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Scoliosis in Adolescents Normally, a spine when viewed from rear should appear straight but if the spine is lateral or curved or sideways or rotated then it is affected by scoliosis. It gives an appearance as if the person has leaned to a side. According to Scoliosis Research Society the definition of scoliosis is the curving of the spine at an angle greater than 10 degrees on an x-ray. Scoliosis is a kind of spinal deformity and shouldn’t be confused to poor posture. Usually there are 4 common kinds of patterns of curves experienced in Scoliosis which are: Thoracic wherein the right side has ninety percent curves, lumbar wherein left side has seventy percent curves, thoracolumbar wherein right side has eighty percent curves and double major where both right and left sides have curves. In majority of the cases, as high as eight to eighty five percent, the cause of the deformity is unknown, this is also known as idiopathic scoliosis. It is observed that females have scoliosis more commonly than males. According to some established facts 3 to 5 children per 1000 has chances of developing spinal curves which is a number big enough requiring medical treatment. There are three types of scoliosis that can develop in children namely congenital, neuromuscular and idiopathic. Congenital scoliosis is seen in 1 out every 1,000 births which is caused due to vertebrae’s failure in normal formation, vertebrae is absent, vertebrae is formed partially and vertebrae is not separated. Neuromuscular scoliosis is linked with various neurological conditions and particularly in children who don’t walk like cerebral palsy, muscular dystrophy, spina bifida, tumors in spinal cord, paralytic conditions and neurofibromatosis. The cause of third type of scoliosis called Idiopathic scoliosis is still unknown. It is further divided into infantile, juvenile and adolescent scoliosis. Infantile scoliosis occurs up to the age of 3 years from birth wherein the vertebrae curve is towards left and is more frequently observed in boys. The curve takes normal shape with the growth of child. Juvenile scoliosis is common in children of age three to nine. Adolescent scoliosis is common in kids of age ten to eighteen and this is also the most common form of scoliosis occurring more in girls than boys. The other possible causes of the deformity include hereditary reasons, different lengths of legs, injuries, infections and tumors. There are numerous symptoms attributed to scoliosis which can vary from individual to individual. The symptoms are: Difference in heights of the shoulders, off-centered head, difference in the height or position of the hip, difference in the position or height of shoulder blade, different arm lengths in straight standing position and lastly different height back sides when the body is bent forward. Other symptoms include leg pain, back pain and change in bladder and bowel habits do not belong to the symptoms of idiopathic scoliosis and require medical checkup by a doctor. The symptoms may be similar to other problems related to spinal cord or other deformities or could result from an infection or injury and consulting a doctor is the best bet in this situation who may conduct diagnosis to know what exactly it is. The diagnosis of scoliosis requires thorough medical history of the teenager, diagnostic tests and also physical examination. The doctor asks for entire prenatal history, birth history and also would want to know if anyone in the family has scoliosis. The doctor may also ask for the milestones related with the development of the teenager since some kinds of scoliosis are known to be related to neuromuscular disorders. The delay in development may need additional medical evaluation. Doctor may also prescribe x-ray, CT scan and MRI scan of the back to measure the degree of curvature in the spinal. There are various treatments available for scoliosis which is decided by the physician depending on teenager’s age, medical history and health in general. The method of treatment also depends on the extent to which disease has reached. The tolerance of the teenager to certain medicines, therapies and procedures are also taken into consideration. Expectations and opinion of the parents or teenager is also the criteria in deciding the type of treatment. The main aim of the treatment is stop the curve from progressing and avert deformity. The treatments include observation and repetitive examinations, bracing and surgery to correct the defect. PPPPP Word Count 725

