Background: Coronavirus disease 2019 (COVID-19) continues to be a pandemic to this time, and chest radiography has been used as a first-line triage tool, due to long turnaround times for real-time reverse transcription polymerase chain reaction (RT-PCR), which remains to be the gold standard in COVID-19 diagnosis. Chest x-ray alone has poor sensitivity to diagnosing COVID-19 and pediatric studies on this are scarce.

Objectives: The main objective is to evaluate the usefulness of a routine chest radiograph as an adjunct to diagnosing suspected pediatric COVID-19, along with its sensitivity, specificity, accuracy, and correlation with the most common pediatric signs and symptoms. In line with this, the radiographic characteristics seen in pediatric COVID-19 patients are presented.

Methods: A cross-sectional study involving a retrospective chart review of 259 pediatric patients admitted in a tertiary hospital with COVID-19 signs and symptoms, with baseline chest x-ray and SARS-CoV2 RT-PCR tests. Correlation of signs and symptoms with chest x-ray findings to RT-PCR positivity was determined using univariate and multivariate logistic regression analysis.

Results: The study was composed of 259 pediatric patients (ages 0-18 years old). Of these, 35 had positive findings with RT-PCR (15%). Sensitivity of a chest radiograph with pneumonia is at 62.9%, while specificity is at 39.3%. Overall accuracy of CXR findings leading to RT-PCR positivity is at 42.5%. Ground glass or hazy opacities was the most common radiographic finding (45.5%), followed by reticular opacities (31.8%). Abnormalities were mostly distributed in the inner lung zone distribution with bilateral lung involvement (90%). Those with difficulty of breathing were more likely to have pneumonia on their CXR, though a finding of pneumonia on CXR did not significantly correlate to a positive RT-PCR.

Conclusions & Recommendations: Findings of pneumonia on a pediatric CXR may not necessarily lead to a positive SARS-CoV2 RT-PCR, but correlating this with the patient's clinical course and symptoms may be beneficial in effective triaging of patients. Reassessment by another radiologist may provide additional strength to this study.

Background: There are no established guidelines preferring mannitol over hypertonic saline in managing increased intracranial pressure in children.

Objective: This systematic review aimed to assess the available data on the efficacy of 20% mannitol and 3% hypertonic saline in decreasing intracranial hypertension in the pediatric age group.

Method: Search was done through PubMed/MEDLINE, Cochrane Central Registry of Clinical Trials (CENTRAL) and EMBASE. The search of articles yielded 280 studies. After applying the inclusion and exclusion criteria, a total of 7 articles were deemed eligible for assessment.

Results: Seven studies with a total of 1,892 pediatric patients met the eligibility criteria: three RCTs and four retrospective studies. From these studies, two randomized controlled studies showed statistically significant evidence that 3% hypertonic saline was superior to 20% mannitol in reducing increased intracranial pressure (ICP) while two other studies had results that were insufficient to establish statistical significance. A study showed that Glasgow coma scale (GCS) scores were higher and length of stay was shorter in patients given hypertonic saline than in the mannitol group. Relative risk of mortality was comparable in both groups. While more episodes of hypotension and rebound increase in ICP was seen with mannitol, both agents reported occurrences of acute kidney injury, hemolysis and hyperchloremic metabolic acidosis.

Conclusion: This review showed that while both agents effectively decreased intracranial pressure, 3% hypertonic saline showed better results compared with 20% mannitol. Due to the limited number and heterogeneity of studies, a pooled analysis of the effects in ICP could not be done. Recommendations: Larger prospective controlled studies using 20% mannitol and 3% hypertonic saline in the treatment of increased ICP in the pediatric age group are needed to render valid affirmations.

BACKGROUND: There are numerous studies on adult patients admitted for COVID-19 but there is paucity of local data in children.

OBJECTIVE: This study aims to determine the clinical presentation and outcome of children admitted for COVID-19.

METHODOLOGY: This is a retrospective review of medical records of patients 0 to 18 years old with COVID-19 admitted in Philippine Children's Medical Center (PCMC). Descriptive statistics summarized the clinical profile of the patients. Pearson's Chi-Square and Fischer's Exact Test were used for data analysis.

RESULTS: There were 100 confirmed COVID-19 pediatric patients admitted at PCMC from March 2020 to March 2021. Most were within the 0-4 years of age (52%). Fever (63%), respiratory symptoms (31%), and shock (28%) were the predominant clinical manifestations. Most (78%) had no exposure to symptomatic household contacts but all came from communities with known local transmission. Fourteen cases of hospital-acquired COVID-19 were also identified. Out of the 100 cases, 53 had critical COVID-19 on admission and 82 had co-morbidities, mostly neurologic, hematologic and infectious diseases. Seventy-four patients recovered and 26 patients died.

Fever (p-value=0.014) and shock (p-value=0.000), thrombocytopenia or thrombocytosis (p=0.030) and electrolyte imbalances (p=0.045) were significantly associated with critical COVID-19. There was no significant association between the presence of co-morbid conditions on admission and clinical outcome. O2 support by facemask (p=0.001) or by mechanical ventilator (p=0.001), and inotropic support (p=0.000) were significantly associated with mortality.

