Asymptomatic Presentation Research Articles

The Utility of Collaterals as a Biomarker in Pediatric Unilateral Intracranial Arteriopathy

BackgroundIntracranial arteriopathies are frequent causes of pediatric stroke and important risk factors for stroke recurrence. Without tissue diagnosis, vascular imaging is relied upon to identify the underlying etiology and prognosis. We hypothesized that children with unilateral intracranial arteriopathy with lenticulostriate collaterals would demonstrate distinct vascular outcomes compared with children without collaterals. MethodsWe retrospectively identified children with unilateral intracranial arteriopathy from two institutions. Two blinded raters from each institution reviewed magnetic resonance or digital subtraction angiography at baseline and ≥12 months. Patients were grouped according to presence or absence of lenticulostriate collaterals. Clinical features and vascular imaging outcomes were compared using univariate analysis and multivariate logistic regression. ResultsForty-four children were included: 22 males, median age 8.2 years (range two to 16.9 years), and further stratified into the collateral group (n = 20) and non-collateral group (n = 24), with median follow-up of 25.5 months and 23 months, respectively. Both groups demonstrated similar rates of progression on vascular imaging at ≥12 months, 50% in the collateral group versus 37.5% in the non-collateral group (P > 0.05). The collateral group was associated with asymptomatic clinical presentation, normal brain MRI, border zone infarcts, and either vascular stabilization or new contralateral disease. The non-collateral group demonstrated either vascular improvement or discordant progression (combination of improved and progressive lesions). Using a multivariate model, collaterals continued to be an independent predictor of vascular outcome. ConclusionsThis study suggests that lenticulostriate collaterals in children with unilateral intracranial arteriopathy may serve as a useful neuroimaging biomarker that helps to stratify patients with distinct clinical features and patterns of vascular evolution.

Clinical Impact of Asymptomatic Presentation Status in Patients With Paroxysmal and Sustained Atrial Fibrillation: The Fushimi AF Registry

The clinical characteristics and outcomes of asymptomatic patients with paroxysmal or persistent/permanent atrial fibrillation (AF) are largely unknown. The Fushimi AF Registry is a community-based prospective survey of patients with AF who visited the participating medical institutions in Fushimi-ku, Japan. We investigated the clinical characteristics and outcomes of asymptomatic vs symptomatic patients in the paroxysmal AF (PAF; n = 1,837) and persistent/permanent (sustained atrial fibrillation [SAF]; n= 1,912) subgroups. In the PAF group, asymptomatic patients were older (asymptomatic vssymptomatic group, 74.1 vs71.1 years of age; P< .01), more often male (62.1%vs55.6%; P< .01), and had a higher CHA2DS2-VASc (congestive heart failure, hypertension, age≥ 75 years, diabetes mellitus, history of stroke, vascular disease, age 65-74 years, and female sex) score (mean, 3.37 ± 1.73 vs2.99 ± 1.63; P< .01), whereas the prevalence of major co-morbidities and CHA2DS2-VASc scores were comparable in the SAF group. Multivariable analysis indicated that age (≥ 75 years), history of stroke/systemic embolism, male sex, and chronic kidney disease were independent determinants of asymptomatic status in the PAF group, whereas age was nonsignificant in the SAF group. During the follow-up period, all-cause mortality was significantly higher (hazard ratio, 1.71 [95%CI, 1.31-2.29]; P< .01) in asymptomatic patients compared with symptomatic patients in the PAF group, whereas it was comparable in the SAF group. Asymptomatic clinical status is associated with older age, male sex, more co-morbidities with a higher stroke risk profile, and a higher incidence of all-cause death in patients with PAF; these characteristics and outcomes were not seen in the SAF group. UMIN Clinical Trials Registry; No.: UMIN000005834; URL: www.umin.ac.jp/ctr/index.htm.

Introduction to anomalous aortic origin of a coronary artery.

Anomalous aortic origin of a coronary artery (AAOCA) occurs when both coronary arteries arise from the same aortic sinus from a single ostium or two separate ostia. While most coronary anomalies are benign, the two most common subtypes that predispose to sudden cardiac death in the young are interarterial anomalous right coronary artery and interarterial anomalous left coronary artery. Practitioners face many challenges with AAOCA. Diagnosing patients may be difficult because children and adolescents are often asymptomatic and first presentation may be sudden death or sudden cardiac arrest. Risk stratification is also challenging as determining which unique characteristics place the child at highest risk of sudden death has not been adequately delineated and ischemic testing may give false negative results. Last, there is significant variability in decision making regarding management of youth with AAOCA. Future research is needed to help determine the best way to identify at-risk children and which treatment is the safest and most efficacious.

