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

This review article gives an overview of pneumonia in the Philippines, with focus on childhood pneumonia. Its primary objective is to provide information on epidemiology, etiology, economic burden, risk factors and prevention of pneumonia. A review of literature was done to gather information about the disease, with emphasis on local data. In the Philippines, pneumonia is the third leading cause of death across all ages and is the most common cause of death among children<5 years of age. A prospective study on Invasive Pneumococcal Disease conducted in the Philippines looked at the incidence of chest x-ray–confirmed pneumonia (N=5,940) in three hospitals over a 2-year period. The highest incidence was seen in those 28 days to <6 months of age at two sites and those 6–12 months of age in another site. Risk factors include not exclusively breastfeeding infants <6 months, undernutrition, zinc deficiency, crowding and exposure to indoor air pollution, low birth weight, poverty and socio-economic factors, presence of underlying comorbidities and immunodeficiency states. CAP ranks number one in processed Philippine Health Insurance (PhilHealth) claims, showing the huge economic burden. Therefore, rationalizing its management with simple standardized guidelines, exclusive breastfeeding for 6 months and continued breastfeeding with appropriate complementary feeding, improving indoor air pollution, and promoting vaccination are effective interventions.
Pneumonia ; Pneumococcal Infections

OBJECTIVES: To determine the impact of hospital-acquired infections (HAI) on the cose and duration of hospitalization among neonatal intensive care unit (NICU) patients from a hospital-based perspective.

METHODS: A case control retrospective study was performed at the 15-bed/crib NICU at PCMC from March 2008 to February 2009. Forty-four neonates who developed HAI while at the NICU were designated as "cases" matched to control subjects (1:1). Control subjects were matched to cases based on gestational age, final diagnosis and date of NICU admission. Eligible cases of HAI were identified retrospectively through the nosocomial infection logbook kept by the Infection Control Nurse. Data collection was done via review of the patient's medical record: gestational age, gender, diagnosis, underlying disease, appropriateness for age, surgical procedure, duration, urgency, classification of surgical intervention, therapeutic procedures prior to first HAI, antibiotic administration prior to diagnosis of first HAI, type of HAI. The length of hospital stay (duration of hospitalization), outcome of the patients and blood isolates of cases of HAI were likewise gathered from the hospital records of each patient. Cost data was obtained from the hospital database.

RESULTS: There was a higher mean cost of hospitalization for NICU patients with HAI Php 275,459 vs 104,407 (USD 5,738 vs USD 2,175). They also had a longer length of stay with a mean of 55.5 days vs 29.3 days. In the analysis using multiple linear regression, the following factors: HAI grouping, length of stay and outcome (mortality) contributed significantly to increased cost.

CONCLUSION: HAIs were associated with increased cost and duration of hospitalization. These contribute significantly to economic burden to the patient and to hospital resources.

Human ; Male ; Female ; Infant Newborn ; Community-Acquired Infections ; infections ; Intensive Care Units, Neonatal ; Cross Infection ; Hospitalization-economics ; costs and cost analysis ;

Purpose: 2-[18F]FDG PET/CT plays an important role in the management of pulmonary nodules. Convolutional neural networks (CNNs) automatically learn features from images and have the potential to improve the discrimination between malignant and benign pulmonary nodules. The purpose of this study was to develop and validate a CNN model for classification of pulmonary nodules from 2-[18F]FDG PET images. Methods: One hundred thirteen participants were retrospectively selected. One nodule per participant. The 2-[18F]FDG PET images were preprocessed and annotated with the reference standard. The deep learning experiment entailed random data splitting in five sets. A test set was held out for evaluation of the final model. Four-fold cross-validation was performed from the remaining sets for training and evaluating a set of candidate models and for selecting the final model. Models of three types of 3D CNNs architectures were trained from random weight initialization (Stacked 3D CNN, VGG-like and Inceptionv2-like models) both in original and augmented datasets. Transfer learning, from ImageNet with ResNet-50, was also used. Results: The final model (Stacked 3D CNN model) obtained an area under the ROC curve of 0.8385 (95% CI: 0.6455–1.0000) in the test set. The model had a sensibility of 80.00%, a specificity of 69.23% and an accuracy of 73.91%, in the test set, for an optimised decision threshold that assigns a higher cost to false negatives. Conclusion A 3D CNN model was effective at distinguishing benign from malignant pulmonary nodules in 2-[18F]FDG PET images.