CONCLUSION: Children admitted for COVID-19 infection generally recover but those with critical COVID-19 is highly associated with mortality.

Objectives. 1) To determine the nutritional status of pregnant adolescents aged 14 to 19 years seen at the Philippine General Hospital Teen Mom Clinic from February to July 2014; 2) To describe the demographic characteristics, pregnancy history, and lifestyle and health habits of adolescent mothers; 3) To describe the adequacy of the daily intake of nutrients (caloric energy, carbohydrates, protein, fats, folate, calcium, and iron) of adolescent mothers; and 4) To determine the association of specific demographic characteristics with body mass index categories.

Methods. This was a prospective cross-sectional study. Included were the pregnant adolescents aged 14 to 19 years of age, referred to the Teen Mom Clinic, who planned to deliver at the Philippine General Hospital. Informed consent and assent forms were signed, and the principal investigator interviewed the subjects for demographic and clinical history at the time of enrolment. The adolescents were taught and instructed to fill up the food diary (2 weekdays and 1 weekend) and the food frequency (once) forms. These were submitted on their next visit and given to a licensed nutritionist for analysis. The nutritional status was assessed by gathering the weight and height of the patients in order to compute for the body mass index at the time of enrolment in the study.

Results. The percentage distribution of nutritional status of pregnant adolescents consisted of the following: 65% normal; 28% underweight; 3.5% overweight; 3.5% obese. The 60 pregnant adolescents had a mean age of 16.9 years (SD 1.2). Their partners had a mean age of 20.3 years [SD 3.8]. On the average, they had a total of five pre-natal checkups. Majority of the respondents (85%) still depended primarily on their parents for financial support. Around 93% of the pregnancies were unplanned. Their median percent adequacy for daily calories was 72%, carbohydrates 69%, proteins 73%, and fats 86%. For the micronutrients, the median percent adequacies for folate, calcium, and iron, based on the needs of pregnant women, were 18%, 63%, and 29%, respectively. If amounts were compared to the requirements by age, the median adequacies of intake were 27%, 50%, and 41%, respectively. The nutritional status was not found dependent on the age, educational attainment, number of siblings, and the monthly family income of the respondents.

Conclusion. Only 65% of the pregnant adolescents had normal nutritional status. There was still an elevated level of malnutrition among pregnant adolescents as shown in this study: 28% were underweight, 3.3% were overweight, and another 3.3% were obese.

BACKGROUND: Epilepsy is a chronic neurologic disorder complicated by neurobehavioral comorbidities, including affective disorders, which adversely affect quality of life. There is increasing prevalence of these disorders in children especially in adolescents, however, the need for mental health care often remains unmet.

OBJECTIVES: The study determined the prevalence of anxiety and/or depression in adolescents with epilepsy and the association of these disorders with sociodemographic variables and seizure-related factors such as age of onset, duration of epilepsy, seizure frequency, electroencephalogram/neuroimaging abnormalities, type of epilepsy including epilepsy syndromes and drug treatment.

METHODOLOGY: This is an analytical, cross-sectional study. All adolescent patients with epilepsy seen at OPD who fulfilled the inclusion and exclusion criteria were screened using the Hospital Anxiety and Depression Scale (HADS)/ Hospital Anxiety and Depression Scale-Pilipino (HADS-P). Charts of the patients at the Neurology section (Pay and Charity service) were reviewed. Epilepsy-related and sociodemographic variables in association with anxiety and depression were determined and analyzed.

RESULTS: A total of 145 adolescent patients were included in the study. There was a 17.4% prevalence of anxiety and 3.4% prevalence of depression in this study population according to the screening tool. However, a confirmatory diagnosis was not done in some patients. There was no significant factor associated with occurrence of anxiety. Factors that were highly associated with depression were a psychiatric illness in the first-degree relative, frequent seizures at onset, no anti-epileptic drug use, and monotherapy at the time of the study. Presence of anxiety also increased the odds of having depression.

CONCLUSION/RECOMMENDATIONS: Affective disorders are common in adolescents with epilepsy and factors related to their occurrence must be anticipated. Hence, the need to screen the patients for psychiatric symptoms early and regularly.

BACKGROUND: Leukemia is the most common malignant neoplasm in childhood, with Acute Lymphoblastic Leukemia (ALL) comprising 71% of cases. Partients undergo intensive course of treatment and complications, making them at risk for psychosocial difficulties. The Pediatric Symptom Checklist (PSC) is a validated psychosocial screening tool for the identification of emotional, cognitive, and behavioral problems in children. It uses subscales to identify impairments in attention, internalizing, and externalizing behaviors.

OBJECTIVE: To screen the psychosocial status of pediatric patients with ALL using the PSC. It aimed to correlate a positive PSC score with factors such age, gender, and on-going chemotherapy.

METHODS: The study design is cross-sectional. Participants were asked to answer the PSC which is a 35-item questionnaire. Total scores were calculated and interpreted based on set cut-off scores.

