Gideon Koren

• Professor
• Head of Department at Ariel University

Obesity is associated with twofold increased risk of neural tube defects (NTD). Research has repeatedly shown that about 70% of NTD are folic-acid dependent. Yet, there is controversy whether folic acid status is the main determinant of the increased risk of obesity-induced NTD. The rational for this review is to update and discuss the evidence on...

Background Hyperemesis Gravidarum (HG) responds only partially to standard antiemetic medications. Cannabis has been known to possess antiemetic effects and there are several medicinal cannabinoids used as anti -emetics for cancer chemotherapy. Its favorable use for HG has been described in social media, but not in the medical literature. Methods...

Background End stage renal disease (ESRD) describes the most severe stage of chronic kidney disease (CKD), when patients need dialysis or renal transplant. There is often a delay in recognizing, diagnosing, and treating the various etiologies of CKD. The objective of the present study was to employ machine learning algorithms to develop a predictio...

Background: Patient satisfaction with the quality of health care services is complex with many known factors impacting upon satisfaction, among them the choice of physician. Previous studies examined characteristics of a woman's choice of gynecologist, but information regarding reasons for these choices among women of Ethiopian descent is lacking....

ackground: Sleep disturbances during pregnancy are associated with higher risks of maternal depression, hypertension, gestational diabetes and preterm labor. Nocturnal plasma melatonin levels are known to increase as pregnancy proceeds, reaching their peak near term. While insomnia is frequently seen in pregnancy, the possible role of maternal mela...

Introduction The medications used in assisted reproduction are given before and during early pregnancy, and hence, they may potentially result in adverse fetal effects. In this review we present an updated account of their fetal safety and discuss methodological challenges in interpretation of existing data. Areas covered The fetal safety/risks of...

Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, affecting up to 80% of expectant women. Measuring the severity of the condition over time is important for management decisions, as well as for research into different therapeutic modalities. Twenty years ago we described and validated the Pregnancy Unique Qua...

This narrative review presents the emerging published evidence on the existence of a phenotypic behavior in children with fetal alcohol spectrum behavior. Such a phenotype, exhibiting high sensitivity, specificity, and predictive values, may assist clinicians and families in identifying children who often miss some of the information needed for ful...

Azithromycin has been increasingly included in the treatment regimens of COVID-19 by clinicians despite debates regarding its efficacy. What about its safety during pregnancy and breastfeeding? Our clinically oriented review which was recently published in Motherisk International Journal provides the answers.

Background: Maternal thyroid dysfunction is suspected of causing adverse neurodevelopmental effects, but current evidence is inconclusive. Epidemiologic investigations generally suggest an association between maternal thyroid dysfunction and neurodevelopment impairments in progeny, but clinical trials of thyroid treatment during pregnancy reported...

Background The purpose of this article is to evaluate the association of voice signal analysis with adverse outcome among patients with congestive heart failure ( CHF ). Methods and Results The study cohort included 10 583 patients who were registered to a call center of patients who had chronic conditions including CHF in Israel between 2013 and...

Background: Throat pain is a common complaint in the ambulatory setting. Diagnosis of group A Streptococcus is made with a culture, molecular test or a rapid antigen detection test from the tonsils or the posterior pharyngeal wall, while other areas of the oral cavity are considered unacceptable. The purpose of the study is to compare cultures fro...

The vast majority of men undergoing prostatectomy experience permanent retrograde ejaculation (RE). While newer, selective techniques of prostatectomy result in lower rates of RE by preserving the innervation to the urethra, the vast majority of men undergoing the classical techniques experience permanent RE due to destruction of the natural mechan...

While for decades attention deficit hyperactivity disorder (ADHD) was regarded as mostly a pediatric condition, it is apparent that many adults continue to be afflicted by this condition, and presently an estimated 30%-40% of patients continue with ADHD symptomatology into adulthood. With more adults using stimulants for ADHD, there is evidence of...

