Indian journal of pediatrics
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Diabetic ketoacidosis is the most common endocrine emergency in children and frequently it is the initial presentation of insulin dependent diabetes mellitus. Despite sophisticated technology and our improved understanding of the pathophysiology of this disease, the mortality from intracranial complications remains constant over the past two decades. ⋯ It remains to be seen if widespread use of this rehydration strategy will improve morbidity in the future. A protocol for managing diabetic ketoacidosis is suggested.
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The routine use of frozen section biopsy to identify distal ganglionic bowel in Hirschsprung's disease is the accepted norm in well developed centers. With the aim of overcoming non-availability of frozen section biopsy and reducing the duration of definitive surgery, an alternative algorithm, based on extramucosal seromuscular biopsy at the time of preliminary fecal diversion and its examination by routine paraffin sections and staining, was developed and used in 100 patients at our centre. This technique accurately marked the ganglionic colon for pull-through operation in 96.2% of cases with rectosigmoid transition zone and in 91.7% of those with transition zone in the descending colon, thus obviating the need for frozen section biopsy and saving nearly one hour during the pull-through surgery. However, in the more proximal varieties of Hirschsprung's disease frozen section biopsy was still considered to be indispensable.
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Spirometry is indicated in all the children with clinical diagnosis of asthma, chronic/recurrent cough or wheeze, exercise induced cough or breathlessness and with recurrent respiratory manifestations. Mid expiratory How 25-75% (MEF 25-75) is an important diagnostic parameters in children due to its effort independence, high sensitivity in bronchodilator reversibility test and also because it represents smaller airways and is likely to be affected in mildest obstruction. ⋯ Therefore it is not useful in children. PEFR monitoring constitutes an important part of the followup care of asthma patients.