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The Nancy Histological Index (NHI) is used to score histologic disease activity in patients with ulcerative colitis (UC). Our goal was to assess the utility of NHI at diagnosis in predicting clinical outcomes in pediatric patients with UC, in comparison to clinical and endoscopic scores. We retrospectively reviewed data at diagnosis of 106 children with UC (59 [55.7%] females; median age 14.4 [11.2–15.9] years, median Pediatric Ulcerative Colitis Activity Index [PUCAI] 35 [25–55]). During a follow‐up of 116 (55–171) weeks, 33 patients (31.1%) required azathioprine therapy, and 32 (30.2%) were escalated to anti‐tumor necrosis factor alpha (anti‐TNFa). The PUCAI and Mayo endoscopic scores at diagnosis were significantly associated with escalation to anti‐TNFa (p= 0.036 and p= 0.02, respectively), but not with initiation of azathioprine or subsequent acute severe colitis (ASC) events. However, the NHI was not associated with subsequent immunomodulators or anti‐TNFa therapy (p= 0.42 and p= 0.78, respectively), nor with future ASC events (p= 0.70). In conclusion, the NHI failed to predict clinical outcomes in newly diagnosed pediatric patients with UC. Histologic evaluation is a key component of disease assessment in patients with ulcerative colitis (UC).The Nancy Histopathology Index (NHI) is a simple scoring tool of histologic disease activity in patients with UC, with high intraobserver and interobserver reliability.The NHI exhibits a modest positive correlation with clinical, laboratory and endoscopic markers of disease activity in pediatric patients with UC. Histologic evaluation is a key component of disease assessment in patients with ulcerative colitis (UC). The Nancy Histopathology Index (NHI) is a simple scoring tool of histologic disease activity in patients with UC, with high intraobserver and interobserver reliability. The NHI exhibits a modest positive correlation with clinical, laboratory and endoscopic markers of disease activity in pediatric patients with UC. The Pediatric Ulcerative Colitis Activity Index and the Mayo endoscopic score at diagnosis were significantly associated with subsequent escalation to antitumor necrosis factor alpha (anti‐TNFa) therapy.The NHI at diagnosis in pediatric patients with UC failed to predict future escalation to immunomodulator or anti‐TNFa therapy, or subsequent acute severe colitis events. The Pediatric Ulcerative Colitis Activity Index and the Mayo endoscopic score at diagnosis were significantly associated with subsequent escalation to antitumor necrosis factor alpha (anti‐TNFa) therapy. The NHI at diagnosis in pediatric patients with UC failed to predict future escalation to immunomodulator or anti‐TNFa therapy, or subsequent acute severe colitis events.

IntroductionHypomyelinating leukodystrophies are a group of genetic disorders, characterised by severe permanent myelin deficiency. Their clinical features include developmental delay with or without neuroregression, nystagmus, central hypotonia, progressing to spasticity and ataxia. HSPD1encodes the HSP60 chaperonin protein, mediating ATP-dependent folding of imported proteins in the mitochondrial matrix. Pathogenic variants in HSPD1have been related to a number of neurological phenotypes, including the dominantly inherited pure hereditary spastic paraplegia (MIM 605280) and the recessively inherited hypomyelinating leukodystrophy 4 (MIM 612233). Subsequently, an additional phenotype of hypomyelinating leukodystrophy has been reported due to de novo heterozygous HSPD1variants.In the current work, we expand the clinical and genetic spectrum of this hypomyelinating disorder by describing a cohort of three patients, being heterozygous for HSPD1variants involving residue Ala536 of HSP60 (the novel p.Ala536Pro variant and the previously reported p.Ala536Val).MethodsClinical and radiological evaluation; whole exome sequencing, in vitro reconstitution assay and patient fibroblast cell lysate analysis.ResultsClinical manifestation was of early-onset nystagmus, tremor and hypotonia evolving into spasticity and ataxia and childhood-onset neuroregression in one case. Brain MRI studies revealed diffuse hypomyelination.The 3D protein structure showed these variants to lie in spatial proximity to the previously reported Leu47Val variant, associated with a similar clinical phenotype. In vitro reconstitution assay and patient fibroblast cell lysate analysis demonstrated that these mutants display aberrant chaperonin protein complex assembly.DiscussionWe provide evidence that impaired oligomerisation of the chaperonin complex might underlie this HSPD1-related phenotype, possibly through exerting a dominant negative effect.

