Kaplan Medical Center

To describe the clinical and laboratory findings, disease course, and treatment effectiveness of a large, genetically homogenous group of patients with deficiency of adenosine deaminase 2 (DADA2), and to identify factors associated with disease-related damage. We conducted a retrospective cohort study that included 45 patients with DADA2 vasculitis with long-term follow-up. Information was collected from patients' charts, including demographic information, clinical presentations, laboratory findings, and treatment. The extent of disease-related damage was determined based on the Vasculitis Damage Index. In this large homogenous cohort, we found that a young age at disease onset and periodic illness that included recurrent episodes of fever, myalgia, and abdominal pain were associated with disease-related damage. Patients with severe DADA2 disease responded favorably to tumor necrosis factor inhibitors (TNFi). Early age of onset and the periodic nature of the disease warrant prompt initiation of TNFi treatment to prevent later complications and severe disease progression.

The prevalence of autoimmune diseases (AIDs) in Ethiopian patients with type 1 diabetes (T1D) is mainly unknown. This study aimed to determine the co-occurrence of AIDs in T1D Ethiopian patients and to compare their prevalence to non-Ethiopian Israeli patients. A retrospective cohort analysis of 12,759 T1D patients, of whom 672 (5.3%) were of Ethiopian descent, aged ≥ 18 years, registered in the Clalit Health Services database was conducted. The AID cases were identified by ICD-10 codes from 2000 to 2023. Additionally, data on thyroid peroxidase antibody (TPO) and tissue transglutaminase (TTG) antibodies were extracted and analyzed. The mean age of the entire cohort was 30.4 ± 18.9 years, 54% were male, and the mean follow-up was 10.9 ± 6.1 years. An additional AID was diagnosed among 14% of the Ethiopian and 26% of the non-Ethiopian populations (p < 0.001), respectively. Although the prevalence of coexisting autoimmune conditions was approximately half in the Ethiopian group, the relative distribution pattern of common and less common AIDs remained similar to that observed in the non-Ethiopian population. The prevalence of AIDs in Ethiopians is lower than in non-Ethiopian patients with T1D, indicating the existence of ethnic differences in susceptibility to AIDs. Nevertheless, the low screening rates highlight the need for greater vigilance and adherence to guidelines by medical staff.

Introduction: Helicobacter pylori (H. pylori) is a common bacterial infection linked to gastritis, peptic ulcers, and gastric cancer. Dietary habits may influence the acquisition, progression, and symptoms of this infection. In Palestine, the prevalence of H.pylori and dietary patterns raise public health concerns. This study explores the association between dietary factors and H. pylori infection severity in Palestine. Objectives: To assess the relationship between specific dietary practices and the prevalence and severity of H. pylori infection in Palestinian patients, aiming to inform preventive strategies and dietary management protocols. Methods: A cross-sectional study was conducted between 2023 and 2024, involving 269 H. pylori patients. Participants completed an online semi-quantitative food frequency questionnaire (FFQ) shared via social media. The questionnaire collected data on demographics, infection status, dietary intake, lifestyle factors, and medical history. Statistical analyses included t-tests, Mann-Whitney U-tests, χ²-tests, and Fisher’s exact tests, with significance set at p ≤ 0.05. Ethical approval was obtained from the IRB of An-Najah National University, Palestine. Results: Significant associations were found between diet and H. pylori symptoms. Fast food consumption correlated with bloating and heartburn (p &lt; 0.01). Low vegetable intake was linked to upper abdominal pain (p &lt; 0.01). Energy drink consumption was associated with bloating and nausea (p &lt; 0.01), and citrus intake with upper abdominal pain (p &lt; 0.01). Conclusion: Certain dietary behaviors, including high fast food and low vegetable intake, may exacerbate H. pylori symptoms. Integrating dietary modifications into H. pylori treatment plans is recommended, especially in resource-limited settings.

