Dr Satyajit Mohanty blogs

How is psoriasis defined? Psoriasis is a chronic inflammatory skin condition which affects approximately 1-3% of the worlds population (1). It appears as red plaques covered with silvery scale that flakes away from the skin. Psoriatic plaques are often found on the elbows, scalp and knees but can also affect other parts of the body such as the face, feet and mucous membranes. Psoriasis is not contagious, nor is it caused by an allergy. However, the tendency to develop the condition can be genetically transmitted.Psoriasis causes itching in 60% to 70% of cases (2). What are the different types of psoriasis? Psoriasis may appear at any age, but there are two peak onset periods; during childhood/early adulthood (early onset psoriasis) and after age 40 (late onset) (1). There is strong evidence for a genetic predisposition to psoriasis, in particular to childhood psoriasis. It is estimated that 71% of patients with childhood psoriasis have a positive family history (2). There are multiple...

Some dermatologists believe that the term "psoriasis" in fact covers six or seven different conditions, which in the future may be distinguished from each other and treated separately. The effect of the drugs that are available today (e.g. local and systemic treatments) is to clear the psoriatic plaques and to prevent relapse. Psoriasis is classified according to the type of lesion into the following subgroups Plaque psoriasis (which is the same as psoriasis vulgaris) Guttate psoriasis Nummular psoriasis Pustular psoriasis Erythrodermic psoriasis Psoriasis arthritis Plaque psoriasis (psoriasis vulgaris) Psoriasis vulgaris is the clinical term for plague psoriasis. Vulgaris means “common” and psoriasis vulgaris is the most prevalent form of psoriasis affecting 95% of people with psoriasis. Lesions are clearly demarcated and may be surrounded by a clear ring. The condition can appear on various parts of the body and lesions vary depending on the body part affected. Plaques var...

How can my psoriasis be assessed in terms of severity? In order to objectively assess the severity of psoriasis, doctors primarily use morphological criteria such as the Psoriasis Area and Severity Index (PASI). This tool allows the extent of lesions to be assessed as well as the degree of erythema and scale. A high score corresponds to an assessment of “severe psoriasis”. " This scoring system has the advantage of being reproducible, but it gives no indication of the objective or subjective severity of the condition," says Professor Grob. Many specialists believe that numerous factors contribute to the severity of psoriasis, such as its impact on quality of life and resistance to treatment, and not just morphological criteria and the extent of lesions. Essentially, the severity of psoriasis relates to how well a patient copes with the condition. The notion of perceived stress is key as psoriasis affects patients very differently. For example, two people who have similar l...

Key points 1. Itching (pruritus) is a disagreeable sensation that causes a more or less irrepressible urge to scratch. 2. Itching and pain do have some features in common. They are both unpleasant sensations. 3. Stress and depression can exacerbate itching. 4. Psoriatic lesions must be treated in order to treat itching. 5. It is important to avoid anything which could encourage itchiness, such as very hot baths and showers, clothing which causes friction and stimulants such as coffee. What about itching? The medical term for itching is “pruritus”. The sensation can be limited to one area of the skin or extend over the whole body. There are numerous causes for itching, such as inflammatory skin conditions or general illnesses. Psoriasis was long believed to be non-pruritic (non-itchy) and not all patients with psoriasis are suffering from itchyness. However, several studies have shown that 80% of patients with psoriasis do experience it. There are varying degrees of itchiness, measured ...

Despite the well-recognized role of lifting in back injuries, the relative biomechanical merits of squat versus stoop lifting remain controversial. In vivo kinematics measurements and model studies are combined to estimate trunk muscle forces and internal spinal loads under dynamic squat and stoop lifts with and without load in hands. Measurements were performed on healthy subjects to collect segmental rotations during lifts needed as input data. Results tell us that passive (muscle or ligamentous) forces and internal compression/shear forces were larger in stoop lifts than in squat ones. These were due to significantly larger thorax, lumbar and pelvis rotations in stoop lifts. So it is advocated squat lifting over stoop lifting as the technique of choice in reducing net moments, muscle forces and internal spinal loads (i.e., moment, compression and shear force). Role of posture in static lifts: Despite the recognition of the contributory role of lifting in spinal injuries, the advanta...

Benefits to patients with low back pain from manipulation have been reported. Little is known about how the loads that are applied affect the spine. Studies of isolated forces applied during HVLA (high-velocity and low-amplitude) procedures in controlled conditions reveal force ranges from 20 N to 550 N at rates up to 7101 N/sec. Vertebral motions arising from these forces have been estimated to be up to 0.1 cm and 1.8 degrees. But complex loads that pass from common lumbar procedures through the spine have not been studied. A group of researchers did an in vivo biomechanical study of three separate manipulation procedures administered in random order. A biomechanical computer model estimated the loads passing through the spine at the level of interest. At last the difference in loading effects from manipulation was contrasted for all six degrees of freedom based on treatment method. Results showed: 1. Muscular response during the procedures was negligible and did not enter into the es...

