Page 25 - DIFDUF

695
“I am always doing that which I cannot do, in order that I may learn how to do it”
PERFECTOR
KEY WORDS:
and cardiac background diseases.
including pre-admission poor diabetes control, younger age,
treatment is partial and associated with the patient profile,
term adherence to discharge recommendation for BB insulin
This study demonstrates that patient and physician short-
COnCluSIOnS
treatment.
follow-up to determine the long-term adherence with insulin
patient hyperglycemia protocols. Also, we did not continue the
hyperglycemia during admission, according to structured in-
Nevertheless, the decision to start BB insulin was based on
fore, some patients might have used insulin before admission.
tion regarding diabetes treatment pre-hospitalization; there-
Our study has several limitations. We did not have informa-
charge report for the primary physician is also needed.
regimen and specifically, insulin. A reasoned and clear dis-
hospital discharge, especially in cases of injectable medication
This finding underscores the need for patient education before
insulin treatments than patients (79% vs. 69.3%, respectively).
the primary physician with discharge recommendations for BB
patient, as indicated by the significantly higher adherence of
[17]. The second gap is between the primary physician and the
patient and adjust the treatment according to their assessment
guidelines, but rather evaluate their adequacy for a particular
nity physicians [6,16]. Physicians often do not blindly follow
tion and direct communication between hospital and commu-
continuity of care and underscore the need for smooth transi-
ABSTRACT:
ment. This incomplete adherence, in many ways, disrupts the
the discharge recommendations for continuous insulin treat-
131118-COHANIM - 131118-COHANIM | 4 - A | 18-11-13 | 11:24:13 | SR:-- | Cyan
by the incomplete adherence of the primary physicians with
#131118-COHANIM - 131118-COHANIM | 4 - A | 18-11-13 | 11:24:13 | SR:-- | Black
131118-COHANIM - 131118-COHANIM | 4 - A | 18-11-13 | 11:24:13 | SR:-- | Yellow
The first gap is between hospital and community as indicated
131118-COHANIM - 131118-COHANIM | 4 - A | 18-11-13 | 11:24:13 | SR:-- | Magenta
Our study emphasizes two gaps in the continuity of care.
range as described for other drugs.
the adherence for BB insulin after discharge falls in the same
myocardial infarction in an Ontario, Canada, registry. Thus,
scribed medication in the first week post-discharge for acute
1
service and Jackevicius et al. [3] found 73% adherence to pre-
tions 30 days after discharge from a general internal medicine
colleagues [12] found 72% adherence with prescribed medica-
In agreement with the findings in the current study, Fallis and
with other prescribed medications post-hospital discharge.
not known. However, some studies examined adherence
Adherence to insulin treatment post-hospitalization is
#
REVIEWS 1 Original articles 3 4,5 The frequency of NOD2/CARD15 varies among different The most common variants associated with Crohn’s disease Diagnosis of IBD is based on a combination of clinical, The consanguinity rate among Bedouin Arabs in southern Our data from a previous report showed that there is an nflammatory bowel disease (IBD) is a chronic inflammatory 2.5–3%, respectively [12-14]. Different reports in European The frequency ranges among U
Correspondence 7. Parker JC, Bunn CC. Sensitivity of the Phadia Elia connective tissue disease screen factors Associated with Recurrence of Tracheoesophageal
Dr. C. Robier for less common disease-specific autoantibodies. J Clin Pathol 2011; 64 (7): 631-3.
Institute of Laboratory Diagnostics, Hospital of the Brothers of St. John of 8. Willems P, De Langhe E, Claessens J, et al. Screening for connective-tissue fistula
God, A-8020 Graz, Austria disease-associated antibodies by automated immunoassay. Clin Chem Lab Med
phone: (43-316) 5989-26671, fax: (43-316) 5989-21505 2018; 56 (6): 909-18.
