Dangers of Trick-or-Treating and Three Bizarre, Scary Diseases

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Halloween is an ancient celtic tradition celebrated on 31st October. It is fun time for children and is very popular in many parts of the world.

Dangers of trick-or-treating come in many forms.

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  • Halloween diarrhea’ caused by artificial sweetener sorbitol in the candy.
  • Doctors and parents should take special precautions in cases of children suffering from juvenile diabetes.
  • Excessive intake of candy without proper oral care may cause tooth decay or dental caries.
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  • Consumption of processed products with excess amounts of salt, sugar and fat can cause obesity and food allergies.
  • There can be an outbreak of serious foodborne infectious disease.
  • Cases of deliberate tampering, poisoning and insertion of foreign material in the candy have been reported. Example: A case of perforated appendicitis due to intake of pin.
  • There are many cases of  burns and house fires during Halloween celebrations. It seems that pumpkins have a round base and some containing many candles can easily overturn causing fires and burns.
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  • Studies suggest the number of childhood pedestrian deaths increased fourfold among children on Halloween evenings when compared with all other evenings.
  • Face paint may contain toxic levels of lead.
  • A study on behaviour of children showed that when children were told to take only one candy, anonymous kids took more candies compared to those children whose name and address were known to the giver. Self-awareness and transgression in children: two field studies.
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Following safety tips have been suggested : 

The hazards of Halloween. 

“Pedestrian safety
• Parents should establish a route for children in a known neighbourhood.
• Children should use flashlights, stay on the sidewalk, stop at intersections and cross intersections in a group.
• Motorists should drive slowly and look carefully for children on medians and in alleyways and driveways.
• Children should consider wearing makeup instead of masks, or wear masks that do not obscure sight or hearing.
General safety planning
• Parents should establish a curfew for older adolescents.
• Children should travel in small groups, be accompanied by an adult, visit only well-lit houses and remain on porches rather than entering houses.
• Children should know their phone numbers, carry coins for emergency telephone calls and have their names and addresses attached to their costumes.
• Rigid or sharp costume knives or swords should not be used.
• All treats should be brought home so that parents can inspect them.
• Adults should prepare for trick-or-treaters by clearing porches, lawns and sidewalks and placing jack-o‚-lanterns away from doorways and landings.

Reference:

Three Bizarre, Scary Diseases: 

1. Alien Hand Syndrome: 

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2.  Waterhouse–Friderichsen syndrome

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3. Hypertrichosis ( “Werewolf Syndrome” )

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 Image Courtesy: pixabay.com

 

                            

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Ghosts from the past – Autopsy Case for Pathologists – Cartoon

Beware Pathologists ! When ghosts and witches question you on the cause of  their death you should be ready to answer all their questions. (Halloween Special)

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Clinicopathological correlation based on pathological finding:

Post mortem examination revealed the progression of complications from acute pancreatitis leading to multiorgan failure.

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The fatty changes of the liver suggest that there was predisposing alcoholic liver disease.

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Previous history of alcoholic pancreatitis and the long standing fibrosis seen around the ampulla of Vater supported this.

This perhaps meant there was an increased risk of pancreatitis from the likely swelling and edema following Endoscopic retrograde cholangiopancreatography (ERCP).

The pancreas was completely necrosed and the lipases released from the destroyed acini lead to the extensive fat necrosis in the abdomen.

The organs confirmed that infection must have occurred from any one of the invasive procedures or surgery.

Spleen had a classic septic appearance.

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There was evidence that disseminated intravascular coagulation may have resulted with the appearance of red spots in the renal cortex and myocardium.

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The features in the kidneys were consistent with the anuric, acute renal failure.

The lungs were seriously congested and airways contained large amount of blood (haemoptysis) necessitating the tracheostomy seen.

The final stage was most likely that a combination of the hypotension and ischaemia from his triple coronary artery atheroma (caused by the above events) lead to a subendocardial infarction.

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Histopathology Images of Myocardial Infarction

Cause of Death:

1a.  Subendocardial Infarction

1b.  Hypotension

1c.  Disseminated Intravascular Coagulation

1d.  Staphylococcal Infection

1e.  Acute Pancreatitis

1f.  Alcohol Liver Disease

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” This pathologist has answered all my questions. If you are a pathologist please join social media immediately, we may need you for consultation. – Witch “

Ask the right question , to the right person, at the right time and Pathology Case of the Day

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My mother’s 4th death anniversary is approaching. She passed away during the festive season. Festivals have never been same since she left us. She was not only bubbly and gorgeous, she always asked the right question at the right time. She extracted the crucial answers  from me, without trying very hard. She always emphasized asking the right question is a powerful skill.

