient first complained of pruritus, localized warmth, and tightness in his neck. Prior tracheostomy excision and cobalt therapy were part of his medical history. After being treated for pneumonia, the patient experienced severe bleeding at the tracheostomy site, which led to additional testing. Many larvae were seen emerging from necrotic tissues during clinical examination, which raised the possibility of myiasis. Sarcophaga spp., a rare discovery in respiratory structures, were confirmed to be present by species identification. More than 100 larvae were removed during the emergency surgical procedure, which also involved replacing the compromised tracheostomy tube and cutting and draining necrotic areas. Following surgery, there were no more bleeding or reinfestation episodes, and the patient showed signs of stable recovery.
p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">The parasitic infestation known as myiasis, which is brought on by dipteran fly larvae, is usually linked to exposed wounds and weakened tissue. Flesh flies, or Sarcophaga species, are drawn to recently opened, exudative wounds, which makes them more likely to infest susceptible people. Although myiasis commonly occurs in cutaneous wounds, ocular, and nasopharyngeal sites, it is extremely uncommon to occur in tracheostomy incisions, especially in tropical areas like the Philippines. The need for increased clinical awareness of this uncommon complication is highlighted by this case, which shows an unusual manifestation of Sarcophaga species myiasis within a tracheostomy tube of a patient who had laryngeal carcinoma following radiation therapy. Prioritizing preventive measures, such as thorough wound hygiene, efficient fly control techniques, and ongoing postoperative monitoring, is necessary due to the grave consequences of tracheostomy-associated myiasis. Parasitic infestations are more likely to occur in patients recuperating from head and neck surgery, especially those who have had extended wound exposure. Patient outcomes can be improved and morbidity can be considerably decreased by teaching family members and caregivers about wound surveillance, early detection, and prompt intervention. To reduce the chance of infestation, preventive measures like appropriate wound dressing, environmental sanitation, and fly management must be strengthened. In order to develop more focused preventive measures, more research is necessary to identify the endemic distribution of rare myiasis-causing species and to characterize them. Clinicians can establish more efficient management procedures by identifying particular environmental factors and patient vulnerabilities that contribute to atypical myiasis cases. The knowledge gathered from this report adds to the body of knowledge on tracheostomy-associated myiasis and is a useful
guide for early detection and treatment of similar cases.
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Human ; Animals ; Male ; Female ; Aged: 65-79 Yrs Old ; Research Report ; Patients ; Carcinoma ; Sarcophagidae ; Tracheostomy

<p style="text-align: justify;"> BACKGROUND: Intracerebral hemorrhage (ICH) is more than twice as common as subarachnoid hemorrhage (SAH) and is more likely to result in death or major disability than cerebral infarction or SAH; having an advance age and hypertension are the most important risk factors for ICH. ICH occurs more frequently among men than women and is significantly more common among young and middle-aged blacks than whites of similar ages. Though this is the current scenario, Asian's ICH incidence is reported higher than those reported for whites in the United States and Europe.p><p style="text-align: justify;"> OBJECTIVES AND METHODOLOGY: This prospective observational study of 74 hypertensive intracerebral hemorrhage' patients admitted at Iloilo Mission Hospital (IMH) for the period of January 1, 2006 to October 31, 2006, aimed at determining the relationship of perilesional edema's role on the outcome of hypertensive patients with intracerebral hemorrhage. Also it seeks to determine the difference in the perlesional edema volume and the Glasgow Coma Scale (GCS) score of patients at the emergency room (ER) when grouped according to location of hemorrhage in the brain; to determine the difference in the edema volume when they are grouped according to deterioration and medical outcome; and to determine the degree of relationship between edema volume and GCS scores as well as edema volume and ICH volume. Environmental factors, variables such as age, sex, compliance to antihypertensive medications, hours of deterioration, and medical and surgical intervention done were also included. T-test for independent samples, one way ANOVA, Pearson's are the statistical tools employed to interpret the present date.p><p style="text-align: justify;"> RESULTS: For the differences in edema size and ER GCS Scores, the results showed no significant difference in the edema size and the QCS score of patients at the ER when they are grouped according to location of bleeding. The table shows that the fewer patients who has bleeding on deep location have acceptable to good GCS score (
Human ; Intracranial Hemorrhage ; Perilesional Edema ; Subarachnoid Hemorrhage

