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.

It can be confusing and sometimes alarming to receive different thyroid test results from two different laboratories, especially when both tests are done on the same day. A slight difference in values does not necessarily mean that your thyroid function has suddenly changed. In many cases, the variation is due to differences in how the tests are performed rather than a change in your health.

The Laboratory Can Make A Difference

One of the biggest reasons for varying results is the laboratory itself. Accredited laboratories, such as NABL-certified labs, follow stringent quality-control measures, use standardised testing protocols and have trained personnel to handle samples correctly. Laboratories with less rigorous quality standards may produce results that are less consistent.

Different Equipment Can Produce Different Results

The equipment and testing methods used can also differ from one laboratory to another. Different analysers, calibration techniques and testing kits can produce slightly different values for thyroid hormones such as TSH, T3, T4, Free T3 and Free T4.

Even the reference ranges printed on reports may not be identical because each laboratory establishes its own normal range based on the equipment used and the population it serves.

Also read: UK Approves Eli Lilly’s Foundayo: Is the GLP-1 Pill Better Than Wegovy, Mounjaro?

The Time Of Your Test Matters

The timing of the test is another important factor. Thyroid-stimulating hormone (TSH) naturally fluctuates throughout the day. It is generally higher during the early hours of the morning and gradually falls as the day progresses.

As a result, a blood sample collected in the afternoon may show a lower TSH level than one collected early in the morning.

Stress, Sleep And Medication Can Affect Results

Lifestyle and biological factors can also influence thyroid hormone levels. Stress, poor sleep, recent illness, medications and even eating before the test may affect the results.

For people taking thyroid medication, blood samples should ideally be collected in the morning on an empty stomach and before taking the daily dose. Testing after medication may temporarily alter hormone levels and make interpretation more difficult.

Also read: Why Women Want Hormonal Health Care, Not Just Pregnancy Care

Biotin And Other Medicines Can Interfere With Thyroid Tests

Certain supplements and medications can interfere with thyroid tests as well. Biotin, commonly found in hair and nail supplements, can falsely lower TSH levels while increasing Free T3 and Free T4 values.

Medications such as amiodarone, glucocorticoids, dopamine and heparin may also affect thyroid hormone measurements. During pregnancy, hormonal changes, particularly increased levels of human chorionic gonadotropin (hCG), can naturally alter TSH values.

Even Sample Handling Can Affect The Report

Laboratory handling also plays a role. Delays in processing, improper storage temperatures, differences in centrifugation timing or sample-handling errors can influence the final result.

In some individuals, thyroid autoantibodies may interfere with laboratory assays, potentially leading to inaccurate Free T3 and Free T4 measurements.

Also read: Silent Neck Swellings: Why An Unusual Lump Should Never Be Ignored

Should You Repeat A Thyroid Test?

Because of these variables, experts recommend getting thyroid tests done at the same accredited laboratory whenever possible. This allows doctors to compare results more reliably over time.

If a thyroid value is only mildly abnormal or falls within a borderline range, it may often be advisable to repeat the test before making a diagnosis or starting lifelong medication.

Ultimately, thyroid test reports should never be interpreted in isolation. Doctors consider the patient's symptoms, medical history, physical examination and repeat test results before deciding on treatment.

Consistency in where and how the test is performed can help avoid unnecessary anxiety and support more accurate clinical decisions.

By Dr Shaheen Guy, General Physician, Saifee Hospital, Mumbai

Robotic surgery has rapidly become one of the most talked-about advances in modern medicine. Yet, for many patients, the technology remains misunderstood.

The first thing to know is that the robot does not perform the operation. Every movement is directed by the surgeon. The robotic platform translates the surgeon’s hand movements into highly precise, tremor-filtered movements inside the body while providing magnified three-dimensional vision and greater instrument dexterity.

The real question, therefore, is not whether robotic surgery is better. It is whether it is the right choice for a particular patient, procedure and surgeon.

Where Robotic Surgery Can Make A Difference?

For many routine operations, conventional laparoscopy may achieve equally good outcomes. Technology should support clinical judgment, not replace it.

Patients should also recognise that outcomes depend far more on the experience of the surgical team than on the robotic system itself. Successful robotic surgery requires specialised training, structured credentialing and a coordinated operating theatre team.

Choosing an experienced surgeon can therefore be more important than choosing a hospital simply because it owns a robotic system.

Also read: 18-Year-Old In Critical Condition After Acidic Substance Allegedly Given Instead Of Anaesthetic During Surgery

Making Robotic Surgery More Accessible

Another important development is that robotic surgery is becoming more accessible. Indigenous platforms are helping expand advanced surgical care beyond a handful of metropolitan hospitals by making robotic programmes more viable for a wider range of healthcare institutions.