P123 Is there a relationship between the tendering history of a genitourinary medicine clinic and its accessibility?

IntroductionSince 2004, DH guidance has recommended that GUM clinics in England should endeavour to see patients within 48 hours of initial contact. Recent changes in service commissioning and the wider adoption of competitive tendering since 2013 has led to concerns about maintaining 48-hour access.AimTo establish whether there is a relationship between the tendering history of a GUM clinic and its accessibility.MethodsPostal questionnaires regarding tendering history were sent to lead clinicians of all 262 GUM clinics in the UK. Only questionnaires which were returned within a two-month window were analysed. Each clinic with a returned questionnaire was telephoned eight times by male and female researchers posing as patients with symptomatic and asymptomatic presentations. The researchers asked to be seen as soon as possible and recorded whether this fell within 48 hours.Results67 clinics (25.6%) returned their questionnaires on time. A chi-square test found no statistically significant difference between clinics tendered within the last five years (n=49) and the rest (n=18), regarding 48-hour access (86.5% and 86.2% respectively, p=0.916). Interestingly, 88% of contacts with clinics still undergoing a tender resulted in a 48-hour appointment compared with 100% of contacts with clinics which completed the process 3–5 years ago. However, this was not statistically significant.DiscussionThe negative effect of tendering on accessibility seems to be overstated. Moreover, if this effect does exist, it seems more pronounced during the actual tender, followed by an apparent boost in access. A larger study may be required to confirm this.

P1071Clinical impact of asymptomatic presentation status in patients with paroxysmal and sustained atrial fibrillation: the fushimi af registry

P1071Clinical impact of asymptomatic presentation status in patients with paroxysmal and sustained atrial fibrillation: the fushimi af registry

Disseminated strongyloidiasis in an immunocompromised host: A case report

Infections caused by Strongyloides stercoralis (S. stercoralis) in human are generally asymptomatic, however in immunocompromised individual, hyperinfection may develop with dissemination of larvae to extra-intestinal organs. The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself, which may lead to low index of suspicion as a consequence. In this report, a case of a Malaysian male with underlying diabetes mellitus, hypertension, cerebrovascular accident, bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented. However, he developed septicemic shock later, and S. stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli. Regardless of aggressive resuscitation, the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome. It was revealed that the current case has alarmed us via incidental finding of S. stercoralis larvae in the tracheal aspirate, indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.

The Predictive Value of Coefficient of PCT × BG for Anastomotic Leak in Esophageal Carcinoma Patients With ARDS After Esophagectomy.

Anastomotic leak was a potentially severe life-threatening complication of esophagectomy, which drew attention in consequence of progressive dyspnea until acute respiratory distress syndrome (ARDS) due to the early asymptomatic presentation. Respiratory failure, caused by ARDS as the severe presentation of anastomotic leak, is the most common organ failure. CRP (C-reactive protein), procalcitonin (PCT), and Blood G (BG) test are the sensitivity markers for inflammatory, sepsis, and fungemia, respectively. Early recognition and intervention treatment of anastomotic leak may alleviate complication and improve outcome. We retrospectively analyzed 71 patients, accepting mechanical ventilation support because of ARDS as the complication after radical resection of esophagus cancer. Clinical data were collected from the patients' electronic medical records, including their clinically hematological examination, drainage fluid cultures, and sputum culture. Accord to appearance of anastomotic leak or not, all patients were divided into 2 groups, leak group and no-leak group. Inflammatory markers, such as CRP, PCT, and the coefficient of BG and PCT, were significantly different between the 2 groups. Respiratory index, white blood cell, hemoglobin (HBG), platelet (PLT), and other clinical factors were not significantly different between the 2 groups. Receiver operating characteristic curves were constructed to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve for various cutoff levels of several factors. Blood G tests presented the better predicting value for anastomotic leak. Blood G tests and PCT should be tested after esophagectomy. The coefficient of PCT and BG (>260) is of great significance, and clinical value to predict anastomotic leak for patients with postesophagectomy ARDS, early PCT and BG test, and especially, dynamic variation may alleviate complication and improve outcome.