Recently, a very dear friend confided that she was having serious problem with a colleague. Tension at work place is not uncommon but it should not be destructive.  I started asking few simple questions.
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    • How long is the conflict going on?
    • What is the root cause of the problem? Is it possible not to take things personally or be judgemental?
    • When was the last time you communicated with this person?
    • Did you clarify your views politely or were you rude and arrogant?
    • How did this person react to what you tried to explain?
    • Do you really know the person as well as you think?
    • Is there something left unsaid?
    • Is there something about you that is causing misunderstanding ?
    • Is the quality of your work getting affected by the behaviour of your colleague?
    • Are you under stress and taken leave from work due to tension?
    • Does the idea of meeting the person everyday at work makes you happy or uncomfortable?
    • Do others in the department have any problem with your colleague or are you the only target?
    • Were you good friends at one point and now drifted apart ?
    • How was your past experience with this person before conflict started ? Has it gradually changed over the years due to specific reason?
    • Is your colleague popular in the workplace ?
    • What kind of friends are close to this person?
    • Do you find the person narcissistic or charismatic?
    • Do you get negative or positive vibes from the person?
    • Do you think the person is capable of handling multiple, major crisis?
    • Does this person have a good sense of humour?
    • Has this person shown positive traits like leadership qualities and creativity ?
    • Do you know anything about this person’s hobby? Hobbies say a lot about human character.
    • Does this person enjoy travelling and to associate with people  from different  race, community, culture and country.
    • Have you noticed whether this person uses more positive or negative words during conversation ? Negative words are hate, liar, jealous, failure, toxic, troll, ugly, cripple, retard. Positive words are charming, successful, brilliant, awesome, gorgeous, dynamic, joy, laughter, fun, beautiful.
    •  Does the person like to gossip and talk too much?
    •  Is this person always cynical and makes sarcastic remarks about those who do not agree with him/her.
    •  Is the person money minded and can go to any extent to reach the goal.
    • There is a difference between constructive and destructive criticism. What kind of a critic is this person ?
    • Are you afraid of this person? Fear is a very powerful emotion. Sometimes fear is triggered by something that is startling or unexpected. Have you spoken about the problem to a third person who is a mutual friend.
    • Do you realize it is alright to be vulnerable and imperfect ?   Imperfection is beauty, madness is genius and it’s better to be absolutely ridiculous than absolutely boring”. Marilyn Monroe.

Finally, I told my friend to write down the answers in a personal note book and think about them.  Never blame, express anger or verbally attack the person. Long term conflict cannot be resolved easily.

If you feel things are getting out of control, speak to your senior and try to get a transfer to another branch of the office. Life is too short to tolerate abusive, intolerant, draining relationships.

Interesting case for the pathologists. A gift for reading my post.

Pathology Case of the Day:

Lesion of the External Auditory Meatus of the Ear.

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Diagnosis

 Image Courtesy: pixabay.com

40 signs you are a “Bookworm” and Pathology Case of the Day

By Dr Sampurna Roy MD

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“You cannot open a book without learning something.
Confucius”

You become a writer when your speech is used for something more than the ordinary needs of daily life.
1) You read everyday.

2) You don’t mind being called a “worm”.

3) You have your own small library.

4) You have a large collection of miniature books.

5) You are not materialistic and prefer to spend money on books rather than clothes or jewellery.

6) Beyond all your medical degrees, certificates and medals, this may be your final stage of higher education.

7) You have a voracious appetite for knowledge.

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8) You hate watching television.

9) You always read the novels before watching the movies based on them. It is a different experience and you always like the original book than the movie.

10) You are secretly planning to delete all your social media accounts.

11) Networking makes you sick.

12) You removed the battery of your cell phone. You don’t want to be disturbed while you are reading.

13) It is holiday and best way to relax is to swing on a hammock and read a wonderful book and get lost in the dream world.

14) You don’t have any vacation plans, so you are reading.

15) You are fascinated by the characters of every novel you read. It gives you fresh ideas to write a new blog post. You have already written many posts on famous literary characters.

16) You have visited some of the best libraries in the world.