Modern scientific investigations into spinal manipulative therapy (SMT) began in 1975. Conditions often treated include acute and chronic low back pain, radicular pain, neck pain, and some forms of headache. The field of spinal manipulation has often been treated by the literature, incorrectly, as being homogeneous. Much of the confusion regarding this form of treatment can be traced to the ambiguity surrounding the procedures themselves. A categorization system for SMT was sought that would be more objective than is clinically available. Such a system may serve as a means to strengthen future studies, determine operating principles, applicability, treatment effectiveness, and nature of the manipulable lesion. Attempt to classify SMTs: Attempt to classify SMTs on biomechanical basis has been taken form different studies are as follows: Studies that include measurements of mechanical characteristics of treatment techniques used under the general headings of SMT or manual therapy, studie...

Spinal manipulation or manual therapy is becoming an increasingly popular method of treating athletes with spinal problems. The primary theoretic basis for the claimed beneficial results of manipulation is the restoration of motion with subsequent effect on ligamentous adhesions, muscle spasm, disk nutrition, and central nervous system endorphin systems. The concept of joint barriers has been developed to differentiate among exercise therapy, mobilization, and manipulation. Research trials suggest that spinal manipulation is beneficial in relieving or reducing the duration of acute low back pain and acute neck pain but has much less effect on chronic low back pain and neck pain. There is evidence that manipulation increases certain parameters of motion of the spine but this evidence is not yet conclusive. There are a wide variety of manipulative procedures that are utilized to manipulate the spine to increase range of motion, and the selection of the procedures is based on manual di...

Given the puzzling etiology of osteoarthritis, different classifications of the disease have been proposed, yet all coincide in making a clear distinction between primary or idiopathic osteoarthritis and secondary osteoarthritis. According to the American College of Rheumatology (ACR): Idiopathic - Localized (spine, knee, hip, hands, feet, elbow, shoulder, and other joints) - Generalized (involving 3 or more joints) Secondary - Trauma - Developmental and congenital diseases (dysplasia, etc.) - Metabolic diseases (gout, etc.) - Endocrine disorders (diabetes, hypothyroidism, etc.) - Calcium deposition diseases (pyrophosphate, hydroxyapatite, etc.) - Other bone and joint diseases (rheumatoid arthritis, etc.) - Neuropathic (Charcot) arthropathy - Septic arthritis - etc. Diagnosis Osteoarthritis is diagnosed by evaluating symptoms related to the location and characteristics of pain, the conditions under which it improves (rest) and worsens (when bearing a load), crepitus, and disorders in t...

Cervical nerve pinch syndrome, a neurapraxia of the brachial plexus, is a common occurrence in contact games. The more serious injury, brachial plexus axonotmesis, has received little attention in the literature. Acute brachial neuropathy is an uncommon etiology of shoulder pain and disability. It can, however, present in association with athletic activity and therefore must be included in the differential diagnosis of athletes with such symptomatology. Findings that should alert the examiner to the possible presence of acute brachial neuropathy include 1) onset with non-contact as well as contact sports, 2) rather acute onset of pain without specific inciting trauma, 3) persistent, often severe pain that continues despite rest, 4) patchy brachial plexus and/or peripheral nerve involvement, and, 5) dominant arm predominance of symptoms and signs. Electromyography and nerve conduction studies often can confirm the diagnosis. Treatment begins with rest and continues through a rehabilitat...

Clinicians routinely consider the success of a thrust manipulation technique based on the presence or absence of an audible pop despite the lack of evidence suggesting that this pop is associated with improved outcomes. Cleland JA et al determined the relationship between the number of audible pops with thoracic spinal manipulation and improvement in pain and function in patients with mechanical neck pain. The study: 78 patients referred to physical therapy with mechanical neck pain underwent a standardized examination and thoracic spine manipulation treatment protocol. All patients were treated with a total of 6 thrust manipulation techniques directed to the thoracic spine followed by a basic cervical range of motion exercise. The treating clinician recorded the presence or absence of a pop during each manipulation. The result & conclusion: The results of this analysis provide preliminary evidence for the hypothesis that there is no relationship between the number of audible pops ...

