2005 Journals

Vol.9 No.1 Jan-June 2005
A COMPARISON OF THE KNOWLEDGE, ATTITUDES AND PRACTICES OF PEDIATRIC RESIDENTS IN PUBLIC AND PRIVATE HOSPITALS ON ADOLECENT IMMUNIZATION
Leilani I. Tajanlangit, M.D.*, Mariella Sugue-Cstillio, M.D.*
*Department of Pediatrics, immunization, adolescents,vaccination, pediatrics practices
Abstract:
Objective: To evaluate the differences in the knowledge, attitudes and practices on adolescent immunization between pediatric residents in public and private hospitals. Study design: Cross sectional analytical study Setting: A survey was done through self-administered questionnaires among pediatric residents in 3 private hospitals and 1 public tertiary hospital. Each respondent completed a questionnaire that contained 21 items on general knowledge, attitudes and practices regarding adolescent immunization.
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BACTERIOLOGICAL ANALYSIS OF RANDOMLY SELECTED REFILLING STATIONS IN THE CITY OF MANILA
Julie Hope Soriano-Pasumbal, M.D.* and Anna Lisa Ong-Lim, M.D.*
Abstract:
Objectives: To test the bacterial growth in randomly selected refilling stations in the City of Manila and to determine other characteristics of the refilling stations which could influence positive or negative results.
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METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AMONG PEDIATRIC PATIENTS AT THE PHILIPPINE GENERAL HOSPITAL
Mary Genevieve Mamauag-Estrada, M.D.*, Carina Cruz, M.D.*, Simone Rosario Cid, M.D.*, Alexander O. Tuazon, M.D.*
Abstract:
Objective: This study aims to identify clinical risk factors associated with Methicillin-resistant Staphylococcus aureus (MRSA) infection among pediatric patients admitted at the Philippine General Hospital and their outcome.
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PROSPECTIVE EVALUATION OF SENSORINEURAL HEARING LOSS AS A COMPLICATION OF MENINGITIS AMONG PEDIATRIC PATIENTS ADMITTED IN A TERTIARY HOSPITAL
Maricel G. Landagan, M.D.*, Marissa B. Lukban, M.D.*
Abstract:
Background: Deafness or some degree of hearing loss is frequent but unpredictable squealer of meningitis with an obvious implication on the development and education of survivors.
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THE VALUE OF LUMBAR PUNCTURE IN SEPSIS NEONATORUM
Emmalyn M. Cruz, M.D.*, Rica R. Canseco, M.D.*, Carmen C. Briones, M.D.*, Charizza A. Sales, M.D.*, Pura Flor D. Isleta, M.D.*, Lorna R. Abad, M.D.*
keywords: Lumbar puncture, sepsis neonatorum
Abstract:
Introduction: Lumbar puncture is done in neonates diagnosed with sepsis neonatorum to rule out the possibility of meningitis.
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EVALUATION OF THE IMMUNOGENICITY AND RAECTOGENICITY OF A RECOMBINANT YEAST – DERIVED HEPATITIS B VACCINE (TEMREVAC – HB)
Gyneth Lourdes G. Bibera, M.D.*
Abstract:
The immunogenicity and reactogenicity of a yeast derived recombinant vaccine (TEMREVAC – HB) was evaluated. A total of 91 subjects. Ages 1-67 years old (46 were children, 45 were adults), were enrolled in the trial and were given TEMREVAC – HB using the 5 ug (1-19 years) and 10 ug (over 19 years) dose in a 3 dose vaccine series at 0.1 and 6 months. Sera to determine antibody titers were evaluated twice at 3 months after 1st injection (T3) and 7 months after the 1st infection (T7). A seropositive titer was defined as ?10 mIU/ml. At T3, seroprotection was 70% and 30% respectively in children and adults.
