Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice.

Despite data suggesting that apolipoprotein B (apoB) measurement outperforms low-density lipoprotein cholesterol level measurement in predicting atherosclerotic cardiovascular disease risk, apoB measurement has not become widely adopted into routine clinical practice. One barrier for use of apoB measurement is lack of consistent guidance for clinicians on how to interpret and apply apoB results in clinical context. Whereas guidelines have often provided clear low-density lipoprotein cholesterol targets or triggers to initiate treatment change, consistent targets for apoB are lacking. In this review, we synthesize existing data regarding the epidemiology of apoB by comparing guideline recommendations regarding use of apoB measurement, describing population percentiles of apoB relative to low-density lipoprotein cholesterol levels, summarizing studies of discordance between low-density lipoprotein cholesterol and apoB levels, and evaluating apoB levels in clinical trials of lipid-lowering therapy to guide potential treatment targets. We propose evidence-guided apoB thresholds for use in cholesterol management and clinical care.

Absence of Synergism between a Dual-AMP Biogel and Antibiotics Used as Therapeutic Agents for Diabetic Foot Infections.

Diabetic foot infections (DFIs) are frequently linked to diabetic-related morbidity and death because of the ineffectiveness of conventional antibiotics against multidrug-resistant bacteria. Pexiganan and nisin A are antimicrobial peptides (AMPs), and their application may complement conventional antibiotics in DFI treatment. A collagen 3D model, previously established to mimic a soft-tissue collagen matrix, was used to evaluate the antibacterial efficacy of a guar gum gel containing pexiganan and nisin alone and combined with three antimicrobials toward the biofilms of Staphylococcus aureus and Pseudomonas aeruginosa isolated from infected foot ulcers. Antimicrobials and bacterial diffusion were confirmed by spot-on-lawn and bacterial growth by bacterial count (cfu/mL). Our main conclusion was that the dual-AMP biogel combined with gentamicin, clindamycin, or vancomycin was not able to significantly reduce bacterial growth or eradicate S. aureus and P. aeruginosa DFI isolates. We further reported an antagonism between dual-AMP and dual-AMP combined with antibiotics against S. aureus.

Specific Six-Transmembrane Epithelial Antigen of the Prostate 1 Capture with Gellan Gum Microspheres: Design, Optimization and Integration.

This work demonstrates the potential of calcium- and nickel-crosslinked Gellan Gum (GG) microspheres to capture the Six-Transmembrane Epithelial Antigen of the Prostate 1 (STEAP1) directly from complex Komagataella pastoris mini-bioreactor lysates in a batch method. Calcium-crosslinked microspheres were applied in an ionic exchange strategy, by manipulation of pH and ionic strength, whereas nickel-crosslinked microspheres were applied in an affinity strategy, mirroring a standard immobilized metal affinity chromatography. Both formulations presented small diameters, with appreciable crosslinker content, but calcium-crosslinked microspheres were far smoother. The most promising results were obtained for the ionic strategy, wherein calcium-crosslinked GG microspheres were able to completely bind 0.1% (v/v) DM solubilized STEAP1 in lysate samples (~7 mg/mL). The target protein was eluted in a complexed state at pH 11 with 500 mM NaCl in 10 mM Tris buffer, in a single step with minimal losses. Coupling the batch clarified sample with a co-immunoprecipitation polishing step yields a sample of monomeric STEAP1 with a high degree of purity. For the first time, we demonstrate the potential of a gellan batch method to function as a clarification and primary capture method towards STEAP1, a membrane protein, simplifying and reducing the costs of standard purification workflows.

In Situ Monitoring of Protein Unfolding/Structural States under Cold High-Pressure Stress.

