2014 Journals

Journal 2014 Vol.15 No.1
Cost-effectiveness analysis of universal mass vaccination with Rotarix® in the Philippines
I-Heng Lee, Baudouin Standaert, Maria Carmen Nievera, M.D., Jossie Rogacion, M.D.
Glaxo SmithKline Vaccines Singapore
Glaxi SmithKline Vaccines Belgium
Glaxi SmithKline Vaccines Philippines
University of the Philippines College of Med
Keywords: Rotavirus vaccine, Rotarix
Abstract:
Rotavirus is among the leading causes of severe gastroenteritis in children. Effective vaccines enable universal mass vaccination (UMV) which incurs high expenditure and therefore economic justification is needed.
Objective: This study aimed to evaluate the cost-effectiveness of UMV with Rotarix ® versus no vaccination program in the Philippines.
Methods: A four-state decision tree model was used to estimate costs and health outcomes subject to annual discount rate of 3.5% Locla and international published data and experts opinions were used for epidemiology, efficacy and resource use input parameters. Analyses were reported as estimated total costs, quality adjusted life years (QALYs) gained, and incremental cost-effectiveness ratio (ICER) in Philippines Peso (PHP) per QALY gained between rotavirus UMV and no vaccination.
Results: From a payer (societal) perspective, the ICER is PHP 12,059/QALY). Sensitivity analyses showed the ICERs below PHP 80,000/QALY, well below 1 time 2012 GDP per capita at PHP 103,366 with the main drivers of uncertainty being the probabilities of mild and moderate diarrhoea and vaccine costs
Conclusion: Rotavirus UMV reduces both health and economic burden of rotavirus induced gastroenteritis. Based on the WHO’s recommended thresholds, Rotarix® vaccination is projected to be very cost-effective in the Philippines in comparison with no vaccination.
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Impact Of Hospital-Acquired Infection On The Cost And Duration Of Hospitalization In The Neonatal Intensive Care Unit
Patricia S. Austria-Cantimbuhan, M.D., Jaime A. Santos, M.D., Loida B. T. Villanueva, M.D.
Keywords: hospital-acquired infections, NICU, neonatal intensive care unit, nosocomial infections.
Abstract:
Objective: To determine the impact of hospital-acquired infections (HAI) on the cose and duration of hospitalization among neonatal intensive care unit (NICU) patients from a hospital-based perspective.
Methodology: A case control retrospective study was performed at the 15 bed/crib NICU at PCMC from March 2008 to February 2009. Forty-four neonates who developed HAI while at the NICU were designated as “cases” matched to control subjects (1:1). Control subjects were matched to cases based on gestational age, final diagnosis and date of NICU admission. Eligible cases of HAI were identified retrospectively through the nosocomial infection logbook kept by the Infection Control Nurse. Data collection was done via review of the patient’s medical record: gestational age, gender, diagnosis, underlying disease, appropriateness for age, surgical procedure, duration, urgency, classification of surgical intervention, therapeutic procedures prior to first HAI, antibiotic administration prior to diagnosis of first HAI, type of HAI. The length of hospital stay (duration of hospitalization), outcome of the patients and blood isolates of cases of HAI were likewise gathered from the hospital records of each patient. Cost data was obtained from the hospital database.
Results: There was a higher mean cost of hospitalization for NICU patients with HAI Php 275,459 vs 104,407 (USD 5,738 vs USD 2,175). They also had a longer length of stay with a mean of 55.5 days vs 29.3 days. In the analysis using multiple linear rgression, the following factors: HAI grouping, length of stay and outcome (mortality) contributed significantly to increased cost.
Conclusion: HAIs were associated with increased cost and duration of hospitalization. These contribute significantly to economic burden to the patient and to hospital resources.
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Comparison Of Treatment Outcomes Among Children Diagnosed With Pulmonary Tuberculosis Treated At The Tb Dots And The Pediatric Outpatient Department
Ma. Erlinda E. De Gracia, M.D.**, Madeleine Grace M. Sosa, M.D.**, Bibiano Reyes Jr, M.D.** *De La Salle University Medical Center, Dasmarinas, Cavite
Keywords: TB DOTS, pediatric pulmonary TB, TB treatment
Abstract:
Background: Although there are many studies on the effects of TB DOTS on the treatment outcomes of adults, there are limited studies in the pediatric population.
