Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report.

BACKGROUND: Twin anemia polycythemia sequence is a rare complication in monochorionic twin pregnancy. CASE PRESENTATION: We describe a case of dichorionic twin pregnancy presenting with suspected twin anemia polycythemia sequence. A 31-year-old White female, on her third pregnancy, had a routine ultrasound scan at 12 weeks gestation, which demonstrated a dichorionic twin pregnancy with one placenta located in the anterior wall and the other in the posterior wall of the uterus. At 21 weeks, a scan demonstrated a 24% growth discordance between the two fetuses with normal Doppler studies and amniotic fluid. At 27 weeks, one twin showed signs of anemia and the other polycythemia; the fetal middle cerebral artery peak systolic velocity was high in the anemic fetus and low in the polycythemic twin (1.8 and 0.5 multiples of the median). An intrauterine blood transfusion was carried out and this increased the fetal hemoglobin concentration in the anemic twin from 3.5 to 12.5 g/dL. At 29 weeks, delivery by cesarean section was carried out because of evidence from middle cerebral artery peak systolic velocity of recurrence of anemia in one twin and worsening polycythemia in the co-twin; at birth the hemoglobin concentrations were 5.6 and 24.9 g/dL, respectively. Histopathological examination confirmed dichorionicity with no communicating vessels between the two placentas. CONCLUSIONS: This is the first case of twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy where intrauterine blood transfusion was used to prolong the pregnancy by almost 2 weeks in a "twin anemia polycythemia sequence-like" setting.

SARS-CoV-2 (COVID-19)-specific T cell and B cell responses in convalescent rheumatoid arthritis: Monozygotic twins pair case observation.

Rheumatoid arthritis (RA) patients present higher risk of SARS-CoV-2 infection (COVID-19), and proper management of the disease in this population requires a better understanding of how the immune system controls the virus. We analyzed the T cell and B cell phenotypes, and their repertoire in a pair of monozygotic twins with RA mismatched for COVID-19 infection. Twin- was not infected, while Twin+ was infected and effectively controlled the infection. We found no significant changes on the αß T cell composition, while γδ T cells and B cells presented considerable expansion of memory population in Twin+ and robust T/B cell responses to several SARS-CoV-2 peptides. T cell receptor ß/γ-chain and immunoglobulin heavy chain next-generation sequencing depicted a remarkable higher diversity in Twin+ compared with Twin-, despite no significant changes being found in variable/joining family usage. Repertoire overlap analyses showed that, although being identical twins, very few clones were shared between them, indicating that COVID-19 may lead to deep changes on the immune cell repertoire in RA patients. Altogether, our results indicate that RA patients may develop robust and persistent COVID-19-specific T/B cell responses; γδ T cells and B cells may play a key role in the management of COVID-19 in RA, and the infection may lead to a profound reshaping of immune cell receptor specificities.

Recurrence of COVID-19 associated with reduced T-cell responses in a monozygotic twin pair.

Recurrence of COVID-19 in recovered patients has been increasingly reported. However, the immune mechanisms behind the recurrence have not been thoroughly investigated. The presence of neutralizing antibodies (nAbs) in recurrence/reinfection cases suggests that other types of immune response are involved in protection against recurrence. Here, we investigated the innate type I/III interferon (IFN) response, binding and nAb assays and T-cell responses to severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) with IFN gamma (IFNγ) enzyme-linked spot assay (ELISPOT) in three pairs of young adult monozygotic (MZ) twins with previous confirmed COVID-19, one of them presenting a severe recurrence four months after the initial infection. Twin studies have been of paramount importance to comprehend the immunogenetics of infectious diseases. Each MZ twin pair was previously exposed to SARS-CoV-2, as seen by clinical reports. The six individuals presented similar overall recovered immune responses except for the recurrence case, who presented a drastically reduced number of recognized SARS-CoV-2 T-cell epitopes on ELISPOT as compared to her twin sister and the other twin pairs. Our results suggest that the lack of a broad T-cell response to initial infection may have led to recurrence, emphasizing that an effective SARS-CoV-2-specific T-cell immune response is key for complete viral control and avoidance of clinical recurrence of COVID-19.

Mysteries of Monozygosity: Theories and Breakthroughs/Twin Research: Rare Case of Lost Twins; Developing a National Twin Registry; Twins' Language and Gesture Delays; DNA Testing for Vanishing Twins/Media Reports: Identical Twins Discordant for COVID Vaccination; World's Oldest Identical Twins; Olympic Athlete Stand-in; Fraternal Twin Football Players.

