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5041. Narcolepsy

may find the article more useful, or one of our other . In this article In This Article Narcolepsy and Cataplexy In this article Narcolepsy is a chronic neurological condition producing disruption to the normal sleep pattern. This produces excessive sleepiness. Narcolepsy may occur with or without cataplexy. Cataplexy is a sudden loss of muscle tone and power in response to strong emotion - it always and only occurs as part of narcolepsy. [ ] The term 'narcolepsy' was first used by Gelineau (...) Patients have persistent sleepiness, which may be irresistible. They may nap during normal activities such as eating and talking. Excessive fatigue is a common complaint and is described by those affected as being a different symptom to sleepiness. [ ] Automatism occurs in many narcolepsy patients - when affected by severe sleepiness, they may have episodes in which they appear to be awake but lack full awareness and may behave inappropriately at such times. EDS symptoms can severely disrupt daily life

2008 Mentor

5042. Managing Epilepsy in Primary Care

'. There are a number of other forms of epilepsy, especially in children. See the separate article for further information. Patients with learning disabilities [ ] Diagnosis of epilepsy in patients with learning difficulties can be difficult. Confusion may arise between stereotypical or other behaviours and seizure activity. Particular attention should be paid to the possibility of adverse cognitive and behavioural effects of anti-epileptic drug (AED) therapy. All adults with epilepsy and learning disabilities (...) should have a risk assessment - eg, bathing and showering, preparing food, using electrical equipment, the suitability of independent living. Epidemiology [ ] The prevalence of active epilepsy is 5-10 cases per 1,000 - but with 5-30% of these misdiagnosed as having epilepsy. [ ] Epilepsy most commonly starts in children or in people older than 60 years of age. Epilepsy is much more common in people with a learning disability. Epilepsy is a feature of over 200 genetic disorders, accounting

2008 Mentor

5043. Malnutrition Full Text available with Trip Pro

deviations below the median of international reference population. Protein energy malnutrition: Poor weight gain. Slowed linear growth. Behavioural changes - irritability, apathy, anxiety, attention deficit. Classically apathetic and quiet when lying in their bed but cry when picked up, with a typical monotonous bleat or loud groan. Three clinical syndromes (note, mixed pictures may occur): Marasmus: Obvious loss of weight with gross reduction in muscle mass, especially from limb girdles. Subcutaneous (...) that in hospitals. In all cases, the majority of subjects were at high risk of malnutrition. Risk factors In children Young age (<5 years) - most vulnerable are premature babies and infants at time of weaning Children with co-existing chronic illnesses or developmental delay. Neglect by care-givers. Poverty and its complex relationships with: Political and economic situation. Education. Sanitation. Seasonal and climatic conditions. Food production and security. Cultural and religious traditions. Prevalence

2008 Mentor

5044. Turner's Syndrome

, specific learning difficulties, social vulnerability (social problems, immaturity, less social activity), foot problems (eg, toenail involution, cellulitis), renal anomalies. Adolescence: impaired pubertal growth spurt (even with oestrogen induction), ovarian failure (absent/incomplete puberty), obesity, hypertension, increased prevalence of immune disorders (eg, autoimmune thyroiditis, coeliac disease, inflammatory bowel disease), specific learning difficulties, social vulnerability, foot problems (...) of chronic conditions. For this reason, multidisciplinary follow-up is required as an exercise in screening and prevention, as well as treatment where necessary. [ ] Cardiac defects are likely to be the most significant associated health problems. [ ] The need for long-term surveillance and awareness of associated conditions should be promoted. Regular renal ultrasound, and screening for and hypertension are recommended. Problems of most concern to patients may vary with age but the main four concerns

2008 Mentor

5045. Transient Ischaemic Attacks

ischemic attack versus transient ischemic attack mimics: frequency, clinical characteristics and outcome. Cerebrovasc Dis. 201132(1):57-64. doi: 10.1159/000327034. Epub 2011 May 25. ; Driver and Vehicle Licensing Agency ; Association of physical activity level and stroke outcomes in men and women: a meta-analysis. J Womens Health (Larchmt). 2010 Oct19(10):1815-22. doi: 10.1089/jwh.2009.1708. ; Vitamin K antagonists versus antiplatelet therapy after transient ischaemic attack or minor ischaemic stroke (...) and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Transient Ischaemic Attacks In this article Description A transient ischaemic attack (TIA) is a temporary inadequacy of the circulation in part of the brain (a cerebral or retinal deficit) that gives a clinical picture similar to a stroke except that it is transient and reversible. Hence, TIA is a retrospective diagnosis. The duration is no more than 24 hours and a deficit that lasts longer

