2017 Journals

Journal 2017 Vol.18 No.1
Toil and Dream On
Carmina A. delos Reyes, M.D.

The editorship came in as a big, BIG surprise. This with a bang and the news that our dear EIC (over the last 15 years), Dr. Cecilia Maramba-Lazarte will relinquish her post. The whole gamut of human emotions came into play as if I were this character Riley from “Inside Out”(Disney). I felt overly surprised. There was sadness, disgust, even fear. Anger? Angst? There was no perfect word to describe what it felt to be tasked to carry on and bring further “THE PIDSP JOURNAL”.

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Journal 2017 Vol.18 No.1
Association Between Breastfeeding And Clinical Outcomes Of Infants With Very Severe Pneumonia
Cherrylyn R. Laguna-Cruz, M.D., Gener T. Becina, M.D.

Objective: To determine the association of breastfeeding with the clinical outcomes of infants with very severe pneumonia.

Methods: This retrospective study included intubated, full-term infants between one to six months of age admitted for very severe pneumonia at the critical care units of the National Children’s Hospital from 2005 to-2015. The 52 subjects per type of feeding (exclusively breastfed and non-exclusively breastfed) were selected using simple random sampling. We examined the association between the type of feeding with the length of ICU stay, ventilator days, health-care-associated infection (HAI) and mortality.

Results: A total of 104 infants were included in the study. The exclusively breastfed (EBF) infants stayed for a shorter amount of time in the ICU than the non-exclusively breastfed (NEBF) infants (p-value = 0.0067). The EBF infants had shorter intubation period and mechanical ventilation use (p value=0.001), and less HAI (p-value = 0.015). There were more infants with very severe pneumonia who died from the NEBF group but no significant association (p-value = 0.076) was found between mortality and the type of feeding.

Conclusion: Exclusively breastfed infants who were admitted for very severe pneumonia at the critical care areas showed better outcomes in terms of shorter ICU stay and ventilator use, and lower incidence of HAI as compared to the NEBF infants. However, data showed no significant association between mortality and type of feeding.

Journal 2017 Vol.18 No.1
Effect Of Bovine Colostrum On The Absolute Neutrophil Counts Of Acute Lymphocytic Leukemia Patients Undergoing Chemotherapy: A Double-Blind Randomized Placebo-Controlled Study
Edith Cyrill L. Caysido, M.D., Ferdinand Ganggangan, M.D., Rainelda P. Runez, M.D.

Background: Changes in the blood cell counts, such as leukopenia and neutropenia, in patients with Acute Lymphoblastic Leukemia (ALL) are common events following chemotherapy. These commonly delay further administration of chemotherapeutic agents. Furthermore, the risk of infection rises correspondingly with the degree of neutropenia. Bovine colostrum is a rich source of immunoglobulins and other antimicrobial factors. These immunoglobulins are believed to improve the immune function and may be effective in the prevention of neutropenia following chemotherapy.

Objective: To determine the efficacy of bovine colostrum in preventing neutropenia among ALL patients undergoing chemotherapy.

Methods: This study included pediatric patients, aged 6 months to 18 years old diagnosed with ALL undergoing chemotherapy. Twenty-one subjects were randomly assigned to receive bovine colostrum or placebo that were taken twice a day for a week beginning from the first day of chemotherapy. Baseline complete blood count (CBC) and the absolute neutrophil count (ANC) were determined before and after 7 days of giving the colostrum or placebo. A ttest was applied to determine significant differences before and after the supplementation on each group.

Journal 2017 Vol.18 No.1
Predictive Factors Of Treatment Failure For Pediatric Community-Acquired Pneumonia C And D In 2-To-59 Months Of Age
Charisse R. Zuniga, M.D., Robert Dennis Garcia, M.D., Rozaida Villon, M.D.

Objective: To determine antibiotic treatment failure rate and predictors of treatment failure in children 2 to-59 months with Pediatric CommunityAcquired Pneumonia-C (PCAP-C) and PCAP-D admitted at Makati Medical Center.

Methods: This prospective cohort study examined 100 children, 2-to-59 months with clinically diagnosed PCAP-C and PCAP-D. Baseline assessment was done on day 1 of hospital stay and follow-up assessments were done on days 3 and 7 or upon discharge for the outcomes of interest.

Results: One hundred children were included in the study and 98% had PCAP-C. This study identified a treatment failure rate of 17% among children with PCAP-C. There was no mortality. Malnutrition and low oxygen saturation on admission were significant predictors of treatment failure.

Conclusion: Antibiotic treatment failure rate was 17%. Malnutrition and hypoxia were significant predictors of treatment failure in children with PCAPC.

