2016 Journals

Journal 2016 Vol.17 No.1
Procalcitonin – Guided Antibiotic Therapy in Pediatric Patients: a Systematic Review
Aina B. Albano-Cabello M.D., Jeff Ray T. Francisco M.D., Anna Lisa T. Ong-Lim M.D., Lorna R. Abad M.D.
Abstract
Background: Serum procalcitonin is a useful biomarker in establishing the presence of bacterial infections and has been used in algorithms to guide antibiotic treatment among adults. It role in pediatric infections, however, remains unclear.
Objectives:  This  research  aims  to evaluate  the  impact  of  serum  procalcitonin  in guiding antibiotic therapy among pediatric patients with suspected local or systemic infections.
Methodology: Randomized  controlled  trials  comparing  procalcitonin-guided antibiotic  therapy  to  clinically  guided  therapy  in pediatric  patients  with  local  or systemic  infections  were  searched  through MEDLINE,  Cochrane,  EMBASE, HERDIN and ClinicalTrials.gov. Hand search in various search engines was also done. Outcomes included antibiotic usage, morbidity and mortality. Two reviewers independently assessed potentially relevant studies. Statistical analysis was conducted using RevMan 5.3 using inverse variance weighting and random effects model.
Results: Five randomized controlled trials were included. Overall, there was a reduction in antibiotic prescription rate in the procalcitonin group compared to controls for all groups (RD -0.13, 95% CI [-021,0.06]; p <0.00001), however, pooled studies were heterogenous. Subgroup analysis showed that for children with pneumonia, procalcitonin guidance significantly reduced antibiotic prescription rate (RD – 012,95% CI [-021,0.04]; p <0.005 ), and may have potential in reducing the duration of therapy (95% CI [-6.8,2,54], p <0.0001) and antibiotic-related adverse effects (RD- 0.17, 95% CI[-0.24,-0.10], p<0.00001) compared to controls. In one study on neonates with early onset sepsis, procalcitonin guidance reduced antibiotic prescription rate by 27% (p=0.0009) and duration of therapy by 22.4 hours (p=0.0009). Procalcitonin guidance has no significant impact on antibiotic prescription rate in children with fever without a source (RD -0.11, 95% CI[0.28,0.05], p=0.190).
Conclusion: Procalcitonin guidance significantly reduces antibiotic prescription rate among children with pneumonia and neonates with early onset sepsis. It has the potential in reducing the duration of antibiotic therapy and antibiotic-related side effects in these populations. ON the other hand, it had no impact among children with fever without a source. These results highlight
the need for algorithm-based approaches using procalcitonin cut-off values to guide antibiotic therapy in children.
| View Full Article in PDF format |

The Association of Pre-Operative Hospital Stay with Surgical Site Infection Among Pediatric Patients After A Clean Neurosurgical Operation
Cleo Anne Marie E. Dy-Pasco, M.D, Cecilia C. Maramba-Lazarte, M.D.
Abstract:
Background: Surgical site infection (SSI) poses a serious threat in Neurosurgery. The mere presence of SSI would warrant a prompt medical and/ or surgical intervention for the outcome is very poor. This study aims to establish whether a pre-operative hospital stay of >7 days & other risk factors predisposes to surgical site infections.
Methods: Retrospective, cross-sectional study of all pediatric patients who underwent clean neurosurgical procedures for the first time from January 1, 2011- June 30, 2014, in the Philippine General Hospital. The primary outcome was the development of a surgical site infection within 30 days from spine surgery or 90 days from intracranial surgery. Univariate and multivariate logistic regression analyses were performed to show the association of demographic and clinical factors with the development of SSI.
Results: 279 medical charts were available for review. Median age was 1 year(5 days to 18 years old). The overall prevalence rate of SSI was 11.26%. Patients with >7 days pre-operative hospital stay had an incidence rate for SSI of 76.47% compared to 23.53% in patients with <7 days pre-operative hospital stay (OR 1.61, CI 0.68-3.84, p=0.280).
Conclusions: The incidence of SSI is high compared to other centers. There was no association of preoperative hospital stay with SSI. The association was significant only for the history of nosocomial infection. Early pre-operative clearance and surgery are recommended. Further prospective studies and surveillance are warranted
| View Full Article in PDF format |

