"Blueberry muffin": Manifestación atípica de una infección congénita frecuente

El síndrome "blueberry muffin" es una dermatosis maculopapular eritematoviolácea como resultado de una hematopoyesis extramedular. Se ha asociado con infecciones del espectro TORCH y causas no infecciosas. Presentamos el caso de un recién nacido pretérmino, quien desde el control prenatal presentó una ecografía con signos sugerentes de infección congénita por citomegalovirus (microcefalia, ventriculomegalia y calcificaciones intracerebrales). Al examen físico presentaba una dermatosis macular violácea compatible con síndrome "blueberry muffin". Se detectó carga viral de citomegalovirus en orina (81,200 copias/ml) e inició tratamiento con ganciclovir, con desenlace fatal. La infección congénita por CMV debe considerarse ante el síndrome "blueberry muffin"; el adecuado abordaje diagnóstico debe ser oportuno y debe incluir antecedentes maternos y perinatales, así como estudios serológicos para infecciones por TORCH con el fin del inicio precoz de tratamiento para evitar complicaciones y secuelas.

Blueberry muffin syndrome is characterized by an erythematousviolaceous maculopapular dermatosis due to extramedullary hematopoiesis. This entity has been associated with TORCH spectrum infections and noninfectious causes. We present the case of a preterm newborn, who since the prenatal control gave an ultrasound with data suggestive of congenital infection by cytomegalovirus (microcephaly, ventriculomegaly, intracerebral calcifications). On physical examination, he presented a violaceous macular dermatosis compatible with blueberry muffin syndrome. Cytomegalovirus viral load was detected in urine (81,200 copies/ml), with fatal outcome. Congenital cytomegalovirus infection should be considered in the presence of a blueberry muffin syndrome; an adequate diagnostic approach that includes maternal and perinatal history is essential, as well as serology studies for diseases of the TORCH spectrum in order to start early with treatment and avoid major comorbidities.

Current Status Of Immunoglobulin M And Immunoglobulin G Seroprevalence Of Torch Infections In Pregnant Women With Bad Obstetric History At A Tertiary Care Hospital

Introduction: TORCH stands for Toxoplasma gondii, Rubella virus, Cytomegalo virus (CMV) and Herpes simplex virus- 2 (HSV-2). These infections are transmitted to the foetus through transplacental route at any time during gestation or sometimes at the time of delivery. The infection may be asymptomatic or mild in mother but associated with inadvertent outcomes for the foetus. One of the causes of BOH is maternal infection. TORCH infection is asymptomatic in pregnant women and on clinical basis it is difficult to diagnose. To study the TORCH infection (IgM and IgG antibodies)Aim: prevalence in pregnant women with Bad Obstetric History. A hospital based cross-sectionalMaterials And Methods: study conducted in Department of Microbiology in collaboration with Department of Obstetrics and Gynecology, SHKM GMC, Nalhar, Nuh, Haryana over a period of one year (February 2020 - January 2021). A total of 90 samples were included in the study including control group. The IgM seroprevalence of TORCH in participants with bad obstetricResults: history was found to be 11.11%. In cases with Bad obstetric history prevalence of IgM Toxoplasma, Rubella, Cytomegalovirus & Herpes Simplex Virus was found as 4.44%, 0%, 2.22% & 4.44% respectively and prevalence of IgG Toxoplasma, Rubella, Cytomegalovirus, & Herpes Simplex Virus was found as 53.33%, 91.11%, 88.89% & 66.67% respectively. This study concluded that a previous history of pregnancy wastage and the serologicalConclusion: screening for TORCH infections during current pregnancy must be considered while managing BOH cases to reduce the adverse fetal outcome

Characterization of placental infection by zika virus in humans: A review of the literature / Caracterização da infecção placentária pelo vírus zika em humanos: Uma revisão da literatura

