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We study propagation in a cyclic symmetric multicore fiber where the core radii randomly fluctuate along the propagation direction. We propose a hybrid analytic-numerical method to optimize the amplitude and frequency of the fluctuations that suppress power transfer between outer and inner cores. This framework allows us to analytically find noise amplitude parameters that optimally suppress crosstalk. Our predictions are confirmed by numerical experiments using finite difference beam propagation methods for realistic C-band fibers. The analytic part of our method is general, provides the optimum fluctuation amplitude independent of the array geometry, as long as normal modes can be calculated. It works for both correlated and uncorrelated fluctuations allowing its use for any given optical system described by coupled mode theory.
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BACKGROUND: Cardiovascular disease accounts for 35% to 50% of the causes of mortality in chronic kidney disease. The majority of patients in substitution therapy in Mexico are subdialyzed owing to limited economic resources. This produces more cardiac deterioration than described in the statistics and has a direct impact on the prognosis of kidney transplantation. The aim of this work was to demonstrate and to quantify the improvement in the echocardiographic parameters 6 months after renal transplantation in patients with stable renal function. METHODS: This was an observational, analytic, prospective study of 23 patients with chronic kidney disease who received transplants in 2016 and had a glomerular filtration rate ≥80 mL/min (Chronic Kidney Disease-Epidemiology Collaboration) 6 months after transplantation. RESULTS: Echocardiographic results showed an increase in the left ventricular ejection fraction from 57.17 ± 10.46% to 64.09 ± 9.8%, an increase in the right ventricular ejection fraction from 0.56 ± 0.09% to 0.60 ± 0.08% and a reduction of the pulmonary arterial systolic pressure from 44.57 ± 13.88 mm Hg to 39.74 ± 11.04 mm Hg. There were also decreases in mitral regurgitation from 1.0 to 0.43, tricuspid insufficiency from 1.35 to 0.43, pulmonary insufficiency from 0.48 to 0.04, and aortic insufficiency from 0.35 to 0.04, all of these significant with P < .05. CONCLUSIONS: There was a significant improvement in cardiovascular function in our population 6 months after transplantation, despite the fact that renal transplantation is performed with greater cardiac deterioration than described in patients in other countries.
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Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Transplante de Rim , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/cirurgia , Idoso , Ecocardiografia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Prognóstico , Estudos ProspectivosRESUMO
The multihost parasites Leishmania spp. infect a broad range of wild mammalian species including bats. Several species of bats have adapted to a variety of food resources and shelters in urban areas. This study aimed to detect Leishmania spp. DNA in bats present in forest fragments located in metropolitan areas endemic for leishmaniasis in Campo Grande, Mato Grosso do Sul (MS), Brazil. Blood samples were obtained from 80 individuals, including eight species of Phyllostomidae and one species of Vespertilionidae. Thirty of the 80 bats were positive for Leishmania spp. using conventional PCR, all belonging to the family Phyllostomidae. Eighteen samples tested by real-time PCR (qPCR) using specific primers for the kDNA of Leishmania infantum were positive. To the best of our knowledge, this is the first report detecting Leishmania spp. in Platyrrhinus incarum in addition to being the first reported detection of L. infantum in the bat species Phyllostomus discolor, Platyrrhinus lineatus, Artibeus planirostris and Artibeus lituratus. Our results show that bats can host Leishmania spp. in areas endemic for leishmaniasis, which must be taken into account in disease control operations by public health authorities.
