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Introduction: THE INTERFACE OF THE SENIOR PHYSICIAN AND GOOGLE FOR DIAGNOSING INTRIGUING CLINICAL RIDDLES.

Introduction: Behçet's disease is an autoimmune inflammatory disorder manifested by oral and genital ulcers along with heterogeneous involvement of various organs including eyes, skin, and blood vessels. Aseptic abscesses are a rare manifestation of autoinflammatory diseases and have been reported in isolated cases as part of Behçet's disease. We present a case of an 18-year-old patient with a new diagnosis of Behçet's disease who presented with aseptic liver abscesses. After an extensive negative infectious workup, the patient was treated with steroids, resulting in rapid and complete clinical and laboratory resolution. This case highlights the importance of clinician awareness of this rare complication to achieve correct diagnosis and appropriate treatment.

Background: Exogenous excessive thyroid hormone intake may result in severe thyrotoxicosis and might be harmful to human health. In spite of this, a growing number of people consume over-the-counter (OTC) products that also contain Triiodothyronine (T3) and Thyroxine (T4). We report a case of Liothyronine-containing tablets consumption causing T3-induced thyrotoxicosis. A 33-year-old obese man (BMI=40 kg/m2) with no thyroid disease had typical signs of substantial thyrotoxicosis (including wide complex tachycardia and chest pain), which were confirmed by endocrine tests: both low thyrotropin (TSH) and free T4 as well as elevated free T3 (FT3). Prior to hospitalization, he had not been exposed to iodinated radiocontrast media and had not taken medications containing iodine, such as amiodarone. However, we discovered that the patient consumed tablets containing Liothyronine (135 µg/tablet) for five days prior to hospitalization following the suggestion of a non-registered individual, who introduced himself as a nutritionist. The tablets were misleadingly presented to the patient as a "weight loss" dietary supplement. The tablets were discontinued and a short term therapy that included Amiodarone (before FT3 arrived) was initiated along with Cholestyramine. After three days in the intensive care unit, the patient's heart rate stabilized and his FT3 level decreased substantially. Following investigations, the Israeli Ministry of Health (MOH) published a warning on its website advising the public to avoid these tablets. After follow-up in the community, a repeat echocardiogram revealed a borderline left ventricle dysfunction. During the four years since the patient was released from our hospital, his TSH levels have been normal.

Conclusions: Liothyronine consumption has been associated with substantial thyrotoxicosis and cardiac damage. The Liothyronine tablets were provided to the patient by an unauthorized party, as a weight losing nutritional supplement. However, this was done without a medical examination or indication. The increase in demand for "weight-losing" products 'over the counter', the lack of effective enforcement in the chain, the way these products are presented and the possibility of those who are not authorized to market and supply them, emphasize the need to settle the regulation of this issue as soon as possible.

Background: The patient-doctor encounter encompasses a comprehensive information and decision-making situation. It involves a gap in knowledge and feelings between the doctor and the patient, which intensifies in sensitive situations, in particular gynecology. It may be accompanied by loss of control, violation of privacy, embarrassment and discomfort. This emotional gap has deepened in the past year following the October 7th terror attack. The current training of medical students and residents is insufficient.

Objectives: To formulate a comprehensive learning model for trauma-informed treatment.

Methods: A steering committee mapped out principles for formulating and implementing the training: dealing with patients who have experienced trauma and identifying the characteristics of the phenomenon, the type and scope of communication skills required, and the tools for its implementation, and processing the therapist's feelings to provide professional confidence relevant to the situation. The patients' expressions were collected as a platform for workshops that included theoretical lectures, patient testimonies and actors' simulations.

Results: A total of 27 residents (in Shamir Hospital) and 35 senior gynecologists from 15 health institutions countrywide were trained. An analysis of the insights reflected the perceived benefit of professionalism, the importance of acquiring professional tools and the need for additional knowledge while enhancing the experience of providing care and service. Participants noted the deepening of the ability to identify the phenomenon and deal with patients who have experienced trauma.

Conclusions: It is important to promote trauma-sensitive testing among gynecologists at a national level, especially in the fields of urogynecology, fertility, pregnancy and obstetrics, alongside other clinical fields (urology, surgery, etc.). We recommend exposing medical students in clinical settings and interns during any internship in order to enhance patient-doctor encounter dialogue. This process will improve professional skills and patient experience at a national level, and increase the overall quality of medical services provided in Israel.