MP72-10 THE PROGNOSTIC IMPLICATION OF BODY MASS INDEX ON POSTOPERATIVE SURVIVAL OUTCOMES IN NON-METASTATIC RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2017MP72-10 THE PROGNOSTIC IMPLICATION OF BODY MASS INDEX ON POSTOPERATIVE SURVIVAL OUTCOMES IN NON-METASTATIC RENAL CELL CARCINOMA Hyung Suk Kim, Chang Wook Jeong, Cheol Kwak, Ja Hyeon Ku, Hyeon Hoe Kim, and Hae Won Lee Hyung Suk KimHyung Suk Kim More articles by this author , Chang Wook JeongChang Wook Jeong More articles by this author , Cheol KwakCheol Kwak More articles by this author , Ja Hyeon KuJa Hyeon Ku More articles by this author , Hyeon Hoe KimHyeon Hoe Kim More articles by this author , and Hae Won LeeHae Won Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2246AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the association between body mass index (BMI) and survival outcomes in patients with non-metastatic RCC. METHODS A single-institutional retrospective analysis was implemented on 2329 patients who underwent radical or partial nephrectomy for non-metastatic RCC from 2000 to 2014. Enrolled patients were grouped into normal (BMI <23kg/m2, n=705), overweight (BMI 23-24.9 kg/m2, n=648), and obese (BMI =25kg/m2, n=976) according to BMI cut-offs for Asian population. Outcomes of interest included recurrence free survival (RFS), overall survival (OS), and cancer-specific survival (CSS). Survival curves for each BMI category were estimated and compared using the Kaplan-Meier method with log-rank test. The impact of BMI as continuous or categorical variables on survival outcomes was assessed with multivariable Cox proportional hazard models. RESULTS Several clinico-pathological factors, including asymptomatic presentation, being female, lower transfusion rate, higher proportion of clear cell histology, and lower frequency of nodal invasion, were observed in association with obese group (all p<0.05). Obese group showed significantly better 5-year RFS (90.7% vs 84.9%, p<0.001), OS (91.8% vs 86.8%, p=0.002), and CSS (94.8% vs 89.4%, p=0.002) rates than normal patients. On multivariable analysis, BMI as continuous variable independently correlated with favorable RFS (hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.89-0.97, p=0.002), OS (HR 0.95; 95% CI 0.91-0.99, p=0.033) and CSS (HR 0.91; 95% CI 0.86-0.97, p=0.002). In addition, multivariable analysis revealed overweight (HR 0.57; 95% CI 0.37-0.87, p=0.009) and obese patients (HR 0.58; 95% CI 0.39-0.87, p=0.009) were associated with significantly reduced risk of RCC related death compared to normal patients. CONCLUSIONS Our data suggest overweight and obesity defined as increasing BMI are generally related to favorable survival outcomes after nephrectomy for non-metastatic RCC. Further basic research will be required to discover the biological mechanisms explaining the positive correlation between high BMI and improved RCC survival. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e958 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Hyung Suk Kim More articles by this author Chang Wook Jeong More articles by this author Cheol Kwak More articles by this author Ja Hyeon Ku More articles by this author Hyeon Hoe Kim More articles by this author Hae Won Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Zany Over Zika Virus: An Overview of Diagnosis and Treatment Modalities.

Zika virus has been a recent international public health concern with outbreaks occurring in the Americas, Caribbean, and Pacific. The zoonotic infection is primarily spread to humans by the bite of an infected Aedes mosquito. The virus also can be transmitted via bodily fluids, sexual intercourse, and maternal-fetal vertical transmission. Asymptomatic presentation is common. If symptoms do occur, individuals display a low-grade fever, maculopapular rash, arthralgia, or conjunctivitis 2 to 7 d after infection. Infection is concerning due to its associated fetal effects in pregnant women and relationship with Guillain-Barre syndrome. Diagnosis should be suspected in individuals with the appropriate symptomatology and exposure history. Diagnostic tests for the Zika virus are available and vary based on symptom duration. Treatment is supportive, and surveillance is suggested for all pregnant women. Prior infection is thought to provide immunity toward future exposures. Prevention and education is key in decreasing the spread of disease.

