2002 Journals

Vol.6 No.1 Jan-Mar 2002
BCG: REVISITED
Nancy Nazarie Bermal, M.D.
Keywords: tuberculosis, clinical practice guidelines

Tuberculosis (TB) claims approximately 2 million lives a year, almost 3 million if the estimate include individuals with HIV who die with active TB. In the Philippines, data from the Philippine Health Statistics in 1998 lists TB as the 6th leading cause of mortality and morbidity. Worldwide, the case of fatality rate is 23% with a greater than 50% rate reported from some African countries with a high prevalence of HIV infection. Approximately 10% of immunocompetent individuals infected with M. tuberculosis will develop active TB some time in their lives.
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THE KNOWLEDGE , ATTITUDE AND UTILIZATION OF THE 1997 NATIONAL TB CONCENSUS FOR CHILDREN IN THE DIAGNOSIS OF PULMONARY TUBERCULOSIS AMONG PHYSICIANS AT THE PHILIPPINES CHILDREN’S MEDICAL CENTER
Luciana U. Tolentino M.D. *, Michael M Resurreccion, M.D.*, Mary Ann C. Bunyi, M.D.*, Jean Marie B. Ahorro, M.D.*, Cecilia Nierva M.D.*, Cristina M. Soriano M.D.*
Keywords: tuberculosis, clinical practice guidelines

Objective: To assess the knowledge, attitude and utilization of the 1997 National TB Concensus for Children among physicians at Philippine Children’s Medical Center in the diagnosis of pulmonary tuberculosis.
Setting: Philippine Children’s Medical Center
Design and Participants: Descriptive study design with a self-administered 30-point questionnaire involving 3 domains (knowledge, attitude and utilization) as a survey instrument was given to all pediatric consultant staff at the Philippine Children’s Medical Center.
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CLINICAL PROFILE OF CULTURE PROVEN TUBERCULOSIS CASES AMONG FILIPINO CHILDREN AGED 3 MONTHS TO 18 YEARS
Cherry Lyn P. Pama, M.D.*, Salvacion R. Gatchalian, M.D.*
Keywords: Tuberculosis in children, culture proven tuberculosis

Background: The gold standard for confirming the diagnosis of childhood tuberculosis (TB) is the isolation of Mycobacterium tuberculosis by culture. The diagnosis in most cases is still base on clinical evidence alone.
Objective: To determine the presentation of tuberculosis in children with culture-confirmed tuberculosis.
Design: Descriptive.
Methods: Sixty-seven children aged 18 years old and below with culture-confirmed tuberculosis seen at Philippine General Hospital (PGH) and Research Institute for Tropical Medicine (RITM) from June 1988 to May 2001 were studied. The demographic data and clinical presentation were analyzed using the Epi-Info version 6.

AFB YIELD OF GASTRIC ASPIRATE AFTER STANDARDIZATION OF GASTRIC ASPIRATE TECHNIQUE
Fejelia D. Diocares M.D.*, Ma Cristina M. Soriano M.D.*, Ma. Anabelle C. Recio, Med Tech III*, Jaime A. Santos M.D.*, Rosalinda B. Soriano M.D.*
Keywords:TB diagnosis, AFB gastric aspirate

Objectives of the study: The general objective is to compare the AFB yield of gastric aspirate smears in children with suspected TB following standardized technique with those using non-standardized method. Specific objectives were to correlate the gastric aspirate AFB smear results with the signs and symptoms suggestive of TB and with other laboratory results.
Methodology: A randomized control study was done at Philippine Children’s Medical Center from July-October 2001 in children up to 18 years old suspected of having TB based on the criteria of the National Concensus on childhood TB (1997) who were not able to expectorate sputum.
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2 YR OLD BOY WITH SPONTANEOUS CHYLOTHORAX
Regina May P. Cabuang, M.D. *

A 2 yr old male, from Guadalupe, Makati was admitted at a tertiary government hospital for further management of pleural effusion. Since one month prior to admission, the patient was noted to have intermittent productive cough associated with colds. Neither consult was done nor medications taken. Three weeks prior to admission, he was noted to have low-grade fever (T37.7-38C) and cough persisted. He was given Paracetamol 250 mg/5ml ½ tsp every 4 hours affording temporary relief. Condition continued which prompted consult at a private hospital where he was assessed to have an Upper Respiratory Tract Infection. He was prescribed to take at home Amoxicillin. Ambroxol and Ascorbic Acid.
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Objectives of the study: To determine the sensitivity of bacteriologic studies in pediatric pulmonary tuberculosis. PATIENTS AND METHODS: Between January 1988 and December 1996, 04 consecutive patients aged 0 to 18 years received a diagnosis of primary pulmonary tuberculosis at our institution. Demographic, clinical, laboratory and bacteriologic data were collected. Clinical specimens were studied for acid-fast bacilli detection by Ziehl-Neelsen stain and cultured for Mycobacterium
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RISK FACTORS FOR MORTALITY IN SERVICE NEONATAL SEPSIS*
Ma. Lourdes A. Salaveria-Imperial, M.D. * Jacinto Blas V. Mantaring III M.D. *

