OBJECTIVE:Limited evidence suggests an association between Helicobacter pylori (H. pylori) infection and diminished cognitive function in children; nonetheless, the role of gastric inflammation remains unclear. We examined the association of H. pylori infection and serum pepsinogens, markers of gastric inflammation, with cognitive function in children aged 10-12 years. METHODS:A prospective cohort study was conducted among 233 infants from Arab towns in Israel, who were followed up at ages 10-12 years. Cognitive function was assessed using the Wechsler Intelligence Scale for Children-IV edition. H. pylori in infancy and at school age was detected via stool antigen detection enzyme immunoassay. Serum pepsinogens I (PGI) and PGII, markers of gastric inflammation, were measured using ELISA. Covariates included sociodemographics, nutritional status, and systemic inflammation. RESULTS:Overall, 134 participants were enrolled, 81 (60.4%) tested H. pylori-positive. Compared to uninfected participants, those with H. pylori-positivity at school age and with a ratio of PGI:PGII≤4.43 (indicating more severe inflammation) had lower full-scale IQ scores: beta coefficient -5.9 (95% CI -11.7, -0.01), as well as those with a PGI:PGII ratio>4.43 (milder inflammation) -7.5 (-12.7, -2.2), adjusting for confounders. Results were similar for the verbal comprehension and working memory scores, and in inverse probability weighted analysis that accounted for the non-inclusion of participants from the original cohort. Children with persistent infection from infancy to school age had the lowest cognitive performance. CONCLUSIONS:H. pylori infection is associated with reduced cognitive performance in school-age children, regardless of gastric inflammation, highlighting its potential role in extra-gastrointestinal outcomes.

Purpose:Antibiotic resistance in uropathogens causing urinary tract infections (UTIs) is increasing; nonetheless, evidence on multidrug-resistant (MDR) bacteria remains limited. We aimed to examine the prevalence and risk factors of Gram-negative MDR bacteria in pediatric UTIs and compared the hospitalization duration and cost between patients with and without MDR. Patients and Methods:A retrospective single-center study was conducted among hospitalized children from 2015 to 2020. Sociodemographic (age, sex, population group, residential socioeconomic status), clinical (prior hospitalizations, antibiotic use, background diseases), and laboratory (complete blood count, C-reactive protein levels) data were collected from medical files. MDR was defined as non-susceptibility to ≥1 agent in ≥3 antimicrobial classes. Results:The study included 506 children (81.8% girls; median age 11 months). Most (94.2%) isolates were Gram-negative. Resistance to ampicillin, trimethoprim/sulfamethoxazole, amoxicillin/clavulanic acid, nitrofurantoin, cefuroxime-axetil, and cefuroxime-sodium was 33.8%, 12.4%, 9.4%, 3.9%, 3.2%, and 2.5%, respectively. MDR prevalence was 6.9% (95% CI 4.8-9.5), and 50.8% (46.4-55.4) showed resistance/intermediate susceptibility to 1-2 antibiotic categories. Arab children had an increased likelihood of MDR (OR=3.29 (95% CI 1.49-7.25) than Jewish children, and children with vs. without a history of antibiotic use before hospitalization (5.06, 1.67-15.31). The likelihood of resistance/intermediate susceptibility to 1-2 antibiotic categories increased in relation to antibiotic use before hospitalization (2.68, 1.25-5.74) and in males vs. females (1.71, 0.99-2.94). No significant differences were found in hospitalization duration or cost between the MDR groups. Conclusion:The prevalence of MDR and non-susceptibility/resistance to 1-2 antibacterial categories in Gram-negative uropathogens is concerning. Our findings underscore the need for tailored empirical therapy and targeted antibiotic stewardship interventions.

