Metabolic syndrome, a constellation of interrelated risk factors of metabolic origin namely, abdominal obesity, insulin resistance, dyslipidemia and hypertension, confers greater risk of cardiovascular disease on its patients than the sum of the individual components. It is increasingly being associated with inflammatory dermatoses, especially psoriasis. Determination of the diagnostic criteria of this syndrome is conditioned by the changing views regarding its pathogenesis. Approximately, a quarter of the world's population harbors this syndrome, whose reported prevalence in India (5-30%) has escalated with an increase in urbanization and socioeconomic status. Due to, up to 3 times, the risk of cardiovascular mortality and up to 24 times risk of diabetes mellitus, the epidemiological significance of metabolic syndrome ideally necessitates formulation of preventive guidelines by public health authorities. Chronic inflammation, involving several cytokines and adipokines, forms the bridge between this syndrome and psoriasis and underlies the formation of atherosclerotic plaque, the primary lesion of coronary artery disease, in whose pathogenesis oxidative stress and genetic factors also play a role. Up to 4-fold increase in the prevalence of metabolic syndrome and 3-fold increased risk of cardiovascular mortality is reported globally in psoriatics. Increasing index of suspicion of this syndrome by the dermatologists, prevention of cardiovascular damage by lifestyle modifications, smoking cessation and redressal of the inherent depression in these patients is as imperative in management as is the specific therapy of the skin lesions of this systemic, rather than "just a skin," disease as well as the lipid-lowering, antihypertensive and antidiabetic agents.

Background: Psoriasis is an immune-mediated chronic skin disease having effects on other organs. It has been linked to diabetes mellitus, hypertension, obesity, and dyslipidemia. All of these components ultimately increase the risk of metabolic syndrome and cardiovascular morbidities. Several studies have been done in the western world to identify the presence of metabolic syndrome (or its components) in psoriatic patients. Aims and Objectives: Our study had been done with the objective of identifying the prevalence of metabolic syndrome in psoriatics in comparison to normal population. Materials and Methods: The study was an institution-based case-control study. Subjects were recruited after obtaining informed consent. Cases of psoriasis were diagnosed clinically, and unrelated healthy volunteers served as controls. Inclusion criteria for cases were patients of clinically diagnosed psoriasis without any co-existent immune-suppressed conditions such as HIV, malignancy, or any other physiological conditions such as pregnancy or lactation that might influence metabolic syndrome. Smokers and alcoholics were also excluded from the study. Metabolic syndrome was defined by Adult treatment panel III criteria. Statistical Analysis: Descriptive statistics were expressed as range, mean ± standard deviation, frequencies (number of cases), and whichever was appropriate. For analytical statistics, numerical data were analyzed using t-test or ANOVA test, and for categorical data, Chi-square and Fischer's exact test were used. P ≤ 0.05 was considered as statistically significant. Results: Abdominal obesity (odds ratio [OR] = 2.6), hypertension (OR = 2.2), hyperglycemia (OR = 2.8), dyslipidemia (OR = 2.9), and metabolic syndrome (OR = 2.6) are associated with psoriasis. Conclusion: Psoriatic patients have an increased risk of developing abdominal obesity, hypertension, hyperglycemia, and dyslipidemia in comparison to general population. All these contribute to higher preponderance to metabolic syndrome.

Introduction: A bone marrow examination is a critical part of the evaluation of patients with a variety of hematopoietic and nonhematopoietic diseases. A Perls' or Prussian blue stain demonstrates hemosiderin in bone marrow macrophages and iron within sideroblasts. Examination of iron stain allows detection not only of an increased or decreased proportion of sideroblasts but also of abnormal sideroblasts. We undertook this study to evaluate the iron stores in bone marrow as judged by Perls' stain. Materials and Methods: A Prospective analysis of 55 bone marrow aspirates in a tertiary care center. Results: Sideroblasts were present in all the cases. They were decreased in iron deficiency anemia (IDA), and few other chronic diseases whereas normal to increase in megaloblastic anemia. According to Gale's method, cases of IDA had absent or decreased iron stores while those of megaloblastic anemia or normoblastic marrows showed normal to increased stores. Grading by the recent intensive method showed combined functional and iron stores deficiency. Conclusion: Perls' stain on bone marrow aspirates is an important tool not only for assessing the iron stores, increased or decreased but also to study abnormal sideroblasts.

