2010 Journals

Vol .11 No.1 Jan-June 2010
EFFICACY OF ZINC AS ADJUNCT IN THE TREATMENT OF PNEUMONIA IN CHILDREN LESS THAN FIVE YEARS: A META-ANALYSIS
Kathlynne Anne Caling Abat, M.D., Jacinto Blas V. Mantaring III, M.D. University of the Philippines College of Medicine- Philippine General Hospital
Keywords: pneumonia, zinc, meta-analysis
Abstract:
Background: Zinc supplementation has been shown to lower mortality and morbidity due to diarrhea and pneumonia. Because of the positive effect of zinc in the prevention of pneumonia, several studies have been conducted to investigate its effect as an adjunct therapy for pneumonia. For this reason, a systematic, quantitative review of available studies is needed to determine the overall effect of zinc as an adjunct in the treatment of pneumonia in children less than five years old.
Objectives: To assess from literature the effect of zinc, when given with antibiotics, in reducing mortality, treatment failure, length of hospital stay, and duration of symptoms of pneumonia in children less than five years old.
Design: Meta-analysis of randomized, placebo-controlled intervention trials.
Methods: Studies for inclusion were identified by PubMed search, journal hand search, and other methods. The authors independently assessed study quality and extracted data.
Statistical Analysis: Revman Version 4.2 was used to analyze the data gathered. The summary relative risks (RRs) and 95% CI for each outcome variable were estimated using a fixed-effects model. Chi-square and I2 were computed to assess for heterogeneity of results.
Results: A total of three acceptable studies were included in the meta-analysis. The summary RRs showed that zinc had no overall treatment effect on mortality from pneumonia (RR 0.69, CI 0.08, 5.70) and treatment failure (RR 1.05, CI 0.74, 1.49). These results were statistically insignificant with p-values of 0.73 and 0.77, respectively. Chi2 and I2 tests showed significant heterogeneity of results for treatment failure (Chi2 = 5.06, I2 = 60.5%). The same tests did not show significant heterogeneity of results for mortality (Chi2 = 0.43, I2 = 0%). In one study, the use of zinc reduced the duration of severe pneumonia with mean difference of four (4.2-4.9) versus five (4.5-5.5) days leading to shorter hospitalization [5 (4.8-5.5) versus six (5.1-6.1) days]. In another study, the zinc group’s recovery rate from very ill status was 2.6 times (p = 0.004) more, and the resolution of fever was 3.1 times (p = 0.003) more than those in the placebo group. However, these results could not be combined due to lack of data on standard deviation.
Conclusion: There is not enough evidence to conclude that zinc is effective in reducing mortality, treatment failure and duration of symptoms of pneumonia. A large population, multi-center, randomized, placebo-controlled trial should be conducted to obtain statistically significant evidence
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CLINICAL AND LABORATORY PROFILE OF URINARY TRACT INFECTION AMONG CHILDREN AT THE OUTPATIENT CLINIC OF A TERTIARY HOSPITAL
April Gamier Bay, MD, Francisco Anacleto, Jr., MD University of the Philippines College of Medicine – Philippine General Hospital
Keywords: urinary tract infection, children, incidence, clinical profile, diagnosis
Abstract:
Introduction: Urinary tract infection (UTI) is a common reason for outpatient consults. It is almost always in the Top Ten consults at the sick-child clinic of a tertiary hospital. However, a study concerning the incidence and clinical and laboratory profiles of UTI in the Philippines has yet to be documented.
Objectives: To determine the incidence rate and clinical and laboratory profiles of UTI among patients who consulted at the pediatric outpatient clinic of a tertiary hospital.
Methods: All patients 0 to 12 years, who were UTI suspects and consulted at the Sick-Child Clinic of a tertiary hospital from January to December 2006 were included in the study. Patients who had recurrent UTI or history of previous UTI and those with co-morbidities such as anatomic and/or functional problems involving the urinary tract were excluded. Chart review was done and the following were noted: demographics and clinical and laboratory characteristics.
Results: Four hundred twenty three patients were included in the study. The incidence rate was 30 per 1000 persons (95% CI). 54% percent were female. The majority of the patients were between 7 to 12 years of age. The most common presenting symptoms were fever, abdominal pain, vomiting, and dysuria. Only 25 patients had urine culture done and only 8 had positive results, mostly with E. coli. The most common antibiotics used were Cotrimoxazole, Cefuroxime, and Amoxicillin.
