Treatment of pneumonia in children (a report of 414 cases in 1945)

1. From February 1945 to February 1946, 414 cases of pneumonia were observed in the Childrens Department of the North General Hospital. This number was 300 more than the number of cases treated in the same hospital in 19442. In the series of 414 cases in 1945, the recovery rate was 62.5% and the fatality rate was 1.9% as compared to the recovery rate of 38.0% and fatality rate of 17.7% in 19443. Common childhood diseases like acute respiratory infections and measles are frequent predisposing conditions to pneumonia; and, definitely, infants below one year were found highly susceptible4. Penicillin and sulfadiazine were effective in the treatment of pneumonia; the average amounts given were 432,000 units and 16.6 grams respectively for a period of approximately 5 days. The response in the two groups was almost identical5. Although there were slightly more toxic manifestations with sulfadiazine (3.0%) than with penicillin (1.6%), they were neither permanent nor severe enough to cause alarm or even fear for the former drug6. Under present circumstances, since adequate doses of either drug will produce identical and an equally satisfactory response in moderate and uncomplicated cases, the cost availability, and case of administration make sulfadiazine a satisfactory drug, provided proper precautions are taken. (Conclusion)

Observations on the use of sulfamerazine in 200 children at the North General Hospital

1. A group of 200 children who received sulfamerazine for infections in which chemotherapy was felt to be indicated, were observed at the North General Hospital during the period from 1946-19472. The youngest was a two-day old infant with bilateral bronchopneumonia; and the oldest, a boy of 15 with basal pneumonia3. Eleven cases showed mild, transient, toxic reactions, of which crystalluria was the most common4. Clinical improvement in bronchopneumonias was observed by the second dose. The response in asthmatic bronchitis was even more remarkable. The average dose used in moderate cases was 4.9 grams in 3.5 days5. The recovery rate in the group of bronchopneumonias was 75.9 per cent; and death rate, 0.73 per cent6. The blood showed no change in the red cells and hemoglobin. There was a drop in the leucocytes to nearly normal. The neutrophiles were diminished, with a corresponding rise in the lymphocytes7. While we are not in a position to deduce from these observations that sulfamerazine is a better sulfonamide than sulfadiazine, we may state that the longer interval of administration, the smaller dose, and the relatively few and mild toxic reactions make it a very satisfactory chemotherapeutic drug. (Summary)

Ascariasis in children and the response to hexylresorcinol

1) A group of 347 children were observed for ascariasis in the Childrens Department of the North General Hospital2) Expulsion of ascaris and recurrent abdominal pain were the most common complaints on admission3) Children under four years comprised the most infested group. Sex had no bearing on the incidence of ascariasis4) Twelve patients presenting manifestations of acute abdomen were studied. All were over five years of age. Only one was operated on, but he was given hexylresorcinol treatment postoperatively. The other eleven cases were treated conservatively, and they were given hexylresorcinol therapy5) Of the 331 cases treated, 75.8% expelled ascaris, and, in most of them, this occurred 24 hours after administration of the crystoids. Most of them expelled less than ten ascaris immediately after therapy; but thirteen passed countless ascaris, and seven passed balls of worms6) Only 6 cases showed some untoward effects, of which first-degree burns of the buccal nucosa was the most common. All these, however, were very mild and transient. (Summary)

Cooperative efforts between private medical and government health sectors in the Philippines through maternal and child health services

This paper describes how the Institute of Maternal and Child Health, a private institution, has joined hands with two entities of the Department of Health, in its extension projects to various provinces and rural areas. These two offices in the government are the Office of Health Education and Personnel Training and the Division of Maternal and Child HealthThe projects consist of Training Programs on Maternal and Child Health in the Institute in Quezon City and in the field (Health Regions 2 and 7) and also Extension Services in the provinces (Rehydration Centers and Pediatric Teams). All these represent cooperative efforts between private medical and government health groups in carrying out health activities for the country. (Summary)

An antibody survey as an index of immunity to poliomyelitis among Filipinos (1963)

