BACKGROUND: Resistance to standard permethrin lotion has been reported. There is a continuing search for more natural and safe remedies for head lice infestation among children. Citronella, a natural repellant, has been reported as a pediculocide.
OBJECTIVE:To compare the efficacy of Citronella shampoo versus 5% permethrin lotion in controlling head lice (Pediculosis humanus capitis) among children between 5 years old.
METHODS: A double-blind randomized clinical trial was performed at the community outpatient department of MPI-Medical Center Muntinlupa Foundation, PNR (Phil. National Railway) Site Bgy. Putatan, City of Muntinlupa. Children living in areas endemic for head lice were screened, and if found positive, were randomized equally to daily citronella shampooing (CS) or permethrin lotion (PL). Subjects were manually 2nd, 7th and 14th day of treatment. Chi-square test was used to compare proportions, which considered p-values less than .05 as statistically significant.
RESULTS: Eighty-two children with head lice were included in the final analysis. Children in both groups were comparable in terms of age, sex, family size with head lice, anthropometric measures, frequency of bathing and shampooing and baseline severity of head lice infestation. Citronella shampoo was as effective as the standard 5% permethrin lotion in eradicating head lice in children. The cure rates were comparable for day 2 (CS=65.1% versus PL=72.1%, p=.76), day 7 (CS=65.1% versus PL= 79.1%, p=.30), and day 14 (CS=81.4% versus PL =90.7%, p=33) of treatment. There were no re-infestations and adverse reactions noted for the use of Citronella and the refragrance was more acceptable.
CONCLUSION: Citronella is a effective as Permethrin lotion in the eradication of headlice and Citronella shampooing can be an alternative natural remedy of headlice and Citrone for pediatric head lice.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Pediculus ; Lice Infestations ; Cymbopogon ; Permethrin ; Outpatients ; Family Characteristics ; Antiparasitic Agents

OBJECTIVE: The purpose of the study was to determine the efficacy of probiotics as adjunct therapy for patients (2 months - 4 years old ) with moderate risk community acquired pneumonia.
METHODS: the study population consisted of 77 children, 2 months - 4 years old with no Hib vaccination, no previous intake of antimicrobials, no contraindications to feed within the first 24 hours upon admission and with informed consent. Participants were randomized to given Ampicillin (100 mkd), supplemented with probiotics (1 sachet for 7 days) while the control group was given Ampicillin and a placebo. Patients with co - morbidities (i.e. cardiac problems, malnutrition etc.), and those with previous intake of antimicrobials were excluded. Both groups were compared based on the following: cardiac rate, respiratory rate, temperature, presence or absence of chest retractions and length of hospital stay. The physicians and patients were blinded as to
RESULTS: For subjects < 1 year old in the probiotics group, cardiac rates normalized at day 2. In the placebo group, fluctuating cardiac rates were noted although this difference was statistically significant. Among >1 year olds, normal cardiac rate was reached on days 4 and 5 in the probiotics group and this was not reached in the placebo group. The respiratory rate normalized in both groups starting day 1 for those < 1 year old. Respiratory rates in the probiotics group were also noted to be lower than placebo group. Among >1 year old, normal respiratory rate was reached on day 2 for both groups. The respiratory rates of the probiotics group were lower than the placebo group but this was not statistically significant. The decline between the two groups was not significantly different. Presence of chest retractions was lower in the probiotics group as compared to the placebo group by day 4. Both groups had an average length of hospital stay of 3 days.
CONCLUSION: The results of the study suggest that probiotics may possibly be helpful as an adjunctive therapy for patients, 2 months to 4 years old, with moderate risk community acquired pneumonia. **** 1st Place PIDSP Research Contest 2014

Human ; Male ; Female ; Child Preschool ; Infant ; Respiratory Rate ; Probiotics ; Length Of Stay ; Anti-infective Agents ; Temperature ; Ampicillin ; Dietary Supplements ; Pneumonia ; Malnutrition ; Vaccination