Discordance is the Key

AbstractCongenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease characterised by atrioventricular as well as ventriculoarterial discordance. It is usually associated with a variety of severe intracardiac defects. Few patients with this abnormality survive past 50 years. A 54 Yr old male patient referred to our hospital for the management of post MI VSD. At the presentation Patient had mild central cyanosis, clubbing grade 2 and the vitals are stable. Cardiac examination revealed a 2/6 long ESM in a left parasternal area with pulsations in left 2nd and 3rd ICS. There is a lot of discrepancy in both clinical examination and workup. After detailed evaluation patient is diagnosed as having cyanotic congenital heart disease – L TGA + VSD with PS. Survival up to this age is very rare with this combination of associated defects in LTG. The patient is misdiagnosed as coronary artery disease with mechanical complication in another hospital. Unless there is suspicion and having knowledge about the asymptomatic presentation of congenital heart diseases up to this age group, patients will be misdiagnosed and treatment will be delayed.

Orofacial Cysticercosis: A Review

Cysticercosis is a common healthcare problem, especially in developing countries. Orofacial presentation of the disease is rare. It usually manifest as an asymptomatic nodular swelling that is difficult to differentiate clinically, from other orofacial swellings. Diagnosis of cysticercosis is usually not possible clinically owing to its rarity and asymptomatic presentation in orofacial region. Ultrasonography (USG) is the initial and most reliable diagnostic modality for cysticercosis. This review discusses the various oral manifestations, differentials and investigations for oral cysticercosis.

Voriconazole-Induced Periostitis: A Radiographic Progression

We present a case of incidentally discovered Voriconazole-induced periostitis in a patient with chronic lymphocytic leukemia. Voriconazole was initiated approximately two years prior to the periostitis discovery on a chest CT for acute on chronic respiratory failure. Because of the asymptomatic nature of the periostitis and its slow development, it was not reported on imaging for over two years. The periostitis was followed retrospectively over a two-year span from the patient’s surveillance imaging. Although there are several cases of periostitis from chronic Voriconazole use in the literature, this case is made unique in its asymptomatic presentation, allowing for a visual display of periostitis progression over two years. This case highlights the fact that Voriconazole-induced periostitis can be asymptomatic and should, therefore, be readily recognized and include a comprehensive differential.

Doença celíaca materna e baixo peso ao nascer

Celiac disease is a chronic, immune‐mediated, inflammatory disorder of the small intestine, that occurs in response to a permanent intolerance to gluten in genetically predisposed individuals. Its clinical manifestations may vary significantly, including an asymptomatic presentation. In undiagnosed celiac pregnant women, it has been associated with increased risk of low birth weight newborns. This review aims to provide a better understanding of the pathophysiological mechanisms involved in the association between maternal celiac disease and low birth weight through a literature review of the most relevant publications on the subject in the last 20 years.

Stress-induced ischemia caused by conus branch of right coronary to right atrial coronary cameral fistula during treadmill test

A 28-year-old apparently healthy young male working in Border Security Force referred to our institute for annual master health checkup. The routine biochemical tests, 12-lead electrocardiogram (EKG), chest X-ray, and echo were normal. His exercise ECG was remarkable for significant horizontal ST depression in lead I, AVL, V4–V6 during treadmill test at 15 METs. He had usual breathlessness during exercise. Coronary angiogram revealed conus branch of right coronary artery to right atrial coronary cameral fistula draining into right atrium which may be an unusual reason for inducible ischemia at high-intensity exercise as the other coronary arteries were normal. He is now under regular follow-up for need–based, catheter-based intervention in the future because of asymptomatic presentation and small size fistula. A period of 12-month follow-up was uneventful.

Stepwise mass screening for atrial fibrillation using N-terminal pro b-type natriuretic peptide: the STROKESTOP II study design.

