Neurologic infections are related to chronic and life-long neurologic impairment. We aim to describe the outcomes of Filipino children with neurologic infections upon, and within one year from discharge. This data will be useful in developing programs for the prevention and improvement of outcomes in children with neurologic infections. Methods: This is a multicenter, cross-sectional, retrospective cohort study at six tertiary hospitals across the Philippines within four years (2007-2010). A standardized report form was used to collect clinical profile and outcome using inpatient and outpatient records. Neurologic outcome was classified and staged at 3-, 6-, 9- and 12-months postdischarge. Results: A total of 480 patients were included in the analysis (mean age 4.7 ± 5.3 y), most were bacterial in etiology (275 cases, or 57.3%). Severity of illness on admission (Stage 3, p <0.001) and etiologic agent (viral, p <0.001) were correlated with poor neurologic outcome on discharge. Of the 154 patients that had follow-up, 91 cases were observed to have neurologic deficits (severe, 50; moderate, 29; and mild 12). Twenty patients had improvement of neurologic impairment on subsequent follow-up. Motor deficits (64 cases), cognitive disorders (26 cases) and seizures (17 cases) are the most common neurologic sequela

OBJECTIVE

The aim of this study was to compare the outcomes of the shunted and non shunted group of children with tuberculous meningitis hydrocephalus. Another objective is to determine the applicability of the Palur classification and treatment algorithm in managing Filipino children with TBM hydrocephalus.

METHODS

Forty nine children that satisfied the criteria for a probable TB meningitis with hydrocephalus in a tertiary hospital were reviewed. Frequency statistics, Chi square and Fischer Exact Test were used
to describe the data collected.

RESULTS

There were 24 males and 25 were female chi ldren. The average age on admission was 9 months. Thirty-one patients were managed medically and eighteen underwent neurosurgical intervention. Of the 31 medically managed, 26 were on stage II and 5 were on stage Ill. Eighty percent of these
medically managed patients survived and six children died. There were 8 children who underwent serial lumbar tap in combination with acetazolamide. Eighty seven per cent of these patients improved as compared to 78% among those on oral acetazolamide alone. Of the 18 children managed surgically, 7 were on stage II and 11 were in stage Ill. Eighty eight percent of these shunted patients survived and 2 children did not improve. Outright VP shunting showed more improvement compared to TV prior to VPS. Early or delayed timing in shunting did not affect outcome on discharge.

CONCLUSION

Medical management still plays a role in treating stage II patients using the BMRC classification and a much higher percentage of survival was noted among patients falling under grade II TBM according to Palur grading. Despite the clarity of the protocol recommended by Palur, treatment and classification should be individualized and based on the local experience of each setting.

Human ; Hydrocephalus

OBJECTIVE

The aim of this study was to compare the outcomes of the shunted and non shunted group of children with tuberculous meningitis hydrocephalus. Another objective is to determine the applicability of the Palur classification and treatment algorithm in managing Filipino children with TBM hydrocephalus.

METHODS

Forty nine children that satisfied the criteria for a probable TB meningitis with hydrocephalus in a tertiary hospital were reviewed. Frequency statistics, Chi square and Fischer Exact Test were used
to describe the data collected.

RESULTS

There were 24 males and 25 were female chi ldren. The average age on admission was 9 months. Thirty-one patients were managed medically and eighteen underwent neurosurgical intervention. Of the 31 medically managed, 26 were on stage II and 5 were on stage Ill. Eighty percent of these
medically managed patients survived and six children died. There were 8 children who underwent serial lumbar tap in combination with acetazolamide. Eighty seven per cent of these patients improved as compared to 78% among those on oral acetazolamide alone. Of the 18 children managed surgically, 7 were on stage II and 11 were in stage Ill. Eighty eight percent of these shunted patients survived and 2 children did not improve. Outright VP shunting showed more improvement compared to TV prior to VPS. Early or delayed timing in shunting did not affect outcome on discharge.

CONCLUSION

Medical management still plays a role in treating stage II patients using the BMRC classification and a much higher percentage of survival was noted among patients falling under grade II TBM according to Palur grading. Despite the clarity of the protocol recommended by Palur, treatment and classification should be individualized and based on the local experience of each setting.

Human ; Hydrocephalus

OBJECTIVE

To compare intravenous, buccal midazolam & rectal diazepam in abating seizures in an emergency setting. Study design: Prospective, non-blinded, Randomized Controlled research.

METHODOLOGY

Children aged 1 month -18 years who presented and developed active seizures in the emergency room in a tertiary hospital from May 1, 2006 -April 30, 2007 were included. Those who have received rescue treatment at home or pre- hospital, with known allergic reaction to either midazolam or diazepam were excluded. Daily randomization sequence was done by drawlots. The dose of buccal/ intravenous midazolam and rectal diazepam administered was designed to give about 0.5mg/kg. Standardized data form was used to record demographic data, adverse effects, seizure type, duration, time to terminate and seizure recurrence. The primary outcome measure was the cessation of clinical seizures within 10 minutes of administration of the randomized drug. If the child was still seizing despite the 1^st treatment line, additional medication was based upon the seizure management protocol of the section.

STATISTICAL ANALYSIS

Pearson correlation coefficient, Chi square, Kruskal Wallis Test.

RESULTS

A total of 34 patients were enrolled in the study. Six were randomized under the rectal gtoup while 15 & 13 children were assigned to the intravenous & buccal Midazolam group respectively. There were l O (29%) females & 24 (71 %) males with age range from 1 month up to 15 years. The top 3 etiologies of the seizures included epilepsy 35%, CNS infections 23% & hyperi:ensive encephalopathy 1 8%. With rectal Diazepam, the mean time to control seizure was 5 minutes & was effective in all (1 00%) patients. With intravenous Midazolam, the mean rime to control seizures was recorded at 7 minutes & 33 seconds & was effective in 14 of 1 5 (93%) subjects. The patients under the buccal route responded similarly with the intravenous Midazolam group with cessation of seizures in 12 of 13 (92%) children. Comparing the three-treatment group using Kruskall Wallis, KW value of0.619 is not significant at 0.05 levels. The seizures of32 (94%) of the subjects were controlled within 10 minutes. Comparing seizure duration with rime to control the attack using the Pearson Correlation, this yielded a coefficient of 0.203 and found to be not significant at 0.05 levels. Comparing the seizure recurrence of the three treatment arms using Chi-square, it showed x2 value of 24.824, which is significant at 0.05 levels. There were no adverse effects reported in chis study.

CONCLUSION

Buccal Midazolam is safe & effective in cessation of seizures in all age groups irrespective of the type and etiology of seizures. There was no statistical significance in time to terminate seizures between the three treatment groups. It has the additional advantage of ease in administration and less seizure recurrence.

Human ; Therapeutics ; Seizures ; Midazolam ; Diazepam ; Emergencies