Sera of 1078 healthy individuals in Manila and neighboring provinces were tested this year (1963) for neutralizing antibodies against each of the three types of polio virus. Individuals tested had not been vaccinated against polio. They ranged in age from 1 month to 25 years and over; the majority were children between 1 to 9 years old: Under 6 months old, 92 were positive for neutralizing antibodies, presumably from the mother through placental transfer. This prevalence rate decreased in the 6-12 month group (61.85), to increase again in age groups 1 to 4 years old. Apparently, these would be the two groups that should be given priority immunization where the vaccine supply is limited. By 5 to 9 years old, 98 were positive for polio antibodies and this rate rose to 100 in the 20-24 year groupThe present study did not include observations on the socio-economic factors in view of the need for detailed consideration of many combined factorsIt was not possible either to determine changing patterns of polio infection as compared to the first work of Hammon (1955) in view of a great difference in the number of individuals tested in these two surveys. (Summary)

A report on the pediatric education seminar Western Pacific Region, World Health Organization Manila, February 13-18, 1967

The regional office for Western Pacific Region, covering 14 countries, has felt the need to investigate and discuss present methods of pediatric teaching and to find out ways of improving pediatric education to meet the needs of these countries. As a WHO release states (WHO-WPI Jan. 67): "The plight of children in a developing countries is still a grim picture ! Disease and death among infants and children in the tropics are still very high, due to the combination of malnutrition, bad hygienve and faulty environment which create a favorable ground for infections and parasitic diseases. Ignorance, poverty and certain harmful traditional practices are also to blame. (Author)

Combined immunization against diptheria, pertussis and tetanus using the triple toxoid - a follow-up of 1,286 cases

A total of 1,286 children, whose ages ranged from three months to 13 years were immunized against diphtheria, pertussis, and tetanus, using the combined alum-precipitated toxoid. The local and systemic reactons are described. Fever was the most frequently encountered reaction. No neurologic complications occurred. The incidence of reactions was less in the older age group, contrary to what has been reported in the literature. Among the immunized children, not one case of diphtheria, pertussis, or tetanus has developed to date. There was one diptheria suspect, but this proved to be negative bacteriologically. (Summary)

Rehydration centers in seven pilot areas in the Philippines

In 1963 the Childrens Medical Center, Philippines, has embarked on a more practical, realistic, and aggressive participation in reducing the incidence and deaths from diarrheas, than it has done in the past. We have felt that persistently high morbidity and mortality statistics for diarrheas warrant something more than short post-graduate courses or seminars on diarrheas for practitioners or treatments of dehydrated patients in this hospitalThus since December 1963 we have organized two pediatric teams of five members each and we have extended our experiences and current knowledge of the management of diarrhea to seven pilot areas in the country, namely Leyte del Sur, Marinduque, Mindoro, Jolo, La Union, Cagayan and SorsogonBesides the curative aspects of diarrheas with emphasis on the establishement of rehydration centers, the objectives of the present project include prevention and seeking of epidemiologic information and etiologic factors, both contributory and exciting. Awareness of a more concetrated attack on diarrheal disease and the need for a multidisciplinary approach to its control is brought into focus. (Summary)

Anaphylactoid purpura associated with cutaneous necrosis and gangrene and its treatment with dextran infusions

A case of a 4-year old Filipino female with anaphylactoid purpura complicated by cutaneous necrosis and gangrene was herein reported. Therapy with 6% Dextran infusions was dramatic and rewarding as evidenced by cessation of further progression of the ischemic lesions and the eventual drying up of almost all cutaneous manifestations. Mention was made of the extreme rarity of the present case as attested by only a few cases so far reported in the literature. (Summary)

The role of national medical associations in the formulation and implementation of national population policies and programmes