The osteopathic philosophy: Osteopathic medicine as we know it begins with Andrew Taylor Still, M.D. (1828 - 1917), who introduced its concepts in 1874. "Osteopathy is based on the perfection of Nature's work. When all parts of the human body are in line we have health. When they are not the effect is disease. When the parts are readjusted, disease gives place to health. According to Dr. Still the musculoskeletal system (bones, muscles, ligaments and connective tissues) is the largest collective system of the body, making up 60 percent or more of the body's mass. From the osteopathic point of view, the musculoskeletal system is the primary machinery of life.Viscera & internal organs with which medicine is always so concerned are the secondary machinery of life. Through careful study and experimentation, he was able to associate abnormalities in the structural system (musculoskeletal system) of the body with signs and symptoms of various diseases. Dr. Still developed ma...

Following is an USDA report................... A group of doctors introduced a document to the floor of the United States Senate back in 1936. . It was a dire warning that the mineral content of the soil was eroding. Vegetables were losing their power and people were at risk. The effects are… US Department of Agriculture’s (USDA) nutritional values for fruits and vegetables today compared to 1975 is as follows: Apples, Vitamin A is down 41% Sweet Peppers, Vitamin C is down 31% Watercress, Iron is down 88% Broccoli, Calcium and Vitamin A are down 50% Cauliflower, Vitamin C is down 45%; Vitamin B1 is down 48%; and Vitmain B2 is down 47% Collards Greens, Vitamin A is down 45%; Potassium is down 60%; and Magnesium is down 85% According to USDA’s own numbers, the vitamin and mineral content has dramatically plummeted – in just 30 years! Notice minerals like iron and magnesium have dropped by more than 80 percent. That’s from commercial farming technology and powerful fertilizers that pract...

Atricle of Siegrist M . In recent years, osteoporosis has become a leading cause of morbidity and mortality in elderly women. Research has demonstrated that the prevention of osteoporosis and osteoporosis-related fractures may best be achieved by initiating sound health behaviors early in life and continuing them throughout life. Evidence suggests that osteoporosis is easier to prevent than to treat. In fact, healthy early life practices, including the adequate consumption of most nutrients, calcium in particular, and regular physical activity, contribute to greater bone mineral mass and optimal peak bone mass. Bone is living tissue that responds to exercise by becoming stronger. Two types of exercises are important for building and maintaining bone mass and density: Weight-bearing exercises, in which bones and muscles work against gravity and resistance training that use muscular strength to improve muscle mass and strengthen bone. Exercise can also improve gait, balance, coordination...

Definition of Injury “Unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy, or the absence of such essentials as heat or oxygen.” Causative factors for sports injuries: Intrinsic factors Age Gender Body size Injury history Fitness level Muscle strength/Flexibility Skill level Psychological state Extrinsic factors Equipment Environment Type of activity Conditioning errors What is Injury Prevention? Injuries are preventable by changing the environment, individual behavior, products, social norms, legislation, and governmental and institutional policies to reduce or eliminate risks and increase protective factors. Primary & secondary prevention: Primary prevention is prevention of occurrence of injury Se...

“How much we need oxygen to live” is only felt at the lack of it. Process of respiration is the fundamental biological process that sustains life. In the exchange of harmful CO2 ; O2 is exchanged. Further without O2 no energy liberating combustion can take. Combustion (process of energy release) in living being was first described by Lavoisier (1743-1794). He discovered the true nature of oxygen & how it’s combustion with carbon & hydrogen result in the formation of CO2, H2O and heat. In 1842, Liebig discovered that the substances burned in the body for energy liberation are carbohydrate, fat & protein. Importance of respiratory exchange ratio in knowing the nutrient fuel of body: In one breath , you normally breathe in more molecules of oxygen than you breathe out molecules of carbon dioxide . The ratio between these CO2 / %O2 is the respiratory exchange ratio (RER). Measuring this ratio can be used for estimating the respiratory quotient (RQ), an indicator of which fu...

Seasonal variation in adult leisure-time physical activity: Pivanik JM et al determined the effect of season on self-reported leisure-time physical activity (LTPA) behaviors of Michigan adults. They found, weekly leisure-time energy expenditure averaged approximately 15-20% higher during spring and summer. Much of this difference was due to active respondents participating in a second activity during these seasons.

following is an abstract of MUDD LM et al(2008) on physical activity recommendation for energy expenditure: Most adults do not meet the American College of Sports Medicine and Centers for Disease Control and Prevention (ACSM/CDC) physical activity recommendations. Even fewer meet the more extreme Institute of Medicine (IOM) physical activity recommendations. Compliance with either recommendation has been conventionally assessed by combining frequencies and durations of self-reported activities. Leisure-time energy expenditure is a cumulative measure of activity that offers an alternative method of defining compliance. PURPOSES:: To calculate the leisure-time energy expenditure of adults complying with the ACSM/CDC or the IOM physical activity recommendations determined by conventional measures and to reexamine compliance with the IOM recommendation using energy expenditure criteria. METHODS:: National, cross-sectional data from the 2000 Behavioral Risk Factor Surveillance System deter...

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