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Renata Yakubov, Erez Nadir, Roni Stein, Adi Klein-Kremer. The Duration of Breastfeeding and Its Association with Metabolic Syndrome among Obese Children. DOI: 10.1155/2015/731319

Itzhak Braverman, Galit Avior, Michael Feldman, Andrei Gubarev, Ronnie Stein, Hakeem Abu Ras, Abdel-Rauf Zeina. Emergency Airway Obstruction in Newborn Due to Congenital Saccular Cyst. DOI: 10.4236/ijohns.2013.21009 

Adi Klein-Kremer, Francis B. Mimouni, Ronnie Stein. Impact Factor of Published Clinical Trials in the Field of Pediatric Infectious Diseases. DOI: 10.12691/ajeid-2-2-2

Avivit Brener, Anat Segev-Becker, Naomi Weintrob, Ronnie Stein, Hagar Interator, Anita Schachter-Davidov, Galit Israeli, Erella Elkon-Tamir, Yael Lebenthal, Ori Eyal, Asaf Oren. Health-Related Quality of Life in Children and Adolescents with Nonclassic Congenital Adrenal Hyperplasia. DOI: 10.4158/EP-2018-0617

Revital Nimri, Eyal Dassau, Tomer Segall, Ido Muller, Natasa Bratina, Olga Kordonouri, Rachel Bello, Torben Biester, Klemen Dovc, Ariel Tenenbaum, Avivit Brener, Marko Šimunović, Sophia D Sakka, Michal Nevo Shenker, Caroline Gb Passone, Irene Rutigliano, Davide Tinti, Clara Bonura, Silvana Caiulo, Anna Ruszala, Barbara Piccini, Dinesh Giri, Ronnie Stein, Ivana Rabbone, Patrizia Bruzzi, Jasna Šuput Omladič, Caroline Steele, Guglielmo Beccuti, Michal Yackobovitch-Gavan, Tadej Battelino, Thomas Danne, Eran Atlas, Moshe Phillip. Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians. 
DOI: 10.1111/dom.13408

Avivit Brener, Yael Lebenthal, Anna Shtamler, Sigal Levy, Ronnie Stein, Aviva Fattal-Valevski, Liora Sagi. The endocrine manifestations of spinal muscular atrophy, a real-life observational study. DOI: 10.1016/j.nmd.2020.02.011

Anat Segev-Becker, Roi Jacobson, Ronnie Stein, Ori Eyal, Asaf Oren, Anita Schachter-Davidov, Galit Israeli, Yael Lebenthal, Naomi Weintrob. Women with Nonclassic Congenital Adrenal Hyperplasia Have Gender, Sexuality, and Quality-Of-Life Features Similar to those of Nonaffected Women. DOI: 10.4158/EP-2019-0509



Objective: The objective of this study was to evaluate whether duration of breastfeeding is associated with a lower prevalence of metabolic syndrome in obese children.

Methods: A retrospective analysis of obese children aged 3 to 18 years followed at a pediatric outpatient clinic at a single center between the years 2008 and 2012. The children were divided according to their breastfeeding duration: no breastfeeding, a short period of breastfeeding, and a long term breastfeeding. Also, they were divided into metabolic and nonmetabolic syndrome groups, based on physical examination and laboratory tests.

Results: Out of 4642 children who visited the clinic, 123 were obese and were included in the study. About half of them matched the metabolic syndrome criteria. There was no correlation between the prevalence of metabolic syndrome and the duration of breastfeeding. Hypertension, abnormal low levels of HDL, high levels of HbA1c, and high fasting triglyceride levels were very common in our study population, yet no statistical significance was noted among the different breastfeeding groups.

Conclusion: In this study, breastfeeding was not associated with a reduced risk for metabolic syndrome, compared with formula feeding, in children who are obese.


Laryngeal cyst causing neonatal airway obstruction during labor is a very rare condition [1]. Congenital laryngeal cysts are a rare cause of neonatal airway obstruction. Traditionally, these cysts have been treated surgically by endoscopic excision or marsupialization. However, the cyst often extends beyond the larynx. We describe a case of a newborn that, during delivery, became cyanotic due to airway obstruction and respiratory distress. To the best of our knowledge this is the first report of a saccular cyst obstructing airway during birth prior to intubation. The immediate and late treatments together with a literature review are described.


