Photo Essay: 6 reasons why Pathologists should read Classic Literature

 

“Classics are books which, the more we think we know them through hearsay, the more original, unexpected, and innovative we find them when we actually read them.
Italo Calvino”

 

I made up this blog post in my mind , discussed it with my friends and retained it in my mind. This is a very old tradition known as  “oral literature” spoken, not written.  Now I am writing it after 10 days.

6 reasons why Pathologists should read Classic Literature:

1. Reading literature  keeps your brain sharp and agile. Mental exercise can improve one’s chances of escaping Alzheimer disease. As you grow older you may forget little things. This is not dementia, it is natural process of aging.  Pathologist are constantly using their brain. One has to promptly remember differential diagnosis of every case, order for appropriate special stains, issue reports  as soon as possible. If you are practising medicine for a long time, it is expected you have read most of the medical books in your subject.  For active, healthy brain try reading classic literature by authors of different race and culture.

A scene from Iliad during battle between Achilles and Hector before the walls of Troy. Homer’s epic poems the Iliad and Odyssey deal with the 10 year’s seige of Troy by Greeks and return of hero Odysseus ( or Ulysses) from the war, in which he has marvellous adventures.  Image –  Image collection of Dr Sampurna Roy MD.

 

2.  You are an academic and working with people from different countries, race and religion.  To know your colleague better read a famous novel from his/her country. It is the best way to know the culture of a different nation. Your colleague will be delighted if you recite few lines from a book of his native country.

The Arabian Night’s Entertainment is a collection of old stories written in Arabic which were first translated into English in 1840. Some have become very popular, like Alibaba and Forty Thieves, a scene from which is illustrated here. Image –  Image collection of Dr Sampurna Roy MD.

3. Your research is successful. You have made a great discovery !!  You want to name a disease or a new tumour, which only you have diagnosed. You can put your own name to a Tumour  or a Syndrome   (Eponym). It is more fun if you use the name of a popular literary character. If you are well-read and familiar with the characters of various classic literatures, the naming procedure will be much easier. Example : Alice in Wonderland Syndrome and Pickwickian Syndrome.

One hot summer afternoon Alice chased a white rabbit down a rabbit hole and began her strange Adventure in Wonderland. This story by Lewis Carroll is one of the most famous children’s books ever written but it appeals to people of of all ages. Carroll’s real name was Charles Dodgson. (1832-98). and he was a lecturer in Mathematics at Oxford.   Image –  Image collection of Dr Sampurna Roy MD. Read:  Alice in Wonderland Syndrome ; The disease and the story of Alice’s Adventure.

4.  Some great authors like Charles Dickens , Sir Arthur Conan Doyle, Shakespeare have described many medical conditions in their novels.  If you are familiar with their writings, you can spice up your lecture by quoting from their books, write medical articles and blog posts.

Read: 14 things Pathologists can learn from Sherlock Holmes

Some of the best known characters from the works of Charles Dickens are grouped together in this drawing.   Image –  Image collection of Dr Sampurna Roy MD. Read: 7 things Doctors can learn from Novels by Charles Dickens

5.  If you are blogging on a serious medical subject, knowledge gained from literature will help you to be more creative. It will help you to make a boring subject more exciting.

6.  Read classic literature to avoid digital distraction. After a busy day a beautiful novel can have a relaxing effect on your mind. You will get a   good night’s sleep and be more productive in the morning.

Enjoy images from some timeless classics from my personal  scrapbook collection:

The famous episode from Miguel de Cervantes’s Don Quixote when the hero is about to tilt at windmills, imagining them to be giants. Don Quixote is about the adventures of a foolish and charming knight who wanted to achieve world wide fame.  All kinds of everyday things are seen by him as fearsome and exciting. The book was written as a satirical romance on tales of chivalry. Image –  Image collection of Dr Sampurna Roy MD.

A scene from Beowulf, the epic Anglo-Saxon poem of the 6th century, which shows the hero Beowulf about to be confronted by Grendel – half monster and half man, in the castle of Hrothgar, king of Denmark. Beowulf eventually kills the monster which had terrorised the castle and its inhabitants. Image –  Image collection of  Dr Sampurna Roy MD

The scene from Gulliver’s Travels where Gulliver is captured by the Lilliputians. Image- Image collection of Dr Sampurna Roy MD

The songs of the troubadours originated in Provence – South France. Image- Image collection of Dr Sampurna Roy MD

The wars between the Greeks and Persians, which Herodotus recorded in his celebrated history, included the famous sea battle at Salamis. This was fought in 480 BC between a Persian fleet which is said to have numbered over 800 ships and a much smaller Greek force. Despite the odds against them the Greeks won a great victory and destroyed or captured a large part of Persian fleet. Image- Image collection of Dr Sampurna Roy MD

Fennimore Cooper’s Last of the Mohicans is an exciting tale about the American west. Image – Image collection of Dr Sampurna Roy MD.

