Attention deficit hyperactivity disorder: Perceptions, practice and politics

Abstract: Some of the issues related to the doubts and complexities involved in the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) are reviewed. While some writers claim that it is clear that all children presenting with ADHD should be treated by pharmacological means, there are associated risks and politics. However, in the absence of well established and research-supported alternative understandings of the aetiology and treatment of the disorder, many practitioners feel unable to offer a useful service. Resulting frustrations have led some parents to form their own support networks, which make strong demands for increased services. More creative and innovative therapeutic interventions focusing on the broader impact of ADHD must be developed to deal with this disorder.     

Cerebral oxygenation during cardiopulmonary bypass

Cerebral fractional oxygen extraction (FOE) was monitored in 30 children, using near infrared spectroscopy during cardiopulmonary bypass, to investigate the effect of hypothermia and circulatory arrest. One group of children (n = 15) underwent profound hypothermia with total circulatory arrest (n = 8) or continuous flow (n = 7). Another group (n = 15), of whom only one had circulatory arrest, underwent mild (n = 6) or moderate (n = 9) hypothermia. The mean FOE (SD) before bypass was 0.35 (0.12) and this correlated negatively with the preoperative arterial oxygen content (r = -0.58). Between the stage of cooling on bypass and cold bypass there was a reduction in FOE in all groups. Between cold bypass and rewarming there was an increase in FOE only in the groups with continuous flow. In the circulatory arrest group, the FOE remained low during rewarming and was significantly lower than that of the continuous flow group. No patients died and none had neurological abnormalities postoperatively. Apparent changes in oxidised cytochrome oxidase concentration were also monitored using near infrared spectroscopy. There was a fall in cytochrome aa3 on starting cardiopulmonary bypass, but there were no significant differences in the changes in cytochrome aa3 between any stage in any of the patient groups. Using this non-invasive technique, cooling was shown to reduce cerebral FOE. During rewarming on bypass there was an increase in cerebral FOE only in patients who had had continuous flow bypass. In contrast, the cerebral FOE in those with circulatory arrest remained constant after arrest and during the duration of the study. This may have implications for the timing of hypoxic brain injury.     

MULTIDRUG RESISTANT TUBERCULOSIS – BIOMECHANISM,EPIDEMIOLOGY AND MANAGEMENT STRATEGIES

Muitidrug resistant tuberculosis has shown an alarming increase and this assumes added importance in view of the increasing number of HIV infected patients. This article reviews the biomechanism of resistance and discusses the present stategies that are available and recommended to tackle the rising incidence of tuberculosis due to resistant mycobacteria.KEYWORDS: Antitubereular drugs, Drug resistance, Mycobacterium tuberculosis     

Vitamin A intake and xerophthalmia among Indian children

OBJECTIVE: To estimate prevalence of xerophthalmia and to assess dietary intake of vitamin A in Indian children aged under 6 y. DESIGN: Cross sectional study. STUDY SETTING: Urban slums under Urban Health Centre affiliated to Department of Preventive and Social Medicine, Government Medical College, Nagpur, India. PARTICIPANTS: The study included 1094 all children under 6 y of age, from two randomly selected urban slums. METHODS: Xerophthalmia was diagnosed on the basis of ocular signs and symptoms (WHO recommendations). Dietary intake of vitamin A was assessed by using one year recall method recommended by International Vitamin A Consultative Group. RESULTS: Prevalence of xerophthalmia was estimated to be 8.7%. Nine hundred and ninety-five (90.9%) study subjects were identified as inhabitants consuming dietary vitamin A at below recommended levels. (UPF score < 210). Five hundred and ninety-three (54.2%) study subjects were consuming dietary vitamin A at approximately less than 200 RE/d (UPF score < 120) while 402 (36.2%) were consuming approximately 200-300 RE/d (UPF score 120-210). The prevalence of xerophthalmia was found to be decreasing as the score of usual pattern of food consumption (UPF) increased. CONCLUSIONS: Children with a dietary intake represented by a UPF score of less than 120 were at high risk of developing xerophthalmia, whereas, those consuming vitamin A equal to a UPF score greater than 120 were at comparatively less risk despite being below the recommended levels.     

Efficacy of occupational therapy and serial casting in lower limbs of cerebral palsy children administered with phenol nerve block

To see the efficacy of occupational therapy and serial casting over occupational therapy alone in case of sciatic nerve block in cerebral palsy children.In the study 18 spastic cerebral palsy children were treated with in-traneural phenol block (open technique) followed by occupational therapy to bring out functional change. All the 18 patients were administered with intraneural phenol block. In 9 patients serial casting combined with occupational therapy (experimental group) was given while in another group 9 patients were treated with occupational therapy alone (control group). The treatment session for each patient lasted for 6 weeks. To measure the outcome GMFM 66, pediatric balance test (PBT), active range of motion, passive range of motion, modified Ashworth scale were used as tool.There was significant reduction in spasticity of all the 18 patients (after administration of intraneural phenol nerve block) when compared with their pre-operative status. There was significant improvement of gross motor function (GMFM 66), active and dynamic balance (through PBT), and active range of movement of knee joint in experimental group. There was no significant difference between the groups in passive range of motion and reduction of spasticity.The study concludes that intraneural phenol block reduces spasticity in cerebral palsy children to a significant level thus improving the functional outcome in these children. Serial casting when combined with occupational therapy after phenol block gives much better and quicker improvement in gross motor function and motor milestone development.