The processes that give rise to monozygotic (MZ) twins remain elusive. This article describes various theories of MZ twinning that have been examined over the years, although they continue to be speculative. It has also been impossible to know if a singleton began life as an MZ twin; however, a critical technological breakthrough can now reveal this important birth history information with a high degree of certainty. The section that follows presents reviews of current research regarding rare twin loss, development of a twin registry, twins' communicative delays and DNA testing for vanishing twins. The article concludes with a survey of newsworthy twins, namely identical twins discordant for COVID vaccination, the world's oldest identical twins, an Olympic athletic stand-in and fraternal twin football players.

Changes in physical activity levels and mental health during COVID-19: Prospective findings among adult twin pairs.

BACKGROUND: Physical distancing and other COVID-19 pandemic mitigation strategies have negatively impacted physical activity (PA) levels and mental health in cross-sectional studies. The purpose of this study was to investigate associations between changes in PA and mental health outcomes during the COVID-19 pandemic, following implementation of mitigation strategies, in a sample of adult twins. METHODS: This was a prospective study of 3,057 adult twins from the Washington State Twin Registry. Study participants completed online surveys in 2020, at baseline (March 26 -April 5), and three follow-up waves (W1: April 20 -May 3; W2: Jul 16 -Aug 2; W3: Sept 16 -Oct 1). Physical activity was operationalized as self-reported moderate-to-vigorous PA (MVPA) and neighborhood walking (minutes/week), and mental health outcomes, operationalized as self-reported anxiety and perceived stress were assessed in the three waves of follow-up. Latent growth curve models (LGCMs) were used to assess changes in PA and mental health outcomes over time. Parallel LGCMs were used to estimate the cross-sectional, parallel, and prospective associations between PA and mental health over time. All models took into within-pair correlations and adjusted for age, sex, and race. RESULTS: Individuals' amount of MVPA and walking decreased over time, whereas levels of anxiety remained stable, and stress increased slightly. Cross-sectional associations observed between both PA predictors and mental health outcomes were weak. After taking into account cross-sectional associations between PA and mental health outcomes, changes in PA over time were not associated with changes in mental health outcomes over time. CONCLUSIONS: Over a time period aligned with COVID-19 mitigation strategies and social restrictions, changes in physical activity was not associated with changes in anxiety or stress levels in the current sample. Nonetheless, the average decline in PA over time is worrisome. Public health resources should continue to promote PA as a means to improve physical health during the pandemic.

Impairment of CD4+ T and Memory B Cell Responses but Normal Memory CD8+T-Cell Activation on Crohn's Disease after COVID-19 Vaccination: A Twin Case.

Vaccines to prevent the impact of SARS-CoV-2 are now available, including for patients with autoimmune diseases. However, there is no information about how inflammatory bowel disease (IBD) treatment could impact the cellular and humoral immune responses. This study evaluated SARS-CoV-2-specific humoral and cellular responses after vaccination with a two-dose schedule in a Crohn's disease patient treated with Infliximab (10 mg/kg); we included comparisons with a monozygotic twin. The results showed that the Crohn's disease's twin (twin 2) had no antibody detection and reduced activation of CD4+ T cell responses, unlike the twin without the autoimmune disease (twin 1). Twin 2 developed antigen-specific central memory CD8+ T-cells and IFNγ production after the second dose of COVID-19 vaccination, similar to twin 1. These findings elucidated the role of T-cell immunity after COVID-19 immunization on IBD patients despite the lack of antibody production. Finally, our observation supports the consensus recommendation for IBD patients to receive COVID-19 vaccines.

Twins Separated at Birth: Across a Country and Around the World/Twin Research: Memorial Tribute to Isaac Blickstein, MD; Infanticide and Sacrifice of Archaic-Aged Twins and Triplets; Prehistoric Twin Burials; Highlights from a Conference on Three Identical Strangers/Media Reports: An Atypical Twin Father; An Actor's Twin Brother; Twin Link to Tulsa, Oklahoma Massacre; Superfetated Twins; Twin Comedians and Script Writers; Indian Twins' Loss to COVID-19.

Every reared-apart monozygotic (MZ) twin pair offers a fresh perspective on human developmental questions. This is true regardless of whether the co-twins were raised in the same country or across the globe. The members of two pairs of separated MZ female twins have recently come to attention. In one case the twins were raised by different families in Argentina; in the other case the twins were raised by different families in Sweden and Vietnam. The perceptions and perspectives of these twins are insightful. The twin research section that follows begins with a tribute to our late esteemed colleague, Dr Isaac Blickstein (1953-2020). Research concerning the infanticide and sacrifice of Archaic-aged twins and triplets and prehistoric twin burials is reviewed next. Highlights from a conference focused on the 2018 film Three Identical Strangers are also included in this portion. The final section of this article includes media reports of an atypical twin father, an actor's twin brother, a twin link to the 1921 Tulsa, Oklahoma massacre, the birth of superfetated twins, twin comedians and script writers and Indian twins' tragic loss to COVID-19.

