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sensing, which is a process through which bacteria respond
fengycins, eliminates S. aureus by inhibiting S. aureus quorum
showed that a widespread class of Bacillus lipopeptides, the
Staphylococcus aureus in a rural Thai population. The authors
abolished colonization by the dangerous pathogen
consumption of probiotic Bacillus bacteria comprehensively
understood. piewngam and colleagues reported that the
the mechanisms that underlie these effects remain poorly
and thus to reduce susceptibility to infection. However,
are thought to reduce intestinal colonization by pathogens,
KEY WORDS:
health. In particular, live probiotic bacteria obtained with food
Probiotic nutrition is frequently claimed to improve human
pathogen elimination by probiotic Bacillus via signaling interference
Capsule
distinct regions of an antigen can be presented by MHC class
noncontiguous peptides generated by cis-splicing of two
from intracellular proteins, recent studies have shown that
that these peptides are contiguous segments derived
presented to CD8 + T cells. Although it has been assumed
(MHC) class I molecules in the endoplasmic reticulum and
degradation are loaded onto major histocompatibility complex
Intracellular protein-derived peptides generated by proteasomal
Stitching peptides for presentation
Capsule
evaluation and a review of the literature. Autoimmun Rev 2017; 16 (12): 1224-29.
in anti-nuclear antibodies indirect (ANA) immunfluorescence test: a multicenter
6. Rigon A, Infantino M, Merone M, et al. The inter-observer reading variability
antibody-negative samples. Clin Chem 2005; 51 (12): 2426-7.
5. Bossuyt X, Luyckx A. Antibodies to extractable nuclear antigens in antinuclear
(ANA) testing. Autoimmun Rev 2016; 15 (3): 272-80.
4. Fritzler MJ. Choosing wisely: review and commentary on anti-nuclear antibody
medicine”? Autoimmun Rev 2018; 17 (6): 636-8.
autoimmunity “to the concept of” autoimmunity as a red flag in preventive
for morbidities in the general population?: From the concept of “benign
ABSTRACT:
(RF) (and antinuclear antibodies (ANA)) become routinary screening test
3. Ferraccioli G, Alivernini S, Tolusso B, Gremese E. Should rheumatoid factor
18 (3-4): 141-3.
about systemic sclerosis: the opportunity for a very early diagnosis. IMAJ 2016;
2. Giuducci S, Bellando-Randone S, Matucci-Cerinic M. A new way of thinking
as anti-nuclear antibodies. Ann Rheum Dis 2014; 73: 17-23.
mendationds for the assessment of autoantibodies to cellular antigens referred to
1. Agmon-Levin N, Damoiseaux J, Kallenberg C, et al. International recom-
References
1,2
email: christoph.robier@bbgraz.at
phone: (43-316) 5989-26671, fax: (43-316) 5989-21505
God, A-8020 Graz, Austria
Institute of Laboratory Diagnostics, Hospital of the Brothers of St. John of
Dr. C. Robier
Correspondence
Original articles Original articles 3 1,2 Recurrence of TEF is a long-term complication associated Long-term sequelae of esophageal atresia with TEF include The etiology is currently unknown; however, environmental leak is more prevalent with a long gap atresia [5]. Interestingly, patients with congenital esophageal stenosis [11]. Anastomotic common in patients with a previous anastomotic leak and in with feeding, or with recurrent pneumonia. Recurrence i
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Adherence to insulin treatment post-hospitalization is Correspondence nOD2/CARD15 Mutations among Bedouin Arabs with
not known. However, some studies examined adherence Dr. S. Koren
with other prescribed medications post-hospital discharge. Diabetes Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel Inflammatory Bowel Disease: frequency and phenotype
In agreement with the findings in the current study, Fallis and phone: (972-8) 977-8333
fax: 972-8) 977-9642
colleagues [12] found 72% adherence with prescribed medica- email: shlomitks@gmail.com Correlation
tions 30 days after discharge from a general internal medicine
service and Jackevicius et al. [3] found 73% adherence to pre- References Naim Abu Freha MD MHA , Wafi Badarna MD , Muhammad Abu Tailakh RN MPH PhD , Heba Abu Kaf MD , , Alex Fich MD ,
3
1
2
1
1
scribed medication in the first week post-discharge for acute 1. Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on Doron Schwartz MD , Arik Segal MD , Jabir Elkrinawi MD and Amir Karban MD 4,5
1
1
1
myocardial infarction in an Ontario, Canada, registry. Thus, hospitalization and mortality among patients with diabetes mellitus. Arch Intern
the adherence for BB insulin after discharge falls in the same Med 2006; 166 (17): 1836-41. Departments of Gastroenterology and Hepatology and Internal Medicine E, and Nursing Research Unit, Soroka University Medical Center and Faculty of Health Sciences,
3
1
2
range as described for other drugs. 2. Ho PM, Spertus JA, Masoudi FA, et al. Impact of medication therapy Ben-Gurion University of the Negev, Beer Sheva, Israel
discontinuation on mortality after myocardial infarction. Arch Intern Med 2006;
5
Our study emphasizes two gaps in the continuity of care. 166 (17): 1842-7. Departments of 4 Internal Medicine C and Gastroenterology, Rambam Medical Center, Technion–Israel Institute of Technology, Haifa, Israel
The first gap is between hospital and community as indicated 3. Jackevicius CA, Li P, Tu JV. Prevalence, predictors, and outcomes of primary
by the incomplete adherence of the primary physicians with nonadherence after acute myocardial infarction. Circulation 2008; 117 (8): 1028-36.
