Page 36 - DIFDUF

699
the Medical Statistics Unit, Rambam Health Care Campus.
The authors acknowledge the statistical help of Ms. Ronit Leiba from
Acknowledgement
bronchiolitis and recurrent TEF.
conducted to better understand the association between viral
the year of SBIs insertion was available. The authors included
may be beneficial. Further larger prospective studies should be
and 95%CIs among a subgroup of SBI recipients for whom
against RSV and influenza for patients with a history of TEF
hazards model was used to calculate the hazard ratios (HRs)
TEF. In light of this data, we also suggest that vaccinations
and 95% confidence intervals (95%CIs). A Cox proportional
should be carefully evaluated for the possibility of recurrent
regression models were used to calculate odds ratios (ORs)
with a history of TEF and hospitalizations for viral bronchiolitis
Diseases 9th revision (ICD-9) codes. Multivariable logistic
Even though cause and effect cannot be established, patients
were identified using the International Classification of
COnCluSIOnS
and mammography referrals. Autoimmune/rheumatic disorders
procedure and diagnosis codes, clinical breast examinations,
with respiratory symptoms mimicking bronchiolitis.
Women with Silicone breast implants (SBIs) were identified by
infectious agents in the process or have more hospitalizations
which include up to 20 years of data on 2 million members.
develop recurrence of fistula are more vulnerable to common
computerized databases of Maccabi Healthcare Services (MHS),
increases the risk of recurrence of TEF, or whether patients who
watad and colleagues, in a cross-sectional study, used the
It is impossible to determine whether the bronchiolitis itself
Silicone breast implants and the risk of autoimmune/rheumatic disorders: a real-world analysis
we were unable to establish the cause and effect relationships.
issues are referred. Finally, as it is merely a descriptive study,
tiary center to which patients with more complicated health
study was based in a pediatric pulmonology institute at a ter-
surgery; hence, we could not clearly categorize the TEF. The
increased macrophage numbers in the fibrous cap. Moreover,
Not all patients underwent bronchoscopy prior to the first
induced a marked reduction in SMC and collagen content, but
the relatively small sample size and the retrospective nature.
treatment between 18 and 26 weeks of Western diet feeding
This study has several limitations. The main limitations are
antibodies. Surprisingly, they found that IL-1β antibody
vulnerable to additional insults, such as viral infections.
atherosclerosis were treated with anti-IL-1β or IgG control
lowing TEF repair, the tracheoesophageal area might be more
muscle cell (SMC) lineage-tracing Apoe-/- mice with advanced
of TEF were immunologically intact. We postulate that, fol-
colleagues performed intervention studies in which smooth
unknown. The patients in our study who developed recurrence
subjects were treated with an IL-1β antibody. gomesz and
mechanism for the development of these TEF complications is
Study (CANTOS) trial, in which post-myocardial infarction
anemia and invasive pulmonary aspergillosis [22]. The exact
in the Canakinumab Anti-inflammatory Thrombosis Outcome
in the formation of a TEF [21], and in a patient with aplastic
may improve advanced plaque stability, as recently tested
who had necrotizing candidiasis of the trachea that resulted
poor. A prevailing hypothesis is that reducing inflammation
tion [20], in a patient with human immunodeficiency virus-1
controlling late-stage atherosclerotic plaque stability remains
Despite decades of research, our understanding of the processes
transplant patient following Mycobacterium tuberculosis infec-
has been reported in immunosuppressed patients: in a renal
Interleukin-1β has atheroprotective effects in advanced atherosclerotic lesions of mice
An association between de novo TEF and infectious agents
caused by other viruses, such as rhinovirus and bocavirus.
viruses, and it is possible that a patient had clinical bronchiolitis
with clinical bronchiolitis. Moreover, the panel contains six
lessons from Israel Arab Crohn’s disease cohort. Dig Dis Sci 2005; 50 (9): 1692-7.
rent TEF. PCR for viruses is not always sent for every patient
mutations and the prevalence and phenotypic heterogeneity of Crohn’s disease:
positive PCR for viruses per patient in the patients with recur-
Gastroenterol 2015; 21 (25): 7786-94.
of viral bronchiolitis. Remarkably, we found more episodes of
mutations in North Algerian patients with inflammatory bowel disease. World J
recurrent TEF were respiratory hospitalizations and diagnosis
In the current evaluation, the only factors associated with
gene variants in Moroccan patients. Gene 2012; 499: 121-3.
and open approaches [14].
population with Crohn’s disease. Dig. Dis. Sci 2005; 50 (1): 130-5.
or anastomotic stricture were found between the thoracoscopic
differences in short-term complication rates, anastomotic leak,
Genet 2003; 121A: 240-4.
