Trends in admission and case fatality for acute malnutrition: Kingston 1892-1991

The case fatality ratio (CFR) in acute protein-energy malnutrition (PEM) achieved in the Tropical Metabolism Research Unit (TMRU) was compared with that of other tertiary care facilities in Kingston. Trends in admission and fatality rates, case severity and complications were also examined. From ward admission registers for Bustamante Hospital for Children (BHC), the University Hospital of the West Indies (UHWI), children's wards and the TMRU all cases of PEM admitted from 1982 through 1991 were enumerated and there was a docket search for random subsamples. Ten-year mean CFR percent for BHC was 8.8 (n=1974); for UHWI wards 5.5 (n=658); for TMRU 7.1 (n=662). BHC has the least restrictions on admission and showed most clearly that the peak time in Kingston for admission of PEM was around 1985, falling to a minimum in 1988 - 1990 and rising again in 1991; however, the other sites also showed similar trends. BHC had a range of CFR precent p.a. of 20.0 to 3.0, with a striking fall in the second half of the decade. There was no temporal CFR trend for the UHWI or TMRU. The latter institution had the highest proportion of admissions with marasmic-kwashiorkor and the lowest proportion with recorded infection. The annual variation in numbers of PEM deaths at BHC was best accounted for by (a) percentage change in consumer price index and (b) percentage change in the US$ value of the Jamaican $, in the preceding year, and (c) annual number of admissions, together. Generally, our findings suggest a minor role for expert in-patient management in reducing deaths from PEM

Función tioridea en el desnutrido grave / Thyroid function in severe malnutrition

Entre las enfermedades mas frecuentes que afecta a nuestra población está la desnutrición en sus diversos grados. Y la que causa la mortalidad elevada, dejando secuelas invalidantes, es precisamente la desnutrición grave. La producción adecuada de hormona tiroidea es fundamental para el mantenimiento de la función normal de casi todas las células del organismo, desde el final del primer trimestre de vida fetal hasta la muerte. Aunque todabía no se conoce completamente su mecanismo de acción, la hormona tiroidea es esencial para el crecimiento, el desarrollo y las funciones normales. Tanto un exceso como un deficit pueden tener consecuencias graves, y en ocaciones irreversibles. Como consecuencia de la restricción de nutrientes, el organismo del niño indispensablemente debe realizar una serie de mecanismos adaptivos que le permitan mantener su vida, donde necesariamente deben ser regidos por el sistema endócrino. Por lo tanto cada niño que sufre desnutrición extrema, se convierte en un problema dificil, y los resultados de experiencias foraneas son contradictorias, que facilmente nos llevan a la confusión. Además de que existen otros factores que pudiesen influir como: ambiente familiar etc.