Is your hairdresser having respiratory problem? Do you know the reason?

 

Is your hairdresser coughing, sniffing and has a chronic respiratory problem?  Are you concerned about her health? She should consult a doctor immediately.

According to  a study  by Ümran Toru et al  smoking may aggravate occupational airway disease in hairdressers. Smoking increase both  respiratory complaints and decreased respiratory functions in this profession.

In a study by Brisman et al. that was performed with the aim of evaluating the wheezing, dry cough, and nasal congestion in hairdressers, the survey on respiratory symptoms, atopy, smoking, and job history was answered by three thousand nine hundred and fifty-seven female hairdressers and four thousand nine hundred and five reference women from general population. When compared with references, the ratios of all three symptoms in hairdressers were found to be high and hairdressing was correlated with an increased incidence of respiratory symptoms. The combined effect of hairdressing and smoking was found to be lower than expected and it was proposed that smoking has negative modifying effect.

In a study by Slater et al., the occupational respiratory symptoms in hairdressers were examined. A survey was done on a hundred hairdressers and employees of one hundred and six offices and stores   covering their respiratory symptoms, demographic data and smoking habits. Respiratory functions were measured before each shift. Asthma symptoms, diagnosis, and asthma attack prevalence of hairdressers in the previous twelve-month period were found to be high.  High symptom prevalence in hairdressers was associated with high smoking ratios and average pulmonary function values were found to be low.

According to the study  cough, phlegm, and chest tightness were  noted more in smokers compared to nonsmokers. Rhinitis was also more in smoking hairdressers.

“In conclusion, hairdressers were determined as an occupational group the majority of which was formed by women, in which respiratory complaints and rhinitis history were frequently observed in the subgroup in which cotinine was above 500 ng/mL and where both occupational and smoking status had an additive effect.”

Cutting off smoking could help in this profession.

Reference:

• Ümran Toru, Peri Meram Arbak, Kezban Özmen Süner, Özlem Yavuz, and Naciye Karataş, “Relationship between Respiratory Tract Complaints, Functional Status, and Smoking in Hairdressers, Auto Painters, and Carpenters,” The Scientific World Journal, vol. 2014, Article ID 802705, 7 pages, 2014. doi:10.1155/2014/802705
• “The incidence of respiratory symptoms in female Swedish hairdressers,” The American Journal of Industrial Medicine, vol. 44, no. 6, pp. 673–678, 2003.
• “Occupational respiratory symptoms in New Zealand hairdressers,” Occupational Medicine, vol. 50, no. 8, pp. 586–590, 2000.
  

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Leonardo Da Vinci -When Art meets Medicine

 

“Science comes by observation, not by authority” Leonardo Da Vinci

Presumed Self-portrait Leonardo Da Vinci – 1452- 1519 Leonardo Da Vinci : Superficial anatomy of the shoulder and neck (recto) –  1510  image courtesy: wikimedia-commons Image Courtesy – wikimedia commons

Leonardo Da Vinci,  son of Caterina, a peasant girl and Ser Piero da Vinci, a Florentine notary, is one of the most amazing men who have ever lived. He is considered to be the greatest geniuses of the Italian renaissance. Not only was he a great painter, whose pictures the “Mona Lisa” and “The Last Supper” are among the most famous in the world, but also a sculptor, an architect, a poet and a composer music.

He was a genius of another kind too, for he was a pioneer in science, he studied mathematics and engineering and his ideas and the discoveries he made in work were hundreds of years in advance of his time.

His studies of human anatomy was based on meticulous dissection and showed great knowledge which was far superior to his contemporaries in medical profession.

According to Dr Kenneth D Keele’s strong words -” thus in anatomy as in so many aspects of life’s work, Leonardo was a man who awoke too early in the dawn of the Scientific Renaissance whilst others still slept”

He is an inspiration to many doctors and several interesting medical articles have been written analysing his exquisite  illustrations of human anatomy.

To his remarkable knowledge was added his skill unique skill in recording his findings in paper. These are not only important scientific diagrams but also superb works of art.

The studies of the skeleton and muscles completed between 1508 and 1510 are among his most impressive and beautiful drawings. These beautiful illustrations emphasize the fact that a good diagram will tell more than a thousand words.

The Spine (1508 -10) shows the beautiful natural curve of the vertebral  column, with the vertebrae of each part correctly numbered for the first time.

His drawing “Superficial muscles and veins of  arms shows also the superficial veins of the chest and abdomen.

Leonardo Da Vinci : Studies of Embryos by Leonardo da Vinci (Pen over red chalk 1510-1512) Image courtesy : wikimedia-commons

Leonardo Da Vinci (1452–1519) and reproductive anatomy: Arch Dis Child Fetal Neonatal Ed 1997;77: Peter M Dunn – 

He was the first to observe and comment on the fetal membranes—the chorion,  amnion, and allantois.  His drawing of a fetus in the womb is altogether remarkable and was not bettered for more than two centuries. Of that drawing, he wrote:

“In the case of this child the heart does not beat and it does not breathe because it lies continually in water. And if it were to breathe it would be drowned, and breathing is not necessary to it because it receives life and is nourished from the life and food of the mother.

