A nine-year old myxedematous girl with short stature, isosexual pseudoprecocious puberty and bilateral multicystic ovaries underwent pelvic laparotomy due to an acute abdomen because of adnexal torsion. She also delayed bone, age, severe hypothyroidism, hyperprolactinemia, hyperestrogenism and pituitary adenoma. All of these findings led to the diagnosis of Van Wyk Grumback Syndrome, which is a rare condition characterized by long standing untreated hypothyoidism, pseudoprecocious puberty and nulticystic ovaries. Adminsitration of levothyroxine efected gradual regression and reversal of symptoms. This case highlight the significance of recognizing the clinical features of this syndrome in order to medically treat the child and thus, prevent its undesirable effects in the physial andmental growth an dpossible surgical cimplications that ay affect her future reproductive capacity.

Human ; Female ; Pre-adolescent (a Child 6-12 Years Of Age) ; Syndrome

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.

Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Pre-adolescent (a Child 6-12 Years Of Age) ; Child

BACKGROUND: Painful procedures intensify hospital-related stress and anxiety leading to unpleasant experience that can adversely affect procedure outcomes and health seeking behaviors.

OBJECTIVE: To determine the effect of a cold vibrator device on pain perception of children aged 6-12 years old during Mantoux Test at the Out-Patient Department of the Philippine Children's Medical Center.

METHODOLOGY: This is a single blinded, randomized control trial where one-hundred four (104) subjects were randomly assigned to experimental (54 subjects) and control group (50 subjects) through fishbowl method. The experimental group received the cold vibrator prior to Mantoux test while the control group received the Mantoux test alone. Pre and post procedural heart rate, respiratory rate and oxygen saturation were obtained. The responses were evaluated using the Wong-Baker Faces Pain Scale.

RESULTS: Pain score was higher in the control group. Wilcoxon Rank-Sum Test showed mean rank of 67.5 with aggregated pain rank of 3645.00 compared to experimental group (with cold vibrator) of 36.3 with aggregated pain rank of 1815.00 with a p value 0.0000000046. There was no significant difference between the physiologic parameters (heart rate, respiratory rate, and oxygen saturation) before and after procedure between the two groups.

CONCLUSION AND RECOMMENDATION: The use of the cold vibrator was effective in reducing pain perception. It can be used as an adjunct to mitigate pain for needle-related procedures. Demographic data could also be correlated to the pain scores of the subjects. 

Human ; Male ; Female ; Pre-adolescent (a Child 6-12 Years Of Age) ; Pain ; Pain Perception

BACKGROUND: Despite extensive studies on dengue fever, there is still limited knowledge about factors associated with poor outcomes in cases of dengue fever. The shock index (SI) is a bedside tool previously used in the adult population, adopted as a marker for poor outcomes in many shock states. There are limited studies applying the SI in children. There are also no known local studies applying an age-adjusted version as a marker or predictor of poor outcomes in severe acute illness, such as dengue.

OBJECTIVES: To determine the diagnostic ability of the age-adjusted pediatric shock index in predicting outcomes in cases of dengue admitted at a tertiary children's hospital.

METHODS: This is a prospective cohort study performed in a pediatric tertiary hospital over a period of 30 days. Admitting heart rate (HR) and systolic blood pressure (SBP) were taken to determine their shock index. This was then grouped according to age groups based on known literature and corresponding acceptable age-adjusted shock indices (ASI), and compared with outcomes such as final dengue classification (non-severe vs severe), use of inotropes, and mortality.

RESULTS: A total of 90 patients were identified for the study. Three were excluded due to exclusion criteria. 87 cases were followed up after admission from the ER. Unadjusted Shock Index (USI) was found not to be associated with both final dengue classification (as severe dengue) and use of inotropic support. In contrast, ASI was associated with both final dengue classification (p < 0.001) and use of inotropes (p < 0.039). The ASI had a fairly accurate capability of predicting poor outcomes for both final dengue classifications, with an area under the ROC curve of 0.7122, and eventual use of inotropes, with an area under the ROC curve of 0.6435.

CONCLUSIONS AND RECOMMENDATIONS: SI was found to be a helpful tool in predicting poor outcomes, but only when the Age-adjusted Shock Index (ASI) was used. A longer data collection period is recommended to be able to include mortality as an outcome. The predictive value of the tool can be tested against various other markers of poor outcome to widen the application of this non-invasive measure of hemodynamic status.

Human ; Male ; Female ; Pre-adolescent (a Child 6-12 Years Of Age) ; Child Preschool (a Child Between The Ages Of 2 And 5) ; Dengue

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.

Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Pre-adolescent (a Child 6-12 Years Of Age) ; Child ; Mass Screening ; Sensitivity And Specificity

 

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.

 

Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Pre-adolescent (a Child 6-12 Years Of Age) ; Cross Sectional Studies ; Problem Behavior ; Precursor Cell Lymphoblastic Leukemia-lymphoma

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

Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Pre-adolescent (a Child 6-12 Years Of Age) ; Postoperative Nausea And Vomiting ; Vomiting, Postoperative ; Pericardium ; Acupuncture

BACKGROUND: Ultrasound?guided quadratus lumborum block (QLB) is a regional anesthetic technique which can provide post-op pain control for pediatric patients undergoing abdominal surgery. We hypothesized that the quadratus lumborum block would be as efficacious as a caudal block in providing pain control.

OBJECTIVE: To compare the postoperative analgesic effect of ultrasound-guided QLB versus ultrasound-guided caudal block among 1-6 years old children undergoing lower abdominal and urological surgeries in Philippine Children's Medical Center.

METHODS: This is a single-blinded randomized control trial. 50 patients enrolled aged between 1 and 6 years. The patients were randomly classified into the caudal block group and quadratus lumborum block group. The primary outcome is the need for analgesia during the first 24 hours.

RESULTS: A significant difference in the proportion of patients who requested for rescue analgesia was observed with caudal block having more patients in need of analgesic (100% CB vs 48% QLB, p<0.001). No postoperative complication was observed.

CONCLUSIONS AND RECOMMENDATIONS: The quadratus lumborum block was more effective in reducing the postoperative pain management during the initial 48 hours. Quadratus lumborum block is recommended for future pediatric procedures requiring postoperative pain control, safety, practicality and economy.

Human ; Male ; Female ; Pre-adolescent (a Child 6-12 Years Of Age) ; Child Preschool (a Child Between The Ages Of 2 And 5) ; Analgesia ; Pain, Postoperative ; Diagnostic Imaging