Context: Small bowel perforation is one of the commonest surgical emergencies in our limited resource rural area. Aims: To review the common aetiologies, diagnostic dilemmas and challenges to treat small bowel perforations in the emergency. Settings and Design: This was a prospective study of 33 patients with small bowel perforation managed in a single surgical unit at Rohilkhand Medical College, Bareilly between August 2014 and July 2015. Materials and Methods: Demographic data, clinical presentation, radiological findings, laboratory reports, operative notes, surgical procedure performed, postoperative progress, complications, hospital stay, mortality notes of all the patients were meticulously entered in a previously prepared proforma for this purpose. Results: Twenty-seven (81.8%) patients were males and 6 (18.2%) were females with ages ranging from 10 to 80 years. Abdominal pain and distension was the commonest presenting symptom in all 33 (100%) patients. 17 (51.5%) patients had evidence of pneumoperitoneum on erect plain X-ray chest and abdomen. 23 (70%) patients were of duodenal perforation, 3 (9%) of jejunal whereas 7 (21%) had a single ileal perforation. Anterior wall perforation in the duodenum due to nonsteroidal anti-inflammatory drugs (NSAIDs)/steroid was the commonest etiology in 21 (63.6%) patients. The mean hospital stay was 22 days and there were two mortalities. Conclusions: Small bowel perforations in rural areas like ours have etiological factors very different from counterparts in the West. Unregulated and indiscriminate use of NSAIDs/steroids still accounts for the high rate of duodenal perforation in our rural area. Insanitary conditions lead to endemic typhoid infections and perforations causes which have been eliminated from developed countries.

Background: In this study, we used nitroglycerine (NTG) as an adjuvant to lignocaine in intravenous regional anesthesia (IVRA) to enhance the analgesic property of lignocaine. Aim: To evaluate the effect of addition of NTG to lignocaine in IVRA. Objective: To find out the onset, duration, and requirement of postoperative analgesics with the addition of NTG. Materials and Methods: This was a randomized (block randomization), double-blinded, placebo-controlled study of 60 patients of the American Society of Anesthesiologists Class I and II, undergoing hand and forearm surgeries. Patients received IVRA with 3 mg/kg 2% lignocaine diluted to a total volume of 40 ml to which either 150 μg NTG or equal volume of saline was added. Intraoperatively and postoperatively, pain score was evaluated using visual analog scale. The sensory and motor block onset and recovery time and the subsequent analgesic requirement in first 24 h were recorded. Results: Motor and sensory block onset time were significantly shorter (P < 0.001), and motor and sensory block recovery time were prolonged (P < 0.001) in NTG group compared to plain lignocaine group. Intra-operatively fentanyl requirement was significantly lower and quality of sensory and motor blockade was better in study group than control group (P < 0.001). In addition, patients in NTG group required significantly less number of analgesics in the first 24 h as compared to the other group. Nitrates are potent relaxers of vascular smooth muscles and act by dilating veins, arteries, and arterioles. In IVRA, most of the anesthetic agent is absorbed into the limb tissue. Thus, the local anesthetic agent reaches to the nerves and nerve endings quickly. Thus shortens the onset time and also prolongs sensory and motor blockade and reduces total analgesic consumption in first 24 h without significant side effects. Conclusion: NTG as an adjuvant to lignocaine for IVRA reduces the total analgesic consumption in first 24 h and improves sensory and motor block without side effects.

Background: Management of Type 2 diabetes (T2D) requires comprehensive control of three metabolic parameters (A1c, blood pressure, and cholesterol [ABC]), popularly known as the "ABCs" of diabetes. We studied the prevalence of patients reaching the ABC goals in Indian diabetes patients. Materials and Methods: The study was conducted at two tertiary level care centers in India. All patients with a diagnosis of T2D (aged 30-75 years, 1 year duration, received a prescription for an oral hypoglycemic agent, or insulin) seen between January and June 2014 were included in this cross-sectional, observational study. Patients with a major illness, recent surgery or diabetic ketoacidosis, use of glucocorticoids, posttransplant, and gestational diabetes were excluded from the study. Descriptive statistics were used for describing the data, and Chi-square test was used for analyzing the frequency distribution. Results: The study participants (531 male:469 female) had a mean age of 46.9 ± 12.3 year, body mass index of 28.2 ± 5.5 kg/m ² , and an A1c of 8.7 ± 1.9%. A total of 90 patients (9%) achieved the 3 part ABC goal. The 2 point goal of adequate control of blood pressure (BP) and lipids is achieved in the majority of the patients (46.5%). The individual goals of all the three constituents were achieved by 201 patients for glucose, 942 patients for BP and 509 patients for the low-density lipoprotein cholesterol. Conclusion: Our data showed that only 9% of patients achieved the ABC goals. Our study highlights the urgent unmet need, to improve the quality of diabetes care in our country.

