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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.127, No.10, October 2023
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Original Article
Title
Changes in the Number of Children Who Visited a Hospital for Psychosomatic Disease Caused by Long-term School Closure for Infection Control of Coronavirus Disease 2019
Author
Chizu Habukawa1)2) Katsumi Murakami2)3) Ryuta Ishii2)4) Yoshitoki Yanagimoto2)5) Takeshi Inoue2)6) Ayumi Okada2)7) Seiji Yoshida2)8) Yoshito Takenaka2)9) Ryoko Otani2)6) Ryoichi Sakuta2)6) Chie Tanaka2)7) Chikako Fujii2)7) Yoshie Shigeyasu2)7) Tatsuo Fuchigami2)10) Yasuhiro Watanabe2)11) Yukihiko Fujita2)12) Kenshi Koyanagi2)13) Reiko Matsushima2)14) Akiko Ohori2)15)16) Akira Nagai2)17) Toshiyuki Iguchi2)18) Nobuyuki Eshima4) and Shinichiro Nagamitsu2)19)
1)Department of Pediatric Allergy, Minami Wakayama Medical Center
2)Epidemiologic Study Group, Japanese Society of Psychosomatic Pediatrics
3)Department of Psychosomatic Medicine, Sakai Sakibana Hospital
4)Department of Pediatrics and Child Health, Kurume University School of Medicine
5)Department of Pediatrics, Kansai Medical University
6)Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center
7)Department of Child Psychosomatic Medicine, Okayama University Hospital
8)Department of Pediatrics, Osaka Medical and Pharmaceutical University
9)Takenaka Kids Clinic
10)Department of Pediatrics, IMS Fujimi General Hospital
11)Akita Prefectural Center on Development and Disability
12)Department of Pediatrics, Ashikaganomori Ashikaga Hospital
13)Nagasaki Prefectural Center of Medicine and Welfare for Children
14)Department of Pediatrics, Seikeikai Hospital
15)Graduate School of Human Science, Tezukayamagakuin
16)Psychosomatic Children's Clinic
17)Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development
18)Department of Pediatrics, Hoshigaoka Maternity Hospital
19)Department of Pediatrics, Fukuoka University
Abstract
Objectives: Our objective was to investigate changes in the number of children who visited a hospital for psychosomatic disease caused by long-term school closures due to COVID-19.
Methods: Data were collected at 12 medical facilities with child mental health specialists. Information from outpatient records for fiscal years (FY) 2018-2020 was obtained for disease names using the ICD-10 codes, number of psychosomatic disorder management fees, age, and sex. In month-by-month comparisons between patient numbers for each disease in FY 2018, 2019, and 2020, a statistical hypothesis testing method using the asymptotic normality of the Poisson distribution was used to determine significant increases/decreases in patient numbers.
Results: The total number of all pediatric visits in FY 2020 significantly decreased in most months compared with FY 2019. Many pediatric psychosomatic disorder-related disease receipts including pediatric psychosomatic disorders, eating disorders, sleep disorders, and pervasive developmental disorders decreased significantly in April and May, but several increased significantly from August onward. Significant total patient count increases were also observed for truancy, orthostatic hypotension, somatoform disorders, and hyperactivity disorder in many months compared with FY 2018. The total number of psychosomatic disorder management fees also increased significantly in many months in 2020.
Discussion: Appropriate medical care is needed to treat these mental and physical health problems caused by long-term school closures due to COVID-19.
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Original Article
Title
The Characteristics of Hospitalized Pediatric Patients with Moderate and Severe COVID-19 in Japan
Author
Yuto Otsubo1) Meiwa Shibata1)2) Kenta Kuruma1) Ayumi Tada1) Kimihiro Taniguchi1) Hanako Funakoshi1)2) Kazue Kinoshita3) Hiroshi Hataya4) Osamu Saito5) Kazuhiro Uda1)2)6) and Yuho Horikoshi1)2)
1)Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center
2)Division of Immunology, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center
3)Division of Molecular Biology, Tokyo Metropolitan Children's Medical Center
4)Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center
5)Department of Critical Care and Emergency Medicine, Tokyo Metropolitan Children's Medical Center
6)Department of Pediatrics, Okayama University Hospital
Abstract
Background/Aims: As the majority of coronavirus disease 2019 (COVID-19) cases in children are mild, experiences of moderate and severe COVID-19 or multisystem inflammatory syndrome in children (MIS-C) are limited. The aim of our study was to elucidate clinical characteristics and management of hospitalized children with and without comorbidities.