OBJECTIVES:Rotavirus vaccination is effective in preventing acute gastroenteritis (AGE), but evidence regarding its potential non-specific effects remains elusive. We examined the associations of prior rotavirus vaccination with clinical and laboratory parameters in children with viral AGE, exploring potential non-specific effects of rotavirus vaccination. METHODS:A single-center study was conducted in Israel, including 494 children aged 2-23 months hospitalized during 2011-2015. Demographics and clinical and laboratory data were obtained via parental interviews and from medical records, and rotavirus vaccination status (pentavalent vaccine) was determined via the national immunization registry. RESULTS:Overall, 8.7% of the participants were unvaccinated for rotavirus, 29.8% were partially vaccinated, and 61.5% were fully vaccinated. Fully vaccinated participants had significantly higher hemoglobin (beta coefficient 0.58, 95% confidence interval 0.18-0.98), hematocrit (1.89, 0.77-3.03), and lymphocyte (1.51, 0.63-2.39) levels, but a lower neutrophil-lymphocyte ratio than unvaccinated participants. The likelihood of having a urine culture performed was lower among the fully vaccinated participants (odds ratio = 0.21, 0.07-0.61). Complete-series vaccination was inversely related to rotavirus detection (odds ratio = 0.17, 0.05-0.57). CONCLUSIONS:Rotavirus vaccination correlates with better nutritional status and lower inflammation in patients with AGE, suggesting additional beneficial effects of the vaccine and highlighting the need to increase vaccination coverage.

BACKGROUND:Prior to the coronavirus disease 2019 (COVID-19) pandemic, bronchiolitis caused by respiratory syncytial virus (RSV) was primarily observed during the winter months. Recently, however, an increase in incidence during the warmer months has been noted. This trend suggests an interaction between RSV and coronavirus, as well as the impact of public health measures, such as hand hygiene, mask-wearing, and social distancing. OBJECTIVES:To characterize bronchiolitis cases in children under 2 years old caused by RSV during the COVID-19 pandemic in Israel from 2018 to 2022. METHODS:We conducted retrospective study by analyzing medical records of children hospitalized with bronchiolitis from January 2018 to December 2022. A comparison was made between cases before and after the first COVID-19 lockdown. RESULTS:A total of 922 children with bronchiolitis were studied: 276 cases occurred before the lockdown and 646 cases afterward. We found an increase in bronchiolitis frequency during the summer following the lockdown and a decrease during the winter (P < 0.0001). In addition, there was a shift in the pathogenic profile, with a notable rise in mixed infections after the lockdown (P < 0.0001). No significant differences in clinical presentation were observed between pre- and post-lockdown periods. CONCLUSIONS:There was a change in bronchiolitis seasonality after the lockdown, with a significant increase in cases during the summer and a rise in mixed infections. Further studies are needed to assess whether this shift is a lasting consequence of the pandemic or a temporary change.

Introduction: High-sensitivity cardiac troponin T (hs-cTnT) is not used routinely as a diagnostic biomarker in newborns. The high precision of hs-cTnT assays increases the ability to determine small differences in cTnT over time and to detect troponin T elevation; thus, we believe that hs-cTnT assays might improve clinical care. We explored the plausible association between hs-cTnT levels (ng/L) in healthy newborns and prolonged second stage of labor, neonatal, and maternal factors. Methods: A prospective study was performed among healthy newborns in the Obstetrics and Gynecology Department at Hillel Yaffe Medical Center in Israel in January-June 2021. The sociodemographic characteristics of the participants, maternal age, gravidity, parity, Pitocin use, epidural analgesia, and neonatal anemia were obtained from the electronic medical records. Gestational age was determined by ultrasound biometric measurements. We classified second-stage labor as normal or prolonged using the WHO guidelines. Samples from umbilical cord blood were drawn using syringes rinsed with anticoagulant by a specialist in pediatrics. The remaining blood was used to determine hs-cTnT levels (ng/L), which was defined as a continuous quantitative variable with the median value and the 25th-75th percentiles. Results: Overall, 184 cord blood samples were performed from healthy newborns (60.6% males) with a median hs-cTnT of 39.03 (25th-75th percentiles = 30.53-54.09) ng/L. A multivariable linear regression model showed no significant association between neonatal anemia and hs-cTnT levels (ng/L) (p = 0.8). Gestational age (B coefficient -4.24, p < 0.001) and gravidity (B coefficient -2.41, p = 0.03) were negatively associated with hs-cTnT levels (ng/L), while Pitocin use (B coefficient 6.91, p = 0.04) and prolonged second stage of labor (B coefficient 18.07, p = 0.02) were positively associated with hs-cTnT levels (ng/L). Conclusions: High hs-cTnT levels (ng/L) were documented in the cord blood of healthy newborns. Hs-cTnT levels were positively correlated with a prolonged second stage of labor and Pitocin use and negatively correlated with longer gestational age and higher gravidity. Hs-cTnT may signify labor-related fetal distress. A larger surveillance study is mandatory to establish this correlation and assess for possible prognostic significance of elevated hs-cTnT in this context. (c) 2023 S. Karger AG, Basel

