Maternal and Perinatal Outcomes in Placenta Previa: A Comprehensive Review of Evidence.

Placenta previa poses significant risks to maternal and perinatal health, yet its management remains challenging. This comprehensive review synthesizes current evidence on maternal and perinatal outcomes in placenta previa, addressing its epidemiology, pathophysiology, diagnosis, and management strategies. Placenta previa complicates pregnancies, with increasing incidence linked to factors such as advanced maternal age and rising cesarean rates. Maternal complications, including hemorrhage and placenta accreta spectrum disorders, pose substantial risks. At the same time, perinatal outcomes are marked by increased rates of preterm birth, intrauterine growth restriction, and neonatal morbidity and mortality. Timely diagnosis and appropriate management, including antenatal corticosteroids and multidisciplinary care, are critical for optimizing outcomes. Future research should focus on improving diagnostic methods, evaluating novel interventions, and assessing long-term neurodevelopmental outcomes. This review underscores the importance of informed clinical practice and ongoing research efforts to enhance outcomes for women and infants affected by placenta previa.

Effects of Variable Embryo Transfer on the Variable Window of Implantation and Analysis of Pregnancy Outcomes.

Background A descriptive analysis of patients who underwent various embryo transfer methods to address the root cause of their infertility at a tertiary infertility care complex in Wardha, India, is presented herein. This analysis aims to evaluate the management of infertility and assess pregnancy outcomes. Methodology We conducted a retrospective cohort study on patients who underwent various embryo transfer methods to address the cause of their infertility, specifically focusing on a variable window of implantation (WOI) at a tertiary infertility clinic over a one-year period. The medical records of 11 patients in both the variable embryo transfer (VET) and control groups were reviewed and analyzed for this article. Results The examination of medical records revealed a significant improvement in the rate of implantation (p-value = 0.04) and clinical pregnancy outcomes (p-value = 0.03) among patients who underwent VET. Comparable statistical outcomes were observed for other variables of pregnancy outcome, including miscarriage rate, multiple pregnancy rate, and biochemical pregnancy rate. Conclusion This retrospective cohort study suggests that the utilization of VET could be a viable option for women experiencing recurrent implantation failure cycles, particularly when an adequate number of embryos are available. This is owing to the challenges in clinically diagnosing a variable WOI. Further studies with a significantly larger sample population are recommended to validate the results and integrate this approach into the standard operating procedures, aiming to enhance the likelihood of pregnancy in these populations.

Utilizing Artificial Intelligence Application for Diagnosis of Oral Lesions and Assisting Young Oral Histopathologist in Deriving Diagnosis from Provided Features - A Pilot study.

Background: AI in healthcare services is advancing every day, with a focus on uprising cognitive capabilities. Higher cognitive functions in AI entail performing intricate processes like decision-making, problem-solving, perception, and reasoning. This advanced cognition surpasses basic data handling, encompassing skills to grasp ideas, understand and apply information contextually, and derive novel insights from previous experiences and acquired knowledge. ChatGPT, a natural language processing model, exemplifies this evolution by engaging in conversations with humans, furnishing responses to inquiries. Objective: We aimed to understand the capability of ChatGPT in solving doubts pertaining to symptoms and histological features related to subject of oral pathology. The study's objective is to evaluate ChatGPT's effectiveness in answering questions pertaining to diagnoses. Methods: This cross-sectional study was done using an AI-based ChatGPT application that provides free service for research and learning purposes. The current version of ChatGPT3.5 was used to obtain responses for a total of 25 queries. These randomly asked questions were based on basic queries from patient aspect and early oral histopathologists. These responses were obtained and stored for further processing. The responses were evaluated by five experienced pathologists on a four point liekart scale. The score were further subjected for deducing kappa values for reliability. Result & Statistical Analysis: A total of 25 queries were solved by the program in the shortest possible time for an answer. The sensitivity and specificity of the methods and the responses were represented using frequency and percentages. Both the responses were analysed and were statistically significant based on the measurement of kappa values. Conclusion: The proficiency of ChatGPT in handling intricate reasoning queries within pathology demonstrated a noteworthy level of relational accuracy. Consequently, its text output created coherent links between elements, producing meaningful responses. This suggests that scholars or students can rely on this program to address reasoning-based inquiries. Nevertheless, considering the continual advancements in the program's development, further research is essential to determine its accuracy levels in future versions.

