On January 25, 2017, with a presentation entitled “One Small Bite for Man, One Giant Challenge for Mankind,” Intern Carlo Francisco C. Castillo and Clerk Christa Z. De Gala discussed the case of Patient L.L., a five year old female kindergarten student in Pasig City with a chief complaint of hematemesis.
Clerk De Gala tackled the patient’s comprehensive history and review of systems, before proceeding to describe the physical examination, differential diagnosis and laboratory tests. The patient was given both an initial impression and admitting diagnosis of hypovolemic shock, secondary to upper gastrointestinal bleeding, and probably secondary to severe dengue, which was consistent with the clinical presentation and the laboratory results of the patient.
Intern Castillo further discussed the case by giving an overview of how to diagnose dengue and how its classification was revised recently, given the overlap between the existing case definitions. He also explained the principle, specificity and sensitivity of the specific tests done on the said virus, such as the NS1 test and Dengue Blot, or the IgM and IgG tests.
The course in the wards of the patient was also reported, revealing that supportive management had been employed until the platelet count improved, her vital signs stabilized and no subjective complains arose, deeming the discharge diagnosis as hypovolemic shock resolved, secondary to upper gastrointestinal bleeding, and secondary to severe dengue recovery phase.
In relation to the case presented, he gave a discussion on the use of Euphorbia hirta (tawa-tawa) as an emerging management tool used against dengue, as it is believed to have pharmacological properties and secondary metabolites that could potentially be the active ingredient, although the course and mechanism of action of the said plant was not expounded. Some findings and methodology of his research studies were then presented in line with the potential bioactivity, inhibitory effect and IL6 secretions of the plant, which boils down to the fact that E. hirta has no approved therapeutic benefit yet.
Intern Castillo also introduced a recent development of a preventive tool against dengue in the context of the dengue vaccine, otherwise known as Dengvaxia, which contains a combination of yellow fever virus and tetravalent dengue virus. Another study, which deals with the community’s knowledge, attitudes and practices towards dengue and the vaccine, was also discussed. He concluded the presentation with a challenge that research is something we all should work on today towards the future.
Dr. Imelda Luna, an Pediatric infectious disease specialist, reacted to the presentation, noting that the control of dengue is multifactorial. She noted that the case diagnosis of dengue was in line with the revised Dengue classification, and also tackled on the administration, side-effects and recommendation of the Dengvaxia vaccine.
The presentation sparked questions from the audience. When asked how to determine Day 1 of the disease and the power or strength, sample size and the outcome of the research studies used, Intern Castillo answered that it is treated as the limiting factor because it is often hard to determine the first day of its occurrence and that they only rely on the patient’s history, as stated by the parents or companion, which was why some of the test do not come as expected. Regarding the power of the study, he stressed that the cells used were pooled and each set-up and sample was done in triplicate. All of the results as well as the sample size were computed using a statistical software.
After the presentation, the winners of this year’s MGMR, champions SLCM Chorale and second place winners St. Luke’s Dance Company, showed the SLCM community their winning performances. Dean Brigido Carandang Jr., was ecstatic with what the students of SLCM have accomplished.