Journal 2017 Vol.18 No.1
Effect Of A Powerpoint Lecture VS Video Presentation On The Knowledge And Attitude On Hiv Among Grade 9 Public School Students
Anne Margarette Canapi, M.D., Jenny Wong, M.D., Kris Ian Mendoza, M.D.

Objective: This study aimed to compare the effect of a powerpoint lecture versus video presentation on the knowledge and attitude on HIV among grades 9 students in a public school in Manila.

Methods: GRADE 9 public school students were randomly assigned into one of two groups, video presentation or PowerPoint presentation. Pre- and post-tests were administered to assess the efficacy of an intervention. Student t-test was used to compare knowledge on HIV/AIDS before and after the intervention, as well as compare the results between the 2 groups. Chi-square was used to compare scores on attitude before and after the intervention, with the level of significance at p=0.05.

Results: Two hundred fourteen students participated in the study, and majority (57%) are females. The mean age of participants is 14.2 years. The difference in scores before and after the intervention was found to be statistically significant (p<0.001) with an approximate increase by 16% and 24% after a video and Powerpoint presentation respectively. The difference between post-intervention scores is statistically significant (p <0.001; 95% confidence interval) in favor of the PowerPoint presentation.

Conclusion: A PowerPoint lecture is more effective than a video presentation in increasing knowledge and developing positive attitude towards HIV/AIDS.

Journal 2017 Vol.18 No.1
Fever Of Unknown Origin In Children: A Five-Year Review
Ma. Fema A. Cabanalan-Rivera, M.D., Ma. Liza M. Antoinette M. Gonzales, M.D.

Objective: The clinical presentation, outcome, and risk factors for mortality in children with Fever of Unknown Origin (FUO) were determined.

Methods: Medical records of pediatric patients admitted for FUO from January 2009 to December 2013 were reviewed. Clinical manifestations, physical exam findings, diagnostic work-ups and final diagnosis were determined, as well as the relationship between final diagnosis and risk for mortality.

Results: Fifty-seven patients with FUO were included. Weight loss, cough, colds, and rashes were common symptoms while pallor, lymphadenopathies, and hepatomegaly were common physical exam findings. All patients underwent Phase I evaluation for FUO, while 73.7% underwent further diagnostic tests. A specific etiology was established in 96.5% of cases: infectious, 43.9%, connective tissue disease, 38.6%, and hematologic/oncologic, 14%. Two cases remained to have no specific diagnosis. Majority of patients had a benign course and were discharged improved (84.2%). The mortality rate is 15.8% and was not associated with any disease category (p-value 0.204).

Conclusion: FUO in children occurs across all age groups. Its clinical presentations are varied and non-specific and common signs and symptoms are pallor, lymphadenopathies, weight loss, cough, colds. and joints pains. Infection is the most common cause of FUO in children, followed by connective tissue diseases and hematologic and oncologic diseases. The mortality rate from FUO is 15.8%

Journal 2017 Vol.18 No.1
Chronic Granulomatous Disease: An Unreported Mutation
Melody O. Kiat, M.D., Stéphanie Boisson-Dupuis, Jean-Laurent Casanova, Jacinta Bustamante, Maria Beatriz P. Gepte, M.D., Jaime A. Santos2, M.D.

Abstract: Chronic Granulomatous Disease (CGD) is caused by defects in the phagocyte NADPH oxidase and occurs in approximately 1:200,000 births worldwide. It presents with early onset of severe recurrent bacterial and fungal infections. This is a case of a 9-year old male with severe, recurrent bacterial infections since 3 weeks of age. Initial Nitroblue tetrazolium (NBT) reduction tests were normal but a DNA analysis revealed a previously unreported homozygous mutation in CYBB, p.S418Y. Dihydrorhodamine (DHR) test showed poor neutrophil oxidation consistent with X-linked CGD. Definitive microbiologic diagnosis is essential for directing therapy for recurrent bacterial and fungal infections. Treatment of infections should be aggressive. Lifelong bacterial and fungal prophylaxis is necessary for prolonged survival. We report a case of confirmed CGD with the previously unreported mutation.

Journal 2017 Vol.18 No.2
Second Stop
Arlene Dy-Co, M.D.
If the first was fast… the second will be faster…
This second issue from your new editors and editorial board is by no means fast but faster than the first one. Without any formal training on medical journal editing, this task is definitely overwhelming if not daunting. A noted medical journal editor once wrote and I quote “I hope that one day every editor gets some training before beginning work.” And we began our work… we have to adapt to you, our
reader’s point of view while upholding the author’s voice. More than checking a paper’s spelling and grammar, we prioritize readability instead of merely coming out with a repository of data.
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Journal 2017 Vol.18 No.2
Clinical Profile and Treatment Outcomes of Childhood Extra-pulmonary Tuberculosis in a Children’s Medical Center
Melody O. Kiat, M.D.

