Skin Disorder-Psoriasis

What is psoriasis?
Psoriasis is an immune-mediated disease that affects the skin.It is typically a lifelong condition. No complete cure for the psoriasis.

Pathogenesis:

• Psoriasis occurs when the immune system mistakes a normal skin for a pathogen and sends out wrong signals that cause overproduction of new skin cells.
• Psoriasis is a long term(chronic) skin problem that causes skin cells to grow too quickly and makes thick, white, silvery or red patches of skin. Normally skin cells grow gradually and flake off every 4 weeks. New skin cells grow to replace the outer layers of the skin as they shed. But in psoriasis  new skin cells move rapidly to the surface of the skin in days rather than week.

Types:
Psoriasis is of 5 types;
1-Plaque
2-guttate
3-inverse
4-pustular
5-erythrodermic
 The most common type is plaque usually appears as red and white hues of scaly patches.

What are the Causes?

• Psoriasis occur when immune system overreacts, causing inflammation and flaking of skin.
• In cases are related to families.Research shows that large number of families are affected by psoriasis and it may pass from parents to children.
• Causes also include; cold dry climate, stress and dry skin. Certain medicines e.g; nonsteroidal anit-inflammatory drugs(NSAIDs).
• Smoking: especially in women.and can make it worse if somebody already have it.
• Psoriasis is not contagious.However, psoriasis has been linked to an increased risk of stroke and treating high blood lipid levels may lead to improvement.

Signs & Symptoms:

• Psoriasis can be mild, with small areas of rash. 
• When psoriasis is moderate or severe, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin.
• If psoriasis is severe, the skin becomes itchy and tender. And sometimes large patches form and may be uncomfortable. The patches can join together and cover large areas of skin, such as the entire back.

Psoriatic arthritis:
In some people, psoriasis causes joints to become swollen, tender, and painful. This is called psoriatic arthritis.
This arthritis can also affect the fingernails and toenails, causing the nails to pit, change color, and separate from the nail bed. Dead skin may build up under the nails.
Symptoms often disappear (go into remission) even without treatment and then return (flare up).

How to Diagnosis?

• Psoriasis diagnosis is usually based on appearance of the patches on skin, scalp or nails.

• KOH test can help too in ruling out fungal infection.

> No special test is needed for psoriasis.

Treatment

• First step, medicated ointments or creams+shampoo called topical treatments, are applied to the skin. If topical treatment fails to achieve the desired goal, then the next step would be to expose the skin to ultraviolet (UV) radiation. This type of treatment is called phototherapy.
• The third step involves the use of medications which are taken internally by pill or injection. This approach is called systemic treatment.

> Phototherapy in the form of sunlight has long been used effectively for treatment. Wavelengths of 311–313 nm are most effective and special lamps are available for this purpose. The exposure time should be controlled (15-30minutes) to avoid over exposure and burning of the skin.
> Vitamins A & D also helps to improve the disease condition.

Human Normal Flora

Normal Flora

What normal flora actually is?

The Bacteria;

a.Is found on body surfaces contiguous with the outside environment

b.Is semi-permanent, varying with major life changes

Can cause infection:

• If misplaced,e.g; fecal flora to urinary tract or abdominal cavity or skin flora to cather.
• Or if any person becomes compromised (immunologically) normal flora may over grow, like; oral thrush.

Contributes to health:

• Protective host defense by maintaining conditions such as pH so other organisms may not grow
• Serves nutritional function by synthesizing: Vitamins K and B
• Boost our immune system — Germ free animals (born and raised in a germ free plastic tent) are very susceptible to disease when removed from the germ free environment because their immune system is underdeveloped.
• Help digest food.

Some Important Normal Flora:

Note; Blood and internal organs, e.g; stomach have None.

