#case reports in bone journal

[literaturepublishersjournal]

Orthopedic Case Reports Journal

Orthopedic Case Reports Journal publishes case reports in Orthopaedics, images in Orthopaedics journal, imaging in Orthopaedics journal, case reports in bone journal, case reports in paediatric Orthopaedics, case reports in Orthopaedics surgery journal etc. 

Orthopaedics is a medical and surgical specialty that is concerned with the correction of deformities or functional impairments of the skeletal system, particularly the spine and its associated structure, ligaments and muscles. Orthopaedic surgeons employ both surgical and nonsurgical interventions for treating their patients. Disease conditions related to musculoskeletal trauma, sports injuries, spinal disorders and injuries, infections, congenital disorders, and tumours are covered under Orthopaedic research.

Clinical Research on Foot & Ankle

Clinical Research on Foot & Ankle: The Journal of Clinical Research on Foot & Ankle is the leading source for original, clinically-focused articles on the surgical and medical management of the foot and ankle. The approach is broad and includes all aspects of the subject from basic science to clinical management. Its purpose is to provide a quality journal to further promote education and research in foot and ankle medicine and surgery.

Clinical Practice (Therapy)

Clinical Practice (Therapy): Orthopedic Case Reports Journal is an open access, peer reviewed scholarly journal that provides an open platform for the worldwide dissemination of original and novel scientific manuscripts based on the various aspects of the adept practical approaches to disease management. 

The journal prioritises the publication of manuscripts that can provide useful insights into the real time efficacy and persisting lacunae in the various principles, tools and techniques involved in the diagnosis and treatment of acute and chronic diseases. The journal acts as a bridge between the medical community and the general population by dispersing scientific advancements in medical and clinical research and manuscripts that highlight how these research advancements can change the currently followed medical procedures.   

Related Journals:  Clinical Data Management. Clinical Research Management, Medical Research Journals, Journal of Medical Science and Clinical Research, Biological and Medical Research, Medical Laboratory, Orthopedic Case Reports Journal, Medical Research Laboratory, Medical Laboratory Techniques, Medicine international Journal, Clinical Laboratory Journal, Clinical Laboratory and Hematology, Clinical Research Laboratories, Journal of Clinical Study, Journal of Clinical Investigation, Clinical Research Database, Clinical Research Database Management, Clinical Research in USA, Journal of Clinical Medicine Research, Journal of International Medicine, Laboratory Journals, Clinical Laboratory Medicine Journals, Journal of Medical Laboratory Science, Laboratory Medicine Journals

Clinical Investigation: Clinical Investigation journal is an open access, peer reviewed journal that provides an open platform for novel scientific manuscripts based on various aspects of clinical studies throughout the world. Clinical investigation journal play a major key role in documenting latest innovations in the field of clinical research area, as it includes clinical trials reports, clinical drug development, safety and effectiveness of medications, diagnostic products, Clinical Trial phase I-IV findings and other related topics of clinical studies.

Journal of Pain & Relief

Journal of Pain & Relief: Pain & Relief covers information regarding types of distressing symptoms like highly unpleasant physical sensation during treatment and healing. Journal of Pain & Relief is a peer reviewed, open access periodical which disseminates scientific information among the medical scientists and researchers in the relevant areas. The journal considers a wide range of topics in the realm of medical sciences which includes but not limited to: Acupuncture, Acute Pain, Anesthesia, Chronic Back Pain, Chronic Pain, Hypnosis, Low Back Pain, Meditation, Nociceptive Pain, Opioid, Orthopedics, Pain killer drugs, Pain Medication, Post-Operative Pain, Reaction to Pain.

Related Journals: Pain Medicine, Pain Management, Pain Medicine Journal, Pain Management Journals, Journal of Pain & Symptom Management, Journal of Pain Management, European Journal of Anesthesiology, Open Pain Journal, Journal of opioid Management, Chronic Pain Management

Journal of Clinical & Experimental Pathology

Journal of Clinical & Experimental Pathology: Journal of Clinical & Experimental Pathology involves with Clinical/medical biology it is concerned with diagnosis parameter of diseases based on analysis of body fluids such as blood, urine. Which also requires some tools of chemistry, microbiology, hematology, and molecular pathology, Experimental pathology is process of microscopic or molecular examination of organs. So this journal mainly focuses on Drugs developed through experiments, case reports, and new innovations in the field of pathology. Journal of Clinical & Experimental Pathology is an open access journal, selected abstracts would be published in this journal.

Related Journals: Pathology Journals, best open access journal, Journals in pathology, Journals of pathology, Clinical pathology, Anatomic pathology, impact factor of pathology journals, British Journal of Pathology, Australian Journal of Pathology, European Journal of Pathology, American Journal of Clinical Pathology

Archives of Medicine

Archives of Medicine: Archives of Medicine is a peer-reviewed, open access journal which provide authors an established, trusted platform for the publication of their work. The journal publishes original research articles, review articles, clinical studies, theories and policies related the academic discipline of medicine and primary care in all areas of medicine. It aims to provide practical up-to-date information in significant research from all subspecialties of medicine. 

Related Journals: Complementary Medicine, Vascular Disease, Diabetic Medicine, Anti-Cancer Drugs, Cardiovascular Toxicology, Emergency Medical Services, Endocrine Oncology, Child Healthcare, Gynecology & Obstetrics, Infectious Diseases, Neurourology, Hepatology, Mental Disorders, Psychological Disorders, Dentistry, Surgical Anesthesia, Molecular Epidemiology, Cancer Therapies, Tropical Medicine and Health, Alzheimer's Disease

Universal Surgery

Universal Surgery: Journal of Universal Surgery is an indexed peer reviewed internationally reputed medical journal. This scholarly Open Access journal aims at exploring new, relevant, and the most compelling developments in the field of Surgery. Journal of Universal Surgery is the best scientific journal that provides a good platform for researchers to publish their valuable work in the mode of research, review articles, case reports, commentaries, short communications, etc. 

Journal Highlights includes: Laparoscopic Surgery, Gallbladder Surgery, Arthroscopic Knee, Scoliosis Surgery, Sinus Surgery, Oral Surgery, Gynecomastia Surgery, Orthognathic Surgery, Thyroid Surgery, Pacemaker Surgery, Appendix Surgery, Endometriosis Surgery, Colorectal Surgery, Open Heart Surgery, Glaucoma Surgery, Hip Surgery, Hysterectomy Surgery, Neck Surgery, Hydrocele Surgery, Ankle Surgery, Outpatient Surgery

Research & Reviews: Journal of Medical and Health Sciences

Research & Reviews: Journal of Medical and Health Sciences: Medical and Health Sciences is an International journal, publishes quarterly (Electronic and Print version) on the aspect of Medical and Health Sciences for an effective scientific reading and public view with an aim to reach the worldwide researchers. It is an open-access journal that aims to serve authors and readers (scientists as well as general masses) by providing them an easy and reliable source of knowledge.

Related Journals: Medical and Health Science Journal, International Journal of Medical and Health Sciences, International Journal of Medical Research & Health Sciences, Innovative Journal of Medical and Health Science, Annals of Medical and Health Sciences Research, Archives of Medicine and Health Sciences, International Journal of Health Sciences and Research, Health Science Journal, Journal of Medical Sciences and Health, International Journal of Innovative Medicine and Health Science, International Journal of Healthcare Sciences, International Journal of Health Sciences, Journal of Sport and Health Science, Current Health Sciences Journal, Medicine and health sciences, International Journal of Medical and Health Research, Journal of Research in Health Sciences, Global Journal of Health Science, Advances in Health Sciences Education, Science Journal of Public Health

Journal of Orthopaedic Oncology

Journal of Orthopaedic Oncology: Journal of Orthopaedic oncology provides a flexible platform for the authors to contribute their research work towards the journal and the editorial office promises a peer review process for the submitted manuscripts for the quality of publishing. For the Publication of the article in this journal peer-review process, at least two independent reviewer’s approval followed by editor approval is required. To maintain the quality in the review process there is an Editorial Manager System, Authors may submit manuscripts and track their progress through the system.

Authors can submit their manuscripts through the journal's online submission portal and For more information on Literature Publishers - orthopedic surgery case reports visit our site:- 

[oxfordpublishers]

Journal of Bone and Joint Diseases Case Reports published Case Reports in Joint Bone Spine, Case Reports in Bone Joint Surgery, Case Reports of Bone Disorders, Case Series of Bone Diseases, Clinical Image in Bone and Joint Diseases, Journal of Bone and Joint Diseases etc. Bone and Joints such as wrists, shoulders, knees, ankles and finger joints allow your body to move with ease.

[bubblegumgothglados]

This is my RACK focused judgment free primer for heavy impact play. It covers every part of the body from head to toe and at no point does it say you can’t do something just the risks of doing so. I don't normally put warnings on my posts but most of my writing is fantasy, this isn't. I'm going to talk about any number of painful deaths and heaps more ways of becoming disabled.

In this primer "you" means the one doing the hitting, "victim" is the one being hit, and "tool" is the thing you're hitting with which could be a fist, foot, hammer, bat, anything. I'm writing it this way because its fun for me.

This primer also assumes you know the different types of impacts and how they affect the body, if you don't go look at my other writings.

Finally i take no responsibility for anything you do. All this information is what i could put together from medical journals and car crash reports if I've got anything wrong (and you can prove it) please let me know.

Enjoy

Head. With hits to the head, the two major concerns are concussions and neck injuries. A concussion occurs when a person’s brain impacts with the inside of their skull, this happens because the brain is suspended in fluid so if the skull stops or starts moving suddenly the brain will move out of sync with the skull. Symptoms of concussions can include headaches, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness, and excessive fatigue. If your victim lost consciousness for any length of time and is having trouble speaking or understanding your words, you need to get them to the ER. There is no cure for a concussion but the best treatment is pain medication and activities that won’t tax the brain to give it time to recover. There are any number of ways to damage a neck, but generally it happens when a person’s neck is moved suddenly and violently or pushed past its limit. Minor injuries should heal by themselves within a few weeks but if unlucky pain and stiffness can last months or even years. For more major injuries, physical therapy or a neck brace might be necessary but only if the pain lasts longer than a few weeks. It’s also possible to hit someone hard enough to break their neck or fracture their skull but that takes a lot of force. All of these injuries can be avoided by supporting your victim’s head and neck by bracing their head against a surface or holding their head with your hand.

Jaw. It takes surprisingly little force to dislocate a jaw, you can do so with a good slap Dislocations are talked about in Note 3 at the bottom of this primer. Heavy bleeding from gums or a tooth that feels loose could indicate a fractured root. This is a fairly minor issue and if you see a dentist quickly they should be able to fix it back in place with no lasting damage. A tooth that has been knocked out completely should survive; get your victim to rinse their mouth out and rinse the tooth off and shove it back into the gap, and then have them see a dentist to make sure it’s properly seated and avoid chewing with it for a while.

Eyes. A fun combination of fragile and complicated. There's no first aid tips I can give you and it'll be real obvious if something is wrong. I will say you don't have to hit someones eye to give them a black eye, it’s bruising around the eye socket that matters. Also check Note 1 about the use of ice when treating injuries.

Nose. It’s more difficult than you think to break a nose. You definitely can with a good punch but you'll have to really commit. A broken nose isn't that serious (I've broken mine twice now) and isn't even ER worthy. If your victim is leaning backwards after breaking their nose the blood will run down the back of their throat potentially making them vomit or very sick. There is a chance a broken nose will heal in a way that restricts breathing in which case your victim may need surgery.