Background: Extra-pulmonary tuberculosis comprises 1.1% of all tuberculosis (TB) cases notified in the Philippines.34 Its diagnosis poses a challenge for clinicians due to the protean ways in which the disease presents. Monitoring its treatment outcome is essential to evaluate the effectiveness of the intervention.

Objective: This study aims to determine the clinical profile and treatment outcomes of children with extra-pulmonary tuberculosis in a children’s medical center.

Methods: This is a retrospective cross-sectional study conducted in a children’s medical center. The medical records of children less than 15 years with extrapulmonary tuberculosis from 2010 to 2014 were reviewed. Demographic, clinical data and treatment outcome were noted.

Results: A total of 140 charts were reviewed. Male to female ratio is 2.3:1. The most common age group was 0-4 years and central nervous system (CNS) was the most predominant site. New cases were 96.4% and 97.1% were clinically diagnosed. History of TB contact was elicited in 36.4% and tuberculin skin test was positive only in 39.3%. The most common presenting symptoms were in association with the site of infection. Results of the different diagnostic modalities used have contributed significantly in establishing the diagnosis. Treatment outcome was favorable at 79.3% while deaths were seen in 11.4% of cases.

Conclusion: The study has shown that proportion of patients with extra-pulmonary tuberculosis was 3%. Treatment outcome was satisfactory at 79.3% but was not significantly associated with the site of infection.

Journal 2017 Vol.18 No.2
A Meta-Analysis on GeneXpert Using Stool Samples in Diagnosing Pediatric Pulmonary Tuberculosis
Othella Mary Ann S. Cacayorin, M.D.

Objectives: To find an alternative specimen for GeneXpert assay in the diagnosis of pediatric pulmonary tuberculosis (PTB). To determine the sensitivity and specificity of using stool samples as an alternative to sputum for GeneXpert assay.

Methods: A systematic search was done using an electronic database (e.g. Pubmed). Using the keywords “GeneXpert”, “tuberculosis”, “Stool samples”. QUADAS-2 checklist was used in assessing the studies gathered. Revman 5.3 was used to determine the sensitivity and specificity of the study included in this meta-analysis.

Results:A total of 185 stool samples were included in this review, which showed a median sensitivity of 77% (IQR 0.63-0.87) and median specificity of 98% (IQR 0.95-1.0).

Conclusion: Despite the heterogeneous sensitivity, GeneXpert has a high specificity, which enabled rapid diagnosis of pulmonary tuberculosis promoting timely initiation of appropriate therapy.

Journal 2017 Vol.18 No.2
A Retrospective Study on Sensitivity, Specificity, Negative Predictive Value, Positive Predictive Value of TB PCR Versus TB Culture in Diagnosing Tuberculosis in Filipino Children Aged 3 Months to 18 Years at a Tertiary Care Center
Jesanel B. Ancheta, M.D., Robert Dennis J. Garcia, M.D.

Objectives: This study aimed to establish the accuracy of TB PCR versus TB culture and rifampicin resistance detection by PCR versus conventional susceptibility testing of body fluids in diagnosing tuberculosis in pediatric patients 3 months to 18 years with suspected tuberculous disease at a tertiary care center.

Methods: This is a retrospective analytical study of patients seen between January 1, 2012 to May 31, 2017, with clinical and radiographic features suggestive of tuberculosis, who had diagnostic testing of body fluids for TB PCR and TB culture.

Results:Among 159 patients suspected of TB, 46 (28%) tested positive by PCR, of which one was rifampicin-resistant. The sensitivity, specificity, positive predictive value and negative predictive values of TB PCR, using TB culture as the gold standard were 90%, 91.6%, 78.3%, and 96.5% respectively. The sensitivity, specificity, positive predictive value, and negative predictive values of TB PCR for detecting rifampicin resistance, using TB culture and sensitivity as the gold standard, were 33%, 100%, 100%, and 95%, respectively. Overall, the accuracy of TB PCR in detecting TB disease is 91.2% and the accuracy of TB PCR in detecting rifampicin resistance is 95%.

Conclusion: Findings in our study suggest that TB PCR play an important role in TB disease diagnosis, but clinical and radiological assessment continue to be essential in the diagnosis of childhood tuberculosis. The accuracy of TB PCR in detecting TB disease in children is 91.2% and the accuracy of TB PCR in detecting Rifampicin resistance is 95%.