Background: Pulmonary thromboembolism (PTE) is frequently evaluated in acute care settings. Despite this, the clinical diagnosis of PTE is difficult. Results of ventilation perfusion (V/Q) scans may be inconclusive, pulmonary angiograms (PAGs) are curbersome, involve risk, and spiral computed tomography are unavailable and expensive. Therefore, it must be emphasized that in order to improve the diagnostic work-up of patients with suspected PTE, the use of clinical score assessment (Wells criteria) and D-dimer testing in routine daily practice could be used as an alternative.Objective: This study aims to determine the relationship between d-dimer levels and Well's criteria, its relationship to different risk factors for developing pulmonary thromboembolism and to correlate the d-dimer levels to patient's outcomes.Methodology: Hemodynamically stable patients who are at risk for developing pulmonary thromboembolism are requested for D-Dimer assay. Prior to the testing, physicians completed for the pretest probability of PTE using Wells clinical model, score 6 points- high probability. Associated co-existing conditions and risk factors were taken into consideration.Results: A total of 62 patients (mean age of 55 years old., 1:1 male: : male-female ratio were enrolleed. Subjects were then classified as to low, intermediate and high risk for developing pulmonary thromboembolism based on Wells criteria.Conclusion: The study showed that the Well's criteria have a highly significant relationship with D-dimer levels. This means that the Wells criteria and D-dimer level, the higher risk it is for the patient to have pulmonary thromboembolism. This study also showed that high D-dimer levels were associated with increased hospital mortality. The combination of physician's pretest probability and D-dimer level results in a significant correlation to mortality.
Human ; Male ; Female ; Middle Aged ; Pulmonary Thrombo- Embolism ; Venous Thrombo- Embolism

Background: Airway inflammation is considered to be important in asthma but is relatively inaccessible to study. Less invasive methods of obtaining sputum from patients unable to produce it spontaneously should provide a useful investigational tool in asthma.Objective: To evaluate the value of eosinophil count in induced sputum and blood count of asthmatic patients and normal subjects.Specific Objectives: (I) to determine the influence of asthma exacerbation with sputum and peripheral eosinophilia, and (2) to determine differences in peripheral and sputum eosinophil count between normal and asthmatic subjects.Study Design : Prospective-Cohort StudySetting: The study was conducted at the Iloilo Mission Hospital, a tertiary private hospital in Iloilo City, Philippines.Methodology: Twenty eight subjects were included in the study. Fifteen asthmatic patients underwent pulmonary function test, sputum induction and blood sampling. Thirteen normal subjects were evaluated using sputum induction and blood sampling.Results: Sputum and peripheral eosinophilia between asthmatic patients with and without chest findings of rales and wheeze do not significantly differ. The significant and positive correlation between forced vital capacity and peripheral eosinophilia may suggest other inflammation or conditions related to asthma such as allergy. Post bronchodilator FEV, significantly and negatively correlated with sputum eosinophilia. Comparison between eosinophilia markers in induced sputum and blood in asthmatic patients and normal subjects revealed that asthmatic tend to have relatively higher and significant sputum eosinophilia than normal subjects.Conclusions: FEVj and forced vital capacity were found to correlate with bronchial inflammation. Sputum eosinophilia were relatively higher among asthmatic patients than normal subjects. Hence, induced sputum could be used as a marker for airway inflammation.
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OBJECTIVE: To evaluate the usefulness and sensitivity of bronchoalveolar lavage (BAL) as compared to sputum culture for the isolation of specific microorganism among adult patients seen at Iloilo Mission Hospital, tertiary hospital in Iloilo City, Philippines.METHODS: This is a retrospective comparative evaluation of culture isolates obtained from sputum and BAL taken from 34 adult patients who underwent bronchoscopy at the Iloilo Mission Hospital from January 2006- September 2007.RESULTS: Pseudomonas Aeruginosa are the most frequent isolated organism in bronchoalveolar lavage. Majority of the sputum culture reVealed no growth of microorganism on final report. Sputum specimens are frequently contaminated by upper respiratory tract bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, enteric gram negative bacteria, and Candida organisms, which are potential lower respiratory tract pathogens. This study shows that there is a significant increase in the number of patients who were found positive with microbial growth culture isolate using BAL. It was noted that 32 out of 34 patients had positive growth culture on BAL as compared with only 23 out of 34 patients had growth of isolate on sputum culture.CONCLUSION: BAL collection provides more definite culture isolate information for characterizing Pseudomonas Aeruginosa infection and growth isolates in which the sputum culture failed to report. This suggests that bronchoscopy specimens are preferable over sputum for the accurate diagnosis of pulmonary infections.