RESULTS: A total of 87 patients with ALL were included in the study. The PSC was able to identify 16 patients (18%) with psychosocial problems. The patients had concerns related to the internalizing subscale, followed by attention and externalizing subscales. There was no association between age, sex, duration of diagnosis, and on-going chemotherapy with the presence of psychosocial issues in patients with ALL.

CONCLUSIONS: In this study, the prevalence of psychosocial issues in patients with ALL is 16%. Screening patients using the PSC can help in the early detection of psychosocial issues among children with ALL. 

RECOMMENDATIONS: A separate study which focuses on both patients and families' psychosocial status is recommended to get an overall picture of the effect of cancer and its treatment. Screening in several points during the course chemotherapy can also be done in future studies.

OBJECTIVE: To compare the effectiveness of preoperative Japanese acupuncture for prevention of post-operative nausea and vomiting (PONV) in non-sedated children for surgery under general anesthesia.

METHODS: This is an RCT studying the effectiveness of press-tack Japanese needles in P6 prior to any sedatives in children age 5-18 years old for surgery under general anesthesia (n=66). Patients were randomized to receive either press-tack needle (n=33) or an identical press-tack without the metal component (n=33). Incidence of PONV was reported using BARF scale. Children, parents, anesthesiologists, and nurses were blinded to group assignment.

RESULTS: Eight of 33 (22%) in the intervention group while 17 of 33 (51.52%) in the placebo group experienced PONV (RR = 0.47, 95% CI [0.24-0.94], p-value 0.0224). One case reported an adverse event of worsening of nausea and vomiting.

CONCLUSIONS: Japanese acupuncture at P6 prior to sedation using press-tack needle significantly reduced the incidence of PONV in children after general anesthesia. KEYWORDS: PONV, POV, P6, PC6, Japanese acupuncture, Acupuncture, RCT

Objective: This study determined the demographic data, clinical profile, treatment and outcome of BCN-IE in children at UP-PGH.

Methods: This is a retrospective study of children with BCN-IE admitted at UP-PGH from 2004-2013. Demographic data, clinical presentation, previous antibiotic use, echocardiographic findings, an antibiotic used and outcome of patients were recorded and analyzed. Results in the demographic and clinical profile were expressed as frequencies, percentages and means. To compare the clinical features, echocardiographic findings and antibiotic regimen used as to the outcome, Fischer's exact test was used.

Results: Among 91 patients diagnosed with infective endocarditis, 61.54% had BCN-IE. The age, gender and clinical presentation were similar to other studies. Clinical presentation and echocardiographic findings did not have influence on outcome of children with BCN-IE. The use of penicillin G and amikacin is associated with unfavorable outcome after 4 weeks or less of administration.

Conclusion: The incidence of BCN-IE is high in UP-PGH. The demographic distribution, clinical and echocardiographic features of patients do not have an influence on the outcome. The trend to the unfavorable outcome with the use of penicillin suggests the need to target fastidious organisms in BCN-IE. Further investigation is warranted to establish the etiologic agents of BCN-IE.

Malignant ovarian germ cell tumors are rare ovarian malignancies accounting for 3 to 5% of all ovarian malignancies. They are mostly seen in adolescents and young women and are usually unilateral making fertility preservation imperative. Raised alpha-feto protein level is the hallmark of this tumor. Presented is a case of a premenarcheal 13 year old female diagnosed with yolk sac tumor and who underwent fertility-sparing surgery and adjuvant platinum-based chemotherapy post-operatively, with good outcome. In young patients, conservative surgery with adjuvant chemotherapy has made the preservation of fertility possible, even in patients with advanced disease. The increase in cure rates has shifted the focus of recent studies to the long term menstrual, reproductive, and gynecologic outcomes in these patients. 

The DSME program is aimed to educate adolescents about diabetes mellitus: disease process, survival skills, exercise management, drug management, diet management, prevent acute and chronic complications and optimize quality of life. This study utilized the quasi experimental pre and post-test design involving 15 adolescent patients with Type 1 Diabetes Mellitus. The DSME materials were composed of five modules that included topics in diabetes awareness, survival skills, exercise, drug and diet management. Knowledge, Fasting Blood Sugar (FBS), Random Blood Sugar (RBS) and waist and hip ratio (WHR) were tested. The Intervention phase was implemented in three months where each module was completed by patients in two weeks. Pre and post-test examinations were done after each module. Participants have very satisfactory knowledge in diabetes awareness, survival skills, exercise, drug management before and after the DSME program. However, participants knowledge in diet management were unsatisfactory before and after the DSME program. FBS were high but RBS levels and WHR were in normal levels before, during and after the DSME program. Knowledge scores were significantly different before and after the implementation of all the modules (Module 1 to Module 5) to the participants. RBS results were significantly different after the implementation of the Module 1- DM awareness and Module 5- diet management. However, no significant differences were obtained in the RBS results of the participants after the implementation of Module 2, 3, 4, and 5. No significant differences were also obtained in the WHR parameters of the participants in each of the implementation of DSME. No significant differences in the FBS results were obtained after the implementation of the DSME modules. The module type DSME is effective in increasing knowledge of the adolescent patients in diabetes and its management. The content of the diet management module needs to be strengthened and be tested again for its effectiveness in increasing knowledge of adolescent patients.