OBJECTIVES: The study aimed to determine the frequency and clinical profile of nosocomial infections among pediatric patients with Acute Lymphoblastic Leukemia (ALL) admitted at the Philippine General Hospital from January 2010 to December 2011.
METHODOLOGY: This is a descriptive cross sectional study involving the review of medical records of pediatric patients with ALL under the charity service of the Section of Pediatric Hematology and Oncology of Philippine General Hospital (PGH). The frequency, clinical presentation, outcome, causes of death and isolated organisms from sterile sites were determined. Fischer's Exact test was used to assess correlation between variables with Gram-negative bacterial infection and mortality.
RESULTS: There were 80 documented nosocomial infections among 45 pediatric patients with ALL. The incidence was 9.22 per 100 admissions. The majority presented initially with fever (50%) and 37 (82%) had neutropenia. Blood stream infections were present in 33 (73%) out of 45 pediatric ALL patients. Gram-negative organisms (76%), particularly Pseudomonas putida (33%), Pseudomonas aeruginosa (12%) and Burkholderia pseudomallei (12%) were isolated in majority of patients. About 42.2% of the 45 patients had resolution of the infection and 26.7% resulted to death primarily caused by septic shock in 7 (58.3%) of the 12 patients identified. Presence of fever (p- value 0.011, RR 2.1094) was associated with presence of Gram-negative bacteria at 5% level of significance and with 2.109 times more risk to having a gram-negative infection. There was no significant correlation between mortality and symptoms of infection.
CONCLUSION: Nosocomial infections remain to be significant cause of morbidity and death among pediatric patients with ALL. Gram negative infections were the most common cause of sepsis in these patients. One fourth of the patients with nosocomial infections died.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Shock, Septic ; Pseudomonas Aeruginosa ; Pseudomonas Putida ; Sepsis ; Fever ; Medical Records ; Precursor Cell Lymphoblastic Leukemia-lymphoma

BACKGROUND: 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.
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: The prevalence of M. pneumoniae infection among the subjects was 25.6%. distinguish M. pneumoniae infection.

Human ; Male ; Female ; Child Preschool ; Infant ; Mycoplasma Pneumoniae ; Prevalence ; Respiratory Tract Infections ; Hospitalization ; Laboratories ; Immunoglobulin M

BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is an emerging health problem in pediatrics. Risk factors are not well established in children.
OBJECTIVE: To determine the risk factors for the development of methicillin-resistant Staphylococcus aureus infections arising in the community.
METHODOLOGY: A restrospective case-control study was performed from January 2004 to December 2011. Cases included patients who were culture positive for Staphylococcus aureus and resistant to methicillin/oxacillin while Control included patients who were sensitive to methicillin/oxacillin. The study identified and analyzed the epidemiology, risk factors and resistance pattern of CA-MRSA isolates.
RESULTS: Three hundred twety three (323) patients with Staphylococcus aureus infections were enrolled: 172 were CA-MRSA infections (cases); and 151 were community acquired methicillin-sensitive Staphylococcus aureus (CA-MSSA) infections (control). Demographic characteristics and clinical profile were skin (cellulitis, furunculosis and abscess) and pulmonary (pneumonica and empyema). The survival rate was high for both groups (>90%). The final multivariate logistic regresion model showed that level of crowding and socio-economic status remained model showed that level of crowding and socio-economic status remained as risk factors for CA-MRSA. The odds of having CA-MRSA in crowded households is 0.35 (90%CI 0.20-0.62) less likely when compared to the odds of acquiring MRSA in less crowded households (p=0.003). Those who had low socio-eonomic had 2.49 times higher chance (90%CI; 1.39 -4.47) of aquiring CA-MRSA compared to those with higher socio-economic status (p=0.01).
CONCLUSION: CA-MRSA is an emerging problem. This warrants recognition of patients with significant risk factors such as low socio-economic status and level of crowding. This may serve guide in choosing the appropriate antimicrobial theraply.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Methicillin ; Methicillin-resistant Staphylococcus Aureus ; Oxacillin ; Furunculosis ; Anti-infective Agents ; Staphylococcal Infections ; Community-acquired Infections

BACKGROUND: Late Onset Neonatal Sepsis (LONS) or nosocomial sepsis has a significant mortality and morbidity that leads to overtreatment. Overtreatment happens when antibiotics are frequently started and/or shifted, eventually leading to increasing antimicrobial resistamce in NICU.
OBJECTIVE: To validate bedside nosocomial sepsis scoringdeveloped by Okascharoen in 2005.
METHODOLOGY: All neonates admitted in NICU suspected of LONS were enrolled. Using Okascharoe scoring, subjects were scored based hypotension/poor perfusion, abnormal body temperature, respiratory insufficiency, complete blood count, and length of umbilical catheter use. Growth of organisms during blood culture is considered positive outcome and is considered confirmed sepsis.
RESULTS: Of the one-hundred-nineteen (119) subjects included in the analysis, 59 were confirmed sepsis and 60 were LONS negative. Subjects with confirmed sepsis had more events of hypotension/poor perfusion (p < 0.001; -0.141, -0.438), thrombocytopenia (p 0.000; -0.169, -0489), and prolonged umbilical catheter usage (p 0.014; -0.051, -0.311). The ROC curve has an AUC of 0.753 (p < 0.001; 0.664-0.842), which means a randomly chosen neonate with LONS will have a higher predicted score than a neonate without LONS. The sensitivity of this tool was 0.92 (0.82-0.97) and specificity of this tool was 0.32 (0.21-0.46) in this setting. The positive LR =1.35 (1.12-1.64) while the negative LR = 0.26 (0.10-0.65)
CONCLUSION: This scoring is a valid tool that can be used in point-of-care scoring for antibiotic stewardship in a neonate with suspected sepsis.
RECOMMENDATION: it is recommended that a score > 5 be used to be predictive of late onset sepsis, and this would have sensitivity of 83.3%, specificity of 61%, positive predictive value of 68.5% and a negative predictive value of 78.3%

