Twins Working Together: Collaboration or Contest/Twin Research: Molar Pregnancy; Social Support; Conjoined Twins; Immune Discordance/Headlines: Twin Politicians; Multiple Birth Marriages; Guinness World Record; Museum of Memory and Human Rights (Santiago, Chile).

Twin research has found genetic influence underlying vocational interests, work values, and job satisfaction. In addition, numerous studies have shown that monozygotic (MZ) twins generally display greater within-pair cooperation and social closeness than dizygotic (DZ) twins. These findings are illuminated by exploring the occupational histories of two female twin pairs, one set MZ and the other set DZ. This is followed by a review of timely twin-based research reports on molar pregnancy, social support, conjoined twinning, and immune discordance. Finally, news items regarding identical twin politicians, multiple birth marriages, a new Guinness World Record for twins, and a twin-family story from the Museum of Memory and Human Rights in Santiago, Chile are both interesting and informative.

Conjoined Twins.

Reported here is a case of conjoined twins presented to ante-natal outpatient department of Paropakar Maternity and Women's Hospital on 21st August 2015 on a 20 year "Primigravida at 27 weeks and 6days of gestation not in labor" referred from a polyclinic following ultrasonography diagnosis for better management. After confirming the diagnosis and counseling the patients regarding mode of delivery and possible outcomes, elective caesarean section was performed and delivered male conjoined twins of Parapagusdicephalus type with poor Apgar score. No resuscitation attempted except oxygen supplementation as per wish of parents and early neonatal deaths occurred at one hour of life. Keywords: conjoined twins; monozygotic twins; siamese twins; twinning; twin pregnancy.

An ethically-justifiable, practical approach to decision-making surrounding conjoined-twin separation.

Conjoined twins present unique ethical and palliative care challenges. We present an ethically-justifiable, practical approach to decision-making with regards to surgical separation. These decisions must account for the short- and long-term prognoses for each infant prior to, and after, separation. Other considerations include the benefits and burdens of separation and the family's values and goals. Caregivers should recognize that decisions surrounding separation may be unduly influenced by social biases. The palliative care team aids in developing goals of care to guide decision-making by promoting communication between the medical team and family. They play an important role in supporting families regardless of the planned course of treatment. This support may be social or spiritual in nature, and is promoted by the interdisciplinary structure of the team. Early involvement of palliative care services facilitates complex decision making and can aid in the transition from cure-oriented therapies to support if needed during and after the dying process.

Family support and media considerations with conjoined twins.

Conjoined twins offer unique challenges for the family and medical care team including psychosocial stressors, religious dilemmas and public relation considerations. The involvement of social workers, child life specialists, chaplains and public relation experts is an important component in the care of conjoined twins. In this paper, we discuss the issues that could be encountered when supporting families with conjoined twins and strategies to address them.

Therapy services and specialized devices for conjoined twins: Unique challenges with conjoined twins and the importance of physical and occupational therapy.

Conjoined twins are a rare occurrence that offer unique challenges and circumstances to therapists. The overall goal of physical and occupational therapy treatment is to provide care that promotes developmental progression to two conjoined individuals with distinct personalities and potentially different physical and medical needs. The unique presentation of conjoined twins must be considered in determining therapeutic goals, interventions and plans of care. Providing therapeutic interventions throughout the NICU stay is a dynamic, evolving process, which challenges the therapy team to work together to find solutions. This paper aims to highlight the considerations, challenges, and strategies used to address barriers in the therapeutic care of conjoined twins.

Highlights from the 15th International Congress of Twin Studies/Twin Research: Differentiating MZ Co-twins Via SNPs; Mistaken Infant Twin-Singleton Hospital Registration; Narcolepsy With Cataplexy; Hearing Loss and Language Learning/Media Mentions: Broadway Musical Recalls Conjoined Hilton Twins; High Fashion Pair; Twins Turn 102; Insights From a Conjoined Twin Survivor.