2008 Mentor

5046. St John's Wort

, and concluded that it was an effective treatment. [ ] SJW is not recommended for use in children or adolescents as there are no robust trials on which to base clinical decision making. [ ] There is no evidence of benefit in attention deficit hyperactivity disorder (ADHD) [ ] or bipolar disorder. [ ] One randomised controlled trial failed to show evidence of benefit for SJW in irritable bowel syndrome. [ ] Contra-indications SJW should be avoided in pregnancy or lactation, due to lack of high-quality, human (...) : the American Psychiatric Association Task Force report. J Clin Psychiatry. 2010 Jun71(6):669-81. doi: 10.4088/JCP.10cs05959blu. ; Mood disorders and complementary and alternative medicine: a literature review. Neuropsychiatr Dis Treat. 20139:639-58. doi: 10.2147/NDT.S43419. Epub 2013 May 14. ; St John's wort for major depression. Cochrane Database Syst Rev. 2008 Oct 8(4):CD000448. ; NICE (September 2005) ; Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children

2008 Mentor

5047. Developmental Screening - 8 and 18 Month Checks

complete abstention. is well recognised in children of mothers who drank heavily in pregnancy but fetal alcohol effects represent a milder form of the condition and it is uncertain if there is any safe level of consumption. There is also some evidence that use of drugs like cannabis may have an adverse effect on neuro-behavioural and cognitive outcomes with an increased risk of attention deficit hyperactivity disorder (ADHD) and learning difficulties. [ ] It may be this is confounded by the presence (...) healthy eating and physical activity. Encourage mothers to breast-feed. Identify problems in children's health and development (for example, learning difficulties) and safety (for example, parental neglect), so that they can get help with their problems as early as possible. Make sure children are prepared for school. Identify and help children with problems that might affect their chances later in life. The document includes a detailed schedule for care during pregnancy, and at each stage

2008 Mentor

5048. Electrical Injuries and Lightning Strikes

these as an indication of cardiac damage. [ ] Delayed arrhythmias are extremely rare and tend to be found in patients who have a previous history of ECG abnormalities (known or subclinical). [ ] Nervous system Acute complications : these include respiratory arrest, seizures, altered mental state, amnesia, coma and expressive dysphasia. Motor deficits have also been reported. Delayed complications : these include spinal cord injury (common) and . [ , ] Acute ischaemic stroke has also been reported. [ ] Peripheral (...) occur, resulting in surrounding tissue damage. Thrombi can also occur at distant sites from the entry point ± late rupture. [ ] There may also be immediate or delayed haemorrhage at the affected site. Musculoskeletal effects Muscle cell disruption occurs, releasing myoglobin and creatinine phosphokinase. Tetanic muscle contractions can result in bone fractures and dislocations as well as torn muscles. There may be patchy swelling and necrosis with delayed development of sepsis. [ ] Compartment

2008 Mentor

5049. Dyslexia

deficit hyperactivity disorder (ADHD). As well as ADHD, dyslexia is also comorbid with language impairment (defined by problems in the development of structural language, including grammar and vocabulary) and speech sound disorder (inability to produce the sounds of the individual's native language accurately and intelligibly). There is evidence for the neurobiological aetiology of developmental dyslexia. A number of susceptibility genes have been suggested. [ ] Presentation Dyslexia often presents (...) with grammatical aspects of reading. Epidemiology [ ] Dyslexia affects all kinds of people regardless of intelligence, race or social class. Prevalence estimates depend on definition but is estimated to be between 5% and 17% of school-aged children. [ ] Adult dyslexia affects about 4% of the population. [ ] There is a relatively small but significant male predominance. However boys with dyslexia come to clinical attention more often than girls because of higher rates of comorbid disorders, including attention

2008 Mentor

5050. Coronary Artery Bypass Grafting

: 10.1093/eurheartj/ehu158. Epub 2014 Apr 18. ; Clinical impact of neurocognitive deficits after cardiac surgery. J Thorac Cardiovasc Surg. 2013 Jun145(6):1545-9. doi: 10.1016/j.jtcvs.2013.02.061. Epub 2013 Mar 25. ; NICE Clinical Guideline (July 2014) I am a 19 Year Old Male, who is 6'6" and weigh 140LBS. Ever since I was about 9 years old or so, i have had to give up all strenuous activity. When i run, or play any kind of Sports i get an... mattg34 Health Tools Feeling unwell? Assess your symptoms (...) in cognition are thought to be mild and to reverse within the first few months after surgery. This has been confirmed in a study of 696 patients in whom neurocognitive deficits were identified both at discharge and at three months postoperatively but were not associated with any significant clinical differences in quality of life or patient outcomes [ ] . Follow-up Attention must be paid to secondary prevention of CHD and . Stopping smoking is essential where relevant. Use of long-term aspirin is essential