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VENTRICULOPERITONEAL SHUNT INFECTIONS IN PEDIATRIC PATIENTS ADMITTED AT THE UP-PGH FROM 1999-2001: CLINICAL PROFILE AND PREDISPOSING FACTORS
Eric ET Aragon, M.D.*, Jedeane C. Mendoza, M.D.*, Marissa B. Lukban, M.D.*
Abstract:
Objectives: To describe the clinical profile of pediatric patients with ventriculoperitoneal shunt infection, determine its incidence, identify predictive factors and identify the common organisms causing shunt infections. Design: Case Control Study Setting: Tertiary hospital
Subjects: Medical records of pediatric patients, less than 19 years of age, who underwent ventriculoperitoneal shunting from January 1999 to December 2001 were reviewed as to the incidence of shunt infection, the clinical profile and possible risk factors predisposing to shunt infection. A total of 130 pediatric patients who underwent ventriculoperitoneal shunting were included in this study. The criteria by Meirovitch1, et al were used for the diagnosis of shunt infection. Predictive factors were analyzed by Chi square and Logit analysis.
Results: Of the 130 pediatric patients who underwent ventriculoperitoneal shunting which were included in this study, 20 patients developed shunt infection. Twenty-seven episodes developed in 20 patients. The infection rate was 15.4%/operalive procedure and 20.8%/patient. Six patients (30%) of the initially infected patients had more than one infectious episode. Predominating pathogens in patients included Stapylococcus aureus (14.8%), Klebsiella sp. (14.8%), Acinetobacter sp. (14.8%) and Staphylococcus epidermidis (11.1%). Fever was the predominant clinical presentation, followed by local signs of infection (erythema, presence of pus/discharge, abscess formation), meningitic symptoms, and symptoms of peritoneal irritation. Management included both medical and surgical treatment in all cases. The most common method was the use of antibiotics together with external ventricular drainage; shunt removal and reinsertion of a new shunt. Risk factors for development of shunt infection identified in this study significant at 95% CI included the operating room used, presence of shunt revision, and the length of hospital stay at the time of shunting.
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MOTHER-REPORTED CONDITIONS WITHIN TWO WEEKS AFTER MASS MEASLES IMMUNIZATION
Maria Cristina D. Reyes, M.D.*, Ma. Cecilia D. Alinea, M.D.*
Abstract: Measles ranks high among the leading causes of infant morbidity and mortality. It is imperative that steps are taken towards the prompt treatment and eradication of measles infection.
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ARSP2005THE 2005 ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA
Celia C. Carlos M.D.*
Keywords: antimicrobial susceptibility, antimicrobial surveillance
Abstract:
Resistance data for 29,782 isolates were reported and analyzed with an increase of 25% from the number reported in 2004. This was mainly due to the increase in the number of bacterial isolates reported for 2005 from twelve out of the 17 sentinel sites, namely Eastern Visayas Regional Hospital (EVR – 79%), Research Institute for Tropical Medicine (RTM – 63%), Lung Center of the Philippines (LCP – 54%), San Lazaro Hospital (SLH – 52%), Cotabato Regional Hospital and Medical Center (CMC – 36%), Philippine General Hospital (PGH – 35%), Bicol Regional Teaching & Training Hospital (BRT – 29%), Baguio General Hospital (BGH – 25%), Vicente Sotto Memorial Hospital (VSM – 21%), Zamboanga Medical Center (ZMC – 20%), National Kidney & Transplant Institute (NKI – 16%) and Davao Medical Center (DMC – 11%) which all had significantly more isolates in 2005. However, five sentinel sites had decreased number of reported isolates for 2005, namely: Celestino Gallares Memorial Hospital (GMH), Rizal Medical Center (RMC), University of Santo Tomas Hospital (STU), Far Eastern University Hospital (FEU) and Corazon Locsin Memorial Hospital (MMH). The major contributors of antibiotic susceptibility data were the Philippine General Hospital
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Vol. 9 No. 2 July-Dec 2005
STUDY OF BACTERIALFLORA IN THE INITIAL OROPHARYNGEAL ASPIRATE AND BLOOD OF POTENTIALLY SEPTIC NEONATES
Pauline Alonday-Pugay, M.D.*, Anna Lisa Ong-Lim, M.D.*
*Department of Pediatrics, UP-PGH Keywords: oropharyngeal aspirate, blood culture, potentially septic neonates
Abstract:
There are a considerable number of admissions of neonates because of vertical transmission of infection. The sterility of amniotic fluid is questionable in cases of premature rupture of membrane (PROM), spontaneous preterm labor, and infection. A Prospective Risk Analytical Study was conducted to evaluate the use of oropharyngeal aspirate in the diagnosis of sepsis in potentially septic neonates born at OB Admitting Section, Philippine General Hospital from March to August 2004.