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Quirópteros , Leishmania/isolamento & purificação , Leishmaniose/veterinária , Animais , Brasil/epidemiologia , Leishmania/classificação , Leishmaniose/epidemiologia , Leishmaniose/parasitologia , Reação em Cadeia da Polimerase em Tempo RealRESUMO
BACKGROUND/AIM: First-line bevacizumab-based therapies have been shown to improve clinical outcomes in patients with non-squamous non-small-cell lung cancer (NSCLC). We aimed to descriptively analyse patients with non-squamous NSCLC who received a long-term period of maintenance bevacizumab. PATIENTS AND METHODS: This retrospective study included 104 patients who had already reached a progression-free survival (PFS) of at least 9 months. RESULTS: Median overall survival and PFS were 30.7 and 15.1 months, respectively. The overall response rate was 83 %. Weight loss ≤5 %, ECOG PS = 0, or low number of metastatic sites seem to be predictive factors of good evolution. The incidence of bevacizumab-related adverse events appeared to be similar as the previous studies. CONCLUSION: Our findings show that there is a long-term survivor group whom the administration of bevacizumab resulted in a relevant prolongation of response without new safety signals. Due to the population heterogeneity, it was not possible to identify the standardised predictive factors.
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Adenocarcinoma/mortalidade , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Carcinoma de Células Grandes/mortalidade , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/mortalidade , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Idoso , Carcinoma de Células Grandes/tratamento farmacológico , Carcinoma de Células Grandes/patologia , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Metástase Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , SobreviventesRESUMO
INTRODUCTION: Although cognitive and learning disorders have been described in patients with epilepsy, very few studies focus on specific disorders such as absence epilepsy. The aim of this study was to evaluate learning skills and academic performance in children and adolescents with absence epilepsy. METHODS: Observational case-control study. Cases were chosen from the Central League against Epilepsy's clinic in Bogotá, Colombia. Controls were selected from a private school and matched with cases by age, school year, and sex. Medical history, seizure frequency, antiepileptic treatment, and academic performance were assessed. Academic abilities were tested with Batería de Aptitudes Diferenciales y Generales (BADyG) (a Spanish-language test of differential and general aptitudes). Data were analysed using Student t-test. RESULTS: The sample consisted of 19 cases and 19 controls aged between 7 and 16. In 15 patients, seizures were controlled; all patients had received antiepileptic medication at some point and 78.9% were actively being treated. Although cases had higher rates of academic failure, a greater incidence of grade retention, and more therapeutic interventions than controls, these differences were not significant. Similarly, there were no significant differences on the BADyG test, except for the immediate memory subcategory on which cases scored higher than controls (P=.0006). CONCLUSION: Children treated pharmacologically for absence epilepsy, whose seizures are controlled, have normal academic abilities and skills for their age.
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Avaliação Educacional , Epilepsia Tipo Ausência/psicologia , Aprendizagem , Adolescente , Estudos de Casos e Controles , Criança , Colômbia , Epilepsia Tipo Ausência/tratamento farmacológico , Feminino , Humanos , Deficiências da Aprendizagem/etiologia , Masculino , Testes NeuropsicológicosRESUMO
INTRODUCTION: Cisplatin plus oral vinorelbine, one of the standard treatments for metastatic non-small-cell lung cancer (NSCLC), is associated with a high rate of neutropenia, and a hemogram is performed on day 8. We analyzed the oncologists' opinions and the result of the hemogram on day 8 to address the question of whether this hemogram could be avoided. MATERIALS AND METHODS: Fifty-eight chemotherapy-naive, advanced NSCLC patients were included. Each received intravenous doses of 75 mg/m(2) cisplatin on day 1 plus oral vinorelbine [60 mg/m(2) in the first cycle (80 mg/m(2) in subsequent cycles) on days 1 and 8], every 3 weeks, for a maximum of six cycles. RESULTS: Out of 257 cycles analyzed, oral vinorelbine was administered on day 8 in 214 (83.2 %) and the dose was canceled in 6 cycles (2.3 %) due to hematological toxicity. On analyzing the patients to whom chemotherapy had been administered on day 8, based on medical opinion without the doctor knowing the hemogram result, we found that the cycle had been administered with a hemogram showing fewer than 1,500 × 10(6) neutrophils in only 3 of the 185 evaluable cycles [event rate of 1.6 %, with confidence interval 95 % = (0.34-4.67 %)]. CONCLUSION: The hemogram on day 8 can be avoided and oral vinorelbine administered in relative safety in patients with good performance status, when confirmed by the clinician's perception, thereby making this regimen more comfortable for the patient. This is the first prospective study to examine this issue.