Background: We examined the extent and correlates of appropriate antibiotic use among children hospitalized with bacterial acute gastroenteritis (AGE) in Israel, a high-income country setting. Methods: Data were collected from children aged 0–59 months who participated in active hospital-based surveillance of AGE undertaken during 2007–2015. Bacterial AGE was defined as having a positive stool culture for Salmonella, Shigella, Campylobacter, or dysentery. Appropriate antibiotic use was defined as the administration of ciprofloxacin, azithromycin, or third-generation cephalosporins during hospitalization or at discharge. Results: Overall, 550 children had bacterial AGE; of those, 369 (67.1% [95% CI 63.1–70.9]) received antibiotics, mostly azithromycin (61.8%) and third-generation cephalosporins (37.9%). Appropriate antibiotic treatment was given to 318/550 (57.8% [95% CI 53.7–61.9]). Children aged 0–11 months vs. 24–49 months were more likely to receive appropriate antibiotic treatment (OR = 1.90 [95% CI 1.09–3.33]). Having dysentery (OR = 5.30 [95% CI 3.35–8.39]), performing blood culture (OR = 1.59 [95% CI 1.02–2.48]), and C-reactive protein (CRP) levels (OR = 1.01 [95% CI 1.01–1.02]) were positively associated with receiving appropriate antibiotic treatment. Conclusions: Most children with bacterial AGE received appropriate antibiotic treatment, which correlated with young age, dysentery, CRP level, and performing blood culture, suggesting more severe illness, thus supporting the clinical decisions of physicians.

Evidence on unnecessary antibiotic use in children with acute viral gastroenteritis (AGE) is scarce. We characterized the extent and correlates of antibiotic use among children hospitalized with viral AGE. A single-center study enrolled children aged 0-59 months hospitalized for AGE between 2008 and 2015 in Israel. Information was collected on laboratory tests, diagnoses, antibiotic treatment, and rotavirus vaccination. Stool samples were tested for rotavirus antigen, GII-norovirus, and stool cultures were performed for bacterial enteropathogens. Data from 2240 children were analyzed. Rotavirus vaccine was given to 79% of eligible children. Rotavirus test was performed on 1419 (63.3%) children. Before the introduction of universal rotavirus vaccination (2008-2010), rotavirus positivity in stool samples was 37.0%, which declined to 17.3% during the universal vaccination years (2011-2015). Overall, 1395 participants had viral AGE. Of those, 253 (18.1% [95% CI 16.1-20.2]) had unnecessary antibiotic treatment, mostly penicillin 46.6%, ceftriaxone 34.0% and azithromycin 21.7%. A multivariable analysis showed an inverse association between rotavirus vaccination and unnecessary antibiotic treatment (odds ratio = 0.53 [95% CI 0.31-0.91]), while positive associations were found with performing chest-X-ray test (3.00 [1.73-5.23]), blood (3.29 [95% CI 1.85-5.86]) and urine cultures (7.12 [3.77-13.43]), levels of C-reactive protein (1.02 [1.01-1.02]) and leukocytes (1.05 [1.01-1.09]). The results were consistent in an analysis of children with laboratory-confirmed rotavirus or norovirus AGE, or after excluding children with CRP > 50 mg/L. In conclusion, antibiotic prescription was common among hospitalized children with viral AGE, which was inversely related to rotavirus vaccination, possibly due to less severe illness in the vaccinated children.

Both the IGF1 axis and hypovitaminosis D play a role in childhood obesity, either as a cause or a causality. While some studies suggest an interrelation between vitamin D status, IGF1, and obesity, this mechanism remains obscure. The aim of this study, therefore, was to explore associations between four genetic polymorphisms in the IGF1 axis in hypovitaminosis D-related obesity. The study included 116 pre-pubertal Israeli Arab children (52 girls), mean age 9.4 ± 2.6. Serum 25(OH)D was measured and anthropometric measures were obtained. Genomic DNA was extracted from peripheral EDTA-treated anti-coagulated blood using a standard protocol. Genotypes were determined using the Taqman allelic discrimination assay. The IGF genetic score was computed according to the additive genetic score model. A moderate-to-high negative correlation (r = 0.580, p < 0.05) was seen between the vitamin D status and body mass index (BMI) percentile of participants with high GS. Yet, no correlations were seen between vitamin D status and BMI percentile for participants with a low-to-moderate genetic score (GS) (GS ≤ 2). These results suggest that IGF1 genetic scores associated with elevated circulating IGF1 may indicate a tendency toward developing hypovitaminosis D-associated obesity.