17) You never get bored in the airport or during long flights. Once you almost missed the flight as you were too busy reading a book.  Suddenly you heard your name being announced repeatedly. You were the last person to enter the plane and everyone was glaring at you.

18) Every book takes you to a different world and expands your mind.

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19) You know the difference between the smell of new and old books.

20) You love the touch of the book. You cannot experience a book without touching the paper.

21) You read when you are happy or when you are sad.

22) You read to forget something or to remember something.

23) You are not in a mood to paint or play a musical instrument. Reading is the next best thing.

24) Reading relieves stress and tension.

25) You live in a quiet, beautiful part of  the city and your neighbours  respect your privacy and “me time”. It helps you to focus on the book you are reading, in a peaceful environment.

26) You read because you can’t stop reading and you are addicted to books.

27) You believe that a book is the best gift that you can give to someone.

28) Birds of a feather flock together. All your friends are book lovers. You exchange books and discuss about various characters with them. You never get time to gossip about people.

29) Some books make you laugh, some make you cry.

30) You can stay up all night to finish a book.

31) You get better sleep after reading a good book.

32) Reading made you more resilient.

32) You read when someone hurts you or when someone  gives you a compliment.

33) You read after you got a promotion or after you lost your job.

34) You read when you feel lonely or if you have a big family and need some quiet time.

35) You read when you are angry and want to cool down.

36) Reading makes your creative juices flow.

37) You are planning to buy a new bookshelf as your room is strewn with books and there is no place to keep them.

38)  You prefer being called a “Bibliophile” rather than a “Bookworm”

39) You need a digital detox and the best way to that  is to read a book.

40) You are an Indian, British, European, American, African, Australian, HUMAN so you love reading.

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You had the patience to visit my blog and read the long list till the end which makes you a “Certified Bookworm”.

If you are a pathologist there is a special gift for you

 Pathology  Case of the Day – Ovarian tumour – 2 sections:

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Diagnosis

 

Clipart Image Courtesy: pixabay.com

Want to be a great Pathologist? Think like Sherlock Holmes

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14 things Pathologists can learn from Sherlock Holmes

By  Dr Sampurna Roy MD

“Nothing is more deceptive than the obvious fact” – Sherlock Holmes

I have been a fan of Sherlock Holmes since the age of twelve. If  I didn’t understand something I would ask my Dad to explain. He seemed to have an answer for all my questions. My father would often laugh and say, you can also be a detective like Sherlock Holmes. As a child I thought he was joking and I would giggle and go back to reading. My father was not joking.

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A few years later I visited London with my parents. I was thrilled to visit 221B Baker Street, the London home of Sherlock Holmes. My parents were amused to see my excitement during sight seeing. I remember frantically collecting souvenirs from the gift shop to make the visit memorable. I was enthralled by Baker street metro station with pipe-smoking, deerstalker cap wearing silhouettes of Sherlock Holmes covering the walls of the station. My father quietly said, you can be a very good detective if you work hard. He gave me a book which he bought in London. It was an autobiography of Sir Arthur Conan Doyle.
After reading the book I knew I wanted to be a doctor, a pathologist and a writer. There is a vast difference between wanting and achieving something. “I am still not an author of a best seller.”

I finally became a doctor and a pathologist. Life brought me right back to Baker Street. I rented a flat in Bickenhall Mansions in Bickenhall Street, located just off Baker Street. The nearest tube station was Baker Street tube station which was 5 minutes walk from the property. The tube station soon became an everyday, crowded place for me. I was no longer a tourist. I was on a mission to learn to be a “good detective” in the land of Sherlock Holmes.

14 things Pathologists can learn from Sherlock Holmes.
1) A pathologist should have an excellent mentor – Sir Arthur Conan Doyle created the famous detective Sherlock Holmes.  He was graduate of the University of Edinburgh Medical School. Doyle  spent nearly ten years practicing general medicine. Later, he specialized in ophthalmology. Doyle was motivated and mentored by legendary teacher, Dr. Joseph Bell, under whom Conan Doyle had studied medicine. Dr Joseph Bell was well known for keen observation of facts and power of deduction. He could reason out other facts from the one he knew. Doyle was fascinated with the incredible abilities of his mentor. Doyle admitted that Sherlock Holmes’ character was based upon Joseph Bell’s way of practicing medicine. It was Sherlock Holmes’ powers of deduction that made him the most famous detective in all fictions.