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<p style="text-align: justify;">BACKGROUND: Over the past century, the physicians' view on pneumonia that is inflammatory disease of the lungs with alveolar involvement has undergone several major changes. Emphasis was placed on anatomic location, histopathology and pathogenesis. Recent evidence suggests that cytokine response may be a useful adjunct in diagnosing pneumonia. Acute tissue injury from virtually any cause including infectious diseases will result in rapid increase in the concentrations of several proteins in the serum including C-Reactive Protein (CRP). Several studies have corroborated the role of CRP in the diagnosis of bacterial versus viral meningitis in children and suspected septicemia in neonates. However, its role in the etiological diagnosis of respiratory infections is not well established.p><p style="text-align: justify;">OBJECTIVES: This study sought to (1) determine CRP as a diagnosis marker among patients with community acquired pneumonia (CAP), (2) evaluate the CRP levels among patients with CAP, (3) determine the correlation between CRP, WBC count and segmenters, and (4) determine if bacterial isolate significantly influence the level of CRP.p><p style="text-align: justify;">RESEARCH DESIGN: Prospective Cohort Studyp><p style="text-align: justify;">SETTING: Iloilo Mission Hospital, a private tertiary hospital in Iloilo City, Philippinesp><p style="text-align: justify;">SUBJECTS: A total of forty one patients 18 years old and above admitted with the diagnosis of CAP from May 1 to November 15, 2004 were included in the study. Expectorated sputum samples were examined and determined suitable for culture if the squamous cells < 5-10/hpf and polymorphonuclear cells > 20-25/hpf. Serum samples for CRP, WBC and segmenters were obtained within the first 24 hours of admission. Descriptive statistics were utilized. The statistical tools employed were means, frequency counts, standard deviation; Pearson's r and serum analysis all set at .05 alpha level of significance.p><p style="text-align: justify;">RESULTS: Fifty eight percent (58 percent) of these patients were classified as CAP moderate risk. Most were males (68 percent) and in their middle adult (56 percent) with mean age of 61. Patients classified as high-risk pneumonia had the highest elevated mean CRP level of 18.87 as compared to patients who were classified as low and moderate risk. Pearson's r was utilized to determine the relationship between CRP, WBC and segmenters. The p-value of 0.05 showed a positive correlation between CRP and segmenters.p><p style="text-align: justify;">CONCLUSIONS: Analysis of the means revealed that Klebsiella pneumonia had the highest CRP mean (89.67). Comparisons of mean CRP by .type of bacteria were found not to be significantly different from each other. Hence bacterial isolate do not influence variability of CRP levels.p>
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<p style="text-align: justify;">BACKGROUND: Transient ischemic attack is no longer considered a benign event but, rather a critical harbinger of impending stroke. Failure to quickly recognize and evaluate this warning sign could mean missing an opportunity to prevent permanent disability or death. There is no reliable way to determine if the abrupt onset of neurologic deficits represents reversible ischemia without subsequent brain damage or if ischemia will result in permanent damage to the brain. Rapid advances in computed tomography (CT) and magnetic resonance imaging (MRI) technology in the last 25 years have contributed significantly to our understanding of the pathophysiology of clinically defined TIAs. OBJECTIVES: This study aims to (1) determine the cranial CT scan findings among TIA patients admitted at Iloilo Mission Hospital for the period of November 2003-November 2005; (2) determine the common clinical features of patients admitted for TIA; (3) determine the most common risk factors in patients with TIA; (4) to determine the proportion of TIA patients admitted who underwent cranial CT scan. METHODS: This is a retrospective study of patients admitted with the diagnosis of TIA from November 2003-November 2005. The clinical history and physical examination as well as cranial CT scan findings were noted. Other pertinent data collected included age, gender, and co-morbid factors. RESULTS: Thirty-seven patients were included in the study, 72.9 percent of whom were above 60 years old. There were 12 (32.4 percent) men and 25 (67.6 percent) women (M:F-1:2.1). Known risk factors that were seen in this series included hypertension (HTN) + hypercholesterolemia (35.1 percent), HPN (29.7 percent), HPN + hypercholesterolemia + diabetes mellitus (24.3 