A systematic review and meta-analysis on the safety and efficacy of Second Dose Immunoglobulin versus High Dose Pulse Methylprednisolone in Refractory Kawasaki Disease

Background@#There is limited information available regarding the management of IVIG-refractory Kawasaki Disease (KD). @*Objective@#This study aimed to evaluate the safety and efficacy of a second intravenous immunoglobulin (IVIG) infusion versus intravenous methylprednisolone (IVMP) in patients with IVIG-refractory KD.@*Methodology@#Cochrane Library, PubMed, Medline, Elsevier (Science Direct), Springer Link and BMJ databases were searched from May 1, 2020 to December 31, 2020. We included randomized controlled trials (RCTs) and high-quality prospective and retrospective studies, with population restricted to children 0 months to 18 years, with KD refractory to initial IVIG at 2g/kg, who remained febrile for 24-48 hours after completion of initial IVIG, and who received second-line monotherapy with either a second dose IVIG or IVMP. We conducted a meta-analysis using Review Manager [RevMan] 5.4.1 software.@*Results@#A total of six studies (n=188 patients) were analyzed. The incidence of coronary artery lesions was comparable between a second dose of IVIG and IVMP (RR 0.82, 0.34-1.96, P=0.66) in patients with IVIG-refractory KD. The rate of fever resolution to a second IVIG, compared to IVMP, was not significantly different between groups (RR 0.97, 0.84-1.13, P=0.72). There was a significantly higher incidence of adverse events in the IVMP group (RR 0.42, 0.26-0.57, P=0.0002), but these were all transient and resolved without further treatment. @*Conclusion@#There is no significant difference in the incidence of coronary artery lesions and rate of fever resolution post-retreatment with a second dose of IVIG versus IVMP in IVIG-refractory KD. More adverse events were reported in the IVMP group.

Infection control and prevention of COVID-19 transmission: Interim recommendations for schools in the Philippine setting (as of August 6,2020)

@#THIS GUIDANCE AIMS TO SUPPORT PHYSICIANS WHO COLLABORATE WITH SCHOOLS AND GOVERNMENT IN CREATING INFECTION CONTROL POLICIES FOR SCHOOL RE-ENTRY IN THE TIME OF COVID-19 PANDEMIC, WHILE TAKING INTO CONSIDERATION THE OVER-ALL HEALTH OF EVERYONE, BASED ON AVAILABLE EVIDENCE. THE GUIDANCE IS DYNAMIC AND MAY CHANGE DEPENDING ON THE RAPIDLY EVOLVING KNOWLEDGE, DATA, AND UNDERSTANDING OF SARS-COV-2 IN THE COUNTRY.

Antimicrobial Stewardship (AMS) program in private hospitals in the Philippines: Its acceptability, barriers, and enablers

Background@#Antimicrobials are drugs that are often misused and inappropriate antimicrobial prescribing often results in poor clinical outcome and drug resistance. Monitoring and regulation of antimicrobial use is currently being done by the Department of Health through the Antimicrobial Stewardship (AMS) Program. There is a need to determine the factors that affect successful implementation of an AMS program in private hospitals in the Philippines. This study was conducted to identify the enablers and potential barriers in implementing an AMS program in nine (9) private hospitals. @*Methodology@#A concurrent mixed methods design was used to assess various stakeholders’ (physicians, administrators, other AMS members) perceptions of existing or proposed AMS programs, and to identify barriers and enablers in their implementation. Quantitative data were collected using self-administered survey questionnaire to assess clinician’s acceptance of AMS programs. Qualitative data were collected through semi-structured one-on-one interviews of clinicians and other AMS personnel and focus group discussions (FGD) of selected clinician groups. Data were gathered from October 2018 to October 2019. @*Results@#409 clinicians were surveyed, 52 were interviewed and 46 sat for 13 sessions of FGDs. Overall, the survey established that physicians were well aware of antimicrobial resistance problem. Majority of the clinicians indicated general agreement with the currently practiced antimicrobial protocols in their hospitals and with the AMS program. However, there were disagreements in perceptions with how antimicrobial restrictions impair prescribing practices and overuse of the same. These responses were strong points of discussion during the Key Informant Interviews (KII) and FGDs. All respondents were amenable with the institutionalization of an AMS program in their hospitals. The hospital leadership’s commitment was determined to be the key enabler of a successful AMS program’s implementation. Barriers identified for hospitals with existing AMS programs were: lack of dedicated staff, resistance and/or non-cooperation of physicians, lack of support from non-medical departments, and inadequate cooperation between hospital personnel. Barriers identified, regardless of the status of the AMS programs were: deficiency in knowledge with developing and implementing an AMS program, inadequate information dissemination, unavailability of an IT-based monitoring for antibiotic use, and the influence of pharmaceutical companies on stakeholders with regards to antimicrobial use. @*Conclusion@#Similar enablers and barriers to a successful implementation of an AMS program were seen in the different hospitals. A hospital leadership’s commitment was determined to be the key enabler. The success or failure of any AMS program appears to depend on physician understanding, commitment and support for such a program. By involving the main players in an AMS program- the hospital administrators, clinicians and other key members, perceived barriers will be better identified and overcome, and enablers will help allow a successful implementation of an AMS program. This multi-center study was funded by Philippine Council on Health Research and Development ( PCHRD) and Pediatric Infectious Disease Society of the Philippines ( PIDSP) and was conducted by the PIDSP Research Committee.

