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Kagan M, Semo-Oz R, Ben Moshe Y, Atias-Varon D, Tirosh I, Stern-Zimmer M, Eliyahu A, Raas-Rothschild A, Bivas M, Shlomovitz O, Chorin O, Rock R, Tzadok M, Ben-Zeev B, Heimer G, Bolkier Y, Gruber N, Dagan A, Bar Aluma BE, Pessach IM, Rechavi G, Barel O, Pode-Shakked B, Anikster Y, Vivante A. Clinical impact of exome sequencing in the setting of a general pediatric ward for hospitalized children with suspected genetic disorders. Front Genet 2023; 13:1018062. [PMID: 36699461 PMCID: PMC9868164 DOI: 10.3389/fgene.2022.1018062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Background: Genetic conditions contribute a significant portion of disease etiologies in children admitted to general pediatric wards worldwide. While exome sequencing (ES) has improved clinical diagnosis and management over a variety of pediatric subspecialties, it is not yet routinely used by general pediatric hospitalists. We aim to investigate the impact of exome sequencing in sequencing-naive children suspected of having monogenic disorders while receiving inpatient care. Methods: We prospectively employed exome sequencing in children admitted to the general pediatric inpatient service at a large tertiary medical center in Israel. Genetic analysis was triggered by general and/or subspecialist pediatricians who were part of the primary inpatient team. We determined the diagnostic yield among children who were referred for exome sequencing and observed the effects of genetic diagnosis on medical care. Results: A total of fifty probands were evaluated and exome sequenced during the study period. The most common phenotypes included were neurodevelopmental (56%), gastrointestinal (34%), and congenital cardiac anomalies (24%). A molecular diagnosis was reached in 38% of patients. Among seven patients (37%), the molecular genetic diagnosis influenced subsequent clinical management already during admission or shortly following discharge. Conclusion: We identified a significant fraction of genetic etiologies among undiagnosed children admitted to the general pediatric ward. Our results support that early application of exome sequencing may be maximized by pediatric hospitalists' high index of suspicion for an underlying genetic etiology, prompting an in-house genetic evaluation. This framework should include a multidisciplinary co-management approach of the primary care team working alongside with subspecialties, geneticists and bioinformaticians.
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Affiliation(s)
- Maayan Kagan
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel
| | - Rotem Semo-Oz
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Rheumatology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yishay Ben Moshe
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Danit Atias-Varon
- Pediatric Nephrology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Irit Tirosh
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Rheumatology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Michal Stern-Zimmer
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviva Eliyahu
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel
| | - Annick Raas-Rothschild
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Institute of Rare Diseases, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Maayan Bivas
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Shlomovitz
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Odelia Chorin
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel,The Institute of Rare Diseases, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Rachel Rock
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel,The Institute of Rare Diseases, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Michal Tzadok
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Bruria Ben-Zeev
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gali Heimer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel,Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yoav Bolkier
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Heart Institute, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Noah Gruber
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Adi Dagan
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Bat El Bar Aluma
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Itai M. Pessach
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel,Department of Pediatric Intensive Care, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gideon Rechavi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel-Hashomer, Israel,Sheba Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ortal Barel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel-Hashomer, Israel,The Genomics Unit, Sheba Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ben Pode-Shakked
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yair Anikster
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel-Hashomer, Israel,Metabolic Disease Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Asaf Vivante
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel,Pediatric Nephrology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,*Correspondence: Asaf Vivante,
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Cohen K, Spielman S, Semo-Oz R, Bitansky G, Gerstein M, Yacobi Y, Vivante A, Tirosh I. Colchicine treatment can be discontinued in a selected group of pediatric FMF patients. Pediatr Rheumatol Online J 2023; 21:2. [PMID: 36600239 PMCID: PMC9811732 DOI: 10.1186/s12969-022-00780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Familial Mediterranean Fever (FMF) patients are required to adhere to a life-long treatment with colchicine, primarily for preventing amyloidosis. As some patients may be asymptomatic for long periods of time, it remains unclear whether it is possible to discontinue colchicine treatment in a selective group of patients. We aimed to identify predictive characteristics for a successful cessation of colchicine therapy. METHODS Out of 646 FMF pediatric patients followed in our referral FMF clinic, colchicine treatment was discontinued in 51 patients. In this study we compared the genetic, demographic, and clinical characteristics between patients for whom a successful cessation of therapy was made (Group 1; n = 21) and patients for whom cessation of therapy was deemed a failure (Group 2; n = 30) and consequently had to resume colchicine therapy. RESULTS Patients for whom a successful cessation of therapy was achieved had no biallelic pathogenic MEFV mutations, were less likely to have "severe attacks" (two or more FMF characteristic symptoms) (24% vs 80%; P = 0.000067) and did not require higher than 1 mg/day of colchicine, prior to the drug cessation. Remission duration under colchicine treatment was significantly higher in group 1 compared with group 2 (4.36 years ±2.12 vs 2.53 years ±2; P = 0.0036). CONCLUSION This study supports the concept of colchicine free remission in a minority of FMF patients (3%). Holding treatment, under close monitoring, may be reasonable when selecting the appropriate patients.