Objective: To present the clinical result of spinal fixation system made entirely of Carbon-Fiber-Reinforced (CFR)–Hybrid Polyaryl–Ether–Ether–Ketone (PEEK). Summary of Background Data: Fusion surgery has been used to treat chronic low back pain caused by degenerative disk disease (DDD). The traditional pedicle screw system made of titanium, though biocompatible, can lead to complications, such as stress shielding and implant failure. Methods: Fifty-two patients with one-level degenerative disc disease, with or without spinal stenosis, were treated with a stand-alone novel pedicular screw system (PSS) made entirely of CFR–PEEK composite biomaterial. Forty-six were followed for 24 months. Changes in pain and disability were evaluated using a 0–10-point visual analog scale (VAS) and a 0–90 (after omitting the question related to sex life) Oswestry Disability Index (ODI), respectively. Imaging evaluations of fusion were performed with standard and dynamic radiographs. Results: Mean age was 58.4 ± 12.7 years. The mean operating time was 114.9 ± 22.7 min; X-ray exposure was 38.5 ± 18.1 s. No operative problems or complications were encountered. Three patients were lost to follow-up and three patients were re-operated. Forty-six patients completed follow-up of 24 months; the mean VAS was 6.49 points for lower back pain and 6.54 for leg pain, and the mean ODI by 41.6. No screw breakage or loosening was reported. Radiological consolidation was observed in all patients within 12 months. No clinical symptoms or radiological signs of adjacent degenerative disc disease were observed up to 24 months. Conclusions: The all CFR–PEEK PSS is user friendly, safe, and compatible with modern imaging techniques. Its mechanical strength lessens the risk of implant failure, while its bone matching elastic modules seem to contribute in the short term to fusion, and in the long term to potential prevention of adjacent disk disease.

This article presents a groundbreaking method for real-time authentication of electronic components during the assembly process. Leveraging images captured by pick-and-place machines, our approach utilizes artificial intelligence (AI) and big data algorithms to discern subtle differences in component appearances, allowing for the identification of specific manufacturing lines and authentic manufacturers. By training our algorithm on a vast dataset of over four billion components, we achieve exceptional performance parameters in most cases exceeding 99.8%, contingent upon the package case of the component. Real-life examples illustrate instances of authenticity mismatches encountered in production, highlighting the method’s effectiveness in identifying errors in the supply chain and detecting counterfeit components. Through cross-referencing with top-side images and supply chain documentation, we validate the results, establishing a new standard for authenticity assurance without reliance on traditional methods. This methodology represents a true AI revolution, promising enhanced supply chain integrity, cost reduction, and mitigation of risks associated with counterfeit components.

To describe the characteristics, secular trends, and outcomes of home parenteral nutrition (HPN) use among children with severe neurological impairment (SNI) and non‐primary digestive disorders from 2010 to 2023 and compare outcomes to children with primary digestive disorders on HPN. A retrospective review of all children with SNI and non‐primary digestive disorders, where HPN was initiated between January 2010 and September 2023 at a tertiary care pediatric hospital. The Mann–Kendall trend test was used to assess trends in HPN initiation. We compared acute care service utilization in the year prior and following HPN initiation. Mortality and ability to achieve enteral autonomy outcomes were compared to those of children with HPN and primary digestive disorders. Of the 205 included children with HPN, 18 children had SNI and non‐primary digestive disorders, 187 children had primary digestive disorders. There was an increase in HPN initiation among children with SNI and non‐primary digestive disorders (p= 0.002) between 2010 and 2020. Among children with SNI and non‐primary digestive disorders, HPN‐related complications (line‐associated infection/thrombus, nephrolithiasis, cholelithiasis) occurred in 72%. There was no change in acute care utilization in the year prior versus year following HPN initiation. Compared with the primary digestive disorders group, children with SNI and non‐primary digestive disorders were less likely to achieve enteral autonomy (p< 0.0001); however, no significant differences in mortality were observed (22% vs. 8%, p= 0.09). HPN is increasingly being used among SNI children with non‐primary digestive disorders. Compared to children with primary digestive disorders on HPN, those with SNI are less likely to achieve enteral autonomy. Home parenteral nutrition (HPN) can be considered among children with severe neurological impairment (SNI) and non‐primary digestive disorders who do not tolerate enteral feeding.The decision to initiate HPN in children with SNI and non‐primary digestive disorders is challenging due to absence of definitive etiologies for gastrointestinal symptoms and the known HPN‐related complications and psychosocial burden. Home parenteral nutrition (HPN) can be considered among children with severe neurological impairment (SNI) and non‐primary digestive disorders who do not tolerate enteral feeding. The decision to initiate HPN in children with SNI and non‐primary digestive disorders is challenging due to absence of definitive etiologies for gastrointestinal symptoms and the known HPN‐related complications and psychosocial burden. The use of HPN among children with SNI and non‐primary digestive disorders is increasing over time.Children with SNI and non‐primary digestive disorders are less likely to achieve enteral autonomy compared to children with primary digestive disorders on HPN; however, mortality rates are similar. The use of HPN among children with SNI and non‐primary digestive disorders is increasing over time. Children with SNI and non‐primary digestive disorders are less likely to achieve enteral autonomy compared to children with primary digestive disorders on HPN; however, mortality rates are similar.