Introduction: Angle of femoral torsion is a normal torsion or twist present in femur that plays an important role in stability and function of the hip joint. The angle of femoral torsion can be defined as the angle formed by femoral condyle's plane (bicondylar plane) and a plane passing through center of neck and femoral head. Abnormal angle of femoral torsion has been implicated in the etiology of hip osteoarthrosis and developmental dysplasia of hip joint. Materials and Methods: This study was carried out on unpaired 280, adult human femora devoid of any gross pathology, 139 male (65 right and 74 left), and 141 female (71 right and 70 left) from bone banks of three medical colleges of Maharashtra. The gender of each specimen was determined by the established practice. Femora were evaluated by Kingsley Olmsted method, and data were tabulated and statistically analyzed. Results: The average angle of femoral torsion 13.39° and 11.23° on the right and left side respectively in male, 16.21° and 13.23° on the right and left side, respectively, in female. Statistical analysis using Student's "t"-test revealed significant difference (P < 0.05), greater angle of femoral torsion in female and on the right side. Conclusion: Knowledge of angle of femoral torsion is becoming significant nowadays with an increase in demand for total hip replacement, as the angle of femoral torsion is crucial to attain a normal activity of the replaced joint.

Context: A robust evaluation system is the backbone of any education system. There are different methods of evaluating answer sheets in a subjective exam such as glance and grade method, scoring pattern system, and training the examiners on model answers before evaluation. However, inter-examiner reliability varies with each of these methods. Aim: The present study was done to find out the inter-examiner reliability in a postgraduate (PG) exam with a glance, grade, and assess method. Materials and Methods: This was a cross-sectional study conducted done during a PG examination in community medicine in a medical college setting. There were four independent assessors who rated 8 PG students over 36 different items in four theory exams. The examiners were blinded during evaluation of answer sheets. Statistical Analysis Used: Reliability statistics, inter- and intra-class correlation coefficients, Pearson's correlation coefficient, and Spearman's rho coefficient between assessors were calculated. Results: There was a significant difference in the mean scores (P < 0.001) of different assessors. However, there was significant reliability and correlation between the assessors (P < 0.05). Pearson's correlation coefficient varied between 0.736 and 0.893 and Spearman's rank coefficient varied between 0.741 and 0.891 this could be due to the fact that the assessors were experienced teachers. Conclusions: Glance and grade method of assessing PGs has good reliability between the assessors. However, the scores can vary significantly between different assessors.

Background: Nonspecific aortoarteritis (NSAA) or Takayasu's arteritis is an inflammatory disorder of large elastic arteries. Imaging plays a vital role in the diagnosis and treatment of such patients. Hence, one should be aware of the imaging profile of NSAA, and the advantages and disadvantages of computed tomography angiography (CTA) and digital subtraction angiography (DSA), which are the two most commonly performed imaging investigations in these patients. Aims: The aims of this study were to evaluate the imaging profile of NSAA in a sub-group of the Indian population, and to compare the efficacy of CTA and DSA in the diagnosis of this entity. Materials and Methods: A prospective study was conducted with 25 patients, who underwent CTA and DSA for suspected NSAA in our institute between January 2009 and September 2010. The data was analyzed in terms of the demographic characteristics of the study group, most common artery involved, most common angiographic type of NSAA, and the CTA and DSA findings in the study group. Results: NSAA predominantly affects young females, as seen in this study, wherein 20 of the 25 patients were females (80%). The most common age group affected was 20-25 years. Most of the patients (44%) had involvement of more than two vessels. The most common aortic branch vessel to be involved was the renal artery. DSA was more sensitive than CTA in detecting aortic or branch vessel stenosis. However, CTA scores over DSA in the evaluation of vessel wall thickness. Conclusion: The imaging profile of NSAA in the Indian population is different from the Japanese population in that the most common branch vessel involved in the Indian population is the renal artery, as opposed to the subclavian artery in the Japanese population. CTA and DSA are both very effective in the diagnosis of NSAA. However, the best imaging modality in NSAA is DSA since it can be used for diagnosis as well as the treatment of NSAA.