Sexually Transmitted Diseases in Adolescents Sexually transmitted diseases are transmitted through unprotected sexual intercourse and are highly infectious diseases. Unprotected sexual contact risks the lives of the young by afflicting with sexually transmitted diseases such as HIV infection and even unwanted pregnancy. Every year, nearly nineteen million cases of sexually transmitted diseases are reported in the United States alone and out of these, half of the cases involve people from the age group of fifteen years to twenty four years. The best way to make sure the adolescent doesn’t contract sexually transmitted diseases is to abstain from all types of sexual activities. In spite of this, if the adolescent becomes sexually active, he/she must be advised by the parents to take precautionary measures to reduce the risk of getting a sexually transmitted disease. The best precautionary measure is to use a condom every time the adolescent has sexual intercourse. Only when other sexually transmitted diseases are prevented and controlled, HIV infections can be prevented. It is best when the adolescent delays and abstains from sexual relationships, because the younger the person, the more susceptible he/she is to get a sexually transmitted disease. Having sexual contact during menstruation is also risky. It is good to avoid anal intercourse and if it is performed condom is a must, even when having oral sex. Every person should get STD checkups as frequently as possible, irrespective of being sexually active or not, after they turn into adolescents. Precaution must also be taken when getting injected by an intravenous drug, that the needle used to inject must be sterile. The adolescent must be educated about the symptoms and risks of sexually transmitted diseases. Adolescents must be thoroughly informed even if they say they know it all. They must be asked to indulge in only safe sex, if doing so. Parents should talk honestly and calmly about safe sex and must answer all their child’s queries. Topics such as STDs, birth control methods, having sex because of peer pressure, and date rape must be discussed in detail. Most people think that kissing is safe, but it can spread the sexually transmitted disease, herpes and many other diseases. Condoms do not provide hundred percent protections for genital warts, AIDs and genital warts. Females shouldn’t douche as it can make the infection go deeper into the reproductive tract and can also wash off spermicidal protection. At a time, sexual intercourse must be provided with only one partner, who isn’t involved with any other sexual partner. The sexually transmitted diseases are Acquired Immune Deficiency Syndrome or AIDS, Human Papillomaviruses or HPVs, chlamydial infections, pelvic inflammatory disease or PID, Gonorrhea, Genital Herpes, syphilis, and genital warts. The symptoms of sexually transmitted diseases take time to surface. Some of them are also symptom less and even these diseases can be contagious. Especially in the case of female, the symptoms of sexually transmitted diseases can be confused with the symptoms of other diseases. But females get severe symptoms and get it more frequently. Sexually transmitted diseases can harm the fallopian tubes and uterus. It can even lead to inflammatory disease, which in turn can cause ectopic pregnancy or infertility. Cervical cancer, in females, can be associated to sexually transmitted diseases. If a female gets a sexually transmitted disease during her pregnancy, the disease can pass onto her child. Sometimes the newborn’s infections can be treated successfully, but at other times, the child can be disabled for life or die. If an adolescent is diagnosed with sexually transmitted diseases, his or her treatment must start immediately. The early the sexually transmitted diseases are diagnosed, the easier it is to treat them successfully. The other sexual partner must be informed so that they can get themselves diagnosed and can undergo treatment. The adolescent must be instructed to stay away from sexual activity while the treatment is going on. The checkup must be followed after the treatment. Tests such as pelvic examination, Pap test, and test for STDs should be taken periodically. Sexually transmitted diseases can affect people of all economic levels and backgrounds. Half of the cases of sexually transmitted diseases involve young people below the age of twenty five. The more sexually active the person is the more risk he/she is. And multiple sex partners at a given time are very dangerous too and must be strictly abstained from. PPPPP Word Count 726

Sprains and Strains in Adolescents Sprains and strains are among the majority of the injuries caused while playing sports. Sports injuries can be caused by small trauma which involves ligaments, muscles and tendons including bruises, sprains and strains. The body part which is most commonly involved in spraining or straining is the ankle. The 3 ligaments that are involved during ankle sprain or strain include anterior talofubular ligament, posterior talofibular ligament and calcaneofibular ligament. An injury caused to the soft tissue as a result of a direct force like fall, kick and blow is called a contusion or a bruise. A sprain is nothing but a ligament injury which is wrenched or twisted. Sprains usually affect knees, wrists and ankles. On the other hand a strain is an injury caused to