A scene from Tom Thumb, one of the fairy tales by the Grimm brothers. These two brothers were learned professors of the German language and literature but they are remembered today for their folk and fairy tales. Image –  Image collection of Dr Sampurna Roy MD.

 

“Where the mind is without fear
and the head is held high, where knowledge is free.
Where the world has not been broken up into fragments by narrow domestic walls.
Where words come out from the depth of truth,  where tireless striving stretches its arms toward perfection.
Where the clear stream of reason has not lost it’s way into the dreary desert sand of dead habit.
Where the mind is led forward by thee into ever widening thought and action.
In to that heaven of freedom, my father,
LET MY COUNTRY AWAKE!”   

by  Rabindranath Tagore, Gitanjali

Fingerprints – You are unique like your fingerprints

 

“Life is like a fingerprint that can’t be changed so make the best impression with it. – Unknown.”

 

“Fingerprints have been used for years as the accepted tool in criminology and for identification. The first system of classification of fingerprints was introduced by Jan Evangelista Purkynje (1787-1869), a Czech physiologist, in 1823. He divided the papillary lines into nine types, based on their geometric arrangement. This work, however, was not recognized internationally for many years. In 1858, Sir William Herschel (1833-1917) registered fingerprints for those signing documents at the Indian magistrate’s office in Jungipoor. Henry Faulds (1843-1930) in 1880 proposed using ink for fingerprint determination and people identification, and Francis Galton (1822-1911) collected 8000 fingerprints and developed their classification based on the spirals, loops, and arches. In 1892, Juan Vucetich (1858-1925) created his own fingerprint identification system and proved that a woman was responsible for killing two of her sons. In 1896, a London police officer Edward Henry (1850-1931) expanded on earlier systems of classification and used papillary lines to identify criminals; it was his system that was adopted by the forensic world.”   Jan Evangelista Purkynje (1787-1869): first to describe fingerprints

Image of Arch pattern (Photo Collection: Dr Sampurna Roy MD)

Tiny ridges and furrows are arranged in distinct patterns at the tip of our fingers and thumbs. No one in the world has fingerprint patterns exactly like that of anyone else in every detail. Even the finger prints of identical twins are not exactly the same. These patterns never  change throughout the life, although the skin may become wrinkled and cracked with old age. If the ridges are examined by magnifying glass, it can be seen that each ridge is studded with small holes. These holes are openings from which sweat escapes from the glands situated below the surface of the skin. When a finger is pressed on some smooth object the small deposits of sweat join together and a picture of the ridges in sweat is left behind. These sweat prints are called “latent prints”. The word “latent” is used to indicate hidden, as the prints are difficult to see.  Powder method for detecting latent fingerprints: a review. 

Image of Whorl pattern (Photo collection Dr Sampurna Roy MD).

Because each person has his or her own fingerprints, they are  obviously an excellent method of identifying people. Fingerprints play an important role in forensic medicine. When a crime is committed, detectives search the scene of the crime look for fingerprints and if they identify any they have a most important clue as to the identity of the criminal. The scientific study of fingerprints is called dermatoglyphics.

“The comparison and identification of crime scene fingerprints is based on human decision making, not a computer algorithm. When a print is lifted from the scene of a crime, it is sent to a professional fingerprint examiner who compares the print to that of a suspect or to the output of a database search. But the ultimate decision about whether the prints came from the same person or two different people is up to the examiner. Fingerprint examiners, with careers often spanning decades, spend several hours a day examining these highly structured fingerprint impressions, which makes them a fascinating expert group for study in their own right. These examiners, however, have testified in court for the past one hundred years as to whether two fingerprints from the same person or different people in the absence of formal data on the extent to which they can correctly match fingerprints to one another” The nature of expertise in fingerprint matching: experts can do a lot with a little.

Image of Composite pattern:  (Photo collection Dr Sampurna Roy MD).

Edward Henry found after many years of work, a method of classifying fingerprints. These are divided into 4 main types – Arch ; Loop ; Whorl and Composite. Every fingerprint belongs to one of these four groups but no two prints have the the same ridge characteristics.

Fingerprints are effectively used for sex determination.

