2013 Journals
Optimizing school-based intestinal helminth control interventions in the Philippines
Vicente Y. Belizario, Jr. *, Alexander H. Tuliao, *, Francis G. Totanes*, Camille L. Asuncion* *National Institutes of Health, University of the Philippines, Manila
Keywords: Soil-transmitted helminthes, Ascaris, Trichuris, Schistosomiasis, Schistosomes, Helminth control
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Suzanne S. Ponio, MD; Carmina A. Delos Reyes, MD * University of the Philippines College of Medicine – Philippine General Hospital
Keywords: Chronic osteomyelitis, Staphylococcus aureus, MSSA, MRSA, pediatric osteomyelitis
Abstract
Background: Osteomyelitis is a debilitating disease if not properly treated. Epidemiologic and microbiologic data will be of great importance in the direction of treatment.
Objective: To determine the epidemiologic and clinical profile of pediatric patients with chronic osteomyelitis admitted at Philippine General Hospital from 2006 to 2010.
Methodology: This is a retrospective study involving a review of medical records of pediatric patients with chronic osteomyelitis admitted at the Philippine General Hospital during the 5 year study period. Frequencies and percentages were computed for nominal data. Comparison of the different variables was done using Chisquare and Fisher Exact test.
Results: Eighty of the 134 cases of pediatric patients with chronic osteomyelitis were reviewed. Twenty-three percent of all operations involved the femur (N=18) and tibia (N=18). On radiograph, the presence of sequestrum was the most common finding noted in 53% of the cases. The predominant organism isolated in bone cultures was MSSA (40%) followed by MRSA (20%). On tissue cultures MRSA was the most common isolate in 34%, followed by MSSA(31%). Majority of the patients were given Oxacillin as empiric therapy (55%).No significant difference was observed with respect to the areas of bone involvement, signs and symptoms, radiologic findings and laboratory parameters between MSSA and MRSA osteomyelitis (p>0.05).
Conclusion: There were 239 per 100,000 cases of chronic osteomyelitis. The most common bones involved were the femur and tibia with sequestrum as the most common radiologic finding. In the previous studies, MRSA was not reported but was noted in the present study. Most of the patients in our study were treated with both antibiotics and surgery to optimize management. Ninety-eight percent of the cases had significant clinical improvement upon discharge. Based on this study, laboratory parameters, clinical manifestations and area involved cannot be utilized in differentiating MRSA from MSSA osteomyelitis. Further studies are needed to support our findings and isolation of the organism is still required for definitive identification to distinguish between MRSA from MSSA osteomyelitis.
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Ceres Paulino, M.D., Robert Dennis Garcia, M.D., Shirley Ong, M.D. * *Makati Medical Center
Keywords: Staphylococcus aureus; MRSA; nasal colonization
Methods: Nasal swabs were taken from each subject and cultured after informed consent was obtained. Statistical analysis was performed to determine factors with significant association with nasal colonization.
Results: Ten (12.9%) out of 77 subjects were positive for S. aureus nasal colonization, one of which was oxacillin-resistant. Only the gross monthly income showed significant association with nasal carriage (p=0.03, OR = 0.59, 95% CI). Four subjects (5.1%) were carriers of S. pneumoniae.
Conclusions: The study shows a relatively low rate of Methicillin Sensitive S. aureus (MSSA) and Methicillin Resistant S. aureus (MRSA) nasal carriage. The MRSA isolate was sensitive to all other anti-staphylococcal drugs tested, similar to other studies on Community Acquired-MRSA (CA-MRSA). Local surveillance studies are essential in the control of CA-MRSA and in guiding local antibiotic policies for staphylococcal infections. Further studies on a bigger population are needed to determine rates, resistance patterns and risk factors associated with nasal colonization.
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Tomas T. Saiton, Jr., M.D. * *Philippine Childrens’ Medical Center
Keywords: invasive Hib disease, ampicillin, chloramphenicol, ampicillin-chloramphenicol combination, third generation cephalosporins, Haemophilus influenzae
Methods: Charts of patients with invasive Hib disease confirmed either by blood culture, CSF culture and/or latex agglutination test from January 1991 to August 2010 were reviewed. Cases were classified into four groups depending on the initial antibiotic given upon admission. The four groups were compared and analyzed in terms of cure rates.