Included were 107 neonates, of these, 15 (14.02%) have maternal risk factor of PROM; 34 (31.78%) have maternal risk factor of spontaneous preterm labor alone; 38 (35.51%) have maternal risk factor of UTI; 15 (14.02%) have maternal risk factor of respiratory tract infection; and 2 (4.6%) have maternal risk factor of fever alone.
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RETROSPECTIVE ANALYSIS OF THE CLINICAL PROFILE AND IMMEDIATE OUTCOME OF PEDIATRIC PATIENTS DIAGNOSED WITH PLEURAL EFFUSION OR EMPYEMA THORACIS, ADMITTED TO A TERTIARY GOVERNMENT HOSPITAL DURING JANUARY 1998 TO DECEMBER 2000
Dexter D. Cheng, M.D.*, Alexander O. Tuazon, M.D.*
*Department of Pediatrics, UP-PGH Keywords: pleural effusion, empyema thoraces
Abstract:
Objective: To review the clinical characteristicsors of patients who developed complicated and non-complicated effussions
Design: This study was a case review over a 3-year period (Jan. 1, 1998 to Dec. 31, 2000) of medical records of children aged 3 months to 17yrs with a final diagnosis of pleural effusion or empyema thoracis
Setting: A tertiary government hospital
Results: Sixteen (16) case records diagnosed with pleural effusion or empyema thoracis from a primary nontuberculous respiratory tract infection were reviewed as to demographics, duration of illness, presenting symptoms, coexisting illness, clinical and laboratory results, and outcome. Of the 16 cases, 6 had non-complicated resolution of parapneumonic pleural effusion while 9 had chest tube thoracostomy inserted. The duration of confinement for complicated effusions was significantly
longer (p-value 0.019) than those of non-complicated parapneumonic effusions.
Conclusion: The presenting signs and symptoms of patients with pleural effusion are febrile, cough, productive cough, dyspnea, and chest pain. The development of complicated parapneumonic effusion is correlated to a prolonged duration of confinement (p-value 0.019).
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A RANDOMIZED PLACEBO-CONTROLLED TRIAL ON THE USE OF PROBIOTICS IN THE PREVENTION OF NOSOCOMIAL INFECTION IN PEDIATRIC PATIENTS WITH HEMATOLOGIC AND ONCOLOGIC DISEASES
Arlene Grace L. Simon, M.D.*, Jossie Rogacion, M.D.*
*Department of Pediatrics, UP-PGH Keywords: probiotics, nosocomial infection, hematologic, oncologic, duration of hospitalization
Abstract:
Background: Despite measures to decrease its incidence, nosocomial infection remains to be a major
problem in most tertiary hospitals. The use of prophylactic antibiotics leads to an increase in bacterial resistance, rather than decreasing the nosocomial infection rate. Other measures have been proposed to combat antibiotic resistance and the development of nosocomial infection, such as the use of probiotics.
Objective: The efficacy of the use of probiotics in the prevention of nosocomial infection and effect on duration of hospitalization was tested in patients with hematologic and oncologic diseases.
Study Design: Randomized placebo-controlled double blind trial using placebo and probiotics.
Intervention: 50 patients out of 76 predicted sample size, with hematologic and oncologic diseases who had a minimum predicted duration of hospitalization of 3 days were enrolled in a double-blind trial and randomly assigned on admission to take either 1 capsule of probiotics (n=25) containing at least 1.5 billion cells of Lactobacillus acidophilus, Bifidobacterium bifidus and Bifidobacterium longus or a comparable placebo (n=25) once daily during their whole hospital stay. The patients were monitored and assessed daily for the development of nosocomial infection and for compliance to administration of the capsules. The patients were also assessed for any possible adverse effects. The counting of the duration of hospital stay started from admission to the emergency room till discharge. Patients were asked to follow up 1 week after discharge.