The navel is the gate from which our body is formed by means of the umbilical vein… This umbilical vein is the origin of all the veins of the creature that is produced in the matrix, and it does not take its origin in any vein of the pregnant woman, because each of these veins is entirely separated and divided from the veins of the pregnant woman, and the veins and arteries are found together in pairs; and it is extremely rare for one to be found without the other being in company with it, and the artery is almost always found above the vein because the blood of the artery is the passage for the vital spirit, and the blood of the veins is that which nourishes the creature…. (the unborn child) is nourished from the same cause as the other members of the mother, and its vital powers are derived from the air which is the common living principle of the human race and other living things.”

Leonardo da Vinci: The Proportions of the Human Figure (Vitruvian Man) – (1490; Pen, ink and watercolour over metalpoint)Image courtesy: wikimedia-commons

 

Leonardo Da Vinci : Anatomy of the Neck – 1515 Image Courtesy – wikimedia-commons

In the course of dissection of the skull and brain Leonardo made many discoveries like maxillary and frontal sinuses (1489).

He was interested in ophthalmology and was probably first to draw the optic chiasma and to demonstrate the path of vision from the back of the eyeball to the base of the brain as in the “Optic Chiasma and cranial nerves”  (1506 -1508).

Leonardo Da Vinci described eye as the “window of the soul.”

Leonardo Da Vinci : Studies of human skull ( Pen, ink and black chalk on paper – 1489) Image Courtesy – wikimedia-commons 

In the 1490s, Leonardo Da Vinci began to investigate the heart and its work. This sketch was part of his study of the human anatomy and the circulation system. Image Courtesy – wikimedia-commons

Leonardo Da Vinci : Study on the proportions of head and eyes – pen and ink – second half of 15^th century. Image Courtesy – wikimedia-commons

Leonardo da Vinci the anatomist” from McMurrich. Image Courtesy – wikimedia-commons

The Principle Organs and Vascular and Urino-Genital Systems of a Woman  (c. 1507) is a drawing by Leonardo da Vinci. Image Courtesy – wikimedia commons

View of a Skull (c. 1489) is a drawing by Leonardo da Vinci   Image Courtesy – wikimedia commons

Leonardo da Vinci, Drawing of the comparative anatomy of the legs of a man and a dog. Image Courtesy – wikimedia commons

Leonardo Da Vinci (1452–1519) and reproductive anatomy: Arch Dis Child Fetal Neonatal Ed 1997;77: Peter M Dunn 

He believed strongly in health care. His instructions have a remarkably modern ring:

If you would keep healthy, follow this regimen: do not eat unless you feel inclined, and sup lightly; chew well, and let what you take be well cooked and simple. He who takes medicine does himself harm; do not give way to anger and avoid close air; hold yourself upright when you rise from table and do not let yourself sleep at midday. Be temperate with wine, take a little frequently, but not at other than the proper meal-times, not on an empty stomach; neither protract nor delay the (visit to) the privy. When you take exercise let it be moderate. Do not remain with the belly recumbent and the head lowered, and see that you are well covered at night. Rest your head and keep your mind cheerful; shun wantonness, and pay attention to diet.

“As a well spent day brings happy sleep, so life well used brings happy death.” Leonardo da Vinci

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Epithelioid Sarcoma – A lethal tumour in young patients -[Infographic]

“What the mind does not know, the eyes do not see”.

Epithelioid Sarcoma is a rare malignat tumour and can look deceptively benign.

It was first described by Laskowski in 1961 as “sarcoma aponeuroticum”  as it involved aponeuroses and surrounding structures.

Later Enzinger introduced the current term “epithelioid sarcoma”.

Only an expert histopathologist with many years experience can think of this rare tumour on haematoxylin and eosin stain.

Smart pathologists have an eye to catch the clues immediately.  Later, immunohistochemistry and cytogenetics  help in confirming the diagnosis.

This tumour can be mistaken for chronic inflammatory condition, necrotizing granulomas, and various fibrohistiocytic tumours.

Wrong diagnosis can delay proper treatment and can actually kill a young patient.

There are star pathologists in every part of the world. I dedicate every blog post for those excellent, silent workers.

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Bubbly “Physaliphorous Cells” of Chordoma [Poster]

 

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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 ”

Want to be smart? Listen to Mozart. Feeling depressed? Listen to sad music.