We can now measure the connectivity of every neuron in a neural circuit1–9, but we cannot measure other biological details, including the dynamical characteristics of each neuron. The degree to which measurements of connectivity alone can inform the understanding of neural computation is an open question10. Here we show that with experimental measurements of only the connectivity of a biological neural network, we can predict the neural activity underlying a specified neural computation. We constructed a model neural network with the experimentally determined connectivity for 64 cell types in the motion pathways of the fruit fly optic lobe1–5but with unknown parameters for the single-neuron and single-synapse properties. We then optimized the values of these unknown parameters using techniques from deep learning11, to allow the model network to detect visual motion12. Our mechanistic model makes detailed, experimentally testable predictions for each neuron in the connectome. We found that model predictions agreed with experimental measurements of neural activity across 26 studies. Our work demonstrates a strategy for generating detailed hypotheses about the mechanisms of neural circuit function from connectivity measurements. We show that this strategy is more likely to be successful when neurons are sparsely connected—a universally observed feature of biological neural networks across species and brain regions.

The unusual defect chemistry of thorium doping in the PbS system was investigated computationally to answer several open questions arising from the experimental observations. These include finding Th in a +4 oxidation state in contrast to Pb, attracting more than two oxygen atoms on average per thorium and affecting the growth morphology of PbS and its electronic properties. We find Th to be energetically stable at the lead lattice position in PbS and to attract 2–3 oxygens, including in the adjacent interstitial position, which binds strongly to Th. This adjacent interstitial atom allows the +4 oxidation state of Th in PbS as observed experimentally. Furthermore, the bandgap of the ideal material increased due to Th incorporation, in agreement with experimental observations. Finally, we calculated the surface energies of the (100), (110), and (111) surfaces for the systems with and without thorium incorporation. Surfaces (100) and (110) were found to have negative surface energies; however, (111) surface energy was positive and, thus, preferred for the growth of Th-doped PbS thin films. These results correlate well with the experimentally observed surface topography change for PbS thin film growth from the (100) to the (111) surfaces with addition of Th.

We report the demonstration of a novel free space optical (FSO) communication scheme utilizing transmitter-side coherent beam combining (CBC) based on an optical phased array (OPA) for adaptive atmospheric turbulence compensation. Coherent combining of 32 amplified laser elements, spatially arranged in a 2D rectangular array, was performed in free space by actuating 32 phase modulators using a high-speed embedded controller. The phase of each element was adjusted in a real-time closed loop to maximize the received beam intensity, thus mitigating turbulence-induced impairments such as beam wander and scintillations. The CBC system was experimentally evaluated over retroreflected FSO links of 2 km and 10 km distance. Alongside a considerable increase in on-axis irradiance, beam steering and tracking abilities were also demonstrated, allowing the main lobe to steer within a spot with a diameter five times wider. In 10 km, CBC pre-compensation proved crucial for detecting the reflected signal, indicating for a considerable gain for atmospheric effects mitigation. A CBC-aided FSO link over 10 km was successfully established, achieving single-channel and polarization data rates of 64 Gbit/s and 100 Gbit/s, with availability rates of 96% and 77%, respectively.

