Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders presenting for treatment in children and adolescents. ADHD is often chronic with prominent symptoms and impairment spanning into adulthood. ADHD is often associated with co-occurring disorders including disruptive, mood, anxiety, and substance abuse. The diagnosis of ADHD is clinically established by review of symptoms and impairment. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry and neuropsychological data. Consideration of all aspects of an individual s life needs to be considered in the diagnosis and treatment of ADHD. 

Multimodal treatment includes educational, family, and individual support. Psychotherapy alone and in combination with medication is helpful for ADHD and comorbid problems. Pharmacotherapy including stimulants, noradrenergic agents, alpha agonists, and antidepressants plays a fundamental role in the long-term management of ADHD across the lifespan. 

The management of ADHD includes consideration of two major areas: non-pharmacological (educational remediation, individual and family psychotherapy) and pharmacotherapy. 

I personally support Psychotherapy. Specialized educational planning based on the child s difficulties is necessary in a majority of cases. Since learning disorders co-occur in one-third of ADHD youth, ADHD individuals should be screened and appropriate individualised educational plans developed. Educational adjustments should be considered in individuals with ADHD with difficulties in behavioral or academic performance. Increased structure, predictable routine, learning aids, resource room time, and checked homework are among typical educational considerations in these individuals. Similar modifications in the home environment should be undertaken to optimize the ability to complete homework. For youth, frequent parental communication with the school about the child s progress is essential. 

Symptoms in children and teenagers 

The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of six. They occur in more than one situation, such as at home and at school. The main signs of each behavioural problem are detailed below:

Inattentiveness: having a short attention span and being easily distracted making careless mistakes   for example, in schoolwork appearing forgetful or losing things being unable to stick at tasks that are tedious or time-consuming appearing to be unable to listen to or carry out instructions constantly changing activity or task having difficulty organising tasks 
Hyperactivity and impulsiveness: being unable to sit still, especially in calm or quiet surroundings constantly fidgeting being unable to concentrate on tasks excessive physical movement excessive talking being unable to wait their turn acting without thinking interrupting conversations little or no sense of danger 
These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline. 

Related conditions in children and teenagers 

Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as: 

anxiety disorder   which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness 
oppositional defiant disorder (ODD)   this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers 
conduct disorder   this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals 
depression 
sleep problems   finding it difficult to get to sleep at night, and having irregular sleeping patterns 
autistic spectrum disorder (ASD)   this affects social interaction, communication, interests and behaviour 
epilepsy   a condition that affects the brain and causes repeated fits or seizures 
Tourette s syndrome   a condition of the nervous system, characterised by a combination of involuntary noises and movements called tics 
learning difficulties   such as dyslexia Symptoms in adults In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD. 
ADHD is a developmental disorder; it's believed that it can't develop in adults without it first appearing during childhood. But it's known that symptoms of ADHD often persist from childhood into a person's teenage years, and then adulthood. Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood. By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives. The symptoms in children and teenagers, which are listed above, is sometimes also applied to adults with possible ADHD. But some specialists say that the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children. For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressure of adult life increases. Adult symptoms of ADHD also tend to be far more subtle than childhood symptoms. 

Some specialists have suggested the following list of symptoms associated with ADHD in adults: 

carelessness and lack of attention to detail 
continually starting new tasks before finishing old ones 
poor organisational skills 
inability to focus or prioritise 
continually losing or misplacing things 
forgetfulness 
restlessness and edginess 
difficulty keeping quiet and speaking out of turn 
blurting out responses and often interrupting others 
mood swings, irritability and a quick temper 
inability to deal with stress 
extreme impatience 
taking risks in activities, often with little or no regard for personal safety or the safety of others   for example, driving dangerously 
Additional problems in adults with ADHD As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions. One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include: 

personality disorders   conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others 
bipolar disorder   a condition that affects your moods, which can swing from one extreme to another 
obsessive-compulsive disorder (OCD)   a condition that causes obsessive thoughts and compulsive behaviour 
The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships, social interaction, drugs and crime. Some adults with ADHD find it hard to find and stay in a job. If you notice any of the above in your child or yourself , it is worth making the effort and spending some time and money to have your child and or yourself assessed on a priority basis as ADHD causes neural changes in the brain. 

Attention Deficit Hyperactivity Disorder (ADHD) - A Guide!