Abstract Objective The aim of the current review is to present a systematic evaluation of reported human placental findings in cases of zika virus (ZIKV) infection. Data sources We reviewed the EMBASE, PUBMED, and SCIELO databases until June 2019, without language restrictions. Selection of studies The search terms placenta AND zika virus were used. The inclusion criteria of the studies were studies that reported placental findings in humans. Experimental studies, reviews, notes or editorials were excluded. A total of 436 studies were retrieved; after duplicate exclusion, 243 articles had their titles screened, and 128 had their abstract read; of those, 32 were included in the final analysis (18 case reports, 10 case series, and 4 cohorts) Data collection We collected data concerning the author, year of publication, study design, number of participants, number of placental samples, onset of symptoms, perinatal outcomes, and main findings on histological analysis. Data synthesis The placental pathologic findings were described as mild and nonspecific, similar to those of other placental infections, including chronic placentitis, chronic villitis, increased Hofbauer cells, irregular fibrin deposits, increased mononuclear cells in the villus stroma, villous immaturity, edema, hypervascularization, stromal fibrosis, calcification, and focal necrosis of syncytiotrophoblasts. Conclusion Zika infection presents unspecific placental findings, similar to other infections in the toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes (TORCH)group. Characterizing and standardizing placental findings after zika virus infection is key to understanding the mechanisms of congenital diseases.

Resumo Objetivo O objetivo desta revisão é apresentar uma avaliação sistemática dos achados relacionados à infecção por zika vírus (ZIKV) na placenta humana. Fontes de dados As bases de dados EMBASE, PUBMED, e SCIELO foram pesquisadas, até junho de 2019, sem qualquer restrição de língua. Seleção dos estudos Os termos placenta E zika virus foram utilizados na busca. Foram incluídos estudos que reportassem achados placentários de infecção em seres humanos, enquanto estudos experimentais, revisões, notas e editoriais foram excluídos. Um total de 436 estudos foram identificados, e 243 tiveram seus títulos lidos após a exclusão de duplicatas. Cento e vinte e oito artigos tiveram seus resumos avaliados, dos quais 32 foram incluídos na análise final (18 relatos de caso, 10 séries de casos, e 4 estudos de coorte). Dados obtidos Foram pesquisados dados relativos ao autor, ano da publicação, desenho do estudo, número de participantes, número de amostras de placenta, início dos sintomas, desfechos perinatais, e principais achados histológicos. Síntese dos dados Os principais achados placentários descritos foram leves e inespecíficos, similares a outras infecções placentárias, incluindo infecção placentária crônica, vilosite crônica, aumento das células de Hofbauer, depósitos irregulares de fibrina, aumento das células mononucleares no estroma viloso, imaturidade vilosa, edema, hipervascularização, fibrose estromal, calcificação, e necrose focal dos sincicitrofoblastos. Conclusão Infecções por ZIKV têm achados placentários inespecíficos, similares aos de outras infecções do grupo toxoplasmose, rubéola, citomegalovírus e herpes (TORCH). Caracterizar e padronizar os achados placentários após infecção por ZIKV é fundamental para entender o mecanismo das infecções congênitas.

Seroprevalence of TORCH infection among pregnant women

Background: TORCH infection complex during pregnancy has bad obstetric outcomes starting from low birth weight to congenital anomalies, sensory neural deafness, mental retardation, cerebral palsy and sometimes to fatal outcomes like abortion and still birth. As these diseases remain mostly asymptomatic these are rarely tested during pregnancy. Serology is the mainstay of diagnosing these infections.. Methods: A cross sectional study was undertaken to estimate the burden of these infections in a rural belt of western Odisha where majority of the population depend upon agricultural work. A total number of 402 antenatal cases were screened by ELISA test for presence of IgG&IgM antibodies against toxoplasma, rubella virus, cytomegalovirus (CMV), herpes simplex virus (HSV) 1 & 2; RPR test was done to know seroprevalence of Syphilis. Results: It was found that Rubella is the most predominant infection being positive in 69.1% of the cases (IgG 68.4%, IgM 0.5%, and both IgG&IgM 0.25%), followed by CMV infection-66.7% (IgG 57.2%, IgM 1.7%, both 7.7%), Toxoplasma infection-39.8% (IgG 38.3%, IgM 0.7%, both 0.7%), HSV 1-23.6% (IgG 21.1%, IgM 2%, both 0.25%) and HSV 2 – 13.2% (IgG 11.7%, IgM 1.6%, both 0.25%). The seoprevalence of syphilis by RPR was least common with 0.5%. Conclusions: This study showed that most of the infections have occurred by 20 years of age and before or during the 1st pregnancy. It is less common among the antenatal cases who have better education and have spouses servicing in private or government sectors signifying the more health and sanitation awareness among this group.

