Eight-month-old twins from Hayward Heath, West Sussex, recently met the surgeon who saved their lives even before they were born. The BBC reports how their mother, Katerina Ahouansou, at six months pregnant, during a routine scan, uncovered a serious issue with their development and blood supply.

Doctors diagnosed the twins with twin-to-twin transfusion syndrome or TTTS. It is a condition where one twin received more blood and nourishment than the other due to uneven blood vessel distribution in the placenta. In case there is no medical intervention, it could be fatal for both the twins.

A Specialist Steps In

This is when Ahouansou was referred to Professor Kypros Nicolaides at King’s College Hospital in London. Professor Nicolaides is a pioneer in fetal medicine and he specializes in a laser procedure that redistributes blood supply between twins in cases of TTTS.

When Ahouansou was scanned, Nicolaides observed that one of the twins were significantly smaller than the other. "There was a very high chance that if we did not intervene, both twins could die," he recalled.

An Operation No Less Than A Miracle

The life-saving laser surgery was performed and within a week the doctors saw an improvement with the twin who was smaller in size. When the twins were born, they weighed 1.5kg and 1.7kg. To recognize the efforts by the surgeon, Ahouansou named them Kai Kypros and Asher Nicolas after Professor Kypros Nicolaides.

Ahouansou also expressed deep gratitude for the professor's expertise and called him "proof that miracles can be performed by people who are devotees to their profession."

Professor Kypros Nicolaides has been at King’s College Hospital since 1980 and is widely regarded as a leader in fetal medicine. His groundbreaking research and development of screening and surgical techniques have saved countless lives.

Through his dedication, Professor Nicolaides has given many families hope, demonstrating how medical advancements continue to improve survival rates for complex fetal conditions like TTTS.

More about Twin-to-twin Transfusion Syndrome

As per the John Hopkins Medicine, TTTS is a rare pregnancy condition that affects identical twins or other multiples. It happens in pregnancies where twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are known as monochorionic.

Sometimes, the blood vessels in the placenta are unevenly distributed, causing an imbalance in blood flow between the twins. The donor twin loses more blood than it receives, leading to malnutrition and potential organ failure. Meanwhile, the recipient twin gets an excess of blood, putting strain on the heart and increasing the risk of cardiac complications.

Impact on the Donor Twin

The donor twin loses blood volume (hypovolemia), reducing kidney function and urine production. This leads to low amniotic fluid levels (oligohydramnios) or, in severe cases, a complete absence (anhydramnios). Without proper blood circulation, the donor twin faces cardiovascular issues, increasing the risk of death.

Impact on the Recipient Twin

The recipient twin experiences excess blood volume (hypervolemia), causing increased urination and excessive amniotic fluid (polyhydramnios). The overworked heart struggles to handle the surplus blood, leading to cardiovascular dysfunction, heart failure, and, in extreme cases, death.

Vitamins and minerals are often consumed for better health and immunity, but a new US study is drawing focus to a danger that may get overlooked. The danger is toxicity if vitamins and minerals are ingested in excessive quantity, particularly for children.

Researchers found that 1,961 children were hospitalised for vitamin and mineral toxicity over a three-year period, according to findings presented at the Pediatric Hospital Medicine 2026 meeting in Kansas City, Missouri.

The researchers used data from the federal Healthcare Cost and Utilization Project Kids’ Inpatient Database, which captures hospital admissions involving children across the US.

But the figure may represent only a part of the problem. “Our study probably only scratched the surface,” lead researcher Marina Masciale, MD, MPH, of Baylor College of Medicine, said while presenting the findings.

Most Poisoning Cases Were Due To Intentional Ingesting

One of the most interesting findings was that the majority of hospital admissions due to vitamin and mineral toxicity was due to intentional ingestion.

That makes the issue different from a child accidentally swallowing one or two tablets. Researchers say the findings highlight the need to consider supplements when assessing children who may deliberately ingest potentially harmful substances.

The database also captured only supplements for which there was a specific toxicity-related ICD-10 diagnostic code. This means poisonings involving supplements that were not coded in this way may not have been included. As a result, the researchers believe the true number of affected children could be substantially higher.

Also read: Is Your Child Suddenly Sluggish, Clumsy? Signs Of Juvenile Arthritis Parents Miss

Why Are Children Getting Poisoned If Vitamins Are Supposed To Be Safe?

