BACKGROUND AND OBJECTIVE

Oral ivermectin, a broad-spectrum anti-parasitic drug, alone or in combination with permethrin, may be a cheaper and more convenient alternative drug to topical permethrin alone in the treatment of classic scabies. There are no previous studies on the treatment acceptability of the three interventions among individual patients with scabies in the Philippines. The purpose of this study was to understand the experiences and perceptions on treatment acceptability for oral ivermectin, topical permethrin or combination treatment among patients with scabies using the multiple-case study approach.

METHODS

We conducted a qualitative multiple case study among adult Filipino patients with classic scabies who were prescribed oral ivermectin, topical permethrin or its combination at a government tertiary hospital dermatology outpatient clinic from December 2022 to September 2023. Semi-structured interviews were used as the primary source of data and analyzed together with chart reviews, Dermatology Life Quality Index (DLQI) scores, and clinical images. Interviews were transcribed, coded, and triangulated with other secondary data. A three-person research team employed a reflexive and iterative process of familiarization, coding, and thematic analysis using a modified Theoretical Framework of Acceptability (TFA) to generate case descriptions, within-case analyses, and cross-case syntheses.

RESULTS

The acceptability of scabies treatments (permethrin, ivermectin, and combination therapy) was generally positive. Permethrin, used in three patient cases, was generally perceived as effective but itch relief varied. The burden of whole-body application of permethrin was context-dependent, influenced by living arrangements and family support. Perceived affordability of permethrin was linked to socioeconomic status. Ivermectin, used by one patient case, was perceived as highly effective with no side effects. Its single dose use did not interfere with patient routine. Combination therapy was also considered effective but potential antagonistic effects and the cost of adding permethrin made it less preferred. Reluctance in taking oral pills was noted. All patients valued medical advice and deferred to their physicians for treatment decisions.

CONCLUSION AND RECOMMENDATIONS

All three treatment options were considered effective and safe. Patients generally preferred permethrin over oral ivermectin due to its topical nature and perceived lower side effects. However, affordability and logistical challenges, especially for large households and low-income families, were noted with permethrin. Oral ivermectin elicited hesitation due to its controversial role in COVID-19 and veterinary use. Concerns about added costs and potential antagonism in combination therapy were raised. Despite these considerations, patients ultimately relied on physicians for treatment decisions. This study underscores the importance of understanding patient perspectives, experiences, and the patient-physician relationship in choosing scabies interventions. Addressing patient concerns, providing education, and ensuring ease of use and affordability can enhance treatment acceptability and adherence for better outcomes.

Human ; Scabies ; Ivermectin ; Permethrin ; Case Study ; Case Reports ; Qualitative Research

Case reports remain to be an essential part of knowledge generation in health care. It is a research design that involves writing about a patient’s illness with either an unusual, new, unexpected, or unique characteristic. It can be about new findings, a novel diagnostic test, unfamiliar adverse events or innovative medical and surgical interventions. It is a detailed description of a patient’s course of illness including symptoms, physical examination findings, laboratory results, treatment modalities and outcomes. The essential element of writing a case report or series is to contribute to the generation of new knowledge. Wellwritten manuscripts have a valuable purpose in medicine as they present new illness, unexpected effects of treatment, novel diagnostic exams or unforeseen patients’ outcomes. The sections of a case report include an Abstract, Introduction or Background, Case Presentation [history, physical examinations, investigations or laboratories, differential diagnosis (if relevant), treatment (if relevant), outcome/follow-up, Discussion, Learning points/Take home messages, Patients perspectives and References. Manuscripts written as case reports or case series by nature of their design are not required to get approval from an Ethics Review Board (ERB). However, there should be an institutional process to clear and register papers. Case reports or a case series has its own distinctive writing components and features as not all single or series of clinical cases are reportable. This article aimed to define case reports/series, describe the different parts, how to write and evaluate a case report manuscript using the CARE guidelines.

