There is no record of both separated ischiopagus tetrapus conjoined twins leading normal lives 22 years after separation. We separated a pair of such twins in 1986 and have followed them up till date. Details regarding the technique of separation and the procedures required to ensure normal defecation and micturition and normal musculoskeletal function have been described by us in earlier communications. In this paper we describe their present status and ability to face the world as independent adult females. The outcome reflects the responsibilities and dedication of pediatric surgeons for infant patients with congenital problems after they have become adults, taking a pivotal role to involve surgeons of other disciplines as and when necessary.

Objectives: Poliglecaprone-25 is a synthetic monofilament suture, commonly used for post-cesarean subcuticular skin closure. The present study was designed to assess the effect of subcuticular skin closure using Monoglyde® vs. Monocryl® poliglecaprone-25 absorbable sutures, on the risk of wound composite outcomes in the first 30 days postpartum [surgical site infection (SSI), wound dehiscence, hematoma or seroma]. Study Design: This is a prospective, single-blind, randomized (1:1), multicentric, two-arm, study performed between September 2020 and December 2021 at two different centres across India. Women (18-40 years) with a singleton pregnancy, requiring cesarean delivery were randomized to Monoglyde® (n=62) or Monocryl® (n=62) suture groups. The primary endpoint is incidence of wound composite outcomes in the first 30 days postpartum (SSI, wound dehiscence, seroma, or hematoma). In addition, the secondary outcomes, incidence of wound composite outcome at all visits (till 4 months), suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures (in case not absorbed or infection), operative time, intraoperative suture handling, postoperative pain, return to normal day-to-day activities, modified Hollander cosmesis score, subject satisfaction score, and adverse events were noted. Results: Non-significant difference between the groups regarding demographic characteristics and primary endpoint, incidence of wound composite outcome was observed. Moreover, no significant difference in suture extrusion and loosening, suture removal and evaluation of microbial deposits on sutures, operative time, intraoperative suture handling, pain, return to normal day-to-day activities, modified Hollander cosmesis, and subject satisfaction score were registered between the groups. Conclusions: This study establishes the clinical equivalence of Monoglyde® and Monocryl® poliglecaprone-25 sutures and both sutures can be used for subcuticular skin closure following cesarean delivery with minimal risk for wound complications.

No abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Stroke in pregnancy is a rare occurrence, its reported incidence being 11-26 deliveries per 100,000. Ischemic strokes are slightly more common than hemorrhages. Subarachnoid hemorrhage, embolism and cerebral venous thrombosis can also occur, albeit with a lesser incidence. Peak incidence of stroke is in the peripartum and postpartum period. Mortality rate of pregnancy associated stroke is 10.13%. Therefore, rapid recognition and management of these patients are imperative to ensure successful outcome. We report a rare case of stroke during pregnancy which has the protein C and protein S deficiency as its precipitating cause. Case Report: We report a case of a 24-year-old female, with previous cesarean section in her third trimester, suddenly developed weakness of left side of the body and deviation of face to the right. There was no history of head trauma, fever, unconsciousness or seizure. She did not have any skin rash, arthritis or signs of deep vein thrombosis. There was no history of prior fetal loss. Protein C and protein S levels were low. Conclusion: We report a rare case of stroke during pregnancy which has the protein C and protein S deficiency as its precipitating cause. Stroke is a recognized complication of pregnancy, is uncommon but feared. Stroke in young adults aged 15-35 years is more common in women with poorer outcome in terms of disability and dependence. Most pregnancy related stroke occurs in peripartum and puerperium.

Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Although it is a well-known cause of pregnancy complications, its epidemiology has not been studied systematically. There are several identifiable predisposing factors for GDM, and in the absence of risk factors, the incidence of GDM is low. Low thyroid hormone levels in early pregnancy are a risk factor for GDM incidence. Although gestational hyperthyroidism is uncommon (0.2%), hypothyroidism (autoimmune disease or suboptimal iodine intake) occurs in 2.5% of women and is predictive of reduced neonatal and child neuropsychological development and maternal obstetric complications.  It is well documented that thyroid disorders are associated with maternal and fetal complications during gestation and sequelea after delivery. The case-finding strategy does not solve the serious problem of leaving undiagnosed and untreated patients without risk factors. In the absence of strong evidence that support universal thyroid screening in pregnancy, current guidelines suggest a case-finding approach targeting thyroid function testing in high-risk groups. A couple have history of sub-fertility. Patient conceived following treatment. During pregnancy, GDM developed and later half of pregnancy was complicated by polyhydramnios. Baby was delivered by LSCS due to PPROM.