Parasitosis intestinales en niños de 3 a 5 años con desnutrición de tipo Kwashiorkor en el Hospital José María Velasco Ibarra 2018-2019 / Intestinal parasitosis in children aged 3 to 5 years with Kwashiorkor-type malnutrition at the José María Velasco Ibarra Hospital 2018-2019

Determinar la ocurrencia de la parasitosis intestinal en niños de 3 a 5 años con desnutrición de tipo Kwashiorkor en el Hospital José María Velasco Ibarra en el periodo 2018-2019 ha sido el objetivo de este estudio descriptivo, de corte transversal. La muestra estuvo conformada por 41 infantes realizándole en la consulta externa su valoración clínica para clasificarlo con la enfermedad desnutrición de tipo Kwashiorkor, lo que incluyó un estudio coproparasitológico verificando la ocurrencia de parásitos intestinales en sus muestras fecales. Los resultados arrojaron que el 65,85% de los pacientes son niñas; el 43,90% corresponden al grupo etario de 5 años; IMC reflejo un 14,32 para los niños y 13,42 para las niñas, reflejándose niveles de desnutrición graves, que se corroboran con los resultados de las pruebas de laboratorio con una albumina sérica que oscila entre 2,05 y 2,63, niños anémicos altamente afectados por poliparásitos intestinales, siendo los más frecuentes: T. trichiura (n=34), A. lumbricoides (n=16) y G. lamblia (n=20). En conclusión, la desnutrición relacionada con la ingesta calórico-proteica, puede ser agravada por la ocurrencia de parásitos intestinales, lo que trae como consecuencia un aumento significativo del riesgo de morbi-mortalidad de niños de 3 a 5 años con desnutrición de tipo Kwashiorkor(AU)

To determine the occurrence of intestinal parasitosis in children aged 3 to 5 years with Kwashiorkor-type malnutrition at the José María Velasco Ibarra Hospital in the period 2018- 2019 has been the objective of this descriptive, crosssectional study. The sample consisted of 41 infants, who performed their clinical assessment in the outpatient clinic to classify it with Kwashiorkor-type malnutrition disease, which included a coproparasitological study verifying the occurrence of intestinal parasites in their fecal samples. The results showed that 65.85% of the patients are girls; 43.90% correspond to the age group of 5 years; BMI reflected 14.32 for boys and 13.42 for girls, reflecting levels of severe malnutrition, which are corroborated with the results of laboratory tests with a serum albumin that ranges between 2.05 and 2.63, boys anemic highly affected by intestinal polyparasites, the most frequent being: T. trichiura (n = 34), A. lumbricoides (n = 16) and G. lamblia (n = 20). In conclusion, malnutrition related to caloric-protein intake can be aggravated by the occurrence of intestinal parasites, which results in a significant increase in the risk of morbidity and mortality in children aged 3 to 5 years with Kwashiorkor-type malnutrition(AU)

Qualite de la relation mere enfant dans la survenue des malnutritions proteino-energetiques. A propos de 102 cas colliges a l'hopital general de Port-Boue

Introduction-objectif : La Malnutrition Proteino- Energetique (MPE) est l'un des graves problemes de sante publique des enfants; d'origine multifactorielle Cette etude avait pour objectif de determiner la part des facteurs relationnels dans la survenue de la malnutrition proteino- energetique. Patients et methodes : cette etude prospective et descriptive a ete realise au service de pediatrie de l'Hopital General de Port-Bouet du 1 er fevrier 2003 au 30 septembre 2003 (08 mois) Resultats et discussion : les nourrissons etaient les plus representes (84;3) avec une predominance masculine (55;9) (inaugurale d'une carence affective) a l'origine du kwashiorkor (83;3) certaines caracteristiques sociodemographiques du nourrisson et du petit enfant telles que l'etat de sante a la naissance; le type d'alimentation ne sont pas specifiques aux MPE. Cependant; la condition d'enfant sevre (75;5) et l'association d'un tableau depressif (83;3) a l'expression clinique de cette MPE donnent ainsi raison aux societes africaines traditionnelles pour qui; le kwashiorkor est avant tout une depression d'abandon

Dislipidemia en niños con desnutrición aguda. Turbo, Colombia / Dyslipidemia in children with acute malnutrition. Turbo, Colombia

Objetivo: comparar el perfil lipídico de niños menores de 5 años con desnutrición aguda con un grupo control. Metodología: estudio descriptivo, de corte transversal, en 43 niños, 26 con desnutrición aguda y 17 con adecuado peso para la talla (P/T). Entre los grupos de estudio se compararon las concentraciones séricas de CT, c-LDL, c-HDL y TG. Resultados: el grupo con desnutrición presentó una frecuencia significativamente mayor de c-HDL bajas comparados con controles (19 vs 7% respectivamente, p=0,036) y un riesgo 1,8 veces mayor de c-HDL bajas (OR=1,8; IC 0,960-3,280). Los TG fueron mayores en los desnutridos, pero sin diferencia significativa con los controles. Las concentraciones de CT, c-LDL y c-HDL disminuyeron significativamente a medida que aumentó el grado de desnutrición, mientras que los TG aumentaron pero no significativamente; en los niños con desnutrición grave el índice arterial TG/c-HDL fue significativamente mayor que en los moderados y en los controles. Los niños con kwashiorkor presentaron las concentraciones más bajas de CT, c-LDL y c-HDL, las más altas de TG y el mayor índice arterial. Conclusiones: los niños con desnutrición aguda grave, especialmente tipo kwashiorkor, presentan concentraciones más bajas de c-HDL y más altas de TG, con un índice arterial alto que los expone a desarrollar ateroesclerosis.

