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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.127, No.11, November 2023
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Original Article
Title
Online Survey on Dietary Habits to Prevent Late Effects in Pediatric and Adolescent/Young Adult Patients with Cancer
Author
Yoko Miyoshi1)2) Makiko Tachibana2) Naoko Nagai3) Naoko Okamoto4) Tadashi Akao5) Kayo Kurotani6) Miho Maeda7) and Chikako Shimizu8)
1)Laboratory of Clinical Nutrition and Development, Department of Health and Nutrition, Osaka Shoin Women's University
2)Department of Pediatrics, Graduate School of Medicine, Osaka University
3)Division of Nutritional Management, Osaka University Hospital
4)Laboratory of Nutritional Epidemiology, Department of Health and Nutrition, Osaka Shoin Women's University
5)First Laboratory of Institutional Food Service Management, Dept. of Health and Nutrition, Osaka Shoin Women's University
6)Department of Health Science, Faculty of Food and Health Science, Showa Women's University
7)Department of Pediatrics, Nippon Medical School Hospital
8)Department of Breast and Medical Oncology, National Center for Global Health and Medicine
Abstract
Pediatric and adolescent/young adult patients with cancer are at risk of late effects. Health management, including dietary habits, is important for the prevention of endocrine and cardiovascular diseases. Therefore, we conducted an online questionnaire survey targeting 100 men and 100 women aged 15−39 years who had undergone cancer treatment and investigated their current dietary habits and requirements. Results revealed that after cancer treatment, patients experienced various health issues, including weight loss, obesity, and high blood pressure. Additionally, 20% of cancer survivors did not receive regular health checkups. Only 40% of the respondents said that they had improved their eating habits, and 30% were willing to make changes. Some patients experienced problems with their eating habits not only during hospitalization but also during and after outpatient treatment. Due to the coronavirus disease pandemic, the frequency of hand washing, gargling, internet and smartphone use, and eating with family members increased. Approximately 20% of the respondents resorted to dietary supplements based on their own judgment. Approximately 70% of respondents reported changes in their eating habits after undergoing cancer treatment, for reasons that included medical conditions, treatment side effects, wanting to live longer, receiving information regarding cancer-fighting foods, and recommendations from friends and family. Information on eating habits was obtained not only from medical and administrative agencies but also from various social media. There were several requests for personalized nutritional guidance. Thus, it is essential to provide information and consultation support to individuals regarding health management, including dietary habits, even after cancer treatment.
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Case Report
Title
A Case of Wheat-induced Anaphylaxis Triggered by Low Dose Aspirin Therapy for Kawasaki Disease
Author
Yasushi Ueno Natsuko Nishi Nozomi Nasu Sachiko Shimomura and Masaaki Yanai
Department of Pediatrics, Kumamoto Regional Medical Center
Abstract
In some cases of food allergy, symptoms are not induced by food intake alone. Rather, they occur only when some inducers are added to the diet. Here, we report a case of food-induced anaphylaxis in a patient receiving low-dose aspirin therapy.
The patient was an eight-month-old boy who used to eat wheat in baby food. He was hospitalized for three days after developing a fever. During this time, he stopped eating baby food and was fed only milk. On the sixth day of fever, he was diagnosed with Kawasaki disease. His fever resolved after intravenous immunoglobulin and aspirin administration. He was discharged on the 11th day of his illness and continued to take low-dose aspirin. The next day, he started to eat baby food again. Soon after, he developed symptoms of anaphylaxis, including generalized urticaria and wheezing. Specific IgE antibody tests were positive for wheat and ω-5 gliadin and negative for all other foods. Aspirin was identified as the most likely trigger for the patient to develop an anaphylactic reaction to wheat. After that, he stopped eating wheat and continued taking aspirin for 3 months. He had no allergic symptoms. An oral food challenge test for wheat was conducted when the patient was 1 year and 2 months old. This yielded a positive result with pruritic wheals developing on the patient's trunk.
Food allergies such as wheat should be considered in patients on aspirin therapy who develop anaphylactic reactions after meals, even if they have recently ingested these foods normally.
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Case Report
Title
The Effect of Insulin Treatment with Continuous Glucose Monitoring for Type 1 Diabetic Patients with Pretreatment Hypoglycemia
Author
Miho Tsuyama Rika Hashi Yuri Suehiro Chizuru Amesara Toshiaki Tanaka Ayumu Takehara Fumiko Torigoe Atsushi Yamauchi Masahiko Kai and Takeshi Okinaga
BellLand General Hospital Pediatrics
Abstract
Patients with type 1 diabetes at an early stage of the disease have residual endogenous insulin secretion and may experience hypoglycemia before starting treatment. How we should manage such cases remains unclear at present. We herein report a two-year-and-eight-month-old boy who was diagnosed with type 1 diabetes based on urine glucose testing performed at his kindergarten. Intermittent scanning continuous glucose monitoring before he started insulin therapy revealed that he had experienced nocturnal hypoglycemia (time per day within target glucose range: [TIR] 34%, time below target glucose range: [TBR] 13%). In this case, blood tests before the start of inulin treatment showed that insulin secretion remained, with a fasting blood glucose level of 49 mg/dL and a serum C-peptide level of 0.16 ng/mL. At 2 h after the meal, his blood glucose level was 248 mg/dL, and his blood C-peptide level was 1.54 ng/mL. We therefore started intensive insulin therapy with the low-dose supplementation of basal insulin, after which his hypoglycemic range (TIR 46%, TBR 4%) and glycemic control both improved. The early initiation of intensive insulin therapy for type 1 diabetics with residual insulin secretory capacity may therefore prevent hypoglycemia due to inappropriate insulin secretion in response to hyperglycemia. In addition, continuous glucose measurement can be used to safely assess such treatment.
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Case Report
Title
A Case of Bacterial Meningitis Caused by Haemophilus influenzae Type a
Author
Mariko Ishimaru1) Yoshihiro Nitta1) Sanae Fujiwara1) Yoshiki Okumura1) Reizaburou Yoshikane2) Mayumi Kubota3) and Masaharu Moroto1)
1)Department of Pediatrics, Fukuchiyama City Hospital
2)Department of Clinical Laboratory, Fukuchiyama City Hospital
3)Department of Bacteriology II, National Institute of Infectious Diseases
Abstract
In Japan, the introduction of the Haemophilus influenzae type b (Hib) conjugate vaccine dramatically reduced the incidence of Invasive Haemophilus influenzae disease (IHD) caused by Hib. However, the incidence of IHD has been increasing in Canada and the US, where the vaccine was introduced earlier than in Japan. In this report, we describe a case of a 2-year-old girl with invasive H. influenzae type a (Hia) disease. To the best of our knowledge, this is the first report of invasive Hia infection in a child with no travel history outside Japan.
The patient was a 2-year-old girl with no significant medical history who presented with a fever from the previous night with fluctuating levels of consciousness. The results of cerebrospinal fluid (CSF) analysis supported a diagnosis of bacterial meningitis. The patient was treated with dexamethasone and antibiotics. CSF and blood cultures confirmed that the H. influenzae serotype was "a". The patient received antimicrobial therapy for 14 days, and she recovered fully without any neurological complications and had no after-effects.
The clinical presentation of Hia is similar to Hib. Hia is a more frequent cause of invasive disease compared with other types and non-typable strains. Currently, non-typable H. influenzae is a leading cause of IHD in Japan, but the number of IHD by non-b capsular strains, including Hia, may increase in the future. Therefore, we will continue to monitor these Hia trends closely and perform a capsular-type analysis when treating patients with IHD.
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