Cheek bone. Below the temple but above the gum line, running from just bellow their ear to their nose. Special mention to this spot because it’s the best place to hit your victim in the head (in my opinion). This piece of bone is very sturdy and not that risky to fracture. Plus, when you hit them here they have to watch it coming.

Neck. The windpipe, jugular, cranial nerves, vagus nerve, carotid arteries, and spine all live here and damage to any of these can cause permanent disability or death. Seek medical attention if your victim has trouble breathing or swallowing, or a lot of pain or swelling. Stingy tools are far less risky here than thuddy tools.

Shoulders. Note 2 on joints. The shoulder blades can either be an ideal impact location or one of the most risky depending on how it’s sitting. If the shoulder blade is jutting out away from the rest of the back, it’s very easy to damage If it’s laying flat against the back, it’s protected by a thick layer of fat and muscle.

Biceps. Top 4 impact location. The main concern is damaging the elbow and shoulder joints, if hitting in a way that will pull on those joints. Much like with the head, bracing the impact area against a surface will minimize the risk. Repeated hits to this area can temporarily disable the arm, which is fun.

Forearm. As above, the main risk is damaging the adjoining joints. There are also several important blood vessels and nerves running through this area and not a lot of fat an muscle to protect them.

Hands. Very little fat or muscle, mostly tendons, nerves, and cartilage. See Note 2 on joints. Special note to the palm, which hurts like hell but is relatively safe because of the extra muscle and fat in that area, great for punishment. Once again, stingy tools are much less risky than thuddy tools.

Breasts/ biceps. Top 4 impact locations. Thick layers of fat, muscle, and bone protect anything vital.

Sternum. That is the bone running down the center of a person’s chest that connects to their ribs. Not in itself very fragile but the cartilage that connects it to the ribs is easily damaged and will take a long time to heal. A fractured sternum will likely cause shortness of breath and pain when taking deep breaths. There's not much to be done about these injuries just rest and avoiding strenuous activity.

Spine. The single most risky impact location. Any damage to the spine risks permanent paralysis of everything below that point. As ever, stingy tools present less risk than thuddy tools.

Rib cage. Designed to protect a person’s most vital organs, the rib cage is very strong. Fractured ribs will cause pain breathing but aren't particularly serious. Snapped ribs can pierce organs If this happens, it'll be immediately obvious and medical intervention is required to prevent painful death. Special note to the 'floating' ribs at the bottom of a persons rib cage which don't connect to the sternum and are therefore much less resilient. Second special note to the spot right above a persons heart. A significantly hard impact at exactly the wrong moment in their cardiac cycle can stop their heart. They will loose consciousness and you will need to give them CPR until they can be defibrillated. This is ridiculously unlikely but better to mention just in case.

Abdomen. If you feel around your victim’s belly, you can figure out the line where their abdominal muscles sit. If you have them tense these muscles, you can hit them fairly hard with relatively little risk because the muscles plus the fat in that area create a thick layer of protection. (Pro tip: "Stay tense or this will might kill you" is not only true but hot and terrifying). Outside of that area or if they don't tense, there's real risk of bruising or even rupturing their intestines, which carries a 50-70% survival rate depending on how quickly you can get them to the ER. Symptoms to look out for are bloating, diarrhea, loss of appetite, and fatigue. Special note to the kidneys, which sit next to the backbone just below the rib cage and are very easily bruised. The primary symptom to look for is blood when peeing. As always, stingy tools carry less risk than thuddy tools.

Gluteus maximus. That's their butt. Hit it as hard as your victim will let you. Enough has been said about this region; I don't feel the need to recover that ground. Note 4 on bruises.

Genitals. I'm not going to get into CBT, that's a separate kink. But the vagina is very durable as it’s pretty much just flesh and fat on the outside Minimal risk, go to town.

Thigh. Top 4 impact location. Outer thigh will hurt more and bruise more. As with the head and arms, the primary risk is damaging the adjoining joints. Note 4 on bruises because this is the primary place for DVT.

Calf. As above. Shins are also a great location for punishment because they hurt like hell.

Feet. Very similar to hands. The soles of a person’s foot are intended to impact with the ground frequently and with some force, so they can take a fair bit of punishment.

Note 1. Ice. It is no longer suggested injury procedure to use ice to reduce swelling. Yes, it is effective at reducing swelling but we now understand swelling is an important part of the healing process and although ice might make it feel and look better in the short term, it actually increases the amount of time the injury will take to heal. You want the blood to be able to flow to the injury to take away dead cells and bring nutrients and energy.

Note 2. Joints. Neck, spine, shoulders, elbows, wrists, fingers, hips, knees, ankles, and toes. The reason these are almost always labeled "red" or "no go" on impact play body maps is because these are choke points for blood vessels and nerves; they are made of fragile tendons and cartilage, and they have very little padding for protection. They're also important for movement day to day and very difficult to heal properly. If a joint is damaged, you can buy braces for every joint from most pharmacies.

Note 3. Dislocations. If you're lucky, a partial dislocation will relocate by itself if you move the joint around as you normally would, not forcing it or trying to manipulate it with your hand, just moving it with its own muscles. If it does naturally relocate but you still have pain a few weeks later seek a medical professional. If you're unlucky or if it’s a total dislocation, you will have to see a medical professional. DO NOT TRY TO FORCE IT BACK INTO PLACE!

Note 4. Bruises. Normally, bruises are nothing to worry about but there are situations where a deep bruise can be a health concern. If the bruise continues to get worse after a week, there could be a hematoma under the skin, which is like a blood clot, and might need to be removed. The other possible complication is Deep Vein Thrombosis, which is a blood clot and can be lethal, if not treated quickly. With DVT, the symptoms are tenderness, warmth, and a "pulling sensation" which are pretty normal impact play symptoms. But if you're doing impact play at the level that could cause DVT, then you and your victim should know their healing process intimately, so if something feels off or isn't healing right, get them to a medical professional; better safe than dead.

[simply-ivanka]

Now the Trump Jurors Can Be Told

Without the limits placed on witness testimony, they can now learn why the case was faulty.

Wall Street Journal - James Freeman

In the Manhattan trial of former President Donald Trump, it seems that partisan judge Juan Merchan insisted on so many limits on the potential testimony of former Federal Election Commission Chairman Bradley Smith that the defense decided it was pointless to put him on the stand. But now the jurors can learn what Journal readers have known for more than a year—hush-money payments to alleged mistresses are not campaign contributions.

This weekend Mr. Smith noted this again on X and also explained in a series of posts why there was a big chronological hole in the claim that a 2016 payment to alleged mistress Stormy Daniels was improperly reported to avoid damaging news prior to that year’s election:

The payment to Daniels was made on Oct. 27. So the payment would not have been reported on the Pre-election report… The next report is the Post-Election Report…

In 2016, the Post-Election Report was required to be filed on December 8, one month after the election. So the prosecution’s theory, that Trump wanted to hide the expenditure until after the election, makes no sense at all…

Even if we assume, incorrectly, that it was a campaign expenditure, it wouldn’t have been reported until 30 days after the election. But again, none of this got to the jury, either through testimony or the judge’s instructions…

Merchan was rather obviously biased here, but I’ll give him the benefit of a doubt and say he was just thoroughly ignorant of campaign finance law, and had no interest in boning up on it to properly instruct the jury.

Mr. Smith sums up the issue under relevant federal law:

There was no illegal contribution or expenditure made, and no failure to report an expenditure. And even if we assume otherwise, the prosecution’s theory made no sense, suggesting no criminal intent.

Could this case look any worse? It seems that even if one made the error of regarding the hush-money payment as a campaign contribution, there would still be ample reason to question the constitutionality of the verdict. Steven Calabresi, who teaches law at Northwestern and Yale, writes for Reason magazine:

In 2010, in Citizens United v. Federal Election Commission, 558 U.S. 310, the Supreme Court held 5 to 4 that the freedom of speech clause of the First Amendment prohibits the government from restricting independent expenditures for political campaigns by closely allied corporations and groups like The Trump Organization. Under Citizens United, it was perfectly legal for The Trump Organization to pay Daniels $130,000 in hush money to conceal her alleged affair with Donald Trump…

Groups contributing to election campaigns can pay for advertising to promote candidates, and they can also pay hush money to keep bad or false stories out of the news. The effect either way is to help the candidate. You can contribute money to generate good publicity.  And, you can contribute money to avoid bad publicity.  The First Amendment protects freedom of speech in both cases.

Mr. Calabresi adds:

The U.S. Supreme Court needs to hear this case as soon as possible because of its impact on the 2024 presidential election between President Trump and President Biden. Voters need to know that the Constitution protected everything Trump is alleged to have done with respect to allegedly paying hush money to Stormy Daniels. This is especially the case because the trial judge in Trump’s Manhattan case wrongly allowed Stormy Daniels to testify in graphic detail about the sexual aspects of her alleged affair with Trump. This testimony tainted the jury and the 2024 national presidential electorate, impermissibly, and was irrelevant to the question of whether President Trump altered business records to conceal a crime. The federal Supreme Court needs to make clear what are the legal rules in matters of great consequence to an election to a federal office like the presidency.  A highly partisan borough, Manhattan, of a highly partisan city, New York City, in a highly partisan state, like New York State, cannot be allowed to criminalize the conduct of presidential candidates in ways that violate the federal constitution.

The Roman Republic fell when politicians began criminalizing politics. I am gravely worried that we are seeing that pattern repeat itself in the present-day United States. It is quite simply wrong to criminalize political differences.

Some readers were disappointed in your humble correspondent for suggesting on Friday that Gov. Kathy Hochul (D., N.Y.) should pardon Mr. Trump. Given the logical and constitutional flaws in the case, these disgruntled readers think it would be better to have this outrage exposed in the appeals process and completely repudiated, whereas a pardon might appear to some to be a merciful response to a legitimate prosecution for the sake of political comity. Perhaps such readers needn’t worry. Jon Levine reports for the New York Post:

A person close to Hochul said a pardon was “unlikely.” 

“I cannot image a world where she would consider doing this, this makes no sense,” said the insider.

[elljayvee]

Today I'm more than usually annoyed with a pop science article, so I'm going to talk about reading these sorts of articles, why you should always be skeptical of claims in them, and some of the ways you can tell the article's author didn't understand what they were reading and told you the wrong thing.

I clicked on an article in Eating Well about low bone density and dementia, because my mother has both. There's not a lot we can do for her now, but I am a curious person. I know Eating Well isn't great at science interpretation and communication, so I'm anticipating that I'm going to need to read the original study already, going in. (How do I know Eating Well isn't a great source usually? Well, I have read it before, and it has some really clear biases if you read a few articles that aren't science communication, and so you get to know a source over time like that. Regardless of how, I'm already suspicious they're not going to do a great job.)

The article is talking about research that shows low bone density may be predictive of dementia risk. It is written by a journalist and reviewed by a dietician. Now, I don't know what review the dietician did, but she did a bad job, and also, so did the journalist, because THE FIRST red flag that goes up is pretty quick: the math is very, very clearly wrong.

This says there are 3651 participants, and that over 11 years, 688 of them developed dementia. This is 18.8% and the article calls it 19%. That's fair! Not a red flag so far, just rounding. Then it says that of the 1211 people with lowest bone density at the start, 90 people (7.4%) developed dementia, and of the 1211 with highest bone density, only 57 (4.7%) did.

