Israel Medical Association Journal

Nothing better reflects the times in which we live–amid missile barrages, air-raid sirens, sheltering in protected rooms, and yet continuing our daily routines and work–than the annual meeting of the editorial boards of the medical journals IMAJ and HaRefuah

The Holocaust represents an extreme failure of medical ethics, with physicians actively involved in crimes against humanity. Rheumatology is directly affected through eponyms that honor Nazi perpetrators and through persistent musculoskeletal consequences observed in Holocaust survivors. In this article, we critically analyzed symbolic (nomenclature) and biological (trauma-related disability) legacies of Nazism in rheumatology. Narrative reviews of PubMed/MEDLINE, Scopus, and Israel Medical Association Journal (IMAJ) as well as key historiographic analyses and clinical studies of musculoskeletal outcomes among Holocaust survivors were included. Ethical codes emerging post-Holocaust (Nuremberg Code and Declaration of Helsinki) were integrated. Renaming Reiter’s syndrome as reactive arthritis and Wegener’s granulomatosis as granulomatosis with polyangiitis represents ethical correction. Clinical evidence shows Holocaust survivors experience such as reduced functional recovery after hip fracture, lower perceived health despite similar objective measures, and greater cardiovascular burden impairing rehabilitation tolerance. Rheumatology must align nomenclature with ethical responsibility and recognize trauma-associated musculoskeletal vulnerability. Historical memory should guide clinical decisions, language, and education

It is 3:00 in the morning at an Israeli medical center. The rhythmic beeping of monitors pierces the silence as an on-call team gathers around a patient's bed. The team includes a Jewish doctor, a Muslim nurse, and a Christian physician. In these critical moments, the only language spoken is the language of medicine–a seamless blend of physiology, pharmacology, and an ancient medical oath.

For us in Israel, this reality is natural and common. Yet, viewed through a historical lens, particularly against the backdrop of World War II when medicine itself was weaponized and conscripted into an extermination machine, this collaboration was nothing short of a monumental triumph of the human spirit. In this editorial, I invite you on a historical journey to revisit two profound narratives where physicians from diverse backgrounds transformed their clinical knowledge and authority into instruments of life and resistance.

In this study on Holocaust (Shoah) survivors, we reviewed accumulated data demonstrating an increased incidence of diabetes and cancer in the later years of survivors. We evaluated the status of high nutrition, compared to the low incidence of the same morbidities affecting the prisoners in the ghettos of World War II, while experiencing severe nutritional deficiency. The assumption of the high glucose requirement of cancer cells is discussed.

Phlycten syndrome was described as a traumatic surgical syndrome of the lower limbs, beginning as streptococcal cellulitis and progressing to necrotizing edema in individuals with starvation-induced hypoalbuminemia and electrolyte imbalance. Independently documented by three physicians during their imprisonment in Nazi concentration camps in World War II, the syndrome also developed when edematous, emaciated prisoners were flogged, causing rapid progression to gangrene and sepsis.

Background: This study provides valuable insight on the importance of antenatal follow-up, despite advances in medical capabilities.

Objectives: To provide current information on mortality rates and causes including demographic parameters.

Methods: A total of 3362 infants were admitted to the neonatal intensive care unit at Kaplan Medical Center between 2009 and 2021. Retrospective data were extracted from a computerized prospective database and further divided to two groups: 2009–2014 and 2015–2021. For sequential variables, we calculated the mean, standard deviation, and median. For categorical variables we calculated the prevalence and performed a chi-square test. The sequential variables did not show a normal distribution according to the Shapiro-Wilk test. Therefore, the A-parameter Mann-Whitney test was used. Results were considered significant when the P-value < 0.05.

Results: A decrease in the death rate was found, but when evaluating the infants who died, a decrease in full antenatal follow-up from 55.2% to 31.5% was seen (P-value = 0.06).

Conclusions: Despite advancements in medical knowledge and capabilities, an association was found between increased mortality and reduced antenatal follow-up.

Background: The rapid evolution of large language models warrants updated benchmarking in ophthalmology to determine whether newer versions offer clinically meaningful improvements over earlier models and human comparators.

Objectives: To evaluate the diagnostic accuracy of ChatGPT-4o and ChatGPT-5 in ophthalmic cases and to compare it with previously reported results of ChatGPT-3.5, residents, and specialists.

Methods: This retrospective cohort study was conducted in one academic tertiary medical center. We reviewed data of patients admitted to the ophthalmology department from June 2022 to January 2023. We then created two clinical cases for each patient. The first was according to medical history alone (Hx). The second added the clinical examination (Hx and Ex). For each case, we asked for the three most likely diagnoses from ChatGPT-4o and ChatGPT-5. We then compared the accuracy rates (at least one correct diagnosis) with previous results of ChatGPT-3.5, residents, and specialists.

