
Dilipkumar PatelWestern Michigan University Homer Stryker MD School of Medicine
Dilipkumar Patel
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Publications (221)
In the quest for winning the game, some athletes take various chemicals (ie, drugs, herbs, or supplements) in attempts to develop greater strength, endurance, or other elements that bring a competitive advantage. There are more than 30,000 chemicals sold throughout the world with unrestrained and unproven claims; however, some athletes consume them...
Neurodevelopmental disabilities are usually a burden for the children, adolescents, young adults, their families, and communities. These issues can complicate their adulthoods and require clinicians to be knowledgeable about these conditions. One of the perplexing problems in this regard is the role of gender and why some conditions are more common...
Young athletes face a unique set of stressors from nonathletes that require careful screening and management. Internalizing disorders, substance use, overtraining, eating disorders, the female athlete triad, and sport-related injury are some psychological issues related to sports participation. Young athletes experiencing these conditions may exper...
Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e...
Selective medical perspectives of pediatric sports medicine are explored in this issue and behavioral perspectives of pediatric sports medicine are discussed in a subsequent journal issue. Concepts are considered now dealing with sports readiness involving the child and adolescent that involve understanding the limits imposed by growth and developm...
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder identified in 4% to 8% of children, adolescents, and adults. Features of ADHD found in childhood and adolescence persist into adulthood in as many as 70% of pediatric patients with this diagnosis. Various behavioral therapies are helpful for ADHD. This discussion focus...
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic...
Most children and adolescents with behavioral and mental health concerns first present to their pediatricians. Although pediatricians are fully cognizant of the importance of addressing behavioral and mental health concerns, they often find it difficult to deliver such care effectively and efficiently within a typical practice setting. Integration...
Autism spectrum disorder (ASD) is a common neurobehavioral disorder with considerable complexity and without clearly defined etiologic underpinnings. A variety of factors are intertwined in this condition including genetic, biochemical, and cellular characteristics. A major aspect of ASD management is behavioral therapy, though pharmacologic agents...
Helicobacter pylori (H. pylori) is amongst the most common chronic bacterial infection in humans. Pediatric patients appear to differ from their adult counterparts in terms of the prevalence, the complication rate, and the rate of antibiotic resistance. In this report, we present an 18-year-old man without any past medical history who was evaluated...
Sport-related concussions (SRC) are an increasingly common concern in young athletes, with long-term cognitive, physiological, behavioral, and psychological adverse outcomes. An estimated 1.1 million to 1.9 million SRCs occur per year in children <18 years old in the United States. The post-concussive state has demonstrated consequences in several...
Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to...
Purpose:
To determine which narrative performance level for each general pediatrics EPA reflects the minimum level clinical competency committees (CCCs) felt should be associated with graduation as well as initial entrustment and compare the narratives associated with the expected narrative performance levels (ENPLs) for each EPA with actual narra...
Developmental diagnosis is based on an understanding of basic concepts of typical and atypical developmental progression. Child development is influenced by multiple factors, including the development of the nervous system and other organ systems, and the child's physical and social environment. Different factors interplay with each other in influe...
Writing is a complex task that is vital to learning and is usually acquired in the early years of life. 'Dysgraphia' and 'specific learning disorder in written expression' are terms used to describe those individuals who, despite exposure to adequate instruction, demonstrate writing ability discordant with their cognitive level and age. Dysgraphia...
Anxiety is prevalent in childhood and adolescence. Youth with maladaptive responses to common situations and stressors are at risk of having anxiety disorders. Persistent anxiety symptoms and anxiety disorders can be debilitating with long-term adverse outcomes in adulthood. Hence, decreasing the burden of anxiety disorders is an important public h...
Patau syndrome, trisomy 13, is a rare genetic condition with notable physical and mental characteristics and an average reported lifespan of 9 months. For years, trisomy 13 was regarded as a lethal condition; however, a few infants survive for many years, creating a dilemma for both the medical practitioner and the family in terms of the appropriat...