Objective: to compare the lipid profile between preschools with and without acute malnutrition. Methods: a cross sectional study was developed in 43 preschools; 26 with and 17 without acute malnutrition. Malnutrition was assessed by weight for height ratio (P/T). Among the study groups were compared serum levels of TC, c-LDL, c-HDL and TG. Results: malnourished group showed a significantly higher frequency of c-HDL levels classified as lower compared with controls (19 vs 7%, respectively, p = 0.036) and a 1.8 times higher risk to c-HDL levels classified as lower (OR = 1,8; CI 0,960-3,280). TG levels were higher in malnourished, but no significant difference with controls. TC, c-LDL, and c-HDL concentration sincreased significantly by increasing the acute malnutrition degree. TG increased but not significantly, in preschool with severe acute malnutrition arterial index TG/HDL-C was significantly higher thanin control group. The lowest concentrations of TC, LDL-C, and HDL-C were detected in preschool affected by kwashiorkor. The highest TG, and arterial index were detected in preschool affected by kwashiorkor. Conclusions: preschool affected by severe acute malnutrition, especially kwashiorkor, has lower HDL-C concentrations, higher TG, and a high index which exposed them to develop atherosclerosis.

The effect of serum magnesium levels and serum Endothelin-1 levels on bone mineral density in protein energy malnutrition / Efecto de los niveles séricos de magnesio y los niveles séricos de Endotelina-1 sobre la densidad mineral osea en la malnutrición calórico-proteica

An inadequate and imbalanced intake of protein and energy results in protein-energy malnutrition (PEM). It is known that bone mineral density and serum magnesium levels are low in malnourished children. However, the roles of serum magnesium and endothelin-1 (ET-1) levels in the pathophysiology of bone mineralization are obscure. Thus, the relationships between serum magnesium and ET-1 levels and the changes in bone mineral density were investigated in this study. There was a total of 32 subjects, 25 of them had PEM and seven were controls. While mean serum ET-1 levels of the children with kwashiorkor and marasmus showed no statistically significant difference, mean serum ET-1 levels of both groups were significantly higher than that of the control group. Serum magnesium levels were lower than normal value in 9 (36%) of 25 malnourished children. Malnourished children included in this study were divided into two subgroups according to their serum magnesium levels. While mean serum ET-1 levels in the group with low magnesium levels were significantly higher than that of the group with normal magnesium levels (p < 0.05), mean bone mineral density and bone mineral content levels were significantly lower (p < 0.05). In conclusion, many factors play a role in the pathophysiology of changes in bone mineral density in malnutrition. Our study suggested that lower magnesium levels and higher ET-1 levels might be important factors in changes of bone mineral density in malnutrition. We recommend that the malnourished patients, especially with hypomagnesaemia, should be treated with magnesium early.

El consumo inadecuado y desbalanceado de proteínas y calorías energía conduce a la malnutrición calórico-proteica (MCP). Se sabe que la densidad mineral ósea y los niveles séricos de magnesio son bajos en los ninos malnutridos. Sin embargo, no está claro el papel que desempenan los niveles séricos de magnesio y los niveles séricos de endotelina-1 (ET-1) en la patofisiología de la mineralización del hueso. Por consiguiente, las relaciones entre los niveles séricos de magnesio y los niveles séricos de ET-1, y los cambios en la densidad mineral ósea, constituyen el objeto de investigación de este estudio. Hubo un total de 32 sujetos; 25 de ellos tenían DCP y 7 eran considerados. Si bien los niveles séricos promedios de ET-1 de los ninos con kwashiorkor y marasmo no mostraron diferencia estadística significativa, los niveles séricos promedio de ET-1 de ambos grupos fueron significativamente más altos que los del grupo de control. Los niveles séricos de magnesio estuvieron por debajo del valor normal en 9 (36%) de 25 ninos malnutridos. Los ninos malnutridos incluidos en este estudio fueron divididos en dos sub-grupos según sus niveles de magnesio en suero. Mientras que los niveles séricos promedio de ET-1 en el grupo con niveles bajos de magnesio fueron significativamente más altos que los del grupo con niveles normales de magnesio (p < 0.05), la densidad mineral ósea promedio y los niveles promedio del contenido mineral óseo fueron significativamente más bajos (p < 0.05). En conclusión, muchos factores juegan un papel en la patofisiología de los cambios en la densidad mineral ósea por la malnutrición. Nuestro estudio sugirió niveles más bajos de magnesio y niveles más altos de ET-1 podrían ser factores importantes en los cambios de densidad mineral ósea en la malnutrición. Se recomienda que los pacientes malnutridos, especialmente a causa de hipomagnesemia, sean tratados con magnesio lo más pronto posible.