Objectives: Adult adenoid hypertrophy is not common. More number of cases of adult adenoid hypertrophy is detected in recent years due to the free availability of endoscopes. The aim of this study is to know the etiopathology of adenoid hypertrophy in adults. Materials and Methods: Twenty-five cases of adult adenoid hypertrophy who underwent adenoidectomy were studied in our institution over a period of 5 years from 2008 to 2013. All the patients underwent diagnostic nasal endoscopy, and associated sinus and nasal pathology were studied. Results: Of 25 cases, 12 were males and 13 were females. In our study adult adenoid hypertrophy was more common in second and third decade. Nasal obstruction was main symptom in 80% of our cases. Allergic symptoms were seen in 28%, headache in 24%, and repeated throat infection in 20%. Adenoidectomy with tonsillectomy was done in 5 cases, adenoidectomy with septoplasty in 5 cases, septoplasty with turbinectomy along with adenoidectomy in 7 cases, functional endoscopic sinus surgery with adenoidectomy in 3 cases, adenoidectomy with tympanoplasty in 2 cases, myringotomy with grommet insertion in 2 patients, and isolated adenoidectomy in 1 patient. Conclusion: Since highest number of cases in our study is in early adulthood, we believe that adenoid hypertrophy is persistence of childhood hypertrophy.

Background: Hydnocarpus laurifolia (Dennst) Sleummer. of Flacourtiaceae family is one important herbal resource widely used in the treatment of intestinal worms, helminthiasis, infected wounds, skin diseases, fever, piles, wounds and inflammation. Different extracts of this plant have been studied for pharmacological activities such as anti-hyperglycemic activity, anti-hyperlipidemic activity etc. Though it is an important plant, till date, no reported pharmacognostical data are available on seeds. Aim: The present study is aimed towards evaluating in detail pharmacognostical characteristics of the seeds of H. laurifolia (Dennst) Sleummer. Materials and Methods: Macroscopic and microscopic pharmacognostical characters of seeds were noted by following standard methods. Results: Pharmacognostical evaluation of seed shows the presence of crystalline masses of calcium carbonate, nonpitted sclereids and stone cells, spherical stone cells, aleurone grains, and fragment of tegmen. Conclusion: The current work appears to be first of its kind and can be considered as reference standards for future studies.

Avulsion is serious injury that may encounter during endotracheal intubation and its management often presents a challenge. Replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. The present article describes the management of air-dried maxillary permanent incisors that have been avulsed due to direct laryngoscopy during the induction of general anesthesia for tonsillectomy procedure. The replanted maxillary central incisors had maintained its function and esthetic for 1 year after replantation. Children in a mixed dentition phase are high-risk group children for traumatic dental injury during laryngoscopy; therefore, Anesthetic Departments should have local protocols to refer patients for dental treatment postoperatively in the event of trauma.

Intrauterine contraceptive devices (IUCD) are an effective way for contraception. Proper patient education at the time of placing the IUCD is important. Otherwise, they may not come for device removal at appropriate time, and it may be left in situ and forgotten, which can lead to complications at a later date. Here, we present a case of a 76-year-old lady who came with postmenopausal bleeding due to a forgotten IUCD leading to actinomycotic endometritis. The device was removed hysteroscopically under general anesthesia followed by appropriate antibiotics and the patient recovered well.

Swelling of the jaw due to metastatic lesions needs careful search for an occult malignancy. Thyroid carcinoma is a rare cause of jaw bone metastasis. A 70-year-old female presented in our chest clinic with progressive shortness of breath for last 1-month and associated painful swelled right jaw for last 4 months. Her computed tomography scan thorax showed bilateral cannon ball metastasis involving all lobes of the lung. Fine-needle aspiration cytology (FNAC) from radiographically evident osteolytic lesion of the mandible was suggestive of metastatic carcinoma probably of thyroid origin. Ultrasonography of the thyroid gland revealed well-defined hypoechoic nodule (measuring about 2 cm × 1.8 cm) with few foci of calcification. FNAC from the thyroid nodule followed by immunocytochemistry was suggestive of follicular carcinoma of the thyroid. We report a very rare presentation, as jaw metastasis in follicular carcinoma of the thyroid.

