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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.126, No.10, October 2022
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Original Article
Title
Study of Fatty Liver Screening Scores in Pediatric Patients Who Require Secondary Screening of Lifestyle-related Diseases
Author
Yuya Kinoshita Mami Fukuma Erika Hori Hirofumi Kurata Takumi Okada Hiroe Ueno Tomoyuki Shimazu Chizuru Ikeda and Hoseki Imamura
Department of Pediatrics, National Hospital Organization Kumamoto Saishun Medical Center
Abstract
Given that there are many cases of fatty liver with normal alanine transaminase (ALT) levels, we aimed to examine the fatty liver screening scores of pediatric patients to select cases requiring subsequent abdominal ultrasonography. We assessed the data collected at the first visit. A retrospective study was conducted among 34 elementary school students who required further consultation and abdominal ultrasonography after their 2017 and 2018 medical examinations. Among them, 23 had fatty liver and 11 did not. The following criteria were adopted for screening fatty liver: (1) ALT ≥20 IU/L, (2) abdominal circumference ≥81 cm, (3) gamma-glutamyl transpeptidase ≥19 U/L, (4) HOMA-IR ≥2.6, and (5) high-density lipoprotein-cholesterol ≥56 mg/dL. Only ALT levels of ≥20 IU/L were assigned 2 points, whereas the others were assigned 1 point. The cutoff score for screening fatty liver was assigned 2 points. We excluded one student whose abdominal circumference could not be measured during the examination. For students with ALT values <40 IU/L (n=27), the fatty liver screening score had 100% sensitivity and 90.0% specificity. For the entire sample (n=33), the screening score had 100% sensitivity and 90.0% specificity. Therefore, in pediatric patients with the above scores of ≥2 points, abdominal ultrasonography is recommended during close examination.
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Original Article
Title
The Needs of Schools and Preschools and the Response of Commissioned Physicians During the Coronavirus Disease 2019 Epidemic
Author
Hidetaka Akiyoshi1) Shoichiro Tanaka2) Takashi Ohya2) Kiyoshi Kurihara3) Takayuki Hijii4) Nobuo Tanaka5) and Jun Morita6)
1)Pediatric Division, Iizuka City Hospital
2)Department of Pediatrics, Aso Iizuka Hospital
3)Kurihara Children's Clinic
4)Hijii Children's Clinic
5)Tanaka Children's Clinic
6)Children's Clinic Morita
Abstract
We conducted a survey of the physical and psychological problems of children and staff with coronavirus disease 2019 and the involvement of commissioned physicians with these problems in schools and preschools. We asked public and private kindergartens, licensed nursery schools, certified nursery schools, public elementary and junior high schools in 15 municipalities in the Chikuho area of Fukuoka prefecture to complete self-administered questionnaires by mail, and confirmed additional items by telephone with facilities that agreed to participate. There was a significant increase in schools that reported problems concerning children during the school closure period and after school resumed (42% and 54%, respectively) in comparison to preschools (24% and 32%) during the same period. There were few consultations with commissioned physicians regarding problems concerning children and staff in schools and preschools. The commissioned doctor was consulted in advance about infection prevention measures by 30% of schools and 20% of preschools, and 28% of schools and 50% of preschools responded that they had no plans to share information in the future. The physical and psychological problems of the children and the specific contents of consultation and information sharing suggest that cooperation with medical care is important, and it is necessary to establish a system to deepen cooperation between schools and preschools and commissioned doctors in the future.
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Original Article
Title
Urinary Tract Infection Caused by Non-typhoidal Salmonella in Two Children and Review of the Literature
Author
Shuji Kuga Keitaro Tsuda and Tamotsu Fujimoto
Department of Pediatrics, Oita Children's Hospital
Abstract
Urinary tract infection caused by non-typhoidal Salmonella (NTS-UTI) is very rare. Therefore, information on the patient's background and clinical picture of NTS-UTI is limited. We herein report the cases of two healthy children who developed NTS-UTI. One case was of a 3-month-old male infant with pyelonephritis who underwent surgery for right vesicoureteral reflux after UTI treatment. The other patient was a 16-year-old adolescent girl with hemorrhagic cystitis which relapsed twice. In both cases, stool and blood culture were negative, and the infection route could not be identified. We examined 22 pediatric NTS-UTI cases in the literature. The median age was 7 years, the male female ratio was 9: 13, and 10 cases (45%) had underlying disorder, of which 6 cases had urinary disorders such as vesicoureteral reflux disease. Twelve patients (50%) had preceding gastroenteritis, with no positive blood cultures or deaths. At least 4 patients (18%) had recurrence or relapse after treatment. NTS-UTI in children should be sought for potential urinary tract diseases and kept in mind with relapses after treatment.
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Original Article
Title
An Investigation of Toothbrush Trauma: a Retrospective Study
Author
Hideto Ansai1) Noriko Morimoto2) Satoshi Tsuji3) and Mitsuru Kubota1)
1)Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development
2)Department of Otorhinolaryngology, National Center for Child Health and Development
3)Department of Pediatric Emergency Medicine and Transport Services, National Center for Child Health and Development
Abstract
Although toothbrush trauma is common in the pediatric emergency department, few studies have examined the details of this subject. In this retrospective study, we investigated the characteristics of toothbrush trauma in children and particularly those patients with abscess complications. The subjects were forty-nine patients who were admitted to our emergency department with toothbrush trauma. In this study, five patients developed abscess complications. In the abscess group, the delay in initial visit to our hospital and the duration of antibiotic treatment were longer, and the frequencies of hospital admission, surgical operation, and admission to the PICU were higher than in the non-abscess group. Although the patients who developed abscess complications were brought to community hospitals and emergency departments within a day of the trauma, they visited our hospital (where a CT scan was performed) more than three days later. Appropriate follow-up is very important to avoid delaying the proper assessment. Only 20% of trauma events were directly witnessed; therefore, further awareness of the danger is required. It is difficult to predict whether the outcomes will be severe or not, and it is imperative that parents are instructed as to which symptoms should prompt return to a hospital.
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Case Report
Title
Achieving a Stable School Life Through Outreach Type Medical Care: an Intervention for Children with Developmental Disabilities
Author
Mizuka Kaji1) Kunitaka Oota1) and Yuko Inagaki1)2)
1)Rokko Island Konan Hospital
2)Konan Women's University
Abstract
Children with developmental disabilities who undergo outpatient treatment have chief complaints of aggression, difficulty in concentrating, and maladjustment. Many schools struggle to provide support for these children. Thus, this study aimed to understand how support can be provided to such children. As an intervention, a pediatrician examined the children's living environment to understand their daily living situation. We held case conferences three times for different professions including pediatricians, elementary school teachers, and care workers. To improve the children's condition, we explained to the attendees the problematic behavior of the children as well as the treatment plan. Eventually, the children could participate in elementary school life and school events. The intervention revealed that a multi-professional collaboration in the educational field was successful. This pediatric medical care model was based on understanding the living environment of the patient. This study demonstrated that the pediatrician's role extends from collaborative medical care model centered on consultations mainly conducted in hospitals to outreach type medical care.
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