We have previously suggested a promising approach for optical layer security, incorporating an all-optical spectrum spreading, spectral phase-encoding time-spreading, and noise-protected coherent communication system. An authorized receiver with the spectral phases key can evoke a multi-homodyne coherent detection (MHCD) to reconstruct the noise-submerged signal. Unless deciphered in real-time, by all-optical means and with the correct phases key mask, an adversary cannot reconstruct the transmitted data, which is permanently lost. This feature prohibits unauthorized offline processing, regardless of the resources and efforts available to the adversary, thus making data-in-transit record-proof and resilient to any computational power, including the quantum computer. In this work, we present a novel security analysis for this approach, where three different types of attacks are proposed and thoroughly studied: Naive, Analytic, and Greedy. These algorithms represent different approaches for all-optical phases key cracking. We formulated a mathematical model for a Naive attacker who trials an arbitrary phase mask. In the Analytic approach, the attacker studies the encoding system by trialing arbitrary test patterns. In contrast, the attacker who employs the Greedy approach maximizes his performance in each step until the desired signal-to-noise ratio (SNR) level is obtained. We analyze these approaches analytically and discuss their cryptanalysis aspects concerning performance, complexity, and the photonic hardware used to decode the phase mask. Our simulations and models suggest a set of conditions for an all-optical transmission system that is impervious to cryptography attacks.

This article examines the role of romantic love among middle and upper-class, married and single heterosexual Jews in German-occupied Warsaw during World War II. It spans from the onset of the war in September 1939, through the establishment of the Warsaw Ghetto, to the mass deportations of 1942. It analyzes the impact of extreme conditions on relationships and delves into emotional experiences and challenges faced by individuals, drawing on the lenses of the history of emotions. It investigates how individuals perceived their roles as partners and managed challenges to love, exploring reactions within the Jewish community of Warsaw. [ABSTRACT FROM AUTHOR]

The article highlights new research showing that strong pre-pandemic family engagement significantly reduced chronic absenteeism and improved student outcomes. Topics discussed include the impact of family engagement on absenteeism, its influence on student proficiency in English and math, and strategies for supporting principals in enhancing family engagement.

•HBI0101, an academic BCMA-CART therapy for MM, is a safe, efficient, and available local alternative to commercial drugs.•High-risk cytogenetic, extramedullary disease, and CART differentiation status are predictors of HBI0101 response durability.

Human activities are driving climate, land cover, and population change (global change), and shifting the baseline geographical distribution of snakebite. The interacting effects of global change on snakes and communities at risk of snakebite are poorly understood, limiting capacity to anticipate and manage future changes in snakebite risk.

Diagnosis of Brugada syndrome (BrS) may be established by exposing a Type 1 Brugada pattern using a sodium channel blocker. Data on the outcomes of different patient populations with drug‐induced Type 1 Brugada pattern are limited. The present study reports on the characteristics and outcome of subjects with ajmaline induced Type 1 Brugada pattern. A multicenter retrospective study including all consecutive cases of ajmaline‐induced Type 1 Brugada pattern from seven centers. A total of 260 patients (69.9% males, mean age 43.4 ± 13.5) were included. Additional characteristics included history of syncope (n= 56, 21.5%), family history of BrS (n= 58, 22.3%) or sudden cardiac death (n= 47, 18.1%) and ventricular fibrillation (n= 3, 1.2%). Patients were divided into those meeting current diagnostic criteria for drug‐induced BrS (DIBrS) and compared to the drug‐induced Brugada pattern (DIBrECG). Females were significantly overrepresented in the DIBrS group (n= 50, 40% vs. n= 29, 21.5%, p= .001). A significantly higher prevalence of type 2/3 Brugada ECG at baseline was found in the DIBrECG group (n= 108, 80.8% vs. n= 75, 60% in the DIBrS, p= .026). During a median follow up of three (IQR 1.50–5.32) years, a single event of significant arrhythmia occurred in the DIBrS group. Less than half of subjects with ajmaline‐induced Brugada pattern met current criteria for BrS. These individuals had very low rate of adverse outcomes during a follow up of 3 years, irrespective of the indication for the test or eligibility for the BrS diagnosis. An analysis of a multicenter cohort of subjects with ajmaline induced Type 1 Brugada pattern showed that <50% of cases met current criteria for BrS. All had a very low rate of adverse outcomes during a follow up of 3 years, irrespective of the indication for the test or eligibility for the BrS diagnosis.