 Image courtesy: pixabay.com

Health Benefits of Music

Singing and enjoying music is a natural instinct. Simple rhythm and melody, to of the most important features of music, are as old as man himself. Your mother may have instinctively sung a lullaby when you were crying as a baby.
Origins of music is almost certainly older than painting, sculpture, poetry or any means man has found for expressing his thoughts and feeling.
The word music is derived from the Greek word Muse. The Greeks believed that each mode was related to a certain state of mind. In the same way today different scales or keys, are sometimes linked with particular state of mind. Some keys are are thought to be happy and others to be sad. Such comparisons are a matter of personal feeling. For the Greeks, however the character of each mode was definite and music played in a particular mode was supposed to bring on a certain state of mind in the listener.
In 1993 Rauscher et al  postulated that, after listening to Mozart’s sonata for 10 minutes a normal person becomes smarter, more creative and showed significantly better reasoning skills. The IQ scores were 8 and 9 points higher after listening to the music. This is known as Mozart effect.
Music therapy plays an important role in clinical conditions such as cardiovascular disorders, cancer pain, epilepsy, depression and dementia.
Studies showed involvement of limbic and paralimbic cerebral structures (such as amygdala, hippocampus, parahippocampal gyrus, temporal poles, insula, ventral striatum, orbitofronal, as well as cingulate cortex) during the processing of music.
Soothing music is known to boost immune response. There is evidence of increase in the activity of natural killer cells, lymphocytes and proinflammatory cytokine interferon-γ.
Music not only improves quality of life, it also has effect on the heart rate and cerebral blood flow and probably prolong life. The greatest benefit on health is observed after listening to classical music and meditation music. Listening to music by Bach, Mozart has a calming effect on the patients. In contrast loud, aggressive rock music  can be dangerous and can lead to stress and cardiac arrhythmias.
Patients with coronary heart disease often suffer from severe mental distress due to diagnosis, hospitalization, surgical procedures. Music relaxes patients who have undergone major cardiovascular surgery.
Reduces anxiety and improve quality of life of patient with depressive symptoms, frail sick elderly patients, patients in acute pain and those in intensive care.
Many nervous patients suffer from uncertainty of outcome of a major surgery and fear of dying. Many patients have doubts about progress in recovery, feel helplessness and loss of self control. In these anxious patients carefully selected music has a calming effect.
Music that conveys sadness can be give real pleasure. Music related to grief and sorrow is more often found beautiful than music that related to joy and happiness.
We all know music, plays, films and paintings with a sad content are very popular. Many films with sad songs and unhappy endings have been blockbusters. We have seen people coming out with tears in their eyes and smile on their lips.
It is believed that the pleasure people experience in music is related to emotions induced by the music. They have often reported that  listening to music changed  their emotions.
Some scholars stated that  hormone prolactin was responsible for feeling pleasure.
According to some researchers feeling of sadness caused by music clear out negative emotion and gives a feeling of satisfaction. The person is able understand his own deep emotion and learns to regulate is feelings. A connection is formed between feelings of the composer and the listener.
Insomnia is a common sleep disorder in modern society. Prenatal sleep disturbance has been associated with pregnancy related complications. Research showed music may be effective for improving sleep quality in adults with insomnia, senior citizens and pregnant women.
If you want to be smart listen to Mozart and if you are depressed listen to sad music.
If you are a night owl listen to the soft relaxing music and go to sleep.

20 signs you are an Empathetic Doctor:

 Image courtesy: pixabay.com

 

Empathy is an important  part of medical profession.  It is the ability to understand other people’s experiences, emotions, and feelings.

20 signs you are an Empathetic Doctor:

1.  You understand the emotional state of the patient
2.  You effectively communicate to the patient that you understand the  situation.  This improves the quality of the patient’s experience and the outcome of the treatment.
3.  Empathy is directly related to clinical competence. You are happy and satisfied with your professional life.  You have not complained of stress or burnout.
4.  You are a doctor of a developing country and often refuse to take professional fee from underprivileged patients.
5.  You have worked in primary health centres in remote villages and in refugee camps.
6.  You have performed more than 1000 autopsies. You are familiar with the emotions that a doctor normally experiences after the death of a patient. You  effectively give professional  support to bereaved families.
7. You often volunteer to do night duty for your unwell colleague. Your colleagues respect you and know that they can depend on you at time of crisis.
8.  You often donate blood as part of donation camp.
9.  You are not in the profession to earn money but to help the sick people. This gives you tremendous sense of achievement.
10.  When you fall sick, you don’t complain. You try your best to take minimum sick leave.
11.   You don’t need to think twice when it is a choice between buying an expensive gift for yourself or making a huge donation for the cancer fund in your country.
12.  Instead of selling your old computer and cell phone, you have given them as  gifts to those who cannot afford to buy them.
13.  There are slums in various parts of your country. You spent time with slum dwellers and have listened to their sad stories with compassion. You have tried your best to help them with medicines and free medical advice.
14.  You have many free educational websites for medical students who cannot afford to buy books.
15.  You always give jobs to married women with grown up children. They need more money to support a family and cannot afford to take holiday from work.
16.  You often raise your voice against rape and sexual exploitation of women at work.
17.  You are actively involved in organisations  dealing with autism and Alzheimer’s disease.
18.  Empathy and compassion runs in your family. You are lucky to have been born in a family of givers. You have seen your parents giving generous donation to the poor and providing shelter and employment to many helpless people.
19.  You are a global traveller which helped you to develop humility and compassion.
20.  You are actively providing support and psychological councelling to peers and  juniors  addicted to drugs and alcohol. Learning to respond to distress with  empathy is a critical task which is associated with positive health outcome and personal achievement.