A study of the prevalence of various lower urinary tract symptoms in children with analysis of comorbidities and uroflowmetry

Background: The International Children’s Continence Society (ICCS) in its standardization article in 2006 and subsequent revision in 2014 have provided guidelines for the diagnosis and management of lower urinary tract symptoms (LUTS) in children. However, the terminologies are still not in common parlance and colloquial terms are being heavily used in India. Objective: The objective of the study was to evaluate the clinical spectrum of LUTS and their comorbidities in children. Materials and Methods: This was an observational cross-sectional study conducted in a tertiary care hospital in Northern India. Children, included in the study, aged 5–12 years who presented with LUTS as defined in the ICCS 2014 updated guidelines. A simultaneous analysis of uroflowmetry graphs was also done in these children and the observations presented in this paper. Results: Enuresis was the most common LUTS with which children presented to the OPD (78% cases) followed by increased frequency of micturition (42%). Among comorbidities, constipation was present in one-third patients of LUTS. Uroflowmetry done in LUTS often yields a normal “bell-shaped” graph in majority of the patients (71%). The study shows that many enuretics have underlying other LUTS and comorbidities that we should be aware of and uroflowmetry, if not coupled with urodynamic studies, is not a game changer. Conclusion: There are not many studies post the standardization of the ICCS conducted in India and this study aims at increasing the awareness of the same among physicians and researchers alike

Evidence-based focused approach for fulfillment of aims: Experiences of an asthma clinic

Background: A new health system for the 21st century should be based on the best scientific knowledge, according to the Institute of Medicine, US. Objective: We have evaluated the effectiveness of asthma clinic providing comprehensive care based on the best available scientific evidence. Materials and Methods: This intervention study was conducted in a tertiary care hospital having a devoted asthma clinic for the  comprehensive management. All children diagnosed as having asthma were included, and data of cases managed from July 2014 to June 2016 were analyzed. Intervention - comprehensive management of asthma including assessment, monitoring, health education, avoidance of triggers, management of comorbid conditions, appropriate medications, written asthma action plan, and counseling for follow-up. Outcome measures were treatment direction, asthma control, emergency visits, and hospitalizations. Results: 260 children were treated over a 2-year period. The effects of focused approach with progressive expertise lead to statistically significant benefits over the two successive years from July 2014 to June 2015 and July 2015 to June2016. These were in: (i) Treatment direction: Cases requiring stepping up of treatment decreased from 36.49% to 17.24% (relative risk [RR]: 0.473 [95% confidence interval {CI}: 0.249-0.895]); p=0.01229, (ii) asthma control: Cases with not well-controlled asthma decreased from 16.44% to 7.02% (RR 0.427: [95% CI: 0.199-0.914]); p=0.045, (iii) emergency department visits decreased from 35.62% to 21.05% (RR 0.591: [95% CI: 0.39-0.897]), p=0.00766, (iv) hospitalizations decreased from 16.44% to 5.26% (RR 0.32: [95% CI: 0.135-0.757]), p=0.00462. Conclusion: Establishing an asthma clinic and progressive expertise leads to significant beneficial results