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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.126, No.4, April 2022
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Review
Title
Why Do We Need an Additional Polio Immunization?
Author
Seigo Korematsu1) Megumi Kubota2) Go Matsuyama3) Haruo Kuroki4) Takashi Nakano5) and Yoshihiro Sekiba6)
1)Department of Pediatrics, Saitama Medical Center
2)Kubota Children's Clinic
3)Yukarigaoka Allergy and Children's Clinic
4)Sotobo Children's Clinic
5)Department of Pediatrics, Kawasaki Medical School
6)Sekiba Clinic
Abstract
Polio is an infectious disease that causes acute flaccid paralysis in 0.1-2% of cases and which may sometimes lead to death or may leave persistent paralysis of the extremities as a sequela. Although there were many pediatric patients in Japan prior to the 1960s, the last patient was reported in 1980, after the introduction of live vaccines. Since 2012, the live-attenuated vaccine has been changed to an inactivated vaccine for routine vaccination. Although inactivated vaccines are safer, a recent report pointed out a decrease in the antibody titer at approximately 5 years after 4-dose vaccination.
Since polio is not eradicated worldwide, the Japanese Society of Pediatrics recommends boosting the inactivated polio vaccine together with the DPT vaccine as a voluntary vaccination the year before entering elementary school. In 2021, routine vaccination has not been introduced, however, some local governments independently subsidize these vaccines.
In this review, we look back on Japan's implementation of polio countermeasures and discuss current issues and steps to be taken.
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Original Article
Title
The Role and Benefit of Psychological Treatment in the Pediatric Department of a Regional Core Hospital
Author
Kazushi Ichikawa Natsuko Ishida and Takuma Sakon
Department of Pediatrics, Fujisawa City Hospital
Abstract
Background: Many children visit a pediatric department with complaints of psychosomatic symptoms. We evaluated the advantages of pediatric psychological treatment administered by a clinical psychologist in a regional core hospital and discussed psychosocial problems of children.
Methods: We assessed 193 children who visited the clinical psychologist at our outpatient department between January 2016 and December 2020. We categorized the subjects into the following 3 groups as per the purpose of consultation: counseling (n=148), intelligence tests (n=21), and development tests of premature infants (n=24).
Results: In the counseling group, the average age at the first visit was 11.0 years, with bimodal peaks at 6 and 13 years old. The ratio of boys to girls was 62: 86, with a female predominance after 12 years old. Various complaints were presented with differences depending on the age group. Frequent complaints were of abdominal pain, school refusal, and headache. Common diagnoses included orthostatic dysregulation and irritable bowel syndrome. In the counseling group, 39 subjects were follow-up, 39 completed treatments, 51 dropped out of treatment, and 6 did not undergo any consultation. The average age of those in the intelligence tests group and the premature infant group were 9.5 and 3 years, respectively.
Discussion: Psychological treatments at the pediatric department is very beneficial for children with psychosocial problems. The drop-out cases that accounted for a third of the counseling group were considered a crucial issue. Pediatricians should coordinate closely with psychologists after learning more about their job functions and roles.
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Original Article
Title
The Impact of National Emergency Concerning COVID-19 on Daily Lives of Children and Persons with Severe, Multiple Disabilities
Author
Shotaro Iwamoto Noriko Yodoya and Masahiro Hirayama
Department of Pediatric, Mie University Hospital
Abstract
The declaration of national emergency issued in April 2020 concerning COVID-19 has changed the lives of children and persons with severe, multiple disabilities, and forced them to refrain from engaging in various daily activities. Here, we conducted questionnaire surveys on guardians and medical/welfare service facilities for children and persons with severe, multiple disabilities in Mie Prefecture to assess the impact of national emergency on their daily lives, and its influence on their health. Questionnaires were sent to 1,599 guardians and facilities and responses were collected from 521 (32.6%), including 79 guardians of children requiring daily medical care; this represents nearly 40% of all children receiving daily medical care in Mie Prefecture. School children were less restricted from the use of service facilities than preschool children but were presented with increased muscle tone and disruption in daily routine. Approximately 40% of service facilities, except for residential care and home care facilities for persons with disabilities, took a cautious approach by suspending their services, while approximately 40% of all facilities remained open, probably reflecting the needs of school children and management challenges. Results suggested that pediatricians, in cooperation with local health administrations and boards of education, as well as physicians at welfare service facilities for persons with disabilities, should advise improvements to the environment of children with severe, multiple disabilities in order for them to safely continue their school lives during the crisis.