the discharge recommendations for continuous insulin treat- 4. Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions
of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med 2007;
ment. This incomplete adherence, in many ways, disrupts the 2 (5): 314-23. nflammatory bowel disease (IBD) is a chronic inflammatory
continuity of care and underscore the need for smooth transi- 5. Cook RI, Render M, Woods DD. Gaps in the continuity of care and progress on ABSTRACT: Background: Inflammatory bowel disease (IBD) prevalence is I disorder of the gastrointestinal tract with two major forms:
tion and direct communication between hospital and commu- patient safety. BMJ 2000; 320 (7237): 791-4. increasing among Bedouin Arabs in Israel. This population is Crohn’s disease (CD) and ulcerative colitis (UC). The Bedouin
nity physicians [6,16]. Physicians often do not blindly follow 6. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. known to have a high rate of consanguinity. NOD2/CARD15 Arab population is a subgroup within the Muslim Arab popu-
Deficits in communication and information transfer between hospital-based and
guidelines, but rather evaluate their adequacy for a particular primary care physicians: implications for patient safety and continuity of care. mutations are well-studied in IBD. lation in Israel. The majority of Bedouin Arabs live in three
patient and adjust the treatment according to their assessment JAMA 2007; 297 (8): 831-41. Objectives: To investigate the frequency of NOD2/CARD15 regions in Israel: southern Israel (Negev desert), central Israel,
[17]. The second gap is between the primary physician and the 7. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and mutations in IBD Bedouin patients and their relevance to and the Galilee. In southern Israel, there are approximately
severity of adverse events affecting patients after discharge from the hospital.
patient, as indicated by the significantly higher adherence of Ann Intern Med 2003; 138 (3): 161-7. disease phenotype. 240,000 Bedouin Arabs [1].
the primary physician with discharge recommendations for BB 8. Rappaport R, Arinzon Z, Feldman J, Lotan S, Heffez-Aizenfeld R, Berner Y. The Methods: The IBD-Arab cohort in southern Israel included 68 Our data from a previous report showed that there is an
patients, of whom 25 Crohn’s disease (CD) patients and 25
insulin treatments than patients (79% vs. 69.3%, respectively). need for medication reconciliation increases with age. IMAJ 2017; 19 (10): 625-30. ulcerative colitis (UC) patients consented to participate (72%). increase in the prevalence of IBD among the Bedouin popula-
This finding underscores the need for patient education before 9. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Blood samples were obtained from all participants who were tion, which could be attributed to the urbanization and mod-
Hyperglycemia: an independent marker of in-hospital mortality in patients with
hospital discharge, especially in cases of injectable medication undiagnosed diabetes. J Clin Endocrinol Metab 2002; 87 (3): 978-82. genotyped for NOD2/CARD15 variants Arg702Trp, Gly908Arg, ernization process with far-reaching lifestyle changes [2].
regimen and specifically, insulin. A reasoned and clear dis- 10. Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia and Leu1007fsinsC. The consanguinity rate among Bedouin Arabs in southern 131118-COHANIM - 131118-COHANIM | 4 - A | 18-11-13 | 11:24:13 | SR:-- | Magenta
charge report for the primary physician is also needed. in hospitalized patients in non-critical care setting: an endocrine society clinical Results: The NOD2/CARD15 mutation frequency was higher in Israel is very high, a recently published report found 44.8% 131118-COHANIM - 131118-COHANIM | 4 - A | 18-11-13 | 11:24:13 | SR:-- | Yellow #131118-COHANIM - 131118-COHANIM | 4 - A | 18-11-13 | 11:24:13 | SR:-- | Black 131118-COHANIM - 131118-COHANIM | 4 - A | 18-11
Our study has several limitations. We did not have informa- practice guideline. J Clin Endocrinol Metab 2012; 97 (1): 16-38. CD than in UC patients. Carrier frequency for the Gly908Arg of consanguinity among Bedouin women who delivered in
tion regarding diabetes treatment pre-hospitalization; there- 11. Standards of Medical Care in Diabetes-2016: Summary of Revisions. Diabetes mutation in CD and UC patients was 8/25 (32%) and 3/25 the maternity wards of the only hospital serving the Bedouin
care. 2016; 39 Suppl 1: S4-5.