Background and Objectives: Neutrophil infiltration is an established signature of Non-Alcoholic Fatty Liver Disease (NAFLD) and Steatohepatitis (NASH). The most abundant neutrophilic peptide, alpha-defensin, is considered a new evolving risk factor in the inflammatory milieu, intimately involved in lipid mobilization. Our objective is to assess for potential association between alpha-defensin immunostains and NAFLD severity. Materials and Methods: We retrospectively investigated the liver biopsies of NAFLD/NASH patients, obtained at Hillel Yaffe Medical center between the years 2012 and 2016. Patients’ characteristics were recorded, including relevant blood tests at the time of biopsy. Each biopsy was semi-quantitatively scored using NAFLD Activity Score (NAS) and NASH fibrosis stage. The biopsies were immunostained for alpha-defensin. The precipitation of alpha-defensin was correlated to NAS and fibrosis. Results: A total of 80 biopsies were evaluated: male ratio 53.2%, mean age 44.9 ± 13.2 years, 54 had fibrosis grades 0–2, and 26 were grade 3–4. Conventional metabolic risk factors were more frequent in the high-grade fibrosis group. Immunostaining for alpha-defensin disclosed higher intensity (a.u.) in grade 3–4 fibrosis relative to grades 0–2, 25% vs. 6.5%, p < 0.05, respectively. Moreover, alpha-defensin staining was nicely co-localized with fibrosis. Conclusions: In our group of NASH/NAFLD patients, higher metabolic risk profile was associated with higher fibrosis grade. Immunostaining for alpha-defensin showed patchy intense staining concordant with high fibrosis, nicely co-localized with histological fibrosis. Whether alpha-defensin is a profibrotic risk factor or merely risk marker for fibrosis must be clarified in future studies.

Background: The long-term relations of socioeconomic status (SES) and early-life exposures with cognitive development at preadolescence are not fully understood, especially in low SES populations. We examined associations of SES and early-life exposures including feeding practices, physical growth and infections with cognitive development among preadolescents from underprivileged communities.Methods: A prospective study was conducted among 146 healthy children from two relatively low SES Arab villages in Israel, who were recruited at age 1-9 weeks and followed until age 18 months. Information was obtained on their feeding practices, health status and growth indica-tors. Cognitive development at age 10-12 years was assessed using the Wechsler Intelligence Scale, including the full-scale intelligence quotient (FSIQ) and scores of four cognitive do-mains. Multiple linear regression models were performed.Results: Nearly all the children (98%) were breastfed in infancy. Bivariate correlations were found of SES, growth indices and rates of diarrheal and respiratory illnesses in infancy, but not of feeding practices, with cognitive scores. In multivariable models, SES was positively (p < 0.001) associated with all the cognitive domains (beta coefficient ranges 4.3 to 8.2). Birth -weight was positively associated with FSIQ (p Z 0.039) and the perceptual reasoning index (p = 0.002). Weight for age Z score at age 10-14 months was positively associated with the verbal comprehension index (p = 0.003). The rate of respiratory illnesses was negatively asso-ciated with the perceptual reasoning index (p = 0.05).Conclusion: SES is strongly associated with cognitive development even in relatively low SES communities. Birthweight, weight indicators and respiratory illness in infancy might affect cognitive development through preadolescence.Copyright 2022, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

Background: It is prudent to develop biomarkers that enhance the differentiation between viral and bacterial infection in order to support expeditious and judicious antimicrobial implementation in emergency department admissions. Human neutrophilic peptides 1-3 (HNP1-3) are the major neutrophilic peptides with potent antimicrobial activity. Methods: We tested the performance of the plasma HNP1-3 test in a prospective observational cohort of children admitted to the emergency department for fever. We validated this test with traditionally used biomarkers and final diagnoses. An expert panel reviewed the patient’s data and gave a final diagnosis. The final diagnosis was classified as definite, probable, or possible. Results: A total of 111 children (98 with fever and 13 control) were recruited: 55% male, mean age 6.3 years. Plasma HNP1-3 levels were higher with bacterial infections: 10,428 (5789–14,866) vs. 7352 (3762–10,672) pg/mL, p = 0.007. HNP1-3 were negatively correlated with age: r = −0.207, p = 0.029. Of the different categorical variables tested, only c-reactive protein (CRP) (≥42.3 mg/dL), neutrophil count (≥10.2), and age (odds ratio = 1.185, p = 0.013 and 95%CI = 1.037–1.354) had significant diagnostic capability for bacterial disease prediction. Conclusions: Due to its low diagnostic value in febrile patients, the HNP1-3 value is not currently recommended to support pathogen differentiation in children in an emergency setting. Further studies are needed to support its clinical use.