Complicated Monochorionic-Diamniotic Twins in a Pregnant Woman with COVID-19 in the Second Trimester.

OBJECTIVE: A majority of studies evaluating the risk of vertical transmission and adverse outcomes in pregnancies with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are mostly based on third-trimester infections. There is limited data available on pregnancy sequelae of maternal infection in the first or second trimester. STUDY DESIGN: We present a patient with monochorionic-diamniotic twins that develops coronavirus disease 2019 infection at 15 weeks of gestation. The pregnancy is further complicated by stage II twin-twin transfusion syndrome. She undergoes laser ablation, which is complicated by development of a subchorionic hematoma. The patient then develops Escherichia coli bacteremia, resulting in septic shock and preterm labor followed by previable delivery at 21 weeks of gestation. Amniotic fluid and placenta were negative for SARS-CoV-2 by real-time polymerase chain reaction. CONCLUSION: This case of SARS-CoV-2 argues against transplacental transmission after a second-trimester infection but brings attention to the possible downstream complications that may arise following early infection. KEY POINTS: · Vertical transmission of SARS-CoV-2 is not evident after a second-trimester infection.. · Antepartum coronavirus disease 2019 may cause vascular placental changes and placental insufficiency.. · SARS-CoV-2 is associated with a maternal hypercoagulable state with adverse perinatal outcomes..

Do Males Affect Twinning Events? A Review of Current Findings/Twin Research Reviews: Monozygotic Twins Discordant for Parkinson's Disease; Fetal Loss in Twin Pregnancies Following Prenatal Diagnosis; Uterine Rupture and Repair in an Early Twin Pregnancy; Twin Study of Affectionate Communication/Human Interest: Conjoined Twins in a Triplet Set; Identical Twin Nurses Deliver Identical Twins; Identical Twins Discordant for COVID-19 Recovery Course; Identical Twins Pass Away from COVID-19; Archeological Finds of Oldest Identical Twins.

Research into the origins of twinning has focused mostly on contributions from the female side of the family. A review of current findings suggests that possible male contributions to twinning events have been overlooked. This section is followed by brief reviews of twin research concerning monozygotic twins discordant for Parkinson's disease, fetal loss in twin pregnancies following prenatal diagnosis, uterine rupture and repair in an early twin pregnancy and a twin study of affectionate communication. The concluding portion of this article presents human interest stories involving twins that are both informative and poignant, namely conjoined twins in a triplet set, identical twin nurses who delivered identical twins, identical twins discordant for COVID-19 recovery course, identical twins who passed away from COVID-19 and archeological finds of the oldest identical twins.

Self-Reported Symptoms of COVID-19, Including Symptoms Most Predictive of SARS-CoV-2 Infection, Are Heritable.

Susceptibility to infection such as SARS-CoV-2 may be influenced by host genotype. TwinsUK volunteers (n = 3261) completing the C-19 COVID-19 symptom tracker app allowed classical twin studies of COVID-19 symptoms, including predicted COVID-19, a symptom-based algorithm to predict true infection, derived from app users tested for SARS-CoV-2. We found heritability of 49% (32-64%) for delirium; 34% (20-47%) for diarrhea; 31% (8-52%) for fatigue; 19% (0-38%) for anosmia; 46% (31-60%) for skipped meals and 31% (11-48%) for predicted COVID-19. Heritability estimates were not affected by cohabiting or by social deprivation. The results suggest the importance of host genetics in the risk of clinical manifestations of COVID-19 and provide grounds for planning genome-wide association studies to establish specific genes involved in viral infectivity and the host immune response.

Liver transplantation and COVID-19: a case report and cross comparison between two identical twins with COVID-19.

BACKGROUND: To this date little information exists on the effects, clinical course and outcome of the COVID-19 among patients undergoing transplantation. CASE PRESENTATION: A 35 year old male referred with loss of sense of smell and taste after having close contact with his brother who was diagnosed with COVID-19 five days prior to his symptoms. The patient had undergone liver transplantation 3 years prior to his referral due to primary sclerosing cholangitis in association with ulcerative colitis and was using immunosuppressive medications. The patient referred to a local physician with mild symptoms of fatigue, cough, myalgia, dizziness, and nausea/vomiting with a fear of contracting the disease. Except for a CRP of 32 his other blood tests were normal. After 3 days of hospital admission the patient was discharged with a good condition. His brother had developed fever, chills, headache, mild dyspnea and an objective loss of sense of smell and taste and was sent home and advised to self-quarantine. Both patients had CT scans in favor of COVID-19. CONCLUSION: Our patient who had liver transplantation and COVID-19 did not present more severe symptoms compared to his counterpart without liver transplantation and did not need to be hospitalized or be given antiviral drugs for COVID-19.