Results: The disease occurred predominantly in children less than two years old. Males were more frequently affected than females. All subjects were not given Hib vaccination. Cure rates were significantly different between ampicillin (33%) and chloramphenicol (89%) groups (p=0.017), and between chloramphenicol (89%) and ampicillin-chloramphenicol (39%) groups (p=0.008). However, cure rates were not significantly different when third generation cephalosporin group (62%) was compared to the other treatment groups (p>0.05). Resistance of Hib was 31% to ampicillin, while <10% to chloramphenicol and third generation cephalosporins. Conclusion: Chloramphenicol is an excellent drug for empiric therapy in highly suspected or proven cases of invasive Hib disease.
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14 year old male with oliguria and respiratory distress- What is your diagnosis?
James Robertson C. Pichel, M.D.*, Dolores D. Bonzon, M.D.*, Francisco E. Anacleto Jr., M.D.* *University of the Philippines College of Medicine- Philippine General Hospital
Abstract:
A 14 year old male from Quezon City Manila was admitted due to oliguria. He presented with 7 days of intermittent fever associated with malaise, photophobia with redness of the eyes. A few hours before admission, he developed repetitive vomiting with decreased urine output. He denied any muscle pain, change in his sensorium or seizure episode. He had a history of wading in flooded waters.
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Fatima Gimenez, M.D.*
Dr. Betty Quiambao, giving the opening remarks, was the emotional catalyst, while Dr. Soriano with her inspirational message provided the much needed nostalgia. Further complemented with a short well documented history of PIDSP via an AVP presentation, which was a tireless collaboration of Dr. Joanne de Castro and her group , not one individual was left dry-eyed.
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Mayan Uy-Lumandas, M.D.,Anna Lisa Ong-Lim, M.D., Ma. Liza Antoinette Gonzales, M.D. University of the Philippines College of Medicine- Philippine General Hospital
Keywords: Leptospirosis, Modified Faine’s criteria, MAT
Methodology: This diagnostic validity study was conducted at the Philippine General Hospital. It included all pediatric patients who were admitted between September 2009 to December 2010 and who satisfied the presumptive and suggestive criteria in the diagnosis of leptospirosis based on the modified Faine’s criteria. A fourfold or greater rise in paired MAT titers was used as the gold standard. Calculations for sensitivity, specificity, positive and negative predictive values, and likelihood ratios of positive and negative tests were computed. Results Thirty-three patients satisfied the diagnosis of leptospirosis based on the criteria; however, only 20 of these had paired MAT titers and were included. The modified Faine’s criteria had a sensitivity of 60%, specificity of 73%, positive predictive value (PPV) of 43%, negative predictive value (NPV) of 85%, positive likelihood ratio of 2 and negative likelihood ratio of 0.4 . Modifying the clinical criteria by revision of the point allocation to create a “Pediatric Locally Modified Criteria” increased the sensitivity to 80%, PPV to 50%, NPV to 92%, positive likelihood ratio to 3 and negative likelihood ratio to 0.3.
Conclusion: The Modified Faine’s criteria had poor sensitivity and low positive predictive value and cannot be recommended as a screening test for the early diagnosis of leptospirosis in children. A proposed modification of the clinical criteria for local application increased diagnostic accuracy but must be further validated in a larger number of pediatric patients in the Philippines.
Marla Balao-Litam, M.D.
Rea Uy-Epistola
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Factors affecting compliance to rabies post-exposure prophylaxis among pediatric patients seen at the Research Institute for Tropical Medicine
Ruth Faye Romero-Sengson *Philippine Children’s Medical Center
Keywords: Rabies post exposure prophylaxis, rabies immunoglobulin
Methods: Pediatric patients zero months to 18 years old who were bitten by animals and thereafter sought consult from January to March 2009. Subjects with Category II and III exposure bites and advised PEP, who have telephone contact numbers, and gave verbal consent to participate were included. Excluded subjects were those who cannot be accessed by telephone or mobile, had previous animal bite and had received prior rabies immunization. Data were gathered through chart review and telephone interviews. Total number of patients who complied and did not comply with PEP and the factors related to compliance were determined.