The body requires many micronutrients in relatively small quantities. Some can become harmful when taken in excessive amounts, particularly certain fat-soluble vitamins that can accumulate in the body.

Minerals can also cause toxicity when consumed in excessive quantities. The symptoms and severity depend on the substance, dose and how quickly treatment is provided.

This is why supplements should not be popped like harmless candies simply because they are sold over the counter.

Also read: Too Much Cow’s Milk Linked To Severe Iron Deficiency In Toddlers, Including Three Deaths

Why Children Are Particularly Vulnerable?

Many supplements also come in colourful, flavoured or chewable forms, making them particularly attractive to younger children.

But the new findings highlight another concern: older children and adolescents may deliberately consume large quantities of supplements, meaning prevention cannot rely only on keeping bottles out of reach.

Parents and caregivers should therefore store vitamins, minerals and other supplements securely and treat them like medicines rather than everyday food products.

What Should Parents If They Suspect An Overdose?

If a child may have swallowed a large amount of vitamins or minerals, parents must not wait for symptoms to appear.

The exact risk depends on what was taken, how much was consumed and the child’s age and weight. Some toxic effects may not be immediately evident.

Medical professionals may need information from the supplement label, including the ingredients and strength, to determine the appropriate treatment course.

Arthritis is often associated with ageing, but it can also affect children. The most common form of chronic arthritis in children under 16, including those as young as 1, is Juvenile Idiopathic Arthritis (JIA).

Because its early symptoms can be subtle, JIA often goes unrecognized, delaying diagnosis and increasing the risk of joint and growth-plate damage.

Children May Not Say They Are In Pain

Young children may not know how to describe joint pain. Instead, they may change their behavior to avoid discomfort, making it important for parents to notice changes in movement and activity.

A toddler may limp, take longer to get ready or become less active, Dr. Rashmi Jinnakeri, Consultant Pediatrician, Apollo Hospital, Bengaluru, told HealthandMe. These signs may be mistaken for a viral infection, growing pains or simple clumsiness.

Also read: Too Much Cow’s Milk Linked To Severe Iron Deficiency In Toddlers, Including Three Deaths

Signs Parents Should Watch For

Unlike an injury, JIA symptoms tend to persist, Dr. Chirag Rajkumar Kopp, Consultant – Clinical Immunology & Rheumatology, Ramaiah Memorial Hospital, told HealthandMe.

Parents should watch for:

• Joint pain or swelling lasting more than six weeks
• Morning stiffness that improves during the day
• Neck or lower back pain with stiffness
• An unexplained limp
• Recurrent fever without an obvious cause
• Skin rashes
• Red eyes or sensitivity to light

Morning sluggishness:

A child who normally wakes up energetic may suddenly take much longer to get out of bed, get dressed or start moving. Similar stiffness or sluggishness may occur after an afternoon nap. This can be one of the more subtle signs of JIA in young children.

Sudden clumsiness:

Parents may notice a child dropping objects, tripping, coloring messily or struggling with buttons and zips. Subtle limping after waking may also occur and can improve as the day progresses.

Avoiding play and physical activity:

Children may begin avoiding sports, physical education or activities they once enjoyed. A child who previously loved running and jumping may increasingly prefer to sit or find reasons not to participate.

Going back on milestones:

Some toddlers may show regression in movement. A child who was walking may start crawling again or frequently ask to be carried. Mild swelling, particularly around a knee, can also be overlooked. If only one joint is affected, parents may assume the child bumped it while playing.

Fatigue, fever and rashes:

Some children may appear unusually tired, have low energy or repeatedly say they cannot walk. Fleeting rashes with fever may be mistaken for viral infections. Repeated low- or high-grade fever without cough, cold or vomiting can also occur.

Read More: 'Let's Fix Our Food': India Launches New Policy To Fight Childhood Obesity, Boost Nutrition

Growing Pains vs Juvenile Arthritis?

Children may describe both conditions simply as “leg pain”, making the distinction difficult, Dr. Rashmi said.

Growing Pains

• Usually occur later in the day after physical activity
• Often affect the thighs, calves or shins
• May improve with massage
• Do not cause joint swelling or redness
• Are usually gone by morning

Juvenile Arthritis

• Is often worse in the morning
• Causes joint-related pain and stiffness
• May cause swelling or redness
• Can improve with movement
• Persists over time, potentially for six weeks or longer

Early Diagnosis Matters

JIA occurs when the immune system mistakenly attacks healthy joints, causing inflammation. The exact cause is not known.