Cutaneous surfaces Including urethra & Outer ear:	Staphylococcus epidermidis (more common) Staph.aureus & diphtheriods & Candida spp. are less common
Nose	Staphylococcus aureus (More common) S.epidermidis, diphtheriods are less common
Orophyranx	Viridans streptococci(including strep.mutans)
Gingival crevices	Anaerobes:Bacteriods,Provetalla,Fusobacterium, Streptococcus,Actinomyces
Colon	Babies; breast-fed only: Bifidobacterium Adult: Bacteriods, Escherichia, Bifidobacterium
Vagina	Lactobacillus

Some important definitions that you should know

Carrier:  Person colonized by a potential pathogen without overt disease.

Bacteremia: Bacteria in bloodstream without clinical signs.

Septicemia: Bacteria in blood stream multiplying with clinical signs.

Zang-Organ Spleen

Spleen

Morphology

Spleen is located in middle energizer, below diaphragm, left to the stomach. Spleen is connected with stomach through membrane and meridian.

Physiological functions:
In charge of transportation and transformation
(1)promoting  digestion and absorption of food, transportation of essence

(2)absorption, transportation and regulating of water essence

 Controlling blood:
Spleen qi controls blood circulating inside vessels without bleeding

Physiological character:
   1. in charge of ascending nutrients

Desire for dryness and aversion to dampness;

• water essence spreading
• spleen transport
• dry spleen is basic condition for regular transportation and transformation

Some relations between spleen and other organs and tissues
Spleen:

• constitution is muscles, in charge of four limbs
• opens to mouth  and manifestation  on lips
• emotion is thinking
• clear saliva from spleen essence, watering out from the corners of mouth

SEASON:

•  spleen communicating  to late summer(the summer solstice—the limit of  heat) 60 days.
• last 18 days of each season.

Stay tuned to get more knowledge about Traditional Chinese Medicine...!!!

Microbes

Comparison of Medically Important Microbial Groups

Characteristics:       Virus            Bacteria           Fungi---Parasites

Cell type :        Acellular (not cell)           Prokaryotic cells                    Eukaryotics

No Nucleus                 Nucleoid region:     Nucleus with nuclear membrane no nuclear membrane

Nucleic acid:         DNA OR RNA              DNA and RNA                DNA and RNA

Replication :         Replicates in host         Binary fission                   G and S phase

Antibiotic                      No                          Yes                       Yes sensitivity:

Ribosomes:                 No                           Yes, 70S                           Yes, 80S

Cell Wall:                No cell wall           Peptidoglycon             Yes,Chitin,glucan, Parasites:No

Interferon                     Yes                            No                                 No Sensitivity :

    

Zang-Organ Lungs

 Lungs

Morphology

• Lungs are located in thorax cavity
• covering on the heart. 
• It has two lobes, left separating into two, while right into three. 
• Throat is the gateway of lungs, nose is the orifice of lungs 

Main physiological functions:
1. In charge of qi and breath
  > In charge of breath air;
    Lungs is the place for air exchange. Through respiratory function, lungs can breath in fresh air, breath out turbid air, to accomplish gas exchange between body and external environment.
-Physiology: opening and descending
-Pathology: fullness, cough,asthma
 > In charge of vital energy (Qi)
in charge of formation and movement of vital energy.

2. In charge of water metabolism
 
  “regulation of water passage”

                                          ''Lung is the super source of water''

   3. Meeting with all the vessels, coordination
    -  Meeting all the vessels;
     through opening and descending,lungs function on air exchange, and send fresh blood to whole body by hundreds vessels

 - In charge of coordination;
keeping  coordination to maintain regular respiration qi, blood, and body fluid

Physiological characteristic
1- Lung as florid canopy:
a. It is known as “florid canopy”, locating in the thorax cavity,covering on the five Zang and six Fu organs,occupying the topmost position

b. lungs occupy the topmost position promote water metabolism, so it is called “the upper source of water”

c. Covering on the five Zang and six Fu organs, lungs open defensive qi to the superficies for protecting body from evils attack.