Abstract Background: Breast cancer is the most common malignancy among women in Israel and globally. Although early detection significantly improves prognosis, 30% of women in Israel are diagnosed at a locally advanced or metastatic stage. In the early 1990s, Israel implemented a national breast cancer screening program, offering biennial mammograms at no cost to women aged 50 and older at average risk. Such organized programs, which provide free and accessible mammography, have been shown to improve adherence rates. Despite this, a substantial proportion of women do not participate in regular screening. Objective: To evaluate adherence to national mammography screening guidelines among Israeli women and identify sociodemographic and clinical factors associated with adherence. Methods: This population-based retrospective study included 100,000 women aged 35-75, using data collected between 2006 and 2020 from the centralized healthcare registry of Clalit, the largest health maintenance organization (HMO) in Israel. Women with a personal history of breast cancer, prior breast surgery, or known genetic predisposition were excluded. Adherence was defined as the proportion of recommended mammograms completed, categorized as: &amp;lt;0.2, &amp;lt;0.5, &amp;lt;0.8, and ≥0.8. The ≥0.8 group was considered fully adherent. Results: A total of 95,603 women met inclusion criteria. Only 17,533 (18%) demonstrated full adherence (≥80%). Among the adherent group, 4% were Ultra-Orthodox Jewish and 13% were Arab. Smoking status was associated with lower adherence; 80% of adherent women were non-smokers. In diabetic women (n=39513), only 5,929 women (15%) demonstrated full adherence. Hormone replacement therapy (HRT) users were more likely to adhere, with 8,943 (51%) meeting the adherence threshold. Women engaged in other preventive health measures were significantly more likely to adhere to mammography screening. Among the adherent group, the median index for Pap smears was 0.18 (IQR: 0.07-0.30), for occult blood testing 0.33 (IQR: 0.17-0.56), and for colonoscopy 0.35 (IQR: 0.00-0.59). Adherence to pneumococcal vaccination showed high adherence to screening mammography with a median index of 1.0 (IQR: 0.60-1.0). In contrast, receipt of influenza vaccination was not associated with mammogram adherence. Conclusion: Despite the availability of a national, no-cost mammography screening program, overall adherence remains low. Sociodemographic characteristics and engagement in other preventive health behaviours significantly influence adherence. Targeted interventions are needed to improve screening rates, particularly among underserved populations. Citation Format: H. Kadar Sfarad, R. Magnezi, O. Eldar Friedman, O. Weinstein. Disparities in Mammography Screening in a Welfare-State Healthcare System: Data from 100,000 Women in Israel [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-22.

Ocular manifestations (OMs) are recognized extraintestinal complications in inflammatory bowel disease (IBD), but their incidence remains understudied. We aimed to evaluate the incidence and trends of OM in a large population-based cohort of adults with newly diagnosed IBD over the past 2 decades. We conducted a retrospective cohort study including all adult-onset IBD patients between 2005 and 2024 in a large health maintenance organization. Patients with pre-existing OM diagnoses were excluded. The primary outcome was incident OM (uveitis, episcleritis/scleritis, or orbital inflammation) after IBD diagnosis. Annual incidence trends were assessed using the Cochran-Armitage test. Risk factors were analyzed via multivariable Cox regression, stratified by IBD type. Among 15 035 newly diagnosed IBD patients (51.8% Crohn's disease [CD], 48.2% ulcerative colitis [UC]), 349 developed an OM over 119 669 person-years (incidence: 2.9 per 1000 person-years; 95% confidence interval [CI], 2.62-3.24). OM incidence was higher in CD than UC (log-rank P < .001) and remained stable over time (P = .125). The median time to OM was 45 months. In CD, female sex (hazard ratio [HR], 1.62; 95% CI, 1.24-2.13) and systemic corticosteroid use (HR, 1.62; 95% CI, 1.18-2.22) were significant risk factors. In UC, corticosteroids (HR, 2.17; 95% CI, 1.40-3.37) and intestinal surgery (HR, 3.50; 95% CI, 1.69-7.28) were associated with increased OM risk. OMs in adult-onset IBD are infrequent but clinically relevant, particularly among CD patients and those with markers of severe disease. Clinician awareness and early referral remain essential for prompt diagnosis and management.

To the Editor: We thank Dr Vijayasimha and colleagues for their thoughtful analysis of our work and their proposal for prospective validation of the Padua × D-dimer (PaDd) score. Their roadmap provides a rigorous framework that addresses critical gaps in our single-center retrospective design. We welcome this opportunity to clarify key methodological considerations and invite the global research community to collaborate on next-generation studies.