a tendon or muscle which usually results from force, stretching and overuse. Sprains/Strains are usually diagnosed by a physician after a physical examination. The physician asks for thorough medical history of the adolescent and asks various questions that lead to the cause of the injury. Various diagnostic procedures are also available which also helps in evaluating the problem. X-ray is one of the oldest and common diagnostic tests done to know the extent and exact location of the injury. An x-ray uses electromagnetic waves to get photos of internal tissues, organs and bones onto a film. MRI scan is one of the recently evolved diagnostic procedures which also help in evaluating a physical injury. This procedure actually called Magnetic Resonance Imaging makes use of bug magnets, computer and radio frequencies to get detailed pictures of structures and organs inside the body. Another diagnostic procedure called Computed Tomography Scan or CT scan is also used to evaluate the extent and location of injury. This procedure uses a blend of computers and x-rays to get cross sectional pictures in horizontal and vertical alignment. It shows thorough pictures of any part of the body like muscles, bones, fat and organs. They provide more information than conventional x-rays. There are various symptoms of strain and sprain depending on each teen’s physical condition and they may vary accordingly. One of the symptoms includes pain in and around the area injury. There could also be a swelling around the injured area. Some teens also experience difficulty when they use or move the area of the body that is injured. Some teenagers also undergo bruises or redness in the area that is injured. Many times the symptoms of sprains and strains may look similar to other medical conditions and a doctor’s advice is the best option in this scenario. Depending on various factors the treatment of sprains and strains will be prescribed by the teenager’s physician that include teenager’s age, overall health of the teenager, and medical history of the adolescent. To what extent the teen is injured is also a factor in determining the nature of treatment. A teenager’s level of tolerance to certain medications, therapies and procedures is also taken into consideration before opting for a particular method of treatment. The treatment also depends of what expectations one has and also preference and opinion. Various options available for treatment include things like restriction of the activity after the injury, application of cast/splint on the injured spot, crutches or wheelchair, physical therapy which involves stretching exercises to give strength to the muscles, tendons and ligaments that are injured and last but not the least is the surgery which is opted for in worst case scenario. In the long-term scenario bruises, sprains and strains heal pretty quickly in kids and teenagers but it is important that the adolescent sticks to the restrictions imposed during the treatment and healing process like restriction of activity and regularly attending physical therapy sessions if any. It is noted that majority of the sports related injuries results either due to traumatic injury or excessive use of muscles and joints. But, they can be avoided and prevented with right training, by wearing right protective gears and by using right equipment for training. PPPPP Word Count 670

Tennis Elbow in Adolescents Tennis elbow is a condition in which tendon fibers that attach on epicondyle on the elbow’s exterior degenerates. The tendons talked about here anchor the muscles that help wrist and hand to lift. Although tennis elbow occurs mostly in patients of thirty to fifty years of age but it can happen to people of any age. Also tennis elbow affects almost fifty percent of teenagers who are in racquet sports thus the name “tennis elbow”. But still most of the patients who suffer with tennis elbow are people who don’t play racquet sports. Majority if the times there isn’t any specific injury before the symptoms start showing up. Tennis elbow can also happen to people who use their forearm muscles frequently and vigorously for day to day work and recreational activities. Ironically some patients develop the condition without any of the activity related reasons that leads to the symptoms. The symptoms of tennis elbow include severe burning pain on the elbow’s exterior region. In majority of the cases this starts as a slow and mild pain gradually worsening with the passage of few weeks or sometimes months. The pain worsens when one tries to lift objects. In some cases it may pain even while lifting light objects like a book or full coffee cup. In the severest cases it can pain even at the movement of the elbow. The diagnosis of the tennis elbow involves physician enquiring about the medical history of the teenager and a physical examination of the elbow by pressing directly on the part where bone is prominent on the elbow’s exterior to check if it causes any pain. The