Conclusion: The incidence rate is higher compared to other studies done in general practice. The presenting signs and symptoms were however similar. Important to note is the high incidence of patients who did not follow up. It is also noted that the gold standard for the diagnosis of UTI, which is the urine culture is very seldom requested. This may lead to the over- or maybe under-diagnosis of UTI and its eventual mismanagement. Therefore, it is recommended that the approach to the diagnosis and management of UTI in children should be reviewed.
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TERROR IN THE AIR: MENINGOCOCCAL DISEASE OUTBREAK IN THE PHILIPPINES
Xenia Cathrine T. Jaramillo Fabay Baguio General Hospital and Medical Center 3rd Prize, PIDSP Poster Contest 2007
Keywords: Neisseria meningitidis, meningococcemia, meningococcus, meningococcal meningitis, meningococcal outbreak
Abstract:
Introduction: Meningococcal disease is caused by Neisseria meningitidis that can present as fever or respiratory infection developing into a fulminant course. In February 2005, WHO experts confirmed that the Cordillera Administrative Region of the Philippines experienced an outbreak of Serogroup A Meningococcal Disease where there was an unusually large proportion of meningococcemia cases.
Objectives: This study aims to describe the clinical profile of pediatric patients discharged from a tertiary hospital with a diagnosis of meningococcal disease and to identify the etiologic agent.
Methodology: This is a retrospective descriptive study involving chart review of patients 0-18 years of age discharged from October 2004 to October 2006 with a diagnosis of either meningococcemia, meningococcal meningitis or both.
Results: There were 217 discharges with this diagnosis. Of these, 100 (46.08%) belonged to the 0-18 years of age, 47% of who were male, 64% were Baguio residents, 28% were 0-1 year old, 19% were between 2-5 years old and 26% were 15-18 years old. 100% had a history of fever and 90% had rashes. 51% had a discharge diagnosis of Meningococcemia. 32% died due to septic shock, DIC. The etiologic agent was identified as Neisseria meningitidis.
Conclusion: Of the study population, 53% were female. Children 0-5 years of age were most affected (47%). 100% had a history of fever. 32% died of septic shock. 62% were confirmed by laboratory. The culprit of this epidemic was a hypervirulent strain of Neisseria meningitidis Serogroup A Subtype A 1.9 sensitive to Penicillin.
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PROFILE OF PEDIATRIC PATIENTS WITH DENGUE FEVER/DENGUE HEMORRHAGIC FEVER OVER A FIVE-YEAR PERIOD (2000-2004)
Jonathan G. Lim, M.D.*, Salvacion R. Gatchalian, M.D.,*** Ma. Rosario Z. Capeding, M.D.** * University of the Philippines College of Medicine- Philippine General Hospital **Research Institute of Tropical Medicine, Muntinlupa
Keywords: dengue, dengue fever, dengue hemorrhagic fever
Abstract:
Objectives: This study was conducted to determine the clinico-demographic profile of pediatric patients who were admitted for dengue infection at the Research Institute for Tropical Medicine (RITM) from 2000 to 2004.
Methods: This is a retrospective, descriptive study. Charts of patients who were less than 19 years of age and were admitted at the RITM due to confirmed dengue (using paired dengue HI titer results) were reviewed.
Results: Two hundred patients qualified for the study. The mean age of the patients was ten years ± four years SD with an equal sex distribution. The most common chief complaint was fever while petechiae were the most common evidence of bleeding. The mean hematocrit among patients was 42 ± 5 vol % and platelet count of 129 ± 53/mm3. Fifty-one percent of the patients had Dengue Hemorrhagic Fever grade II. All subjects were discharged with improved condition. Among the patients, 49% had acute secondary dengue infection, 32% had recent secondary dengue infection, and only 13% had acute primary dengue infection.
Conclusion: The clinico-demographic profile of patients involved in the study was very similar to that of other studies done, both locally and abroad. By using Spearman’s correlation of ranks, the study showed that there was no significant relationship between the severity of dengue infection based on the World Health Organization (WHO) Grade and whether it was a primary or secondary infection with r=.018, p-value=.025.