Respiratory symptoms are the most common manifestation of COVID-19 across all age groups and it is most often associated with radiographical findings consistent with pneumonia.2 A recent systematic review estimated that 16% of children with SARS-CoV-2 infection are asymptomatic,3 or others may present with seizures, gastrointestinal bleeding or jaundice. This reports a 2-year old boy with no known co-morbidity who had a 2-week history of abdominal pain and jaundice then had a rapidly progressive course of neurological deterioration and eventual demise. He had markedly elevated liver enzymes and deranged bleeding parameters with elevated ammonia and ferritin levels. Hepatitis B and hepatitis A titers were non-reactive. He was managed as a case of hepatic encephalopathy secondary to cholestatic jaundice. His chest x-ray was normal but his SARS-CoV-2 RT PCR result was positive with a low cycle threshold. Locally, this is the first reported case of SARS-CoV-2 RT-PCR positive pediatric patient presenting as fulminant hepatic failure with no associated respiratory manifestations. Clinicians should be mindful that such presentation, however uncommon, is possible and a high index of suspicion should be maintained.
COVID-19 ; SARS-CoV-2 ; Liver Failure ; Massive Hepatic Necrosis

The clinical course of COVID-19 in the pediatric population has been reported to be mild in the majority of affected patients. However, a condition referred to as multisystem inflammatory syndrome in children (MIS-C) can occur with SARS-CoV-2 infection where patients can become critically ill. In this series, we describe five pediatric patients with the spectrum of MIS-C associated with SARS-CoV-2 infection.
COVID-19 ; SARS-CoV-2

Purpose: Neoadjuvant chemotherapy (NACT) can change invasive breast carcinomas (IBC) and influence the patients’ overall survival time (OS). We aimed to identify IBC changes after NACT and their association with OS. Materials and Methods: IBC data in pre- and post-NACT samples of 86 patients were evaluated and associated with OS. Results: Post-NACT tumors changed nuclear pleomorphism score (p=0.025); mitotic count (p=0.002); % of tumor-infiltrating inflammatory cells (p=0.016); presence of in situ carcinoma (p=0.001) and lymphovascular invasion (LVI; p=0.002); expression of estrogen (p=0.003), progesterone receptors (PR; p=0.019), and Ki67 (p=0.003). Immunohistochemical (IHC) profile changed in 26 tumors (30.2%, p=0.050). Higher risk of death was significatively associated with initial tumor histological grade III (hazard ratio [HR], 2.94), high nuclear pleomorphism (HR, 2.53), high Ki67 index (HR, 2.47), post-NACT presence of LVI (HR, 1.90), luminal B–like profile (HR, 2.58), pre- (HR, 2.26) and post-NACT intermediate mitotic count (HR, 2.12), pre- (HR, 4.45) and post-NACT triple-negative IHC profile (HR, 4.52). On the other hand, lower risk of death was significative associated with pre- (HR, 0.35) and post-NACT (HR, 0.39) estrogen receptor–positive, and pre- (HR, 0.37) and post-NACT (HR, 0.57) PR-positive. Changes in IHC profile were associated with longer OS (p=0.050). In multivariate analysis, pre-NACT grade III tumors and pre-NACT and post-NACT triple negative IHC profile proved to be independent factors for shorter OS. Conclusion NACT can change tumor characteristics and biomarkers and impact on OS; therefore, they should be reassessed on residual samples to improve therapeutic decisions.

