AI assisted reader evaluation in acute CT head interpretation (AI-REACT): protocol for a multireader multicase study.

INTRODUCTION: A non-contrast CT head scan (NCCTH) is the most common cross-sectional imaging investigation requested in the emergency department. Advances in computer vision have led to development of several artificial intelligence (AI) tools to detect abnormalities on NCCTH. These tools are intended to provide clinical decision support for clinicians, rather than stand-alone diagnostic devices. However, validation studies mostly compare AI performance against radiologists, and there is relative paucity of evidence on the impact of AI assistance on other healthcare staff who review NCCTH in their daily clinical practice. METHODS AND ANALYSIS: A retrospective data set of 150 NCCTH will be compiled, to include 60 control cases and 90 cases with intracranial haemorrhage, hypodensities suggestive of infarct, midline shift, mass effect or skull fracture. The intracranial haemorrhage cases will be subclassified into extradural, subdural, subarachnoid, intraparenchymal and intraventricular. 30 readers will be recruited across four National Health Service (NHS) trusts including 10 general radiologists, 15 emergency medicine clinicians and 5 CT radiographers of varying experience. Readers will interpret each scan first without, then with, the assistance of the qER EU 2.0 AI tool, with an intervening 2-week washout period. Using a panel of neuroradiologists as ground truth, the stand-alone performance of qER will be assessed, and its impact on the readers' performance will be analysed as change in accuracy (area under the curve), median review time per scan and self-reported diagnostic confidence. Subgroup analyses will be performed by reader professional group, reader seniority, pathological finding, and neuroradiologist-rated difficulty. ETHICS AND DISSEMINATION: The study has been approved by the UK Healthcare Research Authority (IRAS 310995, approved 13 December 2022). The use of anonymised retrospective NCCTH has been authorised by Oxford University Hospitals. The results will be presented at relevant conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT06018545.

Implementing a chest X-ray artificial intelligence tool to enhance tuberculosis screening in India: Lessons learned.

Artificial Intelligence (AI) based chest X-ray (CXR) screening for tuberculosis (TB) is becoming increasingly popular. Still, deploying such AI tools can be challenging due to multiple real-life barriers like software installation, workflow integration, network connectivity constraints, limited human resources available to interpret findings, etc. To understand these challenges, PATH implemented a TB REACH active case-finding program in a resource-limited setting of Nagpur in India, where an AI software device (qXR) intended for TB screening using CXR images was used. Eight private CXR laboratories that fulfilled prerequisites for AI software installation were engaged for this program. Key lessons about operational feasibility and accessibility, along with the strategies adopted to overcome these challenges, were learned during this program. This program also helped to screen 10,481 presumptive TB individuals using informal providers based on clinical history. Among them, 2,303 individuals were flagged as presumptive for TB by a radiologist or by AI based on their CXR interpretation. Approximately 15.8% increase in overall TB yield could be attributed to the presence of AI alone because these additional cases were not deemed presumptive for TB by radiologists, but AI was able to identify them. Successful implementation of AI tools like qXR in resource-limited settings in India will require solving real-life implementation challenges for seamless deployment and workflow integration.

Multi-system Inflammatory Syndrome in Children (MIS-C) in two private, urban, tertiary hospitals in Metro Manila, Philippines