Effect of microbubble as local drug delivery system in endodontic management - An In-Vitro study.

Background and Objectives: Microbubbles (MBs) are gas or vapor-filled cavities inside liquids with sizes ranging from 2 to 3 µm. Recently, MBs have shown great promise in nanomedicine owing to their high encapsulation efficiency, targeted drug release, improved biocompatibility, and longer blood circulation. Furthermore, they are more suitable for focusing on particular body regions and are safer and non-invasive. MBs generators are used to create bubbles in fluid dynamics, chemistry, medicine, agriculture, and the environment. Drug delivery using MBs increases penetration without causing systemic toxicity. In this study, we examined whether the use of microbubbles as a local drug-delivery mechanism increases tubular penetration of endodontic medications and irrigant. Materials and Methods: An Enterococcus faecalis culture was added to 38 dentin cylinders of single-rooted teeth. Samples were divided into the experimental and control groups that received a triple antibiotic paste with and without MB infusion (n = 19 in each group), respectively. After 14 days, the number of live bacteria in the samples was determined using confocal laser scanning microscopy. Results: After 14 days of contact with the medication, the percentages of live and dead bacteria were assessed. Results show that Group 2 (Triple antibiotic infused micro bubble) showed significantly (P < 0.05) higher antibacterial efficacy than Group 1 (TAP). Conclusion: In this study, the antibacterial efficacy was significantly higher in the experimental group than in the control group. Therefore, within the limitations of the study it can be said that MB infusion is a viable technique to improve root canal disinfection. Hence, it can be considered as a novel technique for local drug delivery systems in endodontic management.

Advancements and Applications of Preimplantation Genetic Testing in In Vitro Fertilization: A Comprehensive Review.

Preimplantation genetic testing (PGT) has become an integral component of assisted reproductive technology (ART), offering couples the opportunity to screen embryos for genetic abnormalities before implantation during in vitro fertilization (IVF). This comprehensive review explores the advancements and applications of PGT in IVF, covering its various types, technological developments, clinical applications, efficacy, challenges, regulatory aspects, and future directions. The evolution of PGT techniques, including next-generation sequencing (NGS) and comparative genomic hybridization (CGH), has significantly enhanced the accuracy and reliability of genetic testing in embryos. PGT holds profound implications for the future of ART by improving IVF success rates, reducing the incidence of genetic disorders, and mitigating the emotional and financial burdens associated with failed pregnancies and genetic diseases. Recommendations for clinicians, researchers, and policymakers include staying updated on the latest PGT techniques and guidelines, exploring innovative technologies, establishing clear regulatory frameworks, and fostering collaboration to maximize the potential benefits of PGT in assisted reproduction. Overall, this review provides valuable insights into the current state of PGT and its implications for the field of reproductive medicine.

Success in Parenthood: The In Vitro Maturation Breakthrough in Infertility.

This case report revolves around a 37-year-old woman and her 39-year-old husband, who have been married for seven years and were seeking treatment for infertility. The husband has been diagnosed with asthenozoospermia for the past six years and has been on continued medication, and the woman has been diagnosed with polycystic ovarian syndrome (PCOS). To improve fertility outcomes, this case report enlightens the treatment and medical strategy for people with PCOS. Treatment included low-dose ovarian stimulation for the removal of immature eggs, and then in vitro maturation (IVM) of those oocytes was done. Later, intracytoplasmic sperm injection (ICSI) was performed to form the blast. The formed blasts were later cryopreserved till embryo transfer. This case report highlights the importance of preventing the risk of ovarian hyperstimulation syndrome (OHSS) in patients with PCOS.

Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis.

BACKGROUND: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. OBJECTIVE: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. METHODS: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. RESULTS: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI .29 to .28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI .11 to .99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03-1.18, 573 participants; P value = 0.006). CONCLUSION: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods.

Relationship of skin complexion with gingival tissue color and hyperpigmentation. A multi-ethnic comparative study.