Atrial fibrillation (AF) is the most prevalent clinical arrhythmia and a major risk factor for ischaemic stroke. Treatment with oral anticoagulants (OACs) reduces the risk of stroke by two thirds in AF patients with risk factors. Due to its often paroxysmal and asymptomatic presentation, AF is sometimes challenging to diagnose. So far, AF screening studies have applied opportunistic or systematic screening, most often using a single 12-lead electrocardiogram (ECG) recording or ambulatory ECG. We hypothesise that the biomarker N-terminal pro b-type natriuretic peptide (NT-proBNP) is a valuable adjunct in population based AF screening. We are conducting a randomized population-based study on AF screening using ambulatory ECG recording where the decision to use prolonged intermittent ECG recording is directed by NT-proBNP levels, the STROKESTOP II trial. The entire population of inhabitants 75 or 76 years of age (n = 28712) in the capital region of Sweden will be randomized 1:1 to intervention or control group. In the intervention group NT-proBNP will be analysed in all without previously known AF. Those with NT-proBNP ≤ 125 pg/L will make a single one lead ECG recording, participants with NTproBNP ≥ 125 np/L will be instructed to record ECG for 30 s at least twice daily for 2 weeks with a handheld ambulatory ECG recorder. Participants with newly diagnosed or undertreated AF will be referred to a cardiologist and offered OAC treatment. Primary endpoint is incidence of stroke or systemic embolus, during a 5 year follow-up period in the control group vs the group invited to screening.

Initial Presentation of Gastric Cancer Among Various Racial/ethnic Groups at an Academic Center in New York City

Introduction: Due to its often asymptomatic presentation or nonspecific manifestations, over one-third of gastric cancers (GC) are diagnosed at an advanced stage with limited, if any, durable treatment options. The initial presentation of gastric cancer among various racial and ethnic minorities in the USA is not well-described. Methods: We performed a retrospective analysis of patients included in a pathology database with histologically confirmed GC between 2008 and 2016 at a single academic center in NYC, who also had confirmatory endoscopic data available. Patients with cancer of the gastroesophageal junction or cardia were excluded. Age at diagnosis, race/ethnicity, smoking status, and presenting signs and/or symptoms were recorded. Statistical analysis was performed in STATA. Results: 108 patients [67.6% men/32.4% women] were included. Median age at diagnosis was 71.5 (range 41-92) years. Racial/ethnic breakdown was as follows: Hispanic/Latino (n=27), Asian (n=19), African-American (AA) (n=18), European/Russian (n=21), non-European/Russian white (n=5), unknown (n=18). Indications for endoscopy were available in 103/108 patients, with only 3 listing “surveillance” as the indication. Abdominal pain/dyspepsia was the most common presenting symptom (n=53), followed by acute GI bleed (n=27), asymptomatic anemia (n=18), weight loss (n=18), and gastric outlet obstruction (n=9), or a combination of these. 29.3% were stage 3 or more advanced at presentation; less than 20%(n=22) had endoscopies prior to GC diagnosis. Asians (61.8+/-1.6 years), AA (70.4+/-2.6 years), Hispanic/Latinos (71.1+/-2.1 years), and Europeans/Russians (72.2+/- 2.4 years) presented at younger ages versus whites (80+/-0.2 years), but the number in the latter group was small (n=5). There was no difference in presenting symptoms between the groups. Although non-whites presented with higher-grade lesions, there was no difference in stage at presentation between the groups (p=0.216). Conclusion: Patients with higher GC risk based on race/ethnicity had similar stage and presenting symptoms compared to whites, with nearly a third of patients having at least stage 3 GC at diagnosis. Only a minority had endoscopies prior to their one at diagnosis. Further research is needed to clarify whether some races/ethnicities may benefit from GC screening.

Lesiones masivas del manguito de los rotadores

In recent decades, rotator cuff injuries, including massive injuries of it, have become a public health problem because of its high economic impact on health services and labor disabilities caused by these injuries. In general population, the risk of complete rupture is 12%, while in those over 60 years it reaches 48% regardless of symptomatic or asymptomatic presentation of the pathology. To have adequate postoperative scarring of the rotator cuff, many given conditions of bleeding at bone and tendon has to be present as a determining factor on the basis of the biological process of integration. These conditions do not exist in massive injuries as there is a high incidence of osteopenia in the greater tuberosity of the humerus as well as the quality of the remaining tendon tissue is poor, with varying degrees of fatty infiltrates and muscle atrophy, both generating a poor biological environment that favors a large percentage of recurrence. In recent years, the augmentation surgery with biological, synthetic or a combination of both on a stitch placed at the rotator cuff at risk of re-rupture (MRRR) has been promising, supported with a strong theoretical basis in order to achieve a given a biological and mechanical contribution to the compromised rotator cuff tissue. Evidence levelIV.