Association Of Clinical And Laboratory Parameters Of Patients With Neonatal Sepsis
Charlene Capili, M.D.
Abstract: 
Neonatal sepsis is one of the leading causes of death among newborns, and diagnoses is a challenge to clinicians.
Objectives: The present study describes and compares clinical, and hematological profile of neonates, and culture positive and culture negative neonatal sepsis, Children’s Hospital.
Methods: This is a cross sectional study. About with neonatal sepsis with a complete blood count were included in the study. Charts were retrieved from section. Primary outcome measures are the following: increased WBC, increased ANC, IT ratio more than nucleated RBCs.
Results: Forty-seven (35%) subjects had a positive (65%) patients had a negative blood culture. The significantly associated with clinical sepsis (negative p=0.04). On the other hand, the odds of having a 2.29 times more when the patient has poor suck compared not present with poor suck (OR 2.29, p=0.04). There association with the patients’ demographic and having neonatal sepsis. Conclusion: There was no significant difference in culture or a negative blood culture among any demogr hematological profile tested between culture proven neonatal sepsis. Hence, in clinical sepsis, it is still acceptable despite a normal complete blood count and or a negative blood culture.
| View Full Article in PDF format |

Profile Of Community-Acquired Methicillin Resistant Staphylococcus Aureus Skin And Soft-Tissue Infections Among Children Admitted At The Philippine General Hospital
Pauline T. Reyes-Solis, M.D., Salvacion R. Gatchalian, M.D.
Abstract:
CA-MRSA infection is a global concern. It is important to determine the local prevalence of CA-MRSA skin and soft-tissue infection as this information will provide a more accurate and rational basis for empiric treatment, improve management and outcomes in patients, and reduce the economic burden associated with failed treatment. This study was conducted to determine the clinical profile and prevalence of CA-MRSA skin and soft tissue infections among pediatric patients admitted at the Philippine General Hospital.
Methods: A prospective, observational study was performed involving all pediatric patients admitted at U-PGH for skin and soft tissue infections from September to December 2012. Demographic profile, clinical characteristics of patients, results of laboratory examinations, the outcome of treatment were described and summarized. Risk factors for acquisition of MRSA were also determined. Period-prevalence was computed.
Results: There were 25 children admitted for SSTIs, 16 have positive cultures and 62.5% of these had CA-MRSA. The majority were male children younger than 5 years old without identifiable risk factors. infections presented as solitary masses and cellulitis usually at the head and neck area. isolates were taken from aspirates during incision and drainage. Invasive infections were seen 3 patients. The length of hospital stay, type of antibiotics used and surgery performed was variable. All patients were discharge well and there were no mortalities. The period prevalence of CA-MRSA among children with SSTI was 0.36.
Conclusion: CA-MRSA as a cause of SSTIs in Filipino children is an emerging concern, especially in very young patients even without risk factors. management of SSTI’s should include incision and drainage of abcesses and prompt submission of aspirates for culture and antibiotic sensitivity testing. The period prevalence of pediatric patients with SSTI is high among hospitalized patients. Empiric antibiotics with MRSA coverage such as clindamycin and vancomycin should be considered clinical situations wherein MRSA is deemed likely.
| View Full Article in PDF format |

Randomized Controlled Trial Comparing The Efficacy Of 70% Isopropyl Alcohol Hand Rub Versus Standard Hand Washing For Hand Hygiene Among Healthcare Workers
Loralyn Mae O. Lagaya-Aranas, M.D.
Abstract:
Access to handwashing areas is not as convenient as having alcohol in one’s pocket or bedside. Alternatively, cleaning the hands with alcohol can save us a lot of time and effort in disinfecting our hands thus giving us more time for patient care. If alcohol can be proven as effective as soap and water in hand disinfection, then residents and nurses may use this method of hand hygiene instead.
Objective: To compare the efficacy of 70% isopropyl alcohol against standard handwashing in hand hygiene among medical residents and nurses at a tertiary hospital.
Methods: seventy-six doctors and nurses were randomly assigned to two groups with 38 subjects each. Group 1 used plain soap and water while group 2 used 70% isopropyl alcohol hand rub. hand swabbing was done before and after hand hygiene. The presence or absence of bacteria was compared for the same subject, before and after hand disinfection. The mean decrease in colony count in group 1 was compared to group 2.
Results: Both groups were successful in reducing the mean colony count. Handwashing group had a decrease from 27.34 34 +33.17to 3.58+ 6.63 CFU, while the alcohol group from 21.5 + 31.13 to 0.76 + 1.48 CFU, both with p values <0.05. But in comparison, the mean changes for both groups were not statistically significant, therefore no intervention was superior to the other and both were equally effective.
Conclusion: Seven percent isopropyl alcohol is as effective as standard handwashing in disinfection. It is recommended to have 70% isopropyl alcohol at bedside/individually carried by doctors/nurses for easy access. Observation of proper hand washing technique should always be emphasized. Bacterial colony identification is ideal for future studies.
| View Full Article in PDF format |