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THE ANTIHELMINTHIC EFFICACY OF PINEAPPLE FRUIT MEBENDAZOLE ON SOIL TRANSMITTED HELMINTHIASES: A RANDOMIZED CONTROLLED TRIAL
Charina A. Manabo, MD, Melchor Victor G. Frias, MD De La Salle University Medical Center
Keywords: pineapple, ascariasis, trichuris, antihelminthic
Abstract:
Objectives: The study was performed in order compare the antihelminthic efficacy of pineapple fruit versus mebendazole in schoolchildren. Design: The study performed was a single, blinded randomized control trial.
Subjects: Ninety subjects aged 5 to 13 years old and positive for soil-transmitted helminthiases were included in the study.
Methods: Eligible participants were subjected to Kato-Katz for diagnosis and quantitative ova count. Those positive for soil-transmitted helminthes were randomized to Group A (pineapple) and Group B (mebendazole). After 7 days of treatment, stool samples were subjected to another Kato Katz for quantitative ova analysis. Seven hundred fifty ml of puree made from one pineapple, with approximate weight of 750g, was given in divided amounts within 24 hours (250 ml 3x a day) for group A.
Results: Majority (77.78%) were infected with Ascaris lumbricoides. Pineapple exhibited a significant improvement in egg reduction rate (RR) with a p-value of < 0.001 at 95% CI. This showed 83.5 % egg per gram (epg) of feces reduction and a cure rate of 68.9%. Mebendazole also revealed a significant egg reduction with p-value of < 0.001 at 95% CI. It also showed a remarkable egg per gram reduction rate of 92.25% and cure rate of 88.9%. There were no adverse events reported.
Conclusion: Mebendazole, as an antihelminthic, is a better choice; but pineapple fruit may be beneficial as it had a high egg reduction rate and an acceptable cure rate.
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RISK FACTORS FOR CANDIDEMIA IN THE NEONATAL INTENSIVE CARE UNIT OF THE PHILIPPINE GENERAL HOSPITAL FROM OCTOBER 2003 TO AUGUST 2006: A CASE-CONTROL STUDY
Novette Regina M. Morales-Lagunzad*, M.D., Jacinto Blas V. Mantaring, M.D.* University of the Philippines College of Medicine-Philippine General Hospital
Keywords: candidemia, sepsis, risk factors, neonates, candidemia score
Abstract:
Candidemia is a major cause of nosocomial morbidity and mortality in neonates. Prompt diagnosis and treatment is crucial. Risk factor analyses have been conducted worldwide, but limited local data are available. This study was conducted to help pediatricians practicing locally decide when to suspect if a neonate has candidemia; therefore, helping them in the judicious use of empirical antifungal therapy.
Objective: To determine if there was a difference in the risk factors among neonates with candidemia and those without it, who were admitted at the Neonatal Intensive Care Unit of the Philippine General Hospital from October 2003 to August 2006. Methods: Neonates admitted within the mentioned period, surviving at least on the third day of life, and had at least one blood culture on or after day 3 of life were included in the study. A retrospective review of records was performed to identify the presence or absence of known risk factors for candidemia. The outcome of interest was the presence of candidemia. Each variable was analyzed initially using the bivariate analysis chi-square. Cut-off value for inclusion into multivariate analysis was p<0.25. Multivariate analysis, through backward elimination, was done to narrow down independent variables (p value for retention <0.25).
Results: One hundred thirty-eight neonates (69 cases and 69 controls) were included. Based on bivariate analysis, patients exhibiting the following characteristics showed increased risk for candidemia: birth weights of 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) and 1500 to 2449g (OR: 3.84; 95% CI 1.31-11.27); pediatric aging < 28 weeks (OR: 1.42; 95% CI: 1.07-8.5) and 28 to 32 weeks (OR: 1.89; 95% CI: 0.74-4.84); central vascular access (OR: 0.52; 95% CI: 0.26-1.03); prolonged broad-spectrum antibiotic use (OR: 2.0; 95% CI: 0.95-4.2); and increased hospital stay (OR: 0.5; 95% CI: 0.24-1.05). Intralipid use was also associated with candidemia, but was excluded due to insufficient data available. In the multivariate analysis, only patients with birth weights of 1500 to 2449g (OR: 3.65; 95% CI: 1.24-10.77) and 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) qualified. A clinical predictive model in diagnosing candidemia was not possible due to insufficient variables available. Conclusion: Based on the study, infants with lower birth weights (<2500 g) were at most risk for developing subsequent candida infection.
