Day 1 :
- Clinical and Medical Case Reports
Session Introduction
Abigail Barbosa
Cardinal Santos Medical Center, San Juan city, Philippines
Title: Dengue Fever Manifesting as Severe Thrombocytopenia during Parturition: A Case Report
Biography:
Abigail Barbosa is affiliated from Cardinal Santos Medical Center, San Juan city, Philippines
Abstract:
Background: The incidence of Dengue Fever is increasing among the adult population living in endemic areas, consequently increasing the number of cases of dengue infection occurring in pregnancy. Dengue infection in pregnancy can cause marked thrombocytopenia, which carries a major risk for both maternal and fetal morbidity and mortality that may complicate parturition.
Case presentation: A 31 year-old Filipino woman diagnosed gravida 2 para 1 (1001) on her 34 weeks of gestation, presented in our institution with fever for 4 days. The complete blood count as well as serology confirmed dengue fever. The patient was under conservative management despite severe thrombocytopenia with lowest platelet count of 10,000/L. However, persistent uterine contractions prompted emergency repeat cesarean section. There was note of minimal peripartum uterine bleeding, which was successfully managed by blood transfusion and uterotonics and was subsequently discharged with no maternal and fetal complications.
Conclusion: With the similarities in symptoms and laboratory findings in the obstetric population infected by dengue fever, one of the significant impacts of dengue at parturition is that severe bleeding may complicate delivery with dengue during the critical phase, that is the period coinciding with marked thrombocytopenia. Management of dengue-infected parturients is by conservative fluid therapy and transfusion of appropriate blood products when signs of bleeding occur. An important principle in the management of dengue fever in pregnancy is to prioritize maternal well being prior to addressing fetal issues.
Keywords: Dengue Fever, Thrombocytopenia, Pregnancy
Khei Jazzle Lim
The Medical City, Philippines
Title: Appendiceal Mucinous Adenocarcinoma with Concurrent Tuberculous Appendix: An Unusual Overlap of Two Rare Diseases
Biography:
Khei Jazzle M. Lim, MD-MBA, has published few research articles and aspiring to become a Filipino surgeon.
Abstract:
A 52-year-old woman presented with right lower quadrant pain and a palpable mass, and was surgically managed with right hemicolectomy, right en bloc salpingo-oophorectomy, and total omentectomy. Medical treatment with standard quadruple antimycobacterial regimen was also initiated. Histopathologic report showed appendiceal mucinous adenocarcinoma with concurrent tuberculous appendix. Primary tumors of the appendix are rare and present with symptoms of acute appendicitis or a palpable right lower quadrant mass. The appendix is also an uncommon site of granulomatous tuberculosis infection for gastrointestinal extra pulmonary disease. This case report highlights an unusual overlap of the two diseases and a brief review of literature.
Shelton Tacang
Jose R. Reyes Memorial Medical Center, Philippines
Title: Recurrent and metastatic papillary thyroid microcarcinoma presenting as toxic multinodular goiter
Biography:
Dr. Shelton Tacang is a graduate of BS Nursing and has completed his medical degree from the Davao Medical School Foundation in the Philippines. He is currently a senior resident of the Department of Nuclear Medicine at Jose R. Reyes Memorial Medical Center.
Abstract:
Background: Hyperthyroidism does not safeguard individuals from developing thyroid cancer. Papillary thyroid microcarcinoma, notwithstanding its torpid course and low risk classification, has a propensity to induce significant morbidity despite radioactive iodine treatment. Clinical case: We present the unusual case of a 37-year old, Filipino male who demonstrated typical signs and symptoms of toxic multinodular goiter (TMG) including anterior neck mass, tremors, weight loss, excessive sweating, palpitations, easy fatigability and bilateral proptosis. The patient, upon follow up, was found to have agranulocytosis attributed to being on anti-thyroid medication for two years. The patient was then subjected to total thyroidectomy with a histopathology report showing colloid goiter with concomitant papillary thyroid microcarcinoma (0.9 cm in widest diameter). Initial radioactive iodine (RAI) therapy was initiated following surgery and subsequent 131I whole body survey (WBS 131I) a year after, showing a negative result; however, after 2 months of WBS 131I, there was locoregional recurrence detected by neck ultrasound and CT scan, and eventually confirmed on lymph node biopsy after modified radical neck dissection (MRND). In an attempt to ablate the probable micrometastases, a second RAI therapy with a higher dose was administered; and subsequent post-therapy scan revealed recurrence of cancer on the thyroid bed and distant metastasis on the right lower quadrant of the abdomen. Currently, the patient is on suppression therapy and constantly monitored for progression of the disease. Conclusion: Even when aided with strict protocols, clinicians must recognize that guidelines are not surrogate to clinical judgment and that prompt institution of treatment is critical to circumvent potential pitfalls. This case further illustrates the avenue of championing the use of radioactive iodine (RAI) therapy just as in the low risk stratification. Keywords: hyperthyroidism, papillary thyroid cancer, radioactive iodine therapy, toxic multinodular goiter
Myka Janine Villarroya
Far Eastern University Memorial Medical Center, Philippines
Title: A Case Report in Late Detection Of Congenital Adrenal Hyperplasia; Is a Reconstructive Surgery of the External Female Genitalia an Option?
Biography:
Myka Janine Villarroya is a Second Year Obstetrics and Gynecology Resident in Far Eastern University-Nicanor Reyes Memorial Medical Center. She finished her Medical School in the year 2015 in the same institution
Abstract:
Surgical management of Classical congenital adrenal hyperplasia is associated with few immediate postoperative, infectious and urinary complications as well as unwanted permanent outcomes such as Vaginal stenosis and the like. The objective of this report is to present a case of a 22 years old. Nulligravid who was diagnosed with Congenital Adrenal Hyperplasia and Clitoromegaly. Surgical treatment of ambiguous genitalia has evolved continuously and several types of repair exist. The exact method of reconstruction depends on the anatomy of the patient. However with regards in our case, late consultation had been made so the dilemma in reconstructive surgery was to perform it despite of its complications that may happen postoperatively that would affect not just the physical aspect but as well as the mental and psychological aspects of the patient.
The Primary goal of treatment is to reduce the excess androgens production and replace the deficient hormones. Female classical CAH patients also have the option of surgery to correct the appearance of ambiguous genitalia. Usually surgery is thought to be easier when performed within 2-6 months after birth