2008 Mentor

5051. Cholestasis

in the urine. Both of these features suggest cholestasis. Abdominal pain. Fever - suggests infection or cholecystitis. Pruritus - manifest by scratch marks (excoriation). This is a common but not universal feature (ranging from absent to severely disabling), the exact pathophysiology of which is not clearly understood. There may be secondary skin infections if scratching is severe and, in children, there may be associated poor sleep, attention deficits, poor school performance and a form of hyperkinesis (...) the liver for a cause in these patients. Obstructive cholestasis - this is usually as a result of a physical obstruction; the most common causes are gallstones and carcinoma of the head of the pancreas. However, paucity of the ducts (eg, very small bile ducts such as in Alagille's syndrome - an autosomal dominant disorder associated with abnormalities of the liver, heart, skeleton, eye, and kidneys and a characteristic facial appearance) may lead to a functional obstruction. Causes can be subdivided

2008 Mentor

5052. Childhood Nutrition

Guidelines. You may find one of our more useful. In this article In This Article Childhood Nutrition In this article Childhood nutrition should be a balance between the high energy and nutrient content required for growth and development and establishing a healthy diet with weight control, in association with regular physical exercise. The balance between these two aspects changes from the very high-fat content of infancy to the low-fat, high-fibre diet of adulthood. The diet for a child should (...) . Ideally, children should restrict the number of times a day that they have foods and drinks containing sugar and then only have them at mealtimes. Young children should not be put on weight reduction diets but a healthy family approach to food and regular physical activity are important in avoiding excessive weight gain and obesity. Other nutritional requirements The diet must also be high in vitamins and minerals. In particular, a good supply of protein, calcium, iron and vitamins A and D is required

2008 Mentor

5053. Child Health Surveillance Programme

complete abstention. is well recognised in children of mothers who drank heavily in pregnancy but fetal alcohol effects represent a milder form of the condition and it is uncertain if there is any safe level of consumption. There is also some evidence that use of drugs like cannabis may have an adverse effect on neuro-behavioural and cognitive outcomes with an increased risk of attention deficit hyperactivity disorder (ADHD) and learning difficulties. [ ] It may be this is confounded by the presence (...) and physical activity. Encourage mothers to breast-feed. Identify problems in children's health and development (for example, learning difficulties) and safety (for example, parental neglect), so that they can get help with their problems as early as possible. Make sure children are prepared for school. Identify and help children with problems that might affect their chances later in life. The document includes a detailed schedule for care during pregnancy, and at each stage in a child's life. It contains

2008 Mentor

5054. Child - Parent Relationship and Potential Problems

in those living in the social sector (17%) compared with those who owned their accommodation (4%). Neglect and/or abandonment; adopted children or children from foster homes. Residential instability. Child factors A chronically ill or disabled child [ ] . Undiagnosed psychological or developmental problem - eg, attention deficit hyperactivity disorder (ADHD), autistic spectrum disorders [ ] . Difficult temperament of a child and a clash in parenting style. Fragile emotional temperament of a child. Peer (...) , learning disorders, anxiety and depression [ ] , alcohol and drug abuse (particularly associated with mental illness), suicide or self-harming, theft and criminal behaviour. Discipline problems including selfishness, defiance, unstable behaviour, recklessness, deceitfulness, violent behaviour and disruptive behaviour. Educational problems including disruptive behaviour, bullying and decreased learning ability and academic achievements. Epidemiology Prevalence According to the 2004 report from

2008 Mentor

5055. Child Abuse - Recognition

frightened, exploitation or corruption. Sexual abuse : forcing or enticing a child into sexual activity (this includes both penetrative and non-penetrative acts). It also includes "non-contact" activities - eg, involvement in pornography, the child looking at sexual activities or pornographic material, or encouraging inappropriate sexual behaviour in a child. Neglect : the persistent failure to meet a child's basic physical or psychological needs, in a way likely to impair the child's health (...) of violent offending in the family. Mental health disorders, learning disability, physical illness or disability in the carers. Drug or alcohol misuse in the carers - especially if unstable or chaotic drug misuse. Housing or financial problems. Disability or long-term chronic illness in the child. Single parents, especially if immature or unsupported. History of animal/pet maltreatment. Children in the care system. Some children are vulnerable to being "lost" by the system - for example, where

