Singer Jesy Nelson recently shared an emotional update regarding the complications she is experiencing in her pregnancy with twin babies. Former Little Mix singer Jesy, who is having twins with partner Zion Foster, announced that she has been diagnosed with pre-twin-to-twin transfusion syndrome (pre-TTTS). The condition, which is present in pregnancies involving twins with a shared placenta, has serious risks involved and needs intense medical supervision. As Nelson embarks on this difficult journey, her story enlightens us about a rare but dangerous condition many expectant parents may not know much about.

Twin-to-twin transfusion syndrome is a rare but dangerous condition that arises in monochorionic twin pregnancies, in which identical twins share a single placenta. The placenta supplies the developing babies with oxygen, nutrients, and blood flow, but in TTTS, there is an imbalance of blood vessels that interconnect the twins, and thus the vital resources are not evenly distributed. One twin, or the donor twin, shares excess blood with the other, referred to as the recipient twin. This leads to one baby becoming malnourished and possibly anemic, and the other in danger of heart problems due to too much blood.

Nelson described her diagnosis in a heartfelt Instagram video, explaining that she is currently in the pre-stage of TTTS and undergoing frequent monitoring. "I am being scanned twice a week, and each time, things have gotten a little worse," she shared, expressing her fears and hopes for the health of her babies.

Potential Risks of TTTS

If left untreated, TTTS can have devastating consequences. Medical research indicates that:

• 90% of the cases of untreated TTTS lead to loss of one or both twins.
• Despite treatment, only a 70% survival rate for both twins is assured.
• Severe forms can result in preterm labor, cardiac failure in the recipient twin, and organ failure in the donor twin.
• Complications in long-term survivors include neurological damage and developmental delay in surviving infants.

TTTS usually advances in stages, beginning with minimal changes in fluid levels and worsening as one twin continues to get an unequal share of blood. In extreme cases, fetal laser surgery, referred to as the Solomon technique, can be employed to divide the blood vessels and balance the twins.

Why Identical Twin Pregnancies Are More Complicated

Identical twins may develop differently, and their own unique form of placental sharing can have a dramatic effect on pregnancy risk. Jesy Nelson's twins are considered monochorionic diamniotic (mono/di), which means they share a placenta but have two amniotic sacs. This is the type of pregnancy in about 70% of identical twin pregnancies and carries an increased risk of complications like TTTS, umbilical cord entanglement, and growth restriction.

Conversely, dichorionic diamniotic (di/di) twins both have a separate placenta and amniotic sac, which greatly diminishes the threat of TTTS. Twin pregnancy type is normally identified by early ultrasound, with physicians being able to track future complications from inception.

Other Twin Pregnancy Health Risks

Twin pregnancies, even without the presence of TTTS, entail a variety of health risks to the mother as well as infants:

1. Premature Birth

Over 60% of twin pregnancies end in premature delivery, with birth usually taking place before 37 weeks. Premature infants can have immature organs and need neonatal intensive care (NICU) assistance to assist with breathing, feeding, and infection fighting.

2. Gestational Hypertension and Preeclampsia

Pregnant women with multiples are at increased risk of having high blood pressure during pregnancy. This, if left untreated, can result in preeclampsia, a serious complication of pregnancy that can result in damage to organs, preterm labor, and in some cases, maternal or fetal death.

3. Anemia

Pregnant women carrying multiples are twice as likely to experience anemia, a condition where the body does not produce enough healthy red blood cells. This can lead to fatigue, dizziness, and complications during delivery.

4. Birth Defects

According to John Hopkins Medicine, multiple birth babies are twice as likely to have congenital abnormalities compared to single births. These can include heart defects, neural tube defects, and gastrointestinal issues.

5. Amniotic Fluid Imbalances

When twins have to share a placenta, they are more likely to have polyhydramnios (excess amniotic fluid) or oligohydramnios (not enough amniotic fluid). Both result in distress to the babies during fetal development and can result in premature labor.

6. Postpartum Hemorrhage

Twins are at increased risk of excessive postpartum hemorrhage because their uterus is larger and there are greater blood supply needs.

Jesy Nelson's openness about her challenging experience is raising awareness for TTTS, a condition that few individuals—let alone expectant mothers and fathers—might be aware of. Through her tearful video, Nelson stressed the significance of knowing about twin pregnancies aside from the thrill of having multiples. "We had no idea that this type of thing occurs when you're having twins. We just desperately want to make people aware of this because there are so many people who aren't aware."

Her case reminds us of the intricacies involved in twin pregnancy and the significance of early identification and medical management. For mothers carrying twins, frequent ultrasounds and vigilance can become a life-and-death issue for early detection and better outcomes of both babies.

Through constant medical attention and care, she and her partner Zion Foster remain positive and get ready for their babies to be born. In other parents whose situations are no different, the story of Nelson highlights awareness, medical progress, and emotional encouragement in handling complicated pregnancies.

