We are on with our 3rd issue since we took on this task 3 years ago.
The number three spells mystery and magic. In the Biblical tradition, it symbolized wholeness, completeness, perfection. In the Chinese culture, it spelled luck. It is the first number to which “everything” was ascribed. It is the number representing the whole – it has a beginning, middle, and an end.
This is what this 3rd release is all about. There is no unifying theme to speak of, just a cacophony of medical literature drafted to perfection.
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Original Articles
Journal 2018 Vol.19 No.1
A Prospective Cross-Sectional Study on the Prevalence and Factors Associated with Seroprotection after Primary Series of Hepatitis B Vaccination
Adrienne Michelle B. Lu, M.D., Maria Estela R. Nolasco, M.D., Marilou G. Tan, M.D.
Abstract
Objectives: To determine the prevalence and factors associated with seroprotection among children 3 months to 18 years old with primary Hepatitis B vaccination series.
Methodology: This is a prospective cross-sectional study done among children 3 months to 18 years old with complete primary series of Hepatitis B vaccination. Demographic, social and clinical data were correlated with reactivity to antibody to Hepatitis B surface antigen (antiHBs) (>10 IU/L),total antibody to Hepatitis B core antigen (total anti-HBc) and Hepatitis B surface antigen (HBsAg) serologic tests.
Results: Among 110 subjects from different age groups,52% had seroprotective anti-HBs levels, with the highest noted among infants (3 months-2 years) at 82%, followed by 41% from the childhood group (3-9 years) and 26% from adolescent group (10-18 years). Seventy-four percent of subjects with <5 years interval from vaccination were seroprotected, 26% in subjects after 5-10 years, and 38% at more than 10 years after vaccination with significant difference on multi-logistic regression (p value 0.000/0.020). None of the other factors including gender, geographic area, age at first dose, vaccination schedule, type and place of vaccination were significantly associated with seroprotection.
Conclusion: Fifty-two percent of patients among different age groups were seroprotected. Seroprotection was significantly associated with the interval year after vaccination demonstrated at < 50% 5 years and beyond post-vaccination.
Keywords: Hepatitis B seroprotection, Hepatitis B immunization, anti-HBs
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Journal 2018 Vol.19 No.1
Relationship Between Immature Platelet Fraction and Platelet Count among Pediatric Patients with Dengue Fever: A Prospective Cross-Sectional Study
Maria Monette S. Ong-Misa, M.D., Robert Dennis J. Garcia, M.D., Mercy Jeane Uy-Aragon, M.D., Mary Ann Arkoncel-Adapon, M.D.
Abstract
Background and Objectives: Immature platelet fraction (IPF) is a new hematologic parameter that reflects the rate of thrombopoiesis. It has been suggested to be a predictor of platelet recovery in patients with thrombocytopenia. This study aimed to determine the relationship between IPF and platelet count among pediatric patients with thrombocytopenia due to dengue fever.
Methods: This was a prospective cross-sectional study of 77 thrombocytopenic pediatric dengue fever patients. IPF was included in the daily complete blood count extraction. Baseline and daily IPF, platelet count, hematocrit, white blood cell count and presence of fever were recorded according to day of illness. The pattern of IPF in relation to the pattern of platelet count was analyzed. The proportion of patients showing platelet recovery at different time points was also determined. A receiver operating characteristic analysis was done to determine an IPF cut-off value predictive of platelet recovery within 24 hours.
Results: The IPF increased as the platelet count decreased. The highest increase in IPF coincided with the trough of platelet count. Eighty -seven percent of the patients showed platelet recovery after the increasing trend of IPF, 87% after the peak value and 95% after the decreasing trend. An IPF value of more than 6.6% was found to be predictive of platelet recovery within 24 hours, with a sensitivity of 45% and specificity of 70%.
