Page 31 - DIFDUF

701
records. Nine patients (12%) experienced a recurrence of TEF,
patients were excluded due to insufficient data in their medical
Seventy-seven post-TEF repair patients were identified. Three
The authors of a recently published study reported an over-
PERFECTOR
RESULTS
parameters. P < 0.05 was considered as statistically significant.
Mann–Whitney U tests and Fisher’s exact tests for categorical
recurrent TEF in the quantitative parameters were measured by
findings. Differences between the groups with and those without
demographic variables, clinical parameters, spirometry, and CT
Corp, Armonk, NY, USA). Descriptive statistics were used for the
for the Social Sciences statistics software, version 21 (SPSS, IBM
In a study conducted by our group, ECS had a 100% sensitiv-
Statistical analyses were performed using IBM Statistical Package
STATISTICAl METHODS
In one study, the sensitivity was higher for IIF than ESC for
findings were recorded when available.
Spirometry data and main computed tomography (CT)
have been missed prior to the first operation.
fistula de novo in a different location, or a second TEF that may
recurrence of TEF in the same location as the original fistula,
who had a fistula after a prior operation. This term includes
We used the term “recurrence of TEF” to refer to all patients
polymerase chain reaction (PCR) for respiratory viruses.
reasons, number of episodes of viral bronchiolitis, and positive
geal symptoms, number of hospitalizations due to respiratory
included recurrence of the TEF, occurrence of gastroesopha-
post-surgery, and length of the atretic gap. Postoperative data
thoracoscopic repair, need for prolonged respiratory assistance
TEF as a solitary finding or as part of an association, open or
Perioperative data obtained included demographic data,
There is another point that merits mention. It has been shown
in the hospital medical record was insufficient.
approved the study. Patients were excluded if the information
2007 and December 2016. The institutional board reviewed and
pediatric pulmonary institute of our hospital between January
went a previous surgery for TEF and who were followed in the
A retrospective review was conducted of patients who under-
PATIENTS AND METHODS
131118-COHANIM - 131118-COHANIM | 4 - B | 18-11-13 | 11:24:13 | SR:-- | Cyan
#131118-COHANIM - 131118-COHANIM | 4 - B | 18-11-13 | 11:24:13 | SR:-- | Black
131118-COHANIM - 131118-COHANIM | 4 - B | 18-11-13 | 11:24:13 | SR:-- | Yellow
131118-COHANIM - 131118-COHANIM | 4 - B | 18-11-13 | 11:24:13 | SR:-- | Magenta
recurrent TEF and bronchiolitis.
tal. In addition, we aimed to assess the possible association of
the risk factors of recurrent TEF in a tertiary pediatric hospi-
The objective of this study was to describe the incidence and
Such an association has not been reported.
was diagnosed concurrently or shortly after viral bronchiolitis.
have encountered several patients in whom recurrence of TEF
ence recurrence of TEF have not been studied. However, we
In our study, we observed ECS positive /IIF negative results in 2.2%
To the best of our knowledge, later factors that may influ-
coscopic and open approaches [14].
