An infection with the Zika virus (ZIKV) is usually mild, with nonspecific symptoms and most often asymptomatic. However, because of its causal relationship with severe congenital malformations, the ZIKV epidemic became an imperative for mobilization, renewed strategies for vector control, and biomedical research. A congenital Zika syndrome (CZS) has been characterized with 5 distinctive features that focus on brain development abnormalities (including microcephaly and brain calcifications), retinal manifestations, and defects on extremities including congenital contractures and hypertonia. The CZS could be just "the tip of the iceberg", pending the documentation of a spectrum of disease that could manifest later in life, from mild dysfunction to severe disease. It will be a matter of time for neurodevelopmental abnormalities, learning disabilities, and other unknown but yet-to-be-described outcomes to be associated with intrauterine ZIKV infection. In addition, ZIKV infection during pregnancy has been associated with other adverse outcomes. Reports mostly include ZIKV-affected pregnancies, and it will be difficult to clearly establish causality without appropriate control groups. We are summarizing some of the known or reported consequences of such infection during pregnancy. Women of reproductive age and particularly pregnant women are the most vulnerable to the adverse consequences of the ZIKV epidemic. Vector control programs need to be expanded to curtail new infections. Research is needed to develop safe and effective treatments, a preventive or therapeutic vaccine, and specific and sensitive tests and to diagnose and identify correlates of long-term immunity. Vaccines and treatments should be safe to be used in pregnancy. To do nothing would allow thousands of pregnant women to expose their fetuses to an infection that causes birth defects and other problems. Prenatal diagnosis technology development is necessary to be able to predict or diagnose adverse fetal outcomes related to ZIKV. Moreover, these tests should be used in a manner similar to the testing/screening method for neural tube defects and common chromosomal anomalies during prenatal care.

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Se presenta el caso de un recién nacido con el Síndrome Congénito del Zika. Los hallazgos de la autopsia fueron similares a los encontrados en las autopsias de Síndrome de virus Zika realizadas en Brasil. Estudios serológicos en el feto confirmaron la presencia del virus y descartaron otras posibles infecciones. La severidad de los defectos se correlacionó con el tiempo de infección. Se discuten los hallazgos neuropatológicos encontrados en la autopsia, haciendo revisión de la literatura sobre el tema.

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We reported the first case of a congenital intrapelvic presacral neuroblastoma in Puerto Rico managed in the early neonatal period. The preoperative diagnosis was a sacrococcygeal teratoma Altman stage IV classification. This case confirms the importance of a comprehensive physical examination and observation of low-risk newborn infants with a history of adequate prenatal care and an unremarkable fetal ultrasonogram during pregnancy.

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history of angina, myocardial infarction, heart failure, stroke, peripheral vascular disease) in this predominantly African American patient population. We conducted a cross-sectional study involving 41 African American patients (14 M, 27 F; 60 Ϯ 16 years) who were on hemodialysis Ն 3 months. Patient demographics and medical histories were obtained. Predialysis serum PAI-1 (ELISA) and serum carnitine levels (spectrophotometry) were measured. Other markers of inflammation and oxidative stress, including C-reactive protein (CRP), IL-6, IL-10, and TNF-␣, were also measured (ELISA). The subjects were divided into two groups: group 1 (n = 36) -low total serum carnitine (< 31 µmol/L for women and < 42 µmol/L for men) and group 2 (n = 5) -normal total serum carnitine (Ն 31 µmol/L for women and Ն 42 µmol/L for men). There were no significant differences in mean age (60 Ϯ 16 years vs 64 Ϯ 13 years; p = ns), gender, presence of hypertension or diabetes, etiology of CKD or serum levels of CRP, IL-6, IL-10, or TNF-␣ between the groups. PAI-1 levels were significantly higher in subjects in group 1 as compared to group 2 (62 Ϯ 24 IU/mL vs 37 Ϯ 21 IU/mL; p = .03). Nine subjects in group 1 had a composite cardiovascular end point as compared to none in group 2. In this population, patients with low carnitine levels had higher levels of PAI-1 as compared to patients with normal carnitine levels. This study was limited by small sample size and the high prevalence of low carnitine levels in hemodialysis patients. More studies are needed to further clarify this observation and the association with cardiovascular disease.

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