Seroprevalence Of Torch Infections In A Tertiary Care Center – Current Situation

TORCH group of infections (Toxoplasma gondii, Rubella, Cytomegalovirus and the Herpes Simplex Virus) cause diseases in pregnant women and immune–compromised patients where it can lead to poor obstetric outcomes and reproductive failures else may cause life threatening opportunistic infections. There is perceived lacunae in the published literature available for measuring the seroprevalence of these infections in India. A retrospective study was undertaken to determine the seroprevalence of the TORCH infections at a tertiary care centre in northern india. The laboratory data which encompasses the period between Jan 2016 to Oct 2018 involving 1200 patients being treated in various departments of this center was analyzed using ELISA in conjunction with VIDAS and COBAS. The study showed a high seropositivity of the infections caused by the TORCH complex amongst patients despite improved hygiene conditions and health awareness.

Manifestaciones clínicas asociadas al síndrome de TORCH / Clinical manifestations associated to the TORCH syndrome

Las infecciones neonatales se adquieren comúnmente por la vía intrauterina o durante el parto. El acrónimo TORCH fue designado para un grupo de infecciones comunes, y se utiliza de forma universal para caracterizar el cuadro clínico que presenta el feto o el recién nacido compatible con una infección congénita que incluye rash, hepatoesplenomegalia, hidrocefalia o microcefalia, alteraciones cardiovasculares, auditivas y oculares. Las siglas TORCH comprenden toxoplasmosis, otros (sífilis y HIV), rubeola, citomagalovirus y herpes simple. Lo más importante de este término es que dota al médico de las herramientas para hacer un enfrentamiento racional, tanto diagnóstico como terapéutico, y establecer un plan de acción para minimizar los daños producidos por estas infecciones. Con esta revisión nos proponemos destacar las manifestaciones clínicas más importantes asociadas al síndrome de TORCH, así como sus vías de transmisión, diagnóstico y tratamiento de las infecciones que lo comprenden, teniendo en cuenta que con relativa frecuencia en nuestra institución son interconsultados estos pacientes y que de su evaluación correcta y oportuna puede depender un diagnóstico certero, con un tratamiento adecuado, y una mejor evolución de estos(AU)

Neonatal infections are often acquired during pregnancy or childbirth. The acronym TORCH refers to a group of common infections, and is universally used to characterize a clinical status of fetuses or newborns which is compatible with a congenital infection, including rash, hepatosplenomegaly, hydrocephalus or microcephaly, as well as cardiovascular, hearing or sight disorders. The initials TORCH stand for Toxoplasmosis, Other infections (such as syphilis or HIV), Rubella, Cytomegalovirus and Herpes simplex. The term is especially useful because it provides doctors with the tools required for a rational diagnostic and therapeutic response and the development of an action plan aimed at minimizing the damage caused by these infections. The purpose of this review is to present the most important clinical manifestations of the TORCH syndrome, as well as its routes of transmission, diagnosis and treatment of the infections making it up(AU)

Maternal, Foetal And Placental Conditions Associated With Stillbirth: An Exploratory Study