BACKGROUND AND OBJECTIVE: The most frequently seen intra-oral soft tissue is the gingiva. Most often, it is seen as coral-pink tissue that surrounds the neck of the teeth. Gingiva that encircles the tooth necks and covers the alveolar processes of the jaws is an intra-oral tissue that exhibits biomimetic features. The wide range of colors of the gingiva depends on the configuration of gingival vascularity, the degree of epithelial cornification, level of melanogenesis, and the depth of epithelialization. However, the color of the gingiva varies depending on the degree of melanin pigmentation. The current study aimed to identify the different distribution patterns of gingival color and determine the correlation between skin color, gender, and geographical area of origin. MATERIALS AND METHODS: A total of 839 subjects were involved in the study where the gingival color and skin tone were measured using the Dummett-Gupta Oral pigmentation Index (DOPI) combined with VITA VMK MASTER and skin shade method developed by Revlon (USA) and L'Oreal (France) for makeup foundation shades. One investigator was calibrated for the examination of the colors after being tested for normal color vision and color aptitude using the line test. RESULTS: A significant association was found between skin color and gingival pigmentation (χ2 value (6) = 114.48; P = 0.001). It was also found that females (67.1%) significantly had darker gingiva than males (58.3%). The study statistics display that location of the individual was also statistically associated with melanin pigmentation of the gingiva (χ2 value (57) = 559.33; P = 0.001). CONCLUSION: The study concluded that gender, skin color, and individual location are significantly associated with gingival melanin pigmentation.

Unveiling the Hidden Culprit of Posterior Reversible Encephalopathy Syndrome Superimposing Postpartum Eclampsia: A Rare Case.

The rare yet potentially fatal neurological complication known as posterior reversible encephalopathy syndrome (PRES) can manifest during pregnancy. Alongside symptoms such as headaches, nausea, visual disturbances, and altered mental status, patients often experience seizures or loss of consciousness. Imaging typically reveals vascular edema affecting the parietal and occipital lobes within the subcortical region. We present the case of a 24-year-old patient who developed postpartum eclampsia followed by PRES. MRI findings demonstrated hyperintensities in the posterior parietal, frontal, and occipital lobes bilaterally, confirming the diagnosis. Prompt administration of levetiracetam and labetalol led to the resolution of the patient's symptoms. Subsequently, we thoroughly searched online databases for peer-reviewed articles examining the etiology, clinical presentation, and treatment options for PRES. Our evaluation of the case findings alongside existing literature underscored the rarity of PRES occurring concurrently with postpartum eclampsia, highlighting the importance of timely identification and intervention in managing this condition. Further research is warranted to enhance our understanding of PRES in the context of pregnancy-related complications.

Successful Fetal Reduction in Early Second Trimester: Series of Three Cases Conceived With Infertility Treatment.

This case series explores three instances of a successful fetal reduction in early second-trimester pregnancies conceived through infertility treatments. The patients, all admitted to a central Indian tertiary care hospital, underwent assisted reproductive technologies such as in vitro fertilization (IVF) or intrauterine insemination (IUI). Faced with triplet pregnancies, fetal reduction was made to mitigate risks and enhance maternal and fetal well-being. The reduction procedures, conducted either transvaginally or transabdominally under continuous ultrasound guidance, resulted in the cessation of targeted fetal heart activity and motility. Post-reduction, pregnancies progressed without major complications, culminating in successful deliveries via lower segment cesarean section (LSCS) in the third trimester. This case series underscores the importance of selective fetal reduction in managing pregnancies arising from infertility treatments, emphasizing its role in minimizing risks associated with multiple gestations. Using continuous ultrasound guidance during the reduction procedures proved effective in ensuring precision and safety. These cases contribute valuable insights to the evolving field of reproductive medicine, offering clinicians a nuanced understanding of successful interventions to optimize outcomes in complex pregnancies.

Assessment of Reproductive Health Knowledge Among College Students in Northwestern India: A Cross-Sectional Study.

