BACKGROUND: Vitamin D deficiency has been documented as a frequent problem in almost every region of the world even in the tropical countries and its health consequences are enormous. Infancy and adolescence are age groups particularly at risk of developing vitamin D deficiency. However, there are no data on the Vitamin D status of Filipino adolescents.

OBJECTIVES: To determine the serum 25-hydroxyvitamin D levels in Filipino high school students in selected schools in Quezon City

METHODS: A cross-sectional study of Filipino high school students was undertaken. A total of 97 boys and girls aged 11- 18 years old, attending selected private and public secondary schools in Quezon City participated in the study after parents' consent and students' assent were taken. Serum 25(OH)D levels were determined by electrochemiluminescence immunoassay (ECLIA) using Roche HITACHI Cobas e immunoassay analyzer.

RESULTS: The total serum 25-hydroxyvitamin D levels of the students ranged from 19.92 nmol/L to 88.63 nmol/L with a mean of 52.43 nmol/L. Among the 97 high school students, there was a prevalence of hypovitaminosis D (serum 25 (OH)D <50nmol/L) of 41.2% with 20.6% having deficient (

CONCLUSION: Hypovitaminosis D is highly prevalent among Filipino adolescents in secondary school despite abundance of sunlight. Appropriate interventions are needed to address the problem of poor vitamin D status in schoolchildren.

BACKGROUND: One out of 10 Filipino children suffer from bronchial asthma. Its increasing prevalence over the past decades causes significant morbidity to the patients and their families, especially when it is uncontrolled. In developing countries, the form of medicine, cost and access to medications are significant factors in achieving good control of symptoms. No study has been done to determine if the use of low dose oral corticosteroid is a safe and effective alternative treatment for children with asthma.

OBJECTIVE: To compare the safety and efficacy of oral versus inhaled corticosteroid in moderate persistent asthma.

METHODS: An open label randomized controlled trial was carried out in 40 patients 6 to 15 years old with newly diagnosed moderate persistent asthma. They were assigned to either inhaled or oral corticosteroid group. Efficacy of treatment based on daytime and nighttime coughing, limitation of activity, use of bronchodilators, FEV1, PEFR and level of asthma control were assessed. Safety of both treatment options were evaluated by the occurrence of corticosteroid induced hypertension, adrenal insufficiency and diabetes.

RESULTS: The use of inhaled and oral corticosteroid showed improvement in daytime and nighttime cough, need for bronchodilators, limitation of activity, FEV1, PEFR and level of control. Furthermore, both treatment options had comparable safety profile.

CONCLUSION: There was no significant difference on the safety and efficacy of oral versus inhaled corticosteroid in the longterm treatment of moderate persistent bronchial asthma.

BACKGROUND: Human milk is considered the optimal nutritional source for infants. Due to the possibility of microbial contamination during collection and handling, milk is pasteurized to prevent transmission of pathogens. In low-income areas where pasteurization is inaccessible, the pursuit for the best alternative in rendering donor milk safe remains.

OBJECTIVE: We aimed to determine and compare the efficacy of flash heat treatment and holder pasteurization in preserving human milk IgA while reducing bacterial contamination of donor breast milk.

METHODOLOGY: This is an experimental study which utilized pooled donor breastmilk from healthy mothers later subjected to bacterial analysis and immunoglobulin A level determination prior to and post flash heat treatment and pasteurization. Standardized scores were used to normalize population with unknown parameters. T-test comparison of means and Levene's test for equality of variances were used.

RESULTS: Twenty samples of aliquoted breastmilk were subjected to pasteurization and flash heat treatment, both yielding a statistically significant reduction in colony-forming units using Blood agar and MacConkey plates. These sample groups also underwent IgA level determination using Bindarid Kit IgATM and there was no significant decline in IgA levels.

CONCLUSIONS: Flash heat treatment may be an alternative for holder pasteurization in providing safe and effective breastmilk.

BACKGROUND: Neonatal Cholestasiswarrants early, accurate and prompt intervention and comprises a wide spectrum of differential diagnosis which present with overlapping features, thus making a diagnosis difficult.

OBJECTIVE: To evaluate the clinical and laboratory parameters that could aid to differentiate between intrahepatic and extrahepatic neonatal cholestasis.

METHODS: Retrospective and Descriptive study of Neonatal Cholestasis patients who underwent Liver Biopsy and admitted at the Philippine Children's Medical Center from January 2007 to December 2011.

RESULTS: Factors that favor an intrahepatic cause of Cholestasis are ultrasound finding of a normal gallbladder, marked degree of giant cell transformation and presence of extramedullary hematopoiesis. Factors that favor an Extrahepatic cause of Cholestasis are presence of Splenomegaly, markedly elevated GGT, and histopathology findings of Portal and Periportal Ductal proliferation, bile plugs, lesser degree of giant cell transformation, septal fibrosis and cirrhosis, portal and neoductular cholestasis, and Portal-Portal bridges.