percent), hypercholesterolemia alone (5.4 percent); no risk factors (5.4 percent). The most common presenting symptoms were slurred speech, dizziness, and hemiparesis. The duration of symptoms noted in patients with TIA were: 6 hours or less in 54.1 percent, followed by 7-12 hours in 16.2 percent, 13-18 hours in 13.5 percent, and 19-24 hours in 16.2 percent. Cranial CT scansd showed abnormalities in 94.1 percent of TIA patients. There were cerebral and basal ganglia infarctions (32.4 percent) taken with the duration of 6 hours (52.9 percent). Other findings include: cerebellar infarct/multiple infarct (11.8 percent), and lacunar infarct/ bifrontal subdural effusion (2 percent). Two patients had a normal CT Scan. CONCLUSIONS: Cranial CT scan is advantageous in the diagnosis of TIA, because it is easily available and it provides evidence that either substantiates the diagnosis of cerebral ischemia or suggests an alternative diagnosis. Early CT studies demonstrated non-ischemic etiologies. Most of the TIA occur in less than 6 hours from the onset of symptoms. (Author)p>
Ischemic Attack, Transient ; Brain Ischemia

BACKGROUND: Intracerebral hemorrhage (ICH) constitutes 10-15% of all strokes and is associated with poor prognosis. Atherosclerosis is the leading cause of death and disability worldwide. In the USA, there are more than 700,000 stroke victims each year. It is important to identify new risk markers and preventive strategies for ischemic cerebrovascular disease. C-reactive protein (CRP), as a promising biomarker for cardiovascular disease, possibly more predictive of stroke risk, however, independent value has not been established. With the foregoing studies, we strongly believed that this novel research to be conducted will unravel the many therapeutic values of CRP in early diagnosis, prevention and possible cure of cerebrovascular related diseases.OBJECTIVES: To determine the prognostic value of CRP as a diagnostic marker for ICH. Specifically, this will determine its prognostic value and outcome of patients.STUDY DESIGN: Cohort studyPARTICIPANTS: Included were all ICH patients admitted at Iloilo Mission Hospital from April to October 2005, with no previous history of stroke and no focus of infection.RESULTS: Thirty-eight subjects were included, 76 percent of whom had hypertension. Early neurologic deterioration occurred in 15 percent with ICH. The potential risk factors for early deterioration in the univariate analysis, include patients with higher leukocyte count, neutrophil and CRP levels and higher body temperature >37.5 degrees C (p
C-reactive Protein ; Cerebral Hemorrhage ; Stroke ; Hypertension

<p style="text-align: justify;">BACKGROUND: Defined as an acquired deterioration in cognitive abilities that impairs the successful performance of activities of daily living, dementia usually develops among patients with stroke or transient ischemic attack (TIA), Vascular dementia (Vd) is the second most common cause of dementia after Alzheimers Disease (AD) and is thought to be due to impaired blood supply to the brain and divided into different types namely, post-stroke dementia, multi-infarct dementia, and mixed cortical and sub-cortical vascular dementia. Chronic hypertension is reported to cause sub-cortical type of vascular dementia which is usually asymptomatic detectable only by cranial CT scan and Magnetic Resonance Imaging techniques.p><p style="text-align: justify;">OBJECTIVES: To determine the presence of vascular dementia in asymptomatic chronic hypertensive patients using the Mini-Mental Status Examination (MMSE) and compare the MMSE scores and completion time of chronic hypertensive patients with that of non-hypertensive individuals.p><p style="text-align: justify;">METHODS: Prospective cross-sectional analytical study conducted between October 15 to November 18, 2006, at Iloilo Mission Hospital, among non hypertensive and hypertensive patients. Patients with history of stroke, Alzheimer's Disease, Parkinson's Disease, drug or alcohol intoxication, head trauma, and known endocrine, metabolic, neoplastic, psychiatric disorders; those with BP > 150/100 mm Hg during the examination and those with less than seven years of education were excluded in the study.p><p style="text-align: justify;">RESULTS: A total of 46 patients were included in the study, 23 patients were diagnosed to have chronic hypertension. There is significant difference in the mean MMSE scores and mean completion time between chronic hypertensive and non hypertensive patients.p><p style="text-align: justify;">CONCLUSION: MMSE is a cost-effective screening tool for the presence of vascular dementia. A similar study using a larger sample size is recommended. p>
Dementia ; Hypertension ; Dementia, Vascular