• Forensic Identification of Gender from Fingerprints.
• A study of sex differences in fingerprint ridge density in a North Indian young adult population.
• Fingerprint Ridge Density as a Potential Forensic Anthropological Tool for Sex Identification.

Image of Loop Pattern (Photo collection Dr Sampurna Roy MD).

As a histopathologist one should carefully hold the glass slides at the edge. If  you are sitting behind a pile of urgent slides and in a hurry, please do not press your finger at the centre of the coverslip. The finger tip will leave an imprint on the slide causing blurry microscopic image.  I know someone who did this !!!

There are two important conditions  where patients are born without fingerprints.

1) Adermoglyphia  (immigration delay disease):

Adermatoglyphia or “immigration delay disease”: the role of mutations in the SMARCAD1 gene

2) Naegeli-Franceschetti-Jadassohn  syndrome:

Naegeli-Franceschetti-Jadassohn syndrome in a Saudi Arabian family.

The gene for Naegeli-Franceschetti-Jadassohn syndrome maps to 17q21.

”  Our fingerprints cannot be erased from the lives of those we have touched. -Unknown ”

12 health lessons I learned from Dancing in Tagore’s Chandalika

 

Let your life lightly dance on the edges of time like dew on the tip of a leaf. Rabindranath Tagore

When something wonderful happens we use phrases like “I feel like dancing” , “I could jump with joy”, and when we are angry we say “I’m hopping mad”. Do you know why we use these phrases of movement? We are responding to an instinct that is more ancient than speech or music. It is called “Dancing.”

Dancing is the oldest of the arts. Early man danced to describe what he was doing. This was even before he added simple music or songs to accompany the movements.

The urge to dance, or to express ourselves by the movement of our bodies, is so basic that it must have existed in men, even in the ancestors of men for thousands of years.

Dancing makes patterns in space and to have any real meaning requires a sense of rhythm. The body movement perform to some sort of regular beat or pulse. Rhythm is one of the most important features of dancing.

As a little child I took few simple dance lessons in the dancing school of  renowned Amala Shankar.  Later I learned to dance in my school Loreto House, where I studied for 12 years.  Our dance teacher was famous dancer and choreographer Shanti Bose. 

Along with other children I participated in the Bengali “Rabindra Nritya Natya” (Dance Drama) Chandalika.  At an early age I realized that dancing was not just a matter of dance steps. Certain signs have been carefully worked out and instinctive actions play an important role.
Signs have always been used by people to communicate with each other. Example: A nod of the head means the same thing in most parts of the world. Rhythmic movement of fingers and hand gestures are used to express various emotions.

Why should children learn to dance at a young age?  As a doctor now I know the reasons.

1) Dancing is an excellent form of physical exercise.

2) It is an artistic expression through the use of the body. Dancing helps in creative and artistic development of a child.

3) Dancing enhances physical function, mental health, and well-being of a toddler.

4) Dancing improves muscular endurance and strength of the legs.

5) The body becomes more flexible. There is strengthening of lower legs which improves balance and agility. Dancing increases aerobic power and makes one more energetic.

6) It psychologically prepares  a child for more serious activities as it improves brain function. Learning complicated dance steps improves memory.

7) It has a positive effect on cardiovascular system and  improves heart’s ability to pump blood to the lungs.      

8) Dancing helps to keep the joints flexible, the muscles around the joints strong. There is greater strength of hip joint.

9) It strengthens the spinal column and the supporting muscles, ligaments, and tendons.

10) A child grows up to have a graceful bearing and gait.

11) Body of a dancer is trim and fit, with greater than average range of motion.

12) Dancing  instantly elevates mood, boosts happiness,  increases confidence and self-esteem and reduces stress.

As a world traveler I have seen some exceptionally beautiful dance forms like Ballet, Waltz, Tango, Belly Dancing and various types of folk dancing.

I was not born to be a dancer but I have great respect for all professional dancers. They belong to a fascinating world and will remain eternally young and healthy.

Are you super busy? Being busy is a contagious disease. Cure yourself now.

 

“ I have often said that the sole cause of man’s unhappiness is that he does not know how to stay quietly in his room” Blaise Pascal

Did you say you are super busy? I’m sure you are busy. Congrats! You are so important. I am sure your little kids are also very busy. They are following the instructions of a harsh taskmaster to be high achievers and future leaders. Your grandparents are also very busy and active. They are all effectively networking and interacting on social media. Oh they are all so influential !!  Did you say you don’t have a social media account?  Then you are “nobody”.