This IS a red flag. It's a GIANT red flag. This red flag can be seen from SPACE by anyone who knows how percentages work.

Here's how: You have 3651 people. 1211 of them are in the low bone density group, 1211 of them are in the high bone density group, leaving 1249 people. You have 688 total dementia cases, but your high and low groups account for only 147 of them, leaving 541 cases for that middle group. That's a LOT of cases. That middle tertile, just eyeballing it, has to have about 40% of its people with dementia -- that makes low bone density look like it predicts LOWER dementia risk relative to the middle group.

I can write out the equations for you two ways:

3651 - 1211 - 1211 = 1249 688 - 90 - 57 = 541 541/1249 = 0.433 0.433(100) = 43.3%

Because I am someone who does a fair amount of stats for a living, though, what I noticed was pretty much this equation:

0.074(1211) + x(1249) + 0.047(1211) = 0.19(3651) and I knew immediately that x had to be MUCH bigger than it should, which indeed the math bears out: x(1249) = 0.19(3651) - 0.074(1211) - 0.047(1211) x(1249) = 694 - 90 - 57 x = 547/1249 = 0.438 0.438(100) = 43.8%

That 694 is because the authors rounded 18.8 to 19 earlier, not because I can't math. So, due to rounding, you get slightly different answers -- but BOTH of them point to something SERIOUSLY WRONG with the reporting. What is actually going on in that middle tertile? Where do these numbers come from? Well, lucky us, they mention the name of an author, a journal, and a date. Always be wary of pop sci articles that don't give you a way to track down the original, but giving you that way to track things down doesn't mean they aren't still doing a crummy job with their reporting, as we see here.

The original paper is Association of Bone Mineral Density and Dementia: The Rotterdam Study, published March 2023 in Neurology. This is a pretty technical article with a fair amount of math and things in parens etc. etc. and tables and lots of measurements. The table captions are often not the greatest, which makes it a bit harder to read and interpret. For example, in Table 1, items are listed as number(number) and this can be any of:

count (percent) -- this one's usually labeled in the table itself

mean (standard deviation)

median (interquartile range) -- these last two are NOT labeled in the table, so we don't know which set of numbers is which.

Great. Thanks guys. Assuming what's called a "normal distribution" mean (SD) and median (IQR) numbers will be similar, but they're not the same and I'm irritated they're conflated but OK. Soldiering on!

The original study looked at several different measures of bone density, and found only ONE of them to show predictive ability for dementia: the density of the femoral neck. This means that for their article, Eating Well should have looked at the results for femoral neck bone density, which we find in Table 2:

You have the actual numbers for 5 years, 10 years, and study end, as well as the hazard risk (HR) for each bone density tertile, with the highest tertile set as the standard. Numbers in the HR column have 1 as a reference point -- lower than 1 is lower risk than the highest tertile, and higher than 1 is higher risk.

The first thing I noticed is that neither 57 nor 90 occur in the femoral neck section at ALL. Those numbers from the Eating Well article are just not there. I also notice that the other numbers don't align even one little bit -- the number of total cases of dementia is different, for example. I do notice that the column with the 10 year followup has numbers in it close to 57 and 90 (49, 67, 86, totaled to 202) and that the overall numbers for the total study are much higher -- 201, 236, 229. Interesting.

At this point, I just straight-up search the paper for "90", and I find it in Table 2....in the total bone density section, which the paper's authors have said is NOT the section that showed possible predictive results. I search for "57", and also find that in total bone density, and also....wow the EW author straight up failed to read. This is actually worse than I thought.

Read across, these are the 5 year followup numbers (first 2 columns - count and HR), 10 year (middle 2 columns), and total followup numbers (last 2 columns).

We see our friends 57 and 90 in the 10 year columns. 90 is, as described in the EW article, in the lowest bone density tertile, but 57 is NOT in the highest bone density tertile. It's in the middle tertile. The actual number for the highest tertile is 68. Additionally, the total cases for 10 years is nowhere near that 688 number -- it's 215. We only get total case numbers close to 688 when we look at the study end numbers: it's 686, in this particular group. If we look at the study end case numbers for highest, middle, and lowest tertiles, we see WHY this particular measure can't be used to predict anything: they are 227 (highest), 227 (middle), and 232 (lowest) -- not significantly different from each other.

We can also see here that this group of people -- people who had total bone density measurements -- is not 3651, but 3633, which is listed across the bottom row. The overall STUDY had 3651, but not all of them had total bone density recorded.

Now we know that the author of the EW article did all of the following:

read the wrong part of Table 2

mixed up middle and high tertile results

reported 10 year results mixed with total followup results (this resulted in the weird math that alerted me something was very very wrong in the first place).

and the person who was supposed to review the article didn't have even the basic math skills to catch the problem -- which she absolutely should have, as a registered dietician. For giggles, I looked up program requirements for a BS in Dietetics. Programs require things like statistics and precalc -- not math heavy, but the math that alerted me to this problem is VERY basic statistical knowledge, like the kind they teach in 6th grade level statistics, which I know because it was literally in my 6th grader's curriculum this past school year. So a registered dietician DEFINITELY had enough math to catch this problem, and should have, and Eating Well should be ashamed of itself.

SO. What can we learn from this?

Well, science communication is a skill set. Some people have worked very hard to develop that skill set and are excellent at it -- but lots of people do not have it, and even those who do can make mistakes. Many, many pop sci articles are not written by trained science communicators, or people with any education in how to read scientific articles, or people with good reading comprehension, even. It's very common for pop sci articles to have these sorts of errors in them. Therefore:

Always read pop sci articles with a skeptical eye. Ask yourself:

Do these numbers line up? Usually the math in pop sci articles is not very complex -- you can often do some basic arithmetic to make sure it even makes sense, as was the case here.

Does one part of the article seem to contradict another part of the article?

Do I feel confused about what exactly I'm being told? What's not clear about it?

Am I being told about HOW something works or WHY it works or both? Are those two things being conflated somehow?

Is there a link or way to find the original research? If not, my advice is to throw the whole article away. If yes, you can go check it out -- often just looking at the abstract or results section will be enough, and abstracts usually aren't paywalled even if the rest of the article is. You would be surprised how many times the abstract says "we found X" and the pop sci article says "the researchers found Y".

Could I explain this article to someone and have it make sense? If not, why not?

Is the article confusing correlation (these things happen together) with causation (one of these things causes the other)?

Pop sci articles, like other journalistic articles, are extremely subject to bias issues from the publication they're in. A lot of people tend to read pop sci articles as neutral, factual reporting, but they aren't! I mentioned EW's biases earlier -- the one I think is most relevant to how their article is written is a pervasive belief that if you just eat the right things in the right amounts you will be thin and healthy and stave off all kinds of problems. They close their article by mentioning that, although the study's authors are clear that this connection is unlikely to be causative, and that risk factors for low bone density and dementia have substantial overlap, readers should act like it might be causitive with diet and exercise choices that promote bone health. They were so excited to get to their point about fixing your diet that they didn't pay attention to the actual science they were reporting on. (Sidenote: actual scientific journal articles are supposed to be neutral, factual reporting. They also aren't actually that, but there are some measures in place around this to try to prevent the worst effects of bias.)

It's worth brushing up some basic math skills. You don't need to know a lot! Very basic information will help you better understand a lot of articles -- both ones that are accurate and well-written, and ones that are shoddy and should not have been published. I really like Larry Gonick's The Cartoon Guide to Statistics but if your grasp of percentages is shaky, it will be too advanced. A good option might be something like The I Hate Mathematics! Book, which is pretty old but really accessible, but there's probably some newer great ones out there that I just don't know about.

[afeelgoodblog]

1. Girl with incurable cancer recovers after pioneering treatment

A girl’s incurable cancer has been cleared from her body after what scientists have described as the most sophisticated cell engineering to date. Alyssa, whose family do not wish to give their surname, was diagnosed with T-cell acute lymphoblastic leukaemia in May 2021.

Scientists at Great Ormond Street Hospital for Children in London gave her pre-manufactured cells edited using new technology to allow them to hunt down and destroy cancerous T-cells without attacking each other. Less than a month after being given the treatment, she was in remission, and was able to have a second bone marrow transplant.

Can I get a fuck cancer?

2. The UK has made gigabit internet a legal requirement for new homes

Updated regulations require new properties to be built with gigabit broadband connections and make it easier to install into existing blocks of flats across the UK. Connection costs will be capped at £2,000 per home, and developers must still install gigabit-ready infrastructure (including ducts, chambers, and termination points) and the fastest-available connection if they’re unable to secure a gigabit connection within the cost cap

3. US cancer death rate falls 33% since 1991

The rate of people dying from cancer in the United States has continuously declined over the past three decades, according to a new report from the American Cancer Society.

The US cancer death rate has fallen 33% since 1991, which corresponds to an estimated 3.8 million deaths averted, according to the report, published Thursday in CA: A Cancer Journal for Clinicians. Partly due to advances in treatment, early detection and less smoking, report says

. . .

Thank you for following. You can support this newsletter for less than a price of a cup of coffee:

Support with a coffee ❤️

Let’s continue with the good news…

. . .

4. Lab-grown retinal eye cells make successful connections, open door for clinical trials to treat blindness

Retinal cells grown from stem cells can reach out and connect with neighbors, according to a new study, completing a “handshake” that may show the cells are ready for trials in humans with degenerative eye disorders.

Over a decade ago, researchers from the University of Wisconsin–Madison developed a way to grow organized clusters of cells, called organoids, that resemble the retina, the light-sensitive tissue at the back of the eye. They coaxed human skin cells reprogrammed to act as stem cells to develop into layers of several types of retinal cells that sense light and ultimately transmit what we see to the brain.

5. The ozone layer is on track to recover in the next 40 years, the United Nations says

The Earth's ozone layer is on its way to recovering, thanks to decades of work to get rid of ozone-damaging chemicals, a panel of international experts backed by the United Nations has found.

The ozone layer serves an important function for living things on Earth. This shield in the stratosphere protects humans and the environment from harmful levels of the sun's ultraviolet radiation. In the latest report on the progress of the Montreal Protocol, the U.N.-backed panel confirmed that nearly 99% of banned ozone-depleting substances have been phased out.

6. Uganda declares an end to Ebola outbreak

The Ugandan government has declared an end to its Ebola outbreak, less than four months after cases were first reported. Since 20 September, 56 people have died from the virus, which is spread through body fluids, and there have been 142 confirmed infections.

The country has reported no new infections in more than 42 days – twice the maximum incubation period of the virus, a World Health Organization benchmark for a country to be declared Ebola-free.

7. Doggy ‘daycare’ bus in Alaska goes viral on TikTok

Check them out here:

- - -

That's it for this week. If you liked this post you can support this newsletter with a small kofi donation:

Buy me a coffee ❤️

Subscribe for more weekly wholesome news...

[miss-anthropyxx]

Abdomino-pelvic impalement x3 in a 17-year-old who somehow managed to not die

[Original medical journal case report] [Credit to how this was found]

A 17-year-old female fell from second floor directly over iron rods of an under-construction building at midnight. Although three iron rods penetrated inside her body, she was conscious and oriented but cried in pain. Neighbours cut the rods from the iron pillar with drilling machine and shifted the patient from accident site to the emergency department of our hospital which took 5 hours. During this interval, she was in sitting posture and could not lie down fearing additional trauma due to the penetrating rods. On examination, she was conversant and had a pulse rate of 126/minute and pallor. Two iron rods could be seen penetrating her abdomen and pelvis while the third one went through and through her gluteal region [Figure 1].