Results: A total of 63 cases were analyzed, first using history alone and then with examination findings. Based on history alone, GPT-5 and GPT-4o correctly identified 73% and 70% of cases, respectively, outperforming GPT-3.5 (54%, P < 0.05) and approaching the accuracy of residents (75%) and attending physicians (71%, P < 0.05). When physical examination was included, diagnostic accuracy rose to 94% for GPT-5 and 89% for GPT-4o, surpassing GPT-3.5 (68%, P < 0.05) and closely matching or exceeding human performance (residents 94%, attendings 87%).

Conclusions: ChatGPT-4o and ChatGPT-5 significantly outperformed GPT-3.5 and achieved diagnostic accuracy similar or even higher to clinicians in diagnosing ophthalmology cases.

Background: Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis of the skin and internal organs. Its expression can vary across ethnic groups.

Objectives: To compare clinical and serological manifestations of SSc between Jewish and Arab patients in Israel.

Methods: We conducted a retrospective single-center study included 100 patients with SSc selected from our rheumatology clinic at Meir Medical Center, comprising 50 Jewish and 50 Arab patients with available complete clinical and laboratory data. Demographic characteristics, disease features, autoantibody profiles, organ involvement, and treatment patterns were collected.

Results: Most clinical, laboratory, and treatment variables did not differ significantly between Jewish and Arab patients. Significant difference was the higher prevalence of skin telangiectasia in Jewish patients (86%) compared to Arab patients (38%) (P < 0.001) as well as Raynaud phenomenon and pulmonary hypertension. Other manifestations, including organ involvement and autoantibody prevalence, were similar across the groups.

Conclusions: This study reveals significant similarities in the clinical and serological expression of SSc between Jewish and Arab patients in Israel. The higher prevalence of telangiectasia in Jewish patients suggests a possible ethnic or environmental influence on vascular manifestations. Further research is needed to explore the potential genetic or environmental factors contributing to this difference and to assess if this impacts disease progression or treatment outcomes.

Background: Gait disturbances are common in patients undergoing hemodialysis and are associated with increased fall risk, mobility decline, and adverse health outcomes. Prior research suggests that hemodialysis may impact gait parameters such as speed, stride length, and variability; however, findings are inconsistent.

Objectives: To evaluate acute changes in gait metrics before and after hemodialysis using an artificial intelligence (AI) based video gait analysis system.

Methods: We initially enrolled 38 hemodialysis patients, two were excluded due to clothing interference with video analysis (27.8% female, 72.2% male). AI-driven gait analysis was performed immediately before and after dialysis. The system extracted spatiotemporal gait and joint range of motion. Statistical analyses included the Shapiro-Wilk test for normality, Wilcoxon signed-rank tests for non-normally distributed data, and paired t-tests for normally distributed data (P < 0.05).

Results: Gait speed (0.59 m/sec pre-dialysis) remained unchanged post-dialysis (P = 0.876), as did cycle length and time. However, step length significantly decreased post-dialysis (P = 0.001), suggesting a more conservative gait pattern. Knee flexion and extension increased slightly but did not reach statistical significance.

Conclusions: Dialysis does not acutely affect overall gait speed but significantly reduces stride length. Post-dialysis fatigue or hemodynamic shifts may alter walking patterns, highlighting the need for fall prevention strategies and physical rehabilitation interventions in dialysis care. AI-based gait analysis may provide a practical tool for monitoring mobility changes in hemodialysis patients.

Background: Gastroenterological guidelines consider pancreatic serous cystadenomas (SCAs) to have minimal malignant potential and generally do not recommend intervention or surveillance. In contrast, the American College of Radiology recommends surgical consultation for large SCAs (> 4 cm).

Objectives: To evaluate the association between initial SCA size and lesion growth during follow-up.

Methods: The final reports of all patients who underwent magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) at our institution between the years 2011 and 2021 were reviewed for the diagnosis of serous cystadenoma. Patients with typical microcystic serous cystadenomas who had at least two MRCP examinations were included. We collected clinical data from the patients during the follow-up period, including history, symptoms, and laboratory results. The primary and maximal cyst size diameters and additional radiological characteristics were collected.

Results: Our cohort included 35 patients (21 females, 14 males) with a median age of 68 years. The median follow-up period was 32 months. None of our patients developed malignant transformation. Nineteen lesions grew during follow-up. We found no connection between the lesion size at presentation and the enlargement during follow-up. In total, 21 patients had smaller lesions < 4 cm and 14 had larger lesions > 4 cm. There were no significant clinical or radiological differences between the smaller and larger lesions.