physician may also ask the teenager to lift the fingers or wrist and apply pressure to check if it causes any pain again. X-rays are never opted for diagnosis. However a MRI scan may be done to see changes in tendons at the attachment to the bone. There are many treatment options available and in majority of the cases non-surgical treatment is given a try. The ultimate goal of the 1st phase of the treatment is pain relief. Be ready to hear from the physician to stop any activity leading to the symptoms. The doctor may also tell the teenager to apply ice to elbow’s exterior and he/she may also tell the teenager to take anti-inflammatory medicines for relief from pain. The symptoms also diminished with the help of orthotics. The physician may also want to go for counterforce braces and also wrist splints which can greatly cut down symptoms by providing rest to tendons and muscles. The symptoms should show signs of recovery within 4 to 6 weeks otherwise next option would be to go for a injection called corticosteroid in the vicinity of the elbow. This greatly reduces pain and is also very safe to use. There are many side affects involved if it is overused. Once there is a relief from pain the treatment’s next phase starts which involve modification of activities in order to prevent the symptoms from returning. The doctor may also prescribe the teenager to go for physical therapy which may include stretching exercises to gradually increase the strength of the affected tendons and muscles. Physical therapies have high success rates and return your elbow back to normal working again. Again non-surgical procedures are highly successful in eighty five to ninety percent patients. Surgical procedure is considered only when patients undergo relentless pain that doesn’t improve even after 6 months of non-surgical treatment. The procedure involves removal of affected tendon tissue and attaching it back to bone. The surgery is done on outpatient basis and does not need stay at the hospital. The surgery is done by making a small incision on elbow’s exterior’s bony prominence. In recent years a surgery known as arthroscopic surgery has also been developed but no major benefits have been seen using it over the traditional method of open incision. PPPPP Word Count 658

Tests and Examinations for Adolescent Girls Adolescence is the time when girls face many changes as they not only become physically mature, but sexually, too. In order to maintain good health, they need to consult gynecologist, adolescent medicine physician and obstetrician. Adolescents who are sexually active need to get some test done like pelvic examination, Pap test and test for checking sexually transmitted diseases. This helps the early determination of conditions that can affect reproductive, gynecological and sexual health. Schiller test is conducted where the iodine solution is used to cover the cervix. In colposcopy, colposcope is used to check the cervix and the vagina. Cancer is checked by biopsy. In this a small quantity of cervical tissue is removed and a pathologist checks the tissue for abnormal cells. The most important test is the Pap test or a pap smear. The cells from the mouth of the womb or the cervix are collected to check for cancer, abnormal cells, infection or inflammation. The detection of abnormalities shows signs of cancer. Therefore it is recommended that every female must take Pap test regularly to check out for invasive cancers in the early stages itself. And if invasive cancer is detected, it can be successfully treated in the early stages. Apart from detecting invasive cancer, other changes, such as cancer cells or dysplasia and inflammation, of the vagina and cervix can also be determined. Inflammation can be caused by pregnancy, abortion, miscarriage, hormones, trichomoniasis infections, viruses, bacteria, yeast infections, and other medication. The repetition Pap test will be suggested by the gynecologist. When a girl becomes sexually active, she will have to test for cervical cancer after three years of becoming active because it usually takes many years for the significant development of cancer or abnormality. Usually there are some cervical cell changes and transient human papilloma virus infections or HPV infections which are very common. Therefore, a Pap test for cervical cancer is recommended every three years. But women who are under thirty years are at a higher risk of getting HPV infections of higher risk. It would be more feasible if every individual takes advice from her doctor about when she can begin screening, the frequency of the test to be taken, and when she can discontinue the tests. In a Pap test, if abnormal cells are determined, usually more tests are recommended to detect abnormalities which will require treatment. Abnormal Pap test will be handled differently for adolescents when compared to adults. Usually the low grade cervical lesions will not require any treatment and will go away on their own. That