The study aim was to examine the incidence and risk factors of respiratory syncytial virus (RSV) bronchiolitis hospitalisations and disease severity among infants. We compared demographic and health characteristics of children aged 0-23 hospitalised for RSV bronchiolitis (cases, n = 1227) during 2008-2018 and control children (n = 554) of the same age admitted for non-respiratory disease. RSV antigen was detected in nasal swabs by immunochromatography. Multiple logistic regression models were applied. The average annual incidence of hospitalisation for RSV bronchiolitis was 12.6 per 1000 and 1.7 per 1000 (P < 0.001) among infants and toddlers, respectively, with winter seasonality (November-March). The risk of hospitalisation for RSV bronchiolitis increased among children aged 0-5 months (OR 7.66; 95% CI 5.61-10.45) and 6-11 months (OR 12.88, 95% CI 8.48-19.55), compared to those aged 12-23 months. Additional risk factors were living in low vs. higher socio-economic status towns (OR 1.49; 95% CI 1.14-1.95), having chronic medical conditions (OR 2.75; 95% CI 1.61-4.70), birth month (October-January vs. June-September) (OR 2.19; 95% CI 1.60-2.99) and history of stay in neonatal intensive care unit at birth (OR 2.37; 95% CI 1.27-4.41). Male children and those who had pneumonia were more likely to have severe RSV bronchiolitis. In conclusion, the burden of hospitalisations for RSV bronchiolitis is high, especially in young infants. Effective preventive measures such as RSV active vaccines can reduce the risk of hospitalisations for RSV bronchiolitis among these vulnerable groups.

ObjectivesTo examine the association between Helicobacter pylori seroprevalence and serum pepsinogens (PGs) as markers of gastric inflammation), with high neutralizing antibody titers to poliovirus type 1 and 3 vaccine strains among children age 3–4 years, subsequent to sub-clinical infection acquired during a wild-type poliovirus type 1 outbreak in Israel.MethodsA serosurvey was conducted among 336 children aged 5–17 years who were vaccinated with both inactivated polio vaccine and oral polio vaccines. H. pylori serum IgG antibodies and PG concentrations were measured using ELISA. Neutralizing antibodies to poliovirus vaccine strains were measured and children with a titer ≥1:8 were considered immune. High-level immunity was defined as having a serum NA titer >1:2048. Propensity score inverse weighting was used to account for confounders.ResultsNeutralizing antibodies titers ≥1:8 to poliovirus type 1 and 3 vaccine strains were found in 99.4 and 98.2% of the children, respectively. An inverse association was found between H. pylori seropositivity accompanied by PGI:PGII ratio ≤6.5 (marker of gastric inflammation) and high-level immunity to poliovirus type 1: OR 0.39 (95% CI 0.68–0.91), p = 0.027. The association between H. pylori seropositivity of CagA virulent phenotype and polio high immunity was not significant. The association between H. pylori seropositivity and high neutralizing antibodies to type 3 poliovirus was of low magnitude and not significant.ConclusionsH. pylori seroprevalence accompanied by evidence of gastric inflammation was inversely correlated with high titers of neutralizing antibodies to poliovirus in children from a population with near universal polio immunity.

Childhood obesity is a major health problem. We examined differences between children with obesity and normal weight in nutritional and inflammation biomarkers. A cross-sectional study was conducted among healthy children aged 10–12 years from Arab villages in Israel. Parents were interviewed regarding sociodemographic and children’s health status. Body weight and height measurements were performed and weight categories were defined using the 2007 WHO growth curves. Blood samples were tested for complete blood count, levels of iron, ferritin, lipids, uric acid, and C-reactive protein (CRP). Overall, 146 children (59.0% males, mean age = 11.3 [SD = 0.5]) were enrolled. In total 43.8%, 14.1% and 42.3% of the participants had normal weight, overweight and obesity, respectively. A multivariable logistic regression model showed that children with overweight and obesity had lower iron, and HDL-C levels than children with normal weight. Levels of CRP, uric acid, LDL-C and lymphocytes were higher among children with overweight and obesity. In conclusion, our findings highlight the worse metabolic and nutritional status in overweight and obese children. Such markers play a role in metabolic syndrome, thus suggesting that metabolic syndrome might start in childhood.