Background: Stillbirth constitutes about 60% of the perinatal deaths. And this is an event which has always challenged the obstetricians for decades. Various maternal, foetal and placental factors may result to stillbirths. Yet, in spite of the modern facilities available and advances made in the medical field, many times no contributing factors can be attributed to the exact cause of stillbirth and refusal of autopsy examination seals the chapter, with the cause of stillbirth remaining unexplored. Objective: The objective of the current study was to explore the maternal, foetal and placental conditions associated with stillbirth and to ascertain the common causes of stillbirth. Methods: A hospital-based prospective study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical College, Imphal, Manipur in the year 2003. At the time of admission, after obtaining informed verbal consent, a detailed history was taken followed by thorough physical examination and routine investigations were dome for all the admitted patients in the antenatal ward. After delivery, all the women who had stillbirth were approached again to undergo special investigations like blood sugar estimation, VDRL test, urine examination for culture and sensitivity, ELISA for HIV and TORCH antibodies, Widal test, liver function tests and kidney function test. Based on the above findings, the stillbirths were analysed as macerated stillbirths and fresh stillbirths. Results: Only 43 women out of all the 100 women who had stillbirths could be investigated for TORCH antibodies. Out of these 43 women, 4 (9.3%) women were positive for Ig M toxoplasma antibody, 3 (7.0%) women were positive for Ig M Rubella antibody, 10 (23.3%) women were positive for Ig M CMV and 9 (20.9%) women were positive for Ig M HSV I & II indicating present infection. Ig G antibody alone was positive in 25 (58.1%) women for toxoplasmosis, 29 (67.4%) women for Rubella, 31 (72.1%) women for CMV and 20 (67.4%) women for HSV I & II indicating past infection (Table 1). Forty-eight women underwent VDRL testing and 08 (20%) women were found to be positive. Only 20 women gave consent for their placenta to undergo histopathological examination. Among these the commonest histological finding was syncytial knots (70%). Maternal anaemia (78%) was by far the commonest medical condition associated in women who either had macerated or fresh stillbirth. And accidental haemorrhage with or without placenta previa and prolonged/obstructed labour were the common conditions associated with stillbirth. The most probable causes of stillbirth assigned for all the 100 stillbirths, made after careful clinical consideration were intra-partum asphyxia (59%), foetal asphyxia (19%), unexplained intra-uterine deaths (15%) and congenital malformations (7%). Conclusion: Proper antenatal care for screening high risk factors and management thereof and educating the women to overcome the fear for hospital delivery are the needs of the hour. Also, a constant supervision by the senior staffs and their availability for consultation while conducting deliveries in the medical institutions may prevent a sizeable number of stillbirths. Vaginal delivery of difficult and breech delivery may be avoided as far as possible. Instead, Caesarean section should be opted.

Identification of Honeys and Syrups by Microwave Plasma Torch Mass Spectrometry / 分析化学

In this study, a method for rapid identification of three kinds of honey and four kinds of syrup by microwave plasma torch mass spectrometry ( MPT-MS) without sample pretreatment was established. Under the positive ion mode, honey and syrup were ionized by MPT-MS and analyzed by quadrupole mass spectrometry ( QMS). The MS data were analyzed with chemometrics methods. Consequently, principal component analysis ( PCA) showed that PC1, PC2 and PC3 had a total contribution rate of 91. 2％ , and cluster analysis (CA) indicated when the critical value was 7, this method could distinguish honey and syrup in addition to clover honey and inulin syrup. Partial least squares-discriminant analysis ( PLS-DA) also manifested that honey and syrup could be effectively distinguished. Discriminant analysis (DA) demonstrated that the discriminant accuracy of honey and syrup was 100％ . Accordingly, all the results showed that the method of MPT-MS combined with chemometrics could identify honey and syrup rapidly. In brief, this method has the advantages such as fast analysis speed, accurate information extraction, high recognition accuracy and without sample pretreatment, and can be used for the identification of honey and main adulterated syrup.

TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) screening of small for gestational age and intrauterine growth restricted neonates: efficacy study in a single institute in Korea / 소아과

PURPOSE: Routine screening for toxoplasmosis, rubella, cytomegalovirus (CMV), and herpes simplex virus (TORCH) in intrauterine growth restriction (IUGR) and small for gestational age (SGA) neonates has become a common practice. However, the incidence of TORCH varies across countries, and the cost of TORCH testing may be disadvantageous compared to disease-specific screening. To evaluate the efficacy of TORCH screening, the medical charts of IUGR or SGA neonates born in a single institution in Bucheon, Korea from 2011 to 2015 were reviewed. METHODS: The clinical data of the 126 IUGR or SGA neonates were gathered, including gestational age, Apgar scores, neonatal sonographic findings, chromosome study, morbidities, developmental follow-up, and growth catch-up. Maternal factors including underlying maternal disease and fetal sonography were collected, and placental findings were recorded when available. TORCH screening was done using serum IgM, CMV urine culture, quantification of CMV DNA with real-time polymerase chain reaction, and rapid plasma reagin qualitative test for syphilis. Tests were repeated only for those with positive results. RESULTS: Of the 119 TORCH screenings, only one was positive for toxoplasmosis IgM. This result was deemed false positive due to negative IgM on repeated testing and the absence of clinical symptoms. CONCLUSION: Considering the incidence and risk of TORCH in Korea, the financial burden of TORCH screening, and the single positive TORCH finding in our study, we suggest disease-specific screening based on maternal history and the clinical symptoms of the neonate. Regarding CMV, which may present asymptomatically, universal screening may be appropriate upon cost-benefit analysis.

Síndrome de TORCH: Enfoque racional del diagnóstico y tratamiento pre y post natal: Recomendaciones del Comité Consultivo de Infecciones Neonatales Sociedad Chilena de Infectología, 2016 / TORCH Syndrome: Rational approach of pre and post natal diagnosis.: Recommendations of the Advisory Committee on Neonatal Infections. Sociedad Chilena de Infectología, 2016

Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.

There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.

Analysis of TORCH infection in Qujing area / 国际检验医学杂志

Objective To analyze the detection results of TORCH antibodies for further understanding the TORCH infection situation among different groups in Qujing area .Methods The detection results of 3035 cases of TORCH antibodies were retro-spectively analyzed ,and the detection results were grouped into the male group and female group ,juvenile group and adult group , and the positive rate of TORCH antibodies was statistically analyzed .Results (1) In the TORCH-IgG various antibodies detec-tion ,the positive rate of CMV-IgG antibody was highest(84 .78% ) .In the TORCH-IgM various antibodies detection ,the positive rate of RUV-IgM antibody was highest(9 .92% ) .(2)The positive rates of RUV ,CMV and HSVⅠ /Ⅱ-IgG and IgM antibodies in the female group were higher than those in the male group ,and the differences were statistically significant (P0 .05) .(3)The positive rates of TOX ,RUV , CMV and HSVⅠ /Ⅱ-IgG antibodies in the adult group were higher than those in the juvenile group ,the differences were statistical-ly significant (P0 .05) .Conclusion The infection rates of CMV ,RUV ,HSVⅠ /Ⅲ were higher in Qu-jing area .The infection rates are higher in the adult group and female group .Therefore ,TORCH infection should be early found and the infected persons should take some intervention and treatment measures .

Meningococcal disease outbreak related to the World Scout Jamboree in Japan, 2015