Objective: To compare the treatment outcomes of pediatric PTB patients who were treated in the outpatient department (OPD) and the TB DOTS Center from January 2007 – December 2011.
Methodology: A retrospective cohort study was conducted at the de La Salle University Hospital in Dasmarinas, Cavite. Charts of pediatric pulmonary tuberculosis (PTB) patients at the OPD and TB DOTS Center from January 2007 – December 2011 were reviewed. Demographic data as well as outcomes were compared.
Results: There were more patients treated for PTB at the OPD than in the DOTS, with age range between 1 -3 years old. Sixty-three percent of patients at the DOTS were initially seen by private practitioners. After two months of treatment, 98.2% of patients in DOTS and 84.1% in the OPD were still compliant. The difference in percentage of patients with weight gain, relief of fever, and improved general well-being after two months between DOTS and OPD were statistically insignificant. However, the percentage of patients with relief from cough after two months of treatment was significantly higher in DOTS versus the OPD. The treatment success at the DOTS is significant approximately 1.8x times likelihood of successful treatment.
Conclusion: Patients at the DOTS who had cough were more likely to improve than in the OPD. The percentage of patients who defaulted after two months of treatment increased in the OPD. At the end of six months, the TB DOTS had better percentage of successful treatment.
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Evaluation Of Dengue IgA Antibody and NS1 Antigen Rapid Tests As Early Diagnostic Tests For Dengue Virus Infection
Christine Listyawati Irianto, MD, Grace Devota G. Go, MD and Mary Chiles General Hospital
Keywords: Dengue IGA rapid test, dengue NS1 antigen rapid test, dengue rapid diagnostic test.
Abstract:
Background: Dengue is a major health problem. The lack of data on the usefulness of rapid diagnostic tests for early detection of dengue has generated interest in determining their validity.
Objective: This research aimed to determine the validity of dengue IgA antibody versus NS1 antigen test as rapid diagnostic tests for early detection of dengue using Hemagglutination Inhibition test (HI) as standard reference.
Methodology: This study included 51 pediatric patients being evaluated for dengue in a private hospital from March 01, 2012 to October 30, 2012. Paired serum samples from patients suspected of dengue and had fever of not more than seven days were examined. Initial blood samples were collected on the first day of consult and tested for dengue IgA antibody, dengue NSI antigen, and dengue HI tests. Second blood samples for HI were collected seven days after the initial extraction
Results: The 51 serum samples used in this study came from 29 males and 22 females. From these samples, sensitivity of dengue IgA antibody was 80% with 95% CI (70-90) while specificity was at 50% with 95% CI(34-64) while dengue NS1 antigen which showed sensitivity of 27% with 95% CI (15-39) and specificity of 67% with 95% CI (54-86). IgA rapid test demonstrated 71% positivity in detecting acute primary dengue infection and 82% for acute secondary infection. NS1 detected 43% of primary infection and 24% of secondary infection.
Conclusion: Dengue IgA antibody rapid test was more sensitive than NS1 antigen test for early diagnosis of dengue and had better performance in detecting primary and secondary dengue
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The Significance Of Elevated Aspartate Aminotransferase-Alanine Aminotransferase (AST-ALT) Ratio To Prognosticate The Outcome In Pediatric Patients Who Were Admitted For Dengue Shock Syndrome (DSS) In A Tertiary Hospital
Karen P. Alday, M.D.,* Ma. Fe. Johanna D. Castro, M.D.*, Charlene P. Lusanta, M.D.*, Cherrie Rose Y. Cruz, M.D.* *Hospital of the Infant Jesus
Keywords: Denue shock syndrome, sever dengue, dengue hemorrhagic fever
Abstract:
Objective: AST and ALT often rise in dengue patients up to five-fold; they usually peak in the second week of illness. This study aims to determine the significance of elevated AST,ALT;AST:ALT ratio among pediatric patients with Dengue Shock Syndrome (DSS).
Methodology: From October 2008 to October 2009, 57 pediatric patients, who met the criteria for DSS, were admitted in the ICU. AST, ALT and AST:ALT determinations were done open admission.