Renal abscesses are uncommon in otherwise healthy children and adolescents who have no underlying renal structural anomalies. A previously healthy, immunocompetent, 14-year-old male without a history of abdominal trauma or urinary tract infection (UTI) was found to have a renal hematoma that became infected and developed into a renal abscess. He pr...
Anxiety disorders are common in children and adolescents with reported prevalence rates between 10% and 30%. A combined approach to treatment has been found to be the most effective for optimal outcomes and is typically comprised of psychotherapy (especially exposure-based cognitive behavior therapy), family and patient education, and use of medica...
Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder in children and adolescents. ADHD affects multiple aspects of an individual's life and functioning in family, social, and academic realms. Effective management of ADHD is necessary for children and adolescents and may include non-pharmacologic treatments, pharmacol...
Lower back pain in young athletes is a common problem. The prevalence of back pain from different causes in adolescent age group is between 20% and 30%. However, the incidence of low back pain in young athletes varies widely in different sports. Overuse injuries are the most common cause of low back pain in young athletes. In case of overuse injuri...
Puberty is defined by physical growth, development of secondary sexual characteristics, and maturation of psychosocial skills. The initiation and rate of progression of pubertal events varies among adolescents, but pubertal changes occur in a predictable stepwise manner. Factors including individual differences in physical and psychosocial developm...
There are several sets of guidelines recommending sports participation for patients with bleeding disorders. Though there is a perceived risk of injury and the associated bleeding complications, several studies have been done in this patient population and have found no increased risk. In addition, there are many other benefits to participation inc...
Over the past several decades there has been increased participation in sports by children and adolescents at earlier ages in the United States, as well as more intense participation and specialization in sports at very early ages. This trend has also partly contributed to the patterns of injuries seen in young athletes, and especially in recent ye...
Sport-related concussions in young athletes are common, generally under reported and often unrecognized. Preventive strategies include education, modification of sport rules, use of equipment such as headgears, face masks and mouth guards, and neck muscle training. Evidence is limited to support effectiveness of these preventive measures with the e...
Sudden cardiac death (SCD) is a sudden and unexpected death caused by loss of heart of function. SCD may occur in any population, but when it occurs on the playing field in a young individual, communities worldwide are affected. Although these events are rare, media coverage of sudden cardiac arrests in young athletes have created the impression th...
Recurrent or chronic activity related knee pain is common in young athletes. Numerous intrinsic conditions affecting the knee can cause such pain. In addition, knee pain can be referred pain from low back, hip or pelvic pathology. The most common cause of knee pain in young athletes is patellofemoral pain syndrome, or more appropriately termed idio...
Many children participate in organized sports each year as a means of socialization, and physical skill building. Sports participation is dependent on physical growth, and neurodevelopmental readiness of the child. It is important to be aware of a child's level across the various streams of development and engage in specific strategies to optimize...
Individuals suffering from chronic kidney disease (CKD) deal with major morbidity and mortality including poor exercise tolerance. A variety of factors including anemia, poor muscle mass, cardiovascular changes and limited physical activity contribute to exercise intolerance. Studies suggest that early initiation of aerobic and resistance training...
Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to preven...
Sport-related concussions in young athletes are common, generally under reported and often go unrecognized. Concussion in sport may result either from a direct impact to the head or from indirect forces transmitted to the brain from impact elsewhere on the body. Concussions may also result from sudden acceleration, deceleration or rotational forces...
Rhabdomyolysis can occur because of multiple causes and account for 7% of all cases of acute kidney injury annually in the United States. Identification of specific cause can be difficult in many cases where multiple factors could potentially cause rhabdomyolysis. We present a case of 16-year-old male who had seizures and was given levetiracetam th...
Orthopaedic surgeons care for patients with problems related to muscles, bones and joints. Treatment is indicated to improve function, relieve pain, and prevent contractures. Management may include medications, injections, physical and occupational therapy, bracing, and surgery. Providing the best possible care for persons with disabilities require...