The world of the doctors is a busy one. It is possible you may not have efficient junior doctors, helpful colleagues and all the resources to help you at work. Large section of doctors are working in remote district hospitals and small towns in various parts of the world. They are managing to take care of the patients with limited resources and are part of a happy and satisfied community.

Yes, I have also worked in District Hospital under high pressure and  it has prepared me for various difficult situations in my own country.

No matter where you work, how much time and effort you put into your daily activities, you will experience stress numerous times.

You may work for many hours and still you can never get everything done on time.

The people who complain less are those who are experienced and know how to maintain a work life balance.

If you can maintain a routine and organize your workload, you will find ample time to enjoy life and finish your urgent work everyday without screaming “I’m crazy busy”.

As a trainee pathologist I was told that those who complain of being too busy, are usually inefficient and don’t know how to prioritize their work. Busyness does not prove that you are important or a productive person. It means you are inexperienced and unable to handle your work. This applies in case of every profession.

If you want to be productive, don’t feel guilty to sit idle. Learn to be lazy. You will be happy, active and an asset to your own country.

Be more present with your family. Enjoy festivals and weekends, without getting distracted.

Find time to play with your kids , laugh and crack silly jokes.

Be a blogger for fun and entertainment without bragging about your expert skills and knowledge. Write enjoyable posts which everyone can understand.

Learn to be modest. There is always someone smarter, more knowledgeable and charismatic than you. Being envious of others is a waste of time and energy.

Social media is a place to interact with like-minded friends and curate interesting educational contents. It is a global platform for  everyone. Follow and interact with those you feel will provide useful contents. You are your best brand advocate. If your reputation depends on the number of  social media followers, likes and retweets, you have a serious personality disorder.

Please don’t continuously spam your friends with your own blog posts. I find it annoying and I think your close friends feel the same way.

Respect is earned not taken. Read and promote books of senior experts in your field, specially those you know and respect.

You will make everyone uncomfortable if you start talking about race, religion, politics, poverty, war and inequality.

Don’t spread false gossips as you may run into some unexpected problem.

Build meaningful positive, long lasting relationships, which is just not based on give and take.

Crazy busy people suffer from depression, anxiety, high blood pressure and cardiac disease, indigestion, obesity and exhaustion.

You don’t have to attend every conference, and meeting. Take a vacation with your family and cherish those special moments.

If you are rushing from one activity to another, you may earn money and fame, but you will not have the time or energy to enjoy a “good life”.

Don’t sit behind a microscope all day reporting trays of  slides. See the urgents first and take your time to study other cases slowly. Appoint someone to report routine cases.

Stay calm. Even if you are an efficient pathologist there can be unexpected situations like mix-up of biopsy specimens , rude clinician repeatedly troubling you for a preliminary report. You should be able to handle these unpleasant situations smartly.

Don’t check your cell phone in the middle of clinical work.

Spend sometime in the nature, everyday. It can be your own little garden.

Don’t take your loved ones for granted. Be ready to be treated the way you treat others.

Next time you call yourself super busy, may be you should change your way of working and do something that will keep you less busy and more HAPPY.

Life is too short to be “crazy busy”. Don’t let your life pass you by.

Try to maintain a healthy relationship not only with others but also with yourself.

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Cyclops and Cyclopia – A lethal human birth-defect related to Greek mythology

Many medical terms originate from fascinating Greek mythology. Today’s post is about a congenital malformation Cyclopia. Cyclops appear for the first time in literature in Homer’s Odyssey (8th-7th century BC).

Greek Mythology: Cyclops

In the beautiful poem called the Odyssey the Greek poet Homer describes how the hero Odysseus while returning home from Troy to his own kingdom of Ithaca, landed on an island of the Cyclopes.

Cyclopes are giants who had one eye, placed in the centre of their foreheads. They were shepherds and looked after their sheep by day, returning at night to sleep in caves.

Odyssey and some other sailors came to one of these caves which belonged to a giant called Polyphemus. The giant captured the Greeks and started to eat  them for dinner.

At last Odysseus found a long pole and while Polyphemus slept, he thrust it into the eye of the giant and blinded him. Smart Odysseus told Polyphemus that his name was “Nobody”.

Brilliant idea and something to keep in mind in the modern age.

When the giant screamed out in pain other Cyclopes came running out to help him.Polyphemus cried out that “Nobody” had hurt him. To this the Cyclopes replied that if no man had hurt him then it must be one of the gods and, telling Polyphemus to bear the pain as best as he could, they went away again.

Blind Polyphemus tried in vain to catch his prisoners by feeling the back of each sheep. Odysseus and his men escaped by clinging on to the wool underneath the sheep.