Highlights from the 15th International Congress of Twin Studies are presented. The congress was held November 16-19, 2014 in Budapest, Hungary. This report is followed by summaries of research addressing the differentiation of MZ co-twins by single nucleotide polymorphisms (SNPs), an unusual error in infant twin-singleton hospital registration, twins with childhood-onset narcolepsy with cataplexy, and the parenting effects of hearing loss in one co-twin. Media interest in twins covers a new Broadway musical based on the conjoined twins Violet and Daisy Hilton, male twins becoming famous in fashion, twins who turned 102 and unique insights from a conjoined twin survivor. This article is dedicated to the memory of Elizabeth (Liz) Hamel, DZA twin who met her co-twin for the first time at age seventy-eight years. Liz and her co-twin, Ann Hunt, are listed in the 2015 Guinness Book of Records as the longest separated twins in the world.

Ischiopagus and diprosopus in India: two pairs of conjoined twins perceived as incarnations of Hindu deities.

This article briefly reviews two specific types of conjoined twins, ischiopagus and diprosopus, and discusses recent cases of such twins born in India. Some members of the Hindu community worshiped these conjoined twins as incarnations of Hindu deities. In discussing this phenomenon, the authors aim to elucidate certain features of the faith tradition of Hinduism itself. The reception of these conjoined twins as incarnations of Hindu deities can be understood by examining two salient features of Hindu polytheism: the pictorial depiction of Hindu deities with multiple appendages and the concept of an incarnation, or avatar, of a Hindu deity.

Is an account of identity necessary for bioethics? What post-genomic biomedicine can teach us.

Is a theory of identity necessary for bioethics? In this paper I investigate that question starting from an empirical explication of identity based on post-genomics, in particular on epigenetics. After analysing whether the classic problems a theory of identity has to cope with (fictional transplants; conjoined twins; and definition of death) also affect the proposed epigenetic account of identity, I deal with three topics (the assumption of moral responsibility; decision maintenance in the case of advance directives; and the attribution of value to human beings at given developmental stages) to offer an insight on the relationship between that account and bioethics.

Gémeos siameses. Daignóstico ecográfico precoce: a propósito de um caso clínico / Gemelos siameses. Diagnóstico ecográfico precoz: a propósito de un caso / Conjoined twins. Fist trimester sonographic diagnosis: a case report

A existéncia de gémeos siameses é conhecida desde a antiguidade e pode ocorrer em aproximadamente 1 % das gestnóes monozigóticas ou em 1/200,000 nascimentos. No passado, o diagnóstico ecográfico apenas era possível no segundo ou mesmo no terceiro trimestres de gravidez. Actualmente, com o progresso da ecografia com imagens de cada vez melhor resolnáo e com a sua ampla utiliznáo na vigiláncia da gravidez, tornou-se possível o diagnóstico precoce. A ecografia realizada ás 12-13 semanas permite náo só o diagnóstico, mas também avaliar a extensáo de órgáos partilhados e as principais malformnóes associadas, estabelecendo o prognóstico. Assim, de acordo com a gravidade, a interruKáo médica da gravidez pode ser ponderada o mais precocemente possível, minimizando as consequéncias para a grávida e para o casal. Os autores apresentam um caso clínico em que o diagnóstico ecográfico de gémeos siameses craneo-toracópagos foi realizado ás 12 semanas. Posteriormente fazem um breve apanhado sobre a sua etiopatogenia, classifica0o, marcadores ecográficos de diagnóstico e conduta clínica (AU)

La existencia de gemelos siameses es conocida desde la antigüedad y puede ocurrir en aproximadamente el 10/o de las gestaciones monocigóticas o en 1/200.000 partos. En el pasado el diagnóstico ecográfico apenas era posible, incluso en el segundo y tercer trimestre del embarazo. Actualmente con el progreso de la ecografía con imágenes de cada vez mejor resolución y con su amplia utilización durante el embarazo se hizo posible el diagnóstico precoz. La ecografía realizada a la 12-13 semana permite no sólo su diagnóstico, sino también evaluar los órganos afectados y las principales malformaciones asociadas, estableciendo un pronóstico. Así, una interrupción médica del mismo puede ser programada lo más precozmente posible, minimizando las consecuencias para la embarazada. Los autores presentan un caso clínico en el que el diagnóstico ecográfico de gemelos siameses craneotoracópagos fue realizado a las 12 semanas del embarazo, y posteriormente hacen una breve reseña de su etiopatogenia, clasificación, marcadores ecográficos de diagnóstico y conducta clínica (AU)