Childhood Meningitis in an Urban Tertiary Medical Center: A 20-year review

Background@#Meningitis is a neurological emergency causing significant morbidity and mortality. This research determined the etiologies, clinical presentation, and ancillary work-up findings of different types of meningitis.@*Objective@#To characterize the documented pediatric meningitis cases in a tertiary hospital admitted between January 1, 1997 to August 31, 2017. @*Methods@#This was a retrospective study which entailed review of charts of all pediatric cases 0 to 18 years old with a discharge diagnosis of meningitis (bacterial, viral, tuberculous or fungal) from January 1, 1997 to August 31, 2017 at an urban tertiary medical center. @*Results@#This study included 127 subjects, where 74 (58.3%) had bacterial, 34 (26.8%) had viral, 17 (13.4%) had tuberculous, and 2 (1.6%) had fungal meningitis. Streptococcus pneumoniae (12.2%), Haemophilus influenzae type b (6.8%) and Salmonella enteritidis (6.8%) were the top bacteria identified. Neonatal infections were caused by gram-negative bacilli (66.7%) and gram-positive cocci (33.3%). Bacterial, tuberculous, and viral meningitis were seen in the 1-11 months, 2-4 years and 5-10-year age groups respectively. Prolonged fever (mean 27.2, median 14 days) and cranial nerve palsies (23.5%) were noted in tuberculous meningitis (TBM). The highest CSF mean WBC (2043±9056 WBC/µL) and mean protein (300±365.6mg/dL) were seen in bacterial and tuberculous meningitis respectively. The combination of hydrocephalus, basal enhancement and infarct was unique to patients with tuberculous meningitis. Recurrent seizures were the most common complication of bacterial (36.5%), viral (20.6%) and tuberculous (100%) meningitis. Ceftriaxone (24.3%), acyclovir (38.2%), and isoniazid/rifampicin/pyrazinamide/ethambutol (76.5%) were the most common antimicrobials for bacterial, viral, and tuberculous meningitis. Fever duration before admission was significantly longer in TBM (14 days) than in viral (4 days) and bacterial meningitis (2 days). Length of hospital stay for viral meningitis (6.5 days) was significantly shorter than for TB (14 days) and bacterial meningitis (12 days). Mortality rates were 12% and 11% for bacterial and viral meningitis respectively. No mortality was seen in patients with TB and fungal meningitis.@*Conclusions@#In this 20-year review of childhood meningitis, bacterial meningitis was the most common type of pediatric meningitis which presented with marked CSF pleoctyosis. The longest fever duration and the highest proportion of cranial nerve involvement were seen in TBM, which also had the unique combined findings of leptomeningeal enhancement, hydrocephalus and infarct on imaging. Ceftriaxone was the most commonly used antibiotic for bacterial meningitis, except in neonates where a combination of cefuroxime-amikacin was initially given until microbiological confirmation became available. Recurrent seizures were the most common complication of bacterial, viral and TB meningitis. The shortest hospital stay with the highest full recovery rate was seen in viral meningitis.