Background@#MIS-C is an infrequent, but serious complication encountered after acquiring COVID-19 illness in children. There is a lack of local data on MIS-C in the Philippines.@*Objective@#To identify demographic data, co-morbidities, clinical manifestations, laboratory results, 2D-echocardiography findings, acute co-illnesses and complications, treatment, and outcome of children with MIS-C, seen in two, private, urban, tertiary hospitals.@*Methodology@#This is a retrospective, descriptive study of all consecutive MIS-C cases, using the 2020 US CDC definition, seen between July 2020 to January 2023, by a single infectious disease physician. Demographic, epidemiologic, clinical, and physical examination findings; results of laboratory, 2-DE, and radiologic tests; co-illnesses and complications; and therapeutic and outcome data, were entered in a case report form for each patient.@*Results@#Thirty-six patients were seen. MIS-C cases had a median age of 6 years, presented with fever in 97%, while one-half had abdominal pain, vomiting, diarrhea and/or rash. CRP, D-dimer, ferritin, LDH and procalcitonin were generally elevated, and thrombocytopenia was seen in 39%. The most common 2-DE abnormalities were pericardial effusion (50%), coronary artery dilatation or aneurysm (39%) and mitral regurgitation (36%); the 2-DE was normal in 22%. The main complications were pneumonia (31%), myocarditis (28%) and hypotension (14%); 8% had ARDS. Treatment was with corticosteroids (89%) and IVIG (84%). Most (94%) recovered, and the hospital stay was five days, or less, in 86%. The two mortalities were a severely wasted adolescent with previously undiagnosed HIV infection; and an adolescent on chemotherapy for AML, who was also being treated for disseminated TB.@*Conclusions@#There is a need to create a greater awareness of MIS-C as, like Kawasaki disease, it has the potential to be an important cause of acquired heart disease among children.

A comparative study of pediatric patients with Complete vs. Incomplete Kawasaki Disease in a tertiary Hospital: An eleven year review

Introduction@#Kawasaki disease (KD) is the leading cause of acquired heart disease in childhood, but its diagnosis remains challenging since a significant number of cases do not meet the diagnostic criteria (Incomplete KD). This may delay the diagnosis and initiation of treatment, and increase the risk of morbidity from coronary artery complications.@*Objectives@#This study compared the clinical profile and treatment outcomes of children with complete and incomplete KD. @*Methods@#This is a cross-sectional, retrospective study of pediatric patients diagnosed with KD and admitted in a tertiary hospital from January 1, 2010 to December 31, 2020. Demographics, clinical manifestations, laboratories, 2D echocardiography (2DE) findings and treatment outcomes were obtained by review of medical records and analyzed using descriptive statistics. @*Results@#Among 135 patients studied, 71% were classified as Incomplete Kawasaki Disease. Majority (89%) were children more than 1 year old and predominantly male (55%). Five classic features, other than fever, were more frequent in complete KD – bilateral bulbar conjunctivitis, mucosal changes in the lip and oral cavity, polymorphous exanthem, changes in extremities, and cervical lymphadenopathy. Fever (100%), conjunctivitis (100%), rashes (97%) and oral changes (90%) were the most common findings in complete KD, while fever (100%), rashes (56%), conjunctivitis (46%) and oral changes (35%) were noted in incomplete KD. Higher CRP (167 mg/L vs. 100 mg/L) and lower albumin levels (30 g/L vs. 38 g/L) were seen in complete KD. Coronary artery dilatation (56% vs. 48%) was frequently detected in both complete and incomplete KD. Majority (96%) of cases received only one dose of IVIG and 4% needed additional treatment with methylprednisone. @*Conclusion@#The five principal features of KD other than fever, elevated CRP and lower albumin levels were significantly more common in complete cases. No significant differences in the demographics and 2DE findings of children with complete and incomplete KD were observed.

The Etiology of childhood inpatient Pneumonias in two private, tertiary, Metro Manila Hospitals from 1993-2021 seen by one pediatric infectious disease specialist