Results: The differences in the elevation of AST, ALT and AST:ALT in relation to age and sex of patients were not statistically significant (p-value= >0.05). A significance was noted in the ALT elevation when correlated to BMI (p-value 0.04) as opposed to only a marginal significance with AST. The more obese the patient the higher the increase in the level of serum transaminases. There was only marginally significant difference in the elevation AST:ALT ratio according to BMI (p-values 0.06 and 0.09 respectively). A 4-fold increase in both AST and ALT were not significantly associated with the presence or absence of hepatomegaly (p-value = > 0.05). However, there was a significant difference noted in the AST:ALT ratio according to outcome — those who died had an elevated mean ratio than those who survived (p value= 0.01). On the other hand, there was a marginally significant difference in the AST elevation according to outcome (p value = 0.08. A four-fold increase in both AST and ALT were significantly associated with mortality (p- values 0.004 and 0.03 respectively).
Conclusion: AST and ALT elevation of >4-fold may prognosticate the outcome of patients with DSS. Further investigation is required.
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ABCS of Dengue Hemorrhagic Fever and Dengue Shock Syndrome: A WHO and PIDSP Collaborative Training for Pediatricians and Nurses
Marla B. Litam, M.D.
Abstract:
>Dengue cases now occur all year round in the Philippines regardless of the wet and dry seasons. This has prompted the World Health Organization (WHO) in and the PIDSP to conduct a 5-day intensive training on the management of severe dengue hemorrhagic and dengue shock cases at the Philippine Pediatric Society Building in Quezon City last May 19-23, 2014. Fifty (50) pediatricians: general pediatricians, pediatric infectious and intensive care specialists and nurses from all over the country attended the event held at the PPS Auditorium.
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Journal 2014 Vol.15 No.2
A Double Blind Randomized Clinical Trial on the Efficacy of Citronella Shampoo versus 5% Permethrin Lotion in the Treatment of Head Lice Infestation
Robert Eric D. Martinez, M.D., Jeanette P. Samson, M.D.
Keywords: citronella nardus, citronella shampoo, nardus, Cymbopogon shampoo, permethrin Cymbopogon winterianus permethrin lotion, winterianus lotion, Pediculosis Pediculosis humanis humanis capitis, capitis, head lice, Cymbopogon
Abstract
Background: Resistance to standard permethrin lotion has been reported. There is a continuing search for more natural and safe remedies for head lice infestation among children. Citronella, a natural repellant, has been reported as a pediculocide.
Objective: To compare the efficacy of Citronella shampoo versus 5% permethrin lotion in controlling head lice (Pediculosis humanus capitis) among children between 5 years old.
Methods: A double-blind randomized clinical trial was performed at the community outpatient department of MPI-Medical Center Muntinlupa Foundation, PNR (Phil. National Railway) Site Bgy. Putatan, City of Muntinlupa. Children living in areas endemic for head lice were screened, and if found positive, were randomized equally to daily citronella shampooing (CS) or permethrin lotion (PL). Subjects were manually 2nd, 7th and 14th day of treatment. Chi-square test was used to compare proportions, which considered p-values less than .05 as statistically significant.
Results: Eighty-two children with head lice were included in the final analysis. Children in both groups were comparable in terms of age, sex, family size with head lice, anthropometric measures, frequency of bathing and shampooing and baseline severity of head lice infestation. Citronella shampoo was as effective as the standard 5% permethrin lotion in eradicating head lice in children. The cure rates were comparable for day 2 (CS=65.1% versus PL=72.1%, p=.76), day 7 (CS=65.1% versus PL= 79.1%, p=.30), and day 14 (CS=81.4% versus PL =90.7%, p=33) of treatment. There were no re-infestations and adverse reactions noted for the use of Citronella and the refragrance was more acceptable.
Conclusion: Citronella is a effective as Permethrin lotion in the eradication of headlice and Citronella shampooing can be an alternative natural remedy of headlice and Citrone for pediatric head lice.
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A Double Blinded, Randomized Controlled Trial of Multiple Strain Probiotics as Adjunct Therapy for patients 2mos – 4 yrs with Moderate Risk Community Acquired Pneumonia
Paolo Gene A Becina, M.D., Gener T. Becina, M.D.
Keywords: Community Acquired Pneumonia,Multistrain Probiotics, Lactobacillus casei, Lactobacillus rhamnosus, Streptococcus thermophilus, Lactobacillus acidophilus
Abstract:
Objective: The purpose of the study was to determine the efficacy of probiotics as adjunct therapy for patients (2 months – 4 years old ) with moderate risk community acquired pneumonia.