“When this goes unrecognized for too long, the effects don't simply fade with time. Joint damage can become permanent; a child's growth can be affected, and the disability that follows may last well into adulthood,” Dr. Chirag said.

Early treatment with disease-modifying antirheumatic drugs (DMARDs) and, when needed, biologic therapy can control inflammation and help prevent lasting damage. With early recognition and treatment, most children can achieve symptom control and continue to run, play and grow without limitation.

A blood test is considered the first step towards fertility enquiries, but for many, the results might seem like a confusing jumble of numbers and acronyms. Reports sometimes contain terms like AMH, FSH, LH, AFC, and estradiol, which can confuse patients into thinking that a single "abnormal" figure indicates they are unable to conceive.

The truth is more reassuring, and more nuanced. Fertility experts stress that a single test cannot ascertain a person's fertility. Instead, these markers serve as parts of a bigger picture, assisting fertility specialists in comprehending reproductive health and suggesting the best course of action when necessary.

Fertility tests are guides, not verdicts

The idea that a single blood test can determine whether a woman would naturally become pregnant is one of the most widespread myths. Age, egg quality, ovulation, sperm health, uterine health, lifestyle, and underlying medical issues are some of the factors that actually affect fertility.

Although diagnostic markers offer useful information, they must always be interpreted in conjunction with the couple's overall reproductive profile, clinical history, and ultrasound results.

Understanding the ovarian reserve 'AMH'

Anti-Müllerian Hormone (AMH) is perhaps the most talked-about fertility marker today. It is produced by small follicles present in the ovaries. AMH reflects ovarian reserve, which identifies the estimated number of eggs remaining in the ovaries. High AMH indicates larger ovarian reserve, whereas lower levels suggest fewer eggs. However, it can neither measure egg quality nor guarantee the ability to conceive naturally.

Many women with low AMH can still achieve successful pregnancies, especially if they continue to ovulate regularly. Similarly, women with high AMH are not necessarily more fertile; elevated AMH levels in women also mean Polycystic Ovary Syndrome (PCOS), where ovulation may actually be irregular. For fertility specialists, AMH is useful in predicting the number of eggs that are likely to respond to ovarian stimulation medication, based on which they customize IVF treatment.

FSH determines ovarian function

Our pituitary gland produces Follicle Stimulating Hormone (FSH), and this hormone helps in stimulating egg development.

Usually, the second or third day of the menstrual cycle is when FSH is measured. If ovarian reserve is reduced, higher-than-normal levels may imply that ovaries need more stimulation to mature eggs. From cycle to cycle, the FSH levels change.

LH and the ovulation story

FSH and luteinizing hormone (LH) cooperate to control ovulation. The ovary releases a developed egg in response to an increase in LH. LH levels may be disproportionately greater than FSH in PCOS-affected individuals, which can lead to irregular menstrual periods and ovulation. Instead of using LH alone, fertility specialists assess it in link with other hormone markers.

Estradiol and AFC: Completing the picture

An indicator of ovarian activity during the menstrual cycle is estradiol (E2), a type of estrogen generated by growing follicles. Combined interpretation is crucial since elevated early-cycle estradiol levels can occasionally conceal an elevated FSH.

The Antral Follicle Count (AFC), which is done via a transvaginal ultrasound, is another crucial evaluation. AFC gives an additional indication of ovarian reserve by counting the number of visible tiny follicles in the ovaries.

Indeed, the combination of AMH and AFC provides a more thorough insight than any test by itself.

Fertility evaluation isn't just for women

Female hormone testing frequently receives greater attention, whereas male fertility contributes to roughly half of all infertility issues. A semen screening remains one of the most significant and cost-effective tests, measuring sperm count, mobility, and morphology. When necessary, additional hormonal or genetic tests might be suggested.

Era of self-diagnosis

After getting a test report, many people search the web for quick answers, but those numbers without proper medical context from a specialist can cause unnecessary tension. The fertility markers depend on a variety of factors, some of which include: age, weight, menstrual history, prior pregnancies, medications, hormonal status, and lifestyle. Therefore, understanding parameters like “low” or “high” online may create confusion for individuals. Instead, consult a fertility specialist to decode the report.

(Dr Rubeena Zainab, Senior Consultant - Reproductive Medicine, Milann Fertility and Birthing Hospital, Bengaluru)