Introduction@#The scarce local data on the etiology of childhood pneumonia admitted in a hospital has come from a few urban and rural government hospitals. There is no data from private hospitals. Knowing the most likely etiology of pneumonia is of outmost importance as this has implications on the diagnostic modalities requested and the institution of therapy. @*Objectives@#The purpose of this study is to identify clinical and microbiologic diagnoses of clinically- and radiographically-confirmed pediatric pneumonia cases admitted in a private hospital. Secondarily, a discussion of specific etiologies is made. @*Methodology@#Each consecutive, inpatient, pneumonia referral/admission in either one of two private, urban, tertiary hospitals, of a child 18 years and below from 1993 to 2021 was logged into a computer daily by a single pediatric infectious disease specialist. Clinical, epidemiologic, diagnostic and therapeutic data were recorded. All pneumonia cases, except those seen in newborns before their discharge from the nursery, were included. @*Results@#Of the 496 cases, there was a clinical and/or microbiologic etiology in 43% of cases. The bacteremia rate was 6.3%. The most common identifiable etiologies were Mycoplasma pneumoniae (11.9%), Mycobacterium tuberculosis (5.2%), and Staphylococcus aureus (4.2%), while bronchiolitis (5.5%) and measles (4.8%) were the most common clinical diagnoses. There were several cases of ventilator-associated pneumonia and Pneumocystis jirovecii pneumonia. @*Conclusions@#Mycoplasma pneumoniae, tuberculosis, Staphylococcus aureus and Pneumocystis jirovecii are important pneumonia etiologies that have not been widely considered locally. The data presented here mirrors the practice of one pediatric infectious disease doctor in two hospitals where diagnostic and treatment options are readily available and utilized.

Multi-System Inflammatory Syndrome in Neonate (MIS-N) presenting as Bowel Obstruction: A case report

Background@#Since the start of SARS-CoV-2 pandemic, a post-infection hyperinflammatory process in children with features similar to Kawasaki disease, termed multisystem inflammatory syndrome in children (MIS-C),1 was identified. Thousands of MIS-C cases have already been reported worldwide.2 As possible cases of MIS-C in neonates were increasingly identified, multisystem inflammatory syndrome in neonates (MIS-N) as a distinct entity was proposed as neonates may not manifest all the typical features described in older children. @*Case Presentation@#We describe the case of a previously well term neonate with sudden signs of bowel obstruction who later had multisystem involvement (cardiac, gastrointestinal, and hematologic). The baby was born to a 23-yearold multigravida with an unremarkable prenatal history except for COVID-19 infection during her 34th week age of gestation. The mother presented with mild respiratory symptoms and resolved with supportive management. Our patient was born stable, then had sudden manifestations of feeding intolerance on the 16th day of life and upon work-up had moderate anemia, elevated inflammatory and cardiac markers, ileus, and dilatation of proximal left coronary artery. RT-PCR for SARS-CoV2 was negative. The baby was managed with intravenous immunoglobulin (IVIG) and steroids, with rapid clinical and laboratory parameters improvement thereafter. @*Conclusion@#MIS-N is still evolving as a disease entity with no clear, directed guidance yet on diagnosis and management. Management is extrapolated from treatment of MIS-C. Additional case reports and series are warranted to increase awareness and enable better understanding of the disease pathology among clinicians for timely investigation, diagnosis, and management.

Red cell distribution width and its association with Neonatal Bacteremia: A case-control study

Background@#Bacteremia is a major cause of prolonged hospital stay and mortality in neonates and its early diagnosis remains a challenge to pediatricians. Red cell distribution width (RDW) is a component of a complete blood count test which is accessible and inexpensive and has been reported to be a possible diagnostic marker for neonatal bacteremia. This study determined the association of RDW with neonatal bacteremia in term and preterm neonates. @*Methodology@#This is a retrospective case-control study of 26 bacteremic neonates as cases and 104 non-bacteremic neonates, either symptomatic or with risk factors for bacteremia, as controls. Included newborns were seen between January 1, 2010 to September 30, 2021. Laboratory data obtained were CBC, C-reactive protein and blood culture. @*Results@#RDW values between bacteremic and non-bacteremic neonates were not significantly different. There was an association between RDW and neonatal bacteremia at an RDW level of > 16.1, where the likelihood of bacteremia was three times higher compared with lower RDW values. Significantly lower levels of hemoglobin, hematocrit, RBC count, WBC count, platelet count, MCH and MCHC, and a higher CRP level were seen among bacteremic neonates compared to those who were not. The median RDW for both term and preterm neonates was close to 16, with a narrow inter-quartile range at 1 and 2 for controls and cases, respectively. The range (minimum to maximum) of RDW values of bacteremic preterm neonates was more variable than those of term neonates. Using RDW to detect bacteremia, it had an equivocal discriminatory power or AUC of 0.6056. We found insufficient evidence to demonstrate a correlation between RDW and other CBC parameters, except for MCHC. For MCHC, the results suggest a very weak and indirect correlation. @*Conclusion@#RDW was not significantly different between bacteremic and non-bacteremic neonates, but there was a suggested association between RDW and bacteremia at an RDW level of > 16.1, at which level there was a 3-fold risk for bacteremia.