Conclusion: There was an observed inverse relationship between IPF and platelet count but with a statistically weak correlation. The decreasing trend of IPF can be a possible good predictor of an increasing trend in platelet count. These findings suggest a possible role of IPF as an additional parameter to predict platelet recovery in pediatric dengue fever patients.
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Journal 2018 Vol.19 No.1
Compliance to the National Immunization Program: A Review of Immunization Records of Grade 1 Students in a Public Elementary School in Manila for the Academic Year 2017-2018
Jillianne D. Pardo, M.D., Kris Ian B. Mendoza, M.D., DPPS, Jennie A. Wong, M.D., FPPS
Abstract
Background: Vaccination is a cost-effective primary preventive measure against infectious diseases. However, protection for specific diseases may wane over time. The National Immunization Program was launched to improve vaccine coverage but despite this, some countries including the Philippines have erratic vaccine coverage.
Objective: To determine the compliance to the National Immunization Program of Grade 1 students in a public elementary school
Methodology: The study utilized a descriptive cross-sectional design. Simple random sampling of students enrolled in first grade for A.Y. 2017-2018 was done to determine the study respondents. Primary and secondary data were obtained through a pretested structured questionnaire with interview of the students’ caregiver and verification via the students’ immunization records. Compliance to immunization was correlated with the subjects’ age, birth rank, primary caregiver and socio-demographic profile of the caregiver, place of birth and place of vaccination. Data were analyzed using descriptive statistics and logistic regression was used to assess factors for increased vaccination compliance.
Results: Most respondents had their mothers as primary caregivers. Majority were institutional deliveries and immunized at a health center. Mean compliance to vaccination was 69%. Among the factors, only place of birth, specifically, hospital delivery, was associated with increased compliance to vaccination (OR = 0.3312, 90% CI 0.1496 to 0.7333, p value 0.0064). Subjects whose primary caregivers were the mothers and whose parents had higher educational attainment or were both employed were shown to have higher vaccination compliance, although this was not statistically significant. Vaccination coverage was observed to decrease over time as the subjects grew older. Most common reasons cited for missing vaccinations were vaccine unavailability (68%), financial constraints 46%), and lack of information (40%).
Conclusion: Compliance to vaccination in this study was 69% and is affected by multiple factors. Policymakers and stakeholders should address these barriers to improve vaccination coverage and overall health status.
Keywords: immunization, vaccine, children, national immunization program, school-based immunization, EPI
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Journal 2018 Vol.19 No.1
Diagnostic Accuracy of Renal Angina Index in Predicting Acute Kidney Injury in Pediatric Patients with Sepsis: A Philippine Tertiary Hospital Experience
Marc Andrew O. Perez, M.D., Francisco E. Anacleto, Jr., M.D.
Abstract
Background: The coexistence of acute kidney injury (AKI) in sepsis contributes significantly to morbidity and mortality rates. Traditional diagnostic markers still pose variable limitations in early AKI prediction. The use of renal angina index (RAI) as a clinical predictive tool for AKI is an emerging concept.
Objectives: To determine the diagnostic accuracy of RAI in predicting AKI in patients with sepsis
Methodology: This is a five-year retrospective cohort study conducted at the Philippine General Hospital (PGH). Records of eligible patients with sepsis were reviewed. RAI was calculated based on the composite of risk factors and clinical evidence of injury on day 0 of admission stratifying subjects into two groups: RAI (-) and RAI (+) for those with scores ≥ 8. Prediction of AKI with the RAI was analyzed.
Results: A total of 222 patients were enrolled. The RAI (+) group (score ≥ 8) consisted 95 patients (43%). AKI incidence rate was 40.5 % (90/222) and 87/90 patients (91.6%) were classified in the RAI (+) group. The use of RAI in predicting AKI has a sensitivity of 96.7%, specificity of 94.0%, positive predictive value (PPV) of 91.6%, negative predictive value (NPV) of 97.7%, positive likelihood ratio (LR) of 15.95, negative LR of 0.04 and area under the curve-receiver operating characteristic (AUC-ROC) of 0.953 (95% CI 0.92-0.98).