Conclusions: We investigated whether the current radiological recommendations for serous cystadenomas should be revised. Surgical consultation may not be needed for typical asymptomatic SCAs, regardless of the size.

Background: Patient satisfaction is a key indicator of healthcare quality, influencing treatment adherence, clinical outcomes, and hospital reputation. The relationship between length of hospital stay (LOS) and patient satisfaction in neurological inpatients remains understudied, particularly regarding sex differences and neurological diagnosis types.

Objectives: To understand how LOS influences satisfaction and patient experience. To evaluate care strategies and improve communication in neurological settings.

Methods: We conducted a retrospective observational study of 181 patients admitted to the neurology department at Sheba Medical Center between January 2023 and January 2025. Patient satisfaction was assessed using a standardized survey covering overall experience, communication with medical staff, and the discharge process. We used partial correlation analyses and multivariate ANOVA to explore associations of LOS, sex, diagnosis, and satisfaction.

Results: A significant negative correlation was found between LOS and patient satisfaction (r = -0.19, P = 0.012), as well as with perceptions of competency (r = -0.22, P = 0.004), physician communication, and involvement in treatment decisions. Females reported lower satisfaction than males, particularly regarding hospitalization conditions, the discharge process, and staff communication. Diagnosis-specific differences also emerged, with females diagnosed with headache consistently reporting the lowest satisfaction ratings.

Conclusions: Longer hospital stays were associated with lower patient satisfaction. Female sex and diagnosis of headaches influenced patient satisfaction the most. These findings highlight the need for improved communication and enhanced discharge planning to optimize patient satisfaction in neurological settings. Addressing these factors may contribute to more patient-centered care and better overall experiences for hospitalized neurological patients.

In June 2025, amid an escalating military conflict between Israel and Iran, hospitals across Israel were required to reassess and reinforce their emergency preparedness. Civilian populations in central Israel faced direct threats, including missile strikes on residential areas. In response, hospital leadership at Meir Medical Center, a secondary hospital in the center of Israel, issued a directive for an immediate mass casualty incident (MCI) simulation to be designed and executed within 48 hours. The objective was to test the hospital’s operational readiness under real-time wartime conditions, stress key interfaces between pediatric and adult emergency services, and identify latent system vulnerabilities.

Artificial intelligence (AI) has become the emblem of progress. We are told it learns faster, sees patterns invisible to the human eye, and will soon outthink us in every domain, from finance to philosophy, from language to life. In medicine, where decisions carry the weight of saving lives, this narrative has gained traction. Algorithms promise precision without fatigue, accuracy without bias, and reproducibility without emotion. Yet, sometimes, the data tell a quieter story.

Artificial intelligence (AI) and machine learning have moved to the forefront of scientific discourse and clinical medicine, offering improved accuracy and efficiency while raising concerns about transparency, accountability, and unintended consequences. Recent developments, particularly large-scale and generative models, have fueled these debates. However, efforts to mimic aspects of human intelligence long predate ChatGPT. These efforts include the early rule-based systems to Weizenbaum’s ELIZA program, which humorously simulated a Rogerian psychotherapist in its Doctor script [1]. For clinicians, the real test is not whether predictions become marginally more accurate on average, but whether they improve the identification of high-risk patients and meaningfully change management.

Medical education has evolved significantly since the establishment of university-based training in the 12th century, continually adapting to scientific, technological, and societal changes. In the 21st century, rapid advances in digital technologies, artificial intelligence, and the widespread availability of medical information are reshaping the competencies required of physicians. This review explores the concept of the doctor of the future and the implications for medical education and training. Future physicians will require strong cognitive abilities to interpret clinical data, utilize decision support technologies, and make informed clinical judgments while maintaining responsibility for final clinical decisions. At the same time, lifelong learning will be essential as medical knowledge and technologies rapidly evolve. Despite technological progress, core human qualities including empathy and effective communication, are essential traits that will be needed by future physicians. These skills require educational models that integrate technological competence, humanistic care, interdisciplinary teamwork, and adaptable career pathways to meet the challenges of evolving healthcare systems.

The fourth edition of Recurrent Pregnancy Loss: Causes, Controversies and Treatment summarizes the controversies and discuss the scientific basis for the various causes of recurrent pregnancy loss in depth and to clarify the various treatment modalities. The book shows a radical departure from the format of the previous three editions and succeeds profoundly in satisfying its objective. This book, first published in 2007, the second edition in 2014, and the third edition in 2020 became the foremost and most comprehensive work on recurrent pregnancy loss. In the fourth edition there are new chapters on the epigenetics of recurrent pregnancy loss, biochemical pregnancies, inflammatory placental disorders, artificial intelligence, and the role of hydroxychloroquine. This edition also discusses whether the decline in male infertility is reflected in recurrent pregnancy loss.