Case Reports ; Writing

OBJECTIVE: Clinical characteristics and outcome in COVID-19 with brucellosis patients has not been well demonstrated, we tried to analyze clinical outcome in local and literature COVID-19 cases with brucellosis before and after recovery. METHODS: We retrospectively collected hospitalization data of comorbid patients and prospectively followed up after discharge in Heilongjiang Infectious Disease Hospital from January 15, 2020 to April 29, 2022. Demographics, epidemiological, clinical symptoms, radiological and laboratory data, treatment medicines and outcomes, and follow up were analyzed, and findings of a systematic review were demonstrated. RESULTS: A total of four COVID-19 with brucellosis patients were included. One patient had active brucellosis before covid and 3 patients had nonactive brucellosis before brucellosis. The median age was 54.5 years, and all were males (100.0%). Two cases (50.0%) were moderate, and one was mild and asymptomatic, respectively. Three cases (75.0%) had at least one comorbidity (brucellosis excluded). All 4 patients were found in COVID-19 nucleic acid screening. Case C and D had only headache and fever on admission, respectively. Four cases were treated with Traditional Chinese medicine, western medicines for three cases, no adverse reaction occurred during hospitalization. All patients were cured and discharged. Moreover, one case (25.0%) had still active brucellosis without re-positive COVID-19, and other three cases (75.0%) have no symptoms of discomfort except one case fell fatigue and anxious during the follow-up period after recovery. Conducting the literature review, two similar cases have been reported in two case reports, and were both recovered, whereas, no data of follow up after recovery. CONCLUSION These cases indicate that COVID-19 patients with brucellosis had favorable outcome before and after recovery. More clinical studies should be conducted to confirm our findings.
Female ; Humans ; Male ; Middle Aged ; Brucellosis ; COVID-19 ; Retrospective Studies ; SARS-CoV-2 ; Treatment Outcome ; Case Reports as Topic

The objective of this clinical report is to present the first local case of rare cavernous uterine hemangioma. This is a case of a 28‑year‑old G2P1 (1001) during her first trimester of pregnancy who was admitted to our institution for the second time due to profuse vaginal bleeding and severe anemia. The transvaginal scan revealed an embryonic demise of 8 weeks age of gestation noted at the endocervical canal. There is a posterofundal heterogeneous mass measuring 6.3 cm × 5.7 cm × 5.0 cm (volume: 94.2 ml) with multiple cystic spaces, which on Doppler studies showed abundant vascularity suggestive of uterine hemangioma. Antifibrinolytics were administered. The patient underwent emergency hysterectomy with bilateral salpingectomy due to profuse vaginal bleeding with histopathology result of cavernous hemangioma of the uterus. Cavernous uterine hemangioma is a rare vascular lesion that poses a great challenge in the diagnosis and management. There were limited published articles regarding cavernous hemangioma of the uterus. There were conservative treatment options such as uterine artery embolization, the use of hormonal oral contraception, intralesional glucocorticoid therapy, the use of interferon‑α, laser therapy, and surgical excision. Hysterectomy is the definitive treatment for intractable bleeding. It is recommended to establish an international registry for this rare case. The experts in different specialties such as obstetrician‑gynecologists, interventional radiologists, and vascular surgeons, can also formulate an algorithm for its diagnosis and treatment.
Case Reports ; Hemangioma ; Vascular Malformations

Bimaxillary hyperhypodontia (BHH) is a very rare numeric anomaly with a prevalence of 0.002% to 3.1% described by the presence of a supernumerary tooth in the premaxilla region and a missing mandibular incisor tooth. This case highlights the multidisciplinary management of a child presenting with BHH who complies with the recommended protocol by surgically removing the supernumerary tooth and then proceeding with orthodontic treatment for function and aesthetics. A 9-year-old healthy Malay boy presented with a fully erupted tooth 21, a labially palpable bulge of unerupted tooth 11, a missing tooth 32, and a tendency for an anterior and posterior crossbite. The radiographs showed an inverted, unerupted, conical-shaped supernumerary tooth overlapping the unerupted tooth 11 and hypodontia of tooth 32. The management was surgical removal of the supernumerary tooth and the placement of an upper removable appliance with a palatal expansion screw followed by comprehensive fixed orthodontics.
Case Reports [Publication Type]