Impact Factor (IF) is used for evaluating journals; it represents a measure of the average frequency with which an article in a specific journal is cited by other articles in a given period of time. In a previous report we showed that in Neonatology, clinical trials published between 1998 and 2003 were more likely to be published in journals with lower IF had they reported negative results (NR) vs. positive results (PR). This study aimed at determining which biases exist in clinical trials in the field of Pediatric Infectious Diseases; we tested the effect of 5 factors on the likelihood of an article to be published in a high vs. low IF journal: NR vs. PR, sample size, study design (prospective, randomized, double-blinded), funding source, and originating region of the report. We selected articles of clinical trials in the field of Pediatric Infectious Diseases registered in MEDLINE from 2007 to 2011. We recorded the aforementioned factors and the IF of each journal, corresponding to publication year. Trends over time and the differences between studies with NR or PR were examined. IF and sample size were not significantly higher in PR vs. NR studies. Conversely, the aforementioned study design elements produced publications in journals of significantly higher IF. IF increased respectively with the following funding source categories: (i) no source stated; (ii) pharmaceutical company; (iii) non-US competitive; (iv) US national agency (non-NIH); (iv) NIH. Pediatric Infectious Diseases articles with NR vs. PR are not more likely to be published in journals with lower IF. Also, no apparent relationship exists between sample size and IF. Factors associated with the quality of the study, namely design and source of funding, may be more related to the IF of the journal than the type of results reported therein.


Objective: Nonclassic congenital adrenal hyperplasia (NCCAH) is a late-onset milder form of congenital adrenal hyperplasia that differs dramatically from the classic form. Health-related quality of life (HRQOL) in pediatric patients with the sole diagnosis of NCCAH has not been determined; therefore, in this study, we aimed to determine whether HRQOL is compromised in comparison to the general population.

Methods: Single-center, cross-sectional, case-control study. Twenty-three hydrocortisone-treated children and adolescents (7 males) diagnosed with NCCAH by cosyntropin stimulation test and CYP21A2 gene mutation analysis were recruited to this study; 6 healthy siblings were also recruited. HRQOL was assessed by the child and parent-proxy PedsQL Inventory and compared between NCCAH subjects and healthy siblings. HRQOL scores of NCCAH subjects were compared with known standards from the U.S. and Israeli general healthy populations. Anthropometric measurements of children and parents were performed and compared between NCCAH subjects and healthy siblings. Pearson correlation coefficients were calculated.

Results: HRQOL scores of the participants and parents did not differ between NCCAH subjects and healthy siblings. The HRQOL emotional domain scores of the NCCAH patients and parent were significantly lower than the healthy U.S. pediatric population (P = .046) but not different from established standards of the healthy Israeli population (P = .583). Anthropometric measurements were within the normal range and did not differ between NCCAH subjects and their siblings. Total, school functioning, and psychosocial HRQOL domain scores were positively correlated with body mass index-standard deviation score in NCCAH subjects.

Conclusion: HRQOL was not adversely affected by NCCAH among adequately treated children and adolescents. Abbreviations: BMI = body mass index; CAH = congenital adrenal hyperplasia; HRQOL = health-related quality of life; NCCAH = nonclassic congenital adrenal hyperplasia; PedsQL = Pediatric Quality of Life Inventory; SDS = standard deviation score.


Aims: To evaluate physicians’ adjustments of insulin pump settings based on continuous glucose monitoring (CGM) for patients with type 1 diabetes and to compare these to automated insulin dose adjustments.

Methods: A total of 26 physicians from 16 centres in Europe, Israel and South America participated in the study. All were asked to adjust insulin dosing based on insulin pump, CGM and glucometer downloads of 15 patients (mean age 16.2 ± 4.3 years, six female, mean glycated haemoglobin 8.3 ± 0.9% [66.8 ± 7.3 mmol/mol]) gathered over a 3-week period. Recommendations were compared for the relative changes in the basal, carbohydrate to insulin ratio (CR) and correction factor (CF) plans among physicians and among centres and also between the physicians and an automated algorithm, the Advisor Pro (DreaMed Diabetes Ltd, Petah Tikva, Israel). Study endpoints were the percentage of comparison points for which there was full agreement on the trend of insulin dose adjustments (same trend), partial agreement (increase/decrease vs no change) and full disagreement (opposite trend).