Crytomenorrhea arises usually due to the imperforate hymen, sometimes due to vaginal septum, rarely due to cervical agenesis. Here, we present a case of primary amenorrhea resulting from cervical agenesis in a 38-year-old woman. She presented with primary amenorrhea and cyclic lower abdominal pain. She had undergone some surgery 5 years back, details of which were not available. On examination secondary sexual characters were normal, per abdomen there was an 18 weeks size firm abdominopelvic mass. Local vaginal examination showed a blind vaginal pouch. A clinical diagnosis of hematometra due to transverse vaginal septum was made. However, magnetic resonance imaging pelvis suggested hematometra with cervical stenosis. The patient was taken up for examination under anaesthesia (EUA) and exploratory laparotomy. On opening the abdomen uterus found to be enlarged with dense adhesions all around and signs of endometriosis. Extensive adhesiolysis revealed bilateral chocolate cysts of ovaries with hematosalpinges and peritubal adhesions. Hysterotomy and drainage of tarry contents were followed by an exploration of the uterine cavity. The lower pole ended blindly with no evidence of any cervix. Peroperative diagnosis of cervical agenesis leading to hematometra and endometriosis was made. A subtotal hysterectomy with bilateral salpingo-oophorectomy was done. Histopathological examination confirmed ovarian endometriosis and adenomyosis of uterus. Though reconstructive surgery for cervical dysgenesis has been successful in some cases, hysterectomy is generally recommended for cervical agenesis.

Rett syndrome (RTT) is rare, affects predominantly female children. It presents as a pervasive developmental disorder with a remarkable behavioral phenotype. The discovery that mutation in methyl-C-phosphate-G-binding protein 2 causes RTT has focused attention to the importance of epigenetic modifications in neuronal function. We report a case of RTT in a 7-year-old female child and use of behavioral techniques and social skill training to control the behavioral symptoms.

D-trans allethrin, a pyrethroid, is commonly used as a coil mosquito repellant. There are very few reports of human toxicity due to D-trans allethrin. We present the case of an 11-month-old boy who presented to us with excessive salivation, altered sensorium and convulsions following alleged accidental ingestion of a coil containing D-transallethrin. He required mechanical ventilation for a brief period and made a full recovery. Although rare, the possibility of pyrethroid poisoning should be kept in mind in children who present with sudden onset unconsciousness or convulsions.

Hyperthyroidism is a rare cause of hypertension during pregnancy with potentially fatal consequences. It should be detected and treated early in pregnancy so as to prevent maternal and perinatal morbidity and mortality. Management requires multidisciplinary approach between the obstetrician, anesthesiologist, pediatrician, and the endocrinologist. Intraoperative and postoperative management for an emergency cesarean section in a parturient with untreated hyperthyroidism are really risky affair. In this case report, we present anesthetic management in such complicated case with ventricular tachycardia with successful maternal and fetal outcome.

Extramedullary hematopoiesis (EMH) is defined as the production of the myeloid and erythroid elements outside the bone marrow. It is usually a compensatory mechanism of the myeloid and erythroid production due to increased breakdown or diminished production of erythrocytes. Presacral EMH is an extremely rare condition, and there is a limited number of case reports published in the literature. A 39-year-old female patient as a known case of thalassemia intermedia presented with lower abdominal pain. A computerized tomography scan showed a large presacral mass, associated with bone destruction. The patient was admitted for exploratory laparotomy with suspicion to malignant lesions, but the final pathological diagnosis was EMH. It should be considered in differential diagnosis of mass-like lesions in the presacral area in patients with predisposing factors such as thalassemia, although there were malignant features such as bone destruction in imaging studies. Preoperative diagnostic tools such as fine needle aspiration and biopsy could help us to render the definite diagnosis and prevent unnecessary operation.

Hepatic encephalopathy is a frequent and often fatal manifestation of chronic liver disease. The pathogenesis of hepatic encephalopathy is believed to be multifactorial including impaired blood-brain barrier function, imbalance between the excitatory and inhibitory neurotransmitters in cortex, accumulation of various toxic and false neurotransmitters, and lack of nutrients like oxygen and glucose. Signs and symptoms of hepatic encephalopathy varies and commonly ranges from personality changes, disturbed consciousness, sleep pattern alternation, intellectual deterioration, speech disturbances, asterixis to frank coma and even death. Reversible or transient cortical blindness is rare manifestation of hepatic encephalopathy. It may even precede the phase of altered consciousness in such patients. Very few similar cases have been reported worldwide. Hence, we would like to report a case of transient cortical blindness in a patient of hepatic encephalopathy.