Background: Fetal alcohol spectrum disorder (FASD) has been recently estimated to afflict up to 5% of American children. Most of these children exhibit different degrees of symptomatology of disruptive behaviors. Yet, there has been very little research on the efficacy and safety of pharmacological modalities, limited mostly to stimulants for atten...

Background Throat pain is a common complaint in the ambulatory setting. Diagnosis of group A Streptococcus is made with a culture or rapid antigen detection test from the tonsils or the posterior pharyngeal wall, while other areas of the oral cavity are considered unacceptable. The purpose of the study is to compare cultures from the tonsils or pos...

Background Throat pain is a common complaint in the ambulatory setting. Diagnosis of group A Streptococcus is made with a culture, molecular test or rapid antigen detection test from the tonsils or the posterior pharyngeal wall, while other areas of the oral cavity are considered unacceptable. The purpose of the study is to compare cultures from th...

The increasing medicinal use of cannabis during recent years has largely overlooked children and pregnant women due to litigious and ethical concerns. However, over the last few years medicine has observed increasing numbers of children treated with cannabis for autism spectrum disorder (ASD) and fetal alcohol spectrum disorder (FASD), and pregnant...

The increasing medicinal use of cannabis during recent years has largely overlooked children and pregnant women due to litigious and ethical concerns. However, over the last few years medicine has observed increasing numbers of children treated with cannabis for autism spectrum disorder (ASD) and fetal alcohol spectrum disorder (FASD), and pregnant...

Despite effective medications, rates of uncontrolled glucose levels in type 2 diabetes remain high. We aimed to test the utility of machine learning applied to big data in identifying the potential role of concomitant drugs not taken for diabetes which may contribute to lowering blood glucose. Success in controlling blood glucose was defined as ach...

Background: It has been the impression of pediatricians at the Terem Clinic for African asylum seekers in Tel Aviv that they encounter large numbers of anemic children. The objectives of this study were 1) to quantify the prevalence of anemia among African African asylum seeking children treated in the Terem Clinic for refugees in Tel Aviv; 2) to...

Abstract Background Perinatal depression is a common problem that affects about 18% of women worldwide, though the heterogeneity between countries is great. The aims of this study were to assess the prevalence of perinatal depressive symptoms in a national sample of women in Israel, and to investigate associations of these symptoms with demographic...

Background Studies on the prevalence of sleep disorders have found great variability due to different data collection methods and case definitions. We aimed at assessing the prevalence of sleep disorders in a large, unselected population using validated clinical patient records. To the best of our knowledge, this is the first large clinically based...

Background: There is an increasing awareness to ankyloglossia (tongue-tie) in infants, with marked increase in its report in the medical literature. Some reports indicate increase in prevalence. Whether the increase ankyloglossia rate is a real phenomenon or merely reflects increased awareness and reports has to be determined. One explanation for t...

Background: There is controversy whether exposure to assisted reproductive technology (ART) is associated with increased risk of pediatric cancer. We aimed at calculating the overall risk of pediatric cancers after ART in a large cohort of exposed women; and to conduct a systematic review and meta- analysis of cohort studies examining overall risk...

Fetal Alcohol Spectrum Disorder (FASD) describes the wide range of adverse physical, behavioral and cognitive effects resulting from ethanol exposure during embryonic and fetal development. Identification of children suffering from FASD is often difficult, as abuse of ethanol during pregnancy is a heavily stigmatized behavior that receives little p...

Background The progestin dydrogesterone (DYD) is widely used for threatened and recurrent miscarriages, as well as for dysfunctional bleeding, infertility and other obstetric and gynecological indications. While its apparent efficacy has been compared to other progestins, its fetal safety has been only sparsely investigated. Objectives To follow u...

To date, consumer health tools available over the web suffer from serious limitations that lead to low quality health- related information. While health data in our world are abundant, access to it is limited because of liability and privacy constraints. The objective of the present study was to develop and evaluate an algorithm-based tool which ai...