Background Reproductive health knowledge is a critical aspect of overall well-being, particularly among college students who represent a demographic transitioning into adulthood. In northwestern India, where cultural nuances and societal perceptions play a significant role, understanding the factors influencing reproductive health knowledge becomes imperative. This cross-sectional study explores the interplay between demographic factors and awareness of reproductive health and infertility treatment among college students in northwestern India. Methods A diverse sample of 564 college students in northwestern India participated in the study, providing information on key demographic variables, including age, gender, marital status, degree, field of study, and college year. Statistical analysis, including the calculation of p-values, was employed to determine the significance of associations between these demographic factors and the participants' knowledge of reproductive health. Descriptive statistics, including percentages and numbers, were calculated to present a comprehensive overview of the data. To evaluate the significance of associations, chi-square tests were conducted for categorical variables such as age, gender, marital status, degree, field of study, and college year. The p-values were computed to determine the statistical significance of observed relationships, with a significance level set at 0.05. Results The study uncovered notable findings with implications for targeted interventions. Among age groups, participants aged 23-25 exhibited the highest knowledge percentage at 43.22% (51/564), and this association was statistically significant (p = 0.042). Gender disparities were evident, with females showing higher awareness (46.52% (127/564)) compared to males, and this difference was statistically significant (p = 0.001). Marital status revealed significant differences (p = 0.0012), particularly in single individuals who demonstrated a knowledge percentage of 46.52% (127/564). Significant variations were observed based on the degree held, with doctorate holders having the highest awareness at 49.15% (58/564) (p = 0.01). Field of study significantly influenced knowledge (p = 0.0001), particularly in medical and engineering disciplines. College year also exhibited significance (p = 0.003), with the first-year students demonstrating a knowledge percentage of 42.20% (73/564). Conclusions These findings underscore the importance of tailored educational interventions and targeted awareness campaigns. Recognizing the influence of demographic factors on reproductive health knowledge is crucial for developing effective strategies that address the specific needs of college students in northwestern India, promoting a more informed approach to reproductive health and infertility treatment.

Unveiling the Role of Endometrial CD-138: A Comprehensive Review on Its Significance in Infertility and Early Pregnancy.

This review comprehensively examines the role of endometrial CD-138 (syndecan-1) in the context of infertility and early pregnancy. The endometrium, a dynamic tissue responsive to hormonal cues, plays a central role in fertility, and understanding the molecular intricacies governing its function is crucial. CD-138, a cell surface proteoglycan, emerges as a critical player expressed by various endometrial cell types. Our exploration encompasses a brief overview of the endometrium, introducing CD-138 as a significant molecular entity. The rationale for the review underscores the importance of elucidating endometrial factors in fertility and addresses existing knowledge gaps related to CD-138. Throughout the review, we unravel the multifaceted nature of CD-138 and its involvement in infertility, highlighting its potential as a diagnostic marker. Furthermore, insights into CD-138's role during early pregnancy, including trophoblast-endothelial interactions, are discussed. In conclusion, the findings underscore the clinical implications of CD-138, suggesting its utility in diagnostics and offering prospects for targeted therapeutic interventions. The identified knowledge gaps propel future research directions, promising to deepen our understanding of this enigmatic molecule and its transformative potential in reproductive medicine.

Exploring the Association Between Age Groups and Success Patterns in Platelet-Rich Plasma Therapy: A Cohort Study.

Objective This study aimed to comprehensively examine the correlation between success trends in platelet-rich plasma (PRP) therapy and the advancing age of patients undergoing fertility interventions. Methods Female participants were categorized randomly into five age groups undergoing PRP or conventional hormone replacement therapy. Procedures included controlled ovarian stimulation, escalating estrogen dosage, gonadotrophin injections, and embryo transfer post-ovulation trigger. A pivotal PRP intervention was provided to half of the age sub-groups, and endometrial thickness was assessed 24 hours prior to embryo transfer. Statistical analysis employed SPSS 26.0 for Windows Student Version (IBM Inc., Armonk, New York), incorporating descriptive statistics, one-way analysis of variance (ANOVA), Tukey's honestly significant difference (HSD) test to explore age-PRP success relationships (p<0.05). Results The study, involving 60 participants, revealed a balanced patient distribution across age groups, with 20-30 age groups contributing 23.33% each. Baseline characteristics showed no significant differences between PRP and hormone replacement therapy (HRT) groups. Post-intervention, PRP demonstrated consistently higher endometrial thickness (p<0.001) and clinical pregnancy rates (63.33%) compared to HRT (40%). These findings suggest a positive association between PRP therapy and improved outcomes, particularly in younger age cohorts. Conclusion The study challenges traditional perspectives on hormonal influences in fertility, highlighting a potential link between PRP therapy and favorable outcomes among younger age groups. Improved endometrial thickness and clinical pregnancy rates in the PRP group emphasize the need for further exploration of PRP's mechanisms and applications in reproductive medicine.

A Case Series Based on the Mixed Double-Embryo Transfer (MDET) Outcome in Patients With Recurrent Implantation Failure.