leak, or anastomotic stricture were found between the thora-
no differences in short-term complication rates, anastomotic
#
REVIEWS
Original articles Screening for ANA solely by ECS sis for ANA-associated disorders. the costs for the laboratory diagno- and beyond that, markedly reduces sensitivity and specificity for ANA, and ECS enhances the diagnostic 69.9% of SLE, 100% and 84.1% of and ESC were positive in 90.4% and by Willems and co-authors [8], IIF Finally, in a recently published paper IIF than for a solid-phase test [15]. for SSc, the AUC was higher for [1,8,10]. disea
patients showed NOD2/CARD15 mutation frequency ranging For detection of 1007fs sense primers: 5’-CTGAGCCTTTGTT, adherence to discharge recommendations for continuous BB
from 15.2–50% [7,8,15,16]. GATGAGC-3’, and 5’-CAGAAGCCCTCCTGCAGGCCCT-3; insulin treatment. Table 3. Patient adherence by hospitalization parameters
A mutation prevalence of 27% in CD and 7% in UC and antisense primers: 5’-TCTTCAACCACATCCCCATT-3’ Total no adherence partial adherence full adherence p value
patients was reported for Jewish patients [17]. Several stud- and 5’-CGCGTGTCATTCCTTTCATGGGGC-3’ were used. pATIEnT ADHEREnCE By HOSpITAlIzATIOn pARAMETERS n=153 n=25 (16.3%) n=22 (14.4%) n=106 (69.3%)
ies investigated the frequency of NOD2/CARD15 mutations Table 3 describes the association between patient adherence Length of 7.94 ± 6.38 8.36 ± 5.4 9.82 ± 8.45 7.45 ± 6.07 0.27
in the Arab population. A low frequency was found among Multiplex PCR was performed with all four primers in one and hospitalization parameters. No association was found hospitalization
Tunisian and Moroccan CD patients [18,19]. A higher fre- tube using the following conditions: 94ºC for 10 minutes, 35 between the length of hospitalization and/or the number Number of 3.88 ± 1.73 3.88 ± 1.53 4.68 ± 1.81 3.72 ± 1.73 0.061
quency was found among Algerian patients with a frequency cycles (94ºC for 30 seconds, 55ºC for 1 minute, and 72ºC for 1 of co-morbidities and patient adherence. However, a strong background diseases
of 13% among CD patients, 5% in UC patients, and 8% among minute), and an additional extension at 72ºC for 10 minutes. inverse association was found between specific background Background CHD Yes (n=76) 13 (17.1% ) 16 (21.0%) 47 (61.8%) 0.05
healthy control [20]. PCR products were electrophoresed on 2% agarose and visu- diseases and patients adherence. Patients with background Background CHF Yes (n=43) 7 (16.2%) 11 (25.5%) 25 (58.1%) 0.043
Karban et al. [21] found that 8.2% of Arab CD patients in alized with ethidium bromide. A restriction enzyme diges- coronary heart disease (CHD), congestive heart failure
northern Israel carried one NOD2/CARD15 mutation, com- tion assay was used for the detection of G908R as described (CHF), and atrial fibrillation (AF) had significantly lower Background AF Yes (n=34) 4 (11.7%) 11(32.3%) 19 (55.8%) 0.003
pared with 2.3% of controls. by Karban and colleagues [25]. The amplification product of adherence. Physician adherence was not associated with AF = atrial fibrillation, CHD = coronary heart disease, CHF = congestive heart failure
A number of studies investigated the relationship between 380 bp was amplified from genomic DNA using the forward these background diseases (data not shown). It is of interest
the occurrence of a NOD2/CARD15 mutation and phenotype. primer 5’-CCCAGCTCCTCCCTCTTC-3’ and the reverse that patient and physician adherence in eight patients (5.2%) figure 1. [A] Main cause of hospitalization (%), [B] Full adherence
Early age of disease onset and ileal involvement increased the primer 5’-AAGTCTGTAATGTAAAGCCAC-3’. Products whose cause of hospitalization was uncontrolled symptom- (compliance) by cause of hospitalization (%)
likelihood of stricture formation. In addition, fibrostenotic were digested with the enzyme HhaI for 1 hour at 37ºC and atic diabetes (hyperglycemia or hypoglycemia) was 100%. No
behavior was reported [7-9,22]. A rapid and more aggressive analyzed on horizontal 2% agarose gel as restriction fragment other association was found between cause of hospitalization A Cause of hospitalization
form of CD with the trend of multiple surgical interventions length polymorphisms. and adherence [Figure 1]. 60%
and shorter time to surgery was found in another report [23]. Taken together, these data demonstrate that T2DM patient
The main objective of the present study was to determine STATISTICAl AnAlySIS and physician adherence with discharge recommendations for
the frequency of the three common NOD2/CARD15 mutations The results are presented as the mean ± standard deviation for BB insulin treatments are differently affected by background 40%
among the Bedouin Arab IBD patients. A second objective continuous variables and the percentage of total patients for diseases.
was to assess the association between the presence of a NOD2/ categorical data. For the categorical variables, proportions were 20%
CARD15 mutation and clinical features of the disease in this compared using t-test or chi-square, as appropriate.