A systematic review and meta-analysis on the safety and efficacy of Second Dose Immunoglobulin versus High Dose Pulse Methylprednisolone in Refractory Kawasaki Disease

Background@#There is limited information available regarding the management of IVIG-refractory Kawasaki Disease (KD). @*Objective@#This study aimed to evaluate the safety and efficacy of a second intravenous immunoglobulin (IVIG) infusion versus intravenous methylprednisolone (IVMP) in patients with IVIG-refractory KD.@*Methodology@#Cochrane Library, PubMed, Medline, Elsevier (Science Direct), Springer Link and BMJ databases were searched from May 1, 2020 to December 31, 2020. We included randomized controlled trials (RCTs) and high-quality prospective and retrospective studies, with population restricted to children 0 months to 18 years, with KD refractory to initial IVIG at 2g/kg, who remained febrile for 24-48 hours after completion of initial IVIG, and who received second-line monotherapy with either a second dose IVIG or IVMP. We conducted a meta-analysis using Review Manager [RevMan] 5.4.1 software.@*Results@#A total of six studies (n=188 patients) were analyzed. The incidence of coronary artery lesions was comparable between a second dose of IVIG and IVMP (RR 0.82, 0.34-1.96, P=0.66) in patients with IVIG-refractory KD. The rate of fever resolution to a second IVIG, compared to IVMP, was not significantly different between groups (RR 0.97, 0.84-1.13, P=0.72). There was a significantly higher incidence of adverse events in the IVMP group (RR 0.42, 0.26-0.57, P=0.0002), but these were all transient and resolved without further treatment. @*Conclusion@#There is no significant difference in the incidence of coronary artery lesions and rate of fever resolution post-retreatment with a second dose of IVIG versus IVMP in IVIG-refractory KD. More adverse events were reported in the IVMP group.

Global COVID-19 Transmission and Mortality-Influence of Human Development, Climate, and Climate Variability on Early Phase of the Pandemic.

Many of the respiratory pathogens show seasonal patterns and association with environmental factors. In this article, we conducted a cross-sectional analysis of the influence of environmental factors, including climate variability, along with development indicators on the differential global spread and fatality of COVID-19 during its early phase. Global climate data we used are monthly averaged gridded data sets of temperature, humidity and temperature anomaly. We used Human Development Index (HDI) to account for all nation wise socioeconomic factors that can affect the reporting of cases and deaths and build a stepwise negative binomial regression model. In the absence of a development indicator, all environmental variables excluding the specific humidity have a significant association with the spread and mortality of COVID-19. Temperature has a weak negative association with COVID-19 mortality. However, HDI is shown to confound the effect of temperature on the reporting of the disease. Temperature anomaly, which is being regarded as a global warming indicator, is positively associated with the pandemic's spread and mortality. Viewing newer infectious diseases like SARS-CoV-2 from the perspective of climate variability has a lot of public health implications, and it necessitates further research.

Etiology, treatment and outcome of children diagnosed with Secondary Hemophagocytic Lymphohistiocytosis in a tertiary hospital

