MAKING A CASE FOR MORE CASE REPORTS

A case report is a form of medical communication. It is arguably the oldest and basic type of scientific publication,¹ dating from 17th century ² and has since become a key element of medical literature.³ Several definitions have been used to describe this genre, but a very encompassing definition by Carey states that: "A case report is the publication in the medical scientific literature of a single clinical observation whose principal purpose is to generate hypotheses regarding human disease or provide insight into clinical practice".⁴

Case reports allow for anecdotal sharing of personal clinical experiences,¹ which draw attention to crucial observations, uncommon medical occurrences, the mechanisms underlying such conditions, unanticipated adverse effects or benefits of therapeutic measures and novel skills.⁵ They often contain one main message, stimulate the reader's interest, and highlight the "discovery aspect"of medical knowledge.^4,6

Case reports witnessed gradual decline of regard and interest from scientific community of publishers and researchers alike in the second half of the 20th century, with increased emphasis on evidence based medicine.^4,7 Studies examining the frequency with which some top journals publish this type of genre indicated a downward trend.^2,4,6,8,9 Observed reasons include: The believe that case reports provide a lower quality of evidence.^1,8,10; Publishers' obsession with "Impact Factor" (A factor of how many times published articles are cited) - and studies have shown that case reports get much less citations.^4,6,8 and lastly some institutions attach little or no academic value to published case reports with regards to promotion for academicians^5,11-13 causing reduced enthusiasm about writing case reports compared to other types of research works.

Notwithstanding the perceived and actual weaknesses of case reports in terms of generalizability of findings and reproducibility of methods, ability to adduce causality et cetera,¹⁴ there are still numerous benefits, importance and uniqueness of case reports which makes them very relevant in scientific literature.

They can help with the discovery and reporting of novel health occurrences which may alert readers to similar cases,^3,14-16 hypothesis formulation,^{1,4,6,8,14,15} presentation of in-depth narrative studies,¹⁴ study of rare disorders which other study designs like randomized control trials are not ideally suited due to limited number of cases,^4,8,14 changing and/or improving clinical practice,^6,17 resolving ethical constraints that may have disallowed experimental studies,¹⁴ contributing to clinical or medical learning and continuing medical education by presenting day-to-day clinical practice, clinicians' diagnostic reasoning, disease management, and follow-up of cases.^6,8,14-16 Other reported advantages of writing case reports are: Relatively low cost of research and faster publication time,¹⁴ good opportunity for young researchers to learn and hone their skills for scientific writing,^1,4,14,15,18 a source of educational entertainment for some readers and a means of satisfaction for the author.^14,16

It is interesting to note that following the decline in its acceptance, there is currently a gradual rise in the number of published case reports.^4,7 Several journals are becoming increasingly vocal on their support for more case reports to be published, believing they are integral to medical literature.^4,6,8Some journals are now even solely dedicated to this unique style of scientific communication.⁴

Against this background, it is noteworthy that five interesting case reports/case series are featured in this issue of Annals of Ibadan Postgraduate Medicine (AIPM). Situated in a developing country and hosted in a foremost academic health training institution in the country, a significant part of the journal's readership, notably trainee specialist doctors among others will find this edition valuable. Perhaps, clinicians would now begin to find encouragement to write and submit interesting, novel and unique case reports that could add to the body of knowledge, improve clinical practice, provide a clear message and provoke further larger studies that are considered as evidence-based.