Results: One thousand two hundred forty three pediatric patients sought consult and were advised to receive PEP: 757 (61%) were males and 496 (39%) were females. Most common age group was 2-to-5 yrs (41%), followed by 6-to-10 years (32%). A higher proportion of females were noted under Category II exposure while a higher proportion of males were noted under Category III. Most common biting animal was dog. The highest proportion of subjects with multiple body bites were from the very young age group (0 to 1 year old). Most commonly injured body parts were the upper extremities (32.7%), lower extremities (42.7%) and head (16%). The two-site intradermal (ID) rabies vaccine regimen was prescribed on days 0, 3, 7 and 30; however, there was a declining trend in rabies vaccine and rabies immune globulin (RIG) received. Compliance rate of RIG (55%) and rabies vaccine (31%) were low. Factors affecting compliance to rabies PEP were: 1) fear of acquiring rabies and knowledge of the gravity of the disease; 2) vaccine cost and affordability; and 3) knowledge on status of biting animal.
Conclusion: The most salient issue in rabies PEP compliance is the affordability of the vaccine.
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Cynthia Seguerra, M.D.,* Cristan Q. Cabanilla, M.D.* *Philippine Children’s Medical Center
Keywords: Influenza A (H1N1), Reverse Transcription-Polymerase Chain Reaction (RT-PCR)
Methodology: Pediatric patients of the Lung Center of the Philippines seen from May 1 to July 31, 2009 for Influenza-like illness upon presentation and confirmed to have Influenza A (H1N1) virus through Reverse Transcription-Polymerase Chain Reaction (RT-PCR) assay were included in the study. Charts of patients were reviewed. Information from patients was obtained using the WHO Case Summary Form and the National Epidemiology Center Initial Screening of Influenza A (H1N1) form. The patient’s demographic data, clinical characteristics, co-morbid conditions, vaccination, clinical course, complications, anti-viral medications received and adverse reactions, and over-all outcome were noted, as well as, exposure to confirmed cases and history of travel.
Results: Out of the 243 RT-PCR-confirmed patients, 71.6% (n=174) came from the adolescent age group, with a median age of 13 years old. A predominance of male patients (57.2%) was noted. Fever (92%), cough (83.1%), nasal congestion (52.7%) and sore throat (35%) were the most common presenting signs and symptoms. Bronchial asthma (14.4%) was the leading co-morbidity present and pneumonia was the most common complication. Eight patients (3.3%) were hospitalized during the course of the disease. All RT-PCR-confirmed Influenza A (H1N1) patients recovered and no mortality was noted.
Conclusions: In this study, majority of the RT-PCR-confirmed Influenza A (H1N1) patients were characterized by self-limited, uncomplicated, and febrile respiratory illness, who all recovered with minimal complications.
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Resie Aurea O. Casem, MD Saint Louis University Hospital of the Sacred Heart
Keywords: Antibiotic-associated diarrhea, Probiotics, S. boulardii, Saccharomyces boulardii
Background: Diarrhea is one of the most common adverse effects of antibiotic treatment. In Saint Louis University-Hospital of the Sacred Heart (SLU-HSH), about three out of ten patients at the outpatient department and one third of admitted pediatric patients are given antibiotics. Although international studies document the efficacy of probiotics in preventing antibiotic associated diarrhea (AAD), there is limited research in our country about this. Objectives: The main objective of this study was to evaluate the efficacy of a yeast probiotic, Saccharomyces boulardii, in preventing AAD.
Methods: This was a randomized clinical trial conducted between June and October 2012 at Saint Louis University-Hospital of the Sacred Heart. A total of 140 patients aged 6months to 18years with PCAP were enrolled. The patients either received the standard antibiotic treatment alone (control group n=71) or the oral antibiotic treatment plus 250mg of Saccharomyces boulardii (treatment group n=69) twice a day for the entire duration of treatment. Analyses were based on treatment and included data from 136 patients. Results: Patients who received S. boulardii had shorter duration of diarrhea than those who did not receive it [3.06 days (0.68) vs. 2.45 days (0.69), P value of 0.032]. However, the incidence of diarrhea between the two groups was not statistically significant [16 of 68 (23.5%) vs. 11 of 66 (16.7%), P value of 0.391].