Common nutrition problems among children in Oyo East Local

The study examined the common nutritional problems among children in Oyo East Local Government Area of Oyo State. A descriptive research design was used; while the study population consisted of nurses and nursing mothers. These people represented the group of respondents used in the study. In all; one hundred and fifty respondents in the area of study were randomly selected. The variables tested in the area of study include common nutritional problems like kwarshiorkor; marasmus; anaemia and ricket among many others. Data was collected through the use of a self-designed questionnaire; duly validated and tested for reliability. The two results of test retest methods were later compared and correlation co-efficient of 0.65r was obtained; the level of correlation is onsidered acceptable for the study. The data was processed using simple percentage; mean score and chi-square at 0.05 alpha level of significance. The result revealed that children in Oyo East Local Government do not significantly suffer from the most common nutritional deficiencies diseases such as kwashiorkor; marasmus; anaemia and ricket. Based on the findings; It was recommended among others that adequate balanced diet should be given to children; through advocacy and antenatal education. Also; the health workers should encourage and educate nursing mothers on the importance of proper de-worming of children from time to time to prevent worm infestation which may lead to nutritional anaemia and to avoid cultural taboos that prevent children and nursing mothers from eating proteineous food like meat and snail among many others

Kwashiorkor e distúrbio de coagulação: apresentação atípica de fibrose cística / Kwashiorkor and coagulation disturbance: atypical presentation of cystic fibrosis

Enfatizar a apresentação clínica precoce da fibrose cística (FC) em lactente com Kwashiorkor e distúrbio de coagulação, decorrente de hipovitaminose K. DESCRIÇÃO DO CASO: Paciente com três meses e meio, sexo feminino, nascida a termo, peso de 2655g, estatura de 46cm, foi encaminhada para investigação de lesões perineais associadas à monilíase de difícil controle, refratária a diversos antifúngicos e corticoides. Quadro geral caracterizado por baixo ganho ponderal, edema e diarreia. Admissão hospitalar para investigação com hipótese diagnóstica de Kwashiorkor de origem primária ou secundária. Paciente mantida em aleitamento materno exclusivo, sendo observadas perda ponderal e persistência da diarreia. Na internação, foi iniciado tratamento de infecção do trato urinário. A paciente evoluiu com hemorragia digestiva alta e sangramento pela flebotomia em safena direita, sendo identificada coagulopatia responsiva à vitamina K e plasma fresco congelado. Na evolução, foi confirmada esteatorreia e hipoalbuminemia; as sorologias para sífilis, toxoplasmose, mononucleose, citomegalovírus, rubéola, HIV e hepatite B, apresentaram resultado negativo e a pesquisa da mutação ∆F508 heterozigoto para FC foi positiva. A paciente apresentou piora do estado geral com sinais de sepse, evoluindo para óbito. O laudo necroscópico evidenciou elementos característicos de choque séptico com infecção pulmonar, sinais acentuados de desnutrição e fibrose cística do pâncreas. COMENTÁRIOS: A FC pode manifestar-se com quadro de Kwashiorkor e distúrbio de coagulação por deficiência de vitamina K. Os profissionais de saúde devem estar atentos à possibilidade de FC no diagnóstico diferencial dessa situação.

To address the clinical presentation of cystic fibrosis (CF) in an infant presenting Kwashiorkor along with coagulation disturbance due to vitamin K deficiency. CASE DESCRIPTION: A female baby aged three and a half months, born at term, with birth weight of 2655g, and height of 46cm, was referred to a university center due to perineal moniliasis refractory to therapy, including antifungal drugs and corticosteroids. She had poor weight gain, edema, and diarrhea. After hospital admission under the diagnostic hypothesis of Kwashiorkor of primary or secondary origin, the child received exclusive breastfeeding, but lost weight and maintained the diarrhea. At admission, a urinary tract infection was detected and treated. The child developed bleeding of upper digestive tract and phlebotomy incision at the right saphenous vein treated with vitamin K and fresh frozen plasma. Laboratory exams showed steatorrhea and hypoalbuminemia. Serology was negative for syphilis, toxoplasmosis, mononucleosis, cytomegalovirus, rubella, HIV and hepatitis B. Heterozygous ∆F508 mutation for CF was positive. The patient died with a septic shock. Necropsy showed that the septic shock had a pulmonary origin and that malnutrition was secondary to cystic fibrosis of pancreas. COMMENTS: CF may have a clinical presentation as Kwashiorkor with coagulation disturbance caused by vitamin K deficiency. Health professionals should be aware of this possibility in the differential diagnosis of infants with severe malnutrition and edema.