Delicate organ

a- Physiological angel:  lungs is clear and empty organ, easy to be full when breathing in, and easy to be empty when breathing out. It is florid canopy and the meeting place with vessels
b- Pathological angel: Cough, short of breath, hemoptysis,
c- Therapy angel: Light and clear herbs to be used for opening and dispersing, which over-cold, over-warm, over-moisten, over-dryness are not possible.

- In charge of opening and descending:

Some Relations between lungs and other tissues and organs

• manifestation  on skin and skin hair
• opens to nose 
• emotion is worried(sad) 
• body fluid is running nose
• lungs is communicating to autumn

Zang-Organ Heart

    Heart

It looks round in shape and sharp at lower, similar to lotus flower before blossom

Physiological functions:

 1. In charge of blood and vessels:
-Heart qi dominates and regulates blood circulating in the vessels, nourishing and moistening.

• Normal: heart Qi strong—coordination—regular heart beating—not fast, not slow.
• Abnormal: heart Qi weak—imbalance of y-y—irregular heart beating—loose nutrition—palpitation, fullness in chest, cardiac pain, purple lips, thread and choppy.

2.Heart houses mind:
     Commanding whole physiological function of body governing whole mental activities of body.
- Broad mind—the master and general manifestation of human body’s activities;
- Narrow mind—indicating different mental activities including spirit, consciousness, thinking, emotion,and etc.
- Relations between “in charge of blood” and “houses mind”

that is what we called in CM heart is “organ of monarch”, “root of life”, “ master of five Zang and six Fu organs.

 Physiological character:

Heart is Yang organ characterized as smooth and clear.

>Situates in chest, pertains to fire, yang within yang.
>Promotes heart beat, warming whole body, keeps excitation of spirit.

>Free blood circulation is the root of heart vessels. Heart yang warming and promoting, heart yin keeping quiet and inhibition.
>Clear is the key to heart mind. Heart yang promoting and inspiring, heart yin keeping quiet and controlling.

Some relations between heart and other tissues and organs:

• constitution—vessels, manifestation on face
• opens to tongue (meridians , blood, taste, speech)
• emotion is enjoyment(normal stimulation)
• body fluid is sweating(heart blood, heart mind)
• blood and sweating have same origin  
• fear consumes essence 
• manifesting  as sweating
• heart is communicating to summer

Stay here to know more about Zang-Organs

Viscera and Manifestation

Viscera and Manifestation

 Basic Concept 

Viscera, manifestation, communication with nature 

Including five Zang-organs, six Fu-organs, extraordinary  fu organs

> outside manifestation   of physiology and pathology

> natural things communicating to five system

integration of viscera and manifestation

CM deduces the function of viscera through outside manifestation mainly, which is called “knowing the internal from observing the exterior,” or “inducing viscera from checking up the manifestation.”

 Difference between V&M

V&M:
 integration of constitution and function >> heart, inverted lotus flower before blossom, in charge of
                                                                          heart vessels and mind.
Viscera:
concept of anatomy >>>  heart, liver, spleen, eye, ear, nose.

Characteristic of V&M

Human is an integrated body taking five-zang as a center.

Taking five-zang as a center,” internal Zang-fu organs connects to limbs and joints externally” through meridians and collaterals

Liver—gall bladder—tendon—eyes--nails liver system
Heart--small intestine—vessels—tongue--face heart system
Spleen—stomach—muscles—mouth--lips spleen system
lungs—large intestine—skin—nose—pelage (hair) lung system
kidney—urinary bladder—bones—ears—hair kidney system

> Integrated body taking five-zang as a center ;

The physiological function of five Zang relates closely with mind (emotion).

liver stores blood, while blood houses ethereal soul
heart stores vessels, while vessel houses mind
spleen stores nutrients, while Ying houses intention
lung stores qi, while qi houses soul
kidney stores essence, while essence houses will


Stay Tuned for more knowledge..!!