Purpose: Research training for clinicians is becoming relatively common for postdoctoral trainees in academic institutions. In contrast, there are relatively few such training programs for family physician residents. The purpose of this article is to describe a novel program for family medicine trainees in Maccabi Health Services, a large Israeli...

Background and aims: Sodium-glucose linked transporter type 2 (SGLT2) inhibitors are associated with an increased risk of genital infections. However, most of the evidence comes from randomized controlled trials (RCTs). The aim of this trial was to assess the risk of genital infections among female diabetic patients treated with SGLT2 inhibitors in...

Background and aims: Sodium-glucose linked transporter type 2 (SGLT2) inhibitors are associated with an increased risk of genital infections. However, most of the evidence comes from randomized controlled trials (RCTs). The aim of this trial was to assess the risk of genital infections among female diabetic patients treated with SGLT2 inhibitors in...

Aims The goal of the current study was to assess the risk for major congenital malformations following first‐trimester exposure to amoxicillin, or amoxicillin and clavulanic acid (ACA). Methods A population‐based retrospective cohort study was conducted, by linking 4 computerized databases: maternal and infant hospitalization records, drug dispens...

We present a system that jointly harnesses large-scale electronic health records data and a concept graph mined from the medical literature to guide drug repurposing—the process of applying known drugs in new ways to treat diseases. Our study is unique in methods and scope, per the scale of the concept graph and the quantity of data. We harness 10...

Large repositories of medical data, such as Electronic Medical Record (EMR) data, are recognized as promising sources for knowledge discovery. Effective analysis of such repositories often necessitate a thorough understanding of dependencies in the data. For example, if the patient age is ignored, then one might wrongly conclude a causal relationsh...

Background Oral contraceptives (OCs) are one of the most commonly used classes of drugs worldwide. A case of neutropenia and associated infections in a young woman using OCs that settled after discontinuation and reappeared upon re-challenge, has led us to investigate a potential association between oral contraceptives and neutropenia. Objectives...

Introduction Opioids constitute a cornerstone of pain relief treatment. However, opioid safety during pregnancy has not been well established. Recent studies reported an association between in utero opioid exposure and spina bifida. Methods In order to further evaluate the association of opioids exposure during pregnancy with adverse pregnancy out...

Antibiotic resistance is prevalent among the bacterial pathogens causing urinary tract infections. However, antimicrobial treatment is often prescribed ‘empirically’, in the absence of antibiotic susceptibility testing, risking mismatched and therefore ineffective treatment. Here, linking a 10-year longitudinal data set of over 700,000 community-ac...

There has been a dramatic increase in the incidence of autism spectrum disorder (ASD) in recent decades but the causes have not been elucidated. To date, numerous studies have shown that the FDA-recommended doses of folic acid (400 mcg/d) render a protective effect against ASD. Yet, a recent prospective study has claimed that while self-reported fo...

Objective: To examine whether there is an association between the cumulative dose of folic acid (FA) purchased by mothers, and risk of autistic spectrum disorders (ASD) in their progeny. Methods: We identified 2009 singletons who received an ASD diagnosis from a cohort of 480,526 children born in a large health organization in Israel from 2000 t...

Introduction: With the majority of elderly persons consuming multiple drugs, inappropriate drug use is a major issue in geriatric medicine. Areas covered: We reviewed PubMed, Embase, and Cochrane from inception to 1 May 2019 for potentially inappropriate use of medications, polypharmacy, and age-dependent changes in pharmacokinetics and pharmacodyn...

Background Computational models on the basis of deep neural networks are increasingly used to analyze health care data. However, the efficacy of traditional computational models in radiology is a matter of debate. Purpose To evaluate the accuracy and efficiency of a combined machine and deep learning approach for early breast cancer detection appli...