Methods: Subjects were COVID-19 and MIS-C hospitalized patients under 19 years old at Tokyo Metropolitan Children's Medical Center between January 2020 and August 2022.
Results: Out of a total of 713 hospitalized children, 36 patients (5%) were identified as having moderate cases, and 51 patients (7%) as having severe COVID-19 (50) and MIS-C (1). Among a total of 87 cases, 43 cases (49%) had comorbidities. More children with comorbidities were admitted with respiratory illnesses such as pneumonia, while more children without comorbidities were admitted with neurological illnesses such as status epilepticus. Patients without comorbidities who were admitted due to respiratory illnesses were more likely to have co-infection of other respiratory pathogens. Outcomes of 28-days mortality and any severe sequelae were 1 and 5, respectively, of which 5 had acute encephalopathy, 1 had cardiopulmonary arrest, and all had no comorbidities.
Conclusion: Hospitalizations for respiratory illnesses were more common among patients with comorbidities, while hospitalizations for neurological illnesses such as status epilepticus were more common among patients without comorbidities.
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Case Report
Title
A Case of Infantile Systemic Hyalinosis Treated with Regular Intravenous Immunoglobulin Therapy for Hypogammaglobulinemia due to Protein-losing Enteropathy
Author
Keisuke Ogasawara1) Tomoko Mizuno1) Takahiro Kamiya1) Ko Hirata1) Yumie Tamura1) Taisuke Yamauchi1) Tomonori Suzuki1) Ayako Kashimada1) Yuki Mizuno2) Kentaro Okamoto2) Yosuke Tanaka3) Daisuke Kobayashi4) Masatoshi Takagi1) and Tomohiro Morio1)
1)Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University
2)Department of Pediatric Surgery, Tokyo Medical and Dental University
3)Department of Comprehensive Pathology, Graduate School of Medicine, Tokyo Medical and Dental University
4)Department of Human Pathology, Graduate School of Medicine, Tokyo Medical and Dental University
Abstract
Infantile systemic hyalinosis (ISH) is a progressive autosomal recessive disease caused by ANTXR2 gene variant. Clinical symptoms include subcutaneous tumors, joint contractures, chronic discomfort, and growth disorders appear in hyalinosis patients because there is a restriction on the excretion of hyaline in the connective tissue. Diarrhea and recurrent infections were reported in severe cases, but its pathology or the treatment has not been clear.
Here, we present a case of severe ISH with hypogammaglobulinemia and ongoing diarrhea. The results of a human serum albumin scan and a histological analysis of colonic tissue from a lower gastrointestinal endoscopy showed that the cause of the patient's diarrhea was protein-losing enteropathy brought on by the deposition of hyaline. In the same patient, hypogammaglobulinemia, which is thought to be secondary to protein-losing enteropathy, was also observed. Regular intravenous immunoglobulin therapy helped the patient to avoid major infections, therefore this treatment could be a fresh option for severe cases with recurrent infections.