Intellectual disability (ID) is the term used to describe a condition defined by limits in cognitive and adaptive abilities that affect function and initially manifest before 18 years of age. This term supplanted the earlier term ‘mental retardation’ within the past two decades. The term developmental disability (DD) was coined de novo in the 1970s...
Hearing impairment or loss may occur in isolation or in association with other developmental disorders and can be due to numerous causes. The screening and early diagnosis of hearing impairment represents an important public health concern as early intervention is associated with better long-term outcomes. With advances in technology, interventions...
Development generally follows four domains, namely, motor, speech and language, social-emotional, and cognitive. Development is considered typical when it is progressing as expected. The predominant signs and symptoms of atypical development vary depending upon the age of the infant or the child. For example, a delay in achieving motor milestones a...
Children with disabilities utilize higher levels of health services and at higher cost than other children, and there are various barriers to accessing healthcare providers and programs. Focus on high healthcare utilizers like children with disabilities can be used to design new models of care that are efficient. Evidence-based monitoring child dis...
Understanding and being able to apply the principles of pharmacology is a key component in the treatment of patients’ medical conditions. Pharmacokinetics describes the interaction of the body upon a drug and its pathway as it moves across cell membranes. Pharmacodynamics encompasses the relationship between drug concentration and the effect within...
Pain accounts for a large number of office visits yearly. Due to the high prevalence of psychosomatic complaints, it is necessary for the clinician to differentiate between organic and nonorganic causes. It is not only important to identify the psychosomatic symptoms but also how to address a highly sensitive subject with empathy. In this article,...
Fibromyalgia is a chronic disorder characterized by widespread pain, diffuse tenderness, and a number of other symptoms. The word “fibromyalgia” comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Although fibromyalgia is often considered an arthritis-related condition, it is not truly a form o...
Although joint inflammation is a symptom or sign rather than a specific diagnosis, the term arthritis is often used to refer to any disorder that affects the joints. These disorders fall within the broader category of rheumatic diseases. These are diseases characterized by inflammation and loss of function of one or more connecting or supporting st...
Pain is an unpleasant sensory and emotional experience. Pain is generally categorized as nociceptive pain and neuropathic pain. Neuropathic pain in children and adolescents is less common and less well studied. However, the quality of life for children and adolescents with neuropathic pain can be affected significantly. Pain assessment and manageme...
Participation in sports by children in the United States over the past 3 decades has seen a move from spontaneous and fun activity by children and adolescents to a more organized and competitive activity largely governed by adults and sports governing organizations. With this shift we have also seen a trend in participation in organized sports at y...
Back pain is a common symptom for which adolescents present in clinical practice. It is important to differentiate less serious from serious causes of back pain. Most back pain in adolescents is from soft tissue injuries or from bad posture. Soft tissue injuries resolve without complications in few days. Pain related to bad posture needs education...
Pain accounts for a large number of office visits yearly. Due to the high prevalence of psychosomatic complaints, it is necessary for the clinician to differentiate between organic and nonorganic causes. It is not only important to identify the psychosomatic symptoms but also how to address a highly sensitive subject with empathy. In this chapter w...
Pain is an unpleasant sensory and emotional experience. Pain is generally categorized as nociceptive pain and neuropathic pain. Neuropathic pain in children and adolescents is less common and less well studied. However, the quality of life for children and adolescents with neuropathic pain can be affected significantly. Pain assessment and manageme...
ASD is a complex and common neurobehavioral disorder with no identified single specific biologic etiology. Instead there appear to be diverse abnormalities of brain networks with cellular, biochemical, and genetic factors. Though behavioral therapy is a major component to management of individuals with ASD, psychopharmacology has emerged as an impo...