Background: The coronavirus disease, also known as COVID-19, is a highly contagious disease caused by a new strain of the coronavirus SARS-CoV-2. Medical technologists, along with doctors and nurses, are also heroes in the fight against the virus as they risk their own health in order to collect and analyze specimens for the diagnosis of the disease. However, they face numerous challenges along the way. Objectives: This study aimed to better understand the difficulties of medical technologists assigned to collect COVID-19 specimen in tertiary hospitals or laboratories in Metro Manila, Philippines. Methodology: Utilizing the qualitative case study design, the researchers interviewed 14 medical technologists and examined the data according to Colaizzi's method which consisted of grouping and categorizing relevant remarks before formulating themes. Findings: The researchers were able to formulate the following themes: (1) patient-related challenges, namely, attitude, age, health status, and communication; (2) physical challenges, namely, fatigue, work hours, number of patients, and the use of personal protective equipment; (3) environmental challenges, namely, collection setting, temperature, and exposure to the virus; (4) resource challenges, namely, supplies and human resources; and (5) psychological challenges, namely, fear, anxiety, and emotional fatigue. Conclusion The study was able to analyze the obstacles faced by COVID-19 specimen collectors in order to give a means of hearing from and comprehending their viewpoints. This shows the importance of performing regular reviews of healthcare workers to ensure their safety. Medical technologists and their supervisors should be able to communicate effectively in order to improve current standards and procedures.
Medical Laboratory Personnel ; COVID-19 ; Specimen Handling ; Case Reports

Background: Tuberculosis (TB) is a disease that has continuously burdened Filipinos. Various programs have been launched by public and private sectors to decrease the incidence of TB and to scale up TB prevention and control in the country. In line with this, pharmacists have been contributing in the campaign against TB since 2004 through the implementation of the Pharmacy DOTS Initiative (PDI). Through the project Innovations and Multi-Sectorial Partnerships to Achieve Control of TB (IMPACT), PDI was relaunched in the country in 2014. Objectives: This case study aims to evaluate the impact of PDI on TB prevention and control by assessing the effectiveness of the technical assistance package rolled out during program implementation. Methods: A review of documents was done to evaluate the achievement of the specific targets of PDI. Results: Among the targets, the percentage of actively referring pharmacies and the number of referrals made throughout the program failed to meet the target. The remaining program targets such as the establishment of a referral system, training of pharmacy personnel, adoption of a TB DOTS curriculum in pharmacy schools, and presence of national legislation, policies, and guidelines relevant to PDI were satisfactorily met. Conclusion PDI had a good response at the start of its implementation, but several issues resulted in the inability to sustain the interventions and achieve set targets.
Tuberculosis ; Program Evaluation ; Case Reports

Unilateral cervicovaginal agenesis in a didelphic uterus is an extremely rare congenital anomaly. Women born with this anomaly present with menarche associated with progressive dysmenorrhea and symptoms of worsening endometriosis. Presented here is a case of a 12 year old nulligravid who presented with progressive cyclic abdominal pain. Physical examination revealed a tender large right adnexal mass and presence of a vaginal canal and cervix tilted to the left. Sonography showed the presence of uterine didelphys, right hematosalpinx and hematocolpos. Preoperative impression was outflow tract obstruction probably due to Herlyn Werner-Wunderlich syndrome. However, intraoperatively, it was discovered this was a case of uterine didelphys with outflow tract obstruction of the right hemiuterus due to unilateral cervicovaginal agenesis and ipsilateral renal agenesis.