Alterações cutâneas no Kwashiorkor: relato de caso de um homem adulto após cirurgia abdominal / Cutaneous manifestations of kwashiorkor: a case report of an adult man after abdominal surgery

Kwashiorkor é um tipo de desnutrição proteico-energética em que há deficiência dietética de proteína, embora a ingestão de calorias se mantenha adequada. As manifestações cutâneas incluem pele xerótica, com aspecto de esmalte descascado, típica coloração avermelhada a branco-acinzentada dos cabelos, o sinal da bandeira e edema mais evidente, nos membros inferiores e na face, dando aspecto de lua cheia. O presente artigo relata o caso de um paciente adulto, do sexo masculino, previamente submetido à duodenopancreatectomia para tratamento de pancreatite crônica associada ao pseudotumor em cabeça de pâncreas que evoluiu com alterações cutâneas de kwashiorkor após tuberculose pulmonar.

Kwashiorkor is a type of protein-energy malnutrition where diet protein deficit is found, in spite of appropriate caloric intake. Cutaneous manifestations include xerosis, with abnormally dry skin that has a flaking enamel paint aspect, a typical red to gray-white hair color, the "flag sign" and more evident edema in lower limbs and face, giving it a full moon appearance. This article reports a case of a male adult patient who had undergone Whipple surgery for treatment of chronic pancreatitis associated with pseudotumor of the pancreatic head that progressed to cutaneous manifestations of kwashiorkor after pulmonary tuberculosis.

Niveles de albumina y hemoglobina en lactantes desnutridos severos / Albumin and hemoglobin levels in severely malnourished infants

Introducción: Durante los procesos de desnutrición (DNT), se encuentran déficit de macro y micronutrientes. En Colombia la cifra de DNTsevera en niños de 1 a 2 años corresponde al 2% en el año 2000. Objetivo: Determinar los niveles de albúmina (ALB) y hemoglobina (HB), en niños menores de 24 meses con DNT severa, que ingresaron a un Hospital Universitario de Tercer Nivel de Atención del nororiente colombiano, en un periodo de 6 años. Pacientes y métodos: Estudio retrospectivo y comparativo de 134 niños con DNT severa, se diagnosticaron según signos cl ínicos y bioquímicos característicos de Kwashiorkor (KW) y Marasmo (MAR). La muestra fue dividida en tres grupos: DNT severos tipo KW, MAR y grupo control. Conclusiones: Los niveles de ALB y HB, se encuentran disminuidos en los procesos de DNT severa. El comportamiento de los tres grupos estudiados coincide con lo que reporta la literatura hasta el día de hoy.

Introduction: In the category of malnutrition (MNT), we find two main categories, macro and micronutrients deficiency. In Colombia severe MNT rates in children between the ages of 1 to 2 years, corresponded to 2 % according to 2000's statistics. Objective:To determine the levels of albumin and hemoglobin in children less than 2 years old with severe MNT that were treated at a Colombian Hospital University in a period of 6 years. Patients and Methods: Comparative and retrospective study of 134 children with severe,MNT, were diagnosis according to clinical and biochemical signals of Kwashiorkor (KW) and Marasmus (MAR). The children were divided in 3 groups: severe MNT type KW, MAR, and a control group.Conclusions:The albumin and hemoglobin levels are decreased in severe MNT processes. The results found in the 3 groups studied match with the reports showed by the literature today.

Plasma levels of pro-inflammatory [cytokines TNF alpha, IL1 and IL6] in protein energy malnourished children affected by P.falciparum malaria in western Kenya

To determine the levels and possible role of pro-inflammatory cytokines TNF alpha, IL-1 and IL-6 in children with clinical protein energy malnutrition [kwashiorkor, marasmic kwashiorkor or marasmus] alone and in combination with malaria in Western Kenya. Webuye District Hospital, Western province and Moi Teaching and Referral Hospital in Rift Valley province in Western part of Kenya. This hospital based study was done from 2003 to 2005 on inpatient children in the paediatric ward and children at the outpatient clinic. Children aged between 6 to 60 months, admitted to paediatric wards of Webuye sub-District Hospital or Moi teaching and referral hospital Eldoret suffering from either protein-energy malnutrition or malaria or both conditions during the study period were included. Protein energy malnourished was diagnosed both clinically and through anthropometric measurements. Malaria was diagnosed through blood smears using field stain diagnostic method. Controls were children in outpatient clinic on routine medical check-up and ascertained to be without protein energy malnutrition or malaria. A blood drop was taken for malaria blood smears without fasting. Plasma samples from children taken. Equal number of controls were taken. Enzyme linked immunosorbent assay kit was used to assay for the concentrations of the cytokines [TNF alpha, Il1 and IL6] using test kits from Roche diagnostics, Germany. A total of 59 children were included in the study. The mean concentrations of cytokine [TNF alpha] were 41.3 pg/ml in kwashiorkor, 45.2 pg/ml in marasmic/kwashiorkor and 41.9 pg/ml in marasmus patients. The values for IL1 were 67.2 pg/ml in kwashiorkor, 0 pg/ml in marasmic/kwashiorkor and 25.1pg/ml in marasmus patients. The values for IL6 were 65 pg/ml in kwashiorkor, 40.5 pg/ml in marasmic/kwashiorkor and 10 pg/ml in marasmus patients showing, significantly low [p<0.005] values when compared to IL1. Those with kwashiorkor and malaria were 48.8% [p<0.005], marasmic kwashiorkor with malaria [81.8%], marasmus with malaria [88.2%] and Controls [83.3%]. The cytokines were more elevated in kwashiorkor than marasmic kwashiorkor, marasmus or malaria alone. TNF alpha and IL6 could be used as indicators of protein energy malnutrition in malaria infected population

