2013 Journals
Journal 2013 Vol.14 No.1
Optimizing school-based intestinal helminth control interventions in the Philippines
Vicente Y. Belizario, Jr. *, Alexander H. Tuliao, *, Francis G. Totanes*, Camille L. Asuncion* *National Institutes of Health, University of the Philippines, Manila
Keywords: Soil-transmitted helminthes, Ascaris, Trichuris, Schistosomiasis, Schistosomes, Helminth control
Optimizing school-based intestinal helminth control interventions in the Philippines
Vicente Y. Belizario, Jr. *, Alexander H. Tuliao, *, Francis G. Totanes*, Camille L. Asuncion* *National Institutes of Health, University of the Philippines, Manila
Keywords: Soil-transmitted helminthes, Ascaris, Trichuris, Schistosomiasis, Schistosomes, Helminth control
Abstract:
Intestinal helminth infections caused by soil-transmitted helminths and schistosomes bring about the greatest burden of disease in poverty-stricken areas in the developing world. The most vulnerable group and the most significant contributors to disease transmission are the school-age children. While awaiting major improvements on sanitation, the recommended strategy for helminth control is school-based, teacher assisted, mass drug administration (MDA). However, millions of individuals worldwide remain afflicted with these diseases, and the Philippines is no different from many of the developing countries. The overall objective of this paper is to review current Philippine control programs and initiatives and offer evidence based recommendations for improvement. Discrepancies between parasitologic parameters and drug coverage rates pose significant challenges in the control and prevention of helminth infections in the country. School-based MDA may be scaled up after successful local initiatives, where teachers have direct participation in drug administration. There is also a need to involve the social science sector to help address the behavioral aspects of helminth control. Moreover, monitoring and evaluation of interventions through identification of success parameters will contribute to the optimization of school-based helminth control, and to strategies towards effective control of intestinal helminth infections as a public health problem in the country.
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An Epidemiologic Investigation of Chronic Osteomyelitis among Pediatric Patients Admitted from 2006 to 2010 at the Philippine General Hospital
Suzanne S. Ponio, MD; Carmina A. Delos Reyes, MD * University of the Philippines College of Medicine – Philippine General Hospital
Keywords: Chronic osteomyelitis, Staphylococcus aureus, MSSA, MRSA, pediatric osteomyelitis
Abstract
Background: Osteomyelitis is a debilitating disease if not properly treated. Epidemiologic and microbiologic data will be of great importance in the direction of treatment.
Objective: To determine the epidemiologic and clinical profile of pediatric patients with chronic osteomyelitis admitted at Philippine General Hospital from 2006 to 2010.
Methodology: This is a retrospective study involving a review of medical records of pediatric patients with chronic osteomyelitis admitted at the Philippine General Hospital during the 5 year study period. Frequencies and percentages were computed for nominal data. Comparison of the different variables was done using Chisquare and Fisher Exact test.
Results: Eighty of the 134 cases of pediatric patients with chronic osteomyelitis were reviewed. Twenty-three percent of all operations involved the femur (N=18) and tibia (N=18). On radiograph, the presence of sequestrum was the most common finding noted in 53% of the cases. The predominant organism isolated in bone cultures was MSSA (40%) followed by MRSA (20%). On tissue cultures MRSA was the most common isolate in 34%, followed by MSSA(31%). Majority of the patients were given Oxacillin as empiric therapy (55%).No significant difference was observed with respect to the areas of bone involvement, signs and symptoms, radiologic findings and laboratory parameters between MSSA and MRSA osteomyelitis (p>0.05).
Conclusion: There were 239 per 100,000 cases of chronic osteomyelitis. The most common bones involved were the femur and tibia with sequestrum as the most common radiologic finding. In the previous studies, MRSA was not reported but was noted in the present study. Most of the patients in our study were treated with both antibiotics and surgery to optimize management. Ninety-eight percent of the cases had significant clinical improvement upon discharge. Based on this study, laboratory parameters, clinical manifestations and area involved cannot be utilized in differentiating MRSA from MSSA osteomyelitis. Further studies are needed to support our findings and isolation of the organism is still required for definitive identification to distinguish between MRSA from MSSA osteomyelitis.
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Staphylococcus aureus nasal carriage rates among children between oneto- five years in Barangay Pio Del Pilar, Makati City
Ceres Paulino, M.D., Robert Dennis Garcia, M.D., Shirley Ong, M.D. * *Makati Medical Center
Keywords: Staphylococcus aureus; MRSA; nasal colonization
Ceres Paulino, M.D., Robert Dennis Garcia, M.D., Shirley Ong, M.D. * *Makati Medical Center
Keywords: Staphylococcus aureus; MRSA; nasal colonization
Abstract:
Objective: This study aims to determine the staphylococcal nasal carriage rates of children who are between one-to-five years old and residing in Botanical Gardens, Barangay Pio Del Pilar, Makati City. The following shall also be investigated: antibiotic resistance patterns of isolates, factors associated with S. aureus nasal carriage, and other pathologic organisms colonizing the anterior nares in this population.