Your Diagnosis Please: 8-Year-Old Child With Chronic Ear Discharge, Infraorbital Ulcer, And Pneumonia
Carol Stephanie Tan, M.D.
Abstract:
An 8 year-old female consulted at our institution due to left ear discharge. 6 months prior to consulting, the patient developed infraorbital swelling and erthema after she hit a metal post. The site of trauma eventually developed into a 2 x 2 cm abscess, which spontaneously ruptured. She was given cloxacillin for 7 days with no improvement of symptoms. 4 months prior to consulting, she developed foul-smelling left ear discharge, not associated with pain. She was given unrecalled otic drops and oral medications with no improvement. She eventually developed left facial paresis. Due to the persistence of ear discharge, she was brought to a local clinic where she was diagnosed to have chronic suppurative otitis media (CSOM) and referred to our institution.   The patient also had an 8-month history of a recurrent cough and weight loss of 10%  over 3 months. She had no history of fever, seizure, or change in sensorium. She has an older sibling who is an ongoing 2nd month of anti-tuberculosiis treatment. She was given BCG vaccination at birth. Her nutritional status is poor, with meals consisting usually of instant noodles, rice, bread, and cookies.
| View Full Article in PDF format |

Journal 2016 Vol.17 No.2
Editorial:
Keep Calm, The New Editors are Here
Cecilia C. Maramba-Lazarte, MD, MScID, MScCT
 The PIDSP Journal has been a great part of my life for the past 14 years. This is why I have conflicting emotions as I relinquish my post with this last issue. I am happy to be rid of the tedious work involved in preparing each issue. Yet, I am also sad to leave behind performing tasks I have a passion for as well as no longer experiencing the quintessential satisfaction when an issue is completed and made available online….
| View Full Article in PDF format |

Childhood Immunization Schedule 2017
| View Full Article in PDF format |

The Use of Fluorescent Marking Technique as an Indicator Of Cleanliness and Disinfection in the Neonatal Intensive Care Unit
Expedito T. Yala, M.D.*; Cecilia C. Maramba-Lazarte, M.D.
Abstract:
Background: Environmental surfaces harbor pathogens that transmit them and there is a need for environmental cleaning and disinfection to prevent the spread of infection.
Objective: This study aimed to determine if the use of fluorescent marking (FM) technique in high touch areas can be used as an index of cleanliness and disinfection as determined by aerobic colony count.
Methods: This was an experimental study done at the University of the Philippines Philippine General Hospital Neonatal Intensive Care Unit (NICU). A total of 40 surfaces were swabbed for cultures with aerobic colony count (ACC) then adjacent areas are marked with fluorescent gel. After cleaning and disinfection, checking for residual fluorescent markings with congruent environmental culture with an aerobic colony count of the same surface was done. The rate of removal and colony count were then compared to assess the specificity and sensitivity of the fluorescent marking technique as a gauge of cleanliness of high touch surface areas. Any residual fluorescence of the marked areas was considered unclean and an aerobic colony count of < 2.5 – 5CFU/ml ² were considered an acceptable level of cleanliness.
Result: A total of 40 high contact surfaces were sampled from 5 areas were collected. Prior to cleaning, 60% (24) of the  surfaces (60%) did not contain microorganisms. After cleaning, the (FM) had 38% and in the ACC 83% were assessed to be clean. The sensitivity of FM is 85.71% and specificity of 42.42%. The positive predictive value (PPV) is 24% with the positive likelihood ratio (positive LR) of 1.49 and the negative predictive value (NPP) is 93.33%.
Conclusion: The use of Fluorescent Marking technique in high touch areas as an index of cleanliness and disinfection is a good marker for cleanliness and disinfection. Furthermore, it is a simple, rapid, inexpensive and has potential to increase awareness of the environment that can be utilized as an objective parameter to assess cleanliness and disinfection.
| View Full Article in PDF format |