Background The progestin dydrogesterone (DYD) is widely used for threatened and recurrent miscarriages, as well as for dysfunctional bleeding, infertility and other obstetric and gynecological indications. While its apparent efficacy has been compared to other progestins, its fetal safety has not been investigated. Objectives To follow up fetal ou...

Background: Polybrominated diphenyl ethers (PBDEs) are widely used flame retardants, and their endocrine-disrupting properties have focused growing attention regarding their teratogenic potential. We have recently documented that mothers of children born with hypospadias had been exposed to statistically higher levels of PBDE during pregnancy than...

Background Colchicine has been found to be highly effective for the treatment of familial Mediterranean fever (FMF). However, it is FDA-approved only for children older than 4 years owing to the lack of studies in younger children. Objectives Our tertiary pediatric rheumatology department routinely uses colchicine even in very young children with...

The health risks of cigarette smoking have been reported to increase continuously, while it is estimated to be responsible for the death toll of more than seven million people globally each year. In an effort to reduce the risk involved in cigarette smoking, nicotine-free inhalators have been developed as smoking-cessation aids. To evaluate the fea...

Objective Folic acid (FA) supplementation has long been recommended before and during pregnancy to reduce the risk of neural tube defects. Factors influencing adherence to FA supplementation have been extensively evaluated, but little is known on the effect of parity. This study comes to examine the association between parity and maternal use of FA...

Serotonin has important roles in the development of the brain and other organs. Manipulations of synaptic serotonin by drugs such as serotonin reuptake inhibitors (SRI) or serotonin norepinephrine reuptake inhibitors (SNRI) might alter their development and function. Of interest, most studies on the outcome of prenatal exposure to SRI in human have...

Objective. To evaluate the relationship between attention-deficit hyperactivity disorder (ADHD) and injuries and to verify whether methylphenidate (MPH), is associated with decreasing the risk of injuries. Methods. A retrospective cohort study using the computerized database of Maccabi Healthcare Services. The ADHD cohort included all children betw...

Background: Epilepsy is one of the most common chronic neurological conditions and its treatment during pregnancy is challenging. Levetiracetam (LEV) is an antiepileptic medication frequently used during pregnancy. Only a few small studies have been published on LEV monitoring during pregnancy, demonstrating decreased serum LEV levels during the f...

Objective: Colchicine has been found to be highly effective for the treatment of familial Mediterranean fever (FMF). However, it is FDA-approved only for children older than 4 years owing to the lack of studies in younger children. Our tertiary pediatric rheumatology department routinely uses colchicine even in very young children with FMF. The ai...

A 15-year-old girl diagnosed with FASD underwent 100 courses of hyperbasic oxygen therapy (HBOT). Prior to HBOT, single motion emission compute tomographic begin imaging (SPECT) revealed areas of hypo-perfusion bilaterally in the orbitofrontal region, temporal lobes and right dorsolateral—frontal, as well the medial aspect of the left cerebellum. F...

Background Most patients with Parkinson’s disease exhibit intracellular accumulation of the α-synuclein protein encoded by the α-synuclein gene. It was recently shown that β2-adrenoreceptor agonists downregulate this gene, decreasing the apparent risk of Parkinson’s disease by up to 40%. In contrast, exposure to β-blocking drugs increases productio...

A 15-year-old girl diagnosed with FASD underwent 100 courses of hyperbasic oxygen therapy (HBOT). Prior to HBOT, single motion emission compute tomographic begin imaging (SPECT) revealed areas of hypo-perfusion bilaterally in the orbitofrontal region, temporal lobes and right dorsolateral-frontal, as well the medial aspect of the left cerebellum. F...

Our study aimed to estimate the prevalence of heavy fetal alcohol exposure through the analysis of meconium FAEEs as an objective biomarker of fetal exposure. We conducted a study on meconium samples collected nationwide through the Maternal-Infant Research on Environmental Chemicals (MIREC) Study Group. FAEE in meconium was quantified by an establ...