Intravaginal Chlamydia trachomatis Challenge Infection Elicits TH1 and TH17 Immune Responses in Mice That Promote Pathogen Clearance and Genital Tract Damage

While ascension of Chlamydia trachomatis into the upper genital tract of women can cause pelvic inflammatory disease and Fallopian tube damage, most infections elicit no symptoms or overt upper genital tract pathology. Consistent with this asymptomatic clinical presentation, genital C. trachomatis infection of women generates robust TH2 immunity. As an animal model that modeled this response would be invaluable for delineating bacterial pathogenesis and human host defenses, herein we explored if pathogen-specific TH2 immunity is similarly elicited by intravaginal (ivag) infection of mice with oculogenital C. trachomatis serovars. Analogous to clinical infection, ascension of primary C. trachomatis infection into the mouse upper genital tract produced no obvious tissue damage. Clearance of ivag challenge infection was mediated by interferon (IFN)-γ-producing CD4+ T cells, while IFN-γ signaling blockade concomitant with a single ivag challenge promoted tissue damage by enhancing Chlamydia-specific TH17 immunity. Likewise, IFN-γ and IL-17 signaling blockade or CD4+ T cell depletion eliminated the genital pathology produced in untreated controls by multiple ivag challenge infections. Conversely, we were unable to detect formation of pathogen-specific TH2 immunity in C. trachomatis-infected mice. Together, our work revealed C. trachomatis infection of mice generates TH1 and TH17 immune responses that promote pathogen clearance and immunopathological tissue damage. Absence of Chlamydia-specific TH2 immunity in these mice newly highlights the need to identify experimental models of C. trachomatis genital infection that more closely recapitulate the human host response.

Are Saudi medical students aware of middle east respiratory syndrome coronavirus during an outbreak?

SummaryRecently, an outbreak of MERS-CoV occurred in King Abdulaziz Medical City (KAMC), Riyadh. This outbreak contributed to the students at the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) becoming more involved in promoting health awareness in their communities.This was a cross-sectional study that evaluated students in the clinical phase of medical school. The data were collected by an online questionnaire. The measurements were obtained using a researcher-administered and a self-reported questionnaire that had been previously validated. A p-value of less than 0.05 was considered statistically significant.One hundred and thirty-six students participated and showed good awareness regarding the clinical aspects of MERS, such as etiology, diagnosis, management, and prevention. However, 76% of the students were not aware of the mortality rate. Conversely, this study uncovered a low level of awareness in the basic sciences. Interestingly, fifth year medical students were more familiar with the incubation period than final year students (p-value <0.05). Regarding gender differences, more female students were knowledgeable about the incubation period and the possible asymptomatic presentation of the disease than male students (p-value <0.05). However, male students were more aware of the diagnostic tests for MERS than their female counterparts.Medical students were knowledgeable about the clinical aspects of MERS but were lacking background awareness in the basic sciences.

Clinical Characteristics and Prognosis in Children and Adolescents With Autoimmune Hepatitis and Overlap Syndrome.

This is a cohort study of 134 children and adolescents with a known diagnosis of autoimmune hepatitis (AIH). During follow-up, some of them developed autoimmune sclerosing cholangitis (ASC). This study describes the characteristics of the patients upon diagnosis, and their response to treatment and any complications, and compares the patients who developed ASC during follow-up (ASC group) with those who did not (AIH group). A total of 73.1% of the patients were girls with a median age upon diagnosis of 10.41 (7.41-12.53) years. Of 134 patients, 28 (20.9%) developed cholestatic manifestations, with features of ASC. A few differences were observed between the AIH and ASC groups when they were analyzed by χ test, such as the smaller predominance of girls in ASC group (P = 0.04), and more common asymptomatic presentation in the ASC group (P = 0.01). Cirrhosis was observed in 68% of biopsies, with no significant difference between groups (P = 0.43). Of 16 deaths, 15 were in the AIH group and 1 in the ASC group (P = 0.22). Of 11 transplants, 10 were in the AIH group and one in the ASC group (P = 0.53). The presence of cirrhosis at baseline was associated with a smaller survival probability (P = 0.015). The survival rate by Kaplan-Meier method was 94% at 5 years and 80% at 10 years, and was similar in both the groups (P = 0.08). No statistically significant difference was observed between the groups in relation to prognosis and response to treatment.