Journal 2017 Vol.18 No.2
Association of Factors with Successful Treatment Outcome of Childhood Tuberculosis in Barangay Commonwealth, Quezon City, Philippines: A Two-Year Retrospective Study
Christine N. Pecson , M.D., Ana Liza H. Duran, M.D.

Background: Tuberculosis remains a public health concern worldwide. Reports on the association of factors of childhood tuberculosis with treatment outcome are limited.

Objectives: To determine the epidemiology and association of factors of childhood tuberculosis with successful treatment outcome in some of the barangays of Quezon City.

Methodology: This is a retrospective cohort study done at Barangay Commonwealth Health Centers including children 0-14 years old with tuberculosis registered and treated from January 1, 2013 to July 15, 2015. Socio-demographic and clinical data were obtained. Patient profile data, treatment cards and medical records were the data sources

Results: A total of 267 new cases of childhood TB were analyzed. The treatment success rate was 98% (97% completed treatment, 1% cured). The rate of poor treatment outcome including default cases was 2%. There were no reported deaths or treatment failure. On univariate analysis, patients with weight gain (p=0.001) had an odds ratio of 8.085 (95% CI:1.310-49.900) to have a successful treatment outcome. On multivariate analysis, weight gain was significantly associated with treatment success (p=0.042; OR=12.5, 95% CI: 1.091, 143.244). None of the socio-economic and clinical factors studied was associated with successful treatment outcome.

Conclusion: Weight gain is a factor of a successful treatment in childhood tuberculosis. Children who gained weight after treatment are more likely to have a successful treatment outcome.

Journal 2017 Vol.18 No.2
Pediatric Sellar-Suprasellar Tubercular Abscess:A Case Report and Literature Review
Virgi Lea Claudine C. Esquivel-Aguas, M.D.

 Abstract: Sellar-suprasellar tuberculoma represents 1% of all intracranial tuberculomas, which can convert into a pituitary abscess.

Objectives: This paper aims to present a case of a common lesion in an uncommon site,discuss the challenges in diagnosis in terms of clinical manifestations, imaging and histologic findings, discuss aholistic approach to treatment, and enumerate identified clinical outcomes of reported cases in literature.

Methodology: This paper presents a case report of a sellar-suprasellar tubercular abscess, and reviews similar cases reported in literature.

Results: This is a case of a 16-year old female, Filipino, presenting with a chronic history of intermittent headache, fever, blurring of peripheral vision, polyuria, and increased sleeping time. On neurologic examination, the patient had bitemporal hemianopsia and decreased visual acuity on the right eye. Neuroimaging revealed a hypodense lesion at the sellar-suprasellar area with rim-enhancement on CT and MRI, and laboratory findings suggestive of panhypopituitarism. She underwent Right Pterional Craniotomy and intraoperatively there was note of a firm, yellowish capsule with intracapsular yellowish viscous fluid, which was positive for acid fast bacilli. Marsupialization of abscess was performed and hormonal replacement and anti-tubercular medications were given.

Conclusion: Tuberculoma in the sellar-suprasellar area, can impinge on the optic chiasm, producing bitemporal hemianopsia and pituitary dysfunction. It presents like other sellar-suprasellar masses with non-specific symptoms and these masses share similar features on cranial CT scan. Due to the complexity of the disease, treatment of sellar-suprasellar TB requires integrated management of an infectious disease expert, neurologist, neurosurgeon, endocrinologist, and adolescent medicine specialist. Outcomes of four other cases found in literature were generally good after aspiration or drainage of the abscess followed by TB treatment for 15 to 18 months with resulting improvement in vision, marked reduction in the size or complete resolution of the mass, but with one case having loss of pituitary function.

Journal 2017 Vol.18 No.2
Hansen’s Disease in an Adolescent: A Case Report
Patricia Carla N. Asuncion, M.D., Rhanee Lota-Salvado, M.D.

Abstract: Leprosy is a chronic communicable disease that remains to be endemic worldwide and children and adolescents are most vulnerable to infection. A 17-year-old Filipina presented with a 4-year history of multiple skin lesions evolving into various forms, associated with pain and deformity of extremities. She was diagnosed with Hansen’s disease, lepromatous type, in severe erythema nodosum leprosum. She was started on multi-drug therapy with Rifampicin, Clofazimine and Clarithromycin. There was remarkable improvement with arrested progression of skin lesions, conversion of wounds into granulation tissue, significant decrease in painful sensation, and gradual ability to move the extremities. Early recognition of leprosy and prompt initiation of treatment will ultimately prevent complications and disabilities in afflicted patients. A holistic approach is key in the management of children and adolescents with leprosy.