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Affiliation(s)
- Keren Cohen
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Spielman
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ,grid.460042.4Paediatric Rheumatology unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Centrer, 52621 Ramat-Gan, Tel Hashomer Israel ,grid.413795.d0000 0001 2107 2845Department of Paediatrics A, Edmond and Lily Safra Children’s Hospital, Sheba Medical Centre, Tel Hashomer, Israel
| | - Rotem Semo-Oz
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ,grid.460042.4Paediatric Rheumatology unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Centrer, 52621 Ramat-Gan, Tel Hashomer Israel ,grid.413795.d0000 0001 2107 2845Department of Paediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Centre, Tel Hashomer, Israel
| | - Guy Bitansky
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Gerstein
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ,grid.460042.4Paediatric Rheumatology unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Centrer, 52621 Ramat-Gan, Tel Hashomer Israel
| | - Yonatan Yacobi
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ,grid.460042.4Paediatric Rheumatology unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Centrer, 52621 Ramat-Gan, Tel Hashomer Israel
| | - Asaf Vivante
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ,grid.413795.d0000 0001 2107 2845Department of Paediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Centre, Tel Hashomer, Israel
| | - Irit Tirosh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Paediatric Rheumatology unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Centrer, 52621, Ramat-Gan, Tel Hashomer, Israel. .,Department of Paediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel.
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Semo-Oz R, Wagner-Weiner L, Edens C, Zic C, One K, Saad N, Tesher M. Adherence to medication by adolescents and young adults with childhood-onset systemic lupus erythematosus. Lupus 2022; 31:1508-1515. [DOI: 10.1177/09612033221115974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Approximately 20% of all cases systemic lupus erythematous (SLE) are juvenile onset. Children and adolescents with SLE usually present with more severe illness and have a higher mortality rate compared to adults with SLE. Adherence to medications in children and adolescents has a major impact on disease control as well as short- and long-term outcomes. Improved understanding of adherence rates, risk factors for non-adherence, and barriers to adherence are essential in order to increase patient adherence with medication regimens. The aim of our study was to evaluate adherence to medications among children and young adults with pediatric-onset SLE and identify barriers for non-adherence by utilizing several adherence evaluation methods. Methods: Adherence to medications of patients aged 12–25, with childhood-onset SLE was assessed as follows: (1). The brief medication questionnaire (BMQ): self-report tool for screening adherence and barriers to adherence. (2). Mycophenolic acid (MPA) serum level. (3). Medication possession ratio (MPR): data assessing 90-day refills and dispense prior to patient’s enrollment was collected. Results: Of the 38 patients who were enrolled in the study, 65% were found to be non-adherent according to at least 1 measurement method. Forty-four percent of patients were found to be non-adherent based on the self-reported questionnaire (BMQ). Of those taking MMF, 33% had an MPA level < 1 mcg/mL and were defined as non-adherent. Seventeen percent of patients were found to be non-adherent according to pharmacy refills rate. Forty-six percent of patients stated that their medications caused side effects, 33% of patients indicated difficulty remembering to take the medications, and 25% reported difficulty paying for medications. The disease activity index (SLEDAI) score of the “adherent group” at diagnosis was significantly lower compared to the “non-adherent” group. Patients with private insurance had more access barriers to obtaining medications compared to patients with public insurance. Conclusion: Non-adherence to medications is highly prevalent among cSLE patients. Higher SLEDAI score is a risk factor for non-adherence. Adherence to medications should be routinely evaluated among adolescence and young adults with cSLE and barriers to adherence need to be addressed to decrease morbidity and improve patient outcomes.
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Affiliation(s)
- Rotem Semo-Oz
- Section of Pediatric Rheumatology, University of Chicago Medical Center, Chicago, IL, USA
- Department B/Pediatric Rheumatology, Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Linda Wagner-Weiner
- Section of Pediatric Rheumatology, University of Chicago Medical Center, Chicago, IL, USA
| | - Cuoghi Edens
- Sections of Rheumatology and Pediatric Rheumatology, Departments of Internal Medicine and Pediatrics, University of Chicago Medical Center, Chicago, IL, USA
| | - Carolyn Zic
- Section of Pediatric Rheumatology, University of Chicago Medical Center, Chicago, IL, USA
| | - Karen One
- Section of Pediatric Rheumatology, University of Chicago Medical Center, Chicago, IL, USA
| | - Nadine Saad
- Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Melissa Tesher
- Section of Pediatric Rheumatology, University of Chicago Medical Center, Chicago, IL, USA
- Pediatric Rheumatology Clinic, C. S. Mott Children’s Hospital, Ann Arbor, MI, USA
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