Background@#Hemophagocytic lymphohistiocytosis (HLH) is a clinical syndrome that is associated with a variety of underlying conditions leading to the same characteristic hyperinflammatory phenotype. @*Objectives@#To describe the clinical profile of patients diagnosed with HLH admitted between January 1, 2010 to September 30, 2019 in a tertiary care hospital. @*Methods@#Retrospective descriptive study of pediatric patients diagnosed with HLH in a tertiary care hospital. @*Results@#Eleven subjects were included in the study. Age distribution showed a bimodal pattern: < 5 years old (5, 46%) and 10-15 years old (4, 36%). Male to female ratio is 4.5:1. All patients presented with fever (100%) followed by hepatomegaly (5, 45%) and splenomegaly (4, 36%) on physical examination. All eleven subjects fulfilled the following criteria for HLH such as fever, splenomegaly, and hyperferritinemia. Six out of eleven showed hypofibrinogemia (55%) and hypertriglyceridemia (55%). Among the eleven with two cell cytopenia, five presented with anemia (46%), six with neutropenia (55%), while all of them had thrombocytopenia (100%). Other laboratory findings noted were elevated ALT (5, 46%), CRP (4, 36%), AST (3, 27%), alkaline phosphatase (3, 27%), and hyponatremia (3, 27%). EBV and dengue (3, 27%) were the most common etiologies. Pneumonia (3, 27%) was the most common complication, followed by sepsis (2, 18%). All but one patient were responsive to either dexamethasone (7, 64%) and or IVIG (5, 45%) and chemotherapy (1, 9%). The antibiotic most commonly used was piperacillin tazobactam (3, 27%). The median hospital stay was 17 days. There was one mortality (9%). @*Conclusion@#HLH should be considered in children presenting with prolonged fever, hepatomegaly, and or splenomegaly, with hyperferritinemia, thrombocytopenia, anemia and neutropenia.

Fever of unknown origin among children in two private, urban, tertiary hospitals: A 27-year retrospective study

Introduction@#Fever of unknown origin (FUO) is a problem commonly encountered by infectious disease specialists, and even general pediatricians, in spite of the improvement in diagnostic modalities. There is no local study on childhood FUO from a private hospital. Thus, there is a need to determine the etiology of FUO seen in private practice, which may be different from those encountered in government or teaching hospitals.@*Objectives@#The purpose of this study is to identify the etiologies of childhood FUO from two private, urban, tertiary hospitals, as evaluated by a single pediatric infectious disease physician; and to discuss epidemiologic, clinical and diagnostic clues for the most common etiologies. @*Methods@#Childhood FUO cases were compiled from 1993 to 2020. Each consecutive, inpatient, admission or referral of a patient, 18 years or younger, was logged into a personal computer, and the discharge diagnosis for the FUO was recorded. Clinical, epidemiologic, diagnostic and therapeutic data, relevant to the FUO diagnosis were likewise recorded. FUO was defined as daily fever of 380C for ten consecutive days, or more, with no etiology identified after being admitted for seven days. @*Results@#Of 171 cases of childhood FUO, the etiology was an infection in 68%, collagen-vascular disease in 13%, miscellaneous cause in 8%, malignancy in 6%, and no diagnosis in 5%. The most common infections were Epstein Barr Virus (EBV) mononucleosis, tuberculosis, enteric fever, sinusitis, pneumonia and incomplete Kawasaki disease. The most common collagen vascular diseases were juvenile idiopathic arthritis and systemic lupus erythematosus. Hemophagocytic lymphohistiocytosis was the most common miscellaneous cause. Lymphoma was the most common malignancy. @*Conclusion@#This study found EBV mononucleosis, sinusitis, pneumonia, incomplete Kawasaki disease, lymphoma, HLH and Kikuchi-Fujimoto disease to be FUO etiologies not reported previously in other local reports.

Infection control and prevention of COVID-19 transmission: Interim recommendations for schools in the Philippine setting (as of August 6,2020)

@#THIS GUIDANCE AIMS TO SUPPORT PHYSICIANS WHO COLLABORATE WITH SCHOOLS AND GOVERNMENT IN CREATING INFECTION CONTROL POLICIES FOR SCHOOL RE-ENTRY IN THE TIME OF COVID-19 PANDEMIC, WHILE TAKING INTO CONSIDERATION THE OVER-ALL HEALTH OF EVERYONE, BASED ON AVAILABLE EVIDENCE. THE GUIDANCE IS DYNAMIC AND MAY CHANGE DEPENDING ON THE RAPIDLY EVOLVING KNOWLEDGE, DATA, AND UNDERSTANDING OF SARS-COV-2 IN THE COUNTRY.