Results: This paper presents the preliminary results of the study involving 50 patients. Baseline characteristics on admission were found to be similar. The use of probiotics prevented the occurrence of nosocomial infection in patients with hematologic and oncologic diseases as compared to those receiving placebo, 0% vs. 20%, with a relative risk of 0.2 (fisher’s exact test= 0.025,p< 0.05). However, there was no significant statistical difference between the duration of stay of the 2 groups (placebo = 9.4 days compared to probiotics = 8.6 days). The difference in readmission was analyzed using z-test and was also found to be not statistically significant. No adverse effects were reported in both groups.
Conclusion: The use of probiotics in patients with hematologic and oncologic diseases may play a role in the reduction of the occurrence of nosocomial infection, but may not necessarily cause a reduction in the duration of hospital stay. Further confirmation of the results is recommended upon completion of the study.
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A FIVE-YEAR RETROSPECTIVE STUDY ON THE COMMON MICROBIAL ISOLATES AND SENSITIVITY PATTERN ON BLOOD CULTURE OF PEDIATRIC CANCER PATIENTS ADMITTED AT THE PHILIPPINE GENERAL HOSPITAL FOR FEBRILE NEUTROPENIA
Ailyn T. Isais-Agdeppa,M.D.*, Lulu C. Bravo,M.D.*
*Department of Pediatrics, UP-PGH Keywords: febrile neutropenia, malignancy, granulocytopenia, absolute neutrophil count, blood culture
Abstract:
Rationale: Febrile neutropenia is a common clinical problem among pediatric cancer patients. This often necessitates hospitalization and immediate empiric broad spectrum antimicrobial therapy. In selecting the initial antibiotic regimen, the type, frequency and antibiotic susceptibilities of the microbial isolates should be considered.
Objective: To determine the bacterial blood isolates and antimicrobial sensitivity pattern of pediatric cancer patients admitted at the Philippine General Hospital for febrile neutropenia.
Methods: Retrospective study of all pediatric patients diagnosed with a hematologic or oncologic malignancy admitted at the Philippine General Hospital from January 1999 to December 2003 for febrile neutropenia.
Results: A total of 90 patients were included in the study. Sixty two per cent (62%) of the subjects were diagnosed to have hematologic malignancy while 38% are oncologic cases. Only 7% of the patients had growth in the blood culture while 93% had no growth in the blood culture. Causative organisms isolated were Streptococcus viridans, Gram negative bacilli, Staphylococcus epidermidis, Candida sp., Salmonella sp. and Haffnea alveii. All patients received Ceftazidime as empiric antimicrobial therapy in combination with Netilmycin for patients admitted in 1999 or Amikacin for patients admitted from January 2000 to December 2003. S. viridans, G(-) bacilli, Salmonella sp. and H. alveii showed sensitivity to Ceftazidime. All patients given Ceftazidime with Netilmycin/Amikacin became afebrile on the 3rd day of antibiotics with increasing absolute neutropenic count except for patients who developed nosocomial infections causing delay in recovery and prompting shift of antibiotics.
Conclusion: Majority of pediatric cancer patients with febrile neutropenia yielded no growth in blood culture. However, most cases responded well with the empiric antibiotic combination of Ceftazidime and Amikacin. Few cases with isolates were also sensitive to the current antibiotic regimen. The microbiological laboratory should also act in consultation with the clinician to determine the optimal approach for blood cultures in the immunocompromised patients.
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IN VITRO STUDY ON THE ANTIMICROBIAL ACTIVITY OF PROBIOTIC MILK AGAINST COMMON PEDIATRIC COMMUNITY ACQUIRED RESPIRATORY PATHOGENS
Simone Rosario C. Cid, M.D.*, Ma. Carina Cruz, M.D.*, Vincent Faustino, M.D.*, Alexander O. Tuazon, M.D.*
*Department of Pediatrics, UP-PGH Keywords: probiotics, antimicrobial activity, community, acquired pathogens
Abstract:
Objective: To determine the in vitro antimicrobial activity of probiotic containing milk against community acquired bacterial pathogens in the pediatric age group.
Design: Experimental Study
Methods: In vitro analysis of the antimicrobial activity of probiotic milk in comparison to antibiotics against control strains based on the Kirby Bauer Method of disc susceptibility testing. Kruskall Wallis Test was used to analyze the difference between the mean zones of inhibition of the different control groups. Chi square and Fisher Exact Test was used to analyze % susceptibility.