The aim of the study was to define whether anxiety itself or only the treatment with anxiolytic medication is risk factor for hyponatremia and overhydration. A case–control study of patients with a diagnosis of anxiety who received a selective serotonin reuptake inhibitor (SSRI). Serum sodium, urea to creatinine ratio, and odds ratio (OR) of hypona...

The following article from the Journal of Forensic Sciences , “Hair Analysis for Drug‐Facilitated Crime: The Critical Role of Hair Growth Rate” by Koren G, Bellaish E, Maman K, published online on 3rd September 2019 (1) on Wiley Online Library has been withdrawn at the authors’ request, and in agreement between the authors, the Journal’s Editorial...

There are several methods to treat vitamin B12 deficiency (VB12d): intramuscular (IM), oral, sublingual (SL), and intranasal vitamin B12 (VB12) preparations. Large studies comparing the efficacy of SL vs. IM supplements are lacking. The aim of the present study was to compare the efficacy of SL versus the standard IM administration of VB12 in resto...

Objective: Children with autism spectrum disorder (ASD) commonly exhibit comorbid symptoms such as aggression, hyperactivity and anxiety. Several studies are being conducted worldwide on cannabidiol use in ASD; however, these studies are still ongoing, and data on the effects of its use is very limited. In this study we aimed to report the experien...

Importance Previous studies have suggested that Holocaust survivors may experience different chronic comorbidities more often than the general population. However, the mortality hazard among these individuals has not been addressed. Objective To assess the overall mortality rate and comorbidities of a cohort of Holocaust survivors compared with an...

Background: Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in Israel. Fewer than 10 FASD diagnoses were reported between 1998 and 2007; however, several hundred diagnoses have been made since. Furthermore, less than 10% of surveyed Israeli pediatricians reported adequate knowledge of FASD. Objectives: To deter...

While it is well documented that exposure to iodinated contrast media (ICM) can interfere with thyroid function in adults, much less is known about the incidence and risk factors associated with ICM induced hypothyroidism in young children. Using a computerized database we identified 843 children who were exposed to ICM between 1998 and 2015. The i...

In Reply We thank Chen and Chen and Jen et al for their interest in our study¹ and for their thoughtful comments. The search for specific congeners of polybrominated diphenyl ethers (PBDE) that may cause hypospadias has led us to further work, showing that in general, the median concentrations of lower brominated congeners were greater than for hig...

Background and Objective Young children may be accidentally exposed to adult dose forms of medications, some of which can be fatal, even with a single dose. As numerous new medications have been introduced, we herein update a 2004 list of potentially toxic drugs that can be lethal for toddlers when taking one adult dose unit. Methods We reviewed a...

Background and Methods Limited data are available on the safety of fingolimod in pregnant women. We estimated the risk of adverse pregnancy outcomes in women with multiple sclerosis (MS) exposed to fingolimod either shortly before or during pregnancy in prospectively collected cases from clinical trials, observational studies, surveillance programs...

Background Pregnancy outcome following hyperemesis gravidarum (HG) has been sparsely reported. This review article aims at critically reviewing the first prospective study of foetal long-term neurodevelopment after maternal HG. Aims This review aimed at critically appraising the first prospective human study that aimed at investigating long term c...

Objective: Recurrent episodes of acute rheumatic fever may contribute to the development or worsening of rheumatic heart disease. Secondary penicillin prophylaxis (SPP) has been found to significantly reduce the incidence of rheumatic heart disease. This study sought to evaluate adherence to oral and intramuscular SPP in pediatric patients with rh...

Introduction: Fetal alcohol spectrum disorder is presently estimated to affect more than 1-2 % of babies in North America. In Israel it is quite rarely diagnosed. Many of the children adopted from the former Soviet Union were born to alcoholic women. Background: A 4.5 year old boy adopted from Ukraine, presented with inattention, hyperactivity a...