Human ; Female ; Congenital Abnormalities ; Genitalia, Female ; Gynecology ; Philippines ; Case Reports

BACKGROUND: Acute renal infarction often presents with abdominal  pain,  nausea,  vomiting,  and  fever.With other more common illnesses presenting with the same symptoms,
it is often misdiagnosed leading to delayed treatment.We present a case of a young female diagnosed to have Membranous Glomerulopathy who presented with sudden onset  flank  pain  in  whom was initially treated as urinary tract infection.
CASE: A  19-year-old  female  diagnosed  with  membranous glomerulopathy presented at the Emergency Room (ER) with severe,  right  sided,  flank  pain  of  acute  onset,  associated with nausea and vomiting. No fever, dysuria, hematuria, or history of trauma. Her vital signs were within normal range. Abdominal  examination  revealed  a  distended  but  soft non-tender  abdomen  with  positive  shifting  dullness and fluid wave test. Right sided costovertebral angle tenderness was  elicited.Initial diagnostics showed leukocytosis with neutrophilic  predominance,  serum  creatinine  of  0.77mg/dL,  and  proteinuria  of  >600mg/dL.Abdominal  ultrasound showed  non-specific  findings,  thus  contrast-enhanced  computed  tomography  scan  (CT-Scan)  of  the  abdomen was  done which revealed areas of non-enhancement in the upper to middle portions of the right kidney which may relate to areas of ischemia and/or infarction, likely due to thrombosis involving the more distal portion of the right renal artery and massive ascites. Result was confirmed by computed tomography angiography (CTA) of the kidneys showing right renal artery thrombosis. Evaluations for other causes  of  renal  artery  thrombosis  aside  from  patient's concurrent  membranous  glomerulopathy  were  done  and were negative. Anti-coagulation therapy was initiated using low molecular weight heparin (LMWH) and was thereafter maintained on warfarin.
CONCLUSION: A  high  index  of  clinical  suspicion  is  needed to  diagnose  acute  renal  infarction  because  of  its  non-specific symptoms which can mimic other conditions. Early diagnosis and prompt initiation of anti-coagulation therapy is  important  to  avoid  irreversible  kidney  damage.  Acute renal infarction should be considered as a cause of acute onset flank pain in patients with risk factors and normal initial screening test.

Human ; Female ; Adult ; Glomerulonephritis, Membranous ; Heparin, Low-molecular-weight ; Warfarin ; Hematuria ; Creatinine ; Renal Artery ; Dysuria ; Leukocytosis ; Kidney ; Kidney Diseases ; Proteinuria ; Urinary Tract Infections ; Infarction ; Flank Pain ; Case Reports

Objective: To present a unique case of intravascular lymphoma of the inferior turbinate because of its rarity, unusual clinical presentation and difficulty in establishing a diagnosis. Design: Case Report Setting: A tertiary hospital Patient: A 66-year-old male admitted to the hospital due to intermittent high grade fever of six months duration. Result: The patient presented with fever of unknown origin, and exhaustive laboratory, ancillary procedures and biopsies to rule in/out infectious, autoimmune and oncologic causes were performed to arrive at a diagnosis. Nasal endoscopy revealed an enlarged, hypertrophied and violaceous right inferior turbinate with watery to mucoid discharge and septal deviation to the right confirmed by CT scans of the paranasal sinuses. Functional Endoscopic Sinus Surgery (FESS), septoplasty and turbinoplasty with biopsy revealed intravascular lymphoma. Chemotherapy was deferred due to the deteriorating medical condition and the patient expired seven months after the initial onset of symptoms. Conclusion: Patients who present with fever of unknown origin should undergo a thorough otorhinolaryngologic examination to exclude primary ENT conditions and ensure proper management. Given its rarity and multiplicity of presentation, it is extremely difficult to make a diagnosis of intravascular lymphoma. A high index of suspicion of intravascular lymphoma is necessary so that timely acquisition of tissue biopsy of any lesion involved will make a definite diagnosis. (Author)
LYMPHOMA FEVER FEVER OF UNKNOWN ORIGIN CASE REPORTS