Results: Zones of inhibition of probiotic containing milk were observed among the three bacterial pathogens tested. The mean zones of inhibition produced by the probiotic milk showed smaller means for Streptococcus pneumoniae ( 9.04 +/-5.26) and H. influenzae (9.76 +/- 7.65) as compared to their respective antibiotics: Penicillin G (30.18+/-0.70) and Chloramphenicol (30.96+/- 1.86) (p value <0.000001). A larger mean zone of inhibition was produced for Staphyloccocus aureus
(16.96+/- 5.30) compared to Oxacillin (12.92+/- 0.65). Comparison of the % susceptibility showed higher susceptibility of Streptococcus pneumoniae to Penicillin G and H. influenzae to Chloramphenicol when compared to the probiotic containing milk. Staphyloccocus aureus however, showed a better susceptibility to the probiotic containing milk (88%) vs. Oxacillin (64%) with a P value of 0.04.
Conclusion: Probiotic milk containing Lactobacillus and Bifidobacteria was observed to have in vitro
antimicrobial activity against Streptococcus pneumoniae, H. influenzae, and Staphyloccocus aureus . It has a better antimicrobial activity against S. aureus as demonstrated by a larger zone of inhibition and increased proportion of disc susceptibility than Oxacillin.
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THE EFFECT OF TOPICAL APPLICATION OF MUPIROCIN IN INTRAVENOUS CATHETER SITE IN THE INCIDENCE OF SUPERFICIAL PHLEBITIS
Ronald Allan N. Geraldez, M.D.*, Ma. Liza M. Gonzales, M.D.*
*Department of Pediatrics, UP-PGH Key Words: intravenous cannulation, mupirocin, pediatrics, superficial phlebitis, topical antimicrobial
Abstract:
Background: Superficial phlebitis is a common complication of venoclysis although its incidence especially in pediatric hospital setting is not often known and evaluated. A standard aseptic technique in IV line insertion is observed to decrease its incidence but the use of topical antibiotic is rarely used.
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CLINICAL CORRELATION OF NEONATAL AND MATERNAL HEMATOLOGICAL PARAMETERS AS PREDICTORS OF NEONATAL SEPSIS
Willa Antoniette B. Mayuga, M.D.*, Pura Flor D. Isleta, M.D.*
*Department of Pediatrics, UP-PGH Keywords: Neonatal sepsis, hematological parameters, scoring system, newborn perinatal infection
Abstract: 
Objective: To evaluate the neonatal and maternal clinical manifestations and their hematological parameters, individually and in combination, as parameters which can be used to formulate a scoring system in determining neonatal sepsis.
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SERUM CONCENTRATION OF PYRAZINAMIDE SUSPENSION IN CHILDREN WITH TUBERCULOSIS: A THERAPEUTIC DRUG MONITORING
Daisy O. Sanchez, M.D.*, Cecilia C. Maramba, M.D.*
*Department of Pediatrics, UP-PGH Keywords. Pyrazinamide, antituberculosis, therapeutic drug monitoring, pharmacokinetics, tuberculosis
Abstract:
Rationale: Therapeutic drug monitoring (TDM) is a process of adjusting drug dosages on the basis of serum drug concentrations for the purpose of optimizing drug therapy. This study introduces the use of TDM in the management of mycobacterial infections.
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THE ANALYSIS OF CLINICAL AND SOCIAL PROFILE OF CONGENITAL RUBELLA SYNDROME SEEN AMONG UP-PGH PATIENTS FROM THE YEARS 1993 – 2002 (A 10 YEAR PREVALENCE REVIEW)
Coralee Lianko Agnas , M.D.*
*Department of PEdiatrics, UP-PGH Keywords : congenital , epidemiology , socio-demographic , immunization , vaccination
Abstract:
Objectives : 1. To describe the socio-demographic profile of patients with Congenital Rubella Syndrome (CRS) s e e n in UP-PGH for the last 10 years. 2. To compare the clinical profile of patients with Congenital Rubella Syndrome (CRS) seen in UP-PGH
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