Human ; Male ; Adult ; Anti-bacterial Agents ; Neonatal Sepsis ; Anti-infective Agents ; Blood Culture ; Sepsis ; Morbidity ; Hypotension ; Thrombocytopenia ; Blood Cell Count

BACKGROUND: Pediculosis continues to be a common yet neglected public health problem especially in children. Trials to test for effectiveness for head lice interventions are heterogeneous, and a recent systematic review recommended  the use of cluster randomization and centralized administration (e.g. school) of permethrin for pediculosis trials.

OBJECTIVE: To compare the effectiveness of a school-based to a home-based intervention using permethrin 1% shampoo in treating pediculosis capitis. 

METHODS: We conducted a pragmatic, cluster-randomized trial at the Makati Elementary School. All Grade Four students  (n = 211), belonging to a total of five class sections, were invited to participate in the study. Students with a known allergic reaction to permethrin 1% shampoo, with open wounds on the scalp, or were absent on Days 1 or 10 of the intervention period were excluded. The five class sections were randomized to receive permethrin 1% shampoo to be applied either in school, or at home. The students were classified as having none, light, medium, or heavy infestation prior to Day 1 and after Day 10 treatment. Prevalence, incidence, and treatment outcomes were measured.

RESULTS: The baseline prevalence of pediculosis capitis was 58.4%. General characteristics of students were similar between groups. No significant clustering in pediculosis classification was observed. The school-based group had the same prevalence in pediculosis at Days 1 and 10, had no incident cases, and were limited to light infestation by Day 10, but had no treatment success outcomes. The home-based group had increased prevalence by Day 10, poor compliance with Day 1 and 10 shampoo,  incident cases, although it registered a higher treatment success rate.

CONCLUSION: Compared to standard home based intervention, a school-based strategy resulted in less incident cases (0% vs. 37%), reduction in pediculosis severity (p = 0.007), and higher compliance (100% vs. 58.3%). Control of pediculosis in this specific community is largely warranted because of its high prevalence rate of 59.7%.

 

Human ; Male ; Female ; Child ; Pediculus ; Lice Infestations ; Permethrin ; Scalp ; Public Health ; Schools ; Treatment Outcome ; Students ; Hypersensitivity

INTRODUCTION: Healthcare associated infections (HAIs) continue to be a major public health concern throughout the world particularly in developing countries wherein prevalence rates range from 5.7%-19.1%.

OBJECTIVES: The aims of this study were to determine the prevalence of HAIs among pediatric patients admitted at Philippine General Hospital and to describe the trends of annual prevalence of HAIs in relation to infection control programs implemented.

METHODOLOGY: A retrospective study was conducted at the 145-bed capacity wards and intensive care units of the Department of Pediatrics, Philippine General Hospital (PGH) from January 2011 to December 2014 wherein HAI records from the database of the Section of Infectious and Tropical Disease in Pediatrics (INTROP) were reviewed. The following data were collected and encoded: (1) number of patients admitted in the different areas: Pediatric wards (Ward 9 and Ward 11), PICU and NICU; (2) number of patients who developed HAIs; and (3) microbial isolates, sites and antibiotic susceptibility results. Trends of yearly prevalence of HAIs in relation to infection programs implemented were determined, and the microbial isolates and their antibiotic sensitivity patterns were described.

RESULTS: Among 30,032 pediatric patients at risk for HAIs and admitted from January 2011 to December 2014, the prevalence of HAI was 11.37%. There was a decreasing trend in the yearly HAI rates from 2011 to 2014 which coincided with implementation of infection control programs and hiring of a part-time infection control nurse in 2012. The prevalence of HAIs was highest at the PICU (15.17%- 27.81%) followed by the two Pediatric wards, ward 9 (9.03%-19.87%) and ward 11(8.75%-14.76%) and lowest at the NICU (7.52%-9.44%). Top isolates were Pseudomonas putida, Pseudomonas aeruginosa, and Klebsiella pneumonia. Pseudomonas organisms were still sensitive to Ceftazidime, and Klebsiella to Meropenem.