CONCLUSION: In this study, meticulous history and physical examination aid in the diagnosis of Neonatal Cholestasis. Splenomegaly and markedly elevated serum GGT are suggestive of Biliary Atresia, and a normal Gallbladder by Ultrasound favors Neonatal Hepatitis. Although there is significant overlap of histopathologic findings of patients with neonatal cholestasis, certain parameters favor an extrahepatic over an intrahepatic process.

OBJECTIVE: This study aims to assess the knowledge and attitudes of female adolescents aged 14-19 years old seeking consult at Philippine Children's Medical Center regarding cervical cancer screening and HPV vaccine.

DESIGN: Cross-sectional survey of mid to late adolescents.

METHODOLOGY: The survey questionnaire consists of 18 items in the domain of knowledge, attitudes, practice behaviors, barriers and demographic information. Survey forms in a sealed envelope were given to adolescents 14 to 19 years old after obtaining their assent and parents/guardians' consent.

RESULTS: There were a total of 107 respondents; majority belonged to the mid adolescents (14-16 years old), high school level and non sexually active 57%, 64% and 62% respectively. Most of the respondents (60%) were in a relationship or had a boyfriend, 61% engaged in a monogamous sexual relationship with their partners, 10% had 2 partners and 15% had more than 3 partners. There were significantly more late adolescents who are sexually active compared to mid adolescents (67.4% and 14.8%). Awareness of cervical cancer screening is only 23% of the surveyed adolescents (mean age 16.36). Majority of the sexually active respondents knew that HPV infection is through vaginal intercourse, and that pap smear is necessary even if no history of cancer in the family. More respondents with high education knew that avoidance of sexual intercourse, using condom and vaccination are all effective methods of HPV infection prevention. 53% of the respondents heard about HPV vaccine. Sources of information were mostly from the mass media. Majority were willing to receive the vaccine especially if given for free.

CONCLUSION: Knowledge on HPV and Cervical cancer prevention especially through pap smear is poor. Health education and improvement of personal practices should be emphasized as necessary factors for preventing HPV infection acquisition.

BACKGROUND: Lupus nephritis is very common complications in SLE, with clinical symptoms of renal involvement occurring in 30%-70% of patients. Outcomes in children with proliferative lupus nephritis (PLN) show 9-15% progress to end-stage renal disease (ESRD) at 5 years.

OBJECTIVES: This study compared the outcome of children and adolescent patients with lupus nephritis treated with 9 month versus 6 month induction of cyclophosphamide therapy. Renal frequency and adverse effects of IV cyclophosphamide during and after induction therapy were described and determined.

DESIGN: Retrospective Cohort Study

SETTING: Tertiary Hospital

METHODS: Retrospective cohort study comparing 6 and 9 month protocol of IV cyclophosphamide for lupus nephritis were conducted in a government tertiary pediatric hospital in the Philippines. A total of 39 patients with lupus nephritis were gathered, 23 patients underwent 6 months and 16 patients underwent 9 months protocol.

RESULTS: The comparison of two protocols in the administration of intravenous cyclophosphamide (IVCY) did not show significant difference between the two in terms of changes in GFR levels, but some evidence of a greater percent increase from baseline with the 6 months protocol post treatment were observed. Among 39 subjects, creatinine, albumin and urinalysis profile did not also differ between the two groups and levels within each group changed insignificantly over time up to 24 months. Proportion of subjects with renal flare ups, adverse effects and who expired during the study period were also essentially similar between the two groups.

CONCLUSION: IV Cyclophosphamide seems efficacious if given at the very beginning of the flare and at the start after patient was diagnosed with lupus nephritis. No statistically difference between the duration of the protocol. Renal flare ups and adverse effects of cyclophosphamide such as nausea, vomiting and headache were observed similarly between two protocols. Diligent follow up is needed for further studies and specificity of the results.

BACKGROUND AND OBJECTIVE: Kawasaki Disease (KD) is the leading cause of acquired heart disease in children in developed countries. We aimed to determine the predictors of intravenous immunoglobulin (IVIG) resistance based on clinical manifestations and laboratory parameters.

METHODOLOGY: This was a retrospective cohort study of classic KD patients.    

RESULTS: Two hundred and ten patients were included in the study. The mean age was 2.0 ±1.8 years old with slight female predominance at 51.4%. Seven (3.3%) cases were found to be IVIG resistant. There was no significant difference in age, clinical manifestations or fever duration.  Univariate analysis revealed that IVIG resistant group had a heavier weight with mean of 16.4 kg ± 12.2 compared to the IVIG responder group 12.2kg ± 4.8. The IVIG resistant group had a higher white blood cell count of 23.9 ± 7.8 compared to the responder group of 17.9 ± 6.5.                           

CONCLUSION AND RECOMMENDATIONS: There is an IVIG resistance rate of 3.3% among classic KD patients. A high white blood cell count and weight are probable predictors for IVIG resistant KD. We recommend a larger sample size of resistant cases and a case-control multicenter study.

