Aya Biderman

Amivantamab, a bispecific EGFR–MET (Epidermal Growth Factor-Mesenchymal-Epithelial Transition Factor) antibody, is increasingly used in advanced non-small cell lung cancer (NSCLC) and is associated with MET-related adverse events, including peripheral oedema and hypoalbuminamia. We report the case of a woman in her early 70s with metastatic EGFR-positive NSCLC who developed rapidly progressive anasarca, acute kidney injury and profound hypoalbuminaemia immediately after the first dose of amivantamab. Extensive evaluation excluded cardiac failure, nephrotic syndrome, hepatic disease, protein-losing enteropathy, infection, autoimmune disease, plasma cell dyscrasia and tumour progression. Discontinuation of amivantamab and treatment with scheduled intravenous albumin combined with loop diuretics resulted in complete clinical and biochemical recovery, sustained at 6-month follow-up while continuing osimertinib. This case represents a severe manifestation of amivantamab-associated fluid retention and supports the recognition of a drug-induced capillary leak phenotype.

Background/Objectives: Prediabetes significantly increases the risk of type 2 diabetes and related complications. Limited data exist for prediabetes among minority groups in Israel, particularly Bedouins. In the Negev region, Jewish and Bedouin populations differ markedly in culture and socioeconomic status. This study aimed to identify gender- and ethnicity-specific predictors of prediabetes. Methods: This retrospective, population-based observational exploratory study used data from 28,754 adults aged 20–65 years insured by Clalit Health Services in Southern Israel (2010–2020). Individuals with prediabetes were matched 1:1 with controls by age, gender, ethnicity, and year of diagnosis. Multivariate logistic regression models stratified by gender and ethnicity identified independent predictors. Results: Prediabetes was identified at significantly younger ages among Bedouins than Jews (6.8 years in men, 11.3 in women). The strongest predictor across all subgroups was metabolic syndrome (OR 2.0–4.0). Gestational diabetes was a major risk factor in women, particularly Jewish (OR 3.6). Cardiovascular disease and the use of statins or thiazide diuretics were independently associated with increased odds of prediabetes. Triglyceride-to-HDL cholesterol ratio was consistently elevated among prediabetes patients. Conclusions: Metabolic and medication-related factors contribute significantly to prediabetes-associated risk, with distinct gender and ethnic patterns. Culturally tailored early interventions and individualized risk profiling may enhance diabetes prevention in Southern Israel.

Background & Need for Innovation: Ethical dilemmas in healthcare often involve navigating emotional and value-laden challenges. Traditional teaching approaches, such as principle-based frameworks, highlight the theory but do not contain tools to integrate emotional reflection and value prioritization, leaving a gap in preparing physicians for real-world ethical decision making. Goal of Innovation: We introduce a novel visual tool named VIEW (Visual Insight for Ethical Wisdom) that enhances ethical decision making by fostering reflection on values, emotions, and professional identity. Steps Taken for Development and Implementation: The VIEW tool was developed as an interactive framework that allows users to map ethical dilemmas visually. It was implemented in three workshops with 31 participants, including junior and senior physicians and medical educators. Participants used the VIEW to analyze real-life ethical challenges. They created 31 visual maps that captured emotional responses, core values, and interpretations of dilemmas. We qualitatively analyzed these maps, alongside other observations and interviews, to identify key themes. Outcomes of Innovation: Preliminary evaluations indicated that the VIEW tool effectively bridges theory and practice. It externalized thought processes, encouraging emotional awareness, and promoting value-based reasoning. Participants reported improved capacity to navigate complex dilemmas and deeper engagement with their professional identity. Critical Reflection on the Process: This visual tool integrates cognitive and emotional dimensions of ethical reasoning, addressing the limitations of traditional approaches. Its implementation highlights the importance of reflection in medical education and clinical practice. Further research is needed to explore the tool’s broader applicability.

Professor Joe Herman of the Department of Family Medicine Ben-Gurion University of the Negev, Beer-Sheva, Israel died on 2023 March 1 after a brief illness. He was one of the founding fathers of the specialty in Israel, training the first Israeli family physicians who subsequently established family medicine in Israel. He was born in 1928, in the United States, and volunteered to defend Israel in the war after the declaration of independence in 1948. Before training as a physician at the Hebrew University in Jerusalem, Israel, he worked in orchards picking apples, plums, and pears. He entered academia in 1986 at the Ben-Gurion University of the Negev, after 20 years of working as a family doctor in the same farming community where he instructed many of the family doctors practicing today. He continued seeing patients and training family medicine residents and medical students in that urban setting. He promoted family medicine research but chose to remain in the background in the department of Family Medicine directed primarily by physicians he trained and focused on encouraging others to think critically and study questions relevant to family medicine, as well as helping them conceive the study question and methods, interpret the data, provide critical revisions, and draft the manuscript. This he did anomalously by choice.