Inflammatory response in Colombian children with severe protein-energymalnutrition before and after nutritional intervention / Respuesta inflamatoria en niños colombianos con desnutrición grave antes y después del tratamiento nutricional

Aim: To evaluate the changes in C-reactive protein and pro-inflammatory cytokines in severely malnourished children, before nutritional intervention and at the moment of restoring appetite. Methodology: To assess changes in inflammatory mediators, 20 severely malnourished children under 5 years of age, 10 with kwashiorkor and 10 with marasmus were studied. Hemoglobin, total serum proteins, albumin, ferritin, transferrin, ceruloplasmin, C-reactive protein and pro-inflammatory cytokines (IL-8, IL-1β, IL-6,IL-10,TNF-α, and IL-12p70) were determined.Results: Upon hospital admission, the mean values of C-reactive protein in kwashiorkor and marasmus patients (16.3±19.0 mg/l and 23.1±27.9 mg/l, respectively) indicated an inflammatory response process with no difference between both groups (p=1.0). Total protein, albumin, transferrin and ceruloplasmin in children with kwashiorkor were significantly lower than in marasmic children (p=0.003, p=0.007, p=0.035, p=0.007, respectively). All cytokines, except IL-12p70, showed significantly higher concentrations in kwashiorkor than in marasmic children. After the stabilization phase, concentrations of C-reactive protein decreased significantly in both groups and albumin increased to normal values, but cytokines remained high. Conclusion: These results show that malnourished children are able to synthesize C-reactive protein in response to an infectious process. Additionally, higher levels of pro-inflammatory cytokines and depletion of albumin in children with kwashiorkor suggest that these inflammatory mediators could be critical biomarkers during clinical phases of kwashiorkor.

Objetivo: Evaluar los cambios en la concentración de proteína C reactiva y citocinas pro-inflamatorias en niños con desnutrición aguda grave antes del tratamiento nutricional y al recuperar el apetito. Metodología: Se evaluó en 20 niños menores de 5 años con desnutrición aguda grave, 10 con marasmo y 10 con kwashiorkor, el cambio en la respuesta inflamatoria mediante la concentración de ferritina, transferrina, proteínas totales, albúmina, ceruloplasmina, proteína C reactiva y citocinas pro-inflamatorias (IL-8, IL-1β, IL-6,IL-10,TNF-α y IL-12p70).Resultados: Al momento de la admisión, la concentración promedio de proteína C reactiva en niños con kwashiorkor y marasmo (16.3±19.0 mg/l y 23.1±27.9 mg/l, respectivamente) indicaron un proceso inflamatorio activo en ambos grupos (p=1.0). Las proteínas totales, la albúmina, la transferrina y la ceruloplasmina fueron significativamente menores en niños con kwashiorkor que en niños con marasmo (p=0.003, p=0.007, p=0.035, p=0.007, respectivamente). Todas las citocinas, excepto la IL-12p70, mostraron una concentración significativamente mayor en niños con kwashiorkor que en marasmáticos. Después de la fase de estabilización la concentración de proteína C reactiva disminuyó de manera significativa en ambos grupos y la albúmina aumentó a concentraciones normales, pero las citocinas permanecieron altas. Conclusión: Estos resultados muestran que los niños desnutridos graves son capaces de sintetizar proteínas de fase aguda como la proteína C reactiva en respuesta a un proceso infeccioso. Adicionalmente, las mayores concentraciones de citocinas pro-inflamatorias y la mayor depleción de albúmina ocurrida en niños con kwashiorkor sugieren que esos mediadores inflamatorios pueden ser biomarcadores críticos durante las fases clínicas del kwashiorkor.

Desnutrición Hospitalaria / Nosocomial Malnutrition

Hospitalary malnutrition is a highly prevalent entity. Hospitalized patients with severe malnutrition usually show a high morbimortality. Many severe malnutritions inside the hospital could be avoided. The adequate and early nutritional support can mitigate or even spare a severe malnutrition. The introduction of a nutritions support team management in a community hospital is a favorable cost/beneficial resource. Also the possibility of a domiciliary nutritional support, should be a feasibe practice in a high complexity hospital. Still remains as an ethical dilemma to determine when a patient should be considered as terminal and when the nutritional support - even with low complexity and low costis a trifling therapeutics.

