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Biomedical subjects

Dilip R Patel

Publications and source records attributed to Dilip R Patel.

At least 19 recordsLinked to original sources
PubMed2006

Musculoskeletal injuries in sports.

A large number of adolescents participate in various sports. Not withstanding the methodologic problems with epidemiologic data, a large percentage of athletes sustain musculoskeletal injuries. In most instances, the athlete first presents to his or her primary care physician, who must perform the initial assessment and decide on further management. Many injuries can be managed by the primary care physician. It is important to recognize the unique characteristics of adolescent growth and development that have implications for the diagnosis and management of musculoskeletal injuries.

Acute Disease↗
PubMed2005

Pharmacologic interventions for reducing spasticity in cerebral palsy.

Motor function abnormalities are a key feature of cerebral palsy. Spasticity is one of the main motor abnormalities seen in children with cerebral palsy. Spasticity is a velocity dependent increased resistance to movement. While in some children, spasticity may adversely impact the motor abilities, in others, it may help maintain posture and ability to ambulate. Thus, treatment to reduce spasticity requires careful consideration of various factors. Non-pharmacologic interventions used to reduce spasticity include physiotherapy, occupational therapy, use of adaptive equipment, various orthopedic surgical procedures and neurosurgical procedures. Pharmacologic interventions used for reducing spasticity in children with cerebral palsy reviewed in this article include oral administration of baclofen, diazepam, dantrolene and tizanidine, intrathecal baclofen, and local injections of botulinum toxin, phenol, and alcohol.

Administration, Oral↗
PubMed2005

Complementary and alternative medicine in developmental disabilities.

Developmental disabilities (DD) are defined as a diverse group of severe chronic conditions due to mental and/or physical impairments. Individuals with developmental disabilities have difficulty with major life activities including language, mobility, and learning. Developmental disabilities can begin anytime during development--from prenatal up to 22 years of age, and the disability usually lasts throughout a person's lifetime. Autism spectrum disorders, cerebral palsy, mental retardation, and attention deficit hyperactivity disorder are common conditions falling within the definition of developmental disabilities. Complementary and alternative medicine (CAM) is becoming increasingly utilized in the general population for treatment of everything from the common cold to complex and chronic medical conditions. This article reviews the prevalence of different types of CAM used for various developmental disabilities.

Child↗
PubMed2005

Therapeutic interventions in cerebral palsy.

Various therapeutic interventions have been used in the management of children with cerebral palsy. Traditional physiotherapy and occupational therapy are widely used interventions and have been shown to be of benefit in the treatment of cerebral palsy. Evidence in support of the effectiveness of the neurodevelopmental treatment is equivocal at best. There is evidence to support the use and effectiveness of neuromuscular electrical stimulation in children with cerebral palsy. The effectiveness of many other interventions used in the treatment of cerebral palsy has not been clearly established based on well-controlled trials. These include: sensory integration, body-weight support treadmill training, conductive education, constraint-induced therapy, hyperbaric oxygen therapy, and the Vojta method. This article provides an overview of salient aspects of popular interventions used in the management of children with cerebral palsy.

Cerebral Palsy↗
PubMed2005

Kidneys and sports.

With better understanding of the nature of renal disease and its treatment, many more adolescents are now allowed to participate in recreational and competitive sports. The positive physiologic and psychological effects of exercise are increasingly being appreciated in adolescents with chronic diseases. This article reviews relevant aspects of renal disease that have implications for sports participation by adolescents, including hematuria, proteinuria, hyponatremia, hypertension, solitary kidney, exercise-related acute renal failure, and chronic/end-stage renal disease. It also reviews the renal effects of creatine and protein supplementation in athletes.

Acute Kidney Injury↗
PubMed2005

The college athlete.