fore, some patients might have used insulin before admission. 12. Fallis BA, Dhalla IA, Klemensberg J, Bell CM. Primary medication non- (12%), respectively (P = 0.08). Neither the Arg702Trp nor population [3]. As an unfortunate consequence of the high rate
Nevertheless, the decision to start BB insulin was based on adherence after discharge from a general internal medicine service. PloS one Leu1007fsinsC mutation was found in our cohort. No of consanguinity, a high prevalence of genetically determined
hyperglycemia during admission, according to structured in- 2013; 8 (5): e61735. homozygous/compound heterozygote mutations were found. diseases is observed in this population [4].
patient hyperglycemia protocols. Also, we did not continue the 13. Ahmad A, Mast MR, Nijpels G, Elders PJ, Dekker JM, Hugtenburg JG. Genotype-phenotype analysis revealed that CD patients Diagnosis of IBD is based on a combination of clinical,
Identification of drug-related problems of elderly patients discharged from
follow-up to determine the long-term adherence with insulin hospital. Patient Prefer Adherence 2014; 8: 155-65. carrying the Gly908Arg mutation were younger at diagnosis, radiological, endoscopic, and histological criteria. The nucleo-
treatment. 14. Shepperd S, McClaran J, Phillips CO, et al. Discharge planning from hospital to 22.8 ± 4.5 vs. 28.82 ± 9.1 years (P = 0.04). All carriers were tide-binding oligomerization domain 2 (NOD2) gene was identi-
home. Cochrane Database Syst Rev 2010 (1): CD000313. male, compared to 41.2% in non-carriers (P = 0.005). NOD2/ fied in 2001. It is also known as caspase recruitment domain
15. Nazar H, Brice S, Akhter N, et al. New transfer of care initiative of electronic
COnCluSIOnS referral from hospital to community pharmacy in England: a formative service CARD15 mutation carriers with UC were older, 67.0 ± 24.5 (CARD15) located on chromosome 16 [5,6].
This study demonstrates that patient and physician short- evaluation. BMJ Open 2016; 6 (10): e012532. years compared to 41.2 ± 12.3 years (P = 0.006). No other The most common variants associated with Crohn’s disease
term adherence to discharge recommendation for BB insulin 16. Sharma G, Fletcher KE, Zhang D, Kuo YF, Freeman JL, Goodwin JS. Continuity associations regarding disease localization or other clinical include one frameshift insertion leading to early truncation
treatment is partial and associated with the patient profile, of outpatient and inpatient care by primary care physicians for hospitalized older parameter were found. of the protein (Leu1007fsinsC) and two missense mutations
adults. JAMA. 2009; 301 (16): 1671-80.
including pre-admission poor diabetes control, younger age, 17. Vashitz G, Meyer J, Parmet Y, et al. Adherence by primary care physicians to Conclusions: The frequency of NOD2/CARD15 gene mutations (Arg702Trp, Gly908Arg). The presence of one polymorphism
and cardiac background diseases. guidelines for the clinical management of dyslipidemia. IMAJ 2011; 13 (11): 657-62. is high in CD and UC among Bedouin Arab IBD patients and is increased the risk for CD two- to threefold. The presence of
associated with younger age at onset in CD and male gender. two mutations or homozygosity increases the risk of CD 20- to
IMAJ 2018; 20: 695–699 40-fold [6-10].
KEY WORDS: Bedouin Arab, genetic predisposition, inflammatory
“we have forty million reasons for failure, but not a single excuse” The frequency of NOD2/CARD15 varies among different
bowel disease (IBD), NOD2/CARD15 gene mutation,
Rudyard Kipling,(1865–1936), English author southern Israel ethnic groups and geographical regions. The frequency among
Caucasian CD patients ranges from 9–13% for Arg702Trp,
3–6% for Gly908Arg, and 7–16% for Leu1007fsinsC [11].
“I am always doing that which I cannot do, in order that I may learn how to do it” The frequency ranges among UC patients are 4–6%, 2%, and
Pablo Picasso, (1881–1973), Spanish artist 2.5–3%, respectively [12-14]. Different reports in European PERFECTOR
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