This gradual decentralisation means patients in Tier II and Tier III cities can increasingly access advanced minimally invasive surgery closer to home, reducing the need to travel long distances for specialised treatment.

Also read: Osteoporosis Drugs Offer New Hope For Back Pain By Blocking Disc Mineralisation: Study

Could Robotic Surgery Work Across Long Distances?

Innovation is also extending beyond the operating room. Robotic telesurgery, demonstrated successfully using Made-in-India robotic platforms, has shown that expert surgeons can operate across vast distances using secure digital networks.

While widespread adoption will require robust infrastructure and regulatory frameworks, the technology represents an important step towards improving access to specialised surgical expertise.

Also read: Surgeon Barred From Practice After Connecting Wrong Parts of Patient’s Bowels During Emergency Surgery

What Should Patients Ask Their Surgeon?

Patients should look beyond the hype and ask informed questions:

• Is robotic surgery appropriate for my condition?
• What experience does my surgeon have with this procedure?
• What are the expected benefits?
• What are the limitations and risks?
• Would conventional laparoscopy or open surgery be equally suitable?

With indigenous platforms helping decentralise robotic surgery, advanced care is becoming more accessible beyond major metros. The technology has also demonstrated the potential of interhospital telesurgery, enabling expert surgeons to operate across distances and potentially helping bridge gaps in access to highly skilled surgical expertise.

Ultimately, the future of surgery will not be shaped by machines alone. It will be shaped by skilled surgeons using intelligent technology to deliver safer, more precise and equitable patient care.

A cigarette after stress. Chewing tobacco during the day. Smoking to “calm the nerves”

But modern science is forcing us to confront the difficult truth; Tobacco does not treat mental health symptoms, in fact it quietly deepens it.

As Oncologists and physicians, we often see patients who say, “smoking makes them feel normal.” However, in reality, what they are experiencing is nothing more than the temporary relief from nicotine withdrawal not genuine emotional regulation.

Nicotine Creates A Cycle of Temporary Relief And Dependence

When we smoke or chew tobacco, nicotine stimulates dopamine release in the brain, creating a short-lived sense of relaxation or control. But overtime it leads to brain depending on nicotine to achieve the same baseline feeling again and again. The result is a vicious cycle of dependence, irritability, anxiety, and worsening emotional resilience.

Several large studies now show that long-term tobacco use is associated with higher rates of anxiety, depression, sleep issues and substance dependence. A 2023 review published in BMJ found that smoking cessation will result in improvements in both anxiety and depression and an improved mood with benefits comparable to antidepressant treatment in some individuals.

Also read: Lung Health After 40: Natural Changes, Warning Signs And Ways To Protect Your Lungs

Tobacco May Worsen Anxiety, Depression And Sleep Problems

This has serious implications for the urban Indian population in regard to the increasing prevalence of mental exhaustion, lack of social support, digital overload, work-related stress and lack of sleep. Tobacco often enters quietly during vulnerable moments of college pressure, workplace stress, loneliness, grief and gradually shifts from “social habit” to psychological crutch.

Although they think they believe in tobacco, many of them use it, thinking that they are using it to cope with their emotional symptoms, when in fact they are making the symptoms worse.

Also, recognize the biology of tobacco use. For example, the use of nicotine will result in long-term changes in how well your body handles emotional stress because of the role of long-term nicotine exposure in altering the system of cortisol regulation and the stress response pathways in neurons. So, with time, it will become harder and harder for a person to control his/her emotional response to stress because his/her body will not be able to do it. Thus, tobacco has a negative influence on the recovery process from emotional responses to stress, rather than a beneficial one.

Also read: Air Pollution May Increase The Risk Of Painful Rheumatoid Arthritis Flares, Study Finds

How Nicotine Alters The Body’s Stress Response?

Tobacco is a significant preventable risk factor for oral, head and neck, lung, oesophageal, pancreatic and bladder cancers. When many patients arrive at cancer centres, the addiction to tobacco is already set, and it is even more difficult to quit while receiving cancer treatment.

This is why it is important to help move the conversation on tobacco beyond cancer. Now, it's more than just a public health issue; it also includes issues of mental health. Individuals experiencing emotional difficulties should not think that they are being judged. They have to learn to find alternative coping strategies, get psychological support early on in their lives, sleep well, exercise, be part of the community, and access timely medical support. The goal of this care is not just to support someone in quitting tobacco, but to provide support for them to stop needing tobacco in order to feel good.

By Dr Amit Chakraborty, Consultant Oncologist, Saifee Hospital, Mumbai