RESUMO
OBJECTIVE AND DESIGN: The earlier reports of disturbed gastric motility in protein energy malnutrition (PEM) point out to its possible contribution in the difficulties faced during nutritional rehabilitation. This study was thus designed to assess the ultrasonographic gastric emptying time (GET) using 20 ml/kg body weight of both liquid and semisolid meals, in 27 patients suffering from PEM as well as in 15 healthy matching infants to delineate any defect present, its degree in different types of PEM and the effect of nutritional rehabilitation. PATIENTS: The patients were recruited from the in-patient department of Children's Hospital, Ain Shams University, Cairo, Egypt. They were divided into three groups: 10 marasmic infants, 10 marasmic kwashiorkor (marasmic KWO) and seven kwashiorkor (KWO) cases. Ultrasonographic GET assessment was carried out within 72 h of admission and 30+/-7 days after nutritional rehabilitation. RESULTS: The gastric half-emptying time T(1/2) of both liquid and semisolid meals was markedly prolonged in patients with marasmus and marasmic KWO. It was more delayed for the semisolid than the liquid meals. This delay was reversible after nutritional rehabilitation of the patients, indicating that it was secondary to the malnourished status. On the other hand, T(1/2) of both liquid and semisolid meals showed no statistically significant delay in the KWO group and nutritional rehabilitation added no further to the results. CONCLUSION: PEM, especially marasmus and marasmic KWO, causes a delay in GET, which is reversible on nutritional recovery. This must be considered during nutritional rehabilitation of such patients to decrease the duration of their hospitalization and thus decrease the morbidity in PEM.
Assuntos
Esvaziamento Gástrico , Kwashiorkor/fisiopatologia , Desnutrição Proteico-Calórica/fisiopatologia , Estômago/diagnóstico por imagem , Egito , Feminino , Esvaziamento Gástrico/fisiologia , Humanos , Lactente , Kwashiorkor/diagnóstico por imagem , Kwashiorkor/reabilitação , Masculino , Estado Nutricional , Desnutrição Proteico-Calórica/diagnóstico por imagem , Desnutrição Proteico-Calórica/reabilitação , Estômago/fisiopatologia , Fatores de Tempo , UltrassonografiaRESUMO
Echocardiography (ECHO), electrocardiography (ECG), and chest radiography (CXR) were performed in 44 children with kwashiorkor, and 44 age- and sex-matched controls. In patients with kwashiorkor, mean values obtained for end diastolic dimension (29.2 +/- 3.8 mm), end systolic dimension (20.9 +/- 2.8 mm), posterior ventricular wall thickness (5.42 +/- 0.57 mm), and shortening fraction (28.2 +/- 4.3%) were significantly smaller than the corresponding values obtained in the controls -38.0 +/- 5.8 mm (P < 0.001), 27.6 +/- 4.5 mm (P < 0.001), 7.07 +/- 0.71 mm (P < 0.001) and 31.4 +/- 4.5% (P < 0.05), respectively. Similarly, mean cardiothoracic ratio (48.6 +/- 3.4%) and QRS amplitude (13.20 +/- 4.85 mm) were significantly (P < 0.001) smaller in subjects than controls, corresponding values being 54 +/- 3.2 per cent and 20.18 +/- 5.12 mm, respectively. In the subjects, there was very good correlation between posterior ventricular wall thickness and cardiothoracic ratio (r = 0.93; P < 0.001) and also between the estimated left ventricular mass and S1 + R6 amplitude (r = 0.89; P < 0.001).
Assuntos
Cardiomiopatias/diagnóstico por imagem , Kwashiorkor/diagnóstico por imagem , Cardiomiopatias/complicações , Cardiomiopatias/epidemiologia , Estudos de Casos e Controles , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Lactente , Kwashiorkor/complicações , Kwashiorkor/epidemiologia , Masculino , Nigéria/epidemiologia , Análise de RegressãoRESUMO
Computed tomography of the brain was performed initially and after nutritional rehabilitation on 12 children with kwashiorkor. The severe cerebral shrinkage evident initially resolved after nutritional rehabilitation. The mechanism and significance of this reversible abnormality remains to be determined.
Assuntos
Encéfalo/diagnóstico por imagem , Kwashiorkor/diagnóstico por imagem , Atrofia , Encéfalo/patologia , Cefalometria , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Kwashiorkor/dietoterapia , Kwashiorkor/patologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
The present work is the result of a multicentric study performed at Hoima and Kitgum Hospitals in Uganda on a group of 20 children with Kwashiorkor. Bone age was evaluated on the X-ray film of the children's left hand and wrist, according to Tanner and to De Roo, by 2 different evaluators. The final results were compared. Eighty-five % of the patients presented delayed bone maturation: such a result confirms the importance of malnutrition on skeletal development. The data reported by other authors are also discussed.
Assuntos
Determinação da Idade pelo Esqueleto , Osso e Ossos/diagnóstico por imagem , Kwashiorkor/diagnóstico por imagem , Fatores Etários , Criança , Pré-Escolar , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/etiologia , Humanos , Lactente , Kwashiorkor/complicações , Masculino , Estudos Multicêntricos como AssuntoRESUMO
Computed tomography of the brain was performed on eight children aged 1 to 4 years with severe protein energy malnutrition. Clinical features typical of kwashiorkor were present in all the children studied. Severe cerebral atrophy or brain shrinkage according to standard radiological criteria was present in every case. The findings of this study suggest considerable cerebral insult associated with severe protein energy malnutrition.