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Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/patologia , Cisplatino/administração & dosagem , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Vimblastina/administração & dosagem , Vimblastina/análogos & derivados , VinorelbinaRESUMO
BACKGROUND: The present study aimed to provide updated data on anaemia prevalence and management in cancer patients undergoing systemic therapy in Spain. METHODS: This was a multicenter, observational, cross-sectional study performed in 2008. Eligible patients were ≥18 years, with non-myeloid malignancies treated with systemic therapy [chemotherapy (CT), hormonal therapy or immunotherapy]. Anaemia was defined according to WHO as haemoglobin (Hb) < 12 g/dL. RESULTS: The study included 214 patients with a median age of 63 years (range 20-91), 58 % women, 73 % with solid tumours, and 79 % with advanced disease. CT was used in 91 % of patients (26 % with platinum compounds), hormonal therapy in 8.5 %, and immunotherapy in 8.5 %. In our study, 48.1 % of patients [95 % confidence interval (CI) 45.2-58.6] showed anaemia (31 % symptomatic): 42.0 % mild (10 ≤ Hb ≤ 11.9 g/dL), 5.6 % moderate (8 ≤ Hb ≤ 9.9 g/dL), and 0.5 % severe (Hb < 8 g/dL). A higher prevalence was observed in patients treated with CT (51 vs. 20 %, p = 0.01), platinum-based CT (70 vs. 47 %, p = 0.01) or palliative CT (61 vs. 39 %, p = 0.003). Anaemia was also more frequent in patients with more than three lines of CT (83 %) and in the fourth or subsequent CT cycle (58 %). Management in the previous 4 weeks in patients with anaemia was: 62 % did not receive treatment (92 % mild), 24 % received erythropoiesis-stimulating agents (ESAs), 14 % received iron and 8.7 % received transfusion. CONCLUSIONS: In Spanish hospitals, about half of patients with non-myeloid malignancies undergoing systemic therapy fulfilled anaemia criteria (87 % mild). Approximately two-third of patients with anaemia do not receive specific treatment and ESA use is below current guidelines.
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Anemia/etiologia , Neoplasias da Mama/complicações , Neoplasias Gastrointestinais/complicações , Hematínicos/uso terapêutico , Neoplasias Hematológicas/complicações , Neoplasias Pulmonares/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/tratamento farmacológico , Anemia/epidemiologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Terapia Combinada , Estudos Transversais , Feminino , Seguimentos , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/terapia , Inquéritos Epidemiológicos , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/terapia , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prevalência , Prognóstico , Espanha/epidemiologia , Taxa de Sobrevida , Adulto JovemRESUMO
There is evidence linking intrauterine growth retardation with increased cardiovascular risk and diabetes mellitus (DM) later in life. However, little is known about the association between malnutrition during the first year of life and metabolic abnormalities in adulthood. The objective of this study was to assess the effect of documented malnutrition during the first year of life on glucose tolerance, plasma insulin, lipid profile, and blood pressure in early adulthood, as well as to assess the interaction between body mass index (BMI) and malnutrition on these variables. A study group of young men with a documented history of malnutrition during their first year of life was recruited from 4 pediatric hospitals in Mexico City and compared with a control group. Subjects included were 52 men, aged 20.2 +/- 3.6 years, with a mean birth weight of 3.0 +/- 0.7 kg and documented malnutrition in their first year of life; controls were 50 men, aged 23.3 +/- 1.8 years, with a mean birth weight of 3.2 +/- 0.5 kg. Insulin and glucose concentrations, fasting and in response to an oral glucose load, plasma lipids, blood pressure, and an insulin sensitivity index (ISI) were measured. The areas under the curves of glucose (AUCG) and insulin (AUCI) were significantly higher in cases (P =.012 and <.002, respectively), independent of birth weight, BMI, or age. BMI was significantly associated with fasting plasma insulin (FPI), AUCI, ISI, triglyceride, and high-density lipoprotein (HDL)-cholesterol concentrations in cases, but not in controls. These data suggest that early malnutrition in extrauterine life, independently of birth weight, has an adverse effect on insulin metabolism and glucose tolerance in young men, and it worsens as body mass increases even within the normal range of BMI. Therefore, it is advisable to prevent obesity in individuals exposed to early malnutrition.