Participation in sports is important to many college students. Student athletes come from different levels of previous sport experience as they enter collegiate athletics. The primary source of student medical care is the campus student health center. The health care providers at student health centers attend to many of the sports-related concerns of student athletes. Preparticipation evaluation provides an opportunity to assess the general health of the student athlete and to identify conditions that might increase the risk of further injury. Sudden cardiac death and sports-associated concussions have generated much interest and are reviewed in this article. Other areas reviewed here include use of drugs and supplements, ankle sprains, acute knee ligament injuries, back pain, and shoulder impingement syndrome.

Athletic Injuries↗
PubMed2005

College health.

Explore the source record for details and available documents.

Adolescent↗
PubMed2005

Management of sport-related concussion in young athletes.

Sport-related head injuries are a common clinical problem. Most head injuries in young athletes are mild traumatic brain injuries or concussions. The highest number of sport-related concussions has been reported in American football. In addition to the well described physical and psychosocial growth, there is ongoing neurocognitive development of the brain during childhood and through adolescence. This developmental process has direct implications in the assessment and management of head injuries in young athletes. Research on the management and long-term outcome following brain injuries in young athletes is limited. Traditionally, the assessment of concussion has been based on clinical history and physical and neurological examination. Increasingly, neuropsychological testing, especially computerised testing, is providing objective measures for the initial assessment and follow-up of young athletes following brain injuries. Numerous guidelines have been published for grading and return to play criteria following concussion; however, none of these have been prospectively validated by research and none are specifically applicable to children and adolescents.

Acute Disease↗
PubMed2004

Management of pelvic inflammatory disease in adolescents.

Pelvic inflammatory disease (PID) is highly prevalent among sexually active adolescent females. The major organisms are N gonorrhoeae and C trachomatis. Diagnosis is based on historical information and clinical findings. Early diagnosis and treatment effectively reduce the incidence of complications associated with PID. Highly effective treatment regimens are available and main antimicrobials used include quinolones, cephalosporins, metronidazole, doxycycline, and azithromycin. Delay or inadequate treatment is associated with long term sequelae including tubal infertility and chronic pelvic pain. Prevention efforts should be directed towards routine screening and treatment for sexually transmissible infections, public education and provision of resources for treatment and follow-up.

Adolescent↗
PubMed2004

Referral patterns to a pediatric orthopedic clinic: implications for education and practice.

OBJECTIVE: Musculoskeletal medicine is becoming an increasingly essential part of primary care medicine. The American Academy of Pediatrics (AAP) Surgical Advisory Panel recently published voluntary guidelines to establish diagnoses that should be referred to a pediatric specialist rather than a general specialist (pediatric orthopedic surgery vs general orthopedic surgery). Given the crisis in pediatric orthopedic surgery manpower and resources, we believe that these guidelines are useful in defining appropriate referrals. The purpose of this study was to compare diagnoses that primary care pediatric providers believe commonly need referral to the AAP Guidelines for Referral to Pediatric Specialists recommendations for referral to pediatric orthopedic specialists. METHODS: A chart review of successive new referrals (n = 286) to the pediatric orthopedic clinic during a 12-month period was conducted. The following information was collected: 1) diagnosis from referring provider, 2) diagnosis and treatment plan by the pediatric orthopedic surgeon, 3) type of referring provider (eg, pediatrician, family practitioner, resident physician, physician assistant), and 4) patient age. The referring diagnosis, final orthopedic diagnosis, and treatment plan for each patient was compared against the AAP Guidelines for Referral to Pediatric Specialists. The terms "appropriate" and "inappropriate" were used to differentiate those diagnoses that matched versus those that did not match the AAP Guidelines, respectively. RESULTS: This analysis shows that a significant percentage (64.7%) of definitive diagnoses of referred cases were not consistent with the new AAP recommended guidelines for referral to pediatric orthopedic surgeons. In addition, a 23.8% (68 of 286) false-positive rate of referring diagnoses is noted. Cases that required no treatment or follow-up to monitor demonstrated a 32.8% (60 of 183) [(40 no treatment + 20 monitor inappropriate)/(116 no treatment + 67 monitor total)] false-positive rate. CONCLUSIONS: Inappropriate referrals create a large use of pediatric orthopedic resources, which delays care of other, more appropriate patients. A large proportion of referrals indicated either a lack of basic textbook knowledge or lack of examination skills and appropriate diagnostic tools as demonstrated by a high number of definitive diagnosis indicating normal variants.