USMLE information

USMLE

USMLE is the part of United States Medical Licensing Examination,which has 3 steps.

Test Length & Format:

The exam used to be an eight-hour computer-based test taken in a single-day, composed of seven 48-question sections with a total of 322 multiple-choice questions.
One hour is the time provided for each section.
Between test sections,test taker is allotted 45 minutes during test day for personal breaks.There is a 15 minute tutorial at the beginning of the exam, which the test-taker can choose to skip and have that time added to break time.
If the contester finishes any section before given 1 hour time limit the rest unused time is added to the break time.
For Step 1, during the defined time to complete the items in each block, you may answer the items in any order, review your responses, and change answers. After you exit the block, or when time expires, you can no longer review test items or change answers.

Subjects:

Step 1 is designed to test the knowledge about basics subjects which includes;

1-Anatomy
2-Physiology
3-Pathology
4-Pharmacology
5-Biochemistry
6-Microbiology

Interdisciplinary topics, such as nutrition, genetics, and aging
Test items commonly require you to perform one or more of the following tasks:

• Interpret graphic and tabular material
• Identify gross and microscopic pathologic and normal specimens
• Apply basic science knowledge to clinical problems

Step 1 classifies test items into System and Process, as shown below;

-System

40%-50% General principles
50%-60% Individual organ systems

Hematopoietic/lymphoreticular
Nervous/special senses
Skin/connective tissue
Musculoskeletal
Respiratory
Cardiovascular
Gastrointestinal
Renal/urinary
Reproductive
Endocrine

-Process

30%–50% Normal structure and function
30%–50% Abnormal processes
15%–25% Principles of therapeutics
10%–20% Psychosocial, cultural, occupational, and environmental considerations

Criteria:

To be eligible to take the USMLE Step 1, you must be in one of the following categories at the time of application and on the test day:

- a medical student officially enrolled in, or a graduate of, a US or Canadian
- or a student(or graduate) of  medical school outside the United States and Canada and eligible for examination by the ECFMG.

Stay tuned for more information!


The information presented on this page is taken from the official USMLE website www.usmle.org.
Please refer to the official USMLE website for further information regarding USMLE requirements, scheduling your exam and the application process.

Tradition Chinese Medicine

Traditional Chinese Medicine (TCM)

What should you know about TCM?

1-Basic Theories.

2-How to Diagnosis. 

3-Chinese medicinal herbs and formulas.

4-Treatment by Acupuncture and moxibustion.

Yin and Yang refer to the opposite aspects of mutually related things and phenomena

In TCM vital energy is Qi

Qi(vital energy), Blood & Body Fluid

Zangfu-organ: There are 5 organs in TCM  known as Zang-fu Organs.

Five Zang-organs as an integration

      physiological system of human body

System Five zangs  Six fu   Five Tissues   Orifice     Meridian

 H. S     Heart          S.I       vessel           tongue     H. S.I

 Li.S      Liver          G.B      tendon          eye         Li. G.B

 Sp.S    Spleen        St.       muscle         mouth     Sp. St.

 Lu.S     Lung          L.I        skin              nose        Lu.  L.I

 Kid.S   Kidney       U.B      bone             ear         Kid. U.B

 Each of five systems connected to form the integration through meridians, and each unit in which   become component of the integration

Zang organs and Fu organs

Historical Review

1. solid organ and hollow organ  

2. Viscera and bow

3. Yin organ and yang organ

4. Zang organ and Fu organ 

Etiology of TCM

Six exogenous pathogenic factors

1. wind
2. summer-heat
3. dampness
4. dryness
5. cold
6. hear(fire)

-six abnormal climatic changes

-six pathogenic factors

Differentiation of syndromes and Treatment

Eight principles or -parameters

• Yin and Yang
• Exterior and interior
• Cold and heat
• Deficiency and excess

Treatment

Principles of Treatment in TCM includes

 treat cold  with heat 

 treat  heat with  cold

  

 treat  deficiency with  tonification

 treat  excess   with reduction 

Acupuncture

Terminology: acupuncture & moxibustion

acu- (sharp) +  puncture (prick)

moxi (moxa) + bustion (burning)

An overview of  TCM 

(INTRODUCTION)

TCM is a system of diagnosis and healthcare approaches, an component of worldwide medicines.

