Imagine this. A young teenager, 17, years old, who is fully developed. Now imagine this, the same teenager has a fully developed extra set of limbs and a pelvis. That extra set of pair is attached with chest artery. But, how can this happen?

While it is extremely rare, and has a chance of less than one case occurring per 100,000 births. Such things do happen. This is called parasitic twin.

What Is A Parasitic Twin?

It is an extremely rare type of cojoined twin where a baby is born with an underdeveloped twin attached to its body. This condition is also known as vestigial twins. The condition is very closely related to conjoined twins, where babies are connected at birth and share organs. However, the main difference is that in conjoined twins, there are two developed babies, whereas in parasitic twins, only one is fully developed, other one is underdeveloped and non functional.

In such a case, the twin who is developed is medically known as the autositic or the dominant twin. The dominant twin is healthy in most aspect but may have extra tissue, organs, or limbs from the parasitic twin.

The parasitic twin may be attached with the dominant twin through several places. The common joints are at the head, torso, chest, pelvis, buttocks, or back. In these cases, the parasitic twin is not alive and they die either in the womb or during the childbirth.

Doctors Remove Parasitic Twin

Now, let's go back to the case we referred to, where a young teenager had an extra pair of limbs attached to chest. The teenager who has not been named is from Uttar Pradesh's Unnao neighbourhood, and was treated in AIIMS, Delhi. The team of doctors successfully removed the extra set of limbs from his body.

Dr Asuri Krishna, who led the team of specialist who surgically removed the extra limbs told the BBC that only 40 to 50 cases of parasitic twins have been documented in world medical literature, and in those cases, the surgery had been attempted on children. The doctor said that without much medical literature to guide them, the team of doctors depended on "intuition, skill and knowledge".

The doctor shared that the child had two fully formed legs, buttocks and external genitalia, which weighed around 15kg "protruding from his abdomen".

How Was The Surgery Performed?

The doctor shared that first they identified how interconnected the parasitic and host twins were. The doctors took scans and found that parasitic twin was attached to the teen's breastbone. The blood was being supplied from a vessel in his chest. However, "there wasn't much connection with other main organs like the liver or kidneys," said Dr Krishna. The team also found a large cyst in the teen's abdomen.

Then the surgery was performed in two stages. In the first stage, the parasitic twin was removed. Then the cystic mass was extracted from the surrounded area. The entire surgery was completed in two and a half hours and the team of doctors included radiologists, anaesthetists, and plastic surgeons.

The biggest challenge was when the teen's blood pressure dropped as 30 to 40% of his blood flowed to the parasitic twin, however, the doctors were prepared for it and they stabilized him.

Irritable bowel syndrome (IBS) is often characterised by digestive symptoms like abdominal pain, bloating, constipation and diarrhoea. However, the condition involves more than the digestive system.

A new review published in The Lancet explains how interactions between the gut and brain, changes in the gut microbiome, immune activity and the body's response to pain can contribute to the development of symptoms.

The review, titled Irritable bowel syndrome and related disorders of gut-brain interaction, brings focuses on biological and psychological evidence behind IBS. Researchers describe it as a disorder of gut-brain interaction, in which signals between the digestive system and the central nervous system affect gut function.

The authors also discuss chronic constipation and functional diarrhoea, which belong to the bigger group of disorders related to gut-brain interaction. These conditions may affect an estimated 20% of the global population.

What Is The Gut-Brain Connection In IBS?

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The gut and brain communicate continuously through a complex network that involves the central nervous system, autonomic nervous system, enteric nervous system and hypothalamic-pituitary-adrenal (HPA) axis.

The brain can influence intestinal movement, secretion and sensitivity, while signals from the gut can affect how the brain processes pain and other sensations.

In people with IBS, this communication may become disrupted. The result can be changes in bowel movements, more sensitivity to normal digestive processes and abdominal discomfort.

The authors said, “These central and peripheral mechanisms can act in an integrated way to cause IBS symptoms, via the gut-brain axis.”