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2010 CHILDHOOD IMMUNIZATION SCHEDULE FOR FILIPINOS
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Vol.11 No.2 July-Dec 2010
THE 2009 ANTIMICROBIAL RESISTANCE SURVEILLANCE PROGRAM: PROGRESS REPORT
Celia C. Carlos, M.D., Research Institute of Tropical Medicine
Keywords: Antimicrobial resistance, enteric pathogens, respiratory pathogens, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Neisseria gonorrhea, E. coli
Abstract:
Resistance data for 24, 684 isolates were reported and analyzed. The most common specimen sources were respiratory and urine which accounted for 29% and 23% of all specimens respectively. The rest of the specimen sources were blood 18% and wounds 16%. There were 197 genital tract, 315 CSF, and 431 stool isolates reported.
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CLINICAL CHARACTERISTICS OF CHILDREN WITH COMPLICATED COMMUNITY- ACQUIRED PNEUMONIA WHO WERE ADMITTED AT MAKATI MEDICAL CENTER FROM JANUARY 1999 TO AUGUST 2009.
Joanna Bisquera-Cacpal, M.D., Joseph Dale Gutierrez, M.D., Robert Dennis Garcia, M.D. Makati Medical Center
Keywords: pneumonia, complicated pneumonia, pleural effusion, Staphylococcus, Streptococcus
Abstract:
Pneumonia is a prevalent cause of death in children. This study was undertaken to determine the clinical characteristics, outcomes and bacterial etiology of children with complicated community-acquired pneumonia.
Methodology: All patients who were between one month and 18 years old and diagnosed with complicated community-acquired pneumonia at the Makati Medical Center from January 1999 to August 2009 were included. Each case was matched with four controls of uncomplicated pneumonia. Data collected were demographic information, laboratory results, management and outcome.
Results: Thirty-five cases of complicated community-acquired pneumonia were included in the study. There was no significant difference between the demographic profile, class of antibiotics prior to admission, and underlying conditions in both groups. The complicated cases seen were those who developed pleural effusion or intubated or mechanically ventilated. These cases also constitute those who significantly presented fever of longer duration (mean 7.3 days SD ±6.8), higher respiratory rates (34.3 breaths/minute SD± 12.1 p=0.0003) and presented more frequently with retractions (42.9%, p=0.0003). Complicated community-acquired pneumonia had significantly more antimicrobial changes, greater number of days to fever lysis and had longer hospital stays. Cultures of complicated cases had a low yield (23%); positive cultures had growths of Staphylococcus aureus, Streptococcus pneumoniae and Pseudomonas species. Mortality rate was 14.3% for complicated cases, there was none for the control group.
Conclusion: There were no significant differences in the demographic profile, class of antibiotics prior to admission, and underlying conditions between the two groups. Complicated cases presented with fever of longer duration, higher respiratory rates and had more frequent retractions, of longer hospital stay, more frequent changes of antibiotics and a 14.3% mortality rate.
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RACECADOTRIL IN THE TREATMENT OF ACUTE DIARRHEA IN CHILDREN: A META-ANALYSIS
Robina Hao, M.D. *, Michelle De Vera, M.D. *, Emily Resurreccion, M.D.* The Medical City, Ortigas Ave., Pasig City 3rd Place Winner, Poster Research Contest at the 17th Annual PIDSP Convention, 2010
Keywords: diarrhea, racecadotril
Abstract:
Diarrhea has been the subject of considerable attention and effort. A variety of anti-secretory agents have been subjected to countless investigations including racecadotril as an adjunct therapy. Objectives: To assess the effectiveness of racecadotril, along with oral rehydration solution, in the treatment of diarrhea.
Methods: The Cochrane Library and Pubmed were searched for trials; high sensitive search terms were used including “randomized controlled trials”, “racecadotril” and “diarrhea”. Outcome measures were stool output, duration of diarrhea, and number of bowel movements. Data Collection and Analysis: Three reviewers assessed the methodological quality. Analysis was implemented with Review Manager 5 using standard mean difference as treatment measure.