Successful implantation of embryos depends on the synchronous cross-talks between the endometrial wall and the competent blastocyst within the window of implantation (WOI). Hence, the WOI has a major significance in assisted reproductive technology (ART). However, in some cases, women do not have fixed WOI in ART cycles in order to enhance the rate of successful clinical pregnancy. However, there have been stances where women do not have a fixed WOI, and it shifts in subsequent menstrual periods. This contributes to the chances of recurrent implantation failure (RIF). Another factor that contributes to RIF is erratic endometrial receptivity, which hinders the chances of successful implantation of the conceptus in the endometrium. This case series consists of four case studies where the patients were believed to be suffering from RIF due to variable WOI or erratic endometrial receptivity and the routine protocol followed nowadays failed to make them conceive. In order to resolve the condition, we proposed a novel strategy in an attempt to improve pregnancy rates in these cases. An innovative method of embryo transfer known as mixed double-embryo transfer (MDET), which involved the transfer of one day 3 embryo and one day 5 blastocyst on day 6 of progesterone, led to possible pregnancy outcomes. A viable pregnancy was validated based on the human chorionic gonadotropin (ß-hCG) test report, and two of the cases delivered healthy babies. Thus, this case series provides a unique approach to addressing the issues of RIF. However, larger studies are required to validate the possible use of this technique.

Enhancement of Ovarian Reserve and Oocyte Quality After Platelet-Rich Plasma Instillation in a Woman With Diminished Anti-Müllerian Hormone.

Platelet-rich plasma (PRP) is a concentrated platelet preparation known for its regenerative properties due to the various growth factors it contains. Its application in the medical field, including dentistry, gynecology, and plastic surgery, has surged. In obstetrics and gynecology, PRP has shown promise in improving low libido, vaginal rejuvenation, ovarian reserve, and endometrial receptivity. This study presents a 29-year-old woman experiencing primary infertility attributed to low levels of anti-Müllerian hormone alongside the presence of asthenozoospermia in her husband's semen. After failed intrauterine insemination as well as in vitro fertilization (IVF), attempts at laparoscopic PRP treatment were administered before the second IVF cycle to enhance ovarian reserve and quality. The PRP treatment led to an increased follicle count, improved oocyte quality, and a successful pregnancy outcome in the second IVF cycle. PRP treatment promises to be effective in fertility treatments, potentially increasing ovarian reserve, improving oocyte quality, and enhancing successful pregnancy outcomes. This case report highlights its beneficial impact on a couple facing primary infertility, providing hope for patients with similar reproductive challenges.

An Unusual Case of Severe Pre-eclampsia and Pulmonary Edema Following Single Fetal Demise in an In Vitro Fertilization (IVF)-Conceived Twin Gestation: A Twisted Tale of Twins.

There has been a notable rise in instances of multiple-fetus pregnancies over the last decade, attributed to the widespread adoption of assisted reproductive technologies. Moreover, these pregnancies have been associated with the use of drugs to induce ovulation. While some cases involve the loss of one twin with minimal consequences for the surviving twin, the demise of a fetus after the first trimester, especially beyond three months into the pregnancy, can significantly impact the health of both the mother and the surviving fetus. Unfavorable outcomes linked to the loss of one twin after the first trimester include impaired physical growth of the surviving fetus, preterm delivery, neurological abnormalities, and, in certain instances, the death of the surviving twin. This report provides a detailed account of a specific case involving twin pregnancies where a single fetal death occurred at the 24th week of gestation, leading to severe pregnancy-induced hypertension and pulmonary edema. Upon reviewing peer-reviewed articles related to similar cases in online databases, no exact matches were identified for cases with a comparable presentation. The scarcity of literature on the development of pre-eclampsia following the death of a single fetus suggests a gap in obstetric research in this area. Consequently, the uniqueness of this case report arises from its distinctive circumstances and the limited existing literature on the subject within the obstetric community.

Impact of various aligner auxiliaries on orthodontic activity: A systematic review and network meta-analysis.

Background: It is imperative to analyze the forces and moments produced by various auxiliaries in order to select the optimal attachments and, eventually, to maximize the efficacy and efficiency of orthodontic therapy. Through this investigation, we aimed to highlight the impact of various aligner auxiliaries on orthodontic activity in patients undergoing orthodontic treatment on a pre/post treatment protocol basis. Methods: After a thorough search of the online journals, a total of 482 documents were found using keywords such as "Orthodontic Treatment", "Aligner Auxiliaries", "Elastic Ligatures" and "Tooth Movement." The database research, elimination of duplicate studies, data extraction and risk of bias were performed by the authors independently. This systematic review and network meta-analysis included prospective studies and clinical trials to evaluate research that had looked at the impact of various aligner auxiliaries on orthodontic activity in patients undergoing orthodontic treatment. Results: Eight investigations of varying designs were selected for this review. The majority of investigations revealed that aligner auxiliaries significantly improve anterior root torque, rotation, and mesio-distal (M-D) movement, as well as posterior anchoring. They also significantly improved anterior root rotation. However, few studies have presented inconsistent or non-statistically significant findings. Conclusion: Auxiliaries for aligners also appear to improve extrusion and other orthodontic movements, but there is insufficient evidence to support these claims. No research has examined posterior bucco-lingual expansion or tilting. Clarification of the effect of attachments and their related variables requires additional clinical investigations.