Problem: Six invasive meningococcal disease cases occurred among Scottish and Swedish nationals associated with the World Scout Jamboree (WSJ), an international mass gathering, held in Japan. The index case developed symptoms while returning home. The strains from all six cases were identical and seldom seen in Japan. Context: Over 33 000 participants from 155 countries attended WSJ. At the Jamboree site, participants of the North of Scotland’s and Sweden’s units camped within the same subcamp and kept the same schedule of events. No information was available about the Swedish and Scottish cases’ close personal contact history. Action: Health Protection Scotland investigated Scottish cases, conducted active case finding, provided chemoprophylaxis, vaccinated close contacts and advised Scottish WSJ participants and contacts to seek medical care if they developed symptoms. The Public Health Agency of Sweden recommended chemoprophylaxis to all participants in Sweden. In Japan, the Ministry of Health, Labour and Welfare (MHLW) requested the Scout Association of Japan advise all participants to seek medical attention if they developed symptoms. MHLW shared information about the event with local authorities, medical associations, and the Ministry of Education, Culture, Sports, Science and Technology. Outcome: No additional case related to WSJ has been reported. This outbreak highlighted the risk for international spread of invasive meningococcal disease at international mass gatherings. Discussion: Assessing risk, educating participants, enhancing surveillance and sharing timely information among related countries are significant for prevention and response against invasive meningococcal disease outbreaks at mass gatherings.

The burden of congenital rubella syndrome in the Philippines: results from a retrospective assessment

Introduction: In line with the regional aim of eliminating rubella and congenital rubella syndrome (CRS), phased introduction of rubella-containing vaccines (RCV) in the Philippines’ routine immunization programme began in 2010. We estimated the burden of CRS in the country before widespread nationwide programmatic RCV use. Methods: We performed a retrospective chart review in four tertiary hospitals. Children born between 1 January 2009 and 31 December 2014 and identified as possible CRS cases based on the presence of one or more potential manifestations of CRS documented in hospital or clinic charts were reviewed. Cases that met the clinical case definition of CRS were classified as either confirmed (with laboratory confirmation) or probable (without laboratory confirmation). Cases that did not fulfil the criteria for either confirmed or probable CRS were excluded from the analysis. Results: We identified 18 confirmed and 201 probable cases in this review. Depending on the hospital, the estimated incidence of CRS ranged from 30 to 233 cases per 100 000 live births. The estimated national burden of CRS was 20 to 31 cases per 100 000 annually. Discussion: This is the first attempt to assess the national CRS burden using in-country hospital data in the Philippines. Prospective surveillance for CRS and further strengthening of the ongoing measles-rubella surveillance are necessary to establish accurate estimates of the burden of CRS and the impact of programmatic RCV use in the future.

Efeito da soldagem híbrida (plasma + maçarico) na suavização da assinatura torque-ângulo em supraestruturas de COCR sobre minipilares de zircônia ­ parte 1 / Effect of hybrid soldering (plasma + gas torch) technique on suavization of torque-angle signatures at Co-Cr frameworks over zirconia mini-abutmets ­ part I

Objetivo: avaliar as desadaptações em supraestruturas de implantes e a curva de assinatura torque-ângulo dos parafusos protéticos nas condições monobloco e pós-soldagem. Material e métodos: uma base retangular de aço inox recebeu três implantes de hexágono externo (4,1 mm x 10 mm), onde foram parafusados minipilares de zircônia. Após o enceramento e inclusão, as supraestruturas foram fundidas em monobloco com uma liga de cobalto-cromo, e os cilindros foram numerados sequencialmente (1, 2 e 3). A leitura na interface supraestrutura/pilar foi realizada com um microscópio comparador (precisão de 1 µm), três vezes em cada cilindro. A tensão de torque nos parafusos foi medida com um torquímetro eletrônico odontológico (OsseoCare, Nobel Biocare). Depois, as supraestruturas foram seccionadas e soldadas a plasma (pontos de estabilização) e maçarico (preenchimento da área restante). Novamente, as desadaptações e assinaturas dos parafusos foram avaliadas pela mesma metodologia. Resultados: as médias de desadaptações foram maiores nas supraestruturas em monobloco (C1=3,5 µm; C2=0 µm; C3=31,2 µm) do que nas supraestruturas pós-soldagem (C1=3,0 µm; C2=2,9 µm; C3=18,1 µm). Dentro de cada condição, o teste de Kruskal-Wallis mostrou diferença estatisticamente significativa apenas para o cilindro 3 (monobloco: p < 0,00003 / pós-soldagem: p=0,008) em relação aos cilindros 1 e 2. Uma diferença estatisticamente significante foi encontrada apenas no C3, comparando as condições monobloco e pós-soldagem (teste t pareado, p=0,03). A assinatura dos parafusos se mostrou melhor na condição pós-soldagem. Conclusão: a fundição monobloco gera instabilidade na assinatura dos parafusos. A desadaptação nos parafusos protéticos de supraestruturas sobre minipilares de zircônia melhora após secção e soldagem híbrida.