Protein-calorie malnutrition in developed countries

Worldwide, over 70 million children suffer from moderate and severe acute malnutrition. Whereas inadequate intake from food insecurity is the primary means by which Protein-calorie malnutrition [PCM] occurs in developing regions, malnutrition in industrialized countries often develops as a complication of underlying illness. The aim of this paper is to briefly review key points regarding diagnosis and management of PCM and to discuss PCM in developed countries

Respuesta inflamatoria en niños con desnutrición aguda grave y anemia / Inflammatory response in children with severe acute malnutrition and anemia

Introducción: El manejo de la infección todavía es un reto en el tratamiento del desnutrido grave porque la inmunosupresión y la anemia concomitante comprometen la respuesta inflamatoria. Objetivo: Comparar la respuesta inflamatoria entre niños con desnutrición aguda grave tipo marasmo y kwashiorkor y niños eutróficos con y sin anemia (grupos control), mediante la medición de los niveles de proteína C reactiva (PCR) y de las citocinas pro-inflamatorias IL-8, IL-1β, IL-6, IL-10, TNF e IL-12. Metodología: Se realizó un estudio de corte transversal, donde se determinaron los niveles de algunos indicadores de la respuesta inflamatoria como proteína C reactiva (PCR), citocinas pro-inflamatorias como IL-8, IL-1β, IL-6, IL-10, TNF- e IL-12p70, hemoglobina y ferritina en un grupo de 40 niños: 10 con marasmo, 10 con kwashiorkor, 10 eutróficos con anemia y 10 eutróficos sin anemia. Resultados. La PCR fue significativamente mayor en desnutridos que en eutróficos. Las concentraciones de las citocinas pro-inflamatorias fueron mas altas en niños con kwashiorkor seguidos de eutróficos con anemia, marasmáticos y eutróficos sin anemia. La hemoglobina se correlacionó negativamente con los niveles de IL-8 (r=-0,409 p=0,009), IL-6 (r=-0,442 p=0,004) e IL-10 (r=-0,436 p=0,005). Conclusión. Los niños con desnutrición aguda grave producen una respuesta inflamatoria con aumento en los niveles de la PCR y de citocinas pro-inflamatorias que indican infección aun cuando no presenten signos, lo cual apoya la recomendación del protocolo de la OMS de medicarlos con antibioticos. Adicionalmente, estos resultados sugieren que las citocinas pro-inflamatorias podrian participar en la patogenesis de la anemia en pacientes con o sin desnutricion.

The treatment of the infection is still challenging in children with severe malnutrition and immunosupression. Objective: evaluate and compare inflammatory markers such as C-reactive protein (CRP) and proinflammatory cytokines in children with severe malnutrition and anemia. Methodology: levels of hemoglobin, transferrin, CRP and inflammatory markers such as cytokines IL-8, IL-1β, IL-6, IL-10, TNF- and IL-12p70 were assessed in a group of 40 children, nutritional status was also evaluated.10 were classified with marasmus, 10 with kwashiorkor, 10 well nourish with anemia and 10 well nourish with no anemia. Results: C-reactive protein was significantly higher in undernourishment children than in well nourish children. Levels of proinflammatory cytokines were higher in children with kwashiorkor along by well nourish children with anemia, children with marasmus and well nourish children with no anemia. Hemoglobin was no correlated with levels of IL-8 (r=-0,409 p=0,009), IL-6 (r=-0,442 p=0,004) and IL-10 (r=-0,436 p=0,005). Conclusion: malnourished children could develop an inflammatory condition presenting high levels of inflammatory markers such as C-reactive protein (CRP) and proinflammatory cytokines. These results suggest that proinflammatory cytokines may participate in the pathogenesis of anemia in malnourished or well nourished patients.

Serum leptin level among malnourished children with and without pneumonia

Protein-energy malnutrition [PEM] is a significant problem among paediatric population, the most severe forms of PEM were marasmus and kwashiorkor. Infectious complications are important cause of death among children with PEM. PEM is a common cause of secondary immune deficiency and susceptibility to infection in humans. Malnutrition impairs the immunity through a variety of mechanisms. The aim of this study is to evaluate the serum leptin level in children with PEM with and without pneumonia. 60 children were included in the study; 20 were used as a control, 20 child had PEM with out infection and 20 child had PEM associated with pneumonia. All included children were subjected to nutritional assessments. Haematological tests [haemoglobin concentration, white blood cell [WBC] count and differentials including CD4 count and ratio, serum albumin, blood glucose, white blood cell count, urine nitrogen, and serum ferritin], and chest x-ray reports were done. The serum leptin level and CD4 ratio were significantly lower in both groups with PEM when compared to the control group [p < 0.001]. Also, serum leptin level and CD4 ratio were significantly lower in the groups with PEM and pneumonia one compared to the group with PEM without pneumonia [p<0.001]. The leptin hormone has an important role in immune system and its deficiency in PEM together with reduction of CD4 ratio are important factors for contracting infections