Biopharmaceutical formulations may be compromised by freezing, which has been attributed to protein conformational changes at a low temperature, and adsorption to ice-liquid interfaces. However, direct measurements of unfolding/conformational changes in sub-0 °C environments are limited because at ambient pressure, freezing of water can occur, which limits the applicability of otherwise commonly used analytical techniques without specifically tailored instrumentation. In this report, small-angle neutron scattering (SANS) and intrinsic fluorescence (FL) were used to provide in situ analysis of protein tertiary structure/folding at temperatures as low as -15 °C utilizing a high-pressure (HP) environment (up to 3 kbar) that prevents water from freezing. The results show that the α-chymotrypsinogen A (aCgn) structure is reasonably maintained under acidic pH (and corresponding pD) for all conditions of pressure and temperature tested. On the other hand, reversible structural changes and formation of oligomeric species were detected near -10 °C via HP-SANS for ovalbumin under neutral pD conditions. This was found to be related to the proximity of the temperature of cold denaturation of ovalbumin (TCD ∼ -17 °C; calculated via isothermal chemical denaturation and Gibbs-Helmholtz extrapolation) rather than a pressure effect. Significant structural changes were also observed for a monoclonal antibody, anti-streptavidin IgG1 (AS-IgG1), under acidic conditions near -5 °C and a pressure of ∼2 kbar. The conformational perturbation detected for AS-IgG1 is proposed to be consistent with the formation of unfolding intermediates such as molten globule states. Overall, the in situ approaches described here offer a means to characterize the conformational stability of biopharmaceuticals and proteins more generally under cold-temperature stress by the assessment of structural alteration, self-association, and reversibility of each process. This offers an alternative to current ex situ methods that are based on higher temperatures and subsequent extrapolation of the data and interpretations to the cold-temperature regime.

Chronic hepatitis D and hepatocellular carcinoma: A systematic review and meta-analysis of observational studies.

BACKGROUND & AIMS: Chronic hepatitis D (CHD) is the most severe form of chronic viral hepatitis but its role in the development of hepatocellular carcinoma (HCC) remains debated. We conducted a systematic review and meta-analysis of epidemiological studies to examine whether CHD is associated with an increased risk of HCC. METHODS: We searched PubMed, Embase and Web of Science, as well as study references and conference proceedings. We considered cohort and case-control studies allowing the calculation of effect estimates for the association between CHD (exposure) and HCC (outcome) in comparison to chronic hepatitis B. Data extraction and quality evaluation (using the Newcastle-Ottawa scale) were performed independently by 2 authors. Data were pooled using random-effects models. RESULTS: Ninety-three studies (68 case-control studies including 22,862 patients and 25 cohort studies including 75,427 patients) were included. Twelve studies accounted for confounders, in either study design or analysis (10 of which were cohorts), and 11 cohorts were prospective. The overall analysis showed a significantly increased risk of HCC in patients with CHD, despite substantial study heterogeneity (pooled odds ratio 1.28; 95% CI 1.05-1.57; I2 = 67.0%). The association was particularly strong in the absence of heterogeneity for prospective cohort studies (pooled odds ratio 2.77; 95% CI 1.79-4.28; I2 = 0%), and studies with HIV-infected patients (pooled odds ratio 7.13; 95% CI 2.83-17.92; I2 = 0%). CONCLUSIONS: We found a significantly higher risk of HCC in patients with CHD. Although further studies are needed to definitively exclude a potential bias due to antiviral treatments, our findings highlight the rationale for improved screening of hepatitis D virus infection in patients with chronic hepatitis B, and the urgent need for novel and effective antiviral therapies. LAY SUMMARY: Hepatitis D virus (HDV) is a defective pathogen requiring hepatitis B virus (HBV) to complete its life cycle. Chronic hepatitis D is the most severe form of chronic viral hepatitis, increasing the risk of cirrhosis, liver decompensation and death compared to HBV monoinfection. However, the association between HDV infection and increased risk of hepatocellular carcinoma is debated. We conducted a systematic review and found that patients with HDV infection had a significantly higher risk of developing hepatocellular carcinoma than those with HBV monoinfection.

Sulfonated Nanomaterials with Broad-Spectrum Antiviral Activity Extending beyond Heparan Sulfate-Dependent Viruses.

Viral infections are among the main causes of death worldwide, and we lack antivirals for the majority of viruses. Heparin-like sulfated or sulfonated compounds have been known for decades for their ability to prevent infection by heparan sulfate proteoglycan (HSPG)-dependent viruses but only in a reversible way. We have previously shown that gold nanoparticles and ß-cyclodextrins coated with mercapto-undecane sulfonic acid (MUS) inhibit HSPG-dependent viruses irreversibly while retaining the low-toxicity profile of most heparin-like compounds. In this work, we show that, in stark contrast to heparin, these compounds also inhibit different strains of influenza virus and vesicular stomatitis virus (VSV), which do not bind HSPG. The antiviral action is virucidal and irreversible for influenza A virus (H1N1), while for VSV, there is a reversible inhibition of viral attachment to the cell. These results further broaden the spectrum of activity of MUS-coated gold nanoparticles and ß-cyclodextrins.