Methods: Nasal swabs were taken from each subject and cultured after informed consent was obtained. Statistical analysis was performed to determine factors with significant association with nasal colonization.
Results: Ten (12.9%) out of 77 subjects were positive for S. aureus nasal colonization, one of which was oxacillin-resistant. Only the gross monthly income showed significant association with nasal carriage (p=0.03, OR = 0.59, 95% CI). Four subjects (5.1%) were carriers of S. pneumoniae.
Conclusions: The study shows a relatively low rate of Methicillin Sensitive S. aureus (MSSA) and Methicillin Resistant S. aureus (MRSA) nasal carriage. The MRSA isolate was sensitive to all other anti-staphylococcal drugs tested, similar to other studies on Community Acquired-MRSA (CA-MRSA). Local surveillance studies are essential in the control of CA-MRSA and in guiding local antibiotic policies for staphylococcal infections. Further studies on a bigger population are needed to determine rates, resistance patterns and risk factors associated with nasal colonization.
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Methods: Nasal swabs were taken from each subject and cultured after informed consent was obtained. Statistical analysis was performed to determine factors with significant association with nasal colonization.
Results: Ten (12.9%) out of 77 subjects were positive for S. aureus nasal colonization, one of which was oxacillin-resistant. Only the gross monthly income showed significant association with nasal carriage (p=0.03, OR = 0.59, 95% CI). Four subjects (5.1%) were carriers of S. pneumoniae.
Conclusions: The study shows a relatively low rate of Methicillin Sensitive S. aureus (MSSA) and Methicillin Resistant S. aureus (MRSA) nasal carriage. The MRSA isolate was sensitive to all other anti-staphylococcal drugs tested, similar to other studies on Community Acquired-MRSA (CA-MRSA). Local surveillance studies are essential in the control of CA-MRSA and in guiding local antibiotic policies for staphylococcal infections. Further studies on a bigger population are needed to determine rates, resistance patterns and risk factors associated with nasal colonization.
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A retrospective cohort study comparing the cure rates of ampicillin, chloramphenicol, ampicillin and chloramphenicol combination, and third generation cephalosporins as initial antibiotic therapy for invasive Haemophilus influenzae infections
Tomas T. Saiton, Jr., M.D. * *Philippine Childrens’ Medical Center
Keywords: invasive Hib disease, ampicillin, chloramphenicol, ampicillin-chloramphenicol combination, third generation cephalosporins, Haemophilus influenzae
Tomas T. Saiton, Jr., M.D. * *Philippine Childrens’ Medical Center
Keywords: invasive Hib disease, ampicillin, chloramphenicol, ampicillin-chloramphenicol combination, third generation cephalosporins, Haemophilus influenzae
Abstract:
Background/Objective: Haemophilus influenzae type b remains to be a significant etiology of invasive infections specially in children two months to five years old without Hib vaccination. This study was performed to compare the cure rates of ampicillin, chloramphenicol, ampicillin-chloramphenicol combination and third generation cephalosporins as initial antibiotic treatments for documented invasive Hib infections. This study may assist in formulating recommendations on empiric antimicrobial therapy.
Methods: Charts of patients with invasive Hib disease confirmed either by blood culture, CSF culture and/or latex agglutination test from January 1991 to August 2010 were reviewed. Cases were classified into four groups depending on the initial antibiotic given upon admission. The four groups were compared and analyzed in terms of cure rates.
Results: The disease occurred predominantly in children less than two years old. Males were more frequently affected than females. All subjects were not given Hib vaccination. Cure rates were significantly different between ampicillin (33%) and chloramphenicol (89%) groups (p=0.017), and between chloramphenicol (89%) and ampicillin-chloramphenicol (39%) groups (p=0.008). However, cure rates were not significantly different when third generation cephalosporin group (62%) was compared to the other treatment groups (p>0.05). Resistance of Hib was 31% to ampicillin, while <10% to chloramphenicol and third generation cephalosporins. Conclusion: Chloramphenicol is an excellent drug for empiric therapy in highly suspected or proven cases of invasive Hib disease.
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Methods: Charts of patients with invasive Hib disease confirmed either by blood culture, CSF culture and/or latex agglutination test from January 1991 to August 2010 were reviewed. Cases were classified into four groups depending on the initial antibiotic given upon admission. The four groups were compared and analyzed in terms of cure rates.
