Langerhans cell histiocytosis presenting as anterior neck mass in a child: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Thyroid involvement in Langerhans Cell Histiocytosis (LCH) is rare. We report a 10-year-old Filipino male who presented with a rapidly enlarging goiter. Computed tomography scan showed thyroid and bilateral submandibular masses with malignant features, pulmonary blebs and hepatic cysts. Ultrasound-guided core needle biopsy findings were consistent with LCH and chemotherapy was initiated. This case demonstrates that LCH should be considered in patients with goiter. Multidisciplinary management is warranted to achieve proper diagnosis and institute timely treatment.

Cost of hospitalization of pediatric covid-19 patients in a tertiary pediatric hospital in the Philippines

BACKGROUND@#Out of pocket expenses still comprises a major share in health financing. A reactive approach in COVID-19 treatment may be problematic for the patient’s finances. National health insurance systems like PHIC have COVID-related care benefits, but whether these offer sufficient coverage is unknown.@*OBJECTIVES@#This study aims to describe the hospitalization costs incurred by pediatric COVID-19 patients admitted at a Filipino tertiary pediatric hospital, to determine the major cost drivers of hospitalization, and to determine how various payment methods provide coverage in paying for hospitalizations costs.@*METHODS@#Financial statements of pediatric COVID-19 patients were reviewed, from which costs were categorized. Deductions were also compared with total hospitalization to determine adequacy of various financial assistance programs.@*RESULTS@#Fifty-six charts and financial statements were reviewed for a 9-month period. Majority of the patients are of the 1-month to 6-year-old group (39.3%), of critical severity (66.1%), and with comorbidities (76.8%). Aggregated hospitalization costs of all COVID-19 patients amounted to PHP 9.5 million; medical costs accounted for the majority of the hospital costs at 35.40%. Mean total hospitalization cost per patient was determined to be PHP 170,170 and mean daily cost was PHP 16,870. PHIC COVID-19 packages may provide deducted as much as 90.56% of the overall costs, but only 28.6% of patients were able to avail of this privilege. Out-of-pocket expenditure remains at 33% of the total hospitalization cost.@*CONCLUSION@#COVID-19 hospitalization in this institution mainly consists of the 1-month to 6 years old, and the costs in the average can reach up approximately PHP 170,000, as basic medical fees drive the majority of the costs. Patients with no known comorbids tend to have higher costs of care but more data is needed to elaborate on the trend. Availing PHIC packages can greatly ameliorate the financial burden of hospitalization. However, checks in timely and accurate filing of claims should be in place to assure those that can avail this assistance are rightfully supported.@*RECOMMENDATIONS@#A larger patient base with equal representation of patient categories is recommended in order to determine more comprehensive cost patterns and make significant associations.