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national recommendations. However, considering that if the
The use of assays other than IIF is in accordance with inter-
Prolonged respiratory symptoms are described both in
evant ANA included in the panel of these tests may be missed [7].
assays. Furthermore, it has been reported that some clinically rel-
of the test, which is a clear limitation for the use of solid-phase
mated assays is restricted to the antigens incorporated in the panel
Dysfunctional esophageal activity accounts for the gastro-
mated tests may be beneficial. The diagnostic potential of auto-
For laboratories with a high throughput of samples, such auto-
ing a mixture of various extracted antigens have been developed.
commercially available automated solid-phase assays incorporat-
inter-observer variability [6]. To overcome these disadvantages,
well-trained analysts, is quite time-consuming, and shows high
overlooked by IIF [5]. Furthermore, IIF requires experienced and
ANA, especially anti-SSA/Ro and anti-Jo-1 antibodies, may be
routine [1]. However, it has been shown that some subtypes of
TEF is a congenital malformation that requires early inter-
reference screening method for ANA in the clinical laboratory
ing and has been defined as the
the gold standard for ANA screen-
(IIF) on Hep-2 cells is regarded as
Indirect immunofluorescence
approach [2,4].
disease with an “intent to prevent”
medicine [3], especially for the identification of pre- or early
sion whether ANA represent useful biomarkers in preventive
sification criteria [1,2]. Beyond that, there is an open discus-
and polymyositis. ANA are thus incorporated in several clas-
The patients with recurrence of TEF had significantly more
Sjögren’s syndrome, mixed connective tissue disease (MCTD),
systemic lupus erythematosus (SLE), systemic sclerosis (SSc),
T in the diagnosis of systemic autoimmune disorders such as
he detection of antinuclear antibodies (ANA) is important

During the hospitalizations for clinical bronchiolitis, six
solid-phase assay
antinuclear antibodies (ANA), Elia CTD Screen (ECS),
KEY WORDS:
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
The details of patients who were hospitalized for respiratory
131118-COHANIM - 131118-COHANIM | 4 - B | 18-11-13 | 11:24:13 | SR:-- | Magenta
0.009
1 (1–2)
0.42
9/24
< 0.0001
3 (2–6)
1,4 Omid Amouzadeh-Ghadikolai MD , Mariana Stettin MD and Gerhard Reicht MD
7/7
0.073
0.011
3 (2–6)
All the patients with recurrence of TEF who were hospital-
34
value
(n=7)
P
of TEF
Seven out of nine patients with recurrence of TEF and 32 of
#
Original articles 0 (0–1) 15/30 1 (1–2) 19/32 1.5 (1–2) 57 (n=32) of TEF recurrence Recurrence No Original articles This study is the first to evaluate the possible association The recurrence is usually located in the pouch of the origi- Recurrence of TEF manifests with respiratory and gastrointes- Pulmonary function tests demonstrate restrictive patterns in Number of positive PCR per patient (median 25–75%) Episodes of positive PCR during clinical
hospital electronic database. The discharge recommendations STATISTICAl AnAlySIS prevalence was significantly higher in CD patients than in UC quency among Caucasian CD patients ranges from 3–16%
were based on the clinical judgment of physicians during hos- Statistical analyses were performed using IBM Statistical patients. The mutation was observed in 8/25 (32%) of the CD for the different NOD2/CARD15 mutations and 2–6% in UC
pitalization. Package for the Social Sciences statistics software, version 19 patients and in 3/25 (12%) of UC patients. patients [11-14].