Children are much more susceptible to tooth decay and gum disorders than grown-ups. This is because the gum and teeth in toddlers are very delicate. Moreover, children are more attracted to sweets and other food items, which cause damage to the teeth.
Here are several ways to protect the teeth of your little one:
1. Have a dental checkup: you should take your child to a dentist on his first birthday. Early prevention is important as any kind of problem in the teeth will be detected and this will save you from a lot of trouble in the future.
2. Teaching healthy habits: brushing is very important and you should teach your child to brush regularly, more than once a day. Before the development of teeth in your baby, you should brush his gums gently by using water on a soft baby toothbrush or with a clean and soft cloth. After developing teeth, brushing must be practiced with delicate toothbrushes and fluoridated toothpaste. If several teeth touch against each other, you should use flossing. Brushing is essential before going to bed, and no food should be taken after brushing.
3. Prevent" baby bottle decay: you should not let your child go to sleep with a bottle of juice or milk. The sugar contained in these liquids sticks to the child's teeth, which activates bacteria and may lead to tooth decay.
4. Avoid giving juice to your child: juice may be healthy for the body, but it leads to tooth decay in little kids. The amount of regular juice intake should never be above four ounces.
5. Avoid excess use of a sippy cup: sippy cups enable children to shift from bottles to a glass. However, all day long usage of sippy cups should be restricted as it may cause decay on the front and back portions of teeth, when the drinks are rich in sugar.
6. Be careful about sweet medicines: many medicines meant for children are sugary and stick to the teeth, increasing the chance of cavities. Several antibiotics cause overgrowth of candida or yeast and cause an oral disease known as oral thrush. This disease causes creamy patches on the tongue. In case your child needs sweet medicines, brushing should be increased.
7. Stop using a pacifier by the age of 2 or 3: pacifiers are good for children, but using pacifiers for a long period of time affects the lining of teeth. The shape of the mouth may also change. Hence, do not let your child use pacifiers after 2 or 3 years of age.
Children are quite prone to teeth disorders and decay in the teeth. Hence, measures must be taken to protect the teeth of children from any kind of disorder.

Ways to Protect the Teeth of Your Little One

Our kidneys act as filters which constantly flushes out toxins and excess minerals with water in form of urine. Urine contains lots of minerals which may precipitate and form stones. Urine has lots of pro-precipitating agents and anti-precipitating agents. When their balance disturbs due to some disease, stones start forming. These stones may often lead to abdominal pain which is referred to as renal colic. 

What exactly is renal colic? 

Renal or ureteric colic is the term used for typical pain in one side of abdomen in flank region starting from back and radiating forward towards lower abdomen up to scrotum. This is usually associated with nausea, vomiting and urinary discomfort. There may be blood in urine. 

How kidney stones are related to renal colic? 

Kidney stones usually form inside kidney and lies there without causing any pain. But whenever they are dislodged and stuck at mouth of kidney (pelvis) or anywhere in ureter, they block the passage of urine of that kidney. This causes swelling in kidney termed as hydronephrosis. This swelling in kidney causes renal / ureteric colic. This colic is protective phenomenon and tries to push out the stones. Small stones do come out in urine by this natural process. This spontaneous expulsion of small stones is common and many local practitioners used to get credit of it feigning benefit of their medicine. However large stones need some form of intervention to come out. Otherwise, they do harm to kidneys in long term. 

Symptoms of kidney stones along with renal /ureteric colic - 

Most stones which are lying in calyces of kidney are asymptomatic 
Nausea & vomiting 
Frequent urinary tract infections 
Fever with chills 
Foul smelling urine 
Hesitency, frequency and burning in urination 
Blood in urine (urine with a reddish, pink or brownish hue) 
Passage of small stones in urine 
Treatment of renal colic 

Treatment of ureteric/renal stones involves control of symptoms and stone removal. 

Expectant Treatment or Medical Expulsion Therapy: Small stones of less than 4 mm size usually pass on its own and some medicines like alpha-blockers and steroid hasten up their expulsion. Medium size stone (4-6 mm), sometimes passes with aid of these medications. But stones larger than 6 mm usually require intervention. 
Lithotripsy: This method involves breaking of stones by shock waves into small dusty particles which pass through urine on its own. This is usually suitable for stones upto 1.5 cm and lying in kidneys. This is non-operative treatment which can be done on OPD or Daycare basis. 
Ureteroscopy (URS): This method involves entry of very thin semirigid scope through urethra into ureter. Stone is broken by LASER and removed. This involves single day admission and spinal anaesthesia. 
RIRS- Retrograde Intra Renal Surgery: In this method very thin flexible scope in maneuvered through urethra into the upper ureter and pelvi-calyceal system of kidney. Stones in kidney or upper ureter are broken by LASER and removed. This is also done under anaesthesia and requires a day admission. 
Mini- PCNL: This method is suitable for large renal stones. In this technique, a small hole is made into the kidney through back and tiny scope is entered into the kidney. Stones are broken by LASER and removed. This is done under anaesthesia and require two to three days admission.

Renal Colic - Ways it Can Be Treated?

