Results of the new WHO therapeutic protocol in the management of severe malnutrition in Syria

To test the applicability of the new WHO therapeutic protocol in the management of severe malnutrition in childhood in Syria. Methods and Materials: There were 21 children, 12 males and 9 females, suffering from marasmus [16 cases] and marasmic kwashiorkor [5 cases] hospitalized in the Pediatrics Department of Damascus Hospital from January 1, 2001 to September 1, 2001. The new protocol was applied to all of the children included in the study. The children were reevaluated at the end of the treatment period to determine weight, symptoms, infectious status, electrolyte and protein status. The results were compared with the results of the old protocol by comparison with a retrospective study of 21 children hospitalized in 1997-1998. The patients ranged from 40 days to 36 months in age. The weights ranged from 2000-8000 grams. Symptoms were present as follows: diarrhea [71.42%], fever [61.9%], irritability [38%], vomiting [52.4%], cough [42.9%], dyspnea [19.4%], edema [present in all marasmic kwashiorkor cases], and dermal hyperpigmentation in 2 cases. There were 2 cases of pneumonia. There were no cases of meningitis. Blood cultures and urine cultures were negative. The potassium was low in one case of marasmus. The sodium was low in two cases of marasmus. Hypoproteinemia was noted in 28.5%. Hypoalbuminemia was noted in 23.8%. Total hospitalization duration was 9.29 days compared with 12.6 days using the old protocol. The average weight gain during hospitalization was 30.41% in the marasmus cases compared with 3.41% using the old protocol. The weight gain in the marasmic kwashiorkor patients was 4.14%. All of the patients were improved at the end of hospitalization with the exception of 2 cases that were discharged before the end of the protocol against medical advice as requested by the parents. There were no deaths with the new protocol whereas 38% died with the old protocol. Patients were symptom free and all electrolyte abnormalities and infections had disappeared by the end of treatment. This study demonstrates the applicability and efficacy of the new protocol. We recommend that it be used in all Syrian centers in the treatment of severe malnutrition cases

Evaluation of the cardiac functions in Kwashiorkor before and after treatment

The present study revealed that 83.3% of KWO patients showed small cardiac shadow and 16.7% showed cardiomegaly due to pericardial effusion as reported by echocardiography. ECG showed tachycardia, low voltage of QRS complex as well as T wave were found in all KWO patients. After recovery there was significant improvement of ECG changes. Echocardiographic results before treatment revealed that, left ventricular internal dimensions in KWO were significantly smaller when compared with control group. Also, the end-diastolic and the end- systolic posterior wall and septal thickness were significantly diminished in KWO cases. The left ventricular mass was significantly smaller and the heart rate showed significant increase in KWO were significantly smaller when compared with control group. Also, the end- diastolic and the end-systolic posterior wall and septal thickness were significantly diminished in KWO cases. The left ventricular mass was significantly smaller and the heart rate showed significant increase in KWO cases. Left atrial, aortic root, and right ventricular dimensions were significantly smaller in KWO cases. As regards the echocardiographic findings of 14 KWO cases, after treatment and recovery, evidences of improvement of cardiac function and left ventricular performances were detected in these cases. It was revealed that there were significant improvement and increase in left ventricular dimensions and left ventricular mass. The stroke volume and the cardiac output increased significantly. The ejection fraction, the circumferential shortening of the left ventricle [fraction] and the fractional shortening [%] were significantly higher after recovery compared with the results before treatment. The end-diastolic, the end-systolic and the percent of systolic septal thickness showed significant increase. The left atrial, aortic root and right ventricular dimensions showed significant increase after treatment. It was observed that pericardial effusion resolved with recovery of KWO itself

Fósforo sérico en niños con malnutrición de III grado / Serum phosphorus in grade malnourished children

El presente es un estudio prospectivo, longitudinal y comparativo en el que se determino el nivel de fósforo sérico en niños con mal nutrición de III grado (Marasmo, Mixto y Kwashiorkor) con y sin diarrea y que requirieron hidratación parental, suplementandose o no el fósforo con fines de comparación. Se encontró niveles bajos de fósforo (0,93 mMo1/L) en grupo de niños desnutridos y sin diarrea (normal 1,3 - 2,3 mMo1/L). En los niños con diarrea y deshidratación que recibierón hidratación parental sin suplemento de fósforo, los niveles séricos de este bajarón de 1,23 a 0.91 en los que presentaban edemas y de 1,07 a 0,8 en los que no lo contenian. Mientras que en aquellos que presentaban el mismo cuadro pero a quienes se suplementó el fósforo, el promedio mejoró de 0,8 a 1.08 en los que tenian edemas, sin embargo hubo un descenso en los que no tenian edemas de 1,03 a 0,58. La hipofosfatemia se relacionó marcadamente con la hipotonía muscular, mejorando el toniasmo en los niños que fueron suplementados.