ABSTRACT
Background: Asthma in children is difficult to diagnose due to inability of young children to successfully perform spirometry. However some parameters in the spirometry which are relatively effort independent can be very helpful in confirming the diagnosis of asthma. This study was conducted to find out the most commonly affected spirometry parameter in the suspected cases of childhood asthma.Methods: Total 56 children were studied between 7 to 18 years who came for outpatient visit or admitted in the paediatric ward and were clinically suspected to be asthmatic based on asthma predictive index. They were subjected to spirometry in our institute. Baseline and post bronchodilator values of spirometry parameters were studied and analysed using standard statistical tests.Results: Baseline Forced expiratory flow between 25% and 75% of vital capacity (FEF25-75%) was found to be the most commonly affected spirometry parameter in confirming the diagnosis of suspected asthmatics and correlated with the clinical diagnosis of childhood asthma.Conclusions: FEF25-75% can aid in confirming the diagnosis of suspected asthmatic children who are otherwise not treated as asthmatics and remain undiagnosed in view of not meeting the established spirometry criteria for asthma due to poor performance and ignorance of looking at this important and effort independent parameter.
ABSTRACT
Justification: Severe acute malnutrition (SAM) is a major public health issue. It afflicts an estimated 8.1 million under-five children in India causing nearly 0.6 million deaths. The improved understanding of pathophysiology of SAM as well as new internationally accepted growth charts and newer modalities of integrated intervention have necessitated a relook at IAP recommendations. Process: A National Consultative Meeting on Integrated Management of Severe Acute Malnutrition was held in Mumbai on 16th and 17th October, 2010. It was attended by the invited experts in the field. Extensive discussions were held as per the program. The participants were then divided into six groups for detailed discussions. The groups deliberated on various issues pertaining to the task assigned and presented recommendations of the groups in a plenary session. The participants made a list of recommendations after extensive discussions. A Writing Committee was formed and was entrusted with the task of drawing a Consensus Statement on the basis of these Recommendations. After multiple deliberations, the following Consensus Statement was adopted. Objectives: To critically evaluate the current global evidence to formulate a consensus among stakeholders regarding diagnosis and management of SAM. Recommendations: An integrated management of malnutrition is likely to yield more dividends. Thus, management of SAM should constitute an important component of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program. Determination of SAM on the basis of Z-scores using WHO Growth charts is considered statistically more appropriate than cut-offs based on percentage weight deficit of the median. Considering the fact that many children with SAM can be successfully managed on outpatient basis and even in the community, it is no more considered necessary to advise admission of all children with SAM to a healthcare facility. Management of SAM should not be a stand-alone program. It should integrate with community management therapeutic programs and linkages with child treatment center, district hospitals and tertiary level centers offering inpatient management for SAM and include judicious use of ready-to-use-therapeutic Food (RUTF). All sections of healthcare providers need to be trained in the integrated management of SAM.