Lord Caradon in one of his speeches said that "if dealing with the problems of population are left too late, then all our economic and political achievements would be swept away like sand castles before an advancing tide". And so, our message to everyone must denote and connote some urgency because the turn of the country is just around the corner or at the bend. We all recognize and accept the role of the citizen tne volunteer, the employed. In fact, a place in the scheme of things for each. But getting commitment and pursue with increasing interest and vigor, the work momentum of all, through persistent and contained sharing, should keep us moving forward and progressing relentlessly and force-fully towards our principal aim and primordial objective, avowed intention, and desired purpose which is to enhance the quality of lifeExecutive Director Rafael Salas of the UN Fund for Population Activities reminds us that existing difficulties in providing food, training, education, medical attention and employment are going to compound themselves in accelerated ratio to population increase, unless rational solutions are sought and action taken, not when swollen populations are a reality, but now. This is the real objective of WPY, "Action Now". National medical associations by virtue of their organization constitute influential channels through which physicians can exert collective leadership, and action must be now.(Conclusions)

Health picture under one year old as depicted in Philippines health statistics (1966)

In the Philippines, significant gains have been attained in saving infant lives during the past 46 years, with a 58.0% decrease. Thus our infant death rate of 156.7 for 1920 was reduced to 65.5 per 1000 live births in 1966. The present rate, however, continues to be high as compared with most countries, including those around us. Among progressive countries this rate is now only between 10 to 15The Philippines is the fourth in the prevalence list of TB infections among 59 countries tabulated by WHOLosses in the newborn remain high in most countries but patricularly so in developing countries like the Philippines where the latest neonatal death rate remains at 31.2. In fact, in this country, fully half of those who die under one year are in the first month of life and one-fourth of deaths in the newborn period are less than a day old. It is evident that circumstances around birth demand attention if we are to save infant livesIt appears that only about 43.8% of infants who died in 1966 received medical attention which was given by health officers, private practitioners and hospitals in about equal proportions (about 12% each)Only 20% of births took place in hospitals during the year. About 56% of total deliveries were attended by doctors, nurses and midwives. A good 44% of births were attended by traditional midwives or other untrained individuals. It is no wonder that neonatal mortality has remained high and that infections and preventable conditions have no been eliminated among the ten leading causes of neonatal deaths.(Conclusions)

Mass screening of tuberculosis among Filipinos by the Heaf test and its comparison with the Mantoux test

1. In 1962 and 1963 a study was conducted by the authors to determine the usefulness and practicality of the Heaf test for mass screening of tuberculosis2. The study group consisted of children and adults attending 7 public and 2 private schools and institutions in Manila and Quezon City as well as in towns and barrios in the provinces of Cavite, Laguna, Marinduque, Rizal and Bulacan. A total of 7,920 individuals were tested3. The Heaf test was positive in 24.2% of 7,920 children and adults tested4. Reactors to the Heaf test vary in different localities thus: in cities these reached, 22% in towns 27% and in barrios 21%5. The reactor group was found to increase proportionately with icreasing age, which is the usual finding in almost any tuberculin survey by any test used6. In this study, we observed the equivalent of reactions for Heaf and Mantoux tests. Thus, a reaction of 1 to 6 papules to Heaf test is the equivalent of a "soft","erythema" or an induration of less than 10 millimeters by Mantoux which is the accepted positive reaction in the Philippines, has a corresponding 10 mm. induration by Heaf7. The two tests have a high percentage of agreement being 71.6% to 92% in 10 TU and 5 TU, (96%) in which the precentage of disagreement was 4%8, Taking into account the case and convenience of testing, a reasonable overall cost, and the finding of a high percentage of agreement with the standard Mantoux test, this study gives basis for recommending the Heaf test as a mass screening test for tuberculosis. (Summary)

Dengue and dengue-like fevers in children

Dengue fever, a known tropical disease, was overlooked for many years in the Philippines until about 1956 when a virologist, Dr. W. Mcb. Hammon, in an effort to seek the etiology of a febrile hemorrhagic symptom-complex first described in 1954 by Quintos et al found in their blood samples an antibody rise and also isolated strains of dengue virus. In fact, Hammon was convinced for his viral studies that during th epidemic of hemorrhagic fevers in this country,. even influenza-like cases at that time were manifestations of an infection with the same virusThis paper presents observations in a group of 52 children, ranging from 2 to 7 years old, who were hospitalized in 1960 due to fever, headache, abdominal pain, restlessness, flushing, and often with a terminal purplish rash in the hands up to the arms and feet up to the legsThe blood count showed a shift to the left in Schillings hemogram, increase in the stab count, monecytosis and plasmocytosisHemorrhages varying in severity, site and extent (hematuria, melena, epistaxis, petechia or hematuria) were observed in 25 cases (46.1%). Blood studies revealed that the hemorrhagic tendency was the result of increased capillary fragility and permeability rather than the more common concept of thrombocytopeniaAn additional laboratory examination in this study was the hemagglutination inhibition test which has given us some light on the etiology of the symptom complex under study. (Summary)