CARD15(NOD2) gene and Crohn’s disease in Israeli Jewish patients. Am J Med
ous anastomotic leak and congenital esophageal stenosis. No
earlier, known risk factors for such recurrences include previ-
Original articles Original articles Eitan Israeli Eitan Israeli Nature Med 2018; 24: 1418 Int J Epidemiol 2018 Oct 16. doi: 10.1093/ije/dyy217 Confucius, (551 BCE–479 BCE), Chinese philosopher disease. Am J Gastroenterol 20041134-40 :99 ;. phenotype differences between Ashkenazi and Sephardic Jews with Crohn`s 55: 749-53. inflammatory bowel disease: controversies, consensus, and implications. Gut 2006; Gastroenterol 2014; 20 (17): 5008-16. through
#
of Israel, which showed a lower frequency of mutation carriage the NOD2/CARD15 gene and no sequencing of the gene was Short-term Adherence with Discharge Recommendation
and no more than 13%. The Bedouin Arab population is known completed. Third, we did not include a healthy control cohort.
to have a high rate of consanguinity marriage, which might for Insulin Treatment among patients with Type 2 Diabetes
explain the high prevalence of genetic disease [4]. COnCluSIOnS
In the current IBD Bedouin Arab cohort, there are two We found a high prevalence of NOD2/CARD15 mutations in Shlomit Koren MD *, Michael Yoshpa MD *, Ronit Koren MD , Dror Cantrell MD 3,4 and Micha J. Rapoport MD 3,4
2,4
3
1,4
nuclear families; each includes four patients with IBD. This CD and UC patients among Bedouin Arab patients. In our
3
2
population could be an interesting population for further cohort, only the Gly908Arg mutation was identified. NOD2/ 1 4 Diabetes Unit and Departments of Internal Medicine A and Internal Medicine C, Assaf Harofeh Medical Center, Zerifin, Israel
genetic investigation in the future. CARD15 positivity was associated with younger age at diagno- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
There is a large number of reports regarding phenotype- sis and male gender of CD patients.
genotype correlations of NOD2/CARD15 in CD patients
[5-10]. Our results, in agreement with other studies, showed a Correspondence
Dr. n. Abu freha
relationship between the NOD2/CARD15 mutation and early Dept. of Gastroenterology and Hepatology, Soroka University Medical edication non-adherence may reduce the effectiveness
131118-COHANIM - 131118-COHANIM | 4 - A | 18-11-13 | 11:24:13 | SR:-- | Magenta
age on onset, with the age of 22.8 ± 4.5 years in mutation car- Center, Beer Sheva 84101, Israel ABSTRACT: Background: Basal-bolus (BB) insulin treatment is increasingly M of therapies. Non-adherence to prescription medica-
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
riers compared to 28.82 ± 9.1 years in non-carriers (P = 0.04). phone: (972-8) 640-2251 used in poorly controlled diabetes patients during hospital- tions is associated with risk of death and hospitalization [1-3].