CONCLUSION: The overall HAI prevalence during the 4-year study period was 11.37% (9.14% - 13.65%) comparable to those seen in developing countries. There was a decreasing trend of prevalence annually that coincided with the implementation of various infection control programs and the hiring of a part-time infection control nurse. The microbial isolates obtained vary per area but overall the same organisms were isolated during the study periods which were susceptible to the empiric treatment given.

Human ; Male ; Female ; Cross Infection ; Ceftazidime ; Pseudomonas Aeruginosa ; Meropenem ; Anti-bacterial Agents ; Pseudomonas Putida ; Klebsiella ; Intensive Care Units, Neonatal ; Infection Control ; Thienamycins

OBJECTIVE: The aim of this research was to describe the epidemiologic, clinical laboratory and microbiologic characteristics, complications and outcome of pertussis among pediatric patients at the Philippine General Hospital.
METHODS: A retrospective chart review was performed which included pediatric patients with final diagnosis of pertussis, both clinical and laboratory -confirmed admitted from December 2012 to August 2013 at the Philippine General Hospital.
RESULTS: This chart review included 28 pertussis patients highest in those aged 1-3 months (86%), females (57%) and from region 4A (57%). 26 (93%) had exposure to household members with respiratory symptoms and unknown pertussis vaccination status. Of those patients who were eligible for vaccination, only 24% received age-appropriate DPT vaccination.
Onset of illness varied from 3-56 days; majority 9/L, range: 14.7-111.5x109/L;), lymphocytic predominance (mean lymphocyte 0.47, range: 0.20-0.72;) and thrombocytosis (mean platelet count: 567x109/L, range: 269-823x109/L;). 28% were culture positive for B. pertussis, while 86% tested positive for PCR.
The most common complications  were pneumonia requiring mechanical ventilation (64%), ARDS (28%), seizures (21%), nosocomial pneumonia (11%) and myocarditis (11%). The average length of hospital stay was 7.4 days with 13 deaths or 46% case fatality rate. Deaths were attributed to respiratory failure due to progressive pneumonia and ARDS. Other contributing causes were arrhythmia, MODS, and  septic shock.
CONCLUSION: Susceptible young infants acquire pertussis from household contacts with respiratory symptoms. Paroxysmal cough and cyanosis are common clinical features, with leukocytosis, lymphocytosis and thrombocytosis. High case fatality rate for pertussis was noted among these patients.

Human ; Male ; Female ; Infant ; Infant Newborn ; Whooping Cough ; Leukocytosis ; Lymphocytosis ; Cross Infection ; Bordetella Pertussis ; Thrombocytosis ; Respiratory Insufficiency ; Arrhythmias, Cardiac

Measles continues to be a major childhood illness in Baguio City considering that the Philippines is elimination phase due to continuous transmission among susceptible population. Despite a high percentage of anti-measles vaccination coverage, outbreaks have been reported.

OBJECTIVE: The goal of this study is to describe the epidemiology of measles cases during 2010-2012 and relate it to the outbreak response immunization (ORI) and supplemental immunization activities (SIA) of Health Services Office.

METHODS: It is a cross sectional design utilizing data from Philippine Integrated Disease Surveillance and Response (PIDSR) of the City Epidemiology and Surveillance Unit and reports from the Expanded Program on Immunization of the Field Health Service Information System of Baguio City. Simple descriptive statistical analysis utilizing frequency and percentage distribution was used to characterize the measles cases according to age, sex, case final classification and vaccination status.

RESULTS: During the 3-year, period, there were 457 total suspected measles cases with history of fever, generalized rash, and either cough, coryza or conjunctivitis. Outbreak started in February 2010 and reached 97 suspected cases and eventually decreased after the ORI by March to April 2010. The mean age of the cases is 11.18±10.64 years old, 10.28 are aged from 0-8 months. Of this total, 105 (22.98%) were clinically confirmed, 66 (14.44%) were laboratory confirmed positive for anti-measles IgM antibodies, 27, (5.91%) were epidemiologically linked to confirmed cases and 295, (56.67%) discarded non-measles cases. Among 171 laboratory and clinically confirmed cases, 33 (19.30%) did not received measles vaccination, 40 (23.40%) received 1 dose and 54.40% has unknown immunization status.

CONCLUSION: There were observed cased of measles that are out of age targer of the immunization program which necessitates public health action. There is a need to revisit immunization programs and policies to address out of target cases.

Human ; Male ; Female ; Infant ; Cough ; Public Health ; Measles ; Immunization Programs ; Vaccination ; Disease Outbreaks ; Exanthema ; Conjunctivitis ; Immunoglobulin M