2) A pathologist needs a trustworthy, not too clever friend – A loyal, helpful friend is a blessing for a busy, ambitious doctor, to discuss his cases and brag about his successful diagnosis. Sir Arthur Conan Doyle created Dr Watson a faithful companion of Sherlock Holmes in every case.

3) A pathologist should be completely dedicated to his profession. “I cannot live without brain-work.”

4) There is a difference between seeing and observing – Pathologist should have the power of observation: “I see no more than you, but I have trained myself to notice what I see.” 
Just think of the quotation when you diagnose a case of Leishmaniasis, Malakoplakia or any case of “invisible dermatosis” on Hematoxylin and eosin and later confirm with special stains. It can give you a tremendous sense of achievement.

5) Pathologist should have the power to observe and to reason:  “Never trust  general impression”.
“On the contrary, Watson, you can see everything. You fail, however, to reason from what you see.”
These quotations reminded me of a second opinion case I reported few years ago. He was a young Indian boy who presented with a small superficial nodule on the finger. It was reported as benign granuloma annulare. I didn’t like the look of the oval and spindle shaped cells around the necrotic areas. There were little vacuoles and areas of hyalinization. I ordered for cytokeratin, vimentin and epithelial membrane antigen. The lesion turned out to be an epithelioid sarcoma – a malignant tumour in a young 20 year old boy.

6) Pathologist should thoroughly see the slide in a systematic way, from one end to another –  “Not invisible but unnoticed, Watson. You did not know where to look, and so you missed all that was important.”
Whether it is skin biopsy, soft tissue tumour or gastrointestinal biopsy it is easy to miss a small area of malignancy, mitotic figures, or microorganisms hiding behind dense inflammatory cells.

7) Pathologist should not only have power to observe and reason, he should also learn to think backwards and take past clinical history – “In solving a problem of this sort, the grand thing is to be able to reason backward.”
There are dozens of examples where previous history of malignancy has been omitted from the request form. A patient with a metastatic skin nodule with previous history of colonic carcinoma or renal cell carcinoma can completely change the diagnosis.

8) Collecting important data of the patient – “Data! Data! Data!” he cried impatiently. “I can’t make bricks without clay.”  A pathologist should get as much information of the patient as possible. Pathologist should know what  he is looking for and what investigation and special stains will help in reaching the diagnosis.He should talk to the patient’s family interact with clinicians and take help from the radiologist, if necessary. It is a complete team work. Facts should be gathered in details , gross and microscopic features should be correlated, extra blocks should be taken if necessary. Every detail must be scrutinized and described as accurately as possible. A systematic approach reduce diagnostic errors.

9) View of an expert Consultant – An expert in a field with several decades of experience should not take a long time to reach a diagnosis. Sorting out unimportant facts from important facts is possible by experience. “As a rule, when I have heard some slight indication of the course of events I am able to guide myself by the thousands of other similar cases which occur to my memory.”

10) Importance of Differential Diagnosis – “One should always look for a possible alternative, and provide against it. It is the first rule of … investigation. … you should never lose sight of the alternative.” All pathology residents have been warned about this important basic error.  It is a common mistake to have preconceived idea about a particular diagnosis , and then trying to fit in the facts. Many  newly qualified pathologists with limited experience in the diagnosis of wide range of pseudoneoplastic lesions try to match pictures from standard text books. Not all tumours look same. Many benign lesions can mimic  cancer and vice versa creating a diagnostic dilemma. “It is a capital mistake to theorize before you have all the evidence.” Think like Sherlock Holmes and solve the puzzle.

11) Approach to final diagnosis in a complicated case – “How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?”
Sounds familiar ? Yes indeed, in many rare cases pathologists often have a long list of differential diagnosis and reach the final diagnosis by process of elimination. It is important not to ignore the result even if initially it seems unlikely.

12) Pathologists should constantly update their knowledge – Read latest journals and books. Sherlock Holmes had vast collection of books, got evidence based information from local library or other reliable sources.

13) Pathologists should show empathy – Sherlock Holmes was warm, kind, attentive and committed to his clients. He treated member of the royal family or a poor governess with equal respect, kindness and sympathy.