131118-COHANIM - 131118-COHANIM | 4 - A | 18-11-13 | 11:24:13 | SR:-- | Cyan
fax: (972-8) 623-3083
Similar findings were reported in previous studies [8,9,16,18]. email: abufreha@yahoo.de; naimaf@clalit.org.il ization and is commonly recommended at discharge; however, This concern is particularly important at the time of hospital
An important finding of the present work is the gender rela- Reference the extent of adherence with this recommendation is unknown. discharge, which involves a transfer in responsibility from the
tionship. Our results showed that 100% of the NOD2/CARD15 1. Central statistics bureau. Population, by district, sub-district and religion [Available Objectives: To determine short-term adherence of type 2 in-patient provider or hospitalist to the primary care physician
mutation carriers were male, compared to 41% in the non- from http://www.cbs.gov.il/shnaton67/st02_15x.pdf]. [Accessed 1 July 2017]. diabetes mellitus (T2DM) patients discharged from internal [4]. Inadequate hospital–community transition contributes to a
carrier group (P = 0.005). This finding has not been reported 2. Abu Freha N, Schwartz D, Elkrinawi J, et al. Inflammatory bowel disease among medicine wards with recommendation for BB insulin treatment. high rate of adverse events, the majority of which are drug events
previously [6-9]. Bedouin Arab in southern Israel. Urbanization and increasing prevalence rates. Eur Methods: Prescription (primary physician adherence) and [5-7]. Medication reconciliation at hospital admission, transfer,
J Gastroenterol Hepatol. 2015; 27 (3): 230-4.
In our study, no association was found in other parameters, 3. Na’amnih W, Romano-Zelekha O, Kabaha A L, et al. Prevalence of consanguineous purchase (patient adherence) of long-acting and short- and discharge have been designated as required hospital prac-
including disease location and behavior. marriages and associated factors among Israeli Bedouins. J Community Genet 2014; acting insulins during the first month following discharge tices to reduce adverse drug events [8]. At any given moment,
from internal medicine wards was determined in 153 T2DM
The present study included 25 patients with UC. We found 5 (4): 395-8. approximately 30–40% of patients hospitalized in the general
the NOD2/CARD15 mutation in three patients (12%), which 4. Congenital defects and genetic disease among Bedouin population in the Negev, patients. Adherence was defined as full if prescription/ medicine wards have type 2 diabetes mellitus (T2DM) [9].
purchase of both basal (long-acting) and bolus (short-acting)
report from the Health Ministry [Available from http://www.health.gov.il/
is a relatively high-frequency rate compared with previously PublicationsFiles/Genetic-Diseases-Bedouin.pdf]. [Accessed 15 October 2016]. insulin was completed, and as partial if only one kind of At admission, many of these patients are treated with basal-
reported frequency in different ethnic groups [12-14]. [Hebrew]. insulin (basal or bolus) was prescribed/purchased. Association bolus (BB) insulin, as recommended by the American Diabetes
In a genotype-phenotype analysis, age at diagnosis was 5. Ogura Y, Bonen DK, Inohara N, et al. A frameshift mutation in NOD2 associated between demographic and clinical parameters and adherence Association (ADA), due to in-hospital hyperglycemia [10]. At
with susceptibility to Crohn’s disease. Nature 2001; 411 (6837): 603-6.
higher among mutation carriers by about 15 years, but statisti- 6. Hampe J, Cuthbert A, Croucher PJ, et al. Association between insertion mutation in was determined. discharge, this treatment regimen remains relevant in a signifi-
cally non-significant (46.7 ± 16.1 years vs. 30.7 ± 12.7 years; NOD2 gene and Crohn’s disease in German and British populations. Lancet 2001; Results: Full adherence to discharge instructions was higher cant portion of these patients and is included in the recom-
P = 0.06) in the UC cohort. In our genotype-phenotype analy- 357 (9272): 1925-8. for primary physicians than for patients (79.1% vs. 69.3%, mendation discharge letter. A structured discharge treatment
sis, no other differences were found regarding demographic or 7. Lesge S, Zouali H, Cezard JP, et al. CARD15/NOD2 mutational analysis and respectively, P = 0.0182). Pre-hospitalization hemoglobin A1C plan for every diabetes patient has been recommended recently
clinical characteristics of the UC patients. genotype-phenotype correlation in 612 patients with inflammatory bowel disease. was significantly associated with adherence by both patients by the ADA [11]. Non-adherence at the time of hospital dis-
Am J Hum Genet 2002; 70: 845-57.
