Clinical and laboratory profile, management and outcome of pediatric SARS-CoV-2 infection admitted at the Philippine General Hospital

Background@#The Philippines has recorded over 470,000 COVID-19 cases in children, with over 1,500 deaths during the same period. Although a Philippine online pediatric COVID-19 registry exists, this only relies on passive surveillance.@*Objectives@#This study determined the clinical and laboratory profile, risk factors for severe COVID-19, and mortality, management, and outcome of pediatric SARS-CoV-2 patients admitted at the Philippine General Hospital (PGH) from April 2020 to June 2022 to fill in knowledge gaps on the epidemiology of COVID-19 infection in children.@*Methods@#This was a retrospective cohort study of pediatric COVID-19 cases admitted at the PGH, a designated COVID referral center during the study period. Demographic and clinical profile, risk factors, comorbidities, laboratory and radiologic findings, management, and outcomes across different disease severity states were gathered by chart review and the data were analyzed using STATA 17. @*Results@#There were 448 pediatric patients admitted and diagnosed with COVID-19 during the study period. Most patients belonged to the 1-5-year age group (25.9%), had no known exposure to a COVID-19 case (65.4%), were mild cases (37.3%%), and did not receive any dose of the COVID-19 vaccine (96.7%). The most common presenting symptoms across all disease categories were fever (44.4%), cough (28.6%), and shortness of breath (26.6%). Multisystem inflammatory syndrome in children (MIS-C) presented with fever (100%) and rash (53.9%). The risk factors for severe disease were the presence of a congenital anomaly lung disease, and elevated procalcitonin. Most patients with MIS-C were previously well with no comorbidities. Laboratory findings which were markedly elevated among severe and critical cases were ESR, CRP, D-dimer, LDH, and IL-6. Ferritin, procalcitonin (PCT) and IL-6 were elevated only in severe to critical COVID-19 cases and remained within normal for the other disease categories. As to treatment, asymptomatic, mild, and moderate cases were given supportive medications (zinc, vitamin D, and vitamin C), while investigational drugs particularly corticosteroids, IVIG, and remdesivir, were used in severe cases. Antibiotics were given to 71.7% of patients at the outset. As to the outcomes, 89% recovered, while 8.9% died. The case fatality rate from COVID-19 infection was at 2.2%.@*Conclusion@#Admitted pediatric COVID-19 cases are generally mild but admission is due to underlying illness or comorbidities. Those with severe to critical cases have underlying comorbidities and had either progression or complications due to COVID disease. D-dimer, LDH, IL-6, ferritin and procalcitonin were elevated among severe and critical cases which can be utilized as inflammatory markers.

What authors ought to know

@#The Pediatric Infectious Disease Society of the Philippines (PIDSP) Journal has been in circulation since 1996. To this day, it remains to be indexed in the Western Region Pacific Index Medicus (WPRIM), the regional bibliographic index of medical journals published by Member States of the Region. A major target for the journal this year is the planned transition to an online manuscript submission and review system. E-REVIEWS or Enhancing Research Dissemination Via An Efficient Web-based Journal Management System is underway. Preparations for wider indexing is a not too distant project. As the journal committee continues to raise the bar with its timely and relevant publications, we perceive the need for a more comprehensive Publication Ethics and Publication Malpractice Guideline based on the Code of Conduct and Best Practice Guidelines for Journal Editors of the Committee on Publication Ethics. For this reason, the Journal Team is featuring the first of a series of guidelines related to ethics in medical publication to govern all stakeholders.

Enhancing research dissemination via an efficient Web-based Journal Management System (E-REVIEWS)

Background/Objectives@#The current manual processes of manuscript submission, screening, review, and editorial management in the Pediatric Infectious Disease Society of the Philippines (PIDSP) Journal rely heavily on email exchanges between the authors and journal manager, who acts as the liaison for the editors-in-chief (EIC) and peer reviewers. This method proves inefcient. To address this, the PIDSP Journal Editorial Team created E-REVIEWS, aimed at streamlining journal procedures to boost manuscript submissions, and ensure timely publication. @*Methodology@#E-REVIEWS was developed using Python as the primary computer programming language and Django as the web framework. Gitlab served as the repository and facilitated the turnover of the software requirements from developers to PIDSP website administrators. Extensive internal testing preceded the system’s deployment to the PIDSP Journal website for real-world use. @*Results@#E-REVIEWS yielded 11 modules, each with unique functionalities including Registration/Login, Accounts Management, Dashboard, Author Submission, EIC Initial Screening, Similarity Check, Review, Revisions, Manuscript Layout, Editorial, and Help. Deployment to the PIDSP website occurred on May 13, 2024. Two manuscripts underwent screening, review, and editorial processes seamlessly through the system. Identified bugs were promptly addressed.@*Conclusion@#The development of E-REVIEWS hopes to revolutionize research dissemination, ensuring data privacy via its user-friendly automated online manuscript submission, peer review, and editorial process.