Kidney transplantation is the treatment of choice for end-stage renal disease, offering significant survival benefits. However, outcomes vary based on donor type and patient characteristics. We aimed to identify factors influencing long-term survival following kidney transplantation. This was a population-based retrospective cohort study of kidney transplant recipients from 2005 to 2018 in Israel, assessing survival from one-month post-transplant. Univariate and multivariate Cox regression analyses were performed to identify predictors of mortality. Among 1,847 recipients, 679 received kidneys from living donors and 1,168 from deceased donors. The median age was 52 years (IQR 38–62), and the mean post-transplant survival time was 11.9 years (95% CI 11.7–12.3). Increased mortality risk was associated with age over 65 years (HR 3.73), current or past smoking (HR= 1.32), diabetes mellitus (HR= 1.79), heart failure (HR= 1.49), and atrial fibrillation (HR= 1.79). Receiving a kidney from a living donor (HR= 0.49) and higher pre-transplant hemoglobin levels (HR= 0.75) were linked to improved survival. Recipient comorbidities and donor type are key determinants of post-transplant outcomes. These findings support a tailored approach to transplant evaluation, balancing potential survival and quality-of-life benefits with individual risk profiles.

The objectives of our study were to determine the mortality rates, causes, and risk factors of people living with HIV in the modern antiretroviral therapy era, in a major HIV center in Israel. We retrospectively collected data from 1547 patients treated during 2001–2021. We used the Shapiro–Wilk test, Fisher’s exact test, Student’s t test, and chi-square to compare between patients who died and those who did not, and between patients who died from AIDS-related and non-AIDS-related causes. In total, 206 (13.3%) patients died. The causes of death were AIDS-defining diseases (33.5%), cardiovascular diseases (21.8%), non-AIDS infections (16%), and hepatic disorders (7%). The annual mortality rate was 1.31 ± 0.3%. Despite an increase in age (35 ± 13.2 in 2001, 49 ± 13.6 years in 2021; p < 0.001), the mortality rate decreased (2.12% during 2005–2008, 0.71% during 2018–2021; p = 0.0001). AIDS-defining diseases caused 75% of deaths during 2001–2002, and only 25% during 2019–2021. The proportion of cardiovascular deaths increased (8.3% in 2001–2003, 33.3% in 2019–2021; p < 0.001). Low CD4 and high viral load at diagnosis, male gender, non-MSM HIV acquisition (heterosexual transmission and people who inject drugs), and inability to achieve viral suppression because of non-compliance were risk factors for mortality. Mortality rates decreased during 2001–2021; however, the proportion of non-AIDS deaths increased. Early cardiovascular comorbidity screening and targeted adherence interventions in non-MSM populations and in patients with low CD4 are needed.

