Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study.

BACKGROUND: Acute pancreatitis (AP) is an infrequently reported manifestation of leptospirosis. It is more commonly seen in patients with acute respiratory distress syndrome. Despite novel modalities such as extracorporeal membrane oxygenation (ECMO), the mortality rate remains high and whether this is associated with the lung injury caused by the inflammation in AP remains unclear. OBJECTIVES AND METHODS: A descriptive study was conducted at a tertiary hospital in the Philippines. Primary outcome was defined as the presence or absence of AP. Secondary outcomes were defined as 28-day mortality rate, length of hospital stay, ECMO days, renal replacement therapy (RRT) days, days on mechanical ventilation, presence of local complications of AP and development of nosocomial infections. RESULTS: A total of 27 patients were included in the study, and 88.89% (n=24) were men. The mean age for all patients was 33.59±10.22 years. Out of the 27 patients, 19 (70.37%) were diagnosed with AP. Among these 19 patients, one (5.26%) had necrotising pancreatitis and two (10.52%) developed local complications of pancreatitis. Six patients (31.58%) died among those who developed AP, while one (12.50%) died among those who did not. The duration of hospital stay, ECMO, RRT, mechanical ventilation and development of nosocomial infections was also higher in the group who presented with AP. CONCLUSION: AP is an under-reported complication of leptospirosis. Our study demonstrated a higher mortality and morbidity in patients with leptospirosis who developed AP.

Incidental diagnosis of rectal cancer in a patient with papillary thyroid cancer

BACKGROUND: Differentiated thyroid cancer is a common endocrine malignancy with an indolent course and high overall survival rate. With more cases diagnosed early, survivors of this cancer live longer and hence are at risk of second primary cancers. In patients with known primary malignancy, work-up often focuses on the primary disease, so that coexistence of another primary malignant lesion can be missed.CASE PRESENTATION: We report a case of a 78 year-old Filipino male diagnosed to have papillary thyroid cancer with nodal metastases presenting with an incidental rectosigmoid cancer on pre-operative workup.TREATMENT AND OUTCOME: Patient eventually underwent complete surgical removal of both malignancies. He is currently on levothyroxine suppression therapy with no evidence of tumor recurrence for both malignancy and is on close follow-up for cancer recurrence surveillance.CONCLUSION: Clinical vigilance for cancer screening and surveillance is mandatory for patients diagnosed with any type of primary malignancy to reduce the rate of missing secondary primary malignancy simultaneously present in the same patient , Early cancer detection might improve cancer patient's overall prognosis and eventually proved to be life-saving.