Introduction: One of the most widely used methods for estimating patient adherence to drug therapy is the use of proportion of days covered (PDC), which is based on the assumption that patients who chronically purchase a drug do actually consume it. Objectives: To investigate whether PDC reflect adherence based on steady state levels of lithium....

Background: In 2016 Israeli news media reported preliminary results of research claiming higher incidence of microcephaly among newborns in air polluted areas in Haifa Bay. These news prompted high levels of anxiety and anger. Objectives: To quantify the incidence of microcephaly in Haifa Bay and compare it to the rest of Israel. Methods: Empl...

Background: Hyperemesis gravidarum (HG) affects around 1% of pregnant women. The experience is traumatic, and many women hesitate to start a subsequent pregnancy in view of the tendency of HG to re-occur. Objectives: A 25 year old woman who experienced HG in her previous pregnancy was very afraid to start a second pregnancy, as she considered th...

Depression occurs during pregnancy in 3.9-12.8% of the women. The different serotonin reuptake inhibitors (SRIs) are metabolized in the liver by CYP450 enzymes. CYP2D6 metabolizes paroxetine, fluoxetine, duloxetine and venlafaxine, while CYP2C19 deactivates citalopram and escitalopram. Polymorphisms in these enzymes change the metabolic clearance a...

The prevalence of antibiotic resistance in urinary tract infections (UTIs) often renders the prescribed antimicrobial treatment ineffective, highlighting the need for personalized prediction of resistance at time of care. Here, crossing a 10-year longitudinal dataset of over 700,000 community-acquired UTIs with over 6,000,000 personally-linked reco...

This study was designed to track the developmental trajectory, during the first 24 months of life, of 335 low-risk infants later diagnosed with Autism Spectrum Disorder and identify early deviations observed in routine Well Care checkups. We compared their achievements to typically developing children and to children later diagnosed with non-autist...

Objective: To review the existing data regarding varicella zoster virus infection (chickenpox) in pregnancy, interventions to reduce maternal complications and fetal infection, and antepartum and peripartum management . Methods: The maternal and fetal outcomes in varicella zoster infection were reviewed, as well as the benefit of the different t...

Résumé Objectif Analyser les données existantes au sujet de l'infection au virus varicelle-zona pendant la grossesse, des interventions visant à atténuer les complications maternelles et l'infection fœtale, et de la prise en charge antepartum et peripartum. Méthodes Les issues maternelles et fœtales de l'infection au virus varicelle-zona ont été...

Importance Polybrominated diphenyl ethers (PBDEs) are added to many consumer products as flame retardants, and their endocrine-disrupting properties are a growing health concern in pregnancy. Objective To investigate whether in utero PBDE exposure as measured in maternal hair is associated with increased risk for hypospadias. Design, Setting, and...

Background: Neural tube defects (NTDs) affect >300,000 children annually worldwide. The incidence of NTDs in Northern India (7.7/1000), is tenfold higher than in the US (0.7/1000). Higher rates were previously reported in Northern China. The causes of these trends have not been elucidated. Arsenic is a teratogen shown in animals to induce NTDs. Th...

Despite effective medications, rates of uncontrolled hypertension remain high. Treatment protocols are largely based on randomized trials and meta‐analyses of these studies. The objective of this study was to test the utility of machine learning of big data in gaining insight into the treatment of hypertension. We applied machine learning technique...

Over the last few decades there has been a significant worldwide increase in the diagnosis of autism spectrum disorder (ASD), the causes of which are unknown. The biggest environmental change over this decade has been the massive introduction of cellphones. Eye contact is fundamental for infants' development, and parent-infant eye contact is impair...

Hyperemesis gravidarum (HG) is characterized by severe gestational nausea and vomiting, leading to dehydration, electrolyte imbalance and nutritional deficits. HG adversely affects the health and wellbeing of the woman. However, the detrimental impact of HG on fetal brain development has not been addressed. We evaluate herein the emerging evidence...