Yasuyuki Wada

Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren

BACKGROUND To our knowledge, no rigorously designed clinical trials have evaluated the relation between vitamin D and physician-diagnosed seasonal influenza. OBJECTIVE We investigated the effect of vitamin D supplements on the incidence of seasonal influenza A in schoolchildren. DESIGN From December 2008 through March 2009, we conducted a randomized, double-blind, placebo-controlled trial comparing vitamin D(3) supplements (1200 IU/d) with placebo in schoolchildren. The primary outcome was the incidence of influenza A, diagnosed with influenza antigen testing with a nasopharyngeal swab specimen. RESULTS Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D(3) group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P = 0.04]. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements (RR: 0.36; 95% CI: 0.17, 0.79; P = 0.006) and who started nursery school after age 3 y (RR: 0.36; 95% CI: 0.17, 0.78; P = 0.005). In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D(3) compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006). CONCLUSION This study suggests that vitamin D(3) supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren. This trial was registered at https://center.umin.ac.jp as UMIN000001373.

Characteristics of juvenile dermatomyositis in Japan

Questionnaires were sent to 1290 hospitals in Japan asking for data on patients with juvenile dermatomyositis (JDM) diagnosed between June 1984 and May 1994. Of the 204 patients identified by these questionnaires, 102 met the criteria for JDM. JDM is categorized into three subtypes: Banker‐type JDM, Brunsting‐type and fulminant‐type; patients with the latter exhibit markedly elevated serum levels of creatinine phosphokinase (> 10 000 U/mL) and appear to be at risk of renal failure. Cutaneous manifestations were present in 98% of patients and preceded the appearance of other symptoms. This tendency is one of the reasons for the difficulty in some cases in diagnosing the onset of JDM. Better criteria for early treatment of JDM are needed. The results of the present study suggest that itching and calcinosis are factors that indicate a poor prognosis in patients with JDM. Muscle enzyme levels do not always reflect disease activity, suggesting that methods other than measurement of muscle enzymes, such as measurement of the levels of neoprerin and von Willebrand factor antigen, as well as magnetic resonance imaging should be used to be evaluate disease severity. Patients with Brunsting‐type JDM who exhibit dysphagia and antinuclear antibody positivity and patients with Banker‐type JDM should be treated aggressively. Pulse therapy should be selected as the initial therapy in patients with fulminant‐type JDM.

Familial cases with MYH9 disorders caused by MYH9 S96L mutation.

We report familial cases with MYH9 disorders: a 1‐year‐old Japanese boy who presented only with macrothrombocytopenia, and his 33‐year‐old father who had been diagnosed with refractory chronic idiopathic thrombocytopenic purpura, and suffered from hearing loss and chronic renal failure. Peripheral blood smears revealed giant platelets but no Döhle body‐like cytoplasmic inclusion bodies in neutrophils. Heterozygous MYH9 S96L mutations were found in the patient and his father, resulting in the diagnosis of a familial case with MYH9 disorders. The possibility of MYH9 disorders including Epstein syndrome should be assessed in cases of thrombocytopenia through the careful examination of hematological features.

A case of isolated retrograde amnesia following brain concussion

Retrograde amnesia is typically accompanied by anterograde amnesia. However, several recent reports describe isolated retrograde amnesia in which associated anterogarde amnesia was not present. 1–7 In fact, retrograde amnesia has various etiologies (e.g. encephalitis, traumatic, psychiatric) and likely represents a heterogeneous entity that is dependent on multiple memory systems within discrete neural structures. 2,4

Human Parvovirus B19感染症が発症に関与したと考えられた全身型若年性関節リウマチの1女児例

We encountered a case of a girl where Human Parvovirus B19 infection was considered to have been concerned with the development of systemic type juvenile rheumatoid arthritis (JRA). While the affected child did not show any evident infectious erythema-like findings, changes in the serum antibody titer by the EIA method presented the pattern of first infection. During the clinical course the condition of the disease as JRA was serious and hemophagocytic syndrome developed concurrently. Furthermore, the resistance to the treatment was also noted. So the patient was treated with prednisolone combined with low dose weekly MTX therapy. The possibility of Human parvovirus B19 being concerned with the development of rheumatoid arthritis in one form or another has been suggested in recent years. In the disease type with systemic angititis as main pathophysiology, which is called systemic JRA we encountered this time, it is not clear how Human Parvovirus B19 was concerned with the development of this disease, but it appeared to hold a key position in studying pathophysiology of the development.

A novel NR3C2 mutation in a Japanese patient with the renal form of pseudohypoaldosteronism type 1.