For instance, a person with IBS may experience pain or bloating even when the amount of gas or intestinal movement would not cause discomfort in someone without the condition. This is due to a condition called visceral hypersensitivity, in which the nerves supplying the digestive organs become unusually sensitive to internal sensations.

The review explains that changes in both peripheral mechanisms within the gut and central mechanisms involving the brain can contribute to symptoms.

Gut Bacteria And Inflammation May Contribute To IBS

Also read: Can Coffee Trigger Irritable Bowel Syndrome?

The gut microbiome, which consists of microorganisms living in the digestive tract, is another important part of the gut-brain connection.

Changes in the composition and activity of gut bacteria may impact intestinal function, immune responses and communication with the nervous system. The review identifies the following:

• Gut infections: Gastrointestinal infections can trigger IBS symptoms in some people, even after the initial infection has subsided.
• Altered gut microbiome: Changes in intestinal bacteria may affect digestion, immune activity and gut function.
• Increased intestinal permeability: Changes in the intestinal barrier may allow substances to pass through more easily, potentially contributing to immune activation.
• Low-grade inflammation: Mild inflammation in the intestinal lining and changes in immune function may contribute to symptoms.
• Abnormal gut movement: Changes in gastrointestinal motility can cause food and waste to move through the digestive tract too quickly or too slowly.
• Visceral hypersensitivity: Increased sensitivity in the gut can make normal digestive processes feel painful.

Mental Health And IBS

Psychological health is another component of the gut-brain axis. Stress, anxiety and other psychological difficulties can influence how the brain processes pain and communicates with the digestive system.

The HPA axis, which helps regulate the body's response to stress, plays a role in this process . Changes in stress levels can affect gut movement, secretion and sensitivity.

Currently, there is no single biomarker that can diagnose IBS. Doctors assess symptoms, medical history and clinical findings, while using tests to rule out other conditions.

The review highlights that some underlying mechanisms can already be measured through approved tests and questionnaires. These include abnormal bile acid metabolism, accelerated movement of contents through the colon and psychological conditions.

Does a patient’s chances of serious outcomes differ if they are treated by a female doctor? A recent study looks into this hypothesis to ascertain the difference between chances of a patient dying under a male and a female doctor.

According to the study, hospitalised patients treated by female doctors have a lower risk of dying within 30 days. They are also less likely to be re-hospitalised than those treated by male doctors. The study is published in JAMA Network Open.

"Past research has largely focused on surgical patients and the admitting physician only. Our findings add to the growing body of research examining the relationship between physician sex and patient outcomes, broadening the evidence beyond surgical care to a wider range of medical conditions and other physicians," says Dr. Angela Jerath, an ICES scientist, and Associate Professor, Department of Anesthesiology & Pain Medicine at the University of Toronto's Temerty Faculty of Medicine.

After analysing the health records of 958,150 adults admitted to hospitals in Ontario, Canada, between 2008 and 2022, researchers found that the 30-day mortality rate was 12.3% among patients treated by female physicians, compared to 13.7% among those treated by male physicians.

The findings also show a small difference in hospital readmissions. The 30-day readmission rate was 18.6% for patients treated by female doctors and 18.9% for those treated by male doctors.

The researchers examined outcomes across seven common medical conditions, including heart attacks, pneumonia and other acute illnesses.

They also considered the number of hospital days during which patients received care from female doctors, recognising that several doctors may be involved in a patient's treatment during an admission.

Patients Treated By Female Doctors Are Less Likely To Die In A 30-Day Period

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After accounting for patient, physician and hospital characteristics, treatment by a female physician was linked with 12% lower adjusted odds of death within 30 days compared to treatment by a male physician.

The researchers also found that for every 10% increase in the proportion of hospital days managed by female physicians, the adjusted odds of 30-day mortality decreased by 7%. This was observed for most medical conditions that were studied. Atrial fibrillation was the only exception.

The difference in mortality was also seen at longer follow-up periods. Patients treated by female physicians had lower mortality at 90 days and one year.

The findings were observed among both male and female patients. Female patients treated by female physicians had the lowest adjusted 30-day mortality rate in the analysis.