Conclusion: This is the first randomized-controlled trial in our locality which showed evidence that S. boulardii shortens the duration of antibiotic-associated diarrhea.
Regie S. Santos, M.D. Ospital ng Makati
Keywords: Extrapulmonary Tuberculosis, TB meningitis
Methodology: Records of pediatric patients who were admitted in a tertiary government hospital from January 2006 to December 2010 with a diagnosis of Extra-pulmonary Tuberculosis were reviewed. The following information was gathered: demographic profile, clinical profile, results of PPD, complications and mortality rate, and laboratory results.
Results: The sixty-six cases constituted 7.8% of the total pediatric admissions during the same period. There was no significant difference as to sex distribution ( 53% males vs. 47% females, with 1:1 ratio).Majority of cases involved the meninges ( 72.7%), followed by lymph node (6.1%), liver (6.1%), bone (6.1%) and genitourinary (3.0%). The three most common symptoms were nonspecific: fever, anorexia and weight loss. The occurrence of fever was universal among all admitted cases of Extrapulmonary TB. With regards to prognosis, the majority (83%) of cases were discharged in improved condition. The case fatality rate was 16.7%.
Conclusion: The incidence of new cases of EPTB has remained constant, despite the decline in new cases of active pulmonary TB.
Elaine H. Kho, M.D.*, Jonathan Lim, M.D.* *Chong Hua Hospital, Cebu City
Keywords: MRSA, Methicillin resistant Staphylococcus aureus, Methicillin sensitive Staphylococcus aureus, Staphylococcus aureus, Vancomycin
Methods: Charts of patients with MRSA growths were reviewed upon their admission. The sensitivity pattern, demographic profile and risk factors were noted.
Results: Out of the 637 isolates of Staphylococcus aureus, MRSA had a prevalence rate of 38.6% (n=246), while Methicillin Sensitive Staphylococcus aureus (MSSA) had 61.4% (n=391). The prevalence rate of health-care associated MRSA was 2% (n=5). The majority of the specimens sent for culture were wound/abscess (70% of pediatric and 76% of adult patients isolates). All MRSA growths were resistant to penicillin G, ampicillin, oxacillin, cefuroxime and amikacin. Local MRSA strains were still susceptible to ciprofloxacin (82.3%), clindamycin (90.6%), erythromycin (91.5%), and sulfamethoxazole-trimethoprim (85.9%). There was no resistance to linezolid and vancomycin. Vancomycin-resistant Staphylococcus aureus was not isolated. The mortality rate on both pediatric and adult population was 2.1% and 4.8%, respectively.
Conclusion: The prevalence of MRSA is increasing. Clindamycin, erythromycin, sulfamethoxazole- trimethoprim and vancomycin are excellent treatment options treat MRSA.
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We, the Philippine Pediatric Society and the Pediatric Infectious Disease Society of the Philippines, are seriously concerned by the increasing cases of measles which is a highly preventable disease affecting the most vulnerable and the ones most in need of our protection. As reported by the measles Reference Laboratory of RITM, there were 500 and 482 laboratory- confirmed cases in November and December respectively. As Pediatricians and Pediatric Infectious Disease Specialist, who are in the front lines of the battle against childhood diseases, especially vaccine-preventable diseases, this situation is unacceptable.
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Xenia Cathrine Fabay, M.D.
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Year
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EDITOR-IN-CHIEF:
Carmina delos Reyes, M.D.
Arlene Dy-Co, M.D.
EDITORIAL BOARD:
Aubrey Artienda, M.D.
John Andrew Camposano, M.D.
Michelle Carandang-Cuvin, M.D.
Giselle Enriquez-Briones, M.D.
Xenia Cathrine Fabay, M.D.
Elizabeth Gallardo, M.D.
Fatima Gimenez, M.D.
Jonathan Lim, M.D.
Mary Antonette Madrid, M.D.
Sarah Makalinaw, M.D.
Francesca Mae Pantig, M.D.
Paul Sherwin Tarnate, M.D.
Sally Jane Velasco-Aro, M.D.
ADVISERS:
Lulu Bravo, M.D.
Cecilia Maramba-Lazarte, M.D.
JOURNAL MANAGER:
Roan Eireen Buenaventura, M.D.