Pre-hospitalization hemoglobin A1C (HbA1c) levels and (SPSS, IBM Corp, Armonk, NY, USA). Categorical variables are There are limited reports from the Arab world regarding
first month post-discharge data regarding prescription and reported as frequency and percentages, and continuous vari- gEnOTypE-pHEnOTypE AnAlySIS In CD pATIEnTS NOD2/CARD15 mutations. There are several reports in differ-
purchasing of insulin were retrieved from the Israeli national ables are reported as mean ± standard deviation. Categorical Demographic and clinical data comparing the group of CD ent Arab populations in North Africa, Tunisia, Algeria, and
patient database, as this information is not available in the variables were compared using chi-square test or Fisher’s exact mutation carriers with the non-carriers are shown in Table 2. Morocco as well as in the Arab population in another region
hospital electronic database. The last available HbA1c of test and continuous variables by independent samples t-test or The Gly908Arg mutation carriers were younger in age
each patient before admission was analyzed. The results were analysis of variance (ANOVA) test. A two-tailed P < 0.05 was (31.38 ± 8.5 years vs. 38.88 ± 10.4 years; P = 0.07). The age at Table 2. Demographic, clinical characteristics and genotype-phenotype correlation in
from 3–6 months before admission. Our study was approved considered statistically significant. A logistic regression was diagnosis was significantly lower among mutation carriers: 22.8 Crohn’s disease patients
by the research ethics committee at Assaf Harofeh Medical done to calculate adjusted odds ratio of variables. ± 4.5 years and 28.82 ± 9.1 years for non-carrier (P = 0.04). It Gly908Arg carrier Non-carrier P
Center. is noteworthy to mention that all mutation carriers were male Characteristic n=8 (32%) n=17 (68%) value
(100%), whereas in the non-carrier group only 41.2% were male Age, years, mean ± SD 31.38 ± 8.5 38.88 ± 10.4 0.07
pATIEnT ADHEREnCE RESULTS (P = 0.005). When analyzing the disease location according to Age at diagnosis, years, mean ± SD 22.8 ± 4.5 28.82 ± 9.1 0.04
Adherence by patients was defined as “full adherence” if the pATIEnT ADHEREnCE wITH DISCHARgE RECOMMEnDATIOn the Montreal classification, no association was found between Gender, male (%) 8 (100) 7 (41.2) 0.005
patient had purchased basal (long-acting) as well as bolus The study comprised 153 patients. Of these, 81 (53.6%) were the mutation carriers with the non-carriers. No relationship was
(short-acting) insulin, “partial adherence” if the patient had male. The average age was 67.5 ± 13.1 years. Table 1 describes found regarding other parameters including disease behavior, Appendectomy (%) 0 5 (33.3) 0.08
purchased only one kind of insulin (basal or bolus), and “no patient adherence by demographic characteristics and clini- appendectomy history, family history of IBD, smoking history, Family history of IBD (%) 1 (12.5) 4 (23.5) 0.47
adherence” if the patient did not purchase any insulin. cal parameters. The majority of patients, 106 (69.3%), showed treatment with anti-tumor necrosis factor (TNF), and surgery. Smoking history (%) 2 (25.0) 6 (35.3) 0.61
full adherence to discharge instructions. Twenty-five patients Anti-TNF treatment (%) 4 (50.0) 6 (37.5) 0.45
pHySICIAn ADHEREnCE (16.3%) showed no adherence and 22 (14.4%) showed par- gEnOTypE-pHEnOTypE AnAlySIS In uC pATIEnTS Surgery (%) 3 (37.5) 7 (41.2) 0.86
Adherence by physicians was defined as “full adherence” tial adherence. A significant positive association was found We analyzed the phenotypic characteristics presented by all 25 Disease duration, median, years (IQR) 5.5 (4–11.5) 6 (5–15) 0.63
if the primary physician had prescribed basal and bolus between pre-hospitalization HbA1c and patient adherence. UC patients. Of the 25 UC patients, the Gly908Arg mutation was Localization ileal (%) 2 (25) 7 (41) 0.43
insulin, “partial adherence” if only one kind of insulin had The average pre-hospitalization HbA1c was 9.04% ± 2.04 in the detected in three (12%). When comparing mutation carriers to L2 (%) 1 (12.5) 1 (5.9) 0.54
been prescribed, and “no adherence” if no insulin had been full-adherence group, 8.67% ± 1.70 in the partial-adherence non-carriers with regard to age, we found that Gly908Arg carri-
prescribed. group, and 7.51% ± 1.35 in the no-adherence group (P = 0.002). ers are older than non-carriers (67.0 ± 24.5 years vs. 41.2 ± 12.3 L3 (%) 4 (50) 8 (47) 0.61
In addition, there was a trend toward better adherence with years, P = 0.006, respectively). There was a trend toward older L4 (%) 1 (12.5) 1 (5.9) 0.54
Table 1. Patient adherence by demographic characteristics and clinical parameters younger age that did not reach statistical significance. No age at diagnosis (46.7 ± 16.1 years vs. 30.7 ± 12.7 years, P = 0.06). Non-stricturing, non-penetrating disease (%) 4 (50) 12 (71) 0.32
association was found between any other clinical and demo- No significant associations were found regarding other param- Stricturing-disease (%) 2 (25) 4 (24) 0.65
Total no adherence partial adherence full adherence p value
graphic parameters and patient adherence. eters. Demographic and clinical data comparing the mutation Penetrating-disease (%) 2 (25) 1 (5.9) 0.23
n=153 n=25 (16.3%) n=22 (14.4%) n=106 (69.3%) Overall, these data demonstrate that patients with higher carriers and non-carriers are shown in Table 3.