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Case Report
Title
Diabetic Ketoacidosis and Non-occlusive Mesenteric Ischemia in an Adolescent with Type 2 Diabetes Mellitus
Author
Yuki Nagayama1)2) Noriyuki Takubo1) Yayoi Murano1)2) Reina Mayumi1)2) Rieko Yazawa1)2) Ryuki Kawamura3) Tatsuya Fuzinami3) Koumei Igei3) Fumiko Iwashima3) Ja-Mun Chong4) Toshinaru Fukae1) Akimi Ishikawa5) Tetsuo Shono6) Hidenori Haruna1) Hiromichi Shoji1) Tomoyuki Nakazawa2) and Toshiaki Shimizu1)
1)Department of Pediatrics, Juntendo University
2)Department of Pediatrics, Toshima Hospital
3)Internal Medicine, Toshima Hospital
4)Department of Inspection, Toshima Hospital
5)Department of Pediatrics, Juntendo Urayasu Hospital
6)Department of Pediatrics, Saiseikai Kamisu Hospital
Abstract
We report a case of a 14-year-old boy with diabetic ketoacidosis (DKA) and non-occlusive mesenteric ischemia (NOMI). He had a history of obesity since early childhood.
He had been vomiting for 10 days before he was brought to our hospital, and had been drinking sugary beverages. He was transported to our hospital because of upper abdominal pain, dysstasia, and disturbance of consciousness. Laboratory tests revealed a blood glucose level of 718 mg/dL, HbA1c of 13.4%, metabolic acidosis, ketonemia, and ketonuria. DKA was diagnosed based on the criteria of the Japan Diabetes Society. Negative pancreatic islet autoantibodies and the presence of endogenous insulin secretion suggested type 2 diabetes.
After rehydration, insulin administration, and potassium supplementation, the blood glucose and electrolyte levels stabilized, and his symptoms improved. However, 12 hours after admission, he presented with anuria, followed by cardiopulmonary arrest and death. The autopsy revealed NOMI, a condition with a poor prognosis that generally affects the elderly and postoperative patients.
We suggest that NOMI may occur in young people with DKA; therefore, it is necessary to consider NOMI as a possible complication of DKA.
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Case Report
Title
Vulvovaginitis Caused by Neisseria gonorrhoeae in Two Preadolescent Sisters: Infection Contracted by Sharing of the Home Bathroom and Bath Towels
Author
Yuko Moriuchi1)2) Tatsuo Fuchigami1)2) Chihiro Sugiyama1)2) Satoko Takahashi1)2) Jun Negishi1) and Ichiro Morioka2)
1)Department of Pediatrics, IMS Fujimi General Hospital
2)Department of Pediatrics and Child Health, Nihon University School of Medicine
Abstract
Sexual abuse is commonly suspected in children with gonorrhea. Here, we report a case of two preadolescent sisters with vulvovaginitis due to Neisseria gonorrhoeae infection who contracted the infection by sharing a bathroom and bath towels, and not due to sexual abuse.
The two girls were ten and eight years old. They had been diagnosed with Neisseria gonorrhoeae infection and vulvovaginitis based on real-time PCR results and vaginal discharge, respectively. We discussed whether this case was due to sexual abuse with a nurse at the hospital's Child Family Support Committee. We did not notice atypical behaviors in the children and parents, and the child consultation center did not find any history of abuse. However, the mother had gonorrhea symptoms and reported taking baths with her daughters. We inferred that contact infection occurred due to sharing of the bathroom and bath towels. All family members were treated with antibiotics and instructed to avoid taking baths together and sharing bath towels.
Environmental hygiene is important because gonorrhea can be transmitted through non-sexual contact as well. Preadolescent girls are more prone to contract gonorrhea through non-sexual contact because of low estrogen levels and insufficient hygiene maintenance. Given that improper antibiotic treatment may cause infertility or spreading of the infection to other family members; it is essential to assess Neisseria gonorrhoeae infection even in children with symptoms such as urination pain, urethral secretions, and vaginal discharge.
