Severe headache, seizures and supraventricular tachycardia in a 33-year-old Filipino male with confirmed COVID-19: A case report

@#COVID-19 primarily presents as a pulmonary problem, ranging from mild respiratory illness to fatal acute respiratory distress syndrome. Most common manifestations are fever (89%) and cough (72%), while headache and arrhythmia are found in 28% and 17%, respectively. We aim to present a confirmed COVID-19 case presenting with both neurologic and cardiac manifestations. A 33-year-old Filipino male nurse initially consulted at the emergency room due to progressive diffuse headache, with associated localized seizures progressing to generalized tonic clonic seizure and arrhythmia. He had no coryza, cough, sore throat, and diarrhea. He was previously well and had no known co-morbidities or direct exposure to confirmed COVID-19 patients. Physical examination showed elevated blood pressure, tachycardia, and sensory and motor deficits in the left upper and lower extremities. Pertinent diagnostic test results included the detection of SARS-CoV-2 viral RNA via RT-PCR. Imaging studies demonstrated cortical venous thrombosis with hemorrhagic venous infarction in the right parietal lobe. Ground glass appearance on the middle lobe of the left lung was also evident. ECG showed supraventricular tachycardia. Prothrombin time, activated partial thromboplastin time, and D-dimer were all within the normal limits. Carotid massage was done. He was treated with anti-epileptics, anticoagulants, antiarrhythmics, antivirals, antibiotics, and supportive management. During the hospital stay, his symptoms resolved; he was discharged after 21 days. Follow-up done after 3 weeks revealed no recurrence of severe headache, seizure, or tachycardia. It is theorized that an interplay exists between ACE-2 tropism, systemic inflammation, cytokine storm, and hypoxemia in the background of COVID-19 infection. These mechanisms may lead to thrombosis and arrhythmia resulting to neurologic derangements and myocardial injury. Underlying mechanisms make the cerebro-cardiovascular systems vulnerable to the coronavirus disease 2019 infection. COVID-19 should therefore be part of the differential diagnoses in patients presenting with headache, seizures, and arrhythmias.

Feasibility and acceptability of an electronic mobile device application among physicians from the private sector for reporting cases to the national TB program

Introduction@#In the 2016 National TB Prevalence Survey, the prevalence-to-notification ratio for smear-positive pulmonary tuberculosis was 3.1. In the TB registry, 94% of cases were reported by public providers, suggesting insufficient reporting from private physicians. This study describes the feasibility and acceptability of an electronic mobile device application for possible use among private physicians for reporting their TB cases.@*Methods@#This interventional, pre-, and post-test study uses an electronic mobile device application to report TB cases. Using the application, physicians collected and uploaded specific information for reporting cases. The participants were duly-licensed physicians and board certified in any of the following: Internal Medicine, Adult Infectious Diseases, Adult Pulmonology, Pediatrics, Pediatric Infectious Diseases, or Pediatric Pulmonology. The participants used an electronic mobile device application for reporting TB cases. Feasibility and acceptability were assessed using a questionnaire and through a focus group discussion. Data were summarized with mean and standard deviation for continuous variables and proportions for categorical variables.@*Results@#The study was conducted at the Research Institute for Tropical Medicine, a government hospital with a Tuberculosis Directly Observed Treatment Short-Course (TB DOTS) facility. Of the 30 physicians invited to participate, 24 provided consent, but only 15 downloaded the application (age range 34-61, mean 39 years, 11 females). Eleven of 15 physicians (73%) assessed the mobile application as easy to navigate and felt that information encoded was relevant to patient care. However, the internet connection affected the speed of the application. The physicians said they had no time, were too busy, or simply forgot to encode patient data.@*Conclusion@#The use of the application is acceptable but not feasible for use by private physicians. Modification to the application may be done to improve uptake by private physicians.

Profile of patients with oral cavity cancer seen at the Department of Ear Nose Throat – Head and Neck Surgery of the Bicol Medical Center

Objective@#To determine the profile of patients with oral cavity cancer seen at the Ear, Nose and Throat – Head and Neck Surgery (ENT-HNS) Department of the Bicol Medical Center from January 2018 to December 2020.@*Methods@#Design: Retrospective review of records Setting: Tertiary Government Training Hospital Participants: Medical records of patients with oral cavity lesions with malignant biopsy results seen at the Bicol Medical Center Department of ENT-HNS from January 2018 to December 2020. @*Results@#Records of 42 patients were included, 30 (71%) male; 12 (29%) female with the mean age of 62 ± 10.02 (range 34 to 80 years old). Squamous cell carcinoma was the most common histopathologic diagnosis (38/42; 91%), mostly affecting the anterior tongue (16/42; 38%) and buccal regions (14/42; 33%). Most tumors were in advanced stages: 25/42 (59%) in stage IVA; 7 (17%) in stage IVB. A total of 61% (17) of 28 oral cavity cancer patients with recorded risk factors practiced a combination of two or three high risk habits (betel nut chewing, tobacco smoking, alcoholic beverage intake) and a third practiced all three (10/28; 36%).@*Conclusion@#The profile of oral cavity cancer patients in our study is different from the reported profiles in Asia and European and US counterparts. Our profile patient is a married male farmer in the 7th decade of life with poor dental hygiene and advanced stage IV squamous cell carcinoma of the tongue and buccal region, and combined habits of regular alcoholic beverage drinking, chronic tobacco smoking, and/or betel nut chewing, who lives in coastal or mountainous communities where access to health care may be limited.

