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.

When one thinks about cancer, the first thing that comes to mind is a mass of irregular cells growing wildly. But what is a tumour? It is much more than mere cancer cells surrounded by an extensive network of blood vessels, immune cells and various supporting cells. This is the tumour microenvironment.

One of the key residents of the tumour microenvironment is the cancer-associated fibroblast (CAF), which attracts increasing interest of cancer researchers due to the fact that such cells may affect tumour growth, metastasis and therapy response.

Normal fibroblasts have a supportive function in maintaining tissue integrity through the production of collagen and other structural components. However, when cancer arises, some fibroblasts located in or near the tumour acquire an additional function and become activated. Such activated fibroblasts are called CAFs.

How CAFs May Help Cancer Grow And Spread

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CAF involvement could be likened to that of a helper to the tumour. These cells are able to modify the stroma around the cancer cells and thereby facilitate growth and invasion into adjacent tissue. CAFs are also capable of releasing factors that facilitate angiogenesis as well as the behaviour of cancer cells. Evidence exists of a correlation between CAF involvement and tumour progression and metastasis in various types of cancer.

Perhaps more significantly, CAFs can affect the immune response of the body. The immune system in humans is able to detect and target foreign bodies including cancer cells. However, some forms of CAFs play a role in ensuring an immunosuppressed environment that makes it difficult for the immune cells to interact effectively with the tumour cells. This could explain the wide variation in immunotherapy response among patients and different tumour types.

The involvement of CAFs in treatment resistance is another issue that must be considered. Cancer-associated fibroblasts are known to remodel the extracellular matrix, an environment where cells are surrounded by proteins, and generate signals that help cancer cells resist stress induced by chemo and targeted therapy. CAFs therefore make treatment difficult for certain tumours.

Could CAFs Become A New Target For Cancer Treatment?

This field of study is especially important when considering that cancer treatments are becoming increasingly personalized. Today, oncologists take into consideration such features of cancer as genetic mutation, its stage and molecular profile. Tomorrow, taking into account tumor microenvironment can give them additional knowledge on how to treat a specific type of cancer.

But there is one major issue to be taken into consideration: CAFs are not one homogenous group of cells. There can be many types of CAFs that have very different functions, sometimes even opposing. Some of them contribute to tumor growth and some may hinder it. Thus, simply killing all fibroblasts will hardly help. Instead, there are studies on how to selectively target tumor promoting CAFs and how to reprogram them. Several such methods have already been tested clinically.

There is one important point that this research gives to patients: cancer is not just a mass of aberrant cells. Cancer is an ecosystem where cancer cells constantly interact with their environment.

Understanding this ecosystem might someday help oncologists tackle the mechanisms of tumor survival and resistance to therapy- and maybe make current cancer treatments more efficient.

By Dr Pritam Kalaskar, Director, Co-founder and Medical Oncologist- M|O|C Cancer Care, India

Obesity is often associated with obstructive sleep apnea or OSA. Extra body fat is a key risk factor. Still, it is a mistake to think OSA only happens when someone is heavy. Many people who have a normal weight may not connect their symptoms to a sleep issue.

They can go for years without a proper diagnosis. Research also makes it clear that OSA can show up in people who are not obese. Risk may be more than weight-dependent and include factors such as upper airway anatomy, age, sex, family history, and others.

How Airway Anatomy Can Increase The Risk

Weight is only part of the story. The jaw, the palate, the tongue, and the passages in the upper throat can affect what happens during sleep. The airway can narrow or collapse more easily for some people. A person may not be big in body size but can have a tight or smaller upper airway.

They might have a jaw that drops back. Other facial and skull features can also increase the likelihood of OSA. Your nose problems, smoking, drinking and other unwholesome activities on Sunday could also be factors.

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Why Age And Menopause Matter

Age matters too. With time, muscle tone can change. The way the airway works can also shift. As a result, the upper airway may be more likely to collapse during sleep. For women, the risk may also shift around menopause and after it. This is why OSA should not be treated as a problem that only affects overweight men.

The symptoms should be taken seriously, not the scale. Signs such as loud snoring or snoring often, pauses seen in breathing, waking up suddenly and feeling short of breath, or choking during sleep can all call for assessment. Morning headaches can occur as well. Day-to-day problems like poor focus, irritability, and being very sleepy in the daytime are common clues. Some people do not report classic sleepiness. They may mainly notice restless sleep or ongoing tiredness during the day without a clear reason

How Doctors Assess Sleep Apnoea

A clinician should look at more than BMI. They can start with symptoms, a sleep history, neck size, what the upper airways look like, and any related health issues. If obstructive sleep apnoea is a real concern, a sleep test can show whether breathing problems happen during sleep.

The main point is this: a person can be slim and still have sleep apnoea. Deciding on testing should follow the full clinical picture, not body weight by itself. When this is remembered, some people may get help sooner, instead of having their tiredness written off as stress, bad sleep, or just normal fatigue.

A patient suffering from a rare tumour involving the sciatic nerve has made a good recovery following a successful robotic-assisted sciatic nerve schwannoma resection, marking an important milestone in advanced, minimally invasive surgical care.

Sciatic nerve schwannomas are uncommon, benign tumours that develop from the cells surrounding a nerve. Because the sciatic nerve is responsible for important motor and sensory functions of the lower limb, surgery in this region can be technically challenging. The key objective is to remove the tumour while preserving the functioning nerve fibres and minimizing the risk of neurological complications.

How Robotic Technology Can Aid Complex Surgery

The patient underwent robotic-assisted surgery under the care of a multidisciplinary surgical team. The use of robotic technology provided enhanced visualization and precise control of surgical instruments, allowing meticulous dissection around the affected nerve.

For the patient, the successful procedure meant not only removal of the tumour but also the prospect of returning to normal daily activities with preservation of neurological function.

Whenever the doctor operates on a tumour involving an important nerve, their priority is to achieve complete and safe tumour removal while protecting the nerve and its function. Robotic assistance can offer greater precision and visualization in carefully selected cases.

Following the procedure, the patient was closely monitored for neurological recovery and postoperative complications. The patient is doing well and recovering satisfactorily, providing an encouraging outcome following this complex surgical intervention.

How Minimally Invasive Techniques May Benefit Patients

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The case demonstrates how advances in surgical technology can translate into meaningful benefits for patients. Robotic-assisted surgery, when used in appropriately selected cases, can support surgeons in performing delicate procedures with enhanced precision while potentially reducing tissue trauma and facilitating recovery.

For patients diagnosed with nerve tumours, early evaluation and appropriate treatment planning are important. Symptoms can vary depending on the location and size of the tumour and may include pain, tingling, numbness, or weakness in the affected limb. Detailed imaging and neurological assessment help specialists determine the most appropriate treatment strategy.

The successful outcome reflects the importance of combining experienced surgical expertise, advanced technology, and patient-centred care. For this patient, the journey from diagnosis to successful tumour removal and recovery offers an encouraging example of what modern surgical care can achieve.

By Dr. S.K. Bala, Consultant Department of Surgical Oncology & Advanced Robotic Surgery, CMRI, CK Birla Hospitals, Kolkata