Results: The disease occurred predominantly in children less than two years old. Males were more frequently affected than females. All subjects were not given Hib vaccination. Cure rates were significantly different between ampicillin (33%) and chloramphenicol (89%) groups (p=0.017), and between chloramphenicol (89%) and ampicillin-chloramphenicol (39%) groups (p=0.008). However, cure rates were not significantly different when third generation cephalosporin group (62%) was compared to the other treatment groups (p>0.05). Resistance of Hib was 31% to ampicillin, while <10% to chloramphenicol and third generation cephalosporins. Conclusion: Chloramphenicol is an excellent drug for empiric therapy in highly suspected or proven cases of invasive Hib disease.
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14 year old male with oliguria and respiratory distress- What is your diagnosis?
James Robertson C. Pichel, M.D.*, Dolores D. Bonzon, M.D.*, Francisco E. Anacleto Jr., M.D.* *University of the Philippines College of Medicine- Philippine General Hospital
Abstract:
A 14 year old male from Quezon City Manila was admitted due to oliguria. He presented with 7 days of intermittent fever associated with malaise, photophobia with redness of the eyes. A few hours before admission, he developed repetitive vomiting with decreased urine output. He denied any muscle pain, change in his sensorium or seizure episode. He had a history of wading in flooded waters.
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Testimonial Dinner for PIDSP Past Presidents
Fatima Gimenez, M.D.*
Fatima Gimenez, M.D.*
Abstract:
The Presidents dinner last August 23, 2013 held at the EDSA Shang-rila Hotel was definitely a bipolar celebration. Bipolar? Let us be clear that this was meant in a very good way.
Dr. Betty Quiambao, giving the opening remarks, was the emotional catalyst, while Dr. Soriano with her inspirational message provided the much needed nostalgia. Further complemented with a short well documented history of PIDSP via an AVP presentation, which was a tireless collaboration of Dr. Joanne de Castro and her group , not one individual was left dry-eyed.
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Dr. Betty Quiambao, giving the opening remarks, was the emotional catalyst, while Dr. Soriano with her inspirational message provided the much needed nostalgia. Further complemented with a short well documented history of PIDSP via an AVP presentation, which was a tireless collaboration of Dr. Joanne de Castro and her group , not one individual was left dry-eyed.
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Validation of the Modified Faine’s Criteria in the Diagnosis of Leptospirosis in Children Using the Microscopic Agglutination Test as the Gold Standard
Mayan Uy-Lumandas, M.D.,Anna Lisa Ong-Lim, M.D., Ma. Liza Antoinette Gonzales, M.D. University of the Philippines College of Medicine- Philippine General Hospital
Keywords: Leptospirosis, Modified Faine’s criteria, MAT
Mayan Uy-Lumandas, M.D.,Anna Lisa Ong-Lim, M.D., Ma. Liza Antoinette Gonzales, M.D. University of the Philippines College of Medicine- Philippine General Hospital
Keywords: Leptospirosis, Modified Faine’s criteria, MAT
Abstract
Objective: This study aimed to validate the modified Faine’s criteria (Parts A and B) proposed by Brato in the early diagnosis of leptospirosis in children using the microscopic agglutination test (MAT) as gold standard.
Methodology: This diagnostic validity study was conducted at the Philippine General Hospital. It included all pediatric patients who were admitted between September 2009 to December 2010 and who satisfied the presumptive and suggestive criteria in the diagnosis of leptospirosis based on the modified Faine’s criteria. A fourfold or greater rise in paired MAT titers was used as the gold standard. Calculations for sensitivity, specificity, positive and negative predictive values, and likelihood ratios of positive and negative tests were computed. Results Thirty-three patients satisfied the diagnosis of leptospirosis based on the criteria; however, only 20 of these had paired MAT titers and were included. The modified Faine’s criteria had a sensitivity of 60%, specificity of 73%, positive predictive value (PPV) of 43%, negative predictive value (NPV) of 85%, positive likelihood ratio of 2 and negative likelihood ratio of 0.4 . Modifying the clinical criteria by revision of the point allocation to create a “Pediatric Locally Modified Criteria” increased the sensitivity to 80%, PPV to 50%, NPV to 92%, positive likelihood ratio to 3 and negative likelihood ratio to 0.3.
Conclusion: The Modified Faine’s criteria had poor sensitivity and low positive predictive value and cannot be recommended as a screening test for the early diagnosis of leptospirosis in children. A proposed modification of the clinical criteria for local application increased diagnostic accuracy but must be further validated in a larger number of pediatric patients in the Philippines.
Methodology: This diagnostic validity study was conducted at the Philippine General Hospital. It included all pediatric patients who were admitted between September 2009 to December 2010 and who satisfied the presumptive and suggestive criteria in the diagnosis of leptospirosis based on the modified Faine’s criteria. A fourfold or greater rise in paired MAT titers was used as the gold standard. Calculations for sensitivity, specificity, positive and negative predictive values, and likelihood ratios of positive and negative tests were computed. Results Thirty-three patients satisfied the diagnosis of leptospirosis based on the criteria; however, only 20 of these had paired MAT titers and were included. The modified Faine’s criteria had a sensitivity of 60%, specificity of 73%, positive predictive value (PPV) of 43%, negative predictive value (NPV) of 85%, positive likelihood ratio of 2 and negative likelihood ratio of 0.4 . Modifying the clinical criteria by revision of the point allocation to create a “Pediatric Locally Modified Criteria” increased the sensitivity to 80%, PPV to 50%, NPV to 92%, positive likelihood ratio to 3 and negative likelihood ratio to 0.3.