Antimicrobial Stewardship (AMS) program in private hospitals in the Philippines: Its acceptability, barriers, and enablers

Background@#Antimicrobials are drugs that are often misused and inappropriate antimicrobial prescribing often results in poor clinical outcome and drug resistance. Monitoring and regulation of antimicrobial use is currently being done by the Department of Health through the Antimicrobial Stewardship (AMS) Program. There is a need to determine the factors that affect successful implementation of an AMS program in private hospitals in the Philippines. This study was conducted to identify the enablers and potential barriers in implementing an AMS program in nine (9) private hospitals. @*Methodology@#A concurrent mixed methods design was used to assess various stakeholders’ (physicians, administrators, other AMS members) perceptions of existing or proposed AMS programs, and to identify barriers and enablers in their implementation. Quantitative data were collected using self-administered survey questionnaire to assess clinician’s acceptance of AMS programs. Qualitative data were collected through semi-structured one-on-one interviews of clinicians and other AMS personnel and focus group discussions (FGD) of selected clinician groups. Data were gathered from October 2018 to October 2019. @*Results@#409 clinicians were surveyed, 52 were interviewed and 46 sat for 13 sessions of FGDs. Overall, the survey established that physicians were well aware of antimicrobial resistance problem. Majority of the clinicians indicated general agreement with the currently practiced antimicrobial protocols in their hospitals and with the AMS program. However, there were disagreements in perceptions with how antimicrobial restrictions impair prescribing practices and overuse of the same. These responses were strong points of discussion during the Key Informant Interviews (KII) and FGDs. All respondents were amenable with the institutionalization of an AMS program in their hospitals. The hospital leadership’s commitment was determined to be the key enabler of a successful AMS program’s implementation. Barriers identified for hospitals with existing AMS programs were: lack of dedicated staff, resistance and/or non-cooperation of physicians, lack of support from non-medical departments, and inadequate cooperation between hospital personnel. Barriers identified, regardless of the status of the AMS programs were: deficiency in knowledge with developing and implementing an AMS program, inadequate information dissemination, unavailability of an IT-based monitoring for antibiotic use, and the influence of pharmaceutical companies on stakeholders with regards to antimicrobial use. @*Conclusion@#Similar enablers and barriers to a successful implementation of an AMS program were seen in the different hospitals. A hospital leadership’s commitment was determined to be the key enabler. The success or failure of any AMS program appears to depend on physician understanding, commitment and support for such a program. By involving the main players in an AMS program- the hospital administrators, clinicians and other key members, perceived barriers will be better identified and overcome, and enablers will help allow a successful implementation of an AMS program. This multi-center study was funded by Philippine Council on Health Research and Development ( PCHRD) and Pediatric Infectious Disease Society of the Philippines ( PIDSP) and was conducted by the PIDSP Research Committee.