In many ancient Greek stories there is evidence that one eyed Cyclopes had built great walls. The word Cyclopean is still sometimes applied to massive stone structures.

Congenital Disease – Cyclopia

Holoprosencephaly are a group of disorders arising from failure of normal forebrain development during embryonic life. There are three forms of holoprosencephaly: alobar, semilobar, and lobar varieties.

Cyclopia (alobar holoprosencephaly) is a rare and lethal human malformation, resulting from incomplete cleavage of prosencephalon into right and left hemispheres. Approximately 1 in 100,000 births are identified as infants with cyclopia.

Cyclopia typically presents with a median single eye or a partially divided eye in a single orbit, absent nose, proboscis (nose of a mammal, usually long and flexible) like structure on forehead above the eye.

Extracranial malformations described in stillbirths with cyclopia include polydactyl, renal dysplasia, and an omphalocele.

The etiology of this rare syndrome is not clear. Possible risk factors include: maternal diabetes , infections during pregnancy (TORCHs), drugs during pregnancy (alcohol, aspirin and many other teratogenic drugs), exposure to ultraviolet light, and chromosomal anomaly like trisomy 13  and genetic cause.

No one knows whether one eyed Cyclops actually existed or not, but the congenital ophthalmic disease, Cyclopia is certainly named after these mythical characters and we will never forget these giants.

Reference
Cyclopia: a rare condition with unusual presentation – a case report.
Odysseus versus the Cyclops
Cyclopia: from Greek antiquity to medical genetics.

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Are you an Emotionally Intelligent doctor? Find out now! Pathology Case of the Day

Are you using your Emotional Intelligence? It is more important than your intelligence quotient (IQ). 

John D. Mayer and Peter Salovey coined the term Emotional Intelligence in 1990. They defined it as an ability to monitor one’s own and other people’s feelings and emotions, to discriminate among them and to use this information to guide one’s thinking and actions.

An emotionally intelligent doctor is an asset to the medical profession. Unfortunately it is not part of the medical curriculum. If there is a complain against any senior doctor of being rude, arrogant and uncaring he should be send to a special course to cultivate emotional intelligence.

Why Emotional Intelligence matters?

• They are natural influencer, motivator and teachers. People look upto them to get fresh ideas and to learn something new and different.
•  Emotionally intelligent people are usually successful in their personal and professional lives. It is the ability to understand feelings of others that help them to accomplish their desired goal.
•  Employers value Emotional Intelligence (EQ) over Intelligence quotient (IQ).
•  They trust their intuition and 99% of the time it’s right.
• They stay inspired and focused on simultaneously achieving their own mission and helping others achieve theirs. This results in greater overall impact.
• Emotionally intelligent people can understand the emotional state of a close friend or a complete stranger (Example: a patient) and can handle each situation competently.
• They can comfortably work with people from different nationality, religion, race, country and culture.
• Emotionally intelligent people are good listeners and think carefully before giving an opinion on anything.
• .
• They often handle uncomfortable conversation tactfully with a dash of good humour.
• They are not affected by success or by failure.
• Emotionally intelligent people remain calm in stressful situation. They rarely express negative emotions like fear, anger, grief, sadness or jealousy.
• They are completely honest with their close friends about their own side of the story, even if it is a painful truth.
• Emotionally intelligent people are aware of their own strengths and weaknesses.
• They are respectful to all but know how to set boundaries.
• Emotionally intelligent people are excellent networker and have friends from various professions and countries. They don’t just stick to their own tribe. They are all global citizens.
• Emotionally intelligent people can identify negative people easily and can deal with them politely without animosity.
• They are very popular and trusted by lovely friends in real and virtual world. They know the difference between virtual and real life and act accordingly.
•  They take good care of themselves and are surrounded by healthy, happy and creative people.Social media is a great place where behaviours of professionals are openly displayed to the world. You may be a CEO, doctor , lawyer, coach, event organizer or a social media expert. Do you really have enough emotional intelligence or are you wearing a mask?

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  Pathology Case of the Day:

• A nodule on the external ear of a young male.
• Clue:  Adnexal tumour – Papillary projections are lined by two layers of epithelial cells, a columnar luminal cell layer and an outer layer of small cuboidal cells. The stroma is usually infiltrated by a dense mononuclear infiltrate composed entirely of plasma cells.
• 

Diagnosis: Syringocystadenoma Papilliferum of the External Ear

 Image Courtesy: pixabay.com

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An Illustrated Guide to a Pathology Quiz Case

History of the case: Poster 1

Image1

Image 2

Image 3

Image 4

Image 5

Image 6

Poster 2

Poster  3

Final Diagnosis:  Granulomatosis with Polyangiitis (formerly known as Wegener’s Granulomatosis)

Pathology of Wegener’s Granulomatosis (Granulomatosis with Polyangiitis)

Pathology of Wegener’s Granulomatosis (Granulomatosis with Polyangitiis) of the Ear

 Image Courtesy: pixabay.com

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King Tutankhamun – What caused his mysterious death?