Clinical Profile and Outcomes in Acute Viral Encephalitis
Albert Roland Alcaraz, M.D., Martha Lu-Bolanos, M.D., Ma. Liza Antoinette M. Gonzales, M.D.
Abstract:
Objective: This study aimed to determine the clinical profile and outcome of pediatric patients with acute viral encephalitis syndrome admitted at a single tertiary government hospital.
Methods:  All pediatric patients admitted at the Philippine General Hospital from January 2011 to December 2014 and discharged with a final diagnosis of acute  viral  encephalitis  were  included.  After  demographic  data,  clinical manifestations,  and  laboratory  findings  were  collected,  the  outcome  was determined  using  the  Modified  Rankin  Scale  for  children.  The  data  were summarized using descriptive statistics. The median test was used to compare the outcomes while the chi-square test was used to analyze the comparison between study groups.
Results: Sixty-four patients diagnosed with acute viral encephalitis syndrome were included in the study. The highest number of cases was reported in ages 1- 4 years (32.81%) and among the male population (68.75%). The  most common symptoms were seizure (46.87%), abnormal behavior (21.88%), and altered sensorium (20.31%). Forty-four patients had CSF viral studies done, and among them, the 11 (25%) were positive for Japanese encephalitis. The modified  Rankin  scale  showed  that  41  (64.08  %)  subjects  showed  good outcomes,  while  23  (35.23%)  exhibited  poor  outcomes.  There  was  no significant difference in the modified Rankin scale for Japanese encephalitis compared to the other etiologic agents of acute viral encephalitis (p value= 0.717).
Conclusion: In  patients  with  acute  viral  encephalitis,  the  most  common symptoms were seizures, abnormal behavior, and altered sensorium. Majority of the subjects did not show any significant symptoms and disability. No difference was seen in the clinical outcome of patients infected with Japanese encephalitis compared to other etiologic agents, but these results need to be verified by larger studies.<
| View Full Article in PDF format |

Cardiac involvement in Kawasaki disease patients: A Retrospective Study
Pilarica I. Caguiat, M.D., Cherica A. Tee, M.D., Leonila F. Dans, M.D.
Abstract:
Background:  Kawasaki disease is a self-limited disease but it can lead to potentially fatal cardiac complications if not detected and managed accordingly.
Objective:  To  determine  the  incidence  of  cardiac  involvement  in  patients with Kawasaki disease admitted in PGH
Methods: Medical records of patients with KD admitted from January 2012 to  December  2013  were  reviewed.  Demographic,  clinical,  laboratory,  chest radiographic,   electrocardiographic,   and   echocardiographic   data   were recorded. The course, management, length of hospital stay, clinical outcome, duration of OPD follow-up, and medications were evaluated.
Results:  Thirty-eight  patients  with  mean  age  of  2.67  ±  2.26  years  old,  66% males  with  KD  were  included.  Fifty-nine  percent  had  cardiac  involvement, and  among  those  with  cardiac  involvement,  68%  have  coronary  artery dilatation. Seventy-six percent of cases received intravenous immunoglobulin (IVIG) with 55% receiving IVIG within 10 days of illness. The initial cardiac findings  resolved  in  the  subsequent  2d-echo  after  IVIG  except  for  some coronary  artery  abnormalities,  which  resolved  in  5  ±  3.11  months  during follow-up.  There  was  no  mortality.  The  possible  predictive  factors  for  the development  of  cardiac  abnormalities  published  in  other  studies  were  not found to be significantly associated in this study population.
Conclusion: The incidence of cardiac involvement in patients with Kawasaki disease  among  children  admitted  in  PGH is  59% with68% having  coronary artery dilatation, higher than in other published studies.
| View Full Article in PDF format |