Conclusions: RAI is a good screening tool in predicting sepsis-associated AKI among pediatric patients. It provides early recognition of AKI and is a practical method which can be used at bedside.
Keywords: Renal Angina Index, Acute Kidney Injury, Sepsis
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Journal 2018 Vol.19 No.1
Granulocyte Colony Stimulating Factor in Improving Outcomes of Neonatal Sepsis: A Meta-Analysis
Grazielle S. Verzosa, M.D., Mary Mae Catherine N. Yu, M.D., Kathlynne Anne Abat-Senen, M.D.,Maria Isabel O. Quilendrino, M.D.
Abstract
Background: Neonatal sepsis complicated with neutropenia increases risk of mortality by 50%. The immature neutrophil production of neonates is often overwhelmed by severe infection. Granulocyte colony stimulating factor (G-CSF), a naturally occurring cytokine used to support neutrophil recovery during chemotherapy, is a possible treatment that can improve outcomes of neonatal sepsis.
Objectives: To determine the efficacy of G-CSF in decreasing mortality and morbidity in septic neonates.
Methodology: Electronic searches were conducted on online journal databases. Unpublished or ongoing studies ere sought in training institutions accredited by the Philippine Pediatric Society. The investigators included randomized control trials using G-CSF on septic neonates.
Results: Twenty-two trials were identified and thirteen were assessed to be eligible for review. The studies had a total of 530 participants, with the largest having 78 subjects. Relative risks (RR), mean differences (MD) and standard mean differences (SMD) with 95% confidence intervals (CI) using the fixed effect model and random effects model were reported in the results. There was a significant decrease in mortality (RR 0.69, 95% CI 0.48 to 0.99) with a greater reduction for preterm neonates, low birth weight neonates and neutropenic neonates. There was no significant reduction in morbidities caused by neonatal sepsis.
Conclusions: There is moderate quality evidence that suggests that G-CSF as an adjunct treatment for neonatal sepsis significantly decreases mortality with greater benefit to preterm neonates, low birth weight neonates and those with baseline neutropenia. The studies did not show any benefit in reducing sepsis-related morbidity.
Keywords: granulocyte colony stimulating factor, neonatal sepsis, neutropenia
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Journal 2018 Vol.19 No.1
A Retrospective Study on the Outcome of Children with Extensively Drug-Resistant Gram-Negative Infection Treated with Colistin vs. Other Antimicrobials
Carren Anne P. Batalla – Bocaling, M.D., Estrella B. Paje – Villar, M.D.
Abstract
Introduction: The increasing trend of extensively drug-resistant gram-negative infections led to the reconsideration of colistin as a valuable therapeutic option.
Objectives: To describe the clinical profile and treatment response of children with extensively drug resistant (XDR) Gram-negative infections given colistin versus other antimicrobials.
Methods: This retrospective descriptive study involved patients treated for XDR Gram-negative infections from January 2014 to June 2017 in a tertiary hospital in Metro Manila. Descriptive statistics were used to summarize clinical characteristics of subjects.
Treatment response to colistin versus other antimicrobial agents were compared in terms of success, failure, and toxicity. The Fisher-exact and Mann Whitney U tests were used to assess statistical differences between the colistin and non-colistin groups.
Results: Majority of patients with XDR Gramnegative infections had previous antibiotic exposure.
More patients in the colistin group received TPN 43.2% vs 23.7% (p=0.035), had a longer hospital stay prior to the onset of XDR Gram-negative infection, 27 days vs. 15.5 days (p=0.001), and had a longer total hospital stay with a median of 52 days vs 30 days (p < 0.001). Treatment success was significantly higher in the colistin group at 70.3%, as against 46.5% in the non-colistin group (p=0.014). There was no difference in the treatment duration of both groups. The colistin group had longer time to clinical response, with a mean of 6.27 (+ 3.57) days compared with those from the non-colistin group, with a mean of 4.36 (+ 1.77)(p=0.008). The colistin group had more fungal infections during the course of treatment (p=0.001).