Conclusion: The Modified Faine’s criteria had poor sensitivity and low positive predictive value and cannot be recommended as a screening test for the early diagnosis of leptospirosis in children. A proposed modification of the clinical criteria for local application increased diagnostic accuracy but must be further validated in a larger number of pediatric patients in the Philippines.
PIDSP @ 20 squares off with HIV in Subic
Marla Balao-Litam, M.D.
Marla Balao-Litam, M.D.
Abstract:
PIDSP celebrating its 20th year as of existence zeroed in on HIV as the topic for a 2-day symposium in Subic last May 19-20 2013. There were 2 excellent speakers. Dr Annie Ditangco, an HIV authority in the Philippines gave the HIV local experience: status, statistics and scenario for advocates. Issues on patient confidentiality and universal screening were adequately covered which covers the patients, doctors, nurses and students. She was glad to have PIDSP as an ally for to tackle the problems of HIV in children. Professor Usa Thisyakorn of Chulalongkorn University, President of The Thailand Pediatric Infectious Disease Society and International Society of Tropical Pediatrics talked on HIV management in children. She shared Thai success stories on advocacy concerns and breast-feeding issues encountered. Her advocacy breakthrough came in the form of an un-expected financial support from a relative after hearing Dr Usa talk on Thai HIV issues. In an unprecedented move, she also gave full support to the PIDSP HIV advocacy as she later donated her speaker’s honorarium as seed money for PIDSP’s HIV Advocacy.
Doing the Write Stuff: Raising the bar on medical research publishing
Rea Uy-Epistola
Rea Uy-Epistola
Abstract:
Medical writing is more than a craft; it is a skill. Like any skill, strong and good medical writing must be constantly honed and sharpened. An advocate of this principle is the Philippine Infectious Disease Society of the Philippines Journal (PIDSPJ), which conducted a successful second-run of its Medical Writing, Peer Review and Editing Workshop last January 2013 at the Hyatt Hotel, Manila.
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Journal 2013 Vol.14 No.2
Factors affecting compliance to rabies post-exposure prophylaxis among pediatric patients seen at the Research Institute for Tropical Medicine
Ruth Faye Romero-Sengson *Philippine Children’s Medical Center
Keywords: Rabies post exposure prophylaxis, rabies immunoglobulin
Factors affecting compliance to rabies post-exposure prophylaxis among pediatric patients seen at the Research Institute for Tropical Medicine
Ruth Faye Romero-Sengson *Philippine Children’s Medical Center
Keywords: Rabies post exposure prophylaxis, rabies immunoglobulin
Abstract:
Rabies is a viral disease that produces uniformly fatal encephalitis in humans and most other mammals. It remains one of the most common viral causes of mortality in the developing world. Objective: The aim of this study to was determine the factors that affect compliance of pediatric patients advised to receive rabies Post-exposure Prophylaxis (PEP).
Methods: Pediatric patients zero months to 18 years old who were bitten by animals and thereafter sought consult from January to March 2009. Subjects with Category II and III exposure bites and advised PEP, who have telephone contact numbers, and gave verbal consent to participate were included. Excluded subjects were those who cannot be accessed by telephone or mobile, had previous animal bite and had received prior rabies immunization. Data were gathered through chart review and telephone interviews. Total number of patients who complied and did not comply with PEP and the factors related to compliance were determined.
Results: One thousand two hundred forty three pediatric patients sought consult and were advised to receive PEP: 757 (61%) were males and 496 (39%) were females. Most common age group was 2-to-5 yrs (41%), followed by 6-to-10 years (32%). A higher proportion of females were noted under Category II exposure while a higher proportion of males were noted under Category III. Most common biting animal was dog. The highest proportion of subjects with multiple body bites were from the very young age group (0 to 1 year old). Most commonly injured body parts were the upper extremities (32.7%), lower extremities (42.7%) and head (16%). The two-site intradermal (ID) rabies vaccine regimen was prescribed on days 0, 3, 7 and 30; however, there was a declining trend in rabies vaccine and rabies immune globulin (RIG) received. Compliance rate of RIG (55%) and rabies vaccine (31%) were low. Factors affecting compliance to rabies PEP were: 1) fear of acquiring rabies and knowledge of the gravity of the disease; 2) vaccine cost and affordability; and 3) knowledge on status of biting animal.
Conclusion: The most salient issue in rabies PEP compliance is the affordability of the vaccine.