A case of lethal kwashiorkor caused by feeding only with cereal grains / 소아과

Kwashiorkor is a syndrome of severe protein malnutrition, which manifests itself in hypoalbuminemia, diarrhea, dermatitis, and edema. It can be life-threatening due to associated immune deficiency and an increased susceptibility to infections. Kwashiorkor should be treated early with nutritional support and the control of infection. Dilated cardiomyopathy may develop during the treatment and in such cases a poor prognosis is expected. Kwashiorkor has been known as a common disease of poor countries. To date, in fact, there has been no report of kwashiorkor leading to death in technically advanced countries. We here report a fatal case of a baby girl admitted with kwashiorkor. She had been fed only with cereal grain mixed with juice, without any protein supplement, for 2 months. This diet was deficient not because of poverty, but due to the illiteracy of her parents. The patient suffered from diarrhea, whole body edema, hypothermia, and dermatitis. Laboratory findings revealed an immune-deficient state featuring leukopenia and decreased immunoglobulin. Blood and urine cultures revealed Alcaligenes Xylosoxidans growth. The patient was fed frequent small amounts of protein-containing formula and intravenous albumin and micronutrients were administered for nutritional support. She was also treated with intravenous immunoglobulin and antibiotics in order to control infection. Nevertheless, she developed dilated cardiomyopathy and multi-organ failure and died. We review this case in light of the literature.

El mal de ojo y su relación con el marasmo y kwashiorkor: El caso de las madres de Turbo, Antioquia, Colombia / Mal de ojo and its relationship with marasm and kwashiorkor: the Turbo mother’s case

Objetivo: Describir las percepciones y prácticas socio-culturales de las madres frente al proceso de desnutrición aguda grave de los niños: marasmo y kwashiorkor. Metodología: Etnografía descriptiva. Se realizaron 20 entrevistas semiestructuradas, 2 entrevistas grupales y observación en los hogares y en el hospital. El análisis se realizó manualmente. Resultados: Las madres perciben la desnutrición aguda grave como una consecuencia del mal de ojo, el cual afecta a los niños menores de 7 años. El mal de ojo se clasifica como “ojo secador” y “ojo de la calle”. Para las madres, el ojo secador enmagrece totalmente a los niños, lo cual podríamos asimilar al marasmo. No es claro si el ojo de la calle conlleva al kwashiorkor, pero es claro que el kwashirkor es causado por el mal de ojo. Los médicos tradicionales, como los rezanderos, ocupan un lugar importante en el tratamiento de las enfermedades de filiación cultural. Conclusiones: En el modelo biomédico no existen ni el mal de ojo ni la desnutrición como enfermedad. La desnutrición se conceptúa como estado y finalmente se objetiviza en cifras estadísticas, lo cual dificulta la atención integral de los niños. El estudio devela un mundo desconocido por el sistema biomédico, y un mundo de prácticas culturales frente al proceso de desnutrición, que adecuadamente valoradas permitirían mejorar la atención integral y evitar la muerte infantil por desnutrición aguda grave o por el mal de ojo

Objective: To describe perceptions and socio-cultural practices by the mothers facing severe malnutrition in children: Marasm and Kwashiorkor. Methodology: Descriptive ethnography.Twenty semi-structured interviews and two tribal ones were carried. Homes and hospitalized children were observed. Analysis was manually performed. Results: Mother perceives severe malnutrition like “mal de ojo” consequence afflicting children under seven. Mal de ojo is classified as “drying-eye” or as “street-eye”. Mothers think that “drying-eye” emaciates children meaning something like what we call marasm, whereas we cannot tell weather “street-eye” means kwashiorkor; but in any case kwashiorkor is deemed to be caused by mal de ojo. “Traditional” medics like rezanderos perform important tasks in the treatmentof cultural linked illnesses. Conclusions: Malnourishment is considered a “state” and finally it is reduced to statistical data hindering the integral treatment of children. The study reveals a world unknown by the biomedical system and a world of cultural practices facing malnourishment that adequately assessed could improve integral treatment and prevent infant mortality by severe malnourishment or by mal de ojo.

Piel, desnutrición y enfermedad digestiva / Skin, malnutrition and digestive disease

La piel es un órgano muy importante pues nos brinda información visual indispensable para el diagnóstico de múltiples enfermedades. Muchas de éstas afectan el aparato digestivo con repercusión en la piel, otras, afectan la piel y dan signos y síntomas en el aparato digestivo.Así mismo,la deficiencia de nutrientes,calorías, vitaminas y elementos esenciales en el organismo se manifiestan en la piel, el pelo, las uñas y las mucosas brindándonos así todas las herramientas necesarias para el correcto diagnóstico y tratamiento apropiado (AU)

The skin is a very important organ as it provides indispensable visual information for the diagnosis of multiple diseases.Many of these affect the digestive tract with repercussion on the skin, while others compromise the skin and give signs and symptoms in the alimentary tract. In the same way, the deficiency of nutrients, calories, vitamins and essential elements in the organism, have manifestations on the skin, hair, nails and mucosal membranes, providing all the tools that are necessary for a correct diagnosis and appropriate treatment (AU)

Relation between behavioral factors, malnutrition and persistent diarrhea in children under two years of age. A hospital study