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Intolerância à Glucose/etiologia , Insulina/sangue , Distúrbios Nutricionais/metabolismo , Adulto , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Intolerância à Glucose/sangue , Teste de Tolerância a Glucose , Humanos , Lactente , Recém-Nascido , Lipídeos/sangue , Masculino , Fatores de RiscoRESUMO
The prevalence of lipid abnormalities revealed in a survey done in 417 Mexican cities is described. Information was obtained on 15,607 subjects, aged 20 to 69 years. In this report, only samples obtained after a 9- to 12-h fast were included (2,256 cases: 953 men and 1,303 women). The population is representative of Mexican urban adults. Mean lipid concentrations were: cholesterol, 4.80 mmol/l; triglycerides, 2.39 mmol/l; HDL cholesterol, 1.00 mmol/l; and LDL cholesterol, 3.06 mmol/l. The most prevalent abnormality was HDL cholesterol below 0.9 mmol/l (46.2% for men and 28.7% for women). Hypertriglyceridemia (>2.26 mmol/l) was the second most prevalent abnormality (24.3%). Severe hypertriglyceridemia (>11.2 mmol/l) was observed in 0.42% of the population. Increased LDL cholesterol (> or =4.21 mmol/l) was observed in 11.2% of the sample. Half of the hypertriglyceridemic subjects had a mixed dyslipidemia or low HDL cholesterol. More than 50% of the low HDL cholesterol cases were not related to hypertriglyceridemia. Insulin resistance was found in 59% of them. In conclusion, the prevalence of hypoalphalipoproteinemia and other forms of dyslipidemia in Mexican adults is very high and it is among the highest previously reported worldwide.
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HDL-Colesterol/sangue , Hiperlipidemias/epidemiologia , Adulto , Idoso , Colesterol/sangue , LDL-Colesterol/sangue , Complicações do Diabetes , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/epidemiologia , Hiperlipidemias/sangue , Hiperlipidemias/complicações , Hipertensão/complicações , Hipertrigliceridemia/sangue , Hipertrigliceridemia/epidemiologia , Lipoproteínas HDL/sangue , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fenótipo , Triglicerídeos/sangueRESUMO
Protocols for evaluating oral rabies vaccine baits for domestic dogs were field tested in central Mexico, after which dog-food manufacturers and suppliers to the pet-food industry were advised as to potential ingredients for use in prototype dog baits. Bait-preference trials in which confined dogs were used were then undertaken, followed by field tests of free-ranging farmer-owned dogs in three towns in the Nile River Delta region of Egypt. Both confined and free-ranging dogs showed strong preferences for certain baits or bait coatings (poultry, beef tallow, cheese, egg and a proprietary product). Fish-meal polymer baits, widely used for wildlife species, were less preferred. In Egypt, a commercial dog-food-meal bait coated with beef tallow and dry cheese, was consumed at a rate approaching that of a chicken-head bait. The percentage baits that were actually eaten after they had been offered to dogs, ranged from 71-96% for household dogs tested in Mexico, 65-91% for confined dogs (beagles and mixed breeds) tested in the United States, and 32-88% for farmer-owned dogs tested in Egypt.