Conclusion: Based on our institutional experience, colistin is considered relatively effective and safe in treating XDR Gram-negative infections in children.
Keywords: extensively drug-resistant gram-negative infection, healthcare associated infection, colistin
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Journal 2018 Vol.19 No.2
Editorial
Silver Lining
Arlene Dy-Co, M.D.
This issue celebrates the Silver Anniversary of Pediatric Infectious Disease Society of the Philippines (PIDSP), the owner of this journal. For an organization to endure 25 years and be as relevant in the now as it was at its inception is a feat. To be more relevant and more valuable in its Silver year is an honor.
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Feature Article
Vibrant at 25
Fatima Gimenez, M.D.
The year 2018 marks our Silver Anniversary.
As part of the celebration, we will reintroduce ourselves by way of an article that attempts to embrace who we are. Far from being a mere fact sheet and a chronology of activities and accomplishments, this is a glimpse of our team`s life history.
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Original Articles
Journal 2018 Vol.19 No.2
Profile and Treatment Outcome of Patients with Infective Endocarditis Admitted in a Pediatric Medical Center From 2005-2016
Maribel D. Pasaoa , M.D.
Abstract
Background: Infective Endocarditis (IE) is an infection of the endocardial surface of the heart. It remains a life threatening infection among extremes of ages and erroneous or late diagnosis may lead to serious consequences.
Objective: To determine the clinical profile and treatment outcomes of pediatric patients with IE admitted in a pediatric medical center.
Methods: This is a retrospective descriptive study on pediatric patients (0-18 years old) diagnosed with IE from January 2005 to June 2016. Patients’ medical records that satisfied the criteria for IE based on Modified Duke Criteria were included in the study.
Results: A total of 37 charts were reviewed with male to female ratio of 1:1. Most common chief complaint and physical finding were difficulty of breathing and tachycardia,respectively.Cardiac murmur was appreciated upon diagnosis except in one patient. 70% had ventricular septal defect and 24% had rheumatic heart disease. Most common associated non-cardiac condition was the presence of dental caries, while only 11% had history of previous cardiac surgeries. 2-Dimensional Echocardiography (2D-Echo) showed vegetation in 97.2% and 49% had positive growth in blood culture. Most common isolate was Streptococci. Empiric therapy included penicillin G (84%) with gentamicin (76%). Complications noted were brain infarct,pericarditis and pulmonary embolism. Majority were managed medically, 7 patients (19%) had vegetectomy and 9(24%)died during hospitalization.
Conclusion: IE is a common complication of congenital heart disease.High index of suspicion is warranted for the early management and prevention of morbidity and mortality.
Keywords: infective endocarditis, congenital heart disease, Streptococci
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Journal 2018 Vol.19 No.2
Clinical Profile and Factors Affecting Outcome of Children with Hepatic Abscess: 19 Year Study
Adrienne Michelle B. Lu, M.D., Maria Estela R. Nolasco, M.D., Marilou G. Tan, M.D.
Abstract
Objectives: To describe the clinical profile of children with hepatic abscess, determine their laboratory & imaging findings, medical and surgical treatments and study factors affecting its outcome.
Methodology: A retrospective cohort study done in December 2016 on children 0 to Demographic, clinical and diagnostic data were correlated with the outcome and presence of complications.
Results: Thirty cases were identified in 19 years but only 25 charts were available for review. Mean age in years was 5.27 +/- 4.80 SD with male predominance. Fever (96%) and abdominal pain (60%) were common symptoms.Only 9 patients had hepatic abscess culture with Staphylococcus aureus (56%) as the most frequent growth. Anemia (76%) and leukocytosis (96%), and solitary (76%), large abscess >5 cms (60%) involving the right lobe (72%), were the common diagnostic findings. Most were treated with antibiotics alone (60%).All patients improved with no mortality noted, while pleural effusion was seen in 8 out of 12 patients with complications. Only male gender was significantly associated with complications both on chi-square (p0.004) and logistic regression (p 0.008).