Methods: the study population consisted of 77 children, 2 months -4 years old with no Hib vaccination, no previous intake of antimicrobials, no contraindications to feed within the first 24 hours upon admission and with informed consent. Participants were randomized to given Ampicillin (100 mkd), supplemented with probiotics (1 sachet for 7 days) while the control group was given Ampicillin and a placebo. Patients with co – morbidities (i.e. cardiac problems, malnutrition etc.), and those with previous intake of antimicrobials were excluded. Both groups were compared based on the following: cardiac rate, respiratory rate, temperature, presence or absence of chest retractions and length of hospital stay. The physicians and patients were blinded as to
Results: For subjects < 1 year old in the probiotics group, cardiac rates normalized at day 2. In the placebo group, fluctuating cardiac rates were noted although this difference was statistically significant. Among >1 year old , normal cardiac rate was reached on days 4 and 5 in the probiotics group and this was not reached in the placebo group. The respiratory rate normalized in both groups starting day 1 for those < 1 year old. Respiratory rates in the probiotics group were also noted to be lower than placebo group. Among >1 year old, normal respiratory rate was reached on day 2 for both groups. The respiratory rates of the probiotics group were lower than the placebo group but this was not statistically significant. The decline between the two groups was not significantly different. Presence of chest retractions was lower in the probiotics group as compared to the placebo group by day 4. Both groups had an average length of hospital stay of 3 days.
Conclusion: The results of the study suggest that probiotics may possibly be helpful as an adjunctive therapy for patients, 2 months to 4 years old, with moderate risk community acquired pneumonia. **** 1st Place PIDSP Research Contest 2014
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Profile of Nosocomial Infections among Children with Acute Lymphoblastic Leukemia
Paul Candice Ellen M. Eler, M.D., Ma. Ysabel G. Lesaca-Medina, M.D., Cecilliene Acosta, M.D.
Keywords: Nosocomial Infection, Acute Lymphoblastic Leukemia, Gram negative infections, Pseudomonas infections, Burkholderia infections
Abstract :
Objectives: The study aimed to determine the frequency and clinical profile of nosocomial infections among pediatric patients with Acute Lymphoblastic Leukemia (ALL) admitted at the Philippine General Hospital from January 2010 to December 2011.
Methodology: This is a descriptive cross sectional study involving the review of medical records of pediatric patients with ALL under the charity service of the Section of Pediatric Hematology and Oncology of Philippine General Hospital (PGH). The frequency, clinical presentation, outcome, causes of death and isolated organisms from sterile sites were determined. Fischer’s Exact test was used to assess correlation between variables with Gram-negative bacterial infection and mortality.
Results: There were 80 documented nosocomial infections among 45 pediatric patients with ALL. The majority presented initially with fever (50%) and 37 (82%) had neutropenia. Blood stream infections were present in 33 (73%) out of 45 pediatric ALL patients. Gram-negative organisms (76%), particularly Pseudomonas putida (33%), Pseudomonas aeruginosa (12%) and Burkholderia pseudomallei (12%) were isolated in majority of patients. About 42.2% of the 45 patients had resolution of the infection and 26.7% resulted to death primarily caused by septic shock in 7 (58.3%) of the 12 patients identified. Presence of fever (p- value 0.011, RR 2.1094) was associated with presence of Gram-negative bacteria at 5% level of significance and with 2.109 times more risk to having a gram-negative infection. There was no significant correlation between mortality and symptoms of infection.
Conclusion: Nosocomial infections remain to be significant cause of morbidity and death among pediatric patients with ALL. Gram negative infections were the most common cause of sepsis in these patients. One fourth of the patients with nosocomial infections died.
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Prevalence of Mycoplasma pneumoniae Infection among Children with Acute Respiratory Infection: A Prospective Case Control Study
Karen Rose Matias-Toledo, MD, Robert Dennis Garcia, M.D.
Keywords: Mycoplasma pneumoniae, acute respiratory tract infection, mycoplasma infection
Abstract:
Background: Mycoplasma pneumoniae has been implicated as a significant etiologic agent of lower respiratory tract infection among children to 18 years old, however, its prevalence in younger children age 5 years and below appears to be increasing.
Objectives: This study was performed to determine the prevalence, clinical and radiologic features associated with children 5 years old and below admitted with respiratory tract infection.