Activation of the oncogenic miR-21-5p promotes HCV replication and steatosis induced by the viral core 3a protein.

BACKGROUND & AIMS: miR-21-5p is a potent oncogenic microRNA targeting many key tumour suppressors including phosphatase and tensin homolog (PTEN). We recently identified PTEN as a key factor modulated by hepatitis C virus (HCV) to promote virion egress. In hepatocytes, expression of HCV-3a core protein was sufficient to downregulate PTEN and to trigger lipid droplet accumulation. Here, we investigated whether HCV controls PTEN expression through miR-21-5p-dependent mechanisms to trigger steatosis in hepatocytes and to promote HCV life cycle. METHODS: MiR-21-5p expression in HCV-infected patients was evaluated by transcriptome meta-analysis. HCV replication and viral particle production were investigated in Jc1-infected Huh-7 cells after miR-21-5p inhibition. PTEN expression and steatosis were assessed in HCV-3a core protein-expressing Huh-7 cells and in mouse primary hepatocytes having miR-21-5p inhibited or genetically deleted respectively. HCV-3a core-induced steatosis was assessed in vivo in Mir21a knockout mice. RESULTS: MiR-21-5p expression was significantly increased in hepatic tissues from HCV-infected patients. Infection by HCV-Jc1, or transduction with HCV-3a core, upregulated miR-21-5p expression and/or activity in Huh-7 cells. miR-21-5p inhibition decreased HCV replication and release of infectious virions by Huh-7 cells. HCV-3a core-induced PTEN downregulation and steatosis were further prevented in Huh-7 cells following miR-21-5p inhibition or in Mir21a knockout mouse primary hepatocytes. Finally, steatosis induction by AAV8-mediated HCV-3a core expression was reduced in vivo in Mir21a knockout mice. CONCLUSION: MiR-21-5p activation by HCV is a key molecular step, promoting both HCV life cycle and HCV-3a core-induced steatosis and may be among the molecular changes induced by HCV-3a to promote carcinogenesis.

Real-Time Drink Trigger Detection in Free-living Conditions Using Inertial Sensors.

Despite the importance of maintaining an adequate hydration status, water intake is frequently neglected due to the fast pace of people's lives. For the elderly, poor water intake can be even more concerning, not only due to the damaging impact of dehydration, but also since seniors' hydration regulation mechanisms tend to be less efficient. This work focuses on the recognition of the pre-drinking hand-to-mouth movement (a drink trigger) with two main objectives: predict the occurrence of drinking events in real-time and free-living conditions, and assess the potential of using this method to trigger an external component for estimating the amount of fluid intake. This shall contribute towards the efficiency of more robust multimodal approaches addressing the problem of water intake monitoring. The system, based on a single inertial measurement unit placed on the forearm, is unobtrusive, user-independent, and lightweight enough for real-time mobile processing. Drinking events outside meal periods were detected with an F-score of 97% in an offline validation with data from 12 users, and 85% in a real-time free-living validation with five other subjects, using a random forest classifier. Our results also reveal that the algorithm first detects the hand-to-mouth movement 0.70 s before the occurrence of the actual sip of the drink, proving that this approach can have further applications and enable more robust and complete fluid intake monitoring solutions.

Surf Session Events' Profiling Using Smartphones' Embedded Sensors.

The increasing popularity of water sports-surfing, in particular-has been raising attention to its yet immature technology market. While several available solutions aim to characterise surf session events, this can still be considered an open issue, due to the low performance, unavailability, obtrusiveness and/or lack of validation of existing systems. In this work, we propose a novel method for wave, paddle, sprint paddle, dive, lay, and sit events detection in the context of a surf session, which enables its entire profiling with 88.1% accuracy for the combined detection of all events. In particular, waves, the most important surf event, were detected with second precision with an accuracy of 90.3%. When measuring the number of missed and misdetected wave events, out of the entire universe of 327 annotated waves, wave detection performance achieved 97.5% precision and 94.2% recall. These findings verify the precision, validity and thoroughness of the proposed solution in constituting a complete surf session profiling system, suitable for real-time implementation and with market potential.

Eating and Drinking Recognition in Free-Living Conditions for Triggering Smart Reminders.