email: christoph.robier@bbgraz.at 9. Robier C, Amouzadeh-Ghadikolai O, Stettin M, Reicht G. Comparison of the Vered Nir MD *, Michal Gur MD *, Yazeed Toukan MD , Fahed Hakim MD , Arcadi Vachyan MD and Lea Bentur MD 1,2
1,2
1,2
3
1,2
1,2
clinical utility of the Elia CTD Screen to indirect immunofluorescence on Hep 2
References cells. Clin Chem Lab Med 2016; 54 (8): 1365-70. 1 Department of Pediatric Pulmonology, Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
1. Agmon-Levin N, Damoiseaux J, Kallenberg C, et al. International recom- 10. Van der Pol P, Bakker-Jonges LE, Kuijpers JHSAM, Schreurs MWJ. Analytical 2 Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
mendationds for the assessment of autoantibodies to cellular antigens referred to and clinical comparison of two fully automated immunoassay systems for the 3 Department of Pediatric Surgery, Rambam Health Care Campus, Haifa, Israel
as anti-nuclear antibodies. Ann Rheum Dis 2014; 73: 17-23. detection of autoantibodies to extractable nuclear antigens. Clinica Chimica Acta
2. Giuducci S, Bellando-Randone S, Matucci-Cerinic M. A new way of thinking 2018; 476: 154-9.
about systemic sclerosis: the opportunity for a very early diagnosis. IMAJ 2016; 11. Bizzaro N, Brusca I, Previtali G, et al. The association of solid-phase assays to
18 (3-4): 141-3. immunofluorescence increases the diagnostic accuracy for ANA screening in
3. Ferraccioli G, Alivernini S, Tolusso B, Gremese E. Should rheumatoid factor patients with autoimmune rheumatic diseases. Autoimmun Rev 2018; 17 (6): 541-7. The etiology is currently unknown; however, environmental
(RF) (and antinuclear antibodies (ANA)) become routinary screening test 12. Mazurek A, Iwaniec T, Olszowska M, Perricone C, Widlinska B, Podolec P. ABSTRACT: Background: Recurrence of tracheoesophageal fistula (TEF) and genetic factors have been suggested [1,2]. Bronsens and col-
for morbidities in the general population?: From the concept of “benign Antiphospholipid and antinuclear antibodies in young patients after myocardial is reported in 8–20% patients. Factors that may influence
autoimmunity “to the concept of” autoimmunity as a red flag in preventive revascularization procedures. IMAJ 2016; 18 (3-4): 228-31. leagues [1] found that, among 275 patients with TEF, 167 genetic
medicine”? Autoimmun Rev 2018; 17 (6): 636-8. 13. Hoffman IEA, Peene I, Veys EM, De Keyser F. Detection of specific antinuclear recurrence of fistula beyond the postoperative period are not defects of copy number variations (CNVs) (frequency < 0.0005)
4. Fritzler MJ. Choosing wisely: review and commentary on anti-nuclear antibody reactivities in patients with negative anti-nuclear antibody immunofluorescence clear. were reported, suggesting that they can act as a modifier in a
(ANA) testing. Autoimmun Rev 2016; 15 (3): 272-80. screening tests. Clin Chem 2002; 48 (12): 2171-6. Objectives: To evaluate possible factors associated with multiple hit model, or as the second hit in a recessive condi-
5. Bossuyt X, Luyckx A. Antibodies to extractable nuclear antigens in antinuclear 14. Bossuyt X, Fieuws S. Detection of antinuclear antibodies: added value of solid recurrence of TEF beyond the immediate postoperative period.
antibody-negative samples. Clin Chem 2005; 51 (12): 2426-7. phase assay? Ann Rheum Dis 2014; 73 (3): e10. Methods: A single center, retrospective comparison of patients tion. The prevalence of congenital TEF is 1 patient per 2500 live
6. Rigon A, Infantino M, Merone M, et al. The inter-observer reading variability 15. Claessens J, Belmondo T, De Langhe E, et al. Solid phase assays versus automated births [3], with the prevalence remaining constant over the years
in anti-nuclear antibodies indirect (ANA) immunfluorescence test: a multicenter indirect immunofluorescence for detection of antinuclear antibodies. Autoimmun with and without recurrence of TEF was conducted. Medical [4]. The most common type of TEF is C type, which consists of
evaluation and a review of the literature. Autoimmun Rev 2017; 16 (12): 1224-29. Rev 2018; 17 (6): 533-40. records of patients previously operated for TEF who were esophageal atresia and a distal TEF connecting the lower pouch
followed in our pediatric pulmonary institute between January of the esophagus and the trachea [2]. Standard open repair is the
2007 and December 2016 were reviewed.
