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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.127, No.1, January 2023
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Original Article
Title
Impact of School Closure due to the Coronavirus Disease 2019 Pandemic on Weight Management in Obese Children and Adolescents
Author
Mika Makimura Miwa Furuzono Noriko Oyama Atsuko Kawano and Kenichi Miyako
Department of Endocrinology and Metabolism, Fukuoka Children's Hospital
Abstract
We investigated the influence of school closure due to the coronavirus disease 2019 (COVID-19) pandemic on weight management in obese children and adolescents. Subjects were 6−18 years old and had at least two outpatient visits within 1 year before school closure [PHASE 1, P1] and between 1 month before and after school closure [PHASE 2, P2], respectively. In total, 37 patients with simple obesity (OB) comprised the test group and 22 with congenital hypothyroidism (CH) comprised the control group. Patients with complications or medications affecting weight gain were excluded. The rate of change in obesity index per month (ΔOI) based on the standard weight by gender, age, and height of the P1-OB improvement group changed from (−1.07±0.86) %/month in P1 to (+0.77±1.74) %/month in P2, which significantly worsened during school closure (p=0.001). The P1-OB deterioration group exhibited no significant change from (+0.66±0.96) %/month in P1 to (+0.84±1.93) %/month in P2, and a large variation was noted. A significant increase in ΔOI from P1 to P2 was also observed in the CH group, but was mild compared to the P1 obesity improvement group. In particular, the remarkable worsening of obesity in the P1 obesity improvement group was speculated to be due to the change in dietary content and amount of exercise because of school closure. Weight management for obesity during school closure is an important issue to be considered, and medical treatment guidelines regarding dietary exercise should be continually provided.
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Case Report
Title
Allergen Analysis in a Boy with Cashew Nut and Walnut Allergy Who Had Anaphylactic Reaction to Ingestion of Acorn Nuts
Author
Mariko Takeda1) Kazuyuki Sogawa2) Junichi Sato1) and Naoki Shimojo3)
1)Department of Pediatrics, Funabashi City Medical Center
2)Department of Biochemistry, School of Life and Environmental Science, Azabu University
3)Center for Preventive Medical Sciences, Chiba University
Abstract
We report a case of a five-year-old boy with anaphylaxis induced by acorn nuts with allergic reactions to walnuts and cashew nuts. Within 1 hour after consuming boiled acorn nuts, the patient developed ocular itching, eyelid and lip angioedema, unproductive cough, and dizziness. He was treated with intramuscular injection of epinephrine and attended to at the emergency unit. He was treated with systemic antihistamines and steroids. Skin prick tests (prick to prick) were positive to acorn nuts, indicating he had immunoglobulin-E (IgE) antibodies to acorn nuts. Furthermore, by IgE immunoblotting and amino acid analysis we identified a cross-reactive antigen, hypothetical protein RF34 of acorn nuts, walnuts and cashew nuts. To the best of our knowledge, there are few published cases of allergy after eating acorn nuts in Japan and the world. The low incidence of this allergy is probably related to the low rate of human ingestion, but people ingest acorn nuts in some areas, including Asian countries and certain regions in Japan. Patients with tree nut allergy should be cautious with acorn nuts ingestion.
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Case Report
Title
A Case of a Girl with Vogt-Koyanagi-Harada Disease that Developed in the Course of Childhood-onset Diabetes
Author
Shiori Endo1) Daisuke Sugawara1) Misa Matsuura1) Shingen Mitou2) and Kou Ichihashi1)
1)Department of Pediatrics, Jichi Medical University, Saitama Medical Center
2)Department of Ophthalmology, Jichi Medical University, Saitama Medical Center
Abstract
We encountered a case of Vogt-Koyanagi-Harada disease ("Harada disease") during the course of childhood-onset diabetes. At the age of 11, the patient developed slowly progressive type 1 diabetes mellitus with positive anti-glutamic acid decarboxylase antibody, and her glycemic control was good with sensor-augmented pump (SAP) therapy. At 18 years and 6 months, she was diagnosed with Harada disease after a visit to an ophthalmologist with a complaint of visual disturbance. She was treated with steroid pulse therapy for Harada disease, and her ocular symptoms improved. The human leukocyte antigen genotype of the patient was DRB1*04: 05, which was most strongly correlated with susceptibility to Harada disease and was also a frequent phenotype of susceptibility in diabetes mellitus. Therefore, it is essential to include this in the differential diagnostic considerations. In addition, SAP therapy has been helpful in controlling blood glucose during steroid pulse therapy for Harada disease.
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Case Report
Title
Urinary Tract Infection Caused by Serotype 3 Streptococcus pneumoniae despite Additional Vaccination in a Post Liver Transplant Child
Author
Chiaki Tao1) Kensuke Shoji1) Isao Miyairi1) Noriko Takeuchi2) Kenichi Takeshita2) and Naruhiko Ishiwada2)
1)Division of Infectious Diseases, National Center for Child Health and Development
2)Department of Infectious Diseases, Medical Mycology Research Center, Chiba University
Abstract
Immunization using the 13-valent pneumococcal conjugate vaccine (PCV13) followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for patients after organ transplantation, but little is known about its efficacy. A 3-year-old girl who was taking cyclosporine after living donor liver transplantation at 6 months of age for biliary atresia came to our hospital with complaints of fever and poor vitality. Streptococcus pneumoniae was isolated from the urine culture. The isolate was S. pneumoniae type 3, which is a vaccine-resistant serotype and mucoid type. The patient had received two doses of PCV13 and one dose of PPSV23 after liver transplantation. The specific antibody titer and opsonin activity against serotype 3 were relatively low in the acute phase and increased significantly in the recovery phase. UTI due to S. pneumoniae was diagnosed based on the isolation of a single organism, clinical response, and increases in the specific antibody titers and opsonic activity. The development of UTI was attributed to the fact that the organism was S. pneumoniae serotype 3, which does not induce sufficient specific immunity by vaccine, and that the patient was on immunosuppressive drugs after liver transplantation.
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Brief Report
Title
COVID-19 Vaccination - Associated Myocarditis in Children Diagnosed by Cardiac MRI
Author
Shinichi Ishikawa Masahide Nakazima and Takuro Hurukawa
Department of Pediatrics, Asahikawa City Hospital
Abstract
The coronavirus disease 2019 (COVID-19) vaccination-associated myocarditis (C-VAM) has been reported worldwide. To the best of our knowledge, this is the first report to present a pediatric case of C-VAM confirmed by cardiac magnetic resonance imaging (CMR) in Japan.
A 14-year-old boy presented with fever and chest pain after receiving his second dose of COVID-19 vaccine. Electrocardiography revealed extensive ST elevation and blood serum troponin I level was elevated. The diagnosis of C-VAM was confirmed based on CMR findings.
On admission, he was successfully managed with symptomatic treatment. Within a few days, his laboratory test results were normalized; however, abnormal findings persisted on CMR 2 weeks after the vaccination. Currently, he is undergoing regular outpatient follow-up.
We recommend electrocardiography and serum troponin level examination for children who develop chest pain after COVID-19 vaccination.
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