Objective: To determine the mortality of rate of patients with severe sepsis and to determine the risk for mortality within three days after severe sepsis is diagnosed.
Methods: 55 neonates admitted at the intensive care unit of tertiary hospital who fulfilled previously established criteria for severe sepsis were cohorted prospectively and followed to determine the final outcome.
Results: The mortality rate was 90% (50/55), with 72% of the deaths (36/50) occurring within three days after the onset of severe sepsis. In the univariate analysis, factors associated with death were gestational age and bradycardia. The multivariate analysis identified 6 variables which suggested survival beyond 3 days: gestational age (OR 2.86, 95% C 1.40-5.88), appropriateness of weight for gestational age (OR 4.69, 95% CI 1.302-163.94), exchange transfusion (OR 2.24, 95% CI 0-31-15-98), prenatal care (OR 1.65 95% CI 0.14-18.89), antenatal steroids (OR 6.27, 95% CI 0.68-58.03), and temperature instability (OR 1.4, 95% CI, 0.19-10.42). Only gestational age and appropriate weight for age were significant, but due to the wide confidence interval of the latter it could not provide a precise estimate. The rest of the variable did not show any significance.
Conclusions: The results of our preliminary study were inconclusive because of the small sample size to date, and no interaction between the variable could be ascertained. It is recommended that the study be continues to acquire a larger sample size that would enable us to generate a model predictive of mortality risk, and the benefits of exchange transfusion should be further investigated in a randomized controlled trial.
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OUTBREAK OF NON-TYPHOIDAL SALMONELLA IN THE NICU
Marla G. Balao Litam, M.D.* Cecilia C. Maramba – Untalan, M.D.*
Keywords: Salmonella outbreaks, NICU

General Objective: To investigate the outbreak of diarrhea cases in the neonatal intensive care unit, which occurred on Jan 17 –March 19,2000, determine the cause, implement control measures and stop the spread of the disease.
Methods: A possible outbreak was reported on February 17, 2000. Cases were identified by isolation of salmonella in the stool or blood of suspected cases. After which can outbreak of nosocomial diarrhea at the neonatal intensive care unit from January 17, 2000. to March 19, 2000 was confirmed. An epidemic curve was constructed to get information as to possible route of spread. Hypotheses were formulated as to probable cause of the outbreak. Review of infection control practices was conducted and appropriate measures were institutes, Monitoring of new cases of salmonella infection was done through continues surveillance.
Setting: Tertiary government teaching hospital-neonatal intensive care unit in Manila.
Patients: NICU patients who developed diarrhea during the period stated.
Results: Nineteen cases of culture-positive non-typhoidal salmonella C were identified. Eighteen (18) of these were resistant to ampicillin and I was intermediate. This number of confirmed an outbreak of Salmonella C diarrhea at NICO (attach rate of 0.91%) as compared to the same period the previous year when not as single salmonella isolate was reported. Epidemic time curve pointed to a person-to-person type of spread. Several contributing factors were identified: (1) change in NICU setting. (2) increased admissions in a smaller NICU. (3) Limited access to handwashing. (4) Breaks in infection control practices. (5) Nursing personnel to patient ratio was at its lowest. Infection control measures were institutes, mostly strict handwashing, the user of alcohol hand rub, user of gloves and cohorting were implemented by NICU. Last case was reported in March 19, 2000, 4 days after control measures were implemented. Surveillance showed no new cases up to the time of reporting.

INCIDENCE AND RISK FACTORS ASSOCIATED WITH NOSOMIAL INFECTIONS IN A NEONATAL INTENSIVE CARE UNIT OF PHILIIPINES CHILDREN’S MEDICAL CENTER AND ITS CONTROL
Anelyn M. Logrono-Reyes, M.D., Gloria B. Ramirez, M.D.,MHA, Jaime A. Santos, M.D.
Keywords: neonatal infection, nosocomial infections

Objective: To objectives of this study are: 1.) To identify nosocomial infection in the NICU and their sources 2.) To describe the risk factors of infection. 3.) To assess efficacy of standard infection control interventions to decrease the morbidity and mortality in the NICU.
Methods: All patients admitted in the NICU from August to October 2001 were included in the study. The following data were included: age of gestation, birthweight, place and type of delivery, AGPAR score, underlying illness, clinical and laboratory profile, medical interventions, cultures done and antibiotics given. Maternal factors noted were the following: age, gestational history, maternal infection, premature rupture of membrane, premature labor signs and symptoms and laboratory data including cervical culture and histopathology of the placenta to check for chorioamnionitis. Environmental cultures were collected monthly during the investigation. The antimicrobial suspectibility of the isolates was compared with that of the patient. The data were analyzed using EPI Info software. Relative risk and exact 95% confidence intervals were calculated.
Results: There were 148 patients admitted of which 19 were septic and 129 were not septic. The following increased the risk of acquiring nosocomial infections; mechanical ventilation, peripheral and umbilical vein catheterization, amino acid and intralipid transfusion, PRBC and FFP transfusion and user of antibiotics particularly ceftazidime and imipenem. Among the maternal factos, FROM and chorioamnionitis increased the risk of infection. The most common organisms isolated from the patient were: Burkholderia cepacia, Candida albicans, Klebsiella pneumonia and Pseudomonas aeruginosa. From the environment the following were cultured: Psedomonas, Enterobacter; Burkholderia, CONS, Acinetobacter and Bacillus subtitis. Infection control measures were strictly reinforced during the time of study. The infection rate decreased from 34% to 13%.
Conclusion: Gram negative bacteria accounted for most of the nosocomial infections. Medical interventions and maternal infection are the risk factors for neonatal nosocomial infections. Strict adherence to infection control measures can decrease nosocomial infections.