 

“Today the traveller on the Nile enters a wonderland at whose gates rise the colossal pyramids of which he has had visions perhaps from earliest childhood.  James Henry Breasted”.

To know the people and a country you have to visit it. Talk to the people, look into their eyes and try to understand their local culture.

Egypt is an enchanting country with many exciting stories and unsolved mysteries from the past.

Some of the most intriguing questions are related to mysterious death of the great Pharoah (king) Tutankhamun.

The most exciting discovery of ancient Egyptian remains was that of the tomb of  Tutankhamun, the last pharaoh of the XVIIIth dynasty.

The tomb was found in 1922 by an Englishman called Howard Carter who was member of an expedition team led by Lord Carnarvon. The tomb was in the Valley of the Kings, where so many Egyptian kings were buried, but this was only one that had not been broken open or robbed of its treasures.

The mummy of  Tutankhamun himself was enclosed in a decorated coffin of gold, which in its turn was inside two wooden coffin and a stone one. The face of the mummy was covered with a gold mask, decorated with precious stones and there were gold ornaments on the head.

According to Dr Saleem SN et al  “Subcutaneous packing procedure was used as part of mummification of royal Ancient Egyptians dated to 18th to 20th dynasties earlier than what was believed in archaeology. The Ancient Egyptian embalmers must have been skilled in dissection and possessed surgical tools that enabled them to perform this fine procedure.”

Tutankhamun became king when he was only 12 and died unexpectedly at the age of 18 years. If his tomb had not been found with all its treasure he would have been forgotten long time ago.

A curious superstition sprang up about the tomb of Tutankhamun. It was said that the people who broke it open were committing an offence against something sacred, and that they would meet sudden death as a result.

Strange incidents happened and several people connected with discovery did die tragically, one of them being Lord Carnarvon, who died  in Egypt, from poisonous mosqito bite and pneumonia, five months after the finding of the tomb.

According to Dr Gandon the mysterious death of Lord Carnavon after entering the tomb of the Egyptian pharaoh Tutankhamun could be explained by an infection with a highly virulent, long living pathogenic agent. “The ‘curse of the pharaoh‘ has been used as a metaphor for the hypothesis that higher parasite propagule survival selects for higher virulence.”

The cause of  King Tutankhamun’s death has been matter of speculation for several decades. Many interesting medical articles have been written on this subject.

It has been suggested that the young king was murdered by a blow to the head based on skull radiographs obtained by a team of researchers in 1968. Professor R.G. Harrison stated, “While examining X-ray pictures of Tutankhamun’s skull, I discovered a small piece of bone in the left side of the skull cavity. This could be part of the ethmoid bone, which had become dislodged from the top of the nose when an instrument was passed up the nose into the cranial cavity during the embalming process. On the other hand, the X-rays also suggest that this piece of bone is fused with the overlying skull and this could be consistent with a depressed fracture, which had healed. This could mean that Tutankhamen died from a brain hemorrhage caused by a blow to his skull from a blunt instrument.”

According to Hussein et al pathological findings included craniofacial dysmorphia, bilateral alterations of the feet, malarial disease and an acute traumatic fracture of the knee.

Hawass et al. used imaging, anatomical and DNA techniques and suggested Plasmodium falciparum malaria, concomitantly with Morbus Köhler-Freiberg, as his probable cause of death. The authors also indicated that there were no signs of gynecomastia and craniosynostoses (eg, Antley-Bixler syndrome) or Marfan syndrome. Genetic testing for STEVOR, AMA1, or MSP1 genes specific for Plasmodium falciparum revealed indications of malaria tropica in 4 mummies, including Tutankhamun‘s. These results pointed to  avascular bone necrosis along with the malarial infection as the most likely cause of death of Tutankhamun. 

According to Timmann et al “The age of 18–19 years attributed to Tutankhamun makes malaria as his primary cause of death rather unlikely, as a certain degree of  semi-immunity may readily be assumed.”   Plasmodium falciparum malaria was endemic in ancient Egypt and probably caused death. Local residents after continuous exposure to plasmodium developed immunity against both parasites and disease. Fatal courses of malaria usually affect young children (6- 9 year) and pregnant women but not adults.