Aboriginal Peoples Survey, Canada (APS).- Reporting of Indices by the Press.- Accessibility.- Personal and Institutional Accountability.- Acquiescence Response Set.- Action Research.- Bakas Caregiving Outcomes Scale.- Balanced Life.- Bankruptcy.- Barthel Index.- Basic Capabilities Index (BCI).- Calibrated Development Index.- Campbell, Angus.- Canad...
This issue of AM:STARs looks at specific issues within the subspecialty of adolescent medicine that are beneficial to those physicians involved in caring for adolescents and young adults. Subspecialties such as genetics, dermatology, critical care medicine, psychiatry, neurology, pulmonology, endocrinology, and sexual abuse are included. This issue...
This issue of AM:STARs looks at specific issues within the subspecialty of adolescent medicine that are beneficial to those physicians involved in caring for adolescents and young adults. Subspecialties such as genetics, dermatology, critical care medicine, psychiatry, neurology, pulmonology, endocrinology, and sexual abuse are included. This issue...
Sport-related concussion is a common problem encountered by pediatricians and other primary care physicians in their practice. Assessment of concussion is essentially based on clinical evaluation. The Zurich consensus statement provides a basic framework to guide concussion management decisions and recommends an individualized approach to exercisin...
Cardiovascular screening of athletes to prevent sudden death has been a subject of ongoing debate. In the United States, such screening is currently based on history and physical examination. The International Olympic Committee and the European Sports Council require an electrocardiogram (ECG) as part of screening athletes. The 2010 European Societ...
Abstract The purpose of this study is to examine US parental knowledge of human papillomavirus (HPV) in males, views on vaccination, and correlation to vaccination rates. The survey was conducted of clinic population about parental knowledge and beliefs of male HPV health outcomes and vaccination. There were a total of 102 participants who complete...
The current recommendation of the American College of Sports Medicine for proteins is 1.2-1.7 g/kg/day. This recommended protein intake is actually greater than the recommended dietary allowance (RDA) for protein, which is around 0.8 g/kg/day, and is based on several studies that documented increased protein requirement in athletes. Most athletes g...
Sexual behavior is common in adolescents and young adults with or without chronic illness or disability, resulting in high levels of unplanned pregnancy and STDs. Individuals with chronic illness or disability should not receive suboptimal preventive health care. These individuals have a need for counseling regarding issues of sexuality and contrac...
Epidemiologic data gathered over the last 40 years report that the conservative estimate of autistic spectrum disorder prevalence is 27.5 per 10,000 individuals; however, the prevalence estimate based on newer surveys is 60 per 10,000 individuals. Several factors are considered in various epidemiologic surveys of autism, especially the evolution of...
Autism spectrum disorders (ASDs), also called pervasive developmental disorders in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revised), constitute a group of neurodevelopmental disorders that coalesce around a common theme of impairments in social functioning, communication abilities, and repetitive or rigid beh...
Chest pain is a common complaint in children, adolescents, and adults. Although, most children with chest pain do not present in severe distress with serious underlying condition, all need a very careful evaluation to rule of such a disorder. Chest pain in a child can cause significant anxiety for the parents. In adults, chest pain is often a sign...
A growing number of young adults with neurodevelopmental disabilities and chronic diseases necessitates a careful consideration of the issues involved in transition of these youth from a child-focused to an adult-oriented healthcare system. Most adolescents accomplish the transition successfully as a natural process of growth and maturation in all...
The majority of children who are born with or who develop a chronic illness during childhood now survive into the adult years. This can present a considerable challenge to adult clinicians who may not be prepared to care for so-called pediatric disorders. This chapter presents concepts of transitioning for three pediatric endocrine disorders: Turne...
Professionals who work with children and adolescents who have developmental disabilities will find themselves working with
a number of other professionals on various “teams.” These teams are typically composed of practitioners from more than one
discipline working toward the single goal of providing comprehensive patient care. Research on medical a...
This article highlights comments on this question for both teenager and parent, focusing on key underlying concepts as neurodevelopment and sports readiness. Issues regarding neurodevelopment in adolescent sports are considered in this article. Understanding the neurodevelopment of the Adolescent Athlete and how this development impacts sports part...