A part of her cloth also went inside the path of the iron rods. Blood clots could be seen at the entry and exit wounds. Abdomen was not distended, and child had passed clear urine once on her way to the emergency department. There was no evidence of any injury to the chest, head, neck, spine or the extremities. At arrival, along with the primary survey, an intravenous line was secured to start fluids, antibiotics and analgesics. Tetanus toxoid and tetanus immunoglobulin were administered. Simultaneously, samples were sent for routine blood investigations and cross match. Haemoglobin was 8.9 and haematocrit was 27. Chest, abdominal and pelvic skiagrams were taken to assess the passage of the rods and any bony injury. One of the rods could be seen penetrating through the right iliac bone. Another rod went through and through the ascending colon just distal to the ileo-caecal junction and also the right iliac bone. There were no major vascular or urinary injuries. All the solid organs were spared. Resection of the jejunal segment containing the two perforations was done followed by end-to-end jejuno-jejunostomy.

Patient was shifted to the operation theatre and was put in left lateral position between the operation table and shifting trolley, so that the rods came in between the trolley and the operation table. In this position, patient had induction of anaesthesia using 100% oxygen for 3 minutes followed by Etomidate (100 mg), Fentanyl (75 mcg) and Succinylcholine (75 mg) [Rapid sequence induction], followed by intubation using cuffed oro-endotracheal tube of size 7.0. Following this, patient was maintained on Oxygen, Air and Sevoflurane, then patient was shifted to operation table in sitting posture and surgical procedure was started. Rod in the gluteal region was removed first after increasing its entry and exit wounds slightly. It was seen to pierce only the gluteal muscles. The passage was washed with hydrogen peroxide and saline and packed with betadine-soaked gauze. She was then turned supine and laparotomy was done through midline incision. One of the rods was seen to pierce the jejunum twice at approximately 30 and 40 cm from the duodeno-jejunal junction [Figure 2].

Ileo-ascending anastomosis was done after excision of the caecum along with the perforated ascending colon. No orthopaedic intervention was needed for the rod penetrating the right iliac bone. Tension suturing was done after insertion of drains in pelvis, right and left paracolic gutter. She received three units of packed cells in the peri-operative period. Patient was transferred to the Intensive Care Unit post-operatively and was there for 5 days following surgery for intensive monitoring and management. Antifungal agents were added when positive fungal blood culture was seen following fever on 3rd post-operative day. Patient passed flatus on 5th post-operative day and tolerated oral food from the next day. Drains were removed on the 5th post-operative day. Wounds over gluteal and iliac regions were conservatively managed on dressing and antibiotics. The total duration of hospitalization was 24 days and patient were discharged with advice of daily dressing of these wounds. First follow-up was after 15 days of discharge and subsequent two follow-ups were after one and three months of discharge. She has been asymptomatic on follow-ups. Figure [3] shows her scars after 3 months of discharge from hospital.

[baeddel]

tips for writing a character with type 1 diabetes

people make these for whatever disability they have. but most of the time they're not really about writing, they're just informative about the disability, which isn't always that helpful. i thought it'd be fun to do one that takes the writing part seriously. so, here's mine!

the only fictional depiction of diabetes i'm aware of is Paul Blart Mall Cop. it's a pretty stupid point of reference, so i'm mostly going to be talking about the protrayal of the blood plague in Bloodborne instead. perhaps surprisingly, this post contains Bloodborne spoilers.

Table of Contents

Preface on Modes of Narrative Discourse

Tip 1: Varieties of Diabetes

Tip 2: Onset of Diabetes

Tip 3: History of Diabetes

Tip 4: Living with Untreated Diabetes

Tip 5: Treatment of Diabetes Today

Tip 6: Hypoglycemia

Tip 7: Diabetes is an Immune System Disorder

Conclusion

before we start, in this post i'm going to use the division of the narrator's discourse employed by Lubomír Doležel in Narrative Modes in Czech Literature, 1973, 5-10, except i'm using 'third person' and 'first person' instead of Er-form and Ich-form because you'll stop reading if i call them that. here's his chart for reference:

the objective narrators (first and third person) are totally external to the events they narrate and have no interpretations to make about what they see—they write in the detached manner of an ornithologist's field journal. example: Hemmingway's 'the Killers.'

the rhetorical third person narrator gets to interpret what it sees; the interpreter in rhetorical third person will generally be someone not involved in the story, such as the author themselves or a fictional storyteller like Shazarad. example: Balzac's 'Sarrasine' (once the Sarrasine sequence actually starts).

the subjective third person narrator is when the answer to 'who speaks?' and 'who sees?' is different. here, the narrator confines their interpretation to the point of view of a specific character within the story. Dolezel's example: "When Helenka was finishing her internship in orthopaedics, there was in the ward a young man who had broken his thigh-bone. Such a common femur fracture, a rather uninteresting case" (M. Pujmanova, Playing with Fire). the comment that the fracture is "uninteresting" is spoken by the narrator, but it is obviously Helenka's interpretation.

the personal and rhetorical first person narrator is a character within the story who can report on their own thoughts and feelings. the personal narrator acts within the story, while the rhetorical narrator merely comments; generally first-person stories will contain all three kinds of first-person narration; personal for their own actions, rhetorical for the actions of others, and observer's for things like providing context about the enviornment. example: Hajime Kanzaka's 'Slayers.'

i promise it's going to be important. now for the tips!

TIP 1: there are different kinds of diabetes

Type 1 diabetes (5-10% of cases), MODY (1-2%) and MIDD (1%) are genetic, whereas Type 2 (90%) and Gestational Diabetes are acquired. you get Gestational Diabetes during pregnancy and then it goes away (it occurs in 6% of all pregnancies), and you acquire Type 2 diabetes pretty much randomly although it's highly correlated with bodyweight. MIDD is accompanied by hearing loss. there is another unrelated disease which is also called diabetes, diabetes insipidus.

if you're writing about a historical period Type 2 is going to be much less common. the number of people with Type 2 has exploded since the 1960s. "As of 2015 there were approximately 392 million people diagnosed with the disease compared to around 30 million in 1985" (wiki). personally i don't know jack shit about any of those other kinds, so i'm only going to talk about Type 1.

TIP 2: onset is prolonged and dangerous

while Type 1 is entirely genetic, onset doesn't actually start until your teens or twenties. basically, your pancreas just stops working. you cannot predict if this will happen, and you won't notice as soon as it does happen.

when you eat carbs or sugar you're absorbing glucose. your body detects the presence of glucose and the pancreas creates insulin which converts glucose into energy. when your pancreas stops working, you will not produce enough insulin to convert the glucose and it'll stick around in your system indefinitely. this is called 'hyperglycemia' or 'high blood sugars' and it is extremely perilous, but its effects come on slowly.

first of all, you will suffer fatigue and tiredness because you aren't making enough energy. at the same time, all the excess glucose your body isn't using will stick to your cells and cause problems. it sticks to the retina, causing vision problems (everything is white and gooey, like you've been rubbing your eyes). it collects in veins and arteries, slowing the flow of blood to the extremities, causing your hands and feet to become severely cold. you'll be lightheaded and dizzy all the time. you urinate constantly, and you also become extremely thirsty, nothing will parch your thirst, and your urine will be completely clear, like water. you lose a lot of weight. you sleep for extremely long periods of time and no one can wake you up. eventually you'll start to collapse during the day and lose consciousness. then you'll die.

if you're reading this and think you have some of those symptoms, please see a doctor!

for myself, i was collapsing unconscious regularly before anyone realized something was wrong. while i've just described these things as symptoms of a disease, your characters are probably not likely to interpret it as a disease right away. i was about fifteen, so my family probably thought i was just a teenager. i didn't want to go to school, but no teenager wants to go to school. i was sleeping in all the time, but that just meant i was lazy and needed to be disciplined. these years (years!) were very hard in my family; every morning i would fight back visciously to stay in bed. i would refuse to attend school and i would defend myself if they tried to drag me. punching and clawing. i was a disobedient teenager with behavioural problems and poor attendance. in fact, i was very close to death. it was only after i started passing out that it became evident to anyone (including me) that something was wrong with my health. when they took me to the doctors they hospitalized me immediately.

so if you're going to write about a character experiencing the onset of diabetes, they are going to have most of these symptoms, but they will probably not experience them as symptoms. if they are from a society like ours, which puts a lot of value on work ethic, they'll probably blame themselves for their flinching self-discipline. they are not likely to connect things like their worsening eyesight to their sleep and behaviour changes; they all come on slowly, over a long time, and don't look connected. other characters will notice gradual changes in their behaviour; their lover might find that they've become distant and disinterested in sex, the people at their church might notice that they attend less, and so forth. they're likely to have become isolated from the people in their life before they start passing out, so no one might be around to notice. i dropped out of my social life before anyone learned i had diabetes, so my old friends don't know what happened.

so, the onset period of Type 1 Diabetes is inherently denpa (see). it also has a natural narrative arc; there is a period of confusion, uncertainty and conflict which culminates in the dramatic symptoms of prolonged hyperglycemia—the sudden fall from unconsciousness. the diagnosis recontextualizes everything the reader has previously witnessed about this character. it therefore fits well in a slow story which takes place over a long time, months or years, and wants a coy narrator who can fairly hide information from the reader: personal first person, observer's first person, objecive third person or subjective third person. in this situation it's an especially good red herring, for example in a mystery or horror novel where the reader is paying close attention to out-of-character behaviour, and a long, slow, character-focused story is expected. but you could also pick a rhetorical third person narrator who conveys information to us which the characters are ignorant of, allowing the reader to cringe as the characters act on their misapprehensions. example:

once Eric didn't open the door on the third day of knocking Lune said "what the hell, you bastard," and then they said "i didn't need you anyway, and i'm not sad you're breaking up with me." then they went and wrote him a pissed-off letter about how they would just go to Denver on their own after all and they stuffed it in the letterbox. four days later when Eric woke up from his diabetic coma he found the letter.

i understand that suggestions like this can be a bit less than useful, since a lot of writing ideas only work in one story, so if you read it in a post someplace it's probably already too late to use it. i would like to make the case, however, that Type 1 diabetes onset can be a generically useful trope. Amnesia is a generically useful disorder in fiction because of how efficiently it solves narrative problems; it allows first person and subjective third person narrators to hide information, and it gives the characters an excuse to explain known information to the reader—the character just forgot all the important stuff. Type 1 diabetes can't be quite that useful to narrators, but it is quite useful; untreated diabetes causes a person to be inconsistent, unreliable and uanvailable. if you ever need a character to fail to show up at a crucial moment in the story, but you don't have a reason yet—it was the diabetes! EZ! this turns what might have been an inconsistency into a set-up for a later payoff, when they figure out what was wrong with them.

more generally than Type 1 diabetes, 'life-changing symptoms which no one realizes are symptoms' and 'slow onset of an unpreventable disease' are common situations in real life, but don't happen very often in fiction, so you should feel free to use them. it's a device that's used to excellent effect in Bloodborne, where it affects almost every character in the game, since everyone uses a substance the tragic effects of which they could not foreknow. because in Bloodborne it's happening to every character all the time the trope has a stochastic impact on the player; as the player learns more about the plague curiosity gradually shades into dread, the heart sinks with each new phase of the moon as the player worries about the characters they've left back at Oedon Chapel.