A systematic study of trends in the lipophilicity of prominent representatives of the opioid family, including natural, semisynthetic, synthetic, and endogenous neuropeptide opioids, is described. This was enabled by a straightforward 1H NMR-based logP/Ddetermination method developed for compounds holding at least one aromatic hydrogen atom. Moreover, the new method enables a direct simultaneous logDdetermination of opioid mixtures, overcoming the high sensitivity of this family to the measurement conditions, which is critical when a determination of the exact ΔlogDvalues of matched pairs is required. Interpretation of the experimental ΔlogD7.4values of selected matched pairs, focusing inter alia on the 3-OMe and 14-OMe motifs in morphinan opioids, is suggested with the aid of DFT calculations and may be useful for the discovery of new opioid therapeutics.

Recognition of foreign trusts and foundations has been an issue in Israel for many years. Having immigrants from many countries speaking foreign languages and having a legacy of foreign laws and cultures has contributed to the extensive use of foreign trusts in Israel. The Trust Law, and later the Tax Ordinance, as revised in connection with trusts, have endorsed the use of foreign trusts and foundations by non-Israelis investing and doing business in Israel and by Israeli families investing overseas with a requirement for tax and estate planning. In this article, the authors explore the recognition and use of foreign trusts in Israel and give an overview of the respective taxation of trusts.

Catheter ablation for atrial fibrillation (AF) including pulmonary vein isolation and possibly further substrate ablation is the most common electrophysiological procedure. Severe complications are uncommon, but their detailed assessment in a large worldwide cohort is lacking.

Partial-thickness burns are the most common form of burns, affecting the dermis and possibly resulting in scarring and infection. The Spincare System is a new device that uses electrospinning technology to create a temporary skin-like matrix that can be applied to wounds. This study evaluated the performance, safety, and efficacy of Spincare in treating superficial to partial-thickness burns not considered for surgery. A prospective single-arm, open-label, multicenter study was conducted in 3 adult burn units across Israel. Forty-four patients with superficial to intermediate burns of up to 10% of TBSA were enrolled. Spincare was applied to the wounds, and follow-up visits were performed on days 7, 14, and 21 and months 3 and 6 posttreatment. Thirty-one patients with 36 wounds completed the day 21 visit. The mean wound healing area on day 21 was 97.26 ± 9.41%, and the mean healing time was 12.8 ± 4.3 days. Only one moderate adverse event was observed concerning the treatment, and it is important to acknowledge the potential progression of this hypertrophic scar into a keloid. This study demonstrated that Spincare is a safe and effective device for treating superficial to intermediate partial-thickness burns. Spincare achieved rapid and complete wound healing with a low incidence of adverse events.

IMPORTANCE: Data regarding the prevalence of various inherited retinal diseases (IRDs) are limited and vary across populations; moreover, nationwide prevalence studies may be limited to a specific IRD phenotype, potentially leading to inaccurate prevalence estimations. Therefore, nationwide prevalence data are needed. OBJECTIVE: To determine the prevalence of 67 IRD phenotypes in the Israeli population. DESIGN, SETTING, AND PARTICIPANTS: This cohort study collected nationwide data regarding the number of individuals affected with IRD phenotypes assessed in 10 clinical and academic centers in Israel as part of the research activity of the Israeli inherited retinal disease consortium. Data were collected in May 2023 on 9396 individuals residing in Israel who were diagnosed by an ophthalmologist with an IRD using either electroretinography or retinal imaging where included. Individuals with retinal diseases known to have a nonmendelian basis or without a clear genetic basis and those who were reported as deceased at the time of data collection were excluded from this study. MAIN OUTCOMES AND MEASURES: Prevalence of 67 IRD phenotypes. RESULTS: Among the 9396 participants in our cohort, the most common IRD in Israel was retinitis pigmentosa with a disease prevalence of approximately 1:2400 individuals, followed by cone-rod dystrophy (approximately 1:14 000), Stargardt disease (approximately 1:16 000), Usher syndrome (approximately 1:16,000), and congenital stationary night blindness (approximately 1:18 000). The prevalence of all IRDs combined was 1:1043 individuals. CONCLUSIONS AND RELEVANCE: The current study provides large prevalence dataset of 67 IRD phenotypes, some of which are extremely rare, with only a single identified case. This analysis highlights the potential importance of performing additional nationwide prevalence studies to potentially assist with determining the prevalence of IRDs worldwide.