According to Timmann et al  bone lesions of two metatarsals of the left foot and  shortening of the second left toe, indicated  advanced osteonecrosis, osteomyelitis or ulcerative osteoarthritis in the article by Hawass et al.  These radiographic findings are consistent with osteopathological lesions as often noted in sickle cell disease , a haematological condition described to occur in many local residents of Egypt (El-Beshlawy & Youssry 2009). The occurrence of anaemia, other pathological haematologic disorders, and of the haemoglobin mutation that causes sickle cell disease (HbS) has been demonstrated in predynastic Egyptian remains (Marin et al. 1999).

Timmann et al  indicated,  “in contrast to osteonecroses associated with sickle cell disease, Köhler-Freiberg disease is highly unlikely to be a co-cause of death in young adulthood.”

Avascular osteonecroses, inflamed by osteomyelitis and septicaemia  due to pathogenic agents including Salmonella and Staphylococcus,  are known sickle cell disease complications and may be exacerbated by malaria attacks.

Gaucher’s disease (type 1-3) should be considered which may cause painful avascular osteonecroses. Gaucher’s disease is a rare autosomal-recessive lysosomal storage disease and has been described in Egyptians.

Other features considered in the differential diagnosis of avascular osteonecroses in King Tutankhamun’s bones included other inheritable and non-hereditary disorders – trauma, sequelae after osteomyelitis, acute pancreatitis and systemic lupus erythematosus. 

Brandt G.  suggested the theory that Tutankhamun may have suffered from hypophosphatasia, an inherited metabolic disorder that affects especially the musculo-skeletal system in many ways.  The author has compiled both medical and archaeological findings to support his theory and suggests that existing DNA samples of Tutankhamun and other members of his family should be tested for defects on the ALPL gene.

The question on Tutankhamun‘s supposed gynaecomastia cannot be answered as most of mummy’s chest wall was missing.

 All the scientific findings can neither be proved or ruled out.

We do know that the most common diseases of Ancient Egypt were traumatic injuries, malaria and tuberculosis.

King Tutankhamun is one of the most famous  king of Ancient Egypt. It is not surprising that extensive scientific studies have been made to find the actual cause of death. Infectious disease, metabolic disorder, neoplastic lesion, trauma (crash of his chariot causing lethal injury) and even murder have been suggested by various authors.

The cause of death of the great ruler of Egypt will continue to fascinate researchers.  I wrote a similar post about Death of Alexander the great – A medical Enigma. 

The difference between the two cases is that the remains of Alexander the Great was not found, hence anatomical and other scientific examinations could not be done.  In case of King Tutankhamun extensive studies including virtual autopsy, imaging , anatomical and DNA analysis were performed.

Reference:

• Subcutaneous packing in royal Egyptian mummies dated from 18th to 20th dynasties.
• Tutankhamun: evidence-based paleopathology versus “curse of the pharaoh” .
• Purported medical diagnoses of Pharaoh Tutankhamun, c. 1325 BC-.
• Did Tutankhamun suffer from hypophosphatasia?–A hypothetical approach. 
• Paleopathology of the juvenile Pharaoh Tutankhamun-90th anniversary of discovery. 
• Inheritance patterns and pathology of Tutankhamun, Akhenaten, and the eighteenth dynasty pharaohs of ancient Egypt.
• Familial epilepsy in the pharaohs of ancient Egypt’s eighteenth dynasty.
• Tutankhamun: An adrenal tumor? Lancet. 1972;2:1312. 
• Evaluation of the dentoskeletal characteristics of an Egyptian mummy with three-dimensional computer analysis.
• The breasts of Tutankhamun.
• Forensic and pathology remarks concerning the mummified fetuses of King Tutankhamun.
• Mummified daughters of King Tutankhamun: archeologic and CT studies.
• Tutankhamun and sickle-cell anaemia.
•  Malaria, mummies, mutations: Tutankhamun’s archaeological autopsy.
• Plasmodium falciparum toutankhamonensis.
• King Tutankhamun, modern medical science, and the expanding boundaries of historical inquiry.
• Ancestry and pathology in King Tutankhamun’s family.
• Skeletal dysplasia in ancient Egypt.  

•  Image Courtesy: pixabay.com

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Prometheus – A captivating tale of Liver Regeneration.

To a New Yorker this is a very familiar statue. To a tourist and a world traveller it is a precious memory.

I first heard the name “Prometheus” when I visited Rockefeller Center in New York and saw the iconic sculpture.