Background Respiratory syncytial virus (RSV) is a main cause of respiratory tract infections, especially affecting young children. Antibiotics are often unnecessarily prescribed for the treatment of RSV. Such treatments can have effects on antibiotic resistance in future bacterial infections of treated patients and the general population. Objectives We sought to understand the risk factors for and patterns of unnecessary antibiotic prescription in children with RSV. Methods In a single center retrospective study in Israel, we obtained data of children aged <2 years (n=1015) hospitalized for RSV-bronchiolitis during 2008-2018, and ascertained not to have bacterial coinfections. Antibiotic misuse was defined as prescription of antibiotics during hospitalization of the study population. Patient and clinical variables were assessed as predictors of unnecessary antibiotic treatment in a multivariable logistic regression model. Results Unnecessary antibiotic treatment rate of children infected with RSV and ascertained not to have a bacterial coinfection was estimated at 33.4% (95% CI 30.5%-36.4%). Increased likelihood of antibiotic misuse was associated with drawing bacterial cultures, and with variables indicative of a severe patient status: lower oxygen saturation, higher body temperature, tachypnea and prior recent emergency room visit. Older age and female sex were also associated with increased likelihood of unnecessary antibiotic treatment. Conclusions Unnecessary antibiotic treatment in RSV patients was highly common and may be largely attributed to the physicians’ perception of patients’ severity. Improving prescription guidelines, implementing antibiotic stewardship programs and utilizing decision support systems may help achieve a better balance between prescribing and withholding antibiotic treatment.

Ben-Zaken, S, Meckel, Y, Nemet, D, Kassem, E, and Eliakim, A. Genetic basis for the dominance of Israeli long-distance runners of Ethiopian origin. J Strength Cond Res 35(7): 1885-1896, 2021-Israeli long-distance runners of Ethiopian origin have a major influence on the track and field long-distance record table. The aim of this study was to determine whether genetic characteristics contribute to this long-distance dominance. We assessed polymorphisms in genes related to endurance (PPARD T/C), endurance trainability (ACSL A/G), speed (ACTN3 R/X), strength (AGT T/C), and the recovery from training (MTC1 A/T and IL6 G/C) among top Israeli long-distance runners of Ethiopian origin (n = 37), Israeli non-Ethiopian origin runners of Caucasian origin (n = 76), and Israeli nonathletic controls (n = 55). Israeli runners of Ethiopian origin had a greater frequency of the PPARD CC + PARGC1A Gly/Gly polymorphism, associated with improved endurance performance, compared with Israeli runners of non-Ethiopian origins (24 vs. 3%, respectively, p < 0.01); a lower frequency of the ACSL AA polymorphism, favoring endurance trainability (8 vs. 20%, respectively, p < 0.05); a greater frequency of the ACTN3 RR polymorphism, associated with sprint performance (35 vs. 20%, respectively, p < 0.05); a greater frequency of the MCT1 AA genotype, associated with improved lactate transport (65 vs. 45%, respectively, p < 0.05); and a lower frequency of IL-6 174C carriers, associated with reduced postexercise muscle damage (27 vs. 40%, respectively, p < 0.01). There was no difference in the frequency of AGT T/C gene polymorphism between the long-distance runners of Ethiopian and non-Ethiopian origin. Frequencies of PPARD CC + PARGC1A Gly/Gly, MCT1 AA, IL-6 174C, and AGT polymorphism were significantly favorable among Ethiopian, but not among non-Ethiopian, origin runners compared with controls. Taken together, results suggest that genetically, the dominance of Israeli long-distance runners of Ethiopian origin relates not only to endurance polymorphisms but also to polymorphisms associated with enhanced speed performance and better training recovery ability.

