Lidocaine as a diluent for Benzathine Penicillin G for injection pain in children with rheumatic fever and rheumatic heart disease: A randomized double-blind crossover study

@#<p style="text-align: justify;"><strong>BACKGROUND</strong>: Rheumatic fever (RF) and Rheumatic heart disease (RHD) patients Rheumatic Heart Disease (RHD) patients necessitate secondary prophylaxis with benzathine penicillin G (BPG) injection every 3 weeks to prevent recurrences and complications. Patients with rheumatic fever on regular benzathine penicillin G injection usually experience moderate to severe pain resulting to poor compliance to treatment. </p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aims to compare the effect of BPG diluted in lidocaine hydrochloride 1%  versus diluted water in reducing injection pain in patients with RF and RHD.</p><p style="text-align: justify;"><strong>METHODS</strong>: This is a randomized double-blind crossover study conducted at the PCMC OPD. Thirty-three patients diagnosed with RF and RHD were divided into 2 groups; the first group received BPG diluted in sterile water followed by BPG diluted in lidocaine hydrochloride  1% after 21 days, the second group received the same medication in reverse order. Pain scale was measured using Universal pain assessment tool immediately after injection. Paired T test was used to compare the pain score results of the two groups.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Pain score was significantly less in patients who received BPG diluted in lidocaine hydrochloride 1%; from an average pain score of 4.88 to 0.63 (p<0.0001), among those who received BPG diluted in sterile water. No adverse effects were seen in all patients.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This study concluded that BPG diluted in lidocaine hydrochloride 1% significantly and safely reduced post-injection pain. In all patients diagnosed with RF and RHD, BPG injection should be diluted in lidocaine hydrochloride 1% to decrease injection pain and improve patient's compliance.</p>

Electrocardiogram as a predictive tool for the severity and clinical course of pediatric dengue infections

BACKGROUND@#Dengue is a mosquito-borne viral disease that has been a global burden especially in the tropical regions. Cardiac involvement has been discussed in several studies. This is a pilot study to identify electrocardiogram abnormalities and correlate these with the severity of dengue illness.@*OBJECTIVES@#To evaluate the efficiency of electrocardiogram as a predictive tool for the severity and clinical course of pediatric dengue infections.@*METHODS@#This prospective cohort study was conducted at the Philippine Children’s Medical Center from August to October 2017. A total of 325 dengue consults were seen at the pediatric emergency room during the study period. Of these, 66 pediatric patients fulfilled the inclusion criteria for this study. Serial pediatric electrocardiograms (ECG) were performed on days 1, 7, and 14 afebrile. The ECGs were interpreted according to rhythm, axis and duration of waveforms and intervals. These ECG interpretations were subsequently correlated to the patients’ dengue severity and clinical course.@*RESULTS@#Rhythm abnormalities were found in 15 out of the 66 dengue patients for an overall incidence of 23%. All the rhythms were benign and self-limiting, including sinus bradycardia, tachycardia, and first-degree atrio-ventricular block. Majority of the dengue patients had sinus rhythm (42 of 66, 64%), and of these, 8 had heart rates at the lower limits of normal range for age (12%). 23 percent of abnormal rhythms were detected on day 1 of illness. All rhythm abnormalities resolved by day 14 of afebrile.@*CONCLUSION@#The series of ECG did not show clinically significant or life-threatening arrhythmias during the patients’ dengue illness in this cohort. All arrhythmias were benign and self-limiting, regardless of dengue severity. The ECG did not correlate well with and cannot be utilized to predict the clinical course of the dengue illness.@*RECOMMENDATIONS@#A retrospective comparative study is recommended to determine predictability of dengue severity using ECG. A bigger cohort of dengue patients may detect significant arrhythmias not caught in this study.