Objective: to evaluate the misfi t at implant frameworks and the torque-angle signature curves at the prosthetic screws at one-piece and after soldering conditions. Material and methods: a stainless steel rectangular base received 3 external hex implants (4.1 x 10 mm) where zirconia mini-abutments were fastened. After wax-up and investing, the frameworks were one-piece cast with a Co-Cr alloy, and the prosthetic cylinders sequentially identified (1, 2, and 3). The misfit at the framework/abutment interface was measured with a microscope (reading error 1 µm) 3 times for each cylinder. The screw tension was investigated with an electronic torqued device (Osseocare, Nobel Biocare). After, the frameworks were sectioned and soldered with plasma (stabilization points) and gas torch (filling of the remaining areas). Again, the misfit and torque-angle signatures were measured as described. Results: mean misfit values were greater for one-piece castings (C1=3.5 µm; C2=0 µm; C3=31.2 µm) than after soldering (C1=3.0 µm; C2=2.9 µm; C3=18.1 µm). Within each condition, the Kruskal-Wallis test demonstrated a statistically significant difference only for C3 (one-piece casting: p < 0.00003 / after soldering: p=0.008) compared to C1 and C2. Between each condition, a significant difference was seen only for C3 in the one-piece and after soldering conditions (paired t test, p=0.03). The torque-angle signatures demonstrated a better behavior after soldering. Conclusion: one-piece castings provide instability at torque-angle signatures. Thus, the seating of the prosthetic abutments over the zirconia mini-abutments improves after sectioning and hybrid soldering.

Síndrome de TORCH: enfoque racional del diagnóstico y tratamiento pre y post natal. Recomendaciones del Comité Consultivo de Infecciones Neonatales Sociedad Chilena de Infectología, 2016 / TORCH syndrome: Rational approach of pre and post natal diagnosis and treatment. Recommendations of the Advisory Committee on Neonatal Infections Sociedad Chilena de Infectología, 2016

There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.

Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.

Acquired Toxoplasmosis Presenting with a Brainstem Granuloma in an Immunocompetent Adolescent.

Background: Toxoplasmosis is an uncommon disease in immunocompetent people. Case characteristics: We report an adolescent boy with central nervous system toxoplasmosis who presented with progressive lower cranial nerve palsies and a ring-enhancing lesion on neuroimaging. Intervention: Diagnosis of toxoplasmosis was confirmed on histopathology of the excised lesion. Message: Toxoplasmosis should be considered in the differential diagnosis of focal brain lesions irrespective of immune status.

Seroprevalence of Toxoplasmosis in Pregnant Females Attending a Tertiary Care Hospital in Uttar Pradesh, India and its Effect on Perinatal Morbidity and Mortality.

Objective: To document the seroprevalence of toxoplasma in pregnant females attending a tertiary care hospital and to study its effect on perinatal morbidity and mortality. Design: Prospective follow-up study. Setting: Queen Mary’s Hospital, a tertiary level hospital affiliated to King George Medical University (earlier known as KGMC), Lucknow, Uttar Pradesh, India. Sample: All pregnant women coming to this hospital for antenatal care in the Obstetrics and Gynaecology Dept. Methods: Pregnant females were selected through systematic random sampling. A pre-tested semi-structured questionnaire was administered. Blood sample was drawn to detect IgM and IgG antibodies against toxoplasma. Delivery outcomes were recorded with reference to abortions, still births, delivery of congenitally malformed baby and gestational age at delivery. Main outcome measures: Perinatal outcomes among those positive for toxoplasma antibodies. Results: Out of 260 subjects screened, 23 (8.8%) were IgM positive and 40 were IgG positive (15.4%). IgM sero-positivity was observed more in females aged >30 years, those ≥3 gravida, belonging to low socio-economic status, Muslims, those predominantly non-vegetarian and those exposed to raw meat. Still births (17.4% vs. 3.8%; p=0.006), congenital abnormalities (8.7% vs. 0.5%; p=0.002) and abortions (17.4% vs. 2.7%; p=0.001) were more common in those positive for IgM antibodies compared to sero-negatives. Conclusions: Toxoplasma infection plays a role in adverse foetal outcome. Socio‑epidemiological aspects constitute an important contributing factor for the spread of the disease. All pregnant women should be educated and counselled for Routine serological testing for toxoplasma-specific antibodies.