Fluoroscopic-Guided Bilateral Superior Hypogastric Plexus Neurolysis in the Treatment of Intractable Neoplasm-Related Penile Pain.

Intractable penile pain can be a very difficult condition to address. Studies have shown that both locally advanced and metastatic penile cancer, along with its associated management options and subsequent complications, yield a very poor prognosis, with pain being the most feared symptom. Furthermore, a lack of palliative therapy has been demonstrated in this patient population, with an emphasis on the need for implementing future options. This case depicts a 67-year-old male, with a past medical history of metastatic prostate cancer involving the penis, who presented with intractable penile pain. To the authors' knowledge, this will be the first documented case of the successful utilization of a bilateral superior hypogastric plexus neurolysis in the management of intractable neoplasm-related penile pain attributed to both radiation-induced injury in the treatment of malignant neoplasm and penile pain secondary to metastatic prostate cancer to the penis. As a currently under-utilized treatment option in the management of intractable neoplasm-related penile pain, this case presentation acts to increase awareness of its potential use, therefore reducing the need for analgesics and the associated burdens, as well as improving patient palliation. Furthermore, this case offers evidence supporting the encouragement of its use in the general management of intractable penile pain due to other pathophysiology.

Hidrotórax secundario a diálisis peritoneal detectado mediante gammagrafía peritoneal / Hydrothorax secondary to peritoneal dialysis detected by peritoneal scintigraphy

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Gastrostomía Endoscópica Percutánea (PEG). Diez años de experiencia / Percutaneous endoscopic gastrostomy (PEG). Ten years of experience

Introducción: La PEG es una técnica poco agresiva y con escasas complicaciones. Estas características la han convertido en la vía de elección para nutrir a los pacientes que requieren apoyo nutricional por periodos prolongados. Objetivos: Conocer la evolución y calidad de vida de pacientes y cuidadores con nutrición mediante PEG. Métodos: Estudio retrospectivo de pacientes con PEG en un hospital comarcal desde julio de 1998 a julio de2009. Se revisaron los registros hospitalarios y se contacto telefónicamente con los pacientes. Resultados: Se registraron 299 pacientes con PEG Se observó un incremento progresivo de su uso para el tratamiento nutricional. 152 (50,8%). fueron varones La edad fue 73,62 ± 13,05 años, siendo los varones más jóvenes que las mujeres (t = 5,07; p < 0,001). La indicación más frecuente para el uso de la PEG fue la patología neurológica 222 (85,7%). La duración del tratamiento nutricional fue de 390 días (Rango 1-2.913) mostrándose independiente del resto de variables. La finalización del tratamiento fue por: fallecimiento 134 (93,1%), recuperando la vía oral 10 (6,9%) pacientes. La calidad de vida mejoró significativamente tanto en los pacientes (Z = -6,59; p < 0,001)como en los cuidadores (Z = -6,83; p < 0,001) después de la PEG. Conclusiones: Existe un incremento progresivo en el uso de la PEG con un tiempo medio de tratamiento mayor a un año, finalizándose en la mayoría de los pacientes con el fallecimiento. La calidad de vida experimenta una mejoría después de la PEG tanto en los pacientes como en los cuidadores de esta serie (AU)

Introduction: The PEG is shown as a technique rather aggressive and with few complications. These characteristics have become the route of choice for enteral nutrition in patients who require nutritional support for prolonged periods. Objectives: To know the evolution and quality of life of patients and caregivers with nutrition through PEG.Methods: Retrospective study of patients with PEG ina district hospital from July 1998 to July 2009. Were viewed hospital records and telephone contact with patients Results: There were 299 patients with PEG during the study period. There was a gradual increase in its use for nutritional therapy. Males were 152 (50.8%). There were152 (50,8%) males. The age was 73.62 ± 13,05 years,males being the youngest (t = 5.07, P < 0.001). The most frequent indication was “neurological disease” 222(85.7%). The duration of nutrition therapy was 390 days(range 1-2,913) showing independent from the rest of the variables. The completion of treatment was on death 134(93.1%) or recovering the mouth 10 (6.9%). The QL was significantly improved in both patients (Z = -6.59, P <0.001) and caregivers (Z = -6.83, P < 0.001) after PEG. Conclusions: There is a progressive increase in the use of PEG. with the mean time of treatment greater than one year, and being complete in most patients with the death.The quality of life experienced an improvement after PEG in both patients and caregivers in this series (AU)