A high prevalence of behaviors which are related to persistent diarrhea and the prevalence of moderate to severe malnutrition in patients with persistent diarrhea in children. To asses the prevalence of negative behaviors that cause the persistent diarrhea and to asses the prevalence of malnutrition among children with persistent diarrhea and to compare prevalence of malnutrition due to persistent diarrhea to that of national figures. This study was carried out at the Central Teaching Hospital for Children in Baghdad, a total number of 200 cases of persistent diarrhea [lasting more than 14 days] [with no more than 48 hour normal bowel motions in this period] in children less than 2 years of age. The period of the study was one year from the 1st of January 1999 to the thirty-first of December 1999. Information was taken from patient's companions usually the mothers and the patients were selected at inpatient, out patient and Emergency departments in a randomized way. The study showed that the most common age group of persistent diarrhea was the 2[nd] half of the first year constituting [47%] [94/200] of patients with persistent diarrhea. Patients whose mothers were illiterate constituted a high proportion [48%] [96/200]. Patients on bottle or mixed feeding constituted [77%] [144/200]. A high prevalence of some behaviors which is related to persistent diarrhea was noticed like allowing the children to pick up food spilled on the floor and eat it [65%] [130/200], stopping or altering feeding during episodes of diarrhea [78%] [156/200], mothers neglecting washing hands or their babies hands before feeding their children [74%] [148/200] and [66%] [132/200] respectively, failure to introduce solid food in 1st year of life [72.3%] [94/ 130] and failure to eat adult type of food in 2[nd] year of life [65.7%] [46/70]. The prevalence of moderate to severe malnutrition at the three age groups was significantly higher in children with persistent diarrhea in present study compared to general population figures reported by polio immunization national day [PIND] survey at 1999 in Iraq, marasmus was significantly more common in 2[nd] half of the 1[st] year of life and the prevalence of kwashiorkor was significantly higher [15.8%] [11/70] among the older age group [2[nd] year of life]. The most common age group who developed persistent diarrhea was the second half of the first year of life. The negative behaviors of the mothers had a significant effect on the occurrence of persistent diarrhea in children and the development of malnutrition diseases like marsmus and kwashiorkor

Concentracion sérica de cobre ®libre¼ y ceruloplasmina en niños con desnutricion aguda grave antes de iniciar la terapia nutricional y al momento de recuperar el apetito en turbo, antioquia, colombia / Serum concentrations of free copper and ceruloplasmin in children with severe acute malnutrition before nutritional therapy and after children have recovered the apetite in turbo, antioquia, colombia

Introduction: copper supplementation therapy has been used in children with acute and severe malnutrition. Scientific evidence has shown that malnourished children with edema have free copper in plasma which could produce oxidative stress. Objective: To compared plasma concentrations of free copper between children with acute and severe malnutrition and a control group. Methodology: Cross sectional study where 66 normal and malnourished children were studied. A longitudinal study (before and after type) design was used including 40 children with severe and acute malnutrition; free copper was merasured by high-resolution capillary electrophoresis; ceruloplasmin and PCR by nephelometry. Results: In the cross sectional study children with marasmus had higher free copper serum concentrations than children with oedematous malnutrition, but the difference was not significant. In the control group this metal was not found. Children with oedema showed significant lower ceruloplasmin concentrations than children with marasmus (p=0.00) while the difference in PCR was also no significant for both groups. When the relationship between free copper serum concentrations and the presence of infection was analyzed no significant differences were obtained. However, serum albumin concentration was significantly lower for children with oedematous malnutrition than the marasmic group (p=0.016). After children recovered the appetite in the longitudinal study, serum free copper concentration decreased for both groups and ceruloplasmin concentration increased but no significant differences were observed. Conclusion: Copper supplementation could be considered as nutritional therapy for undernourished children since the beginning of the nutritional treatment, as it is recommended by WHO.

Introducción: La recuperación de los niños con desnutrición aguda grave incluye suplementación con cobre desde el inicio de la terapia; existen evidencias que niños edematosos pueden tener cobre libre en plasma el cual podría generar estrés oxidativo. Objetivo: Comparar concentraciones séricas de cobre libre y ceruloplasmina en un grupo de desnutridos agudos graves y un grupo control Metodología: estudio transversal al ingreso entre niños con y sin desnutrición en una muestra de 66 sujetos y longitudinal de tipo antes y después en 40 niños desnutridos. Se determinó cobre libre por electroforesis capilar de alta resolución; ceruloplasmina y PCR por nefelometría, además de variables clínicas Resultados: En el transversal, los marasmáticos presentaron niveles de cobre libre mayores que los edematosos sin diferencia significativa; en el grupo control este metal no se detectó. En los edematosos la concentración de ceruloplasmina fue significativamente menor con relación a los marasmáticos (p=0.00) y la PCR no presentó diferencia significativa entre ellos. No se encontraron diferencias significativas entre los niveles de cobre libre y presencia o no de infección. La albúmina se encontró más baja en los edematosos con diferencia significativa respecto a los marasmáticos (p=0.016). En el longitudinal, al recuperar el apetito el cobre libre disminuyó y la ceruloplasmina aumentó en los dos grupos sin diferencia significativa Conclusión: el suplemento de cobre como componente de la terapia nutricional puede ser suministrado a los desnutridos desde el inicio como lo propone el protocolo de la OMS.