Childhood Meningitis in an Urban Tertiary Medical Center: A 20-year review

Background@#Meningitis is a neurological emergency causing significant morbidity and mortality. This research determined the etiologies, clinical presentation, and ancillary work-up findings of different types of meningitis.@*Objective@#To characterize the documented pediatric meningitis cases in a tertiary hospital admitted between January 1, 1997 to August 31, 2017. @*Methods@#This was a retrospective study which entailed review of charts of all pediatric cases 0 to 18 years old with a discharge diagnosis of meningitis (bacterial, viral, tuberculous or fungal) from January 1, 1997 to August 31, 2017 at an urban tertiary medical center. @*Results@#This study included 127 subjects, where 74 (58.3%) had bacterial, 34 (26.8%) had viral, 17 (13.4%) had tuberculous, and 2 (1.6%) had fungal meningitis. Streptococcus pneumoniae (12.2%), Haemophilus influenzae type b (6.8%) and Salmonella enteritidis (6.8%) were the top bacteria identified. Neonatal infections were caused by gram-negative bacilli (66.7%) and gram-positive cocci (33.3%). Bacterial, tuberculous, and viral meningitis were seen in the 1-11 months, 2-4 years and 5-10-year age groups respectively. Prolonged fever (mean 27.2, median 14 days) and cranial nerve palsies (23.5%) were noted in tuberculous meningitis (TBM). The highest CSF mean WBC (2043±9056 WBC/µL) and mean protein (300±365.6mg/dL) were seen in bacterial and tuberculous meningitis respectively. The combination of hydrocephalus, basal enhancement and infarct was unique to patients with tuberculous meningitis. Recurrent seizures were the most common complication of bacterial (36.5%), viral (20.6%) and tuberculous (100%) meningitis. Ceftriaxone (24.3%), acyclovir (38.2%), and isoniazid/rifampicin/pyrazinamide/ethambutol (76.5%) were the most common antimicrobials for bacterial, viral, and tuberculous meningitis. Fever duration before admission was significantly longer in TBM (14 days) than in viral (4 days) and bacterial meningitis (2 days). Length of hospital stay for viral meningitis (6.5 days) was significantly shorter than for TB (14 days) and bacterial meningitis (12 days). Mortality rates were 12% and 11% for bacterial and viral meningitis respectively. No mortality was seen in patients with TB and fungal meningitis.@*Conclusions@#In this 20-year review of childhood meningitis, bacterial meningitis was the most common type of pediatric meningitis which presented with marked CSF pleoctyosis. The longest fever duration and the highest proportion of cranial nerve involvement were seen in TBM, which also had the unique combined findings of leptomeningeal enhancement, hydrocephalus and infarct on imaging. Ceftriaxone was the most commonly used antibiotic for bacterial meningitis, except in neonates where a combination of cefuroxime-amikacin was initially given until microbiological confirmation became available. Recurrent seizures were the most common complication of bacterial, viral and TB meningitis. The shortest hospital stay with the highest full recovery rate was seen in viral meningitis.

Outcome of current antibiotic regimens used for Neonatal Sepsis in a tertiary hospital

Objective@#This paper looked into the outcome of currently used antibiotic regimens for neonatal sepsis in a tertiary hospital. @*Methods@#This retrospective study reviewed all cases of culture positive neonatal sepsis delivered in a tertiary hospital between January 1, 2000 to December 31, 2015. Demographic profile, stratification as to early-onset and late-onset sepsis, clinical manifestations, culture and antimicrobial susceptibility results, and outcomes were analyzed. @*Results@#There were 28 cases of culture positive neonatal sepsis reported during the study period, and prematurity and low birth weight were the major risk factors identified. Of these, 8 were early-onset sepsis and 20 were late-onset sepsis cases. Respiratory symptoms were the most common presenting manifestations. Sepsis isolates were evenly distributed between gram-negative bacilli and gram-positive cocci with no ESBL E. coli or Klebsiella pneumoniae identified. The institution’s current empiric antibiotic regimen of cefuroxime and amikacin for early-onset neonatal sepsis was shifted to another drug in 57% of cases. Piperacillintazobactam or carbapenem was given for late-onset sepsis. The addition of vancomycin for late-onset sepsis was done where Staphylococcus was considered. Sepsis due to gram-negative bacilli had a high mortality rate.@*Conclusion@#Our institution’s empiric antibiotic regimen which consists of cefuroxime and amikacin for early onset sepsis is effective in 43% of cases. A carbapenem or piperacillin-tazobactam, even without amikacin, proved to be effective for late-onset sepsis. Vancomycin, should be considered for late-onset sepsis, if staphyloccoccal disease is suspected.