The study aim was to examine possible correlates of convulsions in children hospitalized for acute gastroenteritis (AGE). Data collected in a prospective study of AGE hospitalizations in children aged 0–59 months in 3 hospitals in Israel during 2008–2015 were analyzed. Stool samples were tested for rotavirus using immunochromatography and stool culture was performed for the detection of Salmonella , Shigella and Campylobacter We compared clinical and demographic characteristics of children hospitalized for AGE who had convulsions (n = 68, cases) with children hospitalized for AGE without convulsions (n = 3505, controls). Age differed between children with and without convulsions ( p = 0.005); the former were mostly toddlers aged 12–23 months (51%) compared to 30% of the control group. A higher percentage of cases tested positive for Shigella (11% vs. 4%, p = 0.002), the opposite was found for rotavirus (2% vs. 30% p < 0.001). A multivariable model showed that body temperature (OR 2.91 [95% CI 1.78–4.76], p < 0.001) and high blood glucose level (> 120 mg/dL) (OR 5.71 [95% CI 1.27–25.58] p = 0.023) were positively related to convulsions in children with AGE, while severe AGE (Vesikari score ≥ 11) was inversely related with convulsions (OR 0.09 [95% CI 0.03–0.24], p < 0.001). Conclusion: Elevated body temperature is associated with convulsions in children with AGE, but not severity of AGE, while hyperglycemia might reflect a neuroendocrine stress reaction to convulsions, AGE or both.

The intestinal microbiome continues to shift and develop throughout youth and could play a pivotal role in health and wellbeing throughout adulthood. Environmental and interpersonal determinants are strong mediators of the intestinal microbiome during the rapid growth period of preadolescence. We aim to delineate associations between the gut microbiome composition, body mass index (BMI), dietary intake and socioeconomic status (SES) in a cohort of ethnically homogenous preadolescents. This cohort included 139 Arab children aged 10–12 years, from varying socioeconomic strata. Dietary intake was assessed using the 24-h recall method. The intestinal microbiome was analyzed using 16S rRNA gene amplicon sequencing. Microbial composition was associated with SES, showing an overrepresentation of Prevotella and Eubacterium in children with lower SES. Higher BMI was associated with lower microbial diversity and altered taxonomic composition, including higher levels of Collinsella, especially among participants from lower SES. Intake of polyunsaturated fatty acids was the strongest predictor of bacterial alterations, including an independent association with Lachnobacterium and Lactobacillus. This study demonstrates that the intestinal microbiome in preadolescents is associated with socioeconomic determinants, BMI and dietary intake, specifically with higher consumption of polyunsaturated fatty acids. Thus, tailored interventions during these crucial years have the potential to improve health disparities throughout the lifespan.

Understanding the role in pediatric obesity of early life feeding practices and dietary intake at school age is essential for early prevention. The study aimed to examine associations of early life feeding practices, environmental and health-related exposures, and dietary intake at school age as determinants of obesity in children aged 10–12 years. In an earlier study of 233 healthy infants in two Arab towns in northern Israel, neonatal history, feeding practices, and health information were obtained up to age 18 months. This follow-up study assessed dietary intake and anthropometric measurements at age 10–12 years using the 24 h recall method. Overall, 174 children participated in this study. Almost all (98%) the children were breastfed. The prevalence of obesity at school age was 42%. A multivariable model adjusted for energy intake and socioeconomic status showed positive associations of total fat intake and of weight-for-height z score, but not feeding practices in infancy, with obesity. Higher gestational age at birth was associated with lower odds of obesity at age 10–12 years. In conclusion, in a population with near universal breastfeeding, gestational age at birth, weight indicators but not feeding practices in infancy, and total fat intake at school age were associated with increased likelihood of obesity.

The overuse of antibiotics is exacerbating the antibiotic resistance crisis. Since this problem is a classic common-goods dilemma, it naturally lends itself to a game-theoretic analysis. Hence, we designed a model wherein physicians weigh whether antibiotics should be prescribed, given that antibiotic usage depletes its future effectiveness. The physicians' decisions rely on the probability of a bacterial infection before definitive laboratory results are available. We show that the physicians' equilibrium decision rule of antibiotic prescription is not socially optimal. However, we prove that discretizing the information provided to physicians can mitigate the gap between their equilibrium decisions and the social optimum of antibiotic prescription. Despite this problem's complexity, the effectiveness of the discretization solely depends on the type of information available to the physician to determine the nature of infection. This is demonstrated on theoretic distributions and a clinical dataset. Our results provide a game-theory based guide for optimal output of current and future decision support systems of antibiotic prescription.