Capsule Results: The medical records of 74/77 patients previously most common corrective surgery conducted, with thoracoscopic
operated for TEF were evaluated. Nine patients (12%) had a repair being increasingly used. The most common short-term
complication is a postoperative leak from the anastomotic site,
Stitching peptides for presentation recurrence of TEF and 65 did not. These groups had similar age which is more common with a long gap atresia [5].
and gender distribution and similar prevalence of VACTERL
Intracellular protein-derived peptides generated by proteasomal I molecules. faridi and colleagues demonstrated that MHC association. In addition, they had similar length of atretic Long-term sequelae of esophageal atresia with TEF include
degradation are loaded onto major histocompatibility complex class I molecules can present peptides that are generated by gap, rates of thoracoscopic surgery, rates of prolonged need tracheomalacia that typically manifests as a barking cough,
(MHC) class I molecules in the endoplasmic reticulum and the splicing together of segments from two distinct proteins, for respiratory assistance post-surgery, and frequency of wheezing, respiratory distress, and cyanosis with feeding, or even
presented to CD8 + T cells. Although it has been assumed so-called trans-spliced peptides. Precisely how cis- and trans- gastrointestinal symptoms. Notably, the patients who had apneic episodes (dying spells) [6,7]. Recurrent respiratory infec-
that these peptides are contiguous segments derived spliced peptides are generated and how they contribute to T recurrent TEF had significantly more hospitalizations for tions are reported in 44% of patients [6], and early esophageal
from intracellular proteins, recent studies have shown that cell selection and expansion remain to be explored. respiratory symptoms (P = 0.011) and significantly more episodes stricture is a predictive factor for recurrent chest infections [8].
noncontiguous peptides generated by cis-splicing of two Sci Immunol 2018; 3: eaar3947 of clinical bronchiolitis per patient (P < 0.0001). In addition, Gastroesophageal outcomes include dysphagia and acid
distinct regions of an antigen can be presented by MHC class Eitan Israeli the patients with recurrent TEF had significantly more episodes reflux, esophageal strictures, and dysmotility [9]. Esophagitis,
of positive polymerase chain reaction for viruses (P = 0.009). eosinophilic inflammation, esophageal gastric metaplasia, and
Conclusions: Hospitalizations for respiratory symptoms as Barrett’s esophagus are frequently reported [10]. Examination
Capsule well as clinical and/or viral bronchiolitis are associated with with endoscopy and manometry continues to demonstrate near
recurrence of TEF. Even though cause and effect cannot be universal disorganized peristaltic activity.
pathogen elimination by probiotic Bacillus via signaling interference established, these patients should undergo meticulous Recurrence of TEF is a long-term complication associated
evaluation for the possibility of recurrence of TEF. with increased risk of death. The term includes recurrence of
Probiotic nutrition is frequently claimed to improve human to their population density by altering gene regulation.
health. In particular, live probiotic bacteria obtained with food This study presents a detailed molecular mechanism that KEY WORDS: IMAJ 2018; 20: 687–690 TEF in the same location as the original fistula, acquired de
bronchiolitis, tracheoesophageal fistula (TEF)
are thought to reduce intestinal colonization by pathogens, underlines the importance of probiotic nutrition in reducing novo fistula in a different location, or a second TEF that may
and thus to reduce susceptibility to infection. However, infectious disease. The authors also provided evidence that have been missed prior to the first surgery. Overall, reported
the mechanisms that underlie these effects remain poorly supports the biological significance of probiotic bacterial rates of recurrent TEF are 8–20% [3,6,11], mostly 218 months
understood. piewngam and colleagues reported that the interference in humans, and shows that such interference after the initial repair [12]. Sulkowski and colleagues [13]
consumption of probiotic Bacillus bacteria comprehensively can be achieved by blocking a pathogen’s signaling system. racheoesophageal fistula (TEF) is a severe developmental reported that 5% of their 3479 patients required repeated TEF
abolished colonization by the dangerous pathogen Furthermore, these findings suggest a probiotic-based T malformation of the foregut. It may present as a single mal- ligation within 2 years of discharge after their primary surgery.
Staphylococcus aureus in a rural Thai population. The authors method for S. aureus decolonization and new ways to fight formation or accompany other malformations such as the ver- Recurrent TEF usually presents with cough, choking, cyanosis
showed that a widespread class of Bacillus lipopeptides, the S. aureus infections. tebral defects, anal atresia, cardiac defects, tracheoesophageal with feeding, or with recurrent pneumonia. Recurrence is more
fengycins, eliminates S. aureus by inhibiting S. aureus quorum Nature 2018; 562; 532 fistula, renal anomalies, and limb abnormalities (VACTREL). common in patients with a previous anastomotic leak and in
sensing, which is a process through which bacteria respond Eitan Israeli patients with congenital esophageal stenosis [11]. Anastomotic
*The first and second authors contributed equally to this study leak is more prevalent with a long gap atresia [5]. Interestingly,
702 687