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Methods: Pediatric patients zero months to 18 years old who were bitten by animals and thereafter sought consult from January to March 2009. Subjects with Category II and III exposure bites and advised PEP, who have telephone contact numbers, and gave verbal consent to participate were included. Excluded subjects were those who cannot be accessed by telephone or mobile, had previous animal bite and had received prior rabies immunization. Data were gathered through chart review and telephone interviews. Total number of patients who complied and did not comply with PEP and the factors related to compliance were determined.
Results: One thousand two hundred forty three pediatric patients sought consult and were advised to receive PEP: 757 (61%) were males and 496 (39%) were females. Most common age group was 2-to-5 yrs (41%), followed by 6-to-10 years (32%). A higher proportion of females were noted under Category II exposure while a higher proportion of males were noted under Category III. Most common biting animal was dog. The highest proportion of subjects with multiple body bites were from the very young age group (0 to 1 year old). Most commonly injured body parts were the upper extremities (32.7%), lower extremities (42.7%) and head (16%). The two-site intradermal (ID) rabies vaccine regimen was prescribed on days 0, 3, 7 and 30; however, there was a declining trend in rabies vaccine and rabies immune globulin (RIG) received. Compliance rate of RIG (55%) and rabies vaccine (31%) were low. Factors affecting compliance to rabies PEP were: 1) fear of acquiring rabies and knowledge of the gravity of the disease; 2) vaccine cost and affordability; and 3) knowledge on status of biting animal.
Conclusion: The most salient issue in rabies PEP compliance is the affordability of the vaccine.
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CLINICAL PROFILE AND OUTCOME OF PEDIATRIC PATIENTS WITH REVERSE TRANSRIPTION-POLYMERASE CHAIN REACTION (RT-PCR)-CONFIRMED INFLUENZA A (H1N1)
Cynthia Seguerra, M.D.,* Cristan Q. Cabanilla, M.D.* *Philippine Children’s Medical Center
Keywords: Influenza A (H1N1), Reverse Transcription-Polymerase Chain Reaction (RT-PCR)
Cynthia Seguerra, M.D.,* Cristan Q. Cabanilla, M.D.* *Philippine Children’s Medical Center
Keywords: Influenza A (H1N1), Reverse Transcription-Polymerase Chain Reaction (RT-PCR)
Abstract
Background: The World Health Organization declared on June 11, 2009 the first pandemic of the 21st Century caused by the novel Influenza A (H1N1) virus. The virus was observed to be clinically similar to the seasonal influenza, in which case, patients recover even without medical treatment. The virus affected the younger age group even those who are healthy, which make it different from seasonal flu. Objective: The study aimed to describe the clinical profile and outcome of pediatric patients with Reverse Transcription-Polymerase Chain Reaction (RT-PCR)-confirmed Influenza A (H1N1).
Methodology: Pediatric patients of the Lung Center of the Philippines seen from May 1 to July 31, 2009 for Influenza-like illness upon presentation and confirmed to have Influenza A (H1N1) virus through Reverse Transcription-Polymerase Chain Reaction (RT-PCR) assay were included in the study. Charts of patients were reviewed. Information from patients was obtained using the WHO Case Summary Form and the National Epidemiology Center Initial Screening of Influenza A (H1N1) form. The patient’s demographic data, clinical characteristics, co-morbid conditions, vaccination, clinical course, complications, anti-viral medications received and adverse reactions, and over-all outcome were noted, as well as, exposure to confirmed cases and history of travel.
Results: Out of the 243 RT-PCR-confirmed patients, 71.6% (n=174) came from the adolescent age group, with a median age of 13 years old. A predominance of male patients (57.2%) was noted. Fever (92%), cough (83.1%), nasal congestion (52.7%) and sore throat (35%) were the most common presenting signs and symptoms. Bronchial asthma (14.4%) was the leading co-morbidity present and pneumonia was the most common complication. Eight patients (3.3%) were hospitalized during the course of the disease. All RT-PCR-confirmed Influenza A (H1N1) patients recovered and no mortality was noted.
Conclusions: In this study, majority of the RT-PCR-confirmed Influenza A (H1N1) patients were characterized by self-limited, uncomplicated, and febrile respiratory illness, who all recovered with minimal complications.
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Methodology: Pediatric patients of the Lung Center of the Philippines seen from May 1 to July 31, 2009 for Influenza-like illness upon presentation and confirmed to have Influenza A (H1N1) virus through Reverse Transcription-Polymerase Chain Reaction (RT-PCR) assay were included in the study. Charts of patients were reviewed. Information from patients was obtained using the WHO Case Summary Form and the National Epidemiology Center Initial Screening of Influenza A (H1N1) form. The patient’s demographic data, clinical characteristics, co-morbid conditions, vaccination, clinical course, complications, anti-viral medications received and adverse reactions, and over-all outcome were noted, as well as, exposure to confirmed cases and history of travel.