The increasingly aging society in developed countries has raised attention to the role of technology in seniors' lives, namely concerning isolation-related issues. Independent seniors that live alone frequently neglect meals, hydration and proper medication-taking behavior. This work aims at eating and drinking recognition in free-living conditions for triggering smart reminders to autonomously living seniors, keeping system design considerations, namely usability and senior-acceptance criteria, in the loop. To that end, we conceived a new dataset featuring accelerometer and gyroscope wrist data to conduct the experiments. We assessed the performance of a single multi-class classification model when compared against several binary classification models, one for each activity of interest (eating vs. non-eating; drinking vs. non-drinking). Binary classification models performed consistently better for all tested classifiers (k-NN, Naive Bayes, Decision Tree, Multilayer Perceptron, Random Forests, HMM). This evidence supported the proposal of a semi-hierarchical activity recognition algorithm that enabled the implementation of two distinct data stream segmentation techniques, the customization of the classification models of each activity of interest and the establishment of a set of restrictions to apply on top of the classification output, based on daily evidence. An F1-score of 97% was finally attained for the simultaneous recognition of eating and drinking in an all-day acquisition from one young user, and 93% in a test set with 31 h of data from 5 different unseen users, 2 of which were seniors. These results were deemed very promising towards solving the problem of food and fluids intake monitoring with practical systems which shall maximize user-acceptance.

Epistemological world awareness of healthcare faculty. / Consciência de mundo epistemológica de docentes da área da saúde.

OBJECTIVE: To understand how epistemological world awareness is expressed in the educational practices of healthcare professors. METHODS: A qualitative, descriptive, exploratory, and analytical study. Data were collected through open-end interviews and non-participant observation from May to December 2013, with 10 professors from a public university in southern Brazil. The adopted theoretical framework was the composition of Paulo Freire and Lee Shulman. Data were analysed according to the operative proposal of Minayo. RESULTS: The emerging category was Epistemological world awareness of healthcare professors. CONCLUSIONS: For professors to understand and reflect on the core knowledge categories required for their practice, they must have an epistemological world awareness that allows them to perceive themselves as unfinished in relation to the world and able to transform their practice.

Prevalence and risk analysis for depression after open-heart valve replacement surgery.

BACKGROUND AND PURPOSE: Cardiac surgery may account for long term complications as depression. Geriatric Depression Scale (GDS) is a reliable 30-item questionnaire for assessing depressive symptoms in several populations. The aim of the present study was to determine the prevalence and predictors of depression after open-heart valve replacement surgery in a portuguese population. METHODS: Prospective observational study enrolling 52 patients (55.8% men, mean age 67.7 ± 11.3 years) with no history of depression, submitted to elective open-heart valve replacement surgery. Patients completed the GDS questionnaire at 6-month follow-up. Cardiovascular risk factors, medical history, left ventricular function, prescription table, analytical and surgical variables and length of hospital stay were collected to verify its influence on postoperative depression. RESULTS: Twenty-seven patients (41.4% men, mean age 69.3 ± 10.3 years) had scores consistent with symptoms of depression (GDS score >10), representing 51.9% of the sample. Twenty-one (77.8%) were mildly depressed, 6 (22.2%) were severely depressed and only 4 (19.0%) and 3 (50.0%) were on antidepressants, respectively. Postoperative complications (29.6 vs 8.0%, p=0.045), lower postoperative hemoglobin concentration (8.9 ± 0.8 vs 9.8 ± 1.5 g/dL p=0.015) and longer time of hospitalization (12.2 ± 7.7 vs 8.2 ± 3.4 days, p=0.020) were found to be significant predictors for postoperative depression. No other statistically significant differences were found. CONCLUSION: Depression after open-heart valve replacement surgery is frequent but appears to be generally overlooked. Strategies for systematic screening and early guidance should be implemented to ensure better health and quality-of-life of patients undergoing major cardiac surgery.

Advances in structure-based drug design targeting membrane protein markers in prostate cancer.

Prostate cancer (PCa) is one of the leading cancers in men and the lack of suitable biomarkers or their modulators results in poor prognosis. Membrane proteins (MPs) have a crucial role in the development and progression of PCa and can be attractive therapeutic targets. However, experimental limitations in targeting MPs hinder effective biomarker and inhibitor discovery. To overcome this barrier, computational methods can yield structural insights and screen large libraries of compounds, accelerating lead identification and optimization. In this review, we examine current breakthroughs in computer-aided drug design (CADD), with emphasis on structure-based approaches targeting the most relevant membrane-bound PCa biomarkers.

Relative Body Mass Index Improves the BMI Percentile Performance for Detection and Monitoring of Excess Adiposity in Adolescents.