Results: The search yielded 21 results; four of which fulfilled selection criteria. A total of 659 participants were given 1.5mg/kg of racecadotril. The meta-analysis showed that racecadotril is effective in reducing stool output in 48 hours compared to the control group. This finding was congruent for those positive for rotavirus and for the duration of the diarrhea. There were lesser children who revisited their doctors after 48 hours of treatment. The chance of cure after day seven of treatment was higher in the racecadotril group when compared to the control group. Racecadotril with ORS was comparable to ORS alone in terms of safety and tolerability.
Conclusion: There is evidence that the drug racecadotril holds promise in terms of reducing stool output, number of bowel movements and duration of diarrhea. However, well-designed randomized control trails with an adequate sample size and absence of any competitive interest in studying the efficacy and safety of racecadotril in acute diarrhea are needed before we reach any conclusion regarding the role of the drug in diarrhea.
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SEROLOGIC STATUS OF NEONATES BORN TO HEPATITIS B POSITIVE MOTHERS AND GIVEN HEPATITIS B VACCINE AT BIRTH IN A TERTIARY GOVERNMENT HOSPITAL FROM JANUARY 2007 TO JUNE 2008: A PILOT STUDY
Isnihaya M. Mapandi, MD Northern Mindanao Medical Center
Keywords: Seroconversion, Hep B vertical transmission, Hepatitis B vaccine
Abstract:
Background: Data evaluating effectiveness of the Newborn Hepatitis B Immunization program remains unavailable years after its implementation.
Objective: This study describes the serologic status of infants nine-to-18 months, born to Hepatitis-Bs- Antigen-positive mothers and who received Hepatitis B vaccine at birth.
Methodology: Fifty-one infants with complete immunization data and whose parents consented to serologic testing for Hep Bs Ag and Anti HBs were included in the study. Venous blood was collected and tested using SD HBs Ag test kit (Intec) and SD Anti HBs test kit (Bioline).
Results: One of 51 (1.9 %) infants tested was positive for HBs Ag; 22 (43.1%) had Anti HBs seroconversion; and 28 (54%) were non reactive to both Anti HBs and Hep Bs Ag. The infant reactive to Hep Bs Ag received three doses of Hepatitis B vaccine but did not receive HBIg.
Conclusion: Giving of Hepatitis B vaccine with or without HBIg conferred protection from vertical transmission in 98% of the study population. Only 1.9 % (n=1) tested positive for Hep Bs Ag and did not receive protection from Hep B vaccination. The seroconversion rate was only 43.1% even if majority of patients received two subsequent doses of vaccine before serologic testing. There is a need to review the dosing schedule of Hep B vaccination being implemented in our primary care setting to ensure seroconversion after vaccination.
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DETERMINING CORRECT DOSING REGIMENS OF ANTIBIOTICS BASED ON THE THEIR BACTERICIDAL ACTIVITY*
Cecilia C. Maramba-Lazarte, M.D., MScID University of the Philippines College of Medicine-Philippine General Hospital, *Excerpt from “Rational Antibiotic Use for Pediatrics, A Study Guide and Workbook
Keywords:Äntibacterials, antibiotics, rational dosing for antibiotics
Abstract:
Objectives: Upon completion of this chapter, the learner will be able to:
1. Describe the 2 groups of antibiotics based on their bactericidal activity, namely concentration-dependent antibiotics, and time-dependent antibiotics. Name the pk/pd indices which determine efficacy.
2. Recall and define the following terms: area under the concentration vs. time curve (AUC), minimum inhibitory concentration (MIC), peak level (Cmax).
3. Classify the following antibiotics based on their bactericidal activity: penicillins, cephalosporins, aminoglycosides, vancomycin, fluoroquinolones, and carbapenems. Identify the pharmacologic indices used to determine their efficacy
4. Determine the correct dosing regimen of the above antimicrobials based on their pattern of bactericidal activity.
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MANAGEMENT OF A(H1N1) IN THE HOSPITAL SETTING
Abstract:
(An excerpt from the DOH Draft Interim Guidelines No. 22 – Clinical Management of Suspected and Confirmed Human Pandemic (H1N1) 2009 Infection) Go pidsphil.org for the complete guideline.
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