Results: Out of the 243 RT-PCR-confirmed patients, 71.6% (n=174) came from the adolescent age group, with a median age of 13 years old. A predominance of male patients (57.2%) was noted. Fever (92%), cough (83.1%), nasal congestion (52.7%) and sore throat (35%) were the most common presenting signs and symptoms. Bronchial asthma (14.4%) was the leading co-morbidity present and pneumonia was the most common complication. Eight patients (3.3%) were hospitalized during the course of the disease. All RT-PCR-confirmed Influenza A (H1N1) patients recovered and no mortality was noted.
Conclusions: In this study, majority of the RT-PCR-confirmed Influenza A (H1N1) patients were characterized by self-limited, uncomplicated, and febrile respiratory illness, who all recovered with minimal complications.
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SACCHAROMYCES BOULARDII IN THE PREVENTION OF ANTIBIOTIC- ASSOCIATED DIARRHEA IN CHILDREN: A RANDOMIZED CONTROLLED TRIAL
Resie Aurea O. Casem, MD Saint Louis University Hospital of the Sacred Heart
Keywords: Antibiotic-associated diarrhea, Probiotics, S. boulardii, Saccharomyces boulardii
Resie Aurea O. Casem, MD Saint Louis University Hospital of the Sacred Heart
Keywords: Antibiotic-associated diarrhea, Probiotics, S. boulardii, Saccharomyces boulardii
Abstract
Background: Diarrhea is one of the most common adverse effects of antibiotic treatment. In Saint Louis University-Hospital of the Sacred Heart (SLU-HSH), about three out of ten patients at the outpatient department and one third of admitted pediatric patients are given antibiotics. Although international studies document the efficacy of probiotics in preventing antibiotic associated diarrhea (AAD), there is limited research in our country about this. Objectives: The main objective of this study was to evaluate the efficacy of a yeast probiotic, Saccharomyces boulardii, in preventing AAD.
Methods: This was a randomized clinical trial conducted between June and October 2012 at Saint Louis University-Hospital of the Sacred Heart. A total of 140 patients aged 6months to 18years with PCAP were enrolled. The patients either received the standard antibiotic treatment alone (control group n=71) or the oral antibiotic treatment plus 250mg of Saccharomyces boulardii (treatment group n=69) twice a day for the entire duration of treatment. Analyses were based on treatment and included data from 136 patients. Results: Patients who received S. boulardii had shorter duration of diarrhea than those who did not receive it [3.06 days (0.68) vs. 2.45 days (0.69), P value of 0.032]. However, the incidence of diarrhea between the two groups was not statistically significant [16 of 68 (23.5%) vs. 11 of 66 (16.7%), P value of 0.391].
Conclusion: This is the first randomized-controlled trial in our locality which showed evidence that S. boulardii shortens the duration of antibiotic-associated diarrhea.
Background: Diarrhea is one of the most common adverse effects of antibiotic treatment. In Saint Louis University-Hospital of the Sacred Heart (SLU-HSH), about three out of ten patients at the outpatient department and one third of admitted pediatric patients are given antibiotics. Although international studies document the efficacy of probiotics in preventing antibiotic associated diarrhea (AAD), there is limited research in our country about this. Objectives: The main objective of this study was to evaluate the efficacy of a yeast probiotic, Saccharomyces boulardii, in preventing AAD.
Methods: This was a randomized clinical trial conducted between June and October 2012 at Saint Louis University-Hospital of the Sacred Heart. A total of 140 patients aged 6months to 18years with PCAP were enrolled. The patients either received the standard antibiotic treatment alone (control group n=71) or the oral antibiotic treatment plus 250mg of Saccharomyces boulardii (treatment group n=69) twice a day for the entire duration of treatment. Analyses were based on treatment and included data from 136 patients. Results: Patients who received S. boulardii had shorter duration of diarrhea than those who did not receive it [3.06 days (0.68) vs. 2.45 days (0.69), P value of 0.032]. However, the incidence of diarrhea between the two groups was not statistically significant [16 of 68 (23.5%) vs. 11 of 66 (16.7%), P value of 0.391].
Conclusion: This is the first randomized-controlled trial in our locality which showed evidence that S. boulardii shortens the duration of antibiotic-associated diarrhea.
CLINICAL PROFILE OF EXTRAPULMONARY TUBERCULOSIS CASES ADMITTED AND DIAGNOSED IN A TERTIARY GOVERNMENT HOSPITAL FROM JANUARY 2006 TO JUNE 2010
Regie S. Santos, M.D. Ospital ng Makati
Keywords: Extrapulmonary Tuberculosis, TB meningitis
Regie S. Santos, M.D. Ospital ng Makati
Keywords: Extrapulmonary Tuberculosis, TB meningitis
Abstract
Objective: The aim of this study was to determine the prevalence and pattern of Extra-pulmonary Tuberculosis (EPTB) cases that were admitted and diagnosed in a tertiary government hospital from January 2006 to December 2010.
