Browsing by Autor "Chevalier, P"

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["CLAPSEN", a global approach to the rehabilitation of severe childhood malnutrition in Bolivia].
(2000) Sevilla, R; Sejas, E; Zalles, L; Belmonte, G; Chevalier, P; Parent, G; Katherine, H; Kolsteren, P
The "CLAPSEN" approach was developed at the Hospital Materno Infantil German Urquidi in Cochabamba, to provide a global response for the study and treatment of childhood malnutrition. "CLAPSEN" is short for Clinical, Laboratory, Anthropometry, Psychology, Sociology, Nursing (Enfermera in Spanish) and Nutritional care. Most of the malnourished children admitted to Cochabamba Hospital are from poor families, more than three quarters of whom have only recently arrived in the city. Acute malnutrition is just one of the manifestations of a generally unfavorable environment. Malnutrition should not be considered as a simple deficiency in energy, protein or micronutrients, but rather as a multi-deficiency syndrome, also involving a lack of basic health and social care. This study demonstrates that malnourished children display a considerable degree of psychological retardation and of immune system depression. After five weeks of rehabilitation, the children were considered to have recuperated physically, as assessed by anthropometry, but not psychologically, as assessed by the adapted Dewer Score, or immunologically, as shown by the size of the thymus or the extent of maturation of lymphocytes. This strategy was not designed as a long-term approach for treating malnutrition, but rather as a research project to characterize the children arriving at the hospital, to determine the reasons for their malnutrition and to identify strategies that could be implemented earlier by health centers of social services, to prevent deterioration in the condition of these children to severe malnutrition requiring hospital admission. We believe that, in this Latin American context, in which the rate of acute malnutrition is low, the hospital should continue to be involved in the treatment of severely malnourished children with associated diseases. The child's stay in hospital should be short and once the child has recovered clinically, he should be sent home. In light of the observed levels of social deprivation, psychosocial and immune deficits, there appears to be a need for continued support for the family, to ensure the full recovery of the child and to prevent relapses.
El índice de Kanawati-McLaren o relación brazo/cabeza una técnica sencilla de conocer el estado nutricional de un niño
(Facultad de Medicina, Enfermería, Nutrición y Tecnología Médica, 1993) Chevalier, P
Existen muchas técnicas para evaluar el estado de nutrición de un niño: - la encuesta alimentaria retrospectiva, la cual nos permite sondear las carencias posibles en nutrientes de la dieta. - el examen clínico, el cual debido a la ausencia de síntomas en casos de desnutrición leve o moderada, diagnostica solamente casos graves. - la antropometría, que con personal bien adiestrado y el uso bien entendido de las normas internacionales o nacionales, permite un diagnóstico fiable del estado nutricional y de los diferentes grados de desnutrición. - la bioquímica, la cual constituye un complemento de diagnóstico, pero necesita una infraestructura difícil de encontrar fuera de algunos laboratorios, además los parámetros válidos son costosos y necesitan para su interpretación de profesionales calificados
Study of thymus and thymocytes in Bolivian preschool children during recovery from severe protein energy malnutrition
(Facultad de Medicina, Enfermería, Nutrición y Tecnología Médica, 1994) Chevalier, P
ABSTRACT. Impaired cellular immunity in malnourished children is well known but rarely recovery of immunity was assumed during nutritional rehabilitation. Nutritional Acquired Immune Deficiency Syndrome (NAIDS) was directly or indirectly responsible for high morbi-mortality in preschool children. In the CRIN (Centro de Rehabilitación Inmuno-Nutricional), 45 children aged 6 to 55 months, hospitalized with severe malnutrition, were studied during 9 weeks. Anthropometric measurements and echography of the thymic left lobule were carried out weekly and T cell subsets (CD3, CD1 a) were measured monthly. Weight for height was 79% of NCHS (National Center for Health Statistic) median upon admission and still 90% at 5 weeks The immature lymphocyte level was 29% upon admission, 16% after 5 weeks and 10% after 9 weeks (discharge); at the same 349 mm2. Nutritional recovery was faster than Immune recovery. “Apparently” healthy children which had recovered after 5 weeks were still immune depressed and we must consider them as high risk children. These observations indicate that cellular immunity should be evaluated regularly during malnutrition rehabilitation to avoid the frequent failure of nutritional rehabilitation programs. A noninvasive method like thymic echography enables to evaluate indirectly immune recovery.