Results: The percentages for full agreement between physicians on the trend of insulin adjustments of the basal, CR and CF plans were 41 ± 9%, 45 ± 11% and 45.5 ± 13%, and for complete disagreement they were 12 ± 7%, 9.5 ± 7% and 10 ± 8%, respectively. Significantly similar results were found between the physicians and the automated algorithm. The algorithm magnitude of insulin dose change was at least equal to or less than that proposed by the physicians.

Conclusions: Physicians provide different insulin dose recommendations based on the same datasets. The automated advice of the Advisor Pro did not differ significantly from the advice given by the physicians in the direction or magnitude of the insulin dosing.


The introduction of nusinersen, the first therapeutic modality for Spinal Muscular Atrophy (SMA) patients has raised hopes and led to construction of a multi-professional medical SMA service, including pediatric endocrinology. Our study aimed to provide a comprehensive description of the endocrine manifestations of SMA patients with variable degree of sarcopenia. Real-life clinical and laboratory data of 62 SMA patients (age range 3 months to 31 years, 24 type 1, 21 type 2, 17 type 3) were collected including: weight-status, self-reported information on puberty, current pubertal stage, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), basal gonadotropin and androgen levels. Precocious pubarche (mean age at onset 3.9 ± 2.8 years) was found in 24% (15/62) of the SMA cohort [45.9%(11/24) type 1 and 19%(4/21) type 2]. A higher HOMA-IR predicted precocious pubarche after adjustment for SMA type and age (OR=1.42; 95% CI, 1.05, 1.93, P = 0.025). Bilateral cryptorchidism was found in 60% of type 1 and 30% of type 2 boys; type 3 young adult males attained full puberty. Most of the young women had normal pubertal development and regular menses, regardless of degree of obesity. Our findings suggest that isolated precocious pubarche is associated with early-onset insulin resistance linked to severity of muscular atrophy.


Objective: Females with the severe classic forms of congenital adrenal hyperplasia reportedly have a higher frequency of atypical gender identity, nonheterosexual sexual relationships, and cross-gender role behavior. Comparable data and quality-of-life measures among those with the milder, more prevalent form, nonclassic congenital adrenal hyperplasia, are scarce. We aimed to assess health-related quality of life, gender identity, role, and sexual orientation in women with nonclassic congenital adrenal hyperplasia via a prospective, questionnaire-based, case-control study. Methods: Thirty-eight women with nonclassic congenital adrenal hyperplasia (median age 34 years; range, 18 to 44 years) and 62 age-matched female controls were recruited. Outcome measures included the Multi-Gender Identity, Sexuality, and World Health Organization (WHO) quality-of-life questionnaires.

Results: Sociodemographic parameters (marital status, number of children, and educational level) were similar for both groups, as were most measures of the Multi-Gender Identity, Sexuality, and WHO quality-of-life questionnaires. However, “sometimes-feeling-as-a-man and sometimes-feeling-as-a-woman” were more frequently reported in the study group compared to the controls (7/38 [18.4%] vs. 3/62 [4.8%], respectively; P = .02). Furthermore, more nonclassic congenital adrenal hyperplasia women reported first falling in love with a woman (4/37 [10.8%] vs. 0/58 [0%]; P = .02).

Conclusion: Our findings suggest possible subtle differences in gender identity and sexual orientation between adult nonclassic congenital adrenal hyperplasia females and controls. Quality of life was not impaired in individuals within the study group. The impact of exposure to mildly elevated androgen levels during childhood and adolescence on the female brain warrants more in-depth assessment in further studies. Abbreviations: CAH = congenital adrenal hyperplasia; Multi-GIQ = Multi-Gender Identity Questionnaire; NCCAH = nonclassic congenital adrenal hyperplasia; QoL = quality of life.