My today’s story is about Prometheus and his link to Pathology of Liver Regeneration.

According to ancient Greek belief, Prometheus was one of the Titans, a group of gods even older than the Gods of Olympus led by Zeus. Some stories told how Prometheus created man, first making images in the likeness of gods and then giving these images life. After he had put them on earth he gave them a torch which he had lighted at the chariot of sun, and in this way men first got fire.

Image: Wikimedia commons  Prometheus Carrying Fire By Jan Cossiers

Image: Wikimedia commons: Prometheus Brings Fire to Mankind by Heinrich Füger

“If the first Prometheus brought fire from heaven in a fennel-stalk, the last will take it back — in a book.- John Cowper Powys.”

The younger god Zeus later took away this gift of fire when he quarrelled with the people on the earth, but Prometheus discovered where he had hidden it and brought it back again. In revenge Zeus chained Prometheus to a rock in the Caucasus Mountains and sent an eagle to eat his liver. The most interesting part of this story is that Prometheus was immortal and the liver grew back to its original size again in the night. Day after day the eagle came back and ate it again.

( Prometheus bound to a rock, his liver eaten by an eagle and
Credit: Wellcome Library, London. Wellcome Images
images@wellcome.ac.uk
http://wellcomeimages.org)

At one time Zeus offered to release him if he would reveal a secret which threatened the rule of the Gods, but Prometheus refused to be freed in this way. He bore his torture because he knew that in 13th generation a son of Zeus would save him. That is exactly what happened, for the hero Hercules, who was one of Zeus’s sons, killed the eagle and set Prometheus free.

Stories of punishment of Prometheus are frequently used by lecturers on liver regeneration.

According to Dr Chen et al  liver was considered immortal not only because of it’s power of regeneration but because ancient Greeks believed that the liver was the seat of soul and intelligence.  It is clear that ancient Greeks knew about liver’s potential for repair. The fact that the organ grew at night as the eagle ate all day indicates the rate of hepatic regeneration. According to the myth the eagle came every other day, allowing full day to regenerate. The author concluded that the close match between the amount of  liver tissue removed by the eagle, the amount and appropriate rate of recovery suggested that the ancient Greeks had some idea about hepatic regeneration.

 10  facts about Hepatic Regeneration:

• The normal liver consists of a stable population of hepatocytes with a slow turnover rate.
• It has a remarkable capacity for regeneration. It can restore approximately three-quarters of its own mass within within six months.
• After surgical resection and during recovery from submassive liver necrosis, upto 70% of the human liver regenerate.
• In experimental animals  (rat liver) the hepatocytes have an annual turnover of one mitosis per year. After partial hepatectomy there is a burst of mitotic activity so that the liver weight doubles within 48 hours and return to normal weight after 3 to 6 days.
• In human liver, regeneration also occurs rapidly. This is noted in cirrhotic liver.
• After major hepatic resection for tumour, regeneration of normal hepatic volume occurs by 3 to 6 months, and liver function appears normal  within 2 to 3 weeks after surgery.
• Many factors influence regeneration but the precise triggers which stimulate increased mitotic activity are still unknown.
• Hepatic growth factor regulators can be broadly divided into groups : nutrients and hormones, polypeptide growth factors not necessarily specific to the liver and serum or liver-derived growth factors with greater specificity for the liver than other tissue.
• The responsiveness of hepatocytes is strongly influenced by their metabolic state.
• Epidermal growth factor may be one of the hepatotrophic factors with an important role in maintaining hepatocellular function and aiding cellular repair and regeneration.

All those interested in Liver pathology and regenerative medicine will continue to be enthralled by the interesting story of Prometheus, the Greek Titan, who brought fire to mankind. A mythical character whose liver grew back every night after it was torn and eaten everyday by an eagle.

Reference:

Prometheus bound: evolution in the management of hepatic trauma–from myth to reality.

Whither prometheus’ liver? Greek myth and the science of regeneration.

Promethean medicine: spirituality, stem cells, and cloning.

The myth of Prometheus mirrored in intensive medicine.

Hepatic Regeneration-Revisiting the Myth of Prometheus.

Liver regeneration. The Prometheus myth in the light of molecular biology.

Liver regeneration 7. Prometheus’ myth revisited: transgenic mice as a powerful tool to study liver regeneration.

The myth of Prometheus and the liver.

Myth of Prometheus in experimental reality; biochemical researches on the regeneration of the liver.

A20–an omnipotent protein in the liver: prometheus myth resolved?

 Image Courtesy: pixabay.com

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