patient population. Statistical analyses were performed using IBM Statistical DISCUSSION 0%
Package for the Social Sciences statistics software, version 21 In this study we examined the short-term adherence with Cardiac Other Diabetes mellitus accident
(SPSS, IBM Corp, Armonk, NY, USA). P ≤ 0.05 was considered recommendations for continuous BB insulin treatment after Infectious Respiratory Gastrointestinal Renal failure Cerebrovascular
PATIENTS AND METHODS statistically significant. discharge from a general internal medicine service. The
pATIEnTS majority of patients (69.3%) and primary physicians (79.1%) B
Bedouin Arab patients with known CD or UC were included were fully adherent with these discharge recommendations. Compliance
in the present study. Fifty of 68 Bedouin Arab IBD patients RESULTS Two parameters were associated with higher adherence of 100%
(73%) in southern Israel were available for genotyping. Written We recruited 50 Bedouin Arab IBD patients, 25 diagnosed with both patients and physicians: higher pre-admission glycated 80%
informed consent was obtained from all participants. CD and 25 diagnosed with UC. This total comprises 73% of the hemoglobin and younger age. In addition, sub-analysis dem-
Data on demographics, the extent of disease, medical entire cohort of Bedouin Arab IBD patients in southern Israel. onstrated that cardiac patients with background CHD, CHF, 60%
therapy, surgery, disease classification, complications, smoking and/or AF had significantly lower adherence while patients
history, and family history of IBD were obtained via question- nOD2/CARD15 MuTATIOn fREquEnCy whose main cause for admission was uncontrolled diabetes 40%
naires and reviews of patient records. Table 1 shows the frequency of the three mutations of NOD2/ displayed complete adherence. Overall, these data suggest that
The Montreal classification was used for disease classifica- CARD15 in CD and UC patient. Of all IBD Bedouin patients a younger, uncontrolled T2DM patient admitted to an inter- 20%
tion of CD and UC patients [24]. included in the study, 22% carried at least one of the NOD2/ nal medicine ward for a non-cardiac problem is most likely to 0%
The study protocol was approved by the institution’s Helsinki CARD15 mutations. All carriers had the mutation Gly908Arg. continue BB treatment during the first month after discharge. Other
committee and by the health ministry committee. In the IBD Bedouin Arab cohort neither the Arg702Trp nor the This clinical profiling is important as the transition of Cardiac Infectious Respiratory Gastrointestinal Diabetes mellitus Renal failure Cerebrovascular accident
Leu1007fsinsC mutations were found. However, the mutation care from the inpatient to the outpatient setting is a vulner-
DnA ExTRACTIOn AnD gEnOTypIng able time. Adverse events during this transition occur fre-
Patients were genotyped for Leu1007fsinsC and Arg702Trp Table 1. Frequency of the NOD2/CARD15 variants among Bedouin quently and are associated with a higher risk of death and
mutations using single tube allele-specific polymerase chain inflammatory bowel disease patients more frequent readmissions [1,3]. Non-adherence to dis- current study had hyperglycemia during hospitalization, and
reaction (PCR) and for Gly908Arg using restriction enzyme charge recommendations is the most frequent adverse drug therefore were discharged with instructions to continue BB
digestion assay [5,7]. For detection of the R702W, sense Crohn’s disease Ulcerative colitis P event [7,13]. insulin that was initiated during their hospital stay. Better
value
mutation carrier, n
mutation carrier, n
primers: 5’-GAATTCCTTCACATCACTTTCCAGT-3’ and Gly908Arg 8/25 (32%) 3/25 (12%) 0.08 The continuity of patient care post-hospital discharge is a understandings of the key factors that determine the adher-
5’-GCGCATCTGAGAAGGCCCTGTTCT-3’; and antisense Arg702Trp 0 0 – national priority and many authorities emphasize the need ence of these patients with discharge recommendations is
primers: 5’-GTCAACTTGAGGTGCCCAACATT-3’ and – for safe transition of patients from hospital to the outpatient crucial for a smooth transition to the community, to ensure
5’-CGCCCAGCGGGCACAGGCCTGGCACCG-3’ were used. Leu1007fsinsC 0 0 setting [8,10,11,14,15]. We emphasize that the patients in the better glycemic control, and to prevent adverse outcome.
696 693