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Doenças do Cão/prevenção & controle , Vacina Antirrábica/administração & dosagem , Raiva/veterinária , Vacinação/veterinária , Administração Oral , Ração Animal , Animais , Distribuição de Qui-Quadrado , Cães , Egito , México , Raiva/prevenção & controle , Estados Unidos , Vacinação/métodosRESUMO
Enhancement-line human genetic engineering has recurrently been targeted for bioethical discussion and is usually (if not always) illustrated by examples alluding to a genetic technology that is far beyond our current possibilities. By discussing an ambitious project related to solid tumor cancers--multidrug resistance (MDR)--the present paper places the question on a more realistic plane and draws bioethical conclusions to serve as guidelines in the field. The paper also establishes the inadequacy of the prevalent concept of genetic medicine as one of substitution.
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Bioética , Técnicas de Transferência de Genes/normas , Melhoramento Genético , Princípios Morais , Qualidade de Vida , Resistência a Múltiplos Medicamentos/genética , Engenharia Genética/normas , Pesquisa em Genética , Terapia Genética , Características Humanas , Humanos , Medição de Risco , Valores SociaisRESUMO
The case of a 42 years old woman, who had laparoscopic hysterectomy and seven hours after presented with a convulsive crisis and later a coma status, secondary to hyponatremia. Hyponatremia causes, are discussed, as well as its relationship with syndrome of inadequate secretion of antidiuretic hormone, diagnosis, management, prognosis factors and risk.
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Hiponatremia/etiologia , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Adulto , Feminino , Humanos , Histerectomia/métodosAssuntos
Aborto Induzido , Aborto Legal , Atitude do Pessoal de Saúde , Ética Médica , Feminino , Humanos , Gravidez , Porto Rico , Sociedades MédicasRESUMO
The results of the first twelve cases of Laparoscopic Assisted Vaginal Hysterectomy, are presented. The indications for hysterectomy were myomatosis, suspicion of adenomyosis and endometriosis. The surgical technique is described in detail in which a combination of bipolar Kleppinger forceps and reusable scissors were employed. There were two intraoperative accidents. One subcutaneous emphysema of the left half of the abdominal wall, thorax, neck, face and upper limb. The second case was a damage to a branch of the left epigastric artery. The average time was 4 hours 31 minutes which includes 9 patients to which another surgical procedure was practiced. There was no significant bleeding in any of the patients. The postoperative complications were 1 hyponatremia that needed the use of an Intensive Care Unit and the other was periumbilical hematoma of 3 cm. of diameter. The patient was discharged on the one to three postoperative day with an average of two days. The average hospital fee was 35% higher than an abdominal hysterectomy. All the surgery were videotaped and later viewed by the patients. It was concluded that the laparoscopic assistance that is offered to the vaginal hysterectomy is particularly advantageous for hysterectomy especially in the cases where absence of genital prolapse, when uni or bilateral Adnexectomy is required, previous past history of abdomino-pelvic surgery, endometriosis and adhesions. This procedure should be included in the armamentarium of the Gynecological Surgeons but only after and appropriate training.
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Histerectomia Vaginal/métodos , Adenoma/cirurgia , Adulto , Feminino , Humanos , Histerectomia Vaginal/instrumentação , Complicações Intraoperatórias , Leiomioma/cirurgia , Tempo de Internação , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Neoplasias Uterinas/cirurgiaRESUMO
The strict separation of the biological roles of information and function as if they were two mutually exclusive aspects and the absolute identification of the former with nucleic acids and the latter with coded protein machinery has biased biological thinking to the extent that these notions act as very principles in contemporary biology. However, recent discoveries within the realm of RNA-viruses show the traditional application of such notions to be severely limited in conceptual terms.