TIP 3: diabetes was understood from ancient times all over the world

there's a bit of a misconception that nobody knew anything about health and illness until very recently, and past peoples attributed everything to magic. for example, there have been countless attempts to diagnose Hildegard von Bingen with Temporal Lobe Epilespy based on her descriptions of her mystical visions, which—while it isn't refuted by this evidence—seems a bit unchairtable considering she was a physician who especially wrote about epilepsy herself. in short, assume people in the past were medically informed.

according to wikipedia diabetes is one of the oldest diseases described (see). in ancient and imperial China it was called "wasting-thirst", and the article talks about how ancient Egyptian and Indian physicians diagnosed it based on the sweetness of the urine; we actually still diagnose diabetes this way, except we use a chemical that reacts with the urine instead of taste unfortunately. Galen named it diarrhea urinosa, 'diarrhea of the urine', in reference to how much you pee. Galen's medical writing was circulated all over the Middle East and, later, Europe in the medieval period, and diabetes was also described by Celsus who's work was circulated throughout early medieval Europe.

they didn't, however, have an effective treatment for it. if you're writing a historical setting it's likely to mean a long, slow, and unpreventable death. "[Aretaeus of Cappadocia] described the disease as 'a melting down of the flesh and limbs into urine' [...] commenting that "life (with diabetes) is short, disgusting and painful'" (wiki). i'll talk more about contemporary treatment below.

TIP 4: a short, disgusting, and painful life is worth writing about

in tip 3, when we talked about the onset of diabetes, we were thinking from the perspective of a character experiencing gradual changes. but death from untreated diabetes might take years, so they have plenty of time to settle into new habits and routines. it's worth thinking about not just how they change, but what kind of person they become, and therefore might already be before your story starts.

you will get access to the untreated diabetic's first person perspective in the narrative discourse if you're writing them from their own point of view in personal first person or subjective third person, as well as in their character's discourse (ie. dialogue) or in their reported speech. we immediately have some interesting questions about such a character's first person perspective:

1. do they know they have diabetes?

2. if so, are they receiving an ineffective treatment?

Avicenna (our Avicenna!) treated diabetes with "a mixture of lupine, trigonella (fenugreek), and zedoary seed" which could not have helped anyone.

3. if so, do they believe that treatment will work?

i have a very unusual form of Type 1 diabetes which is extremely difficult to treat (there isn't a name for it or anything, as far as i know i'm the only one). it took over ten years to stabilize, and i still have to endure a lot of compromises. all the while i also had Chronic Fatigue Syndrome, which further confused my and my physician's ability to understand what was happening to me. within my own psychology there were two stages of post-diagnosis experience; an initial faith that i would eventually respond to treatment and everything will go back to normal, and the gradual realisation that help isn't coming. yearning and passivity turn to dejection and stubbornness as doctors stop ordering new tests and i stop asking for them.

4. if they don't know they have diabetes, how do they interpret what's going on with them?

earlier on we talked about a hypothetical diabetic who blamed their lack of work ethic for their problems. how are they doing four years later? they might start identifying with their inaccurate self-image; now they've become a bitter, stubbornly workshy Belacqua.

4. how do they live as someone with untreated diabetes?

remember the symptoms from before; aside from constant urination, exhaustion and losing weight, your sleep becomes very disordered. it is difficult to socialize, keep appointments, work. for myself i have never worked a single day, i no longer leave my house, and i usually sleep during the day. as a teenager and young adult, either before diagnosis or during the unstable period where i did not respond to treatment, i certainly became a different person. i gave up on my physical hobbies and focused on things i could do by myself at any time of day. i read a lot of strange books, i argued with strangers online, and so forth. i was probably never destined to be a normal person, but i certainly became more strange, more reclusive, more self-involved, until i no longer even really share a culture with my neighbours. your untreated diabetic will probably be this way. an eternal stranger; a diseased anchorite, slowly dissolving in the latrine, barely touched by the material world which passes overhead.

many characters in Bloodborne are protrayed that way, but Gilbert is a good point of reference. he is locked in his house—we never see his human form—so we encounter him as a disembodied voice. he is a stranger to Yharnam—he is as alienated from it as the player and becomes our confidant—yet he is also the source of special information. he has certain foreknowledge of his own inevitable death; in conversation he is politely dismissive about it, although you can overhear his terrified pleading.

our experience of Gilbert in Bloodborne is a strictly third person one. Gilbert doesn't want to talk about his health, so his statements in character's discourse are brief and a bit dishonest. the player therefore has to read between the lines. after playing some more of the game they probably assume that Gilbert is suffering from the same beast plague everyone else is. when Gilbert finally turns into a beast and attacks the player we are therefore not surprised, but find our suspicions horribly confirmed. this kind of elenctic delivery, which coaxes knowledge from the reader rather than informs them, is an attractive way to present the symptoms of a secondary character who is only available in third person objective, third person subjective or another character's first person, and the nature of their condition never has to be made explicit. such a character might be—as we suggested earlier—missing or unavailable. they might live alone, not work or socialize, sleep all the time, seem exhausted, and so forth. every time these symptoms present themselves it both explains that character's personality and foreshadows their future, either early death or diagnosis.

all together, the symptoms of untreated diabetes can be part of the penumbra of an interesting character, and the progress of their disease can be a useful and emotionally significant means of advancing the plot. to summarize with a simple example, the protagonists might have to go to a certain character's house because it's known that they won't leave it themselves. then you could have a dramatic scene where the fully dressed detective (for example) has to interrogate the emaciated, barely clothed and barely conscious suspect in her tranny hovel while she lies in bed (or even in the bathroom while she pisses involuntarily). he tries to show her his badge but she can't even see it, "for all i see is white—it means God in heaven must be with me, sir." she makes a rotten smile.

TIP 5: treatment is difficult and prone to human error

the first effective treatments for diabetes came in the 18th century when it was discovered that restricting the intake of sugar improved outcomes. the diet which developed as a treatment resembles what today we call the "Keto diet", containing no sugar and few carbs. a diet like this works because it shifts the burden of energy production to the liver, which begins to turn fat into ketones which are converted into energy in a manner similar to glucose, a state called 'ketosis.' this is actually happening during prolonged hyperglycemia in untreated diabetes as well, since the body isn't converting glucose for energy, but at very high sugars these ketones are more likely to turn acidic in the blood and kill you, which is called 'ketoacidosis.' this happened to me and i had to have my blood flushed (after some emergency asthma treatment raised my blood sugars to toxic levels).

you might be surprised to learn this—most people seem to think there was no effective treatment for Type 1 diabetes until the discovery of insulin in the 1920s, but that isn't the case.

regardless, since the discovery of insulin it has been the first line treatment for diabetes. 1923 is the year that Eli Lilly first produced commercial quantities of insulin, incase period matters. wikipedia has a timeline of insulin milestones (see).

while i spent the last 3,000 words talking about the horrors of untreated diabetes, diabetes which is being managed may be nothing more than a nuisance. there are many diabetic athletes. in one study, "the absolute probability of working was 4.4 percentage points less for women and 7.1 percentage points less for men relative to that of their counterparts without diabetes" (see). that's a noticeable amount, but it still means a minority of diabetics are unemployed because of their diabetes (compare to schizophrenia or autism, where only a small percentage find employment). so diabetes is not necessarily even a disability for most diabetics.

insulin is a very effective treatment. normally the pancreas makes insulin in response to glucose; if you make insulin in response to glucose instead, it's like nothings wrong at all! the point is to take an appropriate amount of insulin relative to the amount of carbohydrates you're consuming. in principle there are no dietary restrictions necessary for a diabetic managing their diabetes with insulin, but in practice refined sugars in things like sweets and sodas raise the sugars too dramatically to manage. diabetics should therefore avoid sugary foods as much as possible, but sugars in foods like cottage cheese which are bound to proteins digest much slower and are much easier to manage.

note: the following descriptions of the treatment of diabetes are based on my own experiences and the experiences of people i've met. they may not represent a worldwide view, may be slightly out of date, and are likely to be partial or limited in other ways.

there is a lot of technique involved in taking insulin, most of it is outside the scope of this post. for your purposes it should be enough to know that there are two types of insulin a typical Type 1 diabetic will use: slow release and fast release. i know these as Lenovo and Novorapid, or green and orange insulin (because of the colour of the pens). a typical diabetic will take some slow release insulin at night, and possibly once or twice during the day, and will take rapid insulin every time they consume carbs. the more carbs, the more insulin. the patient is educated in the relationship between carbs, sugars, glucose and sugar levels and afterwards they are responsible for their own insulin management.

insulin is a completely clear, water-like liquid. it comes in pens with metered doses. doses are very small to allow granularity. most people take double digits of rapid insulin with every meal; i take very small doses, 1-2 units at a time, because i'm extremely sensitive to insulin (part of my strange case). disposable needles are screwed onto the top of the pen and discarded after one use. injection is hypodermic; it is typically injected into the outer thighs or at the bottom of the stomach, but it can be injected elsewhere, such as the butt. pens can be disposable or reusable with disposable cartridges of insulin. the injection is painless in my opinion.

most diabetics will also have a blood-glucose reading kit which tells you what your sugar level is. you do this with meals, anytime you think something might be wrong, and to help make decisions relating to sugars (eg. can i wait and order takeout or do i need to eat right now?). to take a blood reading, a disposable strip is inserted into a small computer with a digital screen. the user pricks their finger with a lancet needle (a sort of small needle gun) and draws blood that way. this is a lot more painful than taking insulin!

all that sounds pretty good, right? so why the ominous headline? well, it's very easy to mess this up. if you take too little insulin then you're going to be high blood sugars again. you might feel lightheaded and tired, but short-term high sugars aren't really a big deal. the problem is that you can take too much insulin. apart from mere forgetfulness, there are many situations in life where we end up with less carbs on our plate than we predict. burning some food, ordering at a restauraunt, and other situations out of your control can present dangers any time you have already taken insulin. while you can delay taking rapid insulin until the food is ready, your long-acting insulin is always ticking down. taking too much insulin by mistake or missing a meal entirely because of circumstance happens more often than you think it would, and it always leads to

TIP 6: Hpyoglycemia... Living Hell

shaking hands, vertigo, cold sweat, nausea, intense dysphoria. none of it really does it justice; hypoglycemia is an overwhelming, all-consuming hunger. but it's not a hunger in your stomach, it's like a hunger with your whole body.

if you don't treat a hypo you'll pass out. then you'll die. i have passed out from a hypo before and had to be taken to hospital; my grandfather fortunately found me lying unconscious, otherwise i would have died. while its hard to get to this stage under normal circumstances—you cannot fail to notice hypoglycemia, it's so intense—humans are not always in normal circumstances. especially in a story, you're often talking about abnormal circumstances. getting lost in the forest, your car breaking down in the desert, getting shipwrecked, or even getting locked out of your apartment. these are all potentially lethal predicaments for a diabetic with insulin in their system, their sugars inexorably ticking down to nothing. it's a very dramatic situation which can turn things which are small inconveniences for other characters into life or death situations for the diabetic. meanwhile, hypoglycemia impairs your ability to resolve your situation.