Relationship between immature platelet fraction and platelet count among Pediatric patients with Dengue Fever: A prospective cross-sectional study

Background and Objectives@#Immature platelet fraction (IPF) is a new hematologic parameter that reflects the rate of thrombopoiesis. It has been suggested to be a predictor of platelet recovery in patients with thrombocytopenia. This study aimed to determine the relationship between IPF and platelet count among pediatric patients with thrombocytopenia due to dengue fever.@*Methods@#This was a prospective cross-sectional study of 77 thrombocytopenic pediatric dengue fever patients. IPF was included in the daily complete blood count extraction. Baseline and daily IPF, platelet count, hematocrit, white blood cell count and presence of fever were recorded according to day of illness. The pattern of IPF in relation to the pattern of platelet count was analyzed. The proportion of patients showing platelet recovery at different time points was also determined. A receiver operating characteristic analysis was done to determine an IPF cut-off value predictive of platelet recovery within 24 hours.@*Results@#The IPF increased as the platelet count decreased. The highest increase in IPF coincided with the trough of platelet count. Eighty -seven percent of the patients showed platelet recovery after the increasing trend of IPF, 87% after the peak value and 95% after the decreasing trend. An IPF value of more than 6.6% was found to be predictive of platelet recovery within 24 hours, with a sensitivity of 45% and specificity of 70%.@*Conclusion@#There was an observed inverse relationship between IPF and platelet count but with a statistically weak correlation. The decreasing trend of IPF can be a possible good predictor of an increasing trend in platelet count. These findings suggest a possible role of IPF as an additional parameter to predict platelet recovery in pediatric dengue fever patients.

A retrospective study on sensitivity, specificity, negative predictive value, positive predictive value of TB PCR versus TB Culture in diagnosing tuberculosis in Filipino children aged 3 months to 18 years at a tertiary care center

Objectives@#This study aimed to establish the accuracy of TB PCR versus TB culture and rifampicin resistance detection by PCR versus conventional susceptibility testing of body fluids in diagnosing tuberculosis in pediatric patients 3 months to 18 years with suspected tuberculous disease at a tertiary care center. @*Methods@#This is a retrospective analytical study of patients seen between January 1, 2012 to May 31, 2017, with clinical and radiographic features suggestive of tuberculosis, who had diagnostic testing of body fluids for TB PCR and TB culture. @*Results@#Among 159 patients suspected of TB, 46 (28%) tested positive by PCR, of which one was rifampicin-resistant. The sensitivity, specificity, positive predictive value and negative predictive values of TB PCR, using TB culture as the gold standard were 90%, 91.6%, 78.3%, and 96.5% respectively. The sensitivity, specificity, positive predictive value, and negative predictive values of TB PCR for detecting rifampicin resistance, using TB culture and sensitivity as the gold standard, were 33%, 100%, 100%, and 95%, respectively. Overall, the accuracy of TB PCR in detecting TB disease is 91.2% and the accuracy of TB PCR in detecting rifampicin resistance is 95%. @*Conclusion@#Findings in our study suggest that TB PCR play an important role in TB disease diagnosis, but clinical and radiological assessment continue to be essential in the diagnosis of childhood tuberculosis. The accuracy of TB PCR in detecting TB disease in children is 91.2% and the accuracy of TB PCR in detecting Rifampicin resistance is 95%.

Predictive factors of treatment failure for pediatric community-acquired Pneumonia C And D In 2-To-59 months of age

Objective@#To determine antibiotic treatment failure rate and predictors of treatment failure in children 2 to-59 months with Pediatric Community Acquired Pneumonia-C (PCAP-C) and PCAP-D admitted at Makati Medical Center. @*Methods@#This prospective cohort study examined 100 children, 2-to-59 months with clinically diagnosed PCAP-C and PCAP-D. Baseline assessment was done on day 1 of hospital stay and follow-up assessments were done on days 3 and 7 or upon discharge for the outcomes of interest. @*Results@#One hundred children were included in the study and 98% had PCAP-C. This study identified a treatment failure rate of 17% among children with PCAP-C. There was no mortality. Malnutrition and low oxygen saturation on admission were significant predictors of treatment failure. @*Conclusion@#Antibiotic treatment failure rate was 17%. Malnutrition and hypoxia were significant predictors of treatment failure in children with PCAPC.