THE ROLE OF INTRAPARTUM FEVER IN IDENTIFYING ASYMPTOMATIC TERM NEONATES WITH EARLY-ONSET NEONATAL SEPSIS
J Perinatol, Chen KT, Ringer S, Chen AP, Lieberman E

Objective: To assess the role of intrapartum fever in identifying asymptomatic term neonates with early-onset neonatal sepsis.
Study Design: Retrospective review of all term neonates with sepsis over 7 year period to evaluate the significance of symptoms at delivery and intrapartum sepsis risks factors in identifying neonates with sepsis.
Results: Fifty-three of 90 term neonates with sepsis (59%) were asymptomatic at delivery. Thirty-five of 53 asymptomatic term neonates (66%) met criteria for sepsis evaluations and 18 (34%) were evaluated when symptoms developed after delivery. Among the 35 asymptomatic term neonates meeting criteria for sepsis evaluations, 14 (40%) had evaluations because of intrapartum fever. Thus, 14 of 53 (26%) asymptomatic term fever. Thus, 14 of 53 (26%) asymptomatic term neonates with sepsis (30% of GBS sepsis and 11% non-GBS sepsis) would not have been evaluated if intrapartum fever were ignored.
Conclusion: Over half of term neonates with sepsis were asymptomatic at delivery. Intrapartum fever was helpful in identifying over a quarte of asymptomatic term neotanates with sepsis.
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Vol.6 No.3 Jul-Dec 2002
THE IN VITRO ANTIMICROBIAL ACTIVITY OF PROBIOTIC CONTAINING MILK AND MATURE BREASTMILK AGAINST 5 COMMON PEDIATRIC BACTERIAL PATHOGEN ISOLATES IN MANILA DOCTORS
Maria Rachel Torralba, M.D. *, Cielo Balita-Malijan, M.D. *
Keywords: Antimicrobial activity of probiotic milk
Abstract:
The in-vitro and microbial activity of two probiotic containing milk formula were investigated. This was done by measuring their respective zones of inhibition using the disc plate diffusion technique against five pathogen isolated from Manila Doctors Hospital namely: Klebsiella pneumonia, Escherichia coli, Pseudomonas aeruginosa, Salmonella typhi and Staphylcoccus aureus.
The objectives of the study are:
1.) to determine if the two probiotic containing milk have in vitro antimicrobial activity with five pathogens;
2.) to compare their antimicrobial activity with that of nature breastmilk and
3.) to compare the antimicrobial activity of the two different probiotics containing milk.
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ROTAVIRUS ACUTE GASTROENTERITIS AMONG FILIPINO CHILDREN IN THE YEAR 2001
Maria Ines Bettina L. Santos, M.D. *, Jedas Daag*, Lulu C. Bravo, M.D.*
Keywords: Rotavirus, diarrhea
Abstract:
This is a prospective study to determine the clinical profile of pediatric patients less than 5 years old with rotavirus diarrhea seen at the Philippine General Hospital from August 1 – September 15, 2001. Ninety-one patients with acute diarrhea were included in the study. Of these 39 patients (42.9%) had rotavirus antigen in the stool as detected by the ELISA method. The mean age of the patients was 11.5 months with 61.5% of the patients belonging to the 7-12 months of age, mostly well –nourished. The stools were described as watery (74.4 %), yellow in color (84.7%), with no pus, red blood cells or parasite.
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THE EFFECT OF POVIDINE-IODINE ON THE URINARY BLADDER MUCOSA OF EXPERIMENTAL ANIMALS
Imelda Asetre-Luna, M.D. *, Anna O. Lim, M.D.*, Agnes V. Barrientos, M.D.*, Salvacion R. Gatchalian, M.D.*
Keywords: Providone-iodine, bladder instillation, bladder mucosa, catherization
Abstract:
Objective: To determine the effect of povidone-iodine on the bladder mucosa of experimental animals and to compare the urinalysis and urine culture between the NSS and povidone iodine group.
Design: Descriptive experimental study.
Setting: Animal laboratory at the Veterinary Research Department, Research Institute for Tropical Medicine.
Patients/Participants: ten rabbits randomly assigned to 2 groups: Control/NSS (N=3) and Test/providone-iodine group (N=6). One rabbit served as a baseline and was not treated with any substance.
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