1. Concept of Writing a Case Report
Dr. Renuka P.
ChanRe Diagnostic laboratory

2. Case Report
A clinical case report is the first line of evidence in medical field
Description of a single case with unique features
A means to communicate the information about a rare or unreported condition, a diagnostic method, a complication, or treatment outcome
Used to identify emerging pathology
One of the first steps in writing

3. Hierarchy of evidence Randomised controlled trials,
Controlled trials without randomisation,
Other prospective experimental trials,
Observational studies,
Case-control studies,
Case series,
Case reports; with expert opinion and consensus

4. Famous Case Reports
William MacIntyre and Henry Bence-Jones  found that Mr McBean’s urine was “abound in animal matter” a protein called Bence-Jones protein in Multiple Myeloma
Sigmund Freud recorded case history of OCD (rat man), dissociative disorder (Anna O), phobias (Little Hans) and post-traumatic disorder (wolf man).
Paul Pierre Broca - Broca’s area, the speech production centre in the brain

5. Identify a potential case report
Common manifestation of an unusual disorder
Uncommon manifestation of an usual disorder
A new disorder/treatment
Identify by trying to find the unexplained findings

6. Type of case reports Diagnosis-related Management-related
a. Unusual or new disease.
b. Unusual presentation of known disease.
c. New methods of diagnosis.
d. Unusual or new aetiology.
e. Unexpected association between diseases or symptoms.
Management-related
a. New or improved treatment type.
b. New or rare side effects or complication of treatment

7. Structure of a case report
Title
Abstract (journal dependent)
Introduction (journal dependent)
Case report
Discussion
Acknowledgements (optional)
References
Illustrations (optional)

8. Authors First author: does most work, listed first
2nd, 3rd, etc authors: listed in order of contribution
Senior author: listed last
“Corresponding” author – Usually first or senior author
Only authors who have done a significant contribution should be included
International Committee of Medical Journal Editors guidelines – 3 criteria

9. Introduction/ background
Introduces the patient case to the reader.
Concise, Salient.
State the subject & background information for clarity.
Why this case is unique:
Previously unreported?
A new pattern?
Previously unsuspected relationship?
Unusual diagnosis, prognosis, therapy, harm?
Justify the merit of the case report .
Describe the strategy, extent & dates of the database searched for literature review and provide search terms.

10. Case Presentation
Describe the case in narrative form & chronological order typically comprising clinical history, physical examination findings, investigative results, differential diagnosis, working diagnosis, management, follow-up and final diagnosis
Provide patient demographics (age, sex, height, weight, race, occupation).
Avoid patient identifiers (date of birth, initials).
Describe the patient’s complaint, present illness, social, family history & medical history

11. Literature Review
Can appear after the Case Presentation or usually be included in Discussion section
More specific discussion of the disease entity, therapy, etc.
Focus on the source of surprise or confusion in the case
Not the entire body of work on topic. Remember space limitations!

12. Discussion Most difficult section, should be brief and to-the-point
Explain, clarify and interpret key findings,
Explain the objective of case report
Present the relevant kit literature
Compare and contrast the nuances of the case report with the literature review.
List the limitations of the case report and describe their relevance.
Summarize the salient features of the case report.
Draw recommendations and conclusions.

13. Conclusion Brief and not exceeding one paragraph.
A justified conclusion & evidence-based recommendations only.
Describe how the information learned applies to one’s own practice.
Focus on the main learning points
Take-home message should be emphasized

14. Acknowledgement Optional
Help received from colleagues who do not justify authorship
Sources of funding
Consent from the patient,
Anonymously acknowledging the patient
Patient privacy

15. References Only use references used to support the case study
Just adequate in number
Primarily from peer reviewed journal articles
References should be formatted appropriately, as described in the journal’s instructions for authors or in the Uniform Requirements (Vancouver style, etc) as

16. Abstract Most important part
Concise and condensed version of the case report  with word limit
“Short and sweet”
Structured with no abbreviations
Background : Introduction and Rarity.
Case presentation.
Conclusion – Learning points and impact of report.
Important as indexed by most electronic databases

17. Title Accurately and succinctly describe the case
Sufficiently informative to interest the reader
Effective
Facilitate retrieval with electronic searching

18. Journal Find 3-4 suitable journals Audience Field Impact factor
Likelihood for publication
Review sample of published case reports
Review Instructions for Authors for particular journals
Space limitations are paramount in minds of editors!

19. Review
Revisions: of content, of order, of grammar, for consistency, to follow journal requirements
Use plain simple english
Take support of senior colleague
Get feedback from co-authors

20. Enhance chance of acceptance
Follow the journal’s instructions for authors when preparing a manuscript – Available on journal website
Usually must confirm to: “Uniform Requirements for Manuscripts Submitted to Biomedical Journals”:
When formatting a paper, ensure to satisfy both sets of instructions before submitting a paper.

21. To recapitulate Identify case report Literature search
Uniqueness & learning point of case.
Authors
Appropriate journal – Get instructions
Further literature search
Compile case info and source articles
Assign a reference number to each reference source and form a list
Write up the case and discussion in the required format using reference numbers

22. Case Report Case report should be honest & factual
The case reported should be unique, rare or unusual.
The manuscript should be short and succinct.
The case should add value to diagnosis or management.
There should be a clear learning point

23. Submission
Review the order, attach the relevant documents such as the covering letter, list of authors, labelled photographs, legends, copyright, etc as required
Margins, spacing, figure numbering, and style of references(Vancouver, Harvard, and so on), all are important aspects
Mail your manuscript with cover letter
Acknowledgements

24. Osler once said
“Always note and record the unusual…Publish it. 
Place it on permanent record as a short, concise note. Such communications are always of value.”

25. Wish you the Best for
Medical Writing
Thank You