is the reason why the Pap test is repeated after a gap of six to twelve months, after the original Pap test which identifies abnormalities. But this repetition will vary from individual to individual depending on her health status and kind of abnormalities found. A replacement of the Pap test is thinprep test. It involves new technique for testing cells from the cervix for abnormalities. But the cost of getting a thinprep test done is double the cost of getting Pap test done. The advantage of getting a thinprep test is that it requires to be re-done less number of times and detects lesions in initial stages itself. The cervical cells, instead of getting smeared on a slide, are introduced into a liquid vial. After the filtration of the liquid, the cells from the cervix are examined by being placed on the slide. PPPPP Word Count 576

Acne in Adolescents Acne is one of the most common problems in adolescent teens affecting nearly seventeen million people in the United States. Acne is nothing but a disorder involving sebaceous glands and hair follicles. Acne results from the clogging of sebaceous glands leading to the formation of pimples and cysts. The condition usually begins with the onset of puberty. Going by the facts, as teens attain puberty the androgens also called male sex hormones are produced in high number leading to sebaceous glands becoming over active which results in sebum being produced in high proportions. Sebum, which is nothing but oil is produced by sebaceous glands which travel to the skin surface through hair follicles. But, skin cells block the follicles which results in oil also being blocked. When these hair follicles are blocked it results in the development of skin bacteria known as Propionibacterium Acnes within the follicles which in turn results in swelling of the skin called Acne. If the hair follicles are partially blocked it results in blackheads. If the follicles are completely blocked they result in whiteheads. But if these plugged follicles are not treated they ultimately burst causing the oil, bacteria and skin cells to spill all over the skin resulting in irritation and formation of pimples. Acne can be shallow as well as deep in various individuals depending on the nature of skin and amount of oil produced. There can be various causes why Acne forms. Apart from rising hormone levels due to puberty it can also be attributed to certain other factors like intake of drugs which contain lithium, barbiturates and corticosteroids. Acne can also be caused due to excess grease and oil in the scalp, due to cooking oil and use of some cosmetics can actually alleviate the acne problem. Acne problem many times is inherited also. Acne problem is worsened if the pimples are squeezed or scrubbed too hard. Acne can form at any place of the body but they most commonly form in the areas where there sebaceous glands are present in high proportions like face, chest, shoulders, neck and upper back. The symptoms may differ from person to person but commonly seen symptoms are: formation of blackheads, whiteheads, lesions filled with pus and which are very painful and lastly nodules. One may get confused sometimes as symptoms of acne may be like some other skin condition and it is always advised to consult a doctor in this scenario. There are lots of treatments available today to treat acne. The primary goal of the treatment is to reduce scars and better appearance. There are various treatments and the doctor decides which specific treatment you need based on: the extent of acne problem, age, medical history, overall health, tolerance to specific medications and procedures, expectations and last but not the least what patients prefer. Treatment of acne is classified into topical and systemic drug therapies which are given based on extent of severity. In some instances the combination of both the methods might be the way to go for acne treatment. Topical medication is nothing but creams, gels, lotions, solutions etc. prescribed to patients for acne treatment. Some of the examples of topical medication are: Benzoyl Peroxide which kills the Propionibacterium Acnes bacteria, antibiotics helps in stopping or slowing down the growth of the bacteria and also reduces inflammation, Tretinoin helps in stopping the formation of new acne lesions and Adapalene reduces formation of comedo. Systemic drug therapies involve prescription of systemic antibiotics primarily for the treatment of acne problem which is moderate to severe in nature. The examples of antibiotics prescribed are Doxycycline, erythromycin and tetracycline. In some cases an oral drug called Isotretinoin is prescribed for teenagers with severe acne problem which shrinks down the sebaceous glands that produce oil. The results are pretty good and almost ninety percent of the adolescents have success with this oral drug. But the drug has some serious side-affects and thus it is very important that one consults a doctor before use. PPPPP Word Count 670