Methodology: Records of pediatric patients who were admitted in a tertiary government hospital from January 2006 to December 2010 with a diagnosis of Extra-pulmonary Tuberculosis were reviewed. The following information was gathered: demographic profile, clinical profile, results of PPD, complications and mortality rate, and laboratory results.
Results: The sixty-six cases constituted 7.8% of the total pediatric admissions during the same period. There was no significant difference as to sex distribution ( 53% males vs. 47% females, with 1:1 ratio).Majority of cases involved the meninges ( 72.7%), followed by lymph node (6.1%), liver (6.1%), bone (6.1%) and genitourinary (3.0%). The three most common symptoms were nonspecific: fever, anorexia and weight loss. The occurrence of fever was universal among all admitted cases of Extrapulmonary TB. With regards to prognosis, the majority (83%) of cases were discharged in improved condition. The case fatality rate was 16.7%.
Conclusion: The incidence of new cases of EPTB has remained constant, despite the decline in new cases of active pulmonary TB.
Methodology: Records of pediatric patients who were admitted in a tertiary government hospital from January 2006 to December 2010 with a diagnosis of Extra-pulmonary Tuberculosis were reviewed. The following information was gathered: demographic profile, clinical profile, results of PPD, complications and mortality rate, and laboratory results.
Results: The sixty-six cases constituted 7.8% of the total pediatric admissions during the same period. There was no significant difference as to sex distribution ( 53% males vs. 47% females, with 1:1 ratio).Majority of cases involved the meninges ( 72.7%), followed by lymph node (6.1%), liver (6.1%), bone (6.1%) and genitourinary (3.0%). The three most common symptoms were nonspecific: fever, anorexia and weight loss. The occurrence of fever was universal among all admitted cases of Extrapulmonary TB. With regards to prognosis, the majority (83%) of cases were discharged in improved condition. The case fatality rate was 16.7%.
Conclusion: The incidence of new cases of EPTB has remained constant, despite the decline in new cases of active pulmonary TB.
A RETROSPECTIVE STUDY OF THE PREVALENCE AND SENSITIVITY PATTERN OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN A CHONG HUA HOSPITAL, CEBU CITY, 2007-2010
Elaine H. Kho, M.D.*, Jonathan Lim, M.D.* *Chong Hua Hospital, Cebu City
Keywords: MRSA, Methicillin resistant Staphylococcus aureus, Methicillin sensitive Staphylococcus aureus, Staphylococcus aureus, Vancomycin
Elaine H. Kho, M.D.*, Jonathan Lim, M.D.* *Chong Hua Hospital, Cebu City
Keywords: MRSA, Methicillin resistant Staphylococcus aureus, Methicillin sensitive Staphylococcus aureus, Staphylococcus aureus, Vancomycin
Abstract
Background/Objective: There is a deep concern about the rapid rise in resistance of bacteria to antimicrobial agents. Methicillin-resistant Staphylococcus aureus (MRSA) which pose challenges to the medical community. This study aimed to determine the prevalence and sensitivity pattern of Methicillin-Resistant Staphylococcus Aureus (MRSA) in a tertiary hospital in Cebu City from January 1, 2007 to December 31, 2010.
Methods: Charts of patients with MRSA growths were reviewed upon their admission. The sensitivity pattern, demographic profile and risk factors were noted.
Results: Out of the 637 isolates of Staphylococcus aureus, MRSA had a prevalence rate of 38.6% (n=246), while Methicillin Sensitive Staphylococcus aureus (MSSA) had 61.4% (n=391). The prevalence rate of health-care associated MRSA was 2% (n=5). The majority of the specimens sent for culture were wound/abscess (70% of pediatric and 76% of adult patients isolates). All MRSA growths were resistant to penicillin G, ampicillin, oxacillin, cefuroxime and amikacin. Local MRSA strains were still susceptible to ciprofloxacin (82.3%), clindamycin (90.6%), erythromycin (91.5%), and sulfamethoxazole-trimethoprim (85.9%). There was no resistance to linezolid and vancomycin. Vancomycin-resistant Staphylococcus aureus was not isolated. The mortality rate on both pediatric and adult population was 2.1% and 4.8%, respectively.
Conclusion: The prevalence of MRSA is increasing. Clindamycin, erythromycin, sulfamethoxazole- trimethoprim and vancomycin are excellent treatment options treat MRSA.
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Methods: Charts of patients with MRSA growths were reviewed upon their admission. The sensitivity pattern, demographic profile and risk factors were noted.