The medical name for the yellow tint on your skin and around the white portion of the eye is jaundice. However, jaundice is a symptom of a variety of underlying medical conditions, and not a specific disease. When the body break downs deceased red blood cells, a yellow pigment known as bilirubin is formed. Jaundice develops when your system contains excess bilirubin. Usually, the bilirubin, as well as the dead blood cells, are exterminated by your body.
Jaundice may symbolise a critical problem with your pancreas, blood cells, gallbladder or liver.
Causes:
Jaundice isn t a disease; it is a symptom. Thus if you have jaundice, it might indicate you may have any of the following complications:
Alcohol abuse.
Liver infection.
Liver cancer.
Cirrhosis (Liver scarring mostly due to alcohol).
Gallstones.
Hepatitis (Swollen liver that decreases its functionality).
Pancreatic cancer.
Blood disorders.
An overdose or adverse reaction to certain medications.
Symptoms:
The major indication of jaundice is yellow tinted skin and eyes. In serious cases, the sclera (white parts) of the eye can turn orange or brown. You might additionally exhibit other symptoms such as pale stools and dark urine.
If a concealed condition such as viral hepatitis is causing jaundice, you will probably experience symptoms such as vomiting and excessive fatigue.
Misdiagnosis is common when it comes to jaundice. Sometimes, an abundance of beta carotene (a type of anti-oxidant found abundantly in fruits and plants) can turn your skin yellow.
Treatments:
Since jaundice is a symptom of some other underlying disease, the treatment will focus on that disease. When your treatment starts, the yellow tint will disappear on its own.
If the jaundice is serious, blood transfusions might be needed to expel the excess bilirubin and rejuvenate the body s red blood cells. However, if the body s bile duct mechanism gets blocked, a surgery might be required to unblock the same.

Jaundice: Causes, Symptoms and Treatments

A bone fracture occurs when a strong external force is applied on the bones causing it to break. It is an extremely painful condition that results in days of immobility and rest. There are several reasons which can result in bone fracture, some of them being:

1. Injuries caused in sports
Any sport requires and demands extreme physical exertion and participation. Being involved in any sport therefore automatically increases your risk of incurring injuries. Bone fractures therefore are mostly reported during sports.

2. Osteoporosis
Due to the deficiency of calcium, the bones of both men and women tend to get weak and more susceptible to fracture and breakage. It is one of the primary causes that lead to bone fracture.

3. Osteomalacia
This also refers to a condition wherein the bones become weak and brittle. Much like osteoporosis, osteomalacia too significantly contributes to instances of bone fractures.

4. Osteosarcoma
This is a rare form of bone cancer that most often develops either near the femur or near the shinbone. An instance of this form of bone cancer is most often found in children and weakens the bone, consequently leading to fractures.

Though there may be different causes of broken fractures, its symptoms remain similar. Some of them are-

1. Swelling
One of the most common symptoms of bone fracture is perceptible swelling. If any of your bone is fractured, that particular part will be visibly swollen.

2. Deformity
Bones give your body the shape it has, thereby, any fracture anywhere would inevitably manifest itself as a clear deformity of that particular part.

3. Extreme pain
It goes without saying that a bone fracture would entail excruciating and extreme pain. This pain sharply increases with mobility thereby necessitating complete rest.

4. Temporary loss of function
The part of the body where the bone is broken temporarily becomes dysfunctional. For instance, if the bone in your hand is broken, you will find it extremely difficult to move and do any work with it.

Causes and Symptoms of Bone Fracture

Pulmonary Embolism is a blood clot in the Pulmonary arteries that usually travels from a deep vein in the legs to the lungs. This clot blocks the lungs and creates a life-threatening situation for the patient. With prompt medication and treatment, the risk can be mitigated. 

Symptoms 

The symptoms of Pulmonary Embolism vary with the size and position of the clot. The most common symptoms include pain in the chest and shortness of breath. The patient with Pulmonary Embolism suffers from chest pain occasionally, and it gets worse with physical activity. The pain is deep and feels like a heart attack.

The other common symptoms are: 

  Pain in legs or swelling 

  Fever 

  Irregular heartbeat 

  Fatigue 

  Feeling tired all the time 

  Coughing 

  Dizziness 

  Heartburn 

Causes 

Pulmonary Embolism is caused due to the formation of several clumps or blood clots that enter into the Pulmonary arteries. Typically, these clots are formed from the deep veins of the legs, also known as Deep Vein Thrombosis. The clots block the flow of blood in the lungs, which is fatal to the patients.

These clots gradually build up in the arteries. Some very common causes for the formation of these clots are the release of fats from the broken long bones, the tissue in the bloodstream or air bubble. 

Diagnosis 

The diagnosis of Pulmonary Embolism is difficult in patients who are already suffering from heart or lung conditions. However, doctors look for a D-dimer level in the bloodstream to determine the clots. There are various causes for a high level of D dimer, but it gives a starting point to the doctor to investigate further. 

  Blood Test: The blood test checks the level of D dimer in the blood. If the level is high, the doctor may determine the amount of oxygen level in the blood. Generally, the blood clots lower the level of oxygen in the blood. If the oxygen level is low, doctors doubt the presence of blood clots. 

  Ultrasound: The body imaging method helps doctors to check for clots in the blood without performing any operation. This non-invasive way gives the imagery of the veins. Clumps can easily be seen in the images of the Ultrasound report. 

  CT Scan: The spiral CT scan moves around the body to look for clots in the veins. It is a high-tech method through which doctors determined the number, size, and amount of blood clots in the patients. 

Takeaway 

The treatment for Pulmonary Embolism depends upon the size and number of clots in the body. If a person is already suffering from heart or lungs condition, then he/she shall be given medication accordingly. The most common treatment entails medicines, such as blood thinners, which makes the blood thinner. These medications help in dissolving the clots.

Pulmonary Embolism - How To Detect It?

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