Conclusion: Hepatic abscess is a liver infection usually seen among young and male population, manifesting as fever with anemia and leucocytosis. Most were complicated by pleural effusion with no deaths reported. Male gender had significant association with
complications.
Keywords: hepatic/liver abscess, Staphylococcus aureus, deep-seated infection
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Journal 2018 Vol.19 No.2
Effectiveness of Public Health Education by Lecture on Improving the Knowledge, Attitude and Practices on Leptospirosis Among Adolescents in a Public School in Manila
Jenna Angela D. Rubio, M.D.
Abstracts
Leptospirosis is endemic worldwide. Based on the 2016 Philippine Pediatric Society Disease Registry, there were 800 cases of leptospirosis from May 2006 to August 2016, making it a significant public health concern. Case fatality rate is about 8-9%, with increased prevalence of the disease among adults and adolescents.
Objective: This study was conducted to evaluate the effectiveness of public health education through a lecture on improving the knowledge, attitude, and practice scores on leptospirosis among adolescents from grades 7-10 in a public school in Manila.
Methodology: This was a cross-sectional analytical study. A pre-tested, self administered questionnaire was given among 357 students in a public school in Intramuros, Manila. A lecture regarding leptospirosis was conducted and a post-test was given afterwards. Data was analyzed using paired t-test.
Results: A total of 357 students were included, with an 88.37% response rate. Total mean pre-test knowledge score was 88.64%, and total mean pre-test attitude score was 80.97%. For practices related to leptospirosis, the total mean pre-test score was 72.12%. Pre-test knowledge scores were compared with post-test scores. After the lecture, there was a significant increase in their knowledge on leptospirosis (p=<0.0001). There was also an improvement on post-test scores on attitude and practices regarding leptospirosis (p=<0.0001).
Conclusion: Public health education through a lecture was effective in increasing the knowledge, attitude, and practice scores on leptospirosis among adolescents. This may help in the prevention of the disease in the adolescent population.
Keywords: Leptospirosis, Adolescence, Public Health Education
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Journal 2018 Vol.19 No.2
Microbiologic Profile and Predictors of Severe Outcome of Pediatric Cancer with Febrile Neutropenia Admitted at a Tertiary Medical Center
Andy T. Panes, M.D., Cherry May Villar, M.D., Mary Antonette C. Madrid, M.D.
Abstracts
Background: The treatment of pediatric cancer has advanced dramatically. With the discovery of newer, more potent chemotherapeutic agents, patients are confronted with severe and prolonged degrees of neutropenia, which has inherent consequences.
Objective: The study aimed to determine common microbial isolates and predictors of severe outcome of pediatric cancer patients with febrile neutropenia aged 0-18 years old admitted at a tertiary hospital.
Methods: This was a cross-sectional study on pediatric cancer patients with febrile neutropenia admitted at the Philippine Children’s Medical Center from March 1,2017 to September 30,2017.The clinical presentations of subjects were noted. Patients were categorized as to the presence or absence of severe outcomes. Common microbial isolates were noted. Predictors of severe outcome were identified using stepwise logistic regression analysis.
Results: Out of 105 enrolled patients, 32 developed severe outcomes. The most common isolates were Klebsiella pneumoniae followed by Escherichia coli and Candida species. Univariate analysis showed that acute myelogenous leukemia (p-value: 0.0195), treatment relapse (p-value: 0.0131), ANC on admission 7 days during admission (p-value: 0.0001), non-response to empiric antibiotics (pvalue:0.0001), microbiologically-defined infection (MDI, p-value: 0.0001), fever without a focus p-value:0.001), bloodstream infection (p-value: 0.0192), unknown focus of infection (p-value: 0.0058), and a positive culture (p-value: 0.0001) were related to a severe outcome. None of these predictive variables, however, were statistically significant on multivariate logistic regression analysis.