We have reported before that the incidence of IBD among 8. Ahmad T, Armuzzi A, Bunce M, et al. The molecular classification of the clinical and primary physicians (full-adherence group 9.04% ± 2.04%; charge has been reported by some studies. Notably, Jackevicius
Bedouin Arab is increasing [2], which may be attributed to the manifestations of Crohn’s disease. Gastroenterology 2002; 122: 854-66. no-adherence group 7.51% ± 1.35%, P = 0.002). Age was et al. [3] reported increased 1-year mortality for those patients
change of lifestyle, including urbanization and modernization 9. Cuthbert AP, Fisher SA, Mirza MM, et al. The contribution of NOD2 gene mutations negatively associated with adherence of both primary phy- who did not fill all of their discharge medications after hospi-
with a Western lifestyle, particularly with regard to hygiene and to the risk and site of disease in inflammatory bowel disease. Gastroenterology 2002; sicians and patients; however, this association did not reach talization for acute myocardial infarction, regardless of their
122: 867-74.
nutrition. However, as we expected, we found a high prevalence 10. Bonen DK, Ogura Y, Nicolae DL, et al. Crohn’s disease-associated NOD2 variants statistical significance. Patients with certain background pre-hospitalization treatment [12]. There is no published data
of the NOD2/CARD15 mutation in this specific population. share a signaling defect in response to lipopolysaccharide and peptidoglycan. diseases such as atrial fibrillation, coronary heart disease, and regarding the implementation and continuity of discharge rec-
The Bedouin Arab population in southern Israel is a very Gastroenterology 2003; 124: 140-6. chronic heart failure had significantly worse adherence (P < 0.05). ommendations for insulin-based discharge recommendations.
young society, with 60% of the population younger than age 11. Cavanaugh J. NOD2: ethnic and geographic differences. World J Gastroenterol When the sole cause of admission was diabetes, full adherence We therefore sought to determine short-term (1 month) adher-
2006; 12: 3673-7.
19 years [1]. The compensation of these aforementioned fac- 12. Brant SR, Wang MH, Rawsthorne P, et al. A population-based case control study (100%) of both primary physicians and patients was found. ence of primary physicians and T2DM patients with discharge
tors had led us to expect a continuation of the increase in IBD of CARD15 and other risk factors in Crohn’s disease and ulcerative colitis. Am J Conclusions: Short-term adherence with discharge recom- recommendation for BB insulin regimen.
incidence and prevalence in the future. Also, educational activi- Gastronterol 2007; 102: 313-23. mendation for BB insulin treatment is associated with pre-
ties are very important and could have an important impact. 13. Andriulli A, Annese V, Latiano A, et al. The frame-shift mutation of the NOD2/ hospitalization patient characteristics.
CARD15 gene is significantly increased in ulcerative colitis: an IG-IBD study.
Preventive intervention that has been suggested includes Gastroenterology 2004; 126: 625-7. KEY WORDS: IMAJ 2018; 20: 691–694 PATIENTS AND METHODS
basal-bolus (BB) insulin treatment, diabetes,
dietary changes, reduction in the rate of smoking (which is very 14. McGovern DP, Van Heel DA, Negoro K, et al. Further evidence of IBD5/CARD15 hospitalization, insulin, internal medicine department This research was a retrospective single center study.
high among the population), and minimization of the consan- (NOD2) epistasis in the susceptibility to ulcerative colitis. Am J Hum Genet 2003;
73:1465-6.
guinity rate in the population. In addition, genetic counseling 15. Buening C, Genschel J, Buhner S, et al. Mutations in the NOD2/CARD15 gene DATA RETRIEVAl
may be offerred to populations at high risk.
Demographic and clinical data of T2DM patients discharged
in Crohn’s disease are associated with ileocecal resection and are a risk factor for
PERFECTOR ber of patients. In addition, like most previous studies, our 16. Toerkvist L, Noble CL, Lordal M, et al. Contribution of CARD15 variants in *The first and second authors contributed equally to this study from the internal medicine wards of Assaf Harofeh Medical
reoperation. Aliment Pharmacol Ther 2004; 19: 1073-8.
The limitations of the present study include the small num-
Center with recommendation for BB insulin regimen between
determining susceptibility to Crohn’s disease in Sweden. Scand J Gastroenterol
analysis included only the three most frequent mutations in
1 October 2013 and 31 March 2014 were retrieved from the
2006; 41: 700-5.
698 691