Introduction: Israel has one of the lowest maternal mortality rates globally, at 2.6 per 100,000 births. Most deaths occur between the late second trimester and the postpartum period, primarily due to obstetric complications such as postpartum hemorrhage, sepsis, and amniotic fluid embolism. Unlike the U.S.A., where leading causes include violence and substance abuse, maternal deaths in Israel are predominantly obstetric. A major challenge is distinguishing between preventable and non-preventable deaths. Research suggests that more than 60% of maternal deaths could be avoided with better diagnosis, timely intervention, and improved emergency response. Severe maternal morbidity often serves as a precursor to mortality, emphasizing the need for early detection and intervention. Postpartum hemorrhage, a leading cause of preventable maternal deaths, demonstrates how structured protocols, rapid response systems, and better coordination among medical teams can significantly reduce mortality. In contrast, amniotic fluid embolism remains largely unpredictable and untreatable, highlighting the current limits of medical intervention and the urgent need to intensify research into its underlying mechanisms and potential therapies. Despite Israel's achievements, further reductions in maternal mortality may still be possible. Strengthening medical training, improving emergency responses, and fostering interdisciplinary collaboration could save lives. Every preventable death underscores the need for continuous improvement in maternal care.

Introduction: Oculoplastics is a subspecialty of ophthalmology that focuses on a wide range of disorders affecting the eyelids, lacrimal system, and orbit. Common conditions include ptosis (eyelid drooping), nasolacrimal duct obstruction, thyroid eye disease, orbital fractures, and others.

Introduction: Lower back pain (LBP) is a common symptom among the general population. Most LBPs are classified as non-specific back pain, which is a common reason for seeking medical treatment. However, only a minority will experience a serious etiology whereas most will often present additional risk factors or symptoms.

Aims: Analyzing the current literature and common guidelines to understand the various aspects of overdiagnosing LBP in primary care.

Methods: A current literature review was conducted to investigate the connections between the data and qualitative-quantitative analysis of the data to create a structured summary. Qualitative and quantitative articles discussing, directly or indirectly, the various aspects of overdiagnosis of LBP among primary care providers were included.

Results: Most international clinical guidelines have prioritized non-medical approaches for patients with LBP. Many healthcare providers are not designed to support this approach when guideline-compliant clinical implementation requires system-wide changes.

Conclusions: LBP treatment and diagnosis should pay more attention to primary care physicians as better education and regulation should be implemented to reduce overdiagnosis.

Discussion: Overdiagnosis of LBP in primary care burdens the system and harms patients for many and varied reasons. The existing guidelines must be organized and assimilated among primary care physicians, along with the establishment of a sufficient and uniform comprehensive system that supports the current approach.

Introduction: Syndactyly release is a surgical procedure aimed at restoring hand and finger function while maintaining the natural appearance of the interdigital web space (commissure) as much as possible. The timing of surgery depends on the complexity of the fusion, the patient's age, and their overall medical condition. The traditional technique is based on a zigzag incision and the use of skin grafts combined with local flaps. However, it is associated with a relatively high incidence of complications, such as web creep, hypertrophic scars, flap necrosis, and contractures. This article provides a general overview of syndactyly and reviews an alternative surgical technique that minimizes the need for skin grafts, shortens recovery time, and improves both aesthetic and functional outcomes.

Introduction: A 61-year-old man with a complex cardiovascular history and chronic kidney disease was hospitalized with an anterior STEMI and found on catheterization to have severe occlusions in multiple coronary arteries. He underwent PCI followed by urgent coronary artery bypass surgery. On the day after the surgery, he developed acute abdominal pain, and a CTA revealed thrombosis of the superior mesenteric artery (SMA) with ischemia of the small intestine - a condition that was treated surgically with bowel resection and thrombectomy.

Introduction: Rupture of splenic artery aneurysm (SAA) during pregnancy or the puerperium is an obstetric emergency endangering the lives of both the pregnant patient and the fetus.

Aims: The aim of the current study is to characterize early signs of rupture SAA and recommend optimal management to prevent maternal and fetal mortality.

Methods: We conducted a retrospective follow-up study of cases reported in Israel among women diagnosed with SAA during pregnancy and postpartum. Demographics and obstetrical data of maternal and fetal/newborn were collected.

Results: We identified 13 cases of SAA in Israel between 2010 and 2023. The timing of the diagnosis ranged from the second to the third trimester (no cases were reported in the first trimester), with 2 cases diagnosed in the post-partum period. Three women (23%) died, and three fetuses did not survive (23%).

Conclusions: Rupture of SAA during the pregnancy or in the puerperium is a rare event, however, it is associated with maternal and neonatal mortality. Raising awareness among all healthcare providers to the possible diagnosis of rupture of SAA in pregnant or peri-partum women with nonspecific symptoms, including abdominal pain and hemodynamic deterioration, is crucial for decision making and management of those cases and possibly saving their lives and the lives of their fetuses.

Discussion: In cases presented with undefined symptoms, including abdominal pain and hemodynamic deterioration, the clinician should suspect SAA. Awareness to the possible clinical presentation of SAA rupture during pregnancy is crucial and may prevent mortality for both the pregnant patient and her fetus.