Methods: This is a prospective case control study involving children 5 years old and below with signs and symptoms of respiratory tract infection, and were tested for M. pneumoniae IgM at the Makati Medical Center and admitted between May 1, 2012 to September 30, 2012. Subjects were children with positive M pneumoniae IgM test (MPP) and controls were children with negative M pneumoniae IgM test (MPN). Clinical, radiologic and laboratory characteristics of MPP and MPN were recorded.
Results: Twenty-one out of 82 (25.6%) subjects were MPP. The male to female ratio was 1:1.05 witha mean age of 34 months. Clinical, radiologic characteristic and laboratory findings between MPP and MPN were not statistically significant.
Conclusion: The prevalence of M. pneumoniae infection among the subjects was 25.6%. distinguish M. pneumoniae infection.
***2nd Place PIDSP Research Contest 2013
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Risk Factors for Community Acquired Methicillin Resistant Staphylococcus aureus Infections among 0-18 yrs old: A Retrospective Case- Control Study
Maria Tricia D. Subido, MD, Jaime Santos, M.D.
Keywords: Community-acquired CA)-MRSA infections, methicillin resistant Staphylococcus aureus
Abstract:
Background: Mycoplasma pneumoniae has been implicated as a significant etiologic agent of lower respiratory tract infection among children to 18 years old, however, its prevalence in younger children age 5 years and below appears to be increasing.
Objectives: This study was performed to determine the prevalence, clinical and radiologic features associated with children 5 years old and below admitted with respiratory tract infection.
Methods: This is a prospective case control study involving children 5 years old and below with signs and symptoms of respiratory tract infection, and were tested for M. pneumoniae IgM at the Makati Medical Center and admitted between May 1, 2012 to September 30, 2012. Subjects were children with positive M pneumoniae IgM test (MPP) and controls were children with negative M pneumoniae IgM test (MPN). Clinical, radiologic and laboratory characteristics of MPP and MPN were recorded.
Results: Twenty-one out of 82 (25.6%) subjects were MPP. The male to female ratio was 1:1.05 witha mean age of 34 months. Clinical, radiologic characteristic and laboratory findings between MPP and MPN were not statistically significant.
Conclusion: The prevalence of M. pneumoniae infection among the subjects was 25.6%. distinguish M. pneumoniae infection.
***2nd Place PIDSP Research Contest 2013
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Bedside Prediction Scoring or Emergent Diagnosis of Late Onset Neonatal Sepsis
Peter Francis N. Raguindin M.D., Ma. Victoria A. Samonte M.D., Leonila F. Dan, M.D.
Keywords: Neonatal sepsis, newborn sepsis, clinical prediction rules
Abstract:
Background: Late Onset Neonatal Sepsis (LONS) or nosocomial sepsis has a significant mortality and morbidity that leads to overtreatment. Overtreatment happens when antibiotics are frequently started and/or shifted, eventually leading to increasing antimicrobial resistance in NICU.
Objective: To validate bedside nosocomial sepsis scoring developed by Okascharoen in 2005.
Methodology: All neonates admitted in NICU suspected of LONS were enrolled. Using Okascharoen scoring, subjects were scored based hypotension/poor perfusion, abnormal body temperature, respiratory insufficiency, complete blood count, and length of umbilical catheter use. Growth of organisms during blood culture is considered positive outcome and is considered confirmed sepsis.
Results: Of the one-hundred-nineteen (119) subjects included in the analysis, 59 were confirmed sepsis and 60 were LONS negative. Subjects with confirmed sepsis had more events of hypotension/poor perfusion (p < 0.001; -0.141, -0.438), thrombocytopenia (p 0.000; -0.169, -0489), and prolonged umbilical catheter usage (p 0.014; -0.051, -0.311). The ROC curve has an AUC of 0.753 (p < 0.001; 0.664-0.842), which means a randomly chosen neonate with LONS will have a higher predicted score than a neonate without LONS. The sensitivity of this tool was 0.92 (0.82-0.97) and specificity of this tool was 0.32 (0.21-0.46) in this setting. The positive LR =1.35 (1.12-1.64) while the negative LR = 0.26 (0.10-0.65)
Conclusion: This scoring is a valid tool that can be used in point-of-care scoring for antibiotic stewardship in a neonate with suspected sepsis.
Recommendation: it is recommended that a score > 5 be used to be predictive of late onset sepsis, and this would have sensitivity of 83.3%, specificity of 61%, positive predictive value of 68.5% and a negative predictive value of 78.3%
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