Pseudohypoaldosteronism type 1 (PHA1) is a rare disease characterized by congenital resistance to the action of aldosterone on epithelial tissue; PHA1 results in excessive salt wasting despite very high plasma aldosterone and renin levels (1,2,3). There are 3 types of PHA1. The systemic form of PHA1 is inherited in an autosomal recessive manner and manifests as severe life-long salt wasting caused by mineralocorticoid resistance in multiple target tissues (e.g., sweat glands, salivary glands, colonic epithelium, and lung). The renal form of PHA1 (adPHA1) is inherited in an autosomal dominant manner. In this form, mineralocorticoid resistance exists only in the kidney; moreover, salt wasting and other symptoms improve around 1–3 yr of age (1,2,3). The third type of PHA1 is the transient form, which is commonly seen in patients with urinary tract infection or obstructive uropathy. In the transient form, clinical symptoms disappear after treatment. adPHA1 is caused by a heterozygous mutation in NR3C2, which encodes the mineralocorticoid receptor (MR). Herein, we report the case of a young girl with adPHA1, a novel mutation in NR3C2, hyponatremia, and failure to thrive associated with urinary tract infection. We also describe a genetic analysis of her family.

A boy with erosive arthritis during treatment of severe group-A streptococcal infection

Abstract The patient was admitted to our department with major complaints of fever, swelling of the left thigh, and a cognition disorder. A blood culture yielded type T1, toxin-B-positive group-A streptococcus. Magnetic resonance imaging of the left foot showed fasciitis. Severe group-A streptococcal infection was diagnosed, and the administration of antibiotics, a massive dosage of gamma-globulin, and a steroid preparation were prescribed, which resulted in a general improvement in the symptoms and reductions in the swelling of the left foot and the second finger of the left hand without any sequelae. Following discharge from the hospital, however, destruction of the joint of the first toe of the right foot was recognized. A number of cases of post-streptococcal reactive arthritis (PSRA) have recently been reported, and the pathogenicity of this arthritis, which is different from that of rheumatic fever, has been noted. Severe group-A streptococcal infections, such as the one described here, may develop into erosive arthritis after the symptoms, that affect several organs, have disappeared. We believe that because it is possible for post-streptococcal reactive arthritis to develop, one should be aware of this when dealing with all clinical patients who have streptococcal infections.

11-year-old boy with sarcoidosis and generalized brawny induration of muscle

We report an 11-year-old boy who had sarcoidosis with myopathy, arthritis and renal involvement (nephrocalcinosis and nephrolithiasis). In addition to biopsy, a high signal intensity of the connective tissue in the affected muscles on magnetic resonance imaging (MRI) and normal levels of muscle-related enzymes were considered to be useful indicators for the correct diagnosis. Steroid therapy was effective for his clinical manifestations, but a high signal intensity of connective tissues in the muscles was still observed by MRI after 3 months. Children with sarcoidosis must be carefully followed for a long period because of the high rate of recurrence and severe complications. Magnetic resonance imaging can be recommended for monitoring these patients for long periods.

Study on Septicaemia in Infants and Children in the Past 20 Years

Underlying diseases, complications, clinical findings, and laboratory findings were evaluated in 158 cases of septicaemia admitted to Jikei University Hospital from 1975 to 1994, in order to conjectured factors that prescribe for the prognosis. 50% of the patients had underlying diseases. Malignancy including leukaemia (31 cases, 39.2%) was the most common underlying disease, followed by low birth weight infant (17 cases, 21.5%), aplastic anemia (9 case, 11.4%), and congenital heart disease (7 cases, 8.9%). The death rate for patients with underlying disease (27.8%) was significantly greater than the mortality for normal patients with septicaemia (8.9%) (p < 0.05). Meningitis (24.7%) was the most common complication, followed by DIC (19.6%), shock (15.2%), and pneumonia (10.8%). The mortality rate of septicaemia complicated by shock was 66.7% (p < 0.01), and that complicated by DIC was 45.2% (p < 0.01). The mortality rate for patients with the clinical findings of respiratory distress, cough, abdominal distention, cyanosis, splenomegaly, or peripheral coldness was more than 40% and significantly greater (p < 0.01). Mortality rate in patients with granulocyte counts of < 4.000/mm3, platelet counts of < 5 x 10(4)/ mm3, total protein of < 5.0 g/dl, or ESR of < 20 mm/hr were significantly greater (p < 0.01) than those in patients with normal laboratory findings. Coincidence rate of blood and stool cultures was 57.9% for E. coli, and 28.6% for Klebsiella sp., and that of blood and throat cultures was more than 30% for Pseudomonas sp., Haemophilus influenzae, and Staphylococcus aureus. In the study of antimicrobial susceptibility for microorganisms isolated, the number of drug resistant S. aureus had increased in the last 10 years.