Hypertrophic cardiomyopathy (HOCM) that includes thickening of one or both of the ventricular walls, hypertrophy of the interventricular septum; systolic and diastolic dysfunction, transient hypertrophic sub-aortic stenosis is a well-recognized comorbidity in infants of diabetic mothers. This cardiac complication in the infant of the diabetic mother has recently been named as pathological ventricular hypertrophy to avoid confusion with the autosomal dominant form of congenital HCM. We report a neonate that was diagnosed as case of asymmetrical septal hypertrophy and hypertrophic cardiomyopathy and was born to mother who had poor glycemic control and was treated successfully with propranolol and showed resolution of hypertrophy in follow-up echocardiography.

Dedifferentiated chondrosarcoma (DDCS) comprises approximately 10% of all chondrosarcomas. The tumor generally occurs after the age of 50 years, with equal distribution among males and females. It is most often located in the bones of the pelvis, the proximal femur or humerus, the distal femur, and the ribs. Regardless of treatment, the prognosis is ominous with 90% of patients dying with distant metastases within 2 years. We report a case of DDCS of right proximal femur in a 73-year-old woman. The most important factors affecting survival are early recognition of the radiographic features, adequate histological sampling, and wide-margin resection of the lesion. So for the correct histopathological diagnosis the biopsy sample should be adequate to visualize both cartilaginous and noncartilaginous sarcomatous component which helps to increase the survival of patients before the distant metastasis occurs.

During routine dissection by medical undergraduates, third head of the biceps brachii muscle was found on the left side of a 75-year-old male cadaver in a total of 48 arms dissected in Department of Anatomy Armed Forces Medical College, Pune. Biceps brachii is a muscle of arm having two heads hence the name. The most frequent variation of the muscle is in the number of heads with a prevalence range of 9.1-22.9%. The origin of the supernumerary head in this case was from the humerus, between the insertion of the coracobrachialis and the upper part of the origin of the brachialis, and also from the medial intermuscular septum. The supernumerary head joined the common belly. It was supplied by the musculocutaneous nerve which after emerging from brachialis pierced it near the middle and terminated by finally supplying the biceps belly. In our study, 2.08% (1 of 48) of male cadavers were found to have the third head of biceps. The incidence of this variation can be as much as 10% as, shown in previous studies on Indian population, as reported in standard textbooks of anatomy.

Hereditary spherocytosis (HS) is a familial hemolytic disorder with marked heterogeneity of clinical features ranging from asymptomatic condition to a fulminant hemolytic anemia. HS is characterized by the strong family history of anemia, jaundice, splenomegaly and cholelithiasis. Anesthetic Management of HS with liver dysfunction is very challenging since most of the anesthetic drugs are metabolized by the liver. Hereby, we report anesthetic management in a case of HS with splenomegaly and gall stones for elective splenectomy and cholecystectomy.

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a life-threatening adverse drug reaction that is distinct from other drug-related reactions. We report a rare case of DRESS syndrome following anti-tuberculosis treatment.

"Zika virus" (ZIKV) is an enveloped, icosahedral virus and has a positive-sense, single-stranded RNA genome approximately 11 kb in length. Genetic studies have revealed three ZIKV lineages: East African, West African, and Asian. Serologic studies and virus isolations have demonstrated that the virus has a wide geographic distribution, spanning East and West Africa, the Americas, Indian subcontinent, and Southeast Asia. ZIKV can cause complications such as Guillain-Barré syndrome, meningitis, meningoencephalitis, and myelitis. During pregnancy ZIKV infection can lead to miscarriages and microcephaly, cerebral calcifications, macular neuroretinal atrophy, and loss of foveal reflex in the fetus. A clinically suspected case of infection with dengue negative result should be further tested for Flavivirus, including Zika. Immunofluorescence or enzyme-linked immunosorbent assay is used to detect specific IgM or IgG antibodies against ZIKV. In cases of positive ZIKV infection, symptomatic treatment should be given after excluding other condition such as dengue, malaria, and bacterial infections.