hypoglycemia is used as a plot device in this way in Paul Blart Mall Cop. actually, it's used in a very funny way. they're doing the 'Dark Night of the Soul' beat, where the hero has to look like they're on the verge of defeat, but they turn it around for the climax. so all the action is going on—whatever the hell it is that happens in that movie—and Blart enters hypoglycemia at the worst time. he's lying on the floor, incapacitated... defeated by his illness, just like back in the Police Academy... when he finds—miraculously—just out of reach—a lollipop! sugar! shots of him struggling to reach the lollipop are intercut with the rising action in the A plot. then once he reaches it, it's all gross because it was on the floor. comic gag of him eating a gross, floor lollipop... and then he leaps into action and saves the day!

it's very funny, and part of what makes it funny is how incredibly inaccurate it is. sucking on a lollipop basically gives Blart superpowers; in his post-hypo sugar rush he can accomplish things he couldn't even accomplish normally. it certainly doesn't work that way, you're really going to be in a daze all day and should be in bed. but this goes over while you're watching. what's funny is that they're turning the language of blockbuster cinema to a very mundane, stupid situation, to which it cannot possibly really apply. it's absurd that a diabetic mall cop can turn into a Sylvester Stalone-like movie hero with the help of a piece of candy, and that's the joke the movie is making.

so you can take a lot of artistic license here, and lean on the drama, and the audience will understand. Paul Blart Mall Cop actually takes something like the first step towards making diabetes into a generic narrative disease like Amneisa the way we discussed. by the way, there's another Kevin James movie, Hitch, which does a similar thing with Asthma. in that movie, the Asthma of Jame's character, Albert Brennaman, is made into an image for his imperfection and thus low status as a person (which makes him incompatible with the very high-status woman he is in love with). because asthma attacks take us by surprise, he must use his inhaler at times not of his choosing, and inconveniently expose his poor health and, poetically, his low status. Hitch, the date coach, attempts to make him mask his low-status and, consequently, his asthma, bad advice which Brennaman overcomes in the finale when he opens his big gesture to the leading lady with a few puffs of his inhaler.

it's a bit wasted on those movies, but it's actually very good writing—it's a very good way to use impairments, making them plot devices, poetic motifs and sources of comic relief, without being at all mean spirited.

anyway. there are, again, two ways to depict hypoglycemia: the first-person view of the diabetic, available to personal first person or subjective third person narrators, or the third-person view of another character, available to the rest.

in third person, the hypo is another way in which diabetes is naturally denpa. on this occasion, when we encounter this character, they are acting differently—not just strange, but scarcely human. possessed, possibly even violent. once when i entered hypoglycemia in town i had to try and navigate to a shop and buy a can of soda, since i didn't have anything with me to help. i managed to find a shop, grab a soda and navigate to the till, but i missed the queue entirely and pushed infront of an old lady. she interrupted me to scold me, but once i turned around—i don't know what she saw in me, but she immediately became very frightened and apologized. the situation is even worse for a diabetic who doesn't understand their condition and doesn't know how to help themselves.

if you choose a coy narrator and withold the fact that they're diabetic, or presently low blood sugars, from the reader, you can present a lot of confusing signals to them. it naturally creates an enigma which the reader wishes to solve. and if you choose a narrator who is free to interpret the situation for the reader, such as the rhetorical third person narrator, then it is once again a situation to stage tragic ironies—conflicts or confusions which the reader understands, but which the diabetic character cannot communicate.

it's also a captivating way to introduce a character for the first time. here it's a bit like Father Gascoigne in Bloodborne, who we only meet in person after his blood-craze has begun—sweet blood, ooh, it sings to me—but before and afterwards we have the chance to hear reports about his loving faterhood and doting family.

from the first person, it's probably going to be a bit of a challenge to represent hypogycemia. it is characterized by a total distortion of the inner experience. i generally don't remember what happens during one, but if i do, it is not at all what others recall. only certain prose styles—highly emotional, subjective ones, such as the stream of consciousness—will really be appropriate. it is acceptable to treat it as a blackout, accessible only through vague flashbacks. however, if you are writing a highly emotionally intense story which cares a lot about the inner experience of its characters, hypoglycemia may be an alluring state to paint with. i am not aware of any attempt to render this in prose fiction. Serious Weakness has scenes a bit like that, for other reasons, that's the closest i can compare it, or else some of the junk sickness sequences in Burroughs.

TIP 7: diabetes means being sick all the time

this is a rather minor point, but diabetes is an autoimmune disorder. your immune system is very compromised. you get sick all the time, sometimes for reasons you can't specify. i have severe flu-like symptoms a lot of the year.

in conclusion, i think Type 1 diabetes is a very strange disease with a lot of alarming symptoms which no one is really exploiting in fiction. a lot of our everyday experiences as diabetics lend themselves well to fictional situations and there's a lot of room for the writer to use their artistic license. depending on how you choose to narrate the symptoms of diabetes it can take on many different appearances and colours and therefore fit into a lot of stories. and much of this is probably true not just of diabetes, but of disorders and impairments in general. it's up to you to decide how and why you want to write about impairment, the 'moral' organization of your story which this post doesn't care about. hope that helps you write something, fuckers!

[saleemb]

SSO infection AU :3

(@samanthawd, making an another post because it's lonngg af) (CW// description of corpses and such >:3c) For context; ->Every time a "Najma" and/or "Al Fahr" is mentioned, they're just my OCs, I didn't proof read or anything i had to translate LMAO (from French to English) ->Imane (Jorvik's gazette girl) is the one who keep the journal ->The virus is from Aideen herself, found in a mysterious cave. ->Individuals with Kallters' blood can't be infected.

How it'd spread; I didn't have the will to search correctly, so it's mostly by body fluids, like the flu. Stages of the infections; ->Stage one; Got bitten or infected by contact with fluids from infected individuals (by saliva is the most common case) Experiment is still conscious and lucid, reacts as average as its species. Symptoms take a few days before appearing. ->Stage two;  Experiment starts losing its focus and has an even shorter attention span than the last test. No physical changes except a lack of sensations in the limbs as they start to get purple, black (rotting). It's apparently painful, but the experiment seems to lose consciousness at least 4 times a day. (might be infectious at stage 2, no one can confirm since there is no case reporting an infected from a stage 2 infected.) -> Stage three; IS NOW INFECTIOUS ! If the subject is lucky, it will not lose its limbs, instead, bones are now apparent, if not, the rotting will eat them alive until death( 10% of the infected fails to properly develop and dies from the rotting at stage 2). The apparent bones will remain as the patient will lose all its consciousness, driven by its will to make its body survive. It means feeding itself by any means. Recommended to kill the experiment at its stage before it becomes too powerful. CAUTION; Still infectious and most of the time HOSTILE, please don’t approach any infected alone and without weapons or a mask. ->Stage four; Hostile, will do anything to reach its final stage and find a pack, especially for infected horses. Humans tend to be more… “Lucid” at that state and, most of the experiments tried hiding while hunting for small animals, not being hostile to their cherished ones. ->Stage five; Some experiments survive (up to 10% can pass the fifth stage) to stage 4 rotting and hunting, making them evolve as they can reproduce (Split ?). Highly dangerous and unpredictable. Are always encountered in packs, BE EXTRA CAREFUL! AVOID ANY ENCOUNTER ! ------------------------------------------------------------------------------ Now a few entries i did in Imane's journal :3)) Lisa and Starshine ; The ones who discovered the first infected, Lisa is being brave about it, I’m not sure why, but she decided to take everything in charge, even if most of us aren’t really reassured by Lisa’s mental health. Starshine fell from a cliff a few days before finding the first infected. He’s injured, but fine. He reassures as much as he can, but I’m not sure he’ll survive this. His left rear hoof is still in bad shape.

Alex and Tin Can ; Take part in every exploration outside Valedale (our shelter) with the team… Tin Can always stay with us, in case something happens… We noticed that their thunder powers are very efficient to kill the infected ! Sad we didn’t get Sabine with us, her fire would’ve been so helpful… Linda and Meteor ; Meteor cheers up everyone with Tin Can, helps Linda and Rhiannon take care of the injured. She been searching a cure with the druids, without much success. Anne and Concorde ; Anne helped the exploration team thanks to her portals, she seems to enjoy the fact that Sabine is missing, and she’s in good shape. Hope she could talk more tho.

Katja and Mortifa ; Barrier helpers and helps to build walls with their ice powers. I’ve never seen a blind mare doing this well in combat… But as for her dark rider… Katja disappeared after everyone was safe in Valedale… No one knew where she was going. Probably trying to find the remains of Sabine and Khaan ? She’s really distressed, always on her nerves… She had at least 3 meltdowns, Jay started to get pissed off at her… I’m pretty sure they regret it. Katja’s fine, isn't she ? Herissa and Nihili (?) ; Nihili is still missing, but Herissa pleads, she still have the connection with her stallion… Najma and Alex decided to search for him. Herissa is a pain in the ass when Sabine isn’t here to put her back at her place… Except this… The girl’s fine, more than fine, she’s jumping everywhere and helps everyone (surprisingly) Jay (Jessica) and Acerbus ; Reported missing after a few days with us, supposedly with M. Sands. Sabine and Khaan ; Both found infected by Najma during an exploration in Jorvik City, DO NOT APPROACH ! Her magic is still active, that’s why Katja still hopes to cure her. Najma and Al Fahr ; (They’re my OCs :3) Al Fahr being a good endurance horse, confident in himself and his hooves,  and Najma being more than determined to find Sabine and bring her back makes them good leaders for the exploration team. Najma’s… acting odd since the infection started, I don’t know how to describe it but… Something’s off, she knows something that we don’t. Rania and Delingr ; Missing. Linda said we should search for her and her mothers… We already found Elaine, she reported that her wife is dead and Delingr brought Rania to security in the Wildwoods. I hope they’re both okay… Imane and Sahara ; Hi ! I’m the girl writing this journal ! Me and Sahara are fine, thanks to Najma and her magic… We were on the ferry for Fort Pinta when we saw our first infected ! Avalon ; He’s fine, his grumpy self… He leads very well the resistance and the druids in it, except for his brother of course. Evergray ; He sadly lost his right arm after  he fought Khaan to prevent the infection. He seems okay though, no symptoms, thanks to Linda and Elaine. M. Sands ; ??? (Linda and Najma are suspicious of him, i don’t know if i should write this…) ------------------------------------------------------------------------------ and voilà, sorry for the grammar :(

[syntia13treeman]

Case files 03.01

what I think happened in:

Case 03.01, the case of "Guilt in the Grief Garden" or "Ashes to ashes, meat to roots".

Oh boy, this one's a doozy. Let's go. On 3rd of April 2009 Special Constable Caroline Jennings, 2911, logs a homicide case involving: -Maddie Webber (deceased) -Gerald Andrews (alive ???) -grief counsellor Harriot Manning (hopefully alive) -Dr. Samuel Webber (deceased. Very, very deceased. He is SO dead you guys). -one buried briefcase with its content.

What we know: Dr. Samuel Webber had a wife (Maddie) and his work. He prioritized his work. Maddie was not very happy. Maddie left Samuel (possibly for Gerald), and left some of her things in storage unit when she moved out. Samuel was not very happy. He went to grief counsellor to deal. He got a nice grief-journal, but failed to deal. Obtained medical files of both Maddie and Gerald. Possibly killed Maddie (deceased). Possibly killed or planned to kill Gerald (no status note). Had a panic attack in public, shortly after the (possible) murder. He run away, decided to 'lie low'.