Obesity is defined as excess adipose tissue; however, commonly used methods may under-detect adiposity in adolescents. This study compared the performance of body mass index percentile (BMI%) and relative body mass index (RBMI) in identifying excess body fat percentage (BF%) and estimated RBMI cut points to better stratify severity of adiposity. In 567 adolescents ages 11-19 year, BF% measured by DXA was used to compare BMI% and RBMI performance at different degrees of adiposity. RBMI cut points for adiposity detection were derived via ROC curve analysis. BF% was strongly correlated with BMI% (r = 0.889, p < 0.001) and RBMI (r = 0.901, p < 0.001). However, RBMI exhibited less dispersion and better discriminated the relationship with BF% independent of age, race, and gender. Both BMI% and RBMI performed similarly for detecting high BF% (≥25 BF% in males; ≥30 BF% in females). Nonetheless, the relationship of BMI% with BF% was diminished among leaner adolescents. RBMI detected overweight in 21.3% more females and 14.2% more males. RBMI improved the detection of excess adiposity in individuals otherwise classified as having normal weight or overweight by BMI%. RBMI is a valuable and accessible tool for earlier detection, intervention, and effective follow-up of excess adiposity in youth at higher risk for complications.

Equity and representation in cardiology research: A comprehensive analysis of authorship from low and low-middle income countries in cardiology journals.

Cardiovascular disease is the leading cause of mortality, disproportionately affecting low-income and low-middle-income countries (LICs/LMICs). Despite this, cardiology research commonly comes from affluent regions. This study assessed the authorship trends from LICs/LMICs in cardiology journals listed in PubMed from 2000 to 2022. The World Bank list was used to classify countries. The total number of articles published in the 138 cardiology journals was 529,359. The percentage of articles that included at least one author affiliated with LICs/LMICs institutions was 0.11 % and 2.23 %, respectively. Over the last decade, there has been an increase in the author's representation from LICs/LMICs; however, it is uneven, with some countries experiencing more significant increases (Zambia, Yemen, and Uganda for LICs, and India, Iran, and Lebanon for LMICs). Our findings highlight the inequity of research publication and invite our community to reflect on the need to develop strategies to improve representation from LICs/LMICs.

Atherosclerotic coronary plaque regression from lipid-lowering therapies: A meta-analysis and meta-regression.

Background: Studies reporting collective and comprehensive data on plaque regression of different lipid-lowering therapies (LLTs) are limited. Objectives: We evaluated plaque regression of LLTs based on multiple markers and performed subgroup analyses based on LLT type and post-treatment LDL-C levels. Methods: A literature search was performed to identify studies assessing plaque regression from LLTs. The following LLTs groups were included: High-intensity statin (HIS), HIS+ eicosapentaenoic acid (EPA), HIS + ezetimibe, Low-intensity statin (LIS), LIS + EPA, LIS + Ezetimibe, and PCSK9 inhibitors. Our primary outcomes were change in percent atheroma volume (PAV). Secondary outcomes included mean differences in total atheroma volume (TAV), lumen, plaque, and vessel volumes, fibrous cap thickness (FCT), and lipid arc (LA). Subgroup analyses were performed on LLT type and post-treatment LDL-C levels. Meta-regression was performed to control for covariates. Results: We identified 51 studies with 9,113 adults (22 % females). LLTs reduced PAV levels (-1.10 % [-1.63, -0.56], p < 0.01), with significant reduction observed with HIS, LIS + ezetimibe, LIS + EPA, and PCSK9 inhibitors. LLTs reduced TAV levels (-5.84 mm3 [-8.64 to -3.04] p < 0.01), mainly driven by HIS (-7.60 mm3 [-11.89, -3.31] p < 0.01). LLTs reduced plaque volume and LA and increased FCT. Conclusion: The plaque regression associated with LLTs is observed to be mainly driven by HIS, reducing both TAV and PAV. This suggest that HIS is the most effective LLT for plaque regression. Unstructured abstract: We evaluated plaque regression of LLTs from 51 studies. We found that while reduction of PAV (-1.10 % [-1.63, -0.56], p < 0.01) were present across different LLT types, reduction of TAV (-5.84 mm3 [-8.64 to -3.04] p < 0.01) was mainly driven by HIS (-7.60 mm3 [-11.89, -3.31] p < 0.01). These results suggest that HIS is the most effective LLT for plaque regression.