Results: Out of the 637 isolates of Staphylococcus aureus, MRSA had a prevalence rate of 38.6% (n=246), while Methicillin Sensitive Staphylococcus aureus (MSSA) had 61.4% (n=391). The prevalence rate of health-care associated MRSA was 2% (n=5). The majority of the specimens sent for culture were wound/abscess (70% of pediatric and 76% of adult patients isolates). All MRSA growths were resistant to penicillin G, ampicillin, oxacillin, cefuroxime and amikacin. Local MRSA strains were still susceptible to ciprofloxacin (82.3%), clindamycin (90.6%), erythromycin (91.5%), and sulfamethoxazole-trimethoprim (85.9%). There was no resistance to linezolid and vancomycin. Vancomycin-resistant Staphylococcus aureus was not isolated. The mortality rate on both pediatric and adult population was 2.1% and 4.8%, respectively.
Conclusion: The prevalence of MRSA is increasing. Clindamycin, erythromycin, sulfamethoxazole- trimethoprim and vancomycin are excellent treatment options treat MRSA.
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POSITION STATEMENT OF PPS AND PIDSP ON THE MEASLES OUTBREAK (January 7, 2014)
Abstract:
Immunization is the most cost-effective preventive health measure in this century. Mass Immunization Programs worldwide have eradicated small pox and significantly reduced the incidence of vaccine preventable diseases like diphtheria, tetanus, pertussis, polio, hepatitis B, Haemophilus influenzae type B disease, measles, mumps and rubella. Measles, being a vaccine preventable illness may be eliminated.
We, the Philippine Pediatric Society and the Pediatric Infectious Disease Society of the Philippines, are seriously concerned by the increasing cases of measles which is a highly preventable disease affecting the most vulnerable and the ones most in need of our protection. As reported by the measles Reference Laboratory of RITM, there were 500 and 482 laboratory- confirmed cases in November and December respectively. As Pediatricians and Pediatric Infectious Disease Specialist, who are in the front lines of the battle against childhood diseases, especially vaccine-preventable diseases, this situation is unacceptable.
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We, the Philippine Pediatric Society and the Pediatric Infectious Disease Society of the Philippines, are seriously concerned by the increasing cases of measles which is a highly preventable disease affecting the most vulnerable and the ones most in need of our protection. As reported by the measles Reference Laboratory of RITM, there were 500 and 482 laboratory- confirmed cases in November and December respectively. As Pediatricians and Pediatric Infectious Disease Specialist, who are in the front lines of the battle against childhood diseases, especially vaccine-preventable diseases, this situation is unacceptable.
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INTERIM MANAGEMENT GUIDELINES FOR MEASLES
Abstract:
Measles is a highly contagious viral disease affecting mostly children. There is no specific treatment for measles and most of those affected recover within 2-3 weeks. However, especially in malnourished children and persons with reduced immunity, measles can cause serious complications such as blindness, encephalitis, severe diarrhea, ear infection and pneumonia.
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PIDSP @20 Cascade of Educational Modules
Xenia Cathrine Fabay, M.D.
Xenia Cathrine Fabay, M.D.
Abstract:
PIDSP continues enthusiastically to celebrate its 20 years of existence by being true to its mission to conduct year-long activities that focus on the mission and vision of the Society. After the HIV/AIDS symposium in Subic on May 19-20, 2013, the modules on Appropriate Use of Antimicrobials and Principles of Vaccination were cascaded nationwide among healthcare workers in the different regions of the country. The first lecture on Appropriate Use of Antimicrobials was immediately given 4 days after the Subic CME Activity, on the 24th of May in Baguio General Hospital and Medical Center. And by September 13, just before the culminating activity of PIDSP@20, there were a total of 57 lectures rolled-out, involving a formidable 2552 participants. The most number of lectures (9) was given by Dr. Bettina Santos, while the most number of attendees at one lecture (588) was given by Dr. Xenia Fabay. Dr Sally Gatchalian, Dr. Marie Arciaga and Dr. Betty Quiambao reached the farthest city in the south, Zamboanga City, cascading both modules. On the other hand, Dr. Liza Gallardo gave a lecture on September 25, on Principles of Vaccinology in the most northern city of the country, Laoag City.
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Year
1996 | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022
EDITOR-IN-CHIEF:
Carmina delos Reyes, M.D.
Arlene Dy-Co, M.D.
Carmina delos Reyes, M.D.
Arlene Dy-Co, M.D.
EDITORIAL BOARD:
Mary Ann Bunyi, M.D.
John Andrew Camposano, M.D.
Mary Antoinette Cuady-Madrid, M.D.
Xenia Catherine Fabay, M.D.
Elizabeth Gallardo, M.D.
Fatima Gimenez, M.D.
Jonathan Lim, M.D.
Sarah Makalinaw, M.D.
Francesca Mae Pantig, M.D.
Paul Sherwin Tarnate, M.D.
ADVISERS:
Cecilia Maramba-Lazarte, M.D., MScID, MScCT
JOURNAL MANAGER:
Giselle Mikhaela Enriquez-Briones, M.D.