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Case Report
Title
An Adolescent with Refractory Nephrotic Syndrome Who Developed Inflammatory Bowel Disease Unclassified Following Frequent Rituximab Therapy
Author
Ryo Nakatani1)2) Misako Nakamura1)3) Tatsuya Nishimura1)3) Yoshinobu Ito4) Yuki Naruke5) Yoshiko Natsui4) and Masataka Hisano1)
1)Department of Nephrology, Chiba Children's Hospital
2)Department of Pediatric Nephrology, Tokyo Women's Medical University
3)Department of Pediatrics, The University of Tokyo
4)Department of Emergency and General Pediatrics, Chiba Children's Hospital
5)Department of Pathology, Chiba Children's Hospital
Abstract
A 14-year-old boy with refractory nephrotic syndrome, whose onset was at the age of 3 years old, had received 14 doses of rituximab (RTX) in addition to prednisolone (PSL) 5 mg/day, cyclosporine and mycophenolate mofetil. He was admitted to our hospital for a thorough examination of fever, abdominal pain, and bloody diarrhea. A colonoscopy revealed multiple ulcers throughout the colon, but the findings did not meet the diagnostic criteria for Crohn's disease or ulcerative colitis; therefore viral enterocolitis was suspected. His symptoms improved after total parenteral nutrition and increased doses of immunoglobulin, which had been routinely supplemented for hypogammaglobulinemia caused by RTX. RTX was administered for the last time 5 months previously, and he was discharged after receiving RTX. However, hemorrhoids and perianal abscesses were observed 2 months later, and bloody diarrhea recurred. Compared to the initial examination, there were no significant changes in colonoscopic and pathological findings. Additional immunostaining of colonic biopsies revealed almost no CD19/CD20-positive cells among lymphocytes infiltrating the stroma. Other possibilities that can cause colitis had been ruled out, and based on the clinical course, he was diagnosed with inflammatory bowel disease unclassified associated with RTX. After increasing the PSL dose to 60 mg/day, bloody diarrhea ceased, hemorrhoids and perianal abscess improved, and the patient was discharged 2 weeks later. After a follow-up period of 14 weeks, PSL was tapered to 10 mg/day, and the patient progressed without relapse of symptoms or recurrence of refractory nephrotic syndrome.
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Case Report
Title
Paradoxical Reaction with Cavitation in a Japanese Child Receiving Pulmonary Tuberculosis Treatment
Author
Ryo Kobayashi Kahoru Araki Taisuke Tsuji Toshifumi Yodoshi Tsuyoshi Iwai Masumi Kawaguchi Kei Matayoshi and Saori Kinjo
Department of Pediatrics, Okinawa Prefectural Chubu Hospital
Abstract
Paradoxical reaction (PR) is a temporary condition in which unexpected worsening of lung lesions occur in a patient who has initiated anti-tuberculosis treatment. A 16-month-old boy was referred to our hospital because of contact with his grandmother who tested positive for tuberculosis with a strong positive tuberculin reaction. Although having not had any symptoms, a contrast-enhanced chest CT scan revealed a mass shadow suggestive of a calcified granuloma in the right lung, hilar and mediastinal lymph node enlargement as well as positive T-SPOT tests. We diagnosed primary pulmonary tuberculosis and started empirical combination therapy with three anti-tuberculosis drugs. We took gastric fluid samples on three consecutive days before starting treatment, and gastric juice smear test, culture tests and PCR were all negative. We confirmed the drugs sensitivities from the cultures obtained from his grandmother. Although the clinical course was good, his chest images at subsequent outpatient visits were exacerbated including an infiltrative shadow in the right upper lobe on the 113th day of treatment. Repetitive gastric juice smear tests and gastric juice PCR were all negative. We determined his status as PR and followed up at the clinic without changing drugs. The complete disappearance of the shadow was revealed on day 204, and the treatment was terminated on day 270. In this case, we encountered a pediatric case of PR with a newly cavity formation during tuberculosis treatment. PR is the result of excessive reaction to mycobacterium tuberculosis due to the recovery of cellular immunity following treatment, and hollowed-out lesions are considered to be caused by the host's immune response.