Predictive factors of treatment failure for pediatric community-acquired Pneumonia C And D In 2-To-59 months of age

Objective@#To determine antibiotic treatment failure rate and predictors of treatment failure in children 2 to-59 months with Pediatric Community Acquired Pneumonia-C (PCAP-C) and PCAP-D admitted at Makati Medical Center. @*Methods@#This prospective cohort study examined 100 children, 2-to-59 months with clinically diagnosed PCAP-C and PCAP-D. Baseline assessment was done on day 1 of hospital stay and follow-up assessments were done on days 3 and 7 or upon discharge for the outcomes of interest. @*Results@#One hundred children were included in the study and 98% had PCAP-C. This study identified a treatment failure rate of 17% among children with PCAP-C. There was no mortality. Malnutrition and low oxygen saturation on admission were significant predictors of treatment failure. @*Conclusion@#Antibiotic treatment failure rate was 17%. Malnutrition and hypoxia were significant predictors of treatment failure in children with PCAPC.

Prevalence of Mycoplasma pneumoniae infection among children with acute respiratory tract infection: A prospective case control study

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Mycoplasma pneumoniae has been implicated as a significant etiologic agent of lower respiratory tract infection among children to 18 years old, however, its prevalence in younger children age 5 years and below appears to be increasing.<br /><strong>OBJECTIVES:</strong> This study was performed to determine the prevalence, clinical and radiologic features associated with children 5 years old and below admitted with respiratory tract infection.<br /><strong>METHODS:</strong> This is a prospective case control study involving children 5 years old and below with signs and symptoms of respiratory tract infection, and were tested for M. pneumoniae IgM at the Makati Medical Center and admitted between May 1, 2012 to September 30, 2012. Subjects were children with positive M pneumoniae IgM test (MPP) and controls were children with negative M pneumoniae IgM test (MPN). Clinical, radiologic and laboratory characteristics of MPP and MPN were recorded.<br /><strong>RESULTS:</strong> Twenty-one out of 82 (25.6%) subjects were MPP. The male to female ratio was 1:1.05 witha mean age of 34 months. Clinical, radiologic characteristic and laboratory findings between MPP and MPN were not statistically significant.<br /><strong>CONCLUSION:</strong> The prevalence of M. pneumoniae infection among the subjects was 25.6%. distinguish M. pneumoniae infection.</p>

Staphylococcus aureus nasal carriage rates among children between one-to-five years in Barangay Pio Del Pilar, Makati City

Objective@#This study aims to determine the staphylococcal nasal carriage rates of children who are between one-to-five years old and residing in Botanical Gardens, Barangay Pio Del Pilar, Makati City. The following shall also be investigated: antibiotic resistance patterns of isolates, factors associated with S. aureus nasal carriage, and other pathologic organisms colonizing the anterior nares in this population. @*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.

A case control study of the demographic characteristics, risk factors, clinical findings, treatment and outcome among children 18 years and below who are confirmed to have influenza A H1N1/09 Virus

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> The H1N1/09 virus was reported to be similar to the seasonal flu. However, the World Health Organization (WHO) documented a substantial proportion of patients with H1N1/09 who developed severe illness and death particularly among those with underlying medical conditions. Presently, to our knowledge, there is no data in the Philippines where the demographic and clinical characteristics, risk factors and outcome of children positive for H1N1/09 virus were compared to those with influenza but were negative for H1N1/09.</p> <p style="text-align: justify;"><strong>OBJECTIVE:</strong> The objective of this study was to compare the demographic and clinical characteristics, risk factors, treatment and outcome of the two groups.</p> <p style="text-align: justify;"><strong>METHODS:</strong> A review was done of the charts of 162 patients who were tested for H1N1/09 virus by RT-PCR assay at the Makati Medical Center from May 5 to July 16, 2009. Demographic characteristics, risk factors, clinical features, treatment and outcomes were compared between the two groups. Categorical variables used between the two groups were compared using Fisher's exact test or Chi square test while quantitative variables were compared using T-test; odds ratio was determined.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> A total of 162 patients were included in this study. The largest group of patients positive for H1N1/09 was from the age group of 11-15 years old (35.8%). Risk factors such as travel history and exposure to a confirmed case showed no association to having a positive H1N1/09 test. Clinical features such as fever (100%) and cough (82.1%) were the most common presenting symptoms for both groups. Majority of these patients were given supportive treatment and out of 162 subjects, 91.4 % were treated as outpatient. Clinical outcome showed one mortality from the case group and none from the controls.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> Thus, the demographic characteristics and clinical findings were similar for both groups. Future studies are recommended to include those with influenza-like illness not tested for H1N1/09 virus.</p>