Predictors of Mortality among Pediatric Patients with Leptospirosis: A Multicenter Retrospective Study
Rosalia Belen F. Bonus, M.D., Grace Devota Go, M.D., Joanne De Jesus, M.D., Marxengel Asinas Tan, M.D., Cecilia C. Maramba-Lazarte, M.D.
Abstract
Objective:  Leptospirosis in children is one of the most common diagnostic dilemmas, hence this study was performed to determine the clinical profile, outcome and risk factors associated with mortality in patients seen at tertiary government hospitals from January 2008 to December 2012.
Methods: A  case-control  retrospective  study  was  done  among  admitted patients  at  UP-PGH,  SLH,  and  RITM.  Descriptive  statistics  and  multiple logistic regressions were utilized.
Results: Among the 404 leptospirosis cases included in the study, 94% were male, with 43% belonging to 16-18-year-old age group (age range 3 to 18 years old). A higher occurrence was noted during the rainy season and in Manila.  Clinical findings include fever, abdominal pain, calf tenderness, vomiting and conjunctival  suffusion.  Significant  correlation  was  noted  in  patients  with jaundice (p-value 0.014; OR 6.293, CI 1.449-27.335), dyspnea (p-value 0.004; OR  7.880,  CI  1.967-31.561)  and  cardiac  abnormality  (p-value  0.042;  OR 15.343, CI 1.106-212.853).  Abnormal  laboratory  findings  include  neutrophilia,  azotemia,  creatinemia, anemia,   elevated   bilirubin   levels   and   thrombocytopenia.   Prolonged prothrombin time was associated with poor outcome (p-value 0.004, OR 23, CI 2.79-189.67).  Penicillin  was  the  drug  of  choice  given  to  96.8%.  94.6%  of  cases  who  had oliguric renal failure were conservatively converted to non-oliguric type. 5.4% underwent  peritoneal  dialysis  and  survived.  Inotropes  were  used  in  93%  of non-survivors. The case fatality rate was 3.5% with the cause of death mostly due to Weil’s disease.  The  average  hospital  stay  among  survivors  was  6.8+3.3  days  as compared  with  1.8+1.9  days  in  non survivors.  Shorter  hospital  stay  (p-value 0.00; OR 3.514, CI 2.115-5.839), as well as inotropic support (p-value 0.035; OR 62.511, CI 1.33-2949.134), were associated with poorer outcome, but these findings  can  be  attributed  to  late  presentation  of  cases  at  the  hospital  for admission.
Conclusion:   A5  year  review  of  patients  with  leptospirosis  showed  that jaundice, dyspnea, cardiac abnormality and prolonged prothrombin time were predictive of mortality.
| View Full Article in PDF format |

Randomized Controlled Trial on the Effect of Coconut Oil, Vinegar Plus Cooking Coconut Oil Versus 1% Permethrin Shampoo in the Treatment of Pediculosis
Marian Moreno-Alsasua, M.D.
Abstract
Objective: To determine the efficacy of cooking coconut oil and vinegar as compared to 1% Permethrin shampoo in the treatment of Pediculosis humanus capitis in children 3 – 12 years old.
Methodology: The study was conducted in Barangay 704, Zone 77 in Malate among children 3 – 12 years old.  Two hundred forty-five subjects were screened and the computed sample size was 150.  Subjects were randomized to three treatment groups: coconut oil (CO) group; vinegar plus coconut oil (CV) group; and 1% permethrin shampoo (PS) group. Treatments were given on the 1st and 8th day.  The final level of infestation was determined on the 14th day. Cure rates, failure rates, and expenses were also determined.
Results: Permethrin achieved superiority over plain coconut oil (X2=18.77  p-value = 0.00). There was no sufficient evidence to prove the superiority of permethrin over coconut-vinegar solution (X2=1.04 p-value = 0.30). Twenty-two percent (11) of the participants from the PS group developed itching and irritation.  No  adverse  effect  was  reported  from  the  CO  and  CV  groups. Permethrin was 14 times and five times more expensive than coconut oil and vinegar plus coconut oil, respectively.
Conclusion: Permethrin shampoo had a cure rate of 98%. Plain coconut oil and vinegar plus coconut oil had cure rates of 68% and 94%, respectively. Plain coconut oil had the highest failure rate at 36%, vinegar plus coconut oil at 6%, and permethrin shampoo with 2%. Adverse effects were exclusive to the PS group. Plain coconut oil was the most economical but coconut oil with vinegar with  its  significant  cure  rate  can  be  an  alternative  therapy  to  permethrin shampoo in the treatment of head lice in children.
| View Full Article in PDF format |

Year

1996 | 1997 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022