2008 Mentor

5056. Cerebrovascular Event Rehabilitation

activities (eg, sit-to-stand repetitions), weights (eg, progressive resistance exercise), or resistance exercise on machines such as stationary cycles. Fitness training: encourage people to participate in physical activity after stroke. Cardiorespiratory and resistance training for people with stroke should be started by a physiotherapist with the aim that the person should continue the programme independently based on the physiotherapist's instructions. Offer walking training (treadmill with or without (...) and wishes). Vision, hearing. Assess the effect of visual neglect after stroke on functional tasks such as mobility, dressing, eating and using a wheelchair, using standardised assessments and behavioural observation. Muscle tone, strength, sensation and balance. Impairment of bodily functions, including pain. Activity limitations and participation restrictions. Environmental factors (social, physical and cultural). Provide education and support for people with stroke and their families and carers

2008 Mentor

5057. Drowning and near drowning

/immersion in liquid. Drowning outcomes should be classified as: death, morbidity, and no morbidity. Following a WHO report there is also consensus that the terms wet, dry, active, passive, silent, and secondary drowning should no longer be used [ ] . Pathophysiology After an initial gasp, with possible aspiration, or a period of breath holding, apnoea eventually exceeds breaking point and stimulates hyperventilation, causing aspiration and a variable degree of laryngospasm. This leads to hypoxia (...) . The latter are the risk-taking group. It is also a common form of . [ ] Risk factors These depend on age. In children under one year, unattended buckets of water and the bath account for most cases of drowning. Between 1 and 5 years, unattended swimming pools account for most cases of drowning. [ ] Alcohol use, water sports and unsupervised swimming, particularly in open water, are risk factors in adults. Other risk factors include epilepsy, underlying cardiac dysrhythmias, hyperventilation

2008 Mentor

5058. Accidents and their Prevention

how to minimise their risks of injury during a seizure - eg, take a shower instead of a bath, do not iron when alone and other tips. Identified risk factors for injuries include the number of anti-epileptic drugs, history of generalised seizures and seizure frequency. [ ] Attention deficit hyperactivity disorder: ADHD has been shown to be associated with an increased risk of serious transport accidents. There is evidence that this risk is reduced by medication in male patients but not in females (...) in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study. JAMA Psychiatry. 2014 Mar71(3):319-25. doi: 10.1001/jamapsychiatry.2013.4174. ; Risky play and children's safety: balancing priorities for optimal child development. Int J Environ Res Public Health. 2012 Aug 309(9):3134-48. doi: 10.3390/ijerph9093134. ; Royal Society for the Prevention of Accidents ; NHS Choices ; NICE Clinical Guideline (June 2013) ; NICE CKS, June 2009 ; Smart homes

2008 Mentor

5059. Abnormal Gait Full Text available with Trip Pro

is reduced during the late stage of stance, just before the back foot lifts off. Maximal ankle dorsiflexion is not reduced. Studies have found a strong association between the severity of age-related white matter changes and the severity of gait and motor compromise. Increasing physical activity may reduce the associated risks. [ ] The presence of neurological gait abnormalities in the elderly (without dementia) is a significant predictor of the risk of development of dementia - especially non (...) ). Nature of steps - look for a steppage gait due to foot drop (loss of dorsiflexion) leading to needing to lift the leg higher than normal when walking. This is associated with conditions such as peroneal nerve injury, fibular injury, multiple sclerosis, Guillain-Barré syndrome, and prolapsed intervertebral disc. Difficulty turning: turning problems are common with any gait disorder; turning is generally more difficult than walking. People without balance or gait problems usually can do an 'about-face

2008 Mentor

5060. Body Dysmorphic Disorder (BDD)

and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Body Dysmorphic Disorder In this article Body dysmorphic disorder (BDD) is a preoccupation with an imagined defect in appearance, or excessive concern over a slight physical anomaly. It is characterised by time-consuming behaviours such as mirror gazing, comparing one's appearance with the appearance of others, excessive camouflaging to hide the defect, skin picking and seeking reassurance (...) . [ ] Data concerning sex predominance are sparse. One study of medical students found a higher preponderance in males. [ ] Differences between body dysmorphic disorder and obsessive-compulsive disorder [ ] Although there are many similarities between the two conditions - which often co-exist - some differences have been identified. Patients with BDD have significantly poorer insight than those with obsessive-compulsive disorder (OCD) and are more likely to be delusional. They are also significantly more

2008 Mentor

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