Clinical profile and treatment outcomes of acute cholangitis in children in a Tertiary Government Hospital in the Philippines: A five-year retrospective study

Background@#Acute cholangitis (AC) in children is a rare but life-threatening infection. Symptoms vary from mild to severe disease. There are no local published data on pediatric AC.@*Objective@#To determine the clinical, biochemical, ultrasonographic, microbiologic features, and treatment outcome of pediatric patients with definite AC.@*Methodology@#Cross-sectional study using medical records of pediatric patients diagnosed with definite AC based on the Modified Tokyo Guidelines of 2018 admitted from January 2016 to June 2021.@*Results@#Twenty-seven patients aged 0 to 18 years old (10.06 + 7.34), predominantly male (51.85%) were included. Choledocholithiasis (22%) and post-Kasai biliary atresia (22%) were the common underlying biliary conditions. Fever (88.89%) was the most frequent presenting symptom. Majority were classified as moderate AC (40.74%). Leukocytosis (mean 16×109/L), elevated inflammatory markers (93.33% with CRP >12mg/L and 100% with serum procalcitonin >0.25ng/mL), hyperbilirubinemia (total bilirubin 192.54±126.87umol/L) and elevated alanine transferases (mean 59 IU/L) were noted. Twenty-one out of 27 cases (87%) had a negative blood culture. Only 4 patients underwent bile culture, of which two (50%) grew Klebsiella pneumoniae resistant to empiric antibiotics. Dilated biliary ducts were observed on abdominal ultrasound in 92.59% of patients. Ampicillin-sulbactam (29.63%) was the most commonly utilized antibiotic. Discharge rate was high (88.89%).@*Conclusions@#AC affects all pediatric age groups but clinical presentations vary. Drug resistant organisms are a significant concern but despite this, favorable outcomes have been documented.

Toil and dream on

@#The editorship came in as a big, BIG surprise. This with a bang and the news that our dear EIC (over the last 15 years), Dr. Cecilia Maramba-Lazarte will relinquish her post. The whole gamut of human emotions came into play as if I were this character Riley from “Inside Out”(Disney). I felt overly surprised. There was sadness, disgust, even fear. Anger? Angst? There was no perfect word to describe what it felt to be tasked to carry on and bring further “THE PIDSP JOURNAL”.

Clinical profile of pertussis among pediatric patients admitted at the Philippine General Hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The aim of this research was to describe the epidemiologic, clinical laboratory and microbiologic characteristics, complications and outcome of pertussis among pediatric patients at the Philippine General Hospital.<br /><strong>METHODS:</strong> A retrospective chart review was performed which included pediatric patients with final diagnosis of pertussis, both clinical and laboratory -confirmed admitted from December 2012 to August 2013 at the Philippine General Hospital. <br /><strong>RESULTS:</strong> This chart review included 28 pertussis patients highest in those aged 1-3 months (86%), females (57%) and from region 4A (57%). 26 (93%) had exposure to household members with respiratory symptoms and unknown pertussis vaccination status. Of those patients who were eligible for vaccination, only 24% received age-appropriate DPT vaccination.<br />Onset of illness varied from 3-56 days; majority 9/L, range: 14.7-111.5x109/L;), lymphocytic predominance (mean lymphocyte 0.47, range: 0.20-0.72;) and thrombocytosis (mean platelet count: 567x109/L, range: 269-823x109/L;). 28% were culture positive for B. pertussis, while 86% tested positive for PCR.<br />The most common complications  were pneumonia requiring mechanical ventilation (64%), ARDS (28%), seizures (21%), nosocomial pneumonia (11%) and myocarditis (11%). The average length of hospital stay was 7.4 days with 13 deaths or 46% case fatality rate. Deaths were attributed to respiratory failure due to progressive pneumonia and ARDS. Other contributing causes were arrhythmia, MODS, and  septic shock.<br /><strong>CONCLUSION:</strong> Susceptible young infants acquire pertussis from household contacts with respiratory symptoms. Paroxysmal cough and cyanosis are common clinical features, with leukocytosis, lymphocytosis and thrombocytosis. High case fatality rate for pertussis was noted among these patients.<br /><br /></p>

An epidemiologic investigation of chronic osteomyelitis among pediatric patients admitted from 2006 to 2010 at the Philippine General Hospital

Background@#Osteomyelitis is a debilitating disease if not properly treated. Epidemiologic and microbiologic data will be of great importance in the direction of treatment. @*Objective@#To determine the epidemiologic and clinical profile of pediatric patients with chronic osteomyelitis admitted at Philippine General Hospital from 2006 to 2010. @*Methodology@#This is a retrospective study involving a review of medical records of pediatric patients with chronic osteomyelitis admitted at the Philippine General Hospital during the 5 year study period. Frequencies and percentages were computed for nominal data. Comparison of the different variables was done using Chisquare and Fisher Exact test. @*Results@# Eighty of the 134 cases of pediatric patients with chronic osteomyelitis were reviewed. Twenty-three percent of all operations involved the femur (N=18) and tibia (N=18). On radiograph, the presence of sequestrum was the most common finding noted in 53% of the cases. The predominant organism isolated in bone cultures was MSSA (40%) followed by MRSA (20%). On tissue cultures MRSA was the most common isolate in 34%, followed by MSSA(31%). Majority of the patients were given Oxacillin as empiric therapy (55%).No significant difference was observed with respect to the areas of bone involvement, signs and symptoms, radiologic findings and laboratory parameters between MSSA and MRSA osteomyelitis (p>0.05). @*Conclusion@#There were 239 per 100,000 cases of chronic osteomyelitis. The most common bones involved were the femur and tibia with sequestrum as the most common radiologic finding. In the previous studies, MRSA was not reported but was noted in the present study. Most of the patients in our study were treated with both antibiotics and surgery to optimize management. Ninety-eight percent of the cases had significant clinical improvement upon discharge. Based on this study, laboratory parameters, clinical manifestations and area involved cannot be utilized in differentiating MRSA from MSSA osteomyelitis. Further studies are needed to support our findings and isolation of the organism is still required for definitive identification to distinguish between MRSA from MSSA osteomyelitis.