The existence of conjoined twins has been described since ancient times. It has an incidence of approximately 10/o in monozygotic twins or 1/200,000 live births. In the past, the diagnosis was often first made by ultrasound examination in the second or third trimesters of pregnancy. With the advent of high-resolution obstetric ultrasound imaging and its growing use in pregnancy follow-up, an early diagnosis of this situation was made possible. The ultrasound scan made around the 12-13th week allows not only the diagnosis of this condition, but also has a prognostic value through identification of the extent of organ sharing and main associated malformations. Therefore, in accordance with the prognosis, pregnancy termination ought to be considered as early as possible, minimizing physical and psychological damage to the parents. The authors report a case of craniothoracopagus conjoined twins revealed by ultrasound at 12 weeks' gestation. Afterwards a summary of etiopathology, classification, ultrasound diagnostic criteria and management is made (AU)

Fetos siaameses cefalópagos-toracópagos en gestación triple / Cephalopagus and throacopagus conjoined twins in a triple pregnancy

Describimos un caso de gestación triple complicada con fetos siameses diagnosticada por un estudio ecográfico durante el primer trimestre. En la revisión bibliográfica posterior se encontraron otros 11 casos diferentes publicados. Se trata de una extraña condición, la presentación de siameses en un embarazo triple, lo que supone un importante reto para el obstetra en cuanto a su diagnóstico y manejo. El diagnóstico preciso de la corionicidad en estos casos tiene un papel fundamental en determinar el manejo y resultado de esta entidad (AU)

The report a case of conjoined twins complicating a triplet pregnancy diagnosed by two-dimensional ultrasound in the first trimester of pregnancy and a review of the literature is done to revealed other 11 cases diagnosed prenatally by ultrasound. The rare condition of conjoined twins in a triplet pregnancy poses a significant obstetric challenge from both diagnostic and management points of view. Accurate determination of chorionicity in these cases plays a critical role in determining management and outcome (AU)

One or two: an examination of the recent case of the conjoined twins from Malta.

The article questions the assumption that conjoined twins are necessarily two people or persons by employing arguments based on different points of view: non-personal vitalism, the person as a sentient being, the person as an agent, the person as a locus of narrative and valuation, and the person as an embodied mind. Analogies employed from the cases of amputation, multiple personality disorder, abortion, split-brain patients and cloning. The article further questions the assumption that a conjoined twin's natural interest and wish is separation. I first contend that separation is such a radical procedure as to render the post-separation person different from the pre-separation one. Therefore, it is not possible to benefit the pre-separation twin by the act of separation. The article concludes with a critical evaluation of the tendency in bioethics to regard ethical challenges as rivalry between individuals competing for scarce resources.

Head-counting vs. heart-counting: an examination of the recent case of the conjoined twins from Malta.

This paper reexamines the recent case of the conjoined twins from Malta. Survival was said to be possible only through separation, which would actually leave only one twin alive. The parents refused to allow the killing of one to save the other, but the court ruled that this would amount to the neglect of innocent life. The article questions the assumption that the case is indeed a struggle between two people. Further, it questions the assumption that a conjoined twin's natural interest and wish is separation. Historical evidence shows that many conjoined twins do not wish for separation, even when it becomes a question of survival.The article concludes with a critical evaluation of the tendency in contemporary society and particularly in bioethics to regard ethical challenges as rivalry between individuals competing for scarce resources.

The management of severely malformed newborn infants: the case of conjoined twins.

The birth of 'Siamese' twins in August 2000 whose parents refused to consent to surgery for separation required English courts to decide whether the twins could lawfully be separated despite that refusal when one twin would certainly die as a direct surgical result. The Court of Appeal unanimously upheld the trial judge's decision to authorize surgery, taking account of principles of family law, criminal law and human rights law. Parental duties to the viable twin were found consistent with the justification of allowing, without intending, natural death of the non-viable twin. The right to human dignity of both twins supported the justification of separation surgery. The decision did not elevate physicians' choices over parents', but subjected both to the law. The hospital was found entitled to bring the case to court, but not obliged; it could have declined surgery in conformity with the parents' wishes.

The Manchester Siamese twins case--a French ethical analysis.

Conjoined twins were born on 8th August 2000 in Manchester. After a 2-month period of legal fighting between their parents and the medical team, which was widely reported in the media, the twins were surgically separated on 7th November 2000. This case-report scrutinises the ethical dilemma from a fresh perspective.