[Influence of processed EEG monitoring in the anesthetic management and its cost in off-pump coronary surgery: a research protocol]. / Influência da Monitorização com EEG processado na Conduta Anestésica e seu Custo em Cirurgia Coronária Off-PuMP: Protocolo de Investigação.

BACKGROUD: Although in some studies intraoperative processed EEG monitoring has shown advantages such as less use of hypnotic drugs and decrease duration of both anesthetic emergency and recovery times, there is controversy on the incidence of awareness. It has not been demonstrated that this type of monitoring interferes with length of hospital stay, morbidity and mortality. Processed EEG monitoring, such as the bispectral index (BIS) has been widely accepted in assessing anesthetic depth, yet its usage is not part of the standard monitoring of the American Society of Anesthesiologiy (ASA). Other forms of monitoring anesthetic depth widely used are clinical monitoring associated with monitoring expiratory fraction of halogenated anesthetic agents. METHODOLOGY: Prospective randomized study comparing two groups of patients undergoing coronary artery bypass surgery without cardiopulmonary bypass (CPB): group A - BIS visible (BIS value is shown throughout the procedure) and group B - BIS not visible (BIS is hidden and monitoring of anesthetic depth is based on clinical signs associated with the monitoring of expiratory fraction of halogenated anesthetic agent). The aim of this study is to verify the existence of differences in anesthetic depth and associated costs in the two group study's and also to add evidence to anesthetic depth monitoring in an area where few studies have been done - cardiac surgery.

E6 Tagged Protein Production, Extraction, and Purification from Escherichia coli Lysate.

Cervical cancer has been extensively associated with human papillomavirus (HPV) due to the expression of oncoproteins such as E6. This protein can interfere with p53 tumor suppressor activity, blocking apoptosis of abnormal cells. The functional inhibition of E6 protein is a promising therapeutic strategy for HPV-induced cancers. Conducting biointeraction and characterization studies between E6 protein and potential anti-HPV drugs is necessary to obtain large quantities of high-purity and soluble E6 protein. The recombinant production of E6 protein is particularly challenging because it tends to aggregate. One way to circumvent this problem is to use a dual MBP-His6 tag that can facilitate the expression, proper folding, and solubility of the E6 protein. This chapter outlines effective methods for expressing and obtaining E6 protein with a dual affinity tag by combining different chromatographic methods.

Tea Tree Oil: Properties and the Therapeutic Approach to Acne-A Review.

Acne vulgaris is an inflammatory dermatological pathology that affects mostly young people. However, it can also appear in adulthood, mainly in women. It has a high psychosocial impact, not only at the time of active lesions but also due to the consequences of lesions such as scarring and hyperpigmentation. Several factors are involved in the physiopathology of acne and the constant search for active ingredients is a reality, namely phytotherapeutic ingredients. Tea tree oil is an essential oil extracted from Melaleuca alternifolia (Maiden & Betch) Cheel with known antibacterial, anti-inflammatory, and antioxidant properties, making it a candidate for the treatment of acne. This review aims to describe the various properties of tea tree oil that make it a possible ingredient to use in the treatment of acne and to present several human studies that have evaluated the efficacy and safety of using tea tree oil in the treatment of acne. It can be concluded that tea tree oil has good antibacterial, anti-inflammatory, and antioxidant properties that result in a decrease in the number of inflammatory lesions, mainly papules, and pustules. However, given the diversity of study designs, it is not possible to draw concrete conclusions on the efficacy and safety of this oil in the treatment of acne.

Intracranial Subdural Hygroma: A Rare Complication of Failed Neuraxial Anesthesia?

The unintentional puncture of the dura during epidural procedures is a noteworthy and prevalent complication in obstetric patients. Early recognition can be difficult, particularly when attempts at neuraxial anesthesia are unsuccessful. Rare intracranial complications, such as subdural hematomas and subdural hygromas, can occur after dural puncture and they should be suspected in the presence of atypical headaches or other neurological symptoms. We describe a case of a woman who had an unrecognized dural puncture following failed neuraxial anesthesia and later presented with symptoms of intracranial hypotension. Urgent investigation with cranial CT scan revealed two intracranial subdural hygromas. We discuss the diagnosis, follow-up, and successful management of this case with an epidural blood patch. It is crucial to maintain a high level of suspicion for complications after neuraxial anesthesia and to have a low threshold for imaging and investigation to prevent unfavorable or fatal consequences.