14) Pathologists, in any part of the world, should have knowledge about Tropical Diseases – Sherlock Holmes described many tropical diseases in his adventures, like  tetanus, septicemic plague and leprosy. The origins and routes of transmission of tropical infections were subjects of investigation in many of his stories. He introduced the term “tapanuli fever” in ‘The Adventure of the Dying Detective’ which is probably melioidosis.
A Scientific Detective’s Approach to diagnosis in Pathology:
– A methodical and logical approach to the slide
– Aware of clinical history and other related information
– Necessary investigations including special stains and immunohistochemistry which finally lead to the correct diagnosis.
– Final conclusion is based on correlation of data and observation of minute details of the case.

Sir Arthur Conan Doyle was a medical doctor, creator of Master Detective Sherlock Holmes, author of best sellers. He is an inspiration to doctors who enjoy writing.

 Image Courtesy: pixabay.com

 

Have a Dose of Vitamin Green – Value of plants in everyday life

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“Remember, it is forbidden to live in a town which has no garden or greenery.” – Kiddushin 4:12

Man’s existence on earth depends on all the other living matter around him and a large part of this belongs to the plant kingdom. Without the extraordinary variety of living organisms that make up the world of plants, animal life could not survive and our planet would be barren and lifeless world of deserts.

There is widespread epidemics of obesity, heart disease, depression and mental illness affecting people in many developed and developing countries.  According to researchers exposure to green space has a positive effect on the health of an individual living in a noisy, densely populated city.

“Dr Groenewegen extensively studied the  green elements of the landscape around us which seem to affect health, well-being and feelings of social safety and called his research project Vitamin G, where G stands for the green space around us.”

  1. Some plants are of more use than others. High on the list of plants on which our lives depend are the food crops like wheat, rice, oats, sugar cane. Then there are green vegetables and great variety of fruits.
  2. Grasses provide the basic food foodstuff for cattle and sheep, on which man depends for milk and meat.
  3. Some plants give us beverages like tea and coffee.
  4. Medicinal plants  give us quinine and morphine. More powerful antimalarial drugs are used nowadays. Microscopic plants belonging to the group known as fungi provide antibiotics such as penicillin and streptomycin to fight disease.
  5.  In many countries plant material is used to provide heat by the burning of coal and wood. Wood is used to build furnitures and buildings.  Some plants are used to make clothes.
  6. In most cities, trees are planted and parks are created to improve the environment. Parks provide an important place for people to be active and socialize with friends in a calm and beautiful environment.
  7. Walking in the green space is  linked to a lower likelihood of being overweight or obese.
  8. It is associated with lower rates of diseases such as type 2 diabetes mellitus, colorectal cancer and osteoporosis.
  9. Walking in the nature is an excellent form of exercise for patients recovering from coronary heart disease.
  10. Contact with natural environment  reduce anxiety and tension and helps in dealing with stressful situation.
  11. Regular walking in a beautiful, green environment improves cholesterol level and controls blood pressure.
  12. A city dotted with many parks and gardens can reduce noise and air pollution and elevate the mood of the residents naturally.
  13. After a walk in the garden there is increase in focus and productivity of work.
  14. There is significant improvements in overall health, asthma, and  other respiratory problems.
  15. Researchers have concluded that presence of indoor plants increased patient’s tolerance to pain.
  16. When the working place is decorated with green plants and flowers, there is decrease in health complaints from the workers.
  17. Green spaces has a positive effect on pregnant mothers. Studies have shown beneficial effect of exposure to green spaces on birth weight of the baby.

If you are hungry cook a meal with green leafy vegetables and relax with a cup of green tea. If you feel irritated, impulsive, impatient, frustrated, stop working and take a walk in the green space. Create a cheerful and pleasant environment by decorating your work space with green plants.

Image courtesy: pixabay.com

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20 phobias that can ruin your life – Infographic

By Dr Sampurna Roy MD

Phobias are anxiety disorders that are characterized by an excessive, unreasonable, and persistent fear that is manifested by the presence or expectation of an object or feared situation.

According to Greek mythology Ares was the great Olympian  god of war. His son was Phobos (meaning fear). He was a frightening mythical character . The term phobia, which means “morbid fear” was derived from this mythical character.

Greek physician Hippocrates, described the first case of phobia. He noted that Nicanor ( a Macedonian officer) was afraid of the sound of flutes  played in the  night.

Hundreds of different types of phobias have been described. The name given to a particular phobia is a combination of the Greek word of the object or situation feared and the word phobia.

In this Infographic I have given examples of 20  phobias.

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