1. Case Report Prof. of Clinical Neuroscience Department of Psychiatry
Shahin Akhondzadeh Ph.D., FBPharmacolS., D.Sc.
Prof. of Clinical Neuroscience
Department of Psychiatry
TUMS

2. Introduction ‘…Any patient that goes through the door of this hospital is a potential case report…’ Anonymous (The Montreal General Hospital)

3. Definition Case reports are brief reports describing an isolated clinical case or a small number of cases. They may describe new or uncommon diagnoses, unusual outcomes or prognosis, new or infrequently used therapies and side effects of therapy not usually discovered in clinical trials (Khalid Khan, Peter Thompson)

4. Example of case report. A 64-year old woman presented with diffuse musculoskeletal pain. At the age of 58, she had undergone gastric bypass surgery because of severe obesity. At the age of 59, she underwent modified radical mastectomy for an estrogen receptor-positive T1N0M0 right breast carcinoma and received tamoxifen postoperatively.

5. Initial diagnosis months after mastectomy, she presented with low back pain, myalgias, and fatigue. Alkaline phosphatase was 231 U/L (normal U/L). Bone scan revealed areas of increased activity in the right hip, right inferior pubic ramus, and multiple left ribs, interpreted as consistent with metastases.

6. Blood test. Serum calcium was 7. 8mg/dL Phosphorus 3
Blood test. Serum calcium was 7.8mg/dL Phosphorus 3.1mg/dL Creatinine 0.7mg/dL Albumin 4.0g/dL Alkaline phosphatase 220 U/L (normal less than 130 U/L) Serum 25-hydroxyvitamin D was undetectable (less than 4ng/ml) Parathyroid hormone(PTH) was elevated (338pg/ml; normal pg/mL)

7. Treatment. Ergocalciferol dose was increased to 50,000 IU twice weekly
Treatment. Ergocalciferol dose was increased to 50,000 IU twice weekly. Four months later, her 25-hydroxyvitamin D level was still low (15ng/mL), but she remained pain-free. Khokhar et al.

8. Case reports describing new diagnosis

9. Case Reports describing unusual treatment response

10. Case report-unusual response to treatment
Case report-unusual response to treatment. More recently researchers have used the case report format to share unusual treatment combinations or responses. For example, Treon et al reported in 2004 about an interesting clinical response to sildenafil in Waldenstrom’s macroglobulinemia.

11. Rare Cases

12. Rare cases. In rare cases, a series or more definitive study may be impossible. The reporting of similar rare cases, affords the clinician an opportunity to read this discontinuous “case series” and inform a rational approach to disease.

13. Report. A well-written case report or small uncontrolled series of cases is often the first step in the discovery of new diseases and treatments.(Albrecht et al, Ruben RJ) A good case report has the element of surprise

14. Are Case reports important in the era of evidence based medicine?

15. Potential roles of case reports and case series

16. Potential roles of case reports and case series
Potential roles of case reports and case series. Recognition and description of new diseases. Detection of drug side effects (adverse and beneficial). Study of mechanisms of disease. Medical education and audit. Recognition of rare manifestations of disease (Vandenbroucke J)

17. Impact of case report on medical research

18. Impact of case reports on medical research (Lancet)

19. How to write a good case report

20. Types of case reports Full case reports Images (with legends) Quiz
Letter to editor

21. Anatomy of a case report
Background/Introduction/Abstract
Case report
Discussion
Summary/Learning points
References

22. Case presentation Include relevant details
Be concise yet comprehensive
Remember the difference between “spoken” and “written” language
Make a logical chronologic sequence

23. Submission process Write a good cover letter
Attempt online submission, when possible - quicker turnaround time and cheaper
Check specific journal requirements and comply
Figures - check format required - .jpeg, .tiff