*deep breath* ok, here we go:

Smell of jasmine lures him into a garden that is in full bloom in December (sus) and surrounds 'ruins of bombed-out church' (very sus). He lies down in the wildflowers (as you do) and starts writing in his journal - thoughts, observations and lists. He likes lists. Then he starts hearing, and possibly seeing, Maddie (he seems to be gradually loosing memories, or maybe reliving random phases of his relationship with Maddie.).

And also he starts decomposing (starting from the scratches he got when getting through the bushes). And he's 'pruning' parts of himself. And he writes the whole process down, very clinically but also in a very poetically graphic way.

At some point he tries to leave but can't find a way out and might actually never have tried at all. Oh, and Maddie is definitely with him now, taking care of him and advising on gardening methods, so sweet of her.

Did I mention that at one point Samuel pulls his finger bones out of his left hand and plants them like seeds? He does that. Now you know.

And the more he falls apart, the more cheerful and awed by nature he gets. (Don't pay any attention to the deeply buried part of him that shakes in terror, it's not relevant). It's been night for so long, but now finally there's the sun and Maddie's with him and Samuel is happy. Also probably a tree, or, more likely, a shrub of jasmine.

What we don't know: anything.

Of note: Samuel was not in good mental state when he was writing (duh), and possibly hasn't been for a long time before that. The man is like an avatar of Unreliable Narrator. Any and all of the above might or might not have happened. Maddie left him, and she is dead - but did she leave him for a younger man, or did she leave because he was being both distant and possessive and controlling ("I worry when she is out alone"). (He got paranoid about someone looking at him in subway, he might have been paranoid about his wife talking to another man one time). Did he kill her, or did she die of illness / accident? Was the grief counselling for divorce, or for her death? He had medical files for the (alleged) lover too - did he plan on killing him? Did he succeed? More interestingly:

1). what is up with dates? The police has found and reported the journal in April of 2009, but the date of 'relevant entry' is 07-12-09. Read conventionally, that would be 7th of December 2009, so what's up with that? Was it:

time shenanigans?

Samuel was so out of it he didn't know what year it was

Samuel wrote the date backwards, so it was actually 9th of December 2007 when he got plantified, and his briefcase wasn't found until over a year later.

2). What about Maddie? Samuel kept hearing/seeing her while decomposing in the garden. Was it:

hallucination of his own guilt-ridden mind

Maddie's ghost

something else, using Maddie's voice to trick Samuel into false sense of security?

I don't know, but I see you, loss and regret and longing for loved one's voice. Don't think that I don't. I'm onto you, you little bastards.

[literaturepublishersjournal]

Orthopedic Case Reports Journal publishes case reports in Orthopaedics, images in Orthopaedics journal, imaging in Orthopaedics journal, case reports in bone journal, case reports in paediatric Orthopaedics, case reports in Orthopaedics surgery journal etc. 

Orthopaedics is a medical and surgical specialty that is concerned with the correction of deformities or functional impairments of the skeletal system, particularly the spine and its associated structure, ligaments and muscles.

Authors can submit their manuscripts through the journal's online submission portal and For more information on Literature Publishers - Orthopedic Case Reports Journal visit our site:- 

[oxfordpublishers]

Journal of Bone and Joint Diseases Case Reports published Case Reports in Joint Bone Spine, Case Reports in Bone Joint Surgery, Case Reports of Bone Disorders, Case Series of Bone Diseases, Clinical Image in Bone and Joint Diseases, Journal of Bone and Joint Diseases etc. Bone and Joints such as wrists, shoulders, knees, ankles and finger joints allow your body to move with ease.

[flyonthewallmedstudent]

Leishmaniasis

Case Reports, like we're on a episode of house

23M in Kenya, presenting with months of LOW, persistent fevers, and abdo fullness, found to have massive splenomegaly.

examination: massive splenomegaly (10 cm below costophrenic margin, and will definitely cross midline) and hepatomegaly

pancytopaenic on bloods, plt's down to 40s

diagnosis confirmed on BMAT (parasite seen)

normal HIV, liver and kidney function

Bodies seen on the BMAT below are part of the lifecycle of the parasite that is intracellular, hence you can see the macrophages/neutrophils loaded with them, even bursting

What is it:

think of it when you get a patient with pancytopaenia and hepatosplenomegaly, who either traveled to or is in/from a tropical/subtropic region (where sand flies are)

cause - protozoa parasite Leishmania, transmitted by infected sandflies

Epidemio (when to consider it)

tropics, subtropics (South America, Asia, AFrica), Southern Europe

Microbiology/Transmission

parasite, replicates intracellularly (Leishmania donovani)

transmitted in sand flies (can be unnoticeable and usually bite in dawn or dusk - evenings or night), can also be transmitted via needles/blood

more common in rural areas

I've simplified this, but is more extensively covered in StatPearls and Wiki (there's different species of Leish and sandflies that transmit it)

once bitten, the protozoa are phagocystosed by skin macrophages, which then becomes full of the "bodies" (part of the lifecycle). Eventually these burst to release more of the bodies that infect more macrophages

they eventually are spread via blood to liver/spleen/BM and LNs

Random history:

ancient, records of disease date back to Egyptian mummies from 3000 BC --> positive DNA amplication for Leishmania and on papyrus from 1500 BC

multiple physicians from different times have described the disease, but it's named for 2 who described the parasite's intracellular ovoid body stage in smears from infected patients in India: Lt General William Boog Leishman and Captain Charles Donovan (Ronald Ross named the bodies after the 2 --> "Leishman Donovan bodies"

significant disease in Allied troops in Sicily in WWII, called "jericho buttons" (image on wiki from a WWI trooper serving in the middle east)

Leishman: Scottish pathologist and British Army medical officer, later it's director general in the 20s, did extensive research into the parasite named for him by Sir Ronald Ross. He mistook the parasite he observed for trypanosomes (cause of Chagas in South America and African sleeping sickness in Africa)

Donovan: Irish parasitologist, medical officer in India, observed an epidemic across India just after the rebellion of 1857, discovered the "bodies" in spleen tissue as the causative agent for what the locals called "kala azar" (severe visceral leishmaniasis - see below)

Donovan also discovered the "bodies" of Klebsiella granulomatis, hence these too are named after him (cause of ulcerative granulomas)

It became scandalous as both wanted credit for the "discovery" of this newly identified organism. So Sir Ronald Ross named it for both of them.

Sir Ron, by the way, won a Nobel in Medicine for discovering that malaria is transmitted via mossies (this was also a source of scandal, he was meant to share it with another physician who he accused of fraud - and they never received the award)

finally, it was actually a Russian physician who identified it first, but well, he published in a little known Russian journal which was promptly forgotten.

Clinical features

cutaneous type vs visceral organ type (spleen, liver, bones)

From wiki

can be asymptomatic

cutnaeous: can be there for years and resemble leprosy, causes an open chronic wound (most common), incubation 2-4 weeks on average (nodules at site of inoculation that eventually form ulcers), can heal spontaneously in 2-5 yrs

in diffuse cutaneous cases, can affect face, ears, extensor surfaces

can be muscosal = eg nasal symptoms/epistaxis, severe: perforated septum, this occurs in 1/3 after resolution of cutaenous symptoms (can be severe/lifte threatning, as it can affect vocal cords and cartilage, but oddly not bone)

visceral (incubation periods of up to years until immuncompromise): fever, weight loss, hepatosplenomegaly (spleen more than liver), pancytoaepnia, high total protein and low albumin with hypergammaglobulinaemia

this has seasonal peaks related to sandfly habits and humidity

interestingly it is an infective cause of massive splenomegaly, such that it crosses the midline

Extreme - but noticeable hepatosplenomgealy/abdo fullness, from medscape

can be atypical in HIV co infected patients, LAD in seom regions like Africa

Kala azar = black fever in some severe cases (fatal due to secondary mycobacterial infection or bleeding), refers to damage fto spleen, liver and anaemia

invstigations:

serology not great (minimal humoral response to the parasite), so often requires histopath (tissue sample) for which BMAT is safest in visceral organ involvement

visualisation of amastigotes (or Leishman-Donovan bodies), as intracellular --> can be seen in macrophages (small round bodies) post Giemsa staining

PCR of DNA also possible (as done in the Egyptian mummies)

Image source:

Treatment

liposomal amphotericin B (holy shit strong stuff) in visceral, PO: miltefosine (caution in pregnancy), all have significant ADRs, or paromycin. however, mortality of 10% if visceral left untreated

mixed results with azoles

in HIV co infection - start the HAARTs! can improve survival, mortality is 30% in HIV patients

cutaneous: stibolgluconate (have never heard of these drugs) and megluaine antimoniate, but limited disease often spotnaeously gets cleared by the innate system

prevention:

use DEET insect repellant at dawn and dusk

loose fitting clothing that covers all skin

no vaccine (were attempts at vaccinating dogs, which decreased rates)

sandflies are smaller than mossies, so requires small netting

Differentials for hepatosplenomegaly

Sources:

WHO guidelines

CDC guidlelines

Wiki - Haven't covered pathophysio, but wiki does extensively

StatPearls

DermNet - great resource for all things derm, that my derm colleagues pointed out to me

[killed-by-choice]

“Marina Roe” (France, ~1993)

Death in sickle cell patients after abortion has been documented for decades, but in one especially tragic case, a single abortion that was supposedly “therapeutic” instead ended four lives.

“Marina” was a sickle cell patient who was pregnant in the second trimester with triplets. The report of her death does not specify the exact age of her babies, but countless premature babies delivered in the second trimester have survived when given medical attention. Even if they had been too young to survive, guaranteeing their deaths in utero would have offered no medical benefit— especially since a second-trimester abortion would take much longer than delivery.

The abortion was carried out using prostaglandin E2 instillation. A few hours later, Marina was already showing signs that something was going very wrong. She was suffering from bone and joint pain, and her hemoglobin was only 8 gm/dL. (For reference, 12 gm/dL is considered severely low in most women.) She was given 4 units of blood, but developed trouble breathing and deteriorated so badly over the next four days that she was admitted to the ICU.

By the time she was admitted to the ICU, Marina had trouble breathing and was suffering from confusion. Her chest x-ray showed pulmonary edema. Despite intensive treatment, she became even worse. Doctors put her on a ventilator and performed a heart catheterization. Based on her test results, they suspected an embolism. An exchange blood transfusion of 30 mL was initiated. Despite all attempts, Marina suffered respiratory failure and died the next day of acute right heart failure.

Marina’s postmortem exam found “marked pulmonary vascular congestion with focal alveolar hemorrhage and edema.” In addition, the diagnosis of embolism was confirmed by “massive amounts of fat in lung capillaries typical of fat embolism.” The cause of death was diagnosed as “massive fat embolism resulting from bone marrow necrosis.”

After Marina’s death, her case was analyzed. Several points were noted when the actions taken contributed to her death, including notes on how some should have been handled differently.

First, Marina was more predisposed to bone marrow fat emboli to begin with because of her sickle cell disease. Abortion is very well-documented as a cause for pulmonary emboli even in healthy people, so this should have been carefully considered.