Why Patients May Have Better Outcomes With Female Doctors?

The study did not establish why patients treated by female physicians experienced better outcomes. However, the researchers discussed possible differences in clinical practice and communication.

Female physicians may be more likely to engage in patient-focused communication, spend more time with patients, follow clinical guidelines and involve colleagues in decision-making.

These practices could influence how symptoms are studied, treatment decisions are made and coordinated during hospitalisation.

"The goal is not to favour one group of physicians over another but to identify practices and behaviours that may help improve care across the health system," says Jerath.

"An important strength of this study is that, unlike surgical care, patients admitted to hospital for medical conditions are generally assigned physicians based on rotating schedules rather than patient or referring physician preferences, helping to minimize referral bias."

Eli Lilly's experimental weight-loss drug retatrutide, being referred to as ‘Godzilla’, continues to outperform its rivals like Ozempic.

According to a recent head-to-head Phase 3 clinical trial involving adults with type 2 diabetes, it delivered more than twice the average weight loss achieved with Ozempic.

Ozempic Vs Retatrutide

Participants who took the highest dose of retatrutide lost an average of 20.9% of their body weight over 80 weeks, compared to 9.4% among those receiving Ozempic's highest approved dose for type 2 diabetes.

The trial, called TRANSCEND-T2D-2, involved more than 1,000 adults with type 2 diabetes. It compared once-weekly injections of retatrutide at doses of 9 mg and 12 mg with semaglutide, the active ingredient in Ozempic, at 2 mg.

At the end of 80 weeks, participants taking retatrutide 9 mg lost an average of 44.3 pounds (20.1 kg), while those receiving the 12 mg dose lost 47.4 pounds (21.5 kg). The Ozempic group lost an average of 20.9 pounds (9.5 kg).

The findings mark the first Phase 3 head-to-head comparison of retatrutide with another medicine in this class.

Also read: ‘Godzilla’ Drug Retatrutide Reverses Sleep Apnea In 1 In 4 Diabetes Patients

Retatrutide Also Improved Blood Sugar

The trial found that retatrutide also resulted in produced greater reductions in HbA1c, a measure of average blood glucose over approximately three months.

At 80 weeks, participants taking either dose of retatrutide recorded an average HbA1c reduction of 2.2%, compared to 1.8 % among those receiving Ozempic.

The experimental drug also resulted in greater improvements in cardiovascular risk factors like non-HDL cholesterol, triglycerides and systolic blood pressure.

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Side Effects Of Retatrutide

The most commonly reported side effects of retatrutide were gastrointestinal symptoms like diarrhoea, nausea, constipation, vomiting and indigestion.

Diarrhoea was reported in 28.3% of participants receiving the 9 mg dose and 32.7% receiving 12 mg, compared to 26.4% in the Ozempic group. Nausea occurred in 21.2%, 23.8% and 21.3% of participants, respectively.

Researchers also reported a higher incidence of dysesthesia, an abnormal sensation that can include tingling, burning or skin sensitivity, among participants taking retatrutide.

Treatment discontinuation because of side effects occurred in 4.8% of the 9 mg group and 7.9% of the 12 mg group, compared to 2.7% of the Ozempic group.

More About Retatrutide

Retatrutide is a once-weekly injectable drug that targets three hormone receptors involved in regulating appetite, blood sugar and metabolism. They are GLP-1, GIP and glucagon.

GLP-1 helps regulate appetite and blood sugar while slowing the process of stomach emptying. GIP also plays a role in glucose regulation and insulin release. Glucagon is involved in controlling blood glucose and energy metabolism.

Ozempic, manufactured by Novo Nordisk, acts on the GLP-1 receptor. Eli Lilly's Mounjaro and Zepbound, which contain tirzepatide, target both GLP-1 and GIP receptors.

Retatrutide remains an investigational drug and has not been approved by the US Food and Drug Administration (FDA) or other regulatory authorities.

Eli Lilly plans to submit the drug for FDA approval in early 2027. The company said detailed results from the trial would be presented at a future medical meeting and published in a peer-reviewed journal.