Age, years, mean ± SD 67.5 ± 13.06 71.04 ± 12.48 70.27 ± 12.13 66.15 ± 13.24 0.14 pre-hospitalization HbA1c were significantly more compliant IBD = inflammatory bowel disease, IQR = interquartile range, SD = standard deviation,
TNF = tumor necrosis factor
gender with discharge instructions for continuous BB insulin treat-
Male 81 (53%) 13 (16%) 8 (9.8%) 60 (74%) 0.22
Female 72 (47%) 12 (16.6%) 14 (19.4%) 46 (63.8%) ment. DISCUSSION Table 3. Demographic, clinical characteristics and genotype-
HbA1c, % 8.74 ± 1.97 7.51 ± 1.35 8.67 ± 1.70 9.04 ± 2.04 0.002 IBD prevalence in the Bedouin Arab population is increas- phenotype correlation in ulcerative colitis patients
BMI, kg/m 2 30.3 ± 6.0 30.6 ± 5.5 30.4 ± 6.9 30.2 ± 6.0 0.96 pHySICIAn ADHEREnCE wITH DISCHARgE RECOMMEnDATIOnS ing [2]. In the current study, we investigated the frequency of Gly908Arg
Creatinine, mg/dl 1.56 ± 1.14 1.68 ± 1.64 1.88 ± 1.09 1.46 ± 1.0 0.236 Table 2 describes physician adherence by demographic char- NOD2/CARD15 mutations in this population and its associa- Characteristic carrier n=3 Non-carrier P
(12%)
n=22 (88%)
value
BMI = body mass index, HbA1c = hemoglobin A1C, SD = standard deviation acteristics and clinical parameters of discharged patients. tion with the IBD phenotype. To the best of our knowledge, no
Physician full adherence with discharge instructions was sig- data have been previously reported regarding these mutations Age, years, mean ± SD 67.0 ± 24.5 41.2 ± 12.3 0.006
nificantly higher than patient full adherence, 121 (79.1%) vs. in the Bedouin Arab population in southern Israel. Age at diagnosis, years, mean ± SD 46.7 ± 16.1 30.7 ± 12.7 0.06
Table 2. Physician adherence by demographic characteristics and clinical parameters of 106 (69.3%), respectively (P = 0.0182), suggesting that 20% As expected, and in accordance with previous findings, we Gender, male (%) 1 (33.3) 11 (50.0)
patients 0.53
of physicians do not prescribe insulin according to discharge identified a higher frequency of NOD2/CARD15 mutation in Appendectomy (%) 0 0 –
Total no adherence partial adherence full adherence p value recommendations and an additional subset of patients do CD than UC, 32% vs.12%, respectively. Family history of IBD (%) 0 1 (4.5) 0.88
n=153 n=20 (13.1%) n=12 (7.8%) n=121 (79.1%) not adherent to their physician’s prescription. A significant Interestingly, in our cohort only one of the three NOD2/
Age, years, mean ± SD 67.5 ± 13.06 72.65 ± 11.07 70.25 ± 13.7 66.43 ± 13.16 0.108 association was found between pre-hospitalization HbA1c CARD15 variant mutations was found: the Gly908Arg muta- Smoking history (%) 0 5 (22.7) 0.49
gender and physician adherence as well as a trend toward better tion. No Arg702Trp or Leu1007fsinsC mutations were found Anti-TNF treatment (%) 0 0 –
Male 81 (52.9%) 10 (12.3%) 6 (7.4%) 65 (80.2%) 0.932 adherence with younger age, which did not reach statisti- among the Bedouin Arab IBD patients. In addition, no homo- Past surgery (%) 0 2 (10.0) 0.75
Female 72 (47.1%) 10 (13.8%) 6 (8.3%) 56 (77.7%)
cal significance. No association was found between any zygotes/compound heterozygotes were observed. Proctitis (%) 1 (33.3) 4 (18.2) 0.50
HbA1c, % 8.74 ± 1.97 7.38 ± 1.0 9.18 ± 1.6 8.93 ± 2.04 0.003
other clinical and demographic parameters and physician The frequency of NOD2/CARD15 mutations is relatively Left colitis (%) 2 (66.7) 9 (40.9) 0.41
BMI, kg/m 2 30.3 ± 6.0 29.96 ± 3.86 28.88 ± 4.71 30.5 ± 6.41 0.657 adherence. high among our population. The frequency is ethnic specific Pancolitis (%) 0 9 (41.1) 0.24
Creatinine, mg/dl 1.56 ± 1.14 1.86 ± 1.8 1.57 ± 1.08 1.51 ± 1.01 0.437 These data demonstrate that similarly to patient adherence, and varies in different reports and geographic region. However, IBD = inflammatory bowel disease, SD = standard deviation, TNF = tumor
BMI = body mass index, HbA1c = hemoglobin A1C, SD = standard deviation pre-hospitalization HbA1c and age affect primary physician most reports showed a prevalence of less than 30%. The fre- necrosis factor
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