Adolescent↗
PubMed2004

Value of sports pre-participation examination in health care for adolescents.

Though adolescence is typically perceived as a time of good health in many places in the world,the reality is that adolescents have many health problems, including medical and behavioral disorders. The ideal location for health maintenance visits is the office of a clinician who has an established relationship with the adolescent patient. The clinician can use the interest of youth for sports to improve the health care of these youth in various ways, as reviewed in this article. A sports pre-participation examination (PPE) is recommended before the adolescent engages in organized sports. During this evaluation, various issues can be covered, including anticipatory guidance for sports participation, stress involved with organized sports, drug or supplement abuse in sports, eating disorders, and weight control practices, in-jury prevention, principles of sports participation, the importance of regular physical activity and normal growth and development. The pre-participation examination is reviewed in this article, including taking a proper history, performing the physical examination, and ordering appropriate laboratory tests. Youth with medical illnesses can be clinician-directed to the sports activities that are best and safest for them. Keeping youth active in some type of physical activity is important and thus, the examination can be used to allow full or partial participation in all or only some sports. This paper summarizes the clinician's approach to using sports activities as a way of improving the health of youth.

Adolescent↗
PubMed2003

Behavioral aspects of chronic illness in children and adolescents.

Despite the detail that is provided on the potential negative outcomes of children and families who have chronic illnesses, most of these families show admirable resilience. Most children adjust to their illnesses within 1 year and most families achieve healthy stable functioning with accommodations for the illness. The challenge of adjusting to a chronic illness can provide an excellent opportunity for a child or adolescent to master crucial skills, such as emotion regulation and problem-solving. Mastery of these skills can engender strong self-esteem and confidence. As our knowledge about the predictive factors for positive behavioral outcomes increases, the pediatrician can be in the position to minimize the negative behavioral aspects of chronic illness and facilitate adjustment. Attention to the behavioral aspects of chronic illness in the three critical areas of psychosocial adjustment of the patient, adjustment of the family, and adherence to regimens, allows pediatricians to play a crucial role in prevention, early identification, and early interventions. We hope that the material that is included in this review provides a starting point for clinicians to understand and to begin to assess these critical factors in chronic illness in children and adolescents.

Adaptation, Psychological↗
PubMed2003

Substance abuse in adolescents: a complex conundrum for the clinician.

Substance abuse remains a complex and pervasive conundrum for society and for clinicians seeking to improve the lives of their pediatric patients. Substance abuse is linked to the human instinct for pleasure at any cost and is fueled by enticing encouragement of the media teaching society to seek drug-induced pleasure without fear of negative consequences. Other complications are the limited education about psychoactive substances provided to youth and the health care profession pledged to serve them. Primary care clinicians must provide their adolescent patients with adequate screening and counseling about substance abuse. Treatment of the substance-abusing patient is often a combination of behavioral interventions (including family therapy), and, in limited situations, addiction-specific medications. Research suggests that female drug addicts have a better outcome in female-only drug treatment programs. In addition, new drugs are being developed that target specific brain mechanisms involved in drug addiction; these drugs will have less toxicity and less abuse potential than illicit drugs such as cocaine. Vaccines are being developed that will block the effects of such drugs as cocaine and PCP. Medications developed for the treatment of depression and epilepsy will be a source of medications for the treatment of drug addiction. The study of endorphins and the neurobiology of stress and substance abuse promise to develop potent anti-addiction chemicals, greatly aiding in the war on drug abuse.

Adolescent↗
PubMed2003

Behavioral aspects of children's sports.

This article considers some of the numerous behavioral aspects that are related to children's sports. The pediatrician, during various encounters with the athlete and his or her parents in the office, or on the field, can positively influence the sport participation experience of the athlete, by screening and identifying potential problem areas as well as providing anticipatory guidance on various issues.

Adolescent↗