ABSTRACTThis article examines the role of romantic love among middle and upper-class, married and single heterosexual Jews in German-occupied Warsaw during World War II. It spans from the onset of the war in September 1939, through the establishment of the Warsaw Ghetto, to the mass deportations of 1942. It analyzes the impact of extreme conditions on relationships and delves into emotional experiences and challenges faced by individuals, drawing on the lenses of the history of emotions. It investigates how individuals perceived their roles as partners and managed challenges to love, exploring reactions within the Jewish community of Warsaw.

Management of acute myocarditis (AM) patients experiencing ventricular arrhythmia (VA) during acute illness is controversial, especially regarding early implantable cardioverter-defibrillator (ICD) implantation.

Coherent beam combining (CBC) is a method of enhancing laser power. It has recently transitioned to industrial applications, unveiling new possibilities in laser technology. CBC merges multiple laser channels from a single source, controlling their phase to create constructive or destructive interference. The optical phased array (OPA) and filled aperture methods exemplify CBC's advancements, enabling dynamic and precise beam manipulation. This technological evolution opens avenues for versatile applications in various industries, significantly advancing our capability to harness laser technology for complex tasks.

Estimates of primary productivity have traditionally disregarded dark inorganic carbon fixation by marine microorganisms. Currently, only limited data are available from different systems on this potentially ecologically important process. We present monthly dark inorganic carbon fixation and photosynthetic rates from the euphotic layer of the northern Gulf of Aqaba collected over a decade between 2010 and 2020. Averaged dark inorganic carbon fixation rates from surface to 100 m depth, ranged from 99 to 173 mg C m−2d−1, which corresponds to ~ 43% of the annual primary productivity at this location. The lowest dark inorganic carbon fixation rates were found during winter, contributing ~ 7.5% of the integrated primary productivity. During the oligotrophic summer, dark inorganic carbon fixation comprised a larger fraction of the integrated primary productivity estimated as ~ 12%. In accordance, dark inorganic carbon fixation contributed ~ 6% to the particulate organic carbon flux during the winter and ~ 30% during summertime. Complimentary nutrient‐enrichment bioassays of seawater from 5 m show that dissolved organic nutrient enrichment (P and C based) significantly elevates dark inorganic carbon fixation, whereas addition of dissolved inorganic nutrients (PO43+, NO3−, or both) significantly increased photosynthesis but to a lesser extent dark inorganic carbon fixation. These results suggest that dark inorganic carbon fixation may be an important biochemical process throughout the euphotic zone of oligotrophic seas, and thus should be incorporated into oceanic carbon production estimates.

•Vedolizumab prophylaxis in patients with inborn errors of immunity and inflammatory bowel disease undergoing allogeneic HSCT is well tolerated and safe.•All patients engrafted.•No patients developed acute gut graft-versus-host disease.•Early discontinuation within the first 6 months post-HSCT was feasible in all cases.

Purpose: The polyethylene glycol (PEG) methodology is used for investigating incongruities in laboratory assays, such as thyroid-stimulating hormone (TSH) measurements. The aim of the study is to investigate the practical application of PEG-TSH testing in cases of discrepancies between elevated TSH and normal free thyroxine (FT4) levels. Methods: A real-life observational study conducted in a tertiary medical center. The hospital’s electronic database was queried for TSH tests performed in pediatric patients between 2015 and 2023. Of those, PEG-TSH were identified. Patients’ clinical and biochemical characteristics and PEG-TSH-guided management were assessed. Results: In total, 2949 TSH tests were performed in 891 children and adolescents for various indications. Among them were 61 (2.1%) PEG-TSH results, mean age 7.1 ± 5.3 years, of 38 patients (4.3%), comprised of 16 with congenital hypothyroidism, 16 with subclinical hypothyroidism, and 6 with Hashimoto thyroiditis. Both the TSH and the PEG-TSH levels of patients with congenital hypothyroidism were higher than those of the other two groups (P= 0.021 and P= 0.009, respectively), with no group differences in FT4 levels. Spearman’s correlation analysis revealed a strong association between TSH and PEG-TSH levels: r= 0.871, P&lt; 0.001. In nearly one-half of the cases, clinical decisions made by clinicians (decreasing the dose or not initiating L-thyroxine treatment) were affected by the PEG-TSH results. Conclusion: Our findings support PEG-TSH testing for determining appropriate TSH levels and avoid unnecessary thyroid hormone treatment among children and adolescents. We propose the suitability of managing their clinical condition based upon age-appropriate clinical parameters and FT4 levels when their PEG-TSH levels are within the normal range.