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HIV-1/genética , DNA Viral/genética , Técnicas Genéticas , Genoma Viral , Genótipo , HIV-1/fisiologia , HIV-2/genética , HIV-2/fisiologia , Fenótipo , RNA Viral/genética , Replicação Viral/genéticaRESUMO
We evaluated four baits for the delivery of oral rabies vaccines to dogs. In a controlled study in a town in rural Mexico, 177 randomly selected dogs were assigned to receive one of four experimental baits (two of which were developed by the Denver Wildlife Research Center [DWRC]): one of two cylindrical polyurethane sponges with a corn meal coating (one fried in corn oil [DWRC-corn], the other in fish oil [DWRC-fish]), a fish-flavored polymer bait, or a wax bait. Each dog was also offered a commercial dog biscuit. We recorded whether or not the bait was completely consumed, and used the following measures to estimate the amount of oropharyngeal contact with each bait: total chewing time, presence of pieces of bait on the ground following administration, the total area of ground surrounding the location of ingestion that was covered with green dye contained in each bait, and condition of ampules that contained the dye. The dog biscuits were completely consumed significantly more often than the baits (155 of 176 [88%] for the biscuits versus 89 of 176 [50.5%] for the four baits; P less than 10(-6)), but were chewed for a significantly shorter time than the baits (mean time 34 sec for the biscuit versus 60-82 sec for the four baits: P less than 0.001). The ideal bait would probably combine the attractiveness of the commercial biscuit and the ability of the sponge baits to promote contact with the mucous membranes.
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Doenças do Cão/prevenção & controle , Vacina Antirrábica/administração & dosagem , Raiva/veterinária , Vacinação/veterinária , Administração Oral , Ração Animal , Animais , Países em Desenvolvimento , Cães , Estudos de Avaliação como Assunto , Feminino , Masculino , México , Raiva/prevenção & controle , Saúde da População Rural , Vacinação/métodosRESUMO
We compared three vaccination strategies in three rural communities in Mexico to determine the factors associated with the success of vaccination programs in areas where canine rabies is poorly controlled. In town A, intensive publicity and community participation were used; owners were instructed to bring their dogs to temporary centralized clinics for vaccination. In town B, only brief precampaign publicity was used, followed by vaccination at a centralized site. Minimal publicity was also used in town C, but the vaccination campaign was conducted house to house. A total of 5,426 residents and 1,597 dogs were counted in the three towns (mean human:dog ratio 3.4:1). In Town A, 70.1% (472 of 673) of the dogs were vaccinated; the campaign required 40 person-minutes per dog. Significantly greater proportions were vaccinated in town B (262 of 318 [82.4%]; P less than 0.001) and town C (483 of 561 [86.1%]; P less than 0.00001); each of these latter campaigns required 10 person-minutes per dog. The following factors were positively associated (by multivariate analyses) with vaccination of individual dogs: non-intensive publicity, house-to-house vaccination, dogs owned by a single member of the household, and dogs acquired greater than 15 days after birth. Intensive publicity did not increase the overall success of the vaccination program; the efficiency of centralized versus and house-to-house vaccination was comparable.
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Doenças do Cão/prevenção & controle , Vacina Antirrábica , Raiva/veterinária , Vacinação/veterinária , Administração Oral , Adolescente , Adulto , Fatores Etários , Idoso , Animais , Mordeduras e Picadas/epidemiologia , Criança , Pré-Escolar , Doenças do Cão/epidemiologia , Cães , Habitação , Humanos , Lactente , México/epidemiologia , Pessoa de Meia-Idade , Raiva/epidemiologia , Raiva/prevenção & controle , Vacina Antirrábica/administração & dosagem , População RuralRESUMO
We studied the nutritional parameters in 82 patients with chronic airways obstruction (type chronic bronchitis). Midarm muscle circumference was the earliest parameter affected. Patients were admitted to the hospital when his serum albumin had a value under normal. On the other hand, the outpatients had a serum albumin within the normal limits. When the protein deficiency involved serum prealbumin and serum retinol binding protein the patients were admitted to intensive care unit (ICU). The body weight and triceps skinfold were within the normal limits even in icu's patients, so that, both parameters neither reflect the nutrition status nor the severity of the undernutrition.