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Case Report
Title
Flange Fixing Plate Prevented Tracheostomy Tube Displacement in a Child Requiring Constant Medical Care
Author
Yutaka Ueda1) Hiroko Kakei2) Keisuke Okada1) Takahiro Shimizu1) Takeshi Koga1) Eiji Morita1)3) Toshiko Itazawa1) and Yuko Akioka1)
1)Department of Pediatrics, Saitama Medical University
2)Department of Neonatology, Saitama Medical University
3)Patient and Medical Safety Office, Saitama Medical University
Abstract
With an increase in the number of children with special health care needs (CSHCN) and enforcement of laws associated with CSHCN and caregivers, a support system is needed for medical care in the childrens' homes, nurseries, and primary schools. In particular, tracheostomy tube displacement may fall into the fatal condition; thus, prevention of medical accidents is essential. Introduction of flange fixing plate, named SASAE™, was useful in an infant who needed home mechanical ventilation via tracheostomy to prevent tracheostomy tube displacement.
We report a case of a 10-month-old boy. He was born at 27 weeks of gestation and treated with mechanical ventilation at birth due to neonatal respiratory distress syndrome. At 4 months of birth, he underwent tracheostomy, and at 8 months, he was discharged from our hospital. However, he was brought back at 9 months and 10 months due to tracheostomy tube displacement. After we introduced flange fixing plate "SASAE™" for strengthening the fixation of the tracheostomy tube, no incident of tracheostomy tube displacement was noted in 3 years, neither at home nor at nursery school.
A fixation device preventing the incidence of tracheostomy tube displacement such as "SASAE™" provides safety for CSHCN with tracheostomy not only in hospitals, but also in their homes, nurseries, and primary schools.
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Brief Report
Title
Comprehensive Screening of Late Effects in Childhood Cancer Survivor Long-Term Follow-Up
Author
Shizuyo Nagai1) Yuhachi Ikeda1) Kazuna Yamamoto1) Masami Fujita1) Shinsuke Hoshino1) Yukihiro Matsukawa1) Koji Tagawa1) Takashi Kigawa1) Kenichi Sakamoto1) Tomoyuki Sakai1) Katsuyuki Matsui1)2) Toshihiro Sawai1) Takashi Taga1) and Yoshihiro Maruo1)
1)Department of Pediatrics, Shiga University of Medical Science Hospital
2)Department of Endocrinology, Metabolism and Diabetes, Shiga Medical Center of Children
Abstract
We initiated the comprehensive screening of the Childhood Cancer Survivor follow-up system for outpatients in 2019 to support adequate growth, development, and early detection of late effects. Through this screening process, we were able to detect early conditions with poor subjective symptoms, for instance, hypertension, obesity, and impaired glucose tolerance. Furthermore, the screenings help reevaluate the risks of late effects in patients who were treated a long time previously. These screenings also help patients improve their health literacy. However, the continuation of these screenings during the transitional period requires discussion. Our patients transit limited fields based on their risks. Sharing the process of follow-up systems with several institutions may facilitate the development of effective, feasible, and sustainable systems.
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Brief Report
Title
SARS-CoV-2 Reinfection in a Pediatric Population in 2022
Author
Hiroshi Kinumaki1) Masashi Fujioka2) Yutaka Nakamura3) Naoki Kodo4) Shin Nishihara5) Kiyoharu Okada6) Shinya Tsuchida7) and Tatsuo Nishimura8)
1)Kinumaki Children's Clinic
2)Fujioka Pediatric Clinic
3)Yutaka Children's Clinic
4)Kodo Pediatric Clinic
5)Sukusuku Kid's Clinic
6)Okada Kids Clinic
7)Tsuchida Children's Clinic
8)Nishimura Pediatric Clinic
Abstract
A multi-center study was conducted to determine the prevalence of SARS-CoV-2 reinfection in a pediatric population during the 2022 Omicron SARS-CoV-2 epidemic period. A total of 4,579 patients aged <15 years were diagnosed with COVID-19 at 7 pediatric clinics in the Kinki region during the period from January to October 2022; of those, 66 patients were diagnosed with COVID-19 twice in the study period. Diagnosis of the first infection was most common between January and March, and that of the second between July and October. These time periods were consistent with the sixth epidemic wave caused by BA.1/BA.2 Omicron strains and the seventh caused by BA.5, respectively. Of the 1,765 patients diagnosed with the first infection between January and May, 58 were confirmed to have the second infection by the end of October. The incidence of reinfection was 3.3%.
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