BACKGROUND AND OBJECTIVE: Conventional red cell transfusion formulae used in clinical practice has shown underestimation of the actual post-transfusion hemoglobin level. To address this problem, we aimed to determine if there is an agreement between computed and actual post-transfusion hemoglobin levels using an alternative red cell transfusion formula.

METHODOLOGY: This was a prospective, cross-sectional study. Using Morris' formula, the red cell volume requirements of the participants were computed and post-transfusion hemoglobin levels were obtained for comparison.

RESULT: Majority of the 116participants belongs to age between 2 to 5 years (39.5%) and female (54.3%). Most common indication was hemoglobin level < 7 g/dL with manifestations of anemia (56%). The computed and actual post-transfusion hemoglobin were in agreement. The increase in hemoglobin had direct relationship to the volume of blood transfused and inverse relationship to the age and weight of the patients.

CONCLUSION: Using Morris' formula, the computed and actual post-transfusion hemoglobin values were in agreement. The volume of transfused red cells, age, and weight are predictors of the increase in post-transfusion hemoglobin. This formula can be adopted for Filipino pediatric patients and can obviate the need for hemoglobin determination after transfusion.

BACKGROUND: The diagnosis of asthma is difficult to establish using spirometry in children below 5 years old. Tidal breathing analysis (TBA) can provide useful information about lung function in infants and young children, as it is effort-independent. 

OBJECTIVES: To determine if baseline and post-bronchodilator ratios of the time and volume until peak expiratory flow to the total expiratory time and volume, (tPEF/tE and V PEF/V E) can distinguish asthmatics from normal children.

METHODS: This is a cross-sectional study wherein 146 children ages 6 months to 5 years old completed TBA before and 15 minutes after administration of 250?g of salbutamol via nebulization. Children 3 years old and below who did not cooperate were given sedation with oral diphenhydramine (1mg/kg/dose). The tPEF/tE and VPEF/VE were compared between the controls and asthmatics.

RESULTS: In children below 2 years old, the baseline tPEF/tE of asthmatics and non-asthmatics were 29.6  ± 13.8and 22.0 ± 6.6. The area under the curve (AUC) was 0.649 attPEF/tEof 32.250, with a sensitivity and specificity of 50% and 97%. The baseline VPEF/VE of asthmatics and non-asthmatics were 32.7 ±12.4 and 26.0 ± 4.9.AUC was 0.661 at VPEF/VEof34.500, with a sensitivity and specificity of 50% and 97%.In subjects 2 to 5 years old, the baseline tPEF/tE of asthmatics and non-asthmatics were 35.3 ± 14.7 and 35.0 ± 13.1. The baseline VPEF/VE were 37.0 ± 12.3 and 36.7 ± 10.7. After salbutamol nebulization, the tPEF/tE of asthmatics and non-asthmatics in all ages were 30.9±13.7 and 27.9± 10.8. The VPEF/VE were 34.1± 11.4 and 30.9± 9.0.

CONCLUSION: Baseline tPEF/tE and VPEF/VE can distinguish asthmatics from non-asthmatics in children below 2 years old. However, baseline tPEF/tE and VPEF/VE in children 2 to 5 years old and post-bronchodilator tPEF/tE and VPEF/VE in all ages could not distinguish asthmatics from non-asthmatics after nebulization with 250?g of salbutamol.

BACKGROUND: The burden of sepsis is global despite measures to improve its prompt recognition. However, there is no single reliable parameter for its early detection. Heparin-binding protein (HBP) is a new and promising biomarker for sepsis. Presently, there are no published reports in children apart from a limited study on UTI.

OBJECTIVE: To evaluate the role of HBP as a diagnostic tool and prognostic marker of sepsis syndrome among pediatric patients.

METHODS: This prospective cohort study enrolled pediatric patients who were categorized as SIRS or sepsis syndrome. HBP assay was determined on Day1. Likewise, blood culture was taken. A 7-day observation period using PELOD scoring was done. Final category as SIRS or sepsis syndrome was done on Day7. Statistical analysis was done to know relationship of HBP level to SIRS and sepsis.

RESULTS: 106 patients were included in this study. There was statistical significance in the correlation of HBP assay with presence of growth in blood culture and toxic granulations, length of ventilator support, and development of complications including mortality. The cutoff point was >125ng/mL. Sensitivity and specificity for HBP in sepsis syndrome were 98.31% and 97.87% respectively. Positive predictive value was 98.3%. Negative predictive value was 97.9%. Positive likelihood ratio was 46.2. Negative likelihood ratio was 0.017. Risk ratio was 47.6. Subjects with HBP level of >125 ng/mL had 47.6 times the risk of having sepsis syndrome as compared to those with level

CONCLUSION & RECOMMENDATIONS: Elevated HBP level is a useful diagnostic and prognostic marker for childhood sepsis syndrome. Determination of HBP levels at different time intervals within a longer observation period may give a more accurate description of subject's clinical improvement or progression to MODS or mortality.