Objective: To evaluate the anti Candida activity of Hyptis martiusii decoction and its major compound, caffeic acid alone or in the presence of fluconazole, as well as their cytotoxic effect. Methods: The decoction was characterized using high performance liquid chromatography coupled with diode array detector. For the antifungal activity, the minimum inhibitory concentration (MIC) and the potential effect of the decoction with the fluconazole were evaluated by microdilution method using 96-well microtiter trays. The osmotic fragility test was performed using erythrocytes under saline stress. All tests were performed in triplicate. Results: The chemical characterization of the decoction was performed by high performance liquid chromatography and revealed the presence of seven compounds, including caffeic acid as major constituent. The antifungal tests demonstrated that both decoction (DHm) and caffeic acid obtained from Hyptis martiusii presented MIC and MFC ≥ 4096 μg/mL against Candida albicans and Candida tropicalis strains. However, in the presence of fluconazole, DHm and caffeic acid presented IC

Background: and Purpose Visual hallucinations (VH) and subjective cognitive complaints (SCC) are associated with cognitive impairment (CI) in Parkinson’s disease. Our aims were to determine the association between VH and SCC and the risk of CI development in a cohort of patients with Parkinson’s disease and normal cognition (PD-NC). Methods: Patients with PD-NC (total score of >80 on the Parkinson’s Disease Cognitive Rating Scale [PD-CRS]) recruited from the Spanish COPPADIS cohort from January 2016 to November 2017 were followed up after 2 years. Subjects with a score of ≥1 on domain 5 and item 13 of the Non-Motor Symptoms Scale at baseline (V0) were considered as “with SCC” and “with VH,” respectively. CI at the 2-year follow-up (plus or minus 1 month) (V2) was defined as a PD-CRS total score of <81. Results: At V0 (n=376, 58.2% males, age 61.14±8.73 years [mean±SD]), the frequencies of VH and SCC were 13.6% and 62.2%, respectively. VH were more frequent in patients with SCC than in those without: 18.8% (44/234) vs 4.9% (7/142), p<0.0001. At V2, 15.2% (57/376) of the patients had developed CI. VH presenting at V0 was associated with a higher risk of CI at V2 (odds ratio [OR]=2.68, 95% confidence interval=1.05–6.83, p=0.039) after controlling for the effects of age, disease duration, education, medication, motor and nonmotor status, mood, and PD-CRS total score at V0. Although SCC were not associated with CI at V2, presenting both VH and SCC at V0 increased the probability of having CI at V2 (OR=3.71, 95% confidence interval=1.36–10.17, p=0.011). Conclusions VH were associated with the development of SCC and CI at the 2-year follow-up in patients with PD-NC.

Objective To investigate the antifungal activity of the fern species Lygodium venustum (L. venustum) and Pityrogramma calomelanos (P. calomelanos) against Candida albicans and Candida tropicalis strains. Methods The microdilution method was used to evaluate the antifungal activity, as well as the modulating effects of ethanolic extracts of these plants in combination with fluconazole. The minimum inhibitory concentration (MIC), minimum fungicide concentration and morphological changes were also determined. Results The extract obtained from L. venustum presented a MIC > 8 192 μg/mL, while the extract obtained from and P. calomelanos presented a MIC = 8 192 μg/mL, indicating that they present weak antifungal activity. However, combination of the extracts with Fluconazole potentiated the antifungal activity of this drug. At different experimental conditions, such as concentration of the extract and type of strain, the extracts inhibited hyphae and pseudohyphae formation, indicating that these fern species can affect the morphology of the fungi. Conclusions The extracts obtained from the fern species L. venustum and P. calomelanos dose not present significant antifungal activity. However, P. calomelanos potentiates the activity of fluconazole and both extracts inhibits the morphological changes in Candida species, indicating that they have potential pharmacological activity as modulators of fungal biology. Therefore, novel studies are required to characterize the interference of these extracts in the virulence and pathogenicity of Candida species as well as the potential of fern species to treat fungal infections.