The expecting parents of twin siblings are advised to discuss TTTS screening and possible interventions with their physicians to give their babies the best chance.

The human brain has always been considered to be a single organ. But according to Stanford Medicine researchers, the brain's growth history indicates that it originates from two different populations of early cells that follow separate developmental paths.

The findings, published in Nature Neuroscience, suggest that the front and back parts of the brain develop from different types of progenitor cells, questioning the long-believed idea that the entire brain originates from one common cell.

An important point to note is that this does not mean that humans have two completely separate brains. The two developmental systems ultimately fuse together and function as one brain.

Mechanism Of Brain Forming From Two Cell Groups

During early development, cells called progenitor cells enable the production of specialised brain cells, including neurons. Researchers found that the cells that form the forebrain and midbrain follow a different developmental pathway from those that form the hindbrain, which includes the brainstem.

The forebrain is involved in neurological functions like language, consciousness and higher-level thinking. The hindbrain contains structures that control essential functions including breathing, heartbeat, sleep and swallowing.

Kyle Loh, associate professor of developmental biology at Stanford Medicine and senior author, said, “We’ve shown for the first time that the front of the brain arises from a totally different progenitor cell than the back of the brain.”

He added, “Our discovery means that we can now grow neurons from the back of the brain, the hindbrain, in a petri dish and study their functions.”

Also read: Is Controlling BP Enough After a Brain Bleed? Doctors Explain How to Prevent Another Stroke

A Significant Discovery

Scientists have been able to grow several types of human brain cells in the laboratory, but creating hindbrain neurons has been challenging.

The new findings give some clarity about why some previous approaches were unsuccessful. Researchers were attempting to transform forebrain or midbrain progenitor cells into hindbrain cells, but the Stanford team found that these cells are fundamentally different from the beginning of development.

Jokhai, one of the researchers involved in the study, explained, “Previous attempts to make hindbrain neurons likely tried to coax forebrain and midbrain progenitors into hindbrain cells, which our study shows is not possible.”

He added, “In stem cell biology, people are always fixated with creating the end cell type, like the neuron. But it’s important to begin at the earliest stages of embryonic development.”

Also read: Brain Health After 40: How Diabetes, Menopause And Early Detection Affect Dementia Risk | World Alzheimer’s Day

Study's Implications On Brain Disease Research

The discovery could have various practical implications for neurological research. The hindbrain and brainstem contain neurons involved in breathing, swallowing and movement, meaning researchers need reliable human cells to study diseases that damage these systems.

Stanford scientists say the new findings allowed them to understand and generate functional human hindbrain neurons in the laboratory. This could provide new models for studying conditions like amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA).

Instead of studying these diseases only in animals or using cells that do not accurately represent the affected brain region, researchers may now be able to grow relevant human neurons and investigate how they develop, malfunction and respond to different treatments.

The finding could therefore change not just how scientists understand the human brain's anatomy, but how they understand its origins and how they recreate different brain regions in the laboratory.

As artificial intelligence (AI) rapidly reshapes health research and clinical care, Anthropic and medical knowledge platform OpenEvidence have announced a collaboration to provide AI-powered clinical decision support to healthcare providers in dozens of low- and middle-income countries.

OpenEvidence answers doctors’ clinical questions using peer-reviewed research and treatment guidelines. The platform, already free to clinicians in the US and Europe, will now be extended to providers in countries where access to medical literature, specialist expertise and continuing education may be limited.

The initiative is being rolled out in about 100 countries, including Uganda, Angola, Sudan, Haiti and Mongolia, according to a list provided by OpenEvidence.

“Access to medical knowledge shouldn’t depend on geography,” OpenEvidence founder Daniel Nadler said.

How Can Clinical AI Help Doctors?

Rajeev Jayadevan, former president of IMA Cochin and convener of the Research Cell, Kerala, told HealthandMe that doctors in Western countries already have access to OpenEvidence, which has also been incorporated into electronic medical records at major US hospitals.

He said the platform could help doctors quickly access medical evidence at the point of care.

“The advantage is that the doctor will have instant access to relevant research papers published in multiple journals, all at once, while asking a specific question about a patient while at the bedside,” Dr Rajeev said.

He called it “a major time-saving step for the busy clinician, who may not have the time to go to the library, sit down with medical journals or textbooks, or even do internet-based searches to look for relevant papers”.

Dr Rajeev also said wider access to medical information could help reduce inequalities in healthcare.

“Medical information that directly helps patients must be available to the doctor free of charge,” he said.

However, AI-based clinical tools also have limitations, particularly when used across different healthcare systems.

“Potential disadvantages include the need for doctors to be trained in digital health literacy and the fact that the answer provided by AI algorithms heavily depends on what the doctor asked for, and in what format,” Dr Rajeev said.

“Some of these issues can be ironed out by using templates, so that important information or keywords are not missed by the doctor who enters the query. Other risks include relying on data from other countries and treatment options that are unavailable or expensive for the local community,” he added.