Epidemiological investigation on TORCH infection of children in Pu′er / 国际检验医学杂志

Objective To make an epidemiological investigation on TORCH infection in children in Pu′er city of Yunnan prov‐ince ,in order to provide references for the prevention and treatment of TORCH infection in children .Methods A total of 1 194 children treated at this hospital from January to December 2014 were selected and divided into five age groups .Serum TORCH spe‐cific IgM and IgG antibodies were detected by using enzyme‐linked immunosorbent assay(ELISA) and the positive rate of TORCH specific antibody and TORCH infection rate were comparatively analysed .Results The positive rate of TORCH specific IgM anti‐body was significantly lower than that of IgG .The range of positive rate of IgM was 0 .00% -3 .10% ,and that of IgG was 10 .13% -82 .24% .The total infection rate of TORCH was 96 .98% .There were no significant differences in the infection rate of single item of TORCH or the total TORCH infection rate among the five different age groups(P>0 .05) .The distribution of infec‐tion rate of single item of TORCH among the five age groups was statistically significantly different(P0 .05) .Conclusion Children with TORCH infection in this area mainly are infected by CMV ,followed with RV and HSV infections ,while TOX infection is uncommon .There are no obvious differences in different seasons and children in different age groups .

Seroprevalence of TORCH Infection Within Pre-Pregnancy Women and the Relationship with TNF-αLevel During 2 0 1 5 in Beij ing Area / 现代检验医学杂志

Objective To analysis TORCH pathogens infection of women in childbearing age in Beijing area,and to explore the relationship of TORCH infection with the level of TNF-α.Methods Using ELISA detect serum IgM and IgG antibody of TOX,RV,CMV,HSV-I and HSV-II from 970 cases of women during Jan.2015 to Dec.2015.TNF-αlevels of TORCH infection and control group were also determined by ELISA,the results were analyzed.Results Of 970 women,the IgM pos-itive rates of TOX,RV,CMV,HSV-I and HSV-II were 1.65%,2.16%,4.54%,17.42% and 6.08%,respectively.The IgG positive rates of them were 3.81%,93.40%,92.47%,64.02% and 14.64% respectively.The positive rates of CMV and HSV-I IgM for women <30 years old were higher than that of ≥30 years old (χ2=4.558,4.051;P<0.05).HSV-I IgM had statistically higher infection rate in summer than other seasons (χ2=5.356,P<0.05).TNF-αlevels of TORCH IgM positive group were elevated compared with control group (t=10.219,P<0.01).Conclusion Women planning pregnancy were easier infected by TORCH in Beijing area during 2015 with specific epidemiological features.TNF-αalso plays detri-mental role during reproduction of childbearing age women.

Congenital Cytomegalovirus Infection in Monozygotic Twins with Twin-to-twin Transfusion Syndrome.

Background: Symptoms of congenital cytomegalovirus infection remains unclear. Case characteristics: Extremely low birth weight twins with twin-to-twin transfusion syndrome were infected with cytomegalovirus congenitally.Observation: The donor showed neuronal impairment, whereas the recipient showed hepatic dysfunction. Message: Intrauterine hemodynamics may be important in pathophysiology of congenital cytomegalovirus infection.