Second, it was noted that “Massive transfusion without blood exchange… could have favored bone marrow necrosis and fat emboli by increasing blood viscosity.” Doctors reviewing her case also referenced that PGE2 (the chemical used in Marina’s abortion) also acts as a vasodilator, increasing blood flow on top of the already increased viscosity.

Marina was also given an insufficient exchange transfusion in her last days of life. She was given 30 mL of blood when the medical journal reviewing her case stated that life-threatening situations require at least double that amount. It was also theorized that “the severity of pulmonary involvement in our patient when exchange blood transfusion was performed may also have contributed to the failure of the treatment.” Marina’s treatment was, quite literally, too little too late.

Sherika Mayo, Betty Gail Hines, Margaret Davis, Barbara Riley, “Vera Roe” and “Jenny Roe” are a few other sickle cell patients killed by deadly side effects of their legal abortions, which were all too frequently recommended to them under the suggestion that it would be healthier for them. Women with sickle cell disease (and their children) deserve better.

https://doi.org/10.1002/ajh.2830430431

[anxious-ace]

Chronorun Reports notes:

Van Helsing, Jekyll, and Mrs. Frankenstein (Victor's mom) are siblings with Abraham and Henry being twins and Caroline being a few years younger (specific ages will have to wait until my brain decides that doing math is worth it)

(they are all a mix of Dutch, British, and Swiss btw)

(yes this means that Victor is Van Helsing's and Jekyll's nephew)

Van Helsing formed the HOSC to essentially bring light to all of the scientific discoveries that are happening (Jekyll's serum, any supernatural being he encountered, the time machine, Victor's creation, Griffin's invisibility, and more) but not without the house members' consent

Now let's get into the plot- a good amount of people in this universe have powers (almost all of the members of both societies have powers)

They are as follows:

Van Helsing- gains an ability of whatever type of entity he conquers (if he were to slay a vampire he would only get one of the abilities shared within all vamps. Ie teleportation) as well as natural immunity to most (not all) supernatural attacks and anomalistic mastery (or that could just be from his job)

Jekyll- technically he speaks to Hyde through telepathy as well as having telekinesis

Hyde- telepathy like Jekyll (because of course) and the ability to teleport objects and people away from and to him

(Jekyll and Hyde are forced to work together because they are not able to do what the other can as well as the other)

Victor- weather control (I just wanted to reference the movies, I think he would use it to help him animate the creation)

Griffin- now I know you might think that I'm going to make his invisibility his power, but that's not the case. He can however talk to animals, he just doesn't want anyone to know.

Time traveler- let's get the obvious out of the way, he can see any point in time (past present, and future), and it proved very helpful (but overwhelming and contributes to his time blindness)

Sherlock- like the time traveler, he could be obvious (giving him some kind of hyper-intelligence) so I'll give him tactical analysis and the hyper intertellince (or he could not have the ability and just be that smart, I haven't decided yet)

Watson- since he's a physician and royal army surgeon (according to Wikipedia), giving him a healing ability (more so healing others) would be a fair but obvious move. However, I want his medical knowledge to be utilized (meaning he would use actual medical practices instead of relying on powers) so the proper techniques would still have to be used (more so internal and really bad external wounds, broken bones, and deep/wide cuts being examples)

Gwen- now she could be a little difficult (considering the fact she is someone else's oc and I'm a bit scared to ask because it might look like I'm stealing their idea) so I'll move on for now. (she could have enhanced reflexes as it would be really helpful)

Switching gears to more general ideas (I'm looking for a reason to segway into the investigative committee's powers)

Griffin and the time traveler don't use their names for reasons they'd rather not admit (it has something to do with their experiments)

Van Helsing and Jekyll may make it look like they hate Victor (because he's an irresponsible, spoiled, college dropout who can be a bit of a nervous wreck at the most inconvenient times possible) but they're still trying to help him get over everything (and to take some god damn responsibly for once in his life)

Van Helsing and Watson are transcribing past journals, audio logs (the series takes place in the 21st century), and more as a part of the whole "bring light to all of the scientific discoveries that are happening" thing the HOSC does

The HOSC is very queer (not really with each other but you know)

Jekyll is a trans, ace, gay man (maybe Hyde too, he hasn't really thought about it, both he/him though)

Victor is pansexual and nonbinary (he/they)

Griffin is a bi demi-boy (also he/they)

Sherlock seems to be more interested in his work than in relationships (aroace cis man)

Watson is more open to the idea than Sherlock is though, at some point being stated to have said "I think everyone looks nice, does that mean im attracted to everyone? No not everyone, but certain people attract me more than others." (doesn't put a label on gender either but uses he/it/they)

Time Traveler is a theatre kid so he is probably the most open with his sexuality and gender (gay nonbinary dude using they/it)

Again, I have no idea for Gwen as she is not my character (well none of them are, I might have one at some point but thats not what I'm here for) so I either ask the creator or leave her as unlabelled (which might not be a bad idea actually) although the picrew shows her as aroace

Van Helsing might be the only straight one (I say might be because he doesn't know, still uses he/him though)

Now for the Missing person's investigative committee: they are in charge of finding out the who, where, what, why, when, and how of missing person cases

Utterson and Poole started it after Jekyll faked his death, which happened about a week after Van Helsing got back from killing Dracula (so it was like 7 years ago based on Quincey jr's age in the main story)

I'm now imagining a very stressed Van Helsing hearing about his brother supposedly killing himself because his latest experiment went tits up (excuse me while I try not to cry)

Their powers are:

Utterson- since he's a lawyer, giving him something like Holmes' hyper-intelligence (if it's his ability at all) is kinda obvious so some kind of adaptive ability could be fun (body language analysis could be useful)

Poole- super speed to help him with all of his duties (and in case of emergencies)

Mycroft- I kinda want his to be out of the park but still useful in a way, fuck it he can turn off others' abilities either by touching them or snapping his fingers

Walton- some kind of internal GPS for his traveling

Kemp- I tried reading the invisible man wiki to see what kind of doctor he is (he did go to a medical school so that could help) but couldn't really find anything so im going in sorta blind. I'm just going to make him a shapeshifter

Now that that is out of the way, few more things until pride shit

If someone pisses off Mycroft, their powers are just gone for the day (which could be devasting if they piss him off during a very important mission)

Walton being the youngest (younger than Hyde but older than Victor) means he is often the fastest and most agile of the group (until Poole uses his super speed obviously)

He's basically the group's son (at least to most of them, Mycroft might have some warming up to do)

Now, pride:

Utterson- Jekyll's husband (cis bi man, uses he/him)

Poole- unlabeled sexuality (aro he/it user)

Mycroft- like Van Helsing, he might be the only straight one (uses he/him)

Walton- trans, demisexual man (he/them/it)

Kemp- omnisexual nonbinary (they/them)

@mrhyde-mrseek what do you think?

[coochiequeens]

Women’s history just got richer

Iron Age remains found on the Isles of Scilly belonged to a female warrior, according to the authors of a new study that challenges long-held assumptions about the historical role of women in warfare.

Ever since the burial site was discovered in 1999 at a farm on the British island of Bryher, scientists have been at odds as to whether it belonged to a man or a woman. But thanks to a modern technique that involves analyzing the proteins found in tooth enamel, archeologists say they finally have an answer. 

"We found that this 2,000-year-old burial — one of the richest burials in the southwest of Britain — was a female, or a woman," human skeletal biologist Sarah Stark told As It Happens guest host Aarti Pole.

"It really is opening the door to this hidden female warrior."

Stark works for Historic England, a public agency dedicated to the preservation of historical sites, which led the study into the Iron Age remains. The findings were published in the Journal of Archaeological Science: Reports.

The sword and the mirror 

Iron Age graves with swords usually belong to men, while those with mirrors tend to belong to women, says Stark. But the Bryher burial site contains both. 

"This is something that really sets the Bryher burial apart," Stark said. "This kind of tipped us off into knowing that this person — this woman — was of significance."

She and her colleagues suspect she was "someone that was organizing, commanding or leading in warfare at this time."

Stark says there's a lot we don't know about Iron Age Britain before the arrival of Romans — but one thing we know for sure is that violence and warfare was common.

"We see that men and women were engaging in kind of violent activities based on the trauma that we've seen in other bones in surrounding areas," she said. "So it's not out of the ordinary to think that both men and women should be able to defend themselves."

This presence of both a sword and a mirror in the grave confounded researchers for the last two decades. (Historic England Archive)

It's not just the sword that's connected to war, she says, but potentially the mirror too. 

"To be able to signal to others through beams of light would be a huge advantage, both in either warning … others your in party of a potential attack, or co-ordinating an attack," she said.

Archeologist Bettina Arnold, who was not involved with the study, cautioned against assuming the presence of a sword means the person was a warrior.

Arnold, a University of Wisconsin Milwaukee professor who studies the Iron Age, says it's not uncommon to find weapons buried with women or various types of leaders. They symbolize that "you are protecting your community," she said.

"It's probably more likely a symbol of authority, and of a particular kind of leadership role," Arnold said. "That doesn't necessarily mean they were actually riding into battle."

These Iron Age human remains from Bryher were too fragmented and deteriorated to obtain DNA. (Historic England Archive)

Mirrors, she said, have also been associated with religious or spiritual roles, including fortune telling.

Arnold says she doesn't doubt the existence of female warriors in history, and that, in fact, men may have also been wrongly assumed to be soldiers because of the weapons found in their graves.

To be certain about any individual case, she says you would require multiple lines of evidence, such as markings on the remains that indicate an individual had been in combat.

Tooth technique a real 'game changer'

The human remains found at Bryher, however, are badly fragmented and poorly preserved. That's why previous attempts to determine sex using DNA failed.

But this time, the researchers turned to the teeth. 

"Tooth enamel is the hardest and most durable substance in the human body. It contains a protein with links to either the X or Y chromosome, which means it can be used to determine sex," co-author Glendon Parker, a toxicology at the University of California at Davis, said in a press release.

Analysis of the Bryher remains show a 96 per cent likelihood the bones belonged to a female.

"Given the degraded state of the bones, it's remarkable to get such a strong result. It makes you wonder what could be discovered by re-visiting other badly degraded burials," Parker said.

Aerial view of Bryher island, part of an archipelago known as the Scilly Islands in the United Kingdom. (Dan Turdean/Shutterstock)

The same technique was recently used to reclassify 5,000-year-old remains from an ornate Spanish tomb from male to female.

Arnold called the tooth enamel technique "a total game changer" that's more cost-effective than DNA testing, and more accurate than interpreting objects found in graves. 

Stark says it "opens a huge realm of possibilities where we might start, again, uncovering ... more hidden female warriors."

"We might find it's actually quite common," she said. "We've just been kind of missing them."

Changing historical narratives about gender

This study comes as scientists are re-evaluating many long-held assumptions about gender roles throughout history.

In one recent study, published in June, researchers dispel what they call the "myth" that men were primarily hunters and women were gatherers in early human populations. 

And in 2017, advanced DNA analysis was used to identify a Viking warrior's remains as female.

In the latter case, some archeologists argued those remains could have belonged to someone who, in today's parlance, would be considered transgender or non-binary. 

"That's part of the problem, too, that we're projecting our own ideas — you know, the sort of binary system that we're still kind of tied to, unfortunately — projecting that into the past. And I think you miss a lot that way," Arnold said.

Stark agreed it's something worth considering.

"It's something we want to be quite mindful of when we sort of start to think … in terms of gender and identity, and taking kind of our modern constructs and applying them to the past," she said.