What Are the Ethical Risks of Clinical AI?

The expansion of AI in healthcare comes as the WHO has separately called for stronger ethics oversight of AI-related health research.

In a report published this week, WHO warned that rapid advances in AI are creating challenges around privacy, bias, fairness, transparency and accountability. It said existing research ethics systems may need additional expertise to assess risks associated with AI and large datasets.

Dr Rajeev said AI-driven research, particularly when it involves large datasets crossing national borders, may require ethics committees to include experts in computer science, data ethics and bioinformatics.

“Ethics Committees by themselves will need to be upgraded to incorporate computer scientists, data ethicists, and bioinformaticians.”

WHO also said oversight should extend beyond ethics committees to researchers, funders, scientific journals, data governance bodies, professional societies and regulators.

Why This Matters

For low- and middle-income countries, clinical AI could help bridge gaps in access to medical literature and specialist knowledge. At the same time, WHO has highlighted the need for local capacity and safeguards to ensure that AI systems developed largely in higher-income settings are appropriate for different healthcare systems and do not introduce new inequities.

Postmenopausal bleeding is one of the key warning signs that needs medical intervention as it can be an indicator of endometrial, or womb, cancer. But most women who develop postmenopausal bleeding do not have cancer but still are required undergo several invasive tests to get a clean bill of health.

According to a new study published in The Lancet Obstetrics, Gynaecology & Women’s Health, cells from urine and vaginal fluid could help identify women who need further investigation and reduce the need for unnecessary and uncomfortable invasive procedures. However, the test is not yet accurate enough to replace biopsies or other standard tests these types of cancers.

Cells From Endometrial Tumour May Show Up In Urine And Vaginal Samples

Doctors usually recommend women with postmenopausal bleeding to undergo transvaginal ultrasound, endometrial biopsy and hysteroscopy.

These procedures can be uncomfortable, painful and costly, and some women may need repeat these tests. In the study, only 5.3% of women had endometrial cancer, despite all of them being referred for these tests due to postmenopausal bleeding.

The researchers said that cells shed by an endometrial tumour can travel into the lower genital tract and could be collected through vaginal fluid or urine. Previous research has already indicated that cancer cells could be detected in these samples.

The DETECT study was designed to determine how accurately this approach could detect cancer.

Also read: Endometriosis Can Take Years To Diagnose But This AI Tool Can Identify Its Signs In 18 Milliseconds

About The Study

The study is based on 1,864 women with postmenopausal bleeding from seven hospitals in northwest England between September 2018 and March 2021.

The participants gave their urine and vaginal fluid samples before their routine cancer investigations. Specialist cytopathologists, who were not aware of the women's cancer diagnoses, examined the samples for malignant cancerous cells.

The results were then compared to the women's clinical diagnoses and, where available, tissue histopathology. Among them, 99 had endometrial cancer and 16 had other pelvic cancers, including cervical, ovarian, bladder and colorectal cancers. The test also detected about 8 in 10 womb cancers

When urine and vaginal cytology were combined, the test detected 80.8% of endometrial cancers and correctly identified 92.6% of women who did not have the disease. Its negative predictive value was 98.8%.

In this particular study population, that means a woman with a negative combined result was highly unlikely to have endometrial cancer. But the test was not equally effective at detecting every type of cancer.

It detected 95.8% of high-grade cancers and 96.4% of stage 2 or more advanced cancers. It was more likely to miss low-grade, early-stage tumours. According to the researchers, the urine and vaginal fluid samples may miss early-stage tumours as they may shed fewer cancer cells. The sensitivity of the test was lower than that of transvaginal ultrasound and endometrial biopsy when sufficient tissue was obtained.

Also read: Urine Leakage When You Cough, Sneeze Or Exercise? It Could Be Pelvic Floor Dysfunction, Say Experts

This May Reduce Invasive Tests For Cancers

The study does not suggest that this test could replace conventional methods of diagnosis. It is merely an effective triage tool that could help screen patients and help healthcare providers decide who should actually get invasive tests done.

In the study, 99.1% of women underwent an attempted transvaginal ultrasound, 61.1% underwent an attempted endometrial biopsy and 48.2% underwent hysteroscopy. The failure rate was 25.7% for endometrial biopsy and 17.8% for hysteroscopy, with cervical stenosis and intolerable pain among reported reasons.

The test also produced false positives. Its positive predictive value for endometrial cancer was 38.1%, meaning a positive result would still require further investigation.

The researchers say further studies will establish how the test performs in standard healthcare systems, different populations, and other relevant settings. They also note that highly trained specialist cytopathologists interpreted the samples and helped provide diagnoses, so it remains uncertain whether the same accuracy can be achieved elsewhere.

Another interesting finding from the study is that among 10 women whose initial cytology missed cancer and who underwent repeat sampling, four tested positive on repeat testing, suggesting repeated sampling could improve detection.

The researchers also propose exploring artificial intelligence and image-recognition technology to supplement cytological analysis.