Exercise 4: Case Report & Case Series

Epidemiology
February 16, 2017

Content Outline: o Normal levels of sex hormones allowed

I. Case Report the patient to still develop secondary
A. Background of the Case sexual characteristics
B. Guide Questions 4. What are the important considerations in
II. Case Series undertaking this kind of study?
A. Background of the Case
 Informed consent of the procedures and the
B. Guide Questions
publication of the study
 Patient confidentiality
LEGEND:
  Ethics
   
Presentation Mentioned in Remember Book Other  Completeness and accuracy of case presented
the lecture Trans  Purpose of publishing
OBJECTIVES CASE SERIES
At the end of this exercise, the student shall be able to:  Simply describes the presentation of a disease in a
 Describe how a syndrome is established as a disease number of patients or a group of cases
entity  It does not follow the patients for a period, and it uses
 Identify the difficulties in determining the natural no control or comparison group. Therefore, it cannot
history of the disease establish a cause-and-effect relationship.
 Explain the importance of disease classification  Lacks validity, its validity is entirely a matter for the
 Discuss the limitations of the different sources of reader to decide
morbidity and mortality statistics Reports the frequency of events or outcomes of a
 Generate hypotheses of causal association from a disease, and these may stimulate generation of new
given set of data hypotheses
CASE REPORT It is used as a means of identifying the beginning or
presence of an epidemic
 Among the most common types of studies published  It can be done by almost any clinician who carefully
in medical journals observes and records patient data (High-Yield
 Document unusual medical occurrences and can Biostatistics, Epidemiology and Public Health by
represent the first clues in the identification of new Glaser)
diseases
 Based on the experience of only one person Limitations (2018A):
 Presence of risk factor, however suggestive, may  Control or comparison group is not included
simply be coincidental  No statistical association
 Generalization of the results is limited because the
BACKGROUND OF THE CASE selection of study subjects is unrepresentative
Title: Cause of Primary Amenorrhea in a Filipina: The (because you look at people who already have the
Mayer-Rokitansky-Kuster-Hauser Syndrome disease, not randomly selected)
 Phenotypically female patient with secondary sexual  This study design has case selection bias and lacks
characteristics and normal female external genitalia statistical validity
 Shallow vaginal dimple
 Absence of upper vagina and uterus by transrectal BACKGROUND OF THE CASE
ultrasound Title: Autoimmune Gastritis Presenting as Iron Deficiency
Anemia in Childhood
GUIDE QUESTIONS  Associated with pernicious anemia in adulthood
1. What do you think is/are the objective/s of the  Associated with Iron-deficiency anemia (IDA) in
study? younger patients
 To present an unusual case of sexual  Study aims to contribute to a better characterization of
development disorder clinical and histological expression of autoimmune
 To illustrate the diagnostic work-up of a patient gastritis (AIG) in pediatric patients
presenting with primary amenorrhea
2. Describe how the subject was recruited for this Introduction
particular study.  AIG is an inflammatory condition of the stomach,
 The subject consulted at UPM-PGH and was typically restricted to the corpus and characterized by
found to have a rare sexual development the presence of autoantibodies against the proton
disorder. Thus, she was chosen for this particular pump H+/K+ ATPase (in parietal cells), and to a
study. lesser extent, the intrinsic factor.
 The immunopathogenic basis involves activation of
3. What conclusion can be made based on the
parietal cell-specific T helper type 1 CD4-T cells.
findings of the study?
 True prevalence unclear since it is asymptomatic
 Based on the findings: before clinical presentation as pernicious anemia in
o Uterus, cervix, and part of the vagina adulthood.
were absent leading to the subject’s
inability to get pregnant

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 Exercise 4: Case Report & Case Series
 AIG rare in childhood and two previous series
published incidentally disclosed in the setting of type 1
diabetes and thyroiditis.

GUIDE QUESTIONS
1. What do you think is/are the objective/s of the
study?
 To highlight iron-deficiency anemia (IDA) as a
precocious hematological manifestation of rare
autoimmune gastritis (AIG) in the pediatric age
group
 To illustrate the contribution of gastric corpus
histopathology findings to a definitive diagnosis of
AIG
 To consider AIG in the differential diagnosis on a
setting of personal and/or familial history of
autoimmune disease

2. Describe how the subject was recruited for this

particular study.
 The five cases of pediatric AIG were collected
retrospectively from clinical files covering a 6-
year period (2006-2011). These cases were
selected due to their shared condition
(autoimmune gastritis), all presenting a very
uncommon manifestation (iron-deficiency
anemia).

3. What conclusion can be made based on the

findings of the study?
 Autoimmune gastritis in the pediatric age group
can present as iron-deficiency anemia.
 Presence of corpus atrophic gastritis and positive
anti-parietal cell autoantibodies (PCA) on
endoscopy confirm the diagnosis of AIG.
o This is why it is necessary to include
parietal cell antibodies in the
autoimmune screening panel for
suspected cases.

4. What are the important considerations in

undertaking this kind of study?
 Considerations are the same as those in Case
Reports (see answer in previous part). Also, even
though a large number of cases with shared
manifestations is reported, association cannot be
established because an appropriate comparison
group is missing.

REFERENCES:
 Epidemiology in Medicine (Hennekens and Buring)
 Lecture Notes of Dr. Butacan
 2019A trans

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