Conclusion: K. pneumoniae, E. coli and Candida were the predominant organisms identified in febrile neutropenic cancer patients in our institution. Although AML, treatment relapse, profound neutropenia, fever of >7 days during admission, nonresponse to empiric antibiotics, MDI, fever without a focus, bloodstream infection, unknown focus of infection and a positive culture were related to a severe outcome, multivariate regression analysis did not show these to be significant.
Keywords: Microbiologic profile, Fever, Neutropenia, Predictors
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Journal 2018 Vol.19 No.2
Outcome of Current Antibiotic Regimens used for Neonatal Sepsis in a Tertiary Hospital
Anne Melva V. Meliton-Ruiz, M.D.,Robert Dennis J. Garcia, M.D.
Abstracts
Objective: This paper looked into the outcome of currently used antibiotic regimens for neonatal sepsis in a tertiary hospital.
Methods: This retrospective study reviewed all cases of culture positive neonatal sepsis delivered in a tertiary hospital between January 1, 2000 to December 31, 2015. Demographic profile, stratification as to early-onset and late-onset sepsis, clinical manifestations, culture and antimicrobial susceptibility results, and outcomes were analyzed.
Results: There were 28 cases of culture positive neonatal sepsis reported during the study period, and prematurity and low birth weight were the major risk factors identified. Of these, 8 were early-onset sepsis and 20 were late-onset sepsis cases. Respiratory symptoms were the most common presenting manifestations. Sepsis isolates were evenly distributed between gram-negative bacilli and gram-positive cocci with no ESBL E. coli or Klebsiella pneumoniae identified. The institution’s current empiric antibiotic regimen of cefuroxime and amikacin for early-onset neonatal sepsis was shifted to another drug in 57% of cases. Piperacillintazobactam or carbapenem was given for late-onset sepsis. The addition of vancomycin for late-onset sepsis was done where Staphylococcus was considered. Sepsis due to gram-negative bacilli had a high mortality rate.
Conclusion: Our institution’s empiric antibiotic regimen which consists of cefuroxime and amikacin for early onset sepsis is effective in 43% of cases. A carbapenem or piperacillin-tazobactam, even without amikacin, proved to be effective for late-onset sepsis. Vancomycin, should be considered for late-onset sepsis, if staphyloccoccal disease is suspected.
Keywords: neonatal sepsis, antibiotic, neonate, low birth weight
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Journal 2018 Vol.19 No.2
Tuberculosis Verrucosa Cutis in an 11-year-old girl
A Case Report
Maria Vinna N. Crisostomo, M.D., Karen Lee P. Alabado, M.D., Maricarr Pamela M. Lacuesta-Gutierrez, M.D.
Abstracts
We report a case of an 11-year-old girl who presented with a gradually enlarging verrucous plaque on the left knee for 3 years. Physical examination showed a solitary, slightly erythematous, scaly, verrucous plaque on the left knee measuring about 1.5 cm x 2 cm. Biopsy revealed granulomatous dermatitis consistent with cutaneous tuberculosis. A diagnosis of tuberculosis verrucosa cutis (TBVC) was made and anti-tuberculous therapy was initiated consisting of rifampicin, isoniazid, pyrazinamide and ethambutol for 2 months followed by rifampicin and isoniazid for 4 months. Upon completion of therapy, only a slightly atrophic scar remained, supporting our diagnosis. This report highlights TBVC must be considered in patients with chronic skin lesions in countries with high prevalence of tuberculosis.
Keywords: tuberculosis verrucosa cutis, cutaneous tuberculosis, anti-tuberculosis therapy
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