Early diagnosis of pelvic malignancies

A short narration has been given to orient the general physician on his role in early detection of pelvic malignancy, his position being on the first line of attack. The what, how, where and why of this problem have been presented briefly. (Summary)

The clinical and antibody response to live attenuated measles-virus vaccine observations in the Philippines 1966-1967 (985 vaccines)

1. In 1966 a group of 985 individuals from different localities in the Philippines were vaccinated with Beckenham 31 strain of chick-adapted live attenuated measles virus vaccine, by one single dose injected subcutaneously or intramuscularly2. Of this group, it was possible to follow-up closely 528 individuals. The most important clinical reactions were fever (53.2%), rash (25.8%), respiratory symptom (15.9%) and tonsilitis (8.1%)3. "Vaccine-induced" measles causes mild brief symptoms as compared to "natural" measles, in patients who were observed simultaneously in the hospital4. The sero-conversion rate in 185 vaccinees showed a very good rise in 65% and a less significant rise in 21%5. Only 10.8% of the vaccinees gave no rise and these were among those who had an active immunity or detectable amounts of antibody prior to vaccination. On the whole the antibody response was good6. In this study we have enough evidence to show that immunization with the attenuated live measles virus vaccine is safe and serologically effective. (Summary and conclusions)n

The efficacy of oral electrolyte fluid in the therapy of diarrhea

The administration of an oral electrolyte solution for the provision of maintenance fluid requirement in comparable to strict intravenous fluid therapy in the management of children with acute diarrhea. This efficacy is established on definite clinical and chemical criteria set forth for this studyOral electrolyte solution has the added advantage of being more convenient to administer as it requires less nursing care, and more applicable in remote areas where facilities and equipments for intravenous therapy may be scarce, if not absent. (Summary and conclusion)

Consensus on priority pediatric health concerns in the Philippines

The objective of this conference was to get the consensus on important pediatric health programs, particularly those that are controversial, indefinite or confusing. Comments, views and experience were compiled

Community health services in a rural island setting to complement medical education in the Philippines

This project was conducted to upgrade health care in a rural community and to help realize a more realistic medical education tailored to meet the needs of a developing country. A maternal and child health program was undertaken in Marinduque based on its rural settingPreliminary findings showed an increased consciousness of health and health education was observed in the community. Medical interns and residents expressed a greater sense of responsibility, understanding, interest, and compassion for the less privilege resulting from community involvement

The efficacy of oral penicillin in children by blood level determination

Penicillin is still one of the most useful antibiotics in children. Fortunately, allergic reactions to penicillin in children are neither serious nor alarming. As it is still the drug of choice for prolonged prophylaxis and therapy in such infections as recurrent tonsillitis, recurrent oropharyngitis and rheumatic fever, the authors have welcomed the introduction of a new oral penicillin, phenoxymethyl penicillin (Pen-Vee K)Its use in 40 children with respiratory infections or other infections known to be susceptible to penicillin is reported. These studies were supported by cultures and by a new method of determining antibiotic levels using only as little as 2.5 ul of serum per determination. Our results so far are encouraging. (Summary)

Demethylchlortetracycline: laboratory and clinical observations in infants and children in the Philippines

From our observations in infants and children in the Philippines, DMCT proves to be a useful drug against infections caused by organisms within the spectrum of the tetracyclines. Side reactions are minimal. These consisted mainly of gastrointestinal upset. Both the drop and syrup form produce similar bacteriostatic serum levels which are prolonged for at least 12-13 hours even when the medication is taken after feeding. There is only a slight diffusion of the drug into the cerebrospinal fluid. (Summary)