Plasmodium falciparum ZIP1 Is a Zinc-Selective Transporter with Stage-Dependent Targeting to the Apicoplast and Plasma Membrane in Erythrocytic Parasites.

Replication of the malarial parasite in human erythrocytes requires massive zinc fluxes, necessitating the action of zinc transporters across the parasite plasma and organellar membranes. Although genetic knockout studies have been conducted on a few "orphan" zinc transporters in Plasmodium spp., none of them have been functionally characterized. We used the recombinant Plasmodium falciparum Zrt-/Irt-like protein (PfZIP1) and specific antibodies generated against it to explore the subcellular localization, function, metal-ion selectivity, and response to cellular zinc levels. PfZIP1 expression was enhanced upon the depletion of cytosolic Zn2+. The protein transitioned from the processed to unprocessed form through blood stages, localizing to the apicoplast in trophozoites and to the parasite plasma membrane in schizonts and gametocytes, indicating stage-specific functional role. The PfZIP1 dimer mediated Zn2+ influx in proteoliposomes. It exhibited preferential binding to Zn2+ compared to Fe2+, with the selectivity for zinc being driven by a C-terminal histidine-rich region conserved only in primate-infecting Plasmodium species.

Regeneration Therapy: The Role of Platelet-Rich Plasma in Post-hysterectomy Wound Dehiscence Healing.

A 58-year-old (para 2, living 2, abortion 0), overweight (BMI: 25 kg/m2), post-hysterectomy patient reported with wound dehiscence on day seven. She was a known case of hypertension and type 2 diabetes for the last five years. She presented with symptoms of abnormal uterine bleeding due to leiomyoma. The leiomyoma was refractory to medical management and thus she underwent a total abdominal hysterectomy. She underwent the procedure well after preoperative intensive diabetes and hypertension management. She was managed postoperatively with injectable antibiotics. On day seven postoperatively, the patient started experiencing wound discharge, after which she was treated with broad spectrum higher antibiotics and regular wound dressing with debridement of necrotic debris twice daily for five days. She was planned for alternative therapy in the form of rejuvenation therapy by platelet-rich plasma therapy, which thus helped further shorten her hospital stay and helped the wound to heal better.

Unveiling the Enigmatic: A Rare Presentation of Posterior Reversible Encephalopathy Syndrome in a Primigravida With Twin Pregnancy.

Posterior reversible encephalopathy syndrome (PRES) is a distinctive and challenging neurological condition characterized by a constellation of symptoms, including altered mental status, seizures, headaches, and visual disturbances. It is often associated with abrupt increases in blood pressure or other underlying precipitating factors. While PRES has been recognized for its diverse clinical presentations, it remains an infrequent diagnosis, and its occurrence during pregnancy, especially in primigravida with multiple gestations, is rare. In this context, it is imperative to explore and explicitly mention the underlying factors contributing to PRES in the case, which may include factors such as hypertensive disorders of pregnancy, immunosuppressive therapy, and renal dysfunction. Addressing these factors is essential for a comprehensive understanding of PRES in the context of pregnancy and its implications for clinical management. In this case report, we present an unusual and captivating clinical scenario involving a 19-year-old primigravida admitted to a tertiary care hospital with a twin pregnancy and presenting with complaints of severe back pain and a history of amenorrhea for eight months. The patient's journey unfolds with an emergency cesarean section, resulting in the birth of two healthy female infants and the sudden onset of seizures on the second day postoperatively. This case provides an intriguing glimpse into the complexities of diagnosing and managing PRES, particularly within the unique context of pregnancy. We discuss the clinical course, diagnostic evaluation, and the subsequent management of this challenging case, contributing to the growing body of knowledge on PRES in a pregnancy-related setting.