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Case Report
Title
A Case of Hypereosinophilic Syndrome Associated with Hepatitis with Hypereosinophilia Diagnosed by Liver Biopsy
Author
Ryota Nakagawa1) Aya Takeyama1) Hiroki Tsukada1) Masaki Ito1) and Mitsuaki Hosoya2)
1)Department of Pediatrics, Soma General Hospital
2)Department of Pediatrics, Fukushima Medical College
Abstract
Hypereosinophilic syndrome (HES) is a rare disease characterized by eosinophilic infiltration of some organs and their consequent dysfunction. We herein report a case of HES that involved recurrent hepatic dysfunction with hypereosinophilia that was diagnosed by a liver biopsy after the exclusion of secondary hypereosinophilia. An 11-year-old girl was found to have hepatic dysfunction with hypereosinophilia when she caught a cold and thereafter developed conjunctival jaundice. Her symptoms and laboratory data improved temporarily, but her symptoms recurred after another common cold. As a result, we carefully examined her for hepatic dysfunction and hypereosinophilia. Her blood, bone marrow, stool and radiographic findings did not reveal the cause of hepatic dysfunction nor indicate any parasitic infection, viral infection, allergy or bone marrow disorder. She also had no history of asthma or atopic dermatitis. We performed a liver biopsy after receiving her family's consent. The liver biopsy led to the diagnosis of HES due to a pathologic image of chronic active hepatitis and severe eosinophilic filtration for hepatocytes. Her condition rapidly improved after steroid administration, and there was no recurrence after careful withdrawal of oral steroids.
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Case Report
Title
Three Cases of Systemic Juvenile Idiopathic Arthritis without Arthritis
Author
Hozumi Kanai1) Yuko Akutsu1) Mariko Mouri1) Masaki Shimizu2) Tomohiro Morio1) and Masaaki Mori3)
1)Department of Pediatrics, Medical Hospital, Tokyo Medical and Dental University
2)Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University
3)Department of Lifetime Clinical Immunology, Tokyo Medical and Dental University
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is characterized by a six-week history of arthritis, accompanied by fever and systemic symptoms. The fever lasts for at least two weeks, and its systemic symptoms include skin rashes, lymphadenopathy, hepatosplenomegaly, and serositis. According to the International League of Associations for Rheumatology criteria, a diagnosis of sJIA can only be made when arthritis is present. However, some patients present asymptomatically, which makes diagnosis difficult. We report three sJIA cases without arthritis. These patients developed sJIA symptoms, including a daily fever following a quotidian pattern, rheumatoid rashes, leukocytosis, and elevated serum ferritin. These symptoms met the Yamaguchi diagnostic criteria for adult-onset Still's disease, which reportedly had a similar pathogenic mechanism as sJIA. In our cases, the patterns of the inflammatory cytokines, including interleukin (IL)-6, IL-1, and IL-18, were consistent with sJIA, suggesting their role in its pathogenesis. This study indicated that the Yamaguchi criteria and cytokine profiles were viable diagnostic tools for evaluating sJIA patients.
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Case Report
Title
The Importance of Diagnostic Imaging in Neonatal Intestinal Malrotation: A Case Report
Author
Sota Naruse1) Wataru Sumida2) Shotaro Ando1) Seizi Hayashi1) Toru Kato1) and Noriko Nagai1)
1)Department of Pediatrics, Okazaki City Hospital
2)Department of Pediatric Surgery, Nagoya University Hospital
Abstract
The differentiation with milk allergy and other organic disease is necessary for intestinal malrotation in neonates, and in an atypical case, the diagnosis may be difficult. Delayed diagnosis may also have significant complications.
A seven-day-old female neonate was admitted to our hospital with recurrent vomiting since day 6 of life. On the day of admission, abdominal X-ray, ultrasonography, and gastrointestinal angiography were performed; however, there was no evidence of intestinal malrotation. Since her general condition was relatively good, we kept her under close observation. The second abdominal ultrasound was performed the next day and revealed no indication of malrotation. However, following the examination, the patient began exhibiting biliary vomiting and hematochezia. To rule out intestinal malrotation, the newborn was transported to a surgical institution and subjected to further tests. Intestinal malrotation was highly suspected and emergency surgery was performed. Depending on the type of intestinal malrotation or the location and degree of volvulus, midgut volvulus associated with malrotation may not exhibit typical symptoms or imaging findings. Both newborn infant intestinal malrotation and midgut volvulus are urgent diseases. When the diagnosis is difficult, it is important to integrate various imaging examinations and closely monitor the general condition.
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