It has its own characters: Chinese history, holistic on human body, syndrome differentiation, acupuncture, moxibustion, tuina, etc. 

Part I.   The subject property

1. belong to the category of natural science

   The science of CM is the subject originated from ancient China, deal with the research on human life, health and diseases.

2. possess the characters of social science

3. deeply influenced by ancient philosophy

4. the result of mutual infiltration among different subjects

Part II. The formation and development of TCM

-Definition of “system of TCM”: Theoretical system of TCM is the holism including mechanism(pathology), treatment principle,prescription and herbs(points), the scientific knowledge system concerning about basic concept, basic mechanism and basic method.

-Instruction—the concept of holism.

-Philosophical foundation: essential-Qi, Yin-yang, Five-elements

-Physiological foundation:Zang-fu, Meridians and collateral, essence, Qi, blood,and body fluid.

-Pathological foundation: six exogenous evils, seven emotions, irregular food intake, over-work and over-rest.

-Diagnosis and treatment character: treatment based on syndrome differentiation.

1. The formation of theoretical system TCM

Times: Warring stage to Han Dynasty 

Four classics：

1. Huangdi’s Canon on Medicine.
2. Canon of Medical Problems .
3. Treatises on Exogenous Febrile Diseases and Miscellaneous Diseases. 
4. Shen Nong’s Herbal Classic.

2. Establishment of system TCM

-Four classics are symbol of the establishment.

-Canon of Medicine is the foundation for TCM theory.

A. Stress on holism.

B. Relation between superficial parts and internal organs.

C. Ancient philosophical thoughts.

D. Building up the organic holism by the center of Five-zang organs.

3. Development of system TCM

(1). Enriching period
- Canon of Classic is the first monograph on pulse

- A-B Classic of Acupuncture and Moxibustion is the first monograph on theory of Acupuncture

- General treatise on the causes and syndromes of diseases is the first monograph on etiology,pathology and
 syndromes

- Valuable Prescriptions is the first medical encyclopaedia.

(2).  A breakthrough in development

- Prescriptions Assigned to the Three Categories deal with the theory of three different causes.

- Key to Therapeutics of Children’s Diseases is the first book discussing Zang-fu differentiation.

(3). Further development (Ming and Qing Dynasty)

- Classified Canon and Complete Works of Jing-yue put forward that yang is never in excess while yin is deficient, and treatment must reinforce yin and yang.

- Thorough Knowledge of Medicine considered that Ming Men is between two kidneys and in charge of whole body’s yang Qi.

(4). Combination of both TCM and Western Medicine (recent years)

- Records of TCM and Western Medicine in Combination made bold attempt to integrate TCM and Western Medicine into one system

- continue to development

- system and standard

Part III   features of TCM

>Concept of holism (wholeness)

>Treatment based on syndrome differentiation

Holism

Human body is an organic whole, human beings are interrelated with nature and social conditions

1.Human body is an organic whole

2.Human beings are integrated with natural   conditions

3.Human beings are integrated with social conditions

Treatment based on syndrome differentiation:

Syndrome :

Syndrome is a summarization of the development of a disease at a certain stage, including cause,location, nature,pathogenesis and the relevant symptoms and signs.

Take “external syndrome due to exogenous wind and cold” for example.

The cause is : wind and cold .

The location is : in the superficies .

The nature is : cold.

The pathogenesis is :wind and cold encumbering the superficies and the pulmonary Qi failing to disperse.