Abstract Background Tasty&amp;Healthy (T&amp;H) is a whole food diet shown to induce clinical and biological remission in Crohn’s disease (CD)(1). It eliminates processed foods, gluten, red meat, and dairy (except plain yogurt); no formula or mandatory components are needed. Here we aimed to evaluate whether T&amp;H diet maintenance treatment induces radiologic and endoscopic remission while gradually reintroducing gluten and dairy. Methods Patients, aged 4–37 years, achieving deep remission (MINI index&amp;lt;8 and wPCDAI&amp;lt;12.5/CDAI&amp;lt;150) in the previous TASTI-MM (T&amp;H vs. EEN) and TASTI-E (T&amp;H vs. regular diet) induction RCTs, were enrolled in this open-label maintenance trial and completed 24 weeks on the diet. Gluten and dairy were reintroduced monthly; &amp;gt;30% increase in fecal calprotectin prompted re-elimination of the specific ingredient. Intestinal Ultrasound with Segmental Activity Scoring (IUS-SAS) was performed at weeks 0, 8 and 24 and, in a subset who consented, video capsule-endoscopy (VCE) or ileocolonoscopy at week 24. Results Forty-three patients were enrolled: age 16±5.8 years, 33 children/adolescents; 91% not receiving any therapy besides T&amp;H. Clinical remission at 24 weeks was maintained in 37/43 (86%) participants; 53% successfully re-introduced gluten and dairy. All IUS parameters improved from baseline to weeks 8 and 24 ( including the maximal bowel score (IBUS-SAS 44.9 [IQR 2.1-64.9], 14 [0-48.5], 13.6 [0-34,6]; p = 0.0068) and in the terminal ileum (43 [IQR 0-64.8], 14 [0- 47.5], 5 [0-31], respectively; p = 0.0069). Among 29 patients with paired IUS assessments at baseline and week 24, 86% showed improvement or normalization of the ileal IBUS-SAS score, and 83% (24/29) demonstrated improvement in both the maximal and panenteric cumulative scores. Of the 23 patients who underwent VCE/ileocolonoscopy, 14 (61%) exhibited complete endoscopic healing or had only a few aphthous ulcers. Conclusion The T&amp;H diet, combined with structured, calprotectin-guided reintroduction of gluten and dairy, maintained clinical remission and improved radiological and endoscopic inflammation in patients up to 24 weeks. Reference: 1. Aharoni-Frutkoff Y, Plotkin L, Pollak D, et al. Whole Food Diet Induces Remission in Children and Young Adults With Mild to Moderate Crohn’s Disease and Is More Tolerable Than Exclusive Enteral Nutrition: A Randomized Controlled Trial. Gastroenterology 2025. Conflict of interest: Plotkin, Luba: No conflict of interest Aharoni-Frutkoff, Yonat: No conflict of interest Shavit, Zivia: No conflict of interest Ms. Focht, Gili: No conflict of interest Livovsky, Jessica: No conflict of interest Lev Zion, Raffi: No conflict of interest Ledder, Oren: No conflict of interest Cytter- Kuint, Ruth: No conflict of interest Zharkov, Elena: No conflict of interest Broide, Efrat: No conflict of interest Assa, Amit: No conflict of interest Sigall-Boneh, Rotem: No conflict of interest Weiss, Batia: No conflict of interest Slae, Mordechai: No conflict of interest Dotan, Iris: No conflict of interest Godny, Lihi: No conflict of interest Kierkuś, Jarosław: No conflict of interest Griffiths, Anne: No conflict of interest Naftali, Timna: No conflict of interest Aloi, Marina: No conflict of interest Yerushalmy-Feler, Anat: No conflict of interest Schwerd, Tobias: No conflict of interest Reifen, Ram: No conflict of interest Turner, Dan: No conflict of interest

Background: Antiretroviral therapy (ART) has transformed HIV into a chronic manageable condition, yet metabolic toxicities including pancreatic enzyme alterations remain concerns. While older ART regimens have been associated with hyperamylasemia, the impact of integrase strand transfer inhibitor (INSTI)-based therapies on serum amylase levels has not been specifically examined. Purpose: This study aimed to compare longitudinal patterns of serum amylase levels between people living with HIV receiving INSTI-based versus NNRTI/PI-based ART regimens. Methods: This retrospective observational study analyzed 99 HIV-positive patients at Kaplan Medical Centre, Israel (2002–2023). Participants received either INSTI-based (n = 49) or NNRTI/PI-based (n = 50) regimens for ≥24 months. Serum amylase, viral load, CD4 counts, and metabolic parameters were measured at baseline, one year, and two years. Repeated-measures ANOVA assessed longitudinal changes. Results: NNRTI/PI-treated patients maintained significantly higher mean amylase levels throughout follow-up (baseline: 122.9 ± 42.1 U/L; two years: 129.6 ± 38.0 U/L) compared to INSTI-treated patients (baseline: 78.7 ± 32.3 U/L; two years: 68.4 ± 23.4 U/L; p < 0.0001 at all timepoints). A significant linear time-by-group interaction (p = 0.037) demonstrated divergent trajectories. No clinical pancreatitis was observed in either treatment group during the follow-up period, and all observed variations in serum amylase were biochemical and asymptomatic. While these findings are reassuring regarding acute pancreatic toxicity, the clinical significance of chronic subclinical enzyme elevations remains uncertain. Conclusion: INSTI-based antiretroviral regimens suggest a favorable pancreatic and metabolic safety profile compared with NNRTI/PI-based therapies.