Intellectual disability is characterized by deficits in cognitive and adaptive abilities that initially manifest before 18
years of age. In the United States, the prevalence of intellectual disability is estimated to be between 1 and 3 out of every
100 individuals in the general population. Most individuals have mild intellectual disability and the...
Developmental disabilities or neurodevelopmental disabilities (include intellectual disability) are a diverse group of chronic
disorders that begin at anytime during the development process (including conception, birth, and growth) up to 22 years of
age and last throughout an individual’s lifetime. Major disabilities include intellectual disability...
Development generally follows four domains, namely motor, speech and language, social–emotional, and cognitive. Development
is considered typical when it is progressing as expected. The predominant signs and symptoms of atypical development vary
depending on the age of the infant or the child. For example, a delay in achieving motor milestones as e...
The growing number of young adults with neurodevelopmental disabilities and chronic diseases necessitates a careful consideration
of the issues involved in transition of these youth from a child-focused to an adult-oriented health-care system. Most adolescents
accomplish the transition successfully as a natural process of growth and maturation in a...
Neural tube defects result from failure of neurulation during the early development of the central nervous system. Although
any segment of the developing CNS can be involved, most cases affect the lumbosacral level. Multiple factors have been identified
that increase the risk for neural tube defects. Dietary supplementation with folic acid has been...
Hypertension has been well recognized as a major contributor of chronic cardiovascular disease, resulting in significant morbidity and mortality not only in adults but also in children and adolescents. Primary or essential hypertension refers to cases where no underlying etiology is apparent for the high blood pressure, and accounts for a majority...
Acne vulgaris is a common disorder of adolescents and young adults that can be very severe especially in those with concomitant hyperandrogenic conditions. The pathophysiology of acne vulgaris is reviewed along with its differential diagnosis, including acne variants. Management of acne is also reviewed including use of topical and oral anti-acne a...
Rapunzel syndrome is a rare cause of intestinal obstruction caused by a trichobezoar. There have been fewer than 40 cases reported and only one case was reported to occur in a male to date. We present the youngest patient in the literature and only the second male case.
Overview
Overview This article discusses chronic illness in adolescents and suicide risk. The health professional's role in recognising the association will be explored. The article includes some self-assessment to test the reader's knowledge
An understanding of the basic principles of pharmacokinetics and pharmacodynamics of drugs is important in appropriate therapeutic use of various drugs. In simple terms, the effects of the body on the drug once it has entered the body has been referred to as pharmacokinetics, and it aims to provide a quantitative assessment of the main processes in...
An understanding of synaptic neurotransmission is fundamental to the understanding of various neuropsychiatric symptoms and disorders. It is also essential to the discovery of pharmacologic agents that modulate neurotransmission to alleviate such symptoms and conditions. Various aspects of the process of neurotransmission and the synthesis, release...
An increasing number of studies have evaluated the role of herbal supplements in pediatric disorders, but they have numerous limitations. This review provides an overview of herbal components, regulation of supplements, and importance of product quality assurance. Use of herbal supplements is discussed with reference to factors that influence use i...
Tics in children and adolescents are a common occurrence; however, a small proportion of these disorders require pharmacologic interventions. Several limitations exist with the use of pharmacologic interventions, and hence, a more ideal multidisciplinary approach is recommenced, with emphasis on nonpharmacologic management for improved functioning,...
There is a high prevalence of sleep disorders in children and an apparent increasing need for pharmacologic management. However, because of the paucity of data available with regards to dosing, efficacy, tolerability, and safety profiles of medications as well as a lack of adequate well-designed clinical trials, medications are currently not approv...
This is a commentary of a Cochrane review, published in this issue of EBCH, first published as: Krul M, van der Wouden JC, van Suijlekom-Smit LWA, Koes BW. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007759. DOI: 10.1002/14 651 858.CD007759.pub2.
Further...