The main symptoms brought about are mild fever,anhidrosis,pain of head and body,stuffy nose with clear nasal discharge,or cough,thin whitish fur as well as floating and tense pulse,etc.

For further knowledge about TCM ( Traditional Chinese Medicine )

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Medical Parasitology

What is the purpose of studying Parasitology?

The goal of studying parasitology is to control  or reduce the parasitic diseases。

What are Parasites?

 “all infections agents are parasites”
                                Cameran (1956)

-parasitic pathogens:

Introduction to medical parasitology
- Definition of Medical Parasitology
Human Parasitology (Medical Parasitology) is a branch of medical sciences dealing with the members of the animal kingdom living in and on the body of humans called parasites and with aspects of this host-parasite relationship. 

This science includes the study of parasites  vectors, reservoirs, hosts and all factors of an ecologic and epidemiologic nature associated with disease transmission and prevention. 

-Human  Parasitology:

-Medical Protozoology:

Medical Protozoology deals with protozoa which are one-celled organisms.

-Medical Helminthology:

Medical Helminthology deals with helminths which are worms.

-Medical Arthropodology:

Medical Arthropodology deals with arthropods which are insects and their allies. 

Evolution of parasitism – Life modes of organisms:

Certain relationship between different species of organisms has been established because of their “living together” (symbiosis) during the long history of their evolution.

Symbiosis:

Symbiosis means literally “living together ” Any organism that spends a portion or all of its life intimately associated with another living organism of a different species is known as a symbiont , and the relationship is designated as symbiosis. 

We will discuss three types of Symbiosis here:

Different forms of symbiosis may be distinguished on the basis of whether or not the association is detrimental to one of the two partners.

1. Commensalism:

Commensalism,from the Latin for “eating at the same table”. Two organisms of different species live together, denotes an association that is beneficial to  one partner and at least not disadvantageous to the other.

Pilot fish (Naucrates) and remoras are often cited as examples for commensalism. 

A remora is a slender fish whose dorsal fin is modified into an adhesive organ that it attaches to large fish, turtles. The remora gets free rides and scraps, but it does not harm the host or rob of its food.

2. Mutualism:

A special type of commensalism, known as mutualism, is seen when such association are benificial to both organisms.

Both partners benefit from the association:

A good example is the flagellates and its large herbivorous host animals. The flagellates have cellulases that catabolize cellulose into compounds the host can utilize and the flagellates cannot survive outside the host.

3.  Parasitism:

Parasitism, on the contrary, is a symbiotic relationship in which one animal, the host, is to some degree injured through the activities of the other animal,  the parasite. 
  It is a type of association between two kinds of organisms, one participant, the parasite, lives in or on the body of the other, the host. The parasite is usually the benefited side, i.e. it obtains nourishment from the host, and the host is usually the injured side, it is usually damaged by the parasite. 

The type of Parasite:
> Scorpian:

> Ectoparasite:
   If a parasite are found upon the surface of its host, it is called an ectoparasite.

> Endoparasite:
   Parasite living within the host. May be disstinguished as  endoparasite.

Parasitism as a way of life may be the only possibility for a given organism, or it may be but one alternative.

> Obligate parasite:
   An organisms that can not survive in any other manner is called an obligative parasite.

> Facultative parasite:

 A facultative parasite
is an organism that may exist in a free living state, or as a commensalism, and that if    opportunity presents itself may became parasitic.



> Accidental parasite:
  When a parasite enters or attaches to the body of a species of host in which it does not ordinary live. 

> Permanent parasite:
A parasite lives its entire adult life within or on its host. 

> Temporary parasite:
  Some small organism, such as mosquitoes, feed on their hosts and then leave. 

> Opportunistic parasite:
Some parasites, such as Toxoplasma gondii, usually live in human body and does not cause clinical manifestations ，but when the host’s immunity decreases, they reproduce abnormally and result in diseases.

Stay tuned for more knowledge about Parasitology..!