The aim of this study was to assess the level of awareness of elderly primary caregivers of being at physical and mental health risk due to their caregiving role, as well as to examine the impact of sociodemographic characteristics, patient care characteristics, and situational variables on caregivers’ awareness. Data were collected by interview of a sample of primary caregivers aged 60+. A total of 202 primary caregivers responded positively, representing a response rate of 65% (202/311). We found a low–moderate level of awareness. The final multivariate regression analysis (F (12, 179) = 21.26, p < 0.000) revealed six variables, out of nearly 30, that are associated with a high percentage (59%) of the variability of caregivers’ awareness, namely caregiving burden, caregivers’ self-rated health, patient’s disease severity, caregiver gender, number of children, and familial relation to the patient. Action may be taken to raise caregivers’ awareness. Such interventions would possibly contribute to the quality of life and health of caregivers, enable the optimal treatment of the patient, and reduce the costs imposed on the health system and society in general.

Background: The number of elderly people living in the community who are limited in daily activities is increasing worldwide. This generates prolonged care, which usually falls on one family member, the family caregiver. Caregivers are prone to develop psychosocial and physical symptoms. As a result, the World Health Organization (WHO) issued a clear directive to assess and support these caregivers. The main goals of this study were to assess primary care physicians’ (PCP) awareness to caregivers’ health risks and the extent that they recommended preventive measures to maintain the health of the caregivers. As no suitable instrument existed, a secondary goal was to develop a scale to measure physicians’ awareness to caregivers’ health and preventive treatment and test it’s psychometric properties. Methods: Data were collected from a convenience sample of 201 PCP interviewed with structured questionnaires. Results: The participants’ mean age was 48.5 ± 11.2 years and 53.5% were female. Only 48.5% were Israel medical graduates and 72% were board-certified family physicians. Nearly 34% had been primary caregivers of family members. Most physicians (83.6%) were aware of the primary caregiver’s high-risk for morbidity and mortality, and recommended preventive care. On a multivariate regression, PCP's higher level of risk awareness, their country of medical school and board certification were significant for explaining recommendations for preventive care. However, being a primary caregiver for a sick family member neither contributed significantly to the physicians’ awareness to caregiving risks nor to their preventive care. Conclusion: Although a high percentage of physicians were aware and concerned about caregivers’ health, their preventive care activities were relatively passive. PCPs should take a more active and preventive role for maintaining caregivers’ health.

Background: Studies have found that HbA1C variability is an independent risk factor for diabetic complications in type 2 diabetic patients. This study aims to find factors contributing to higher HbA1C variability in the community. Methods: The study was conducted in the southern district of Israel, in Clalit Health Services (CHS). The study population was type 2 diabetic individuals aged 40–70 years in 2005, with a follow-up period of 11 years, until 2015. The definition of HbA1C variability was done by the standard deviation from the average HbA1C value of the entire study period, which was calculated for each participant. The study population was divided into two groups, “variability group” with HbA1C SD > 1.2, and “comparison group” of participants with HbA1C SD ≤ 1.2. In the univariate analysis we used X² or Fisher test for categorical variables and independent t-test for numeric continuous variables. In the multivariate analysis we used logistic regression as well as assessing for possible interactions. Statistical analysis was ascribed for p < 0.05. All the data was drawn from the computerized medical system used by all primary care physicians and nurses in CHS working in the community. Results: The study population included 2866 participants, the average age was 58.6 years, 43.3% men and 56.7% women. Each participant had an average of 20.9 HbA1C measures in their computerized medical record during the 11 years of follow up. The mean HbA1C value was 7.8%. We found 632 patients (22%) with a high variability, whereas 2234 (78%) had a low variability of HbA1C. In the “variability group” there was a higher percentage of smokers, BMI ≥ 30 and a higher rate of visits to diabetic clinics compared to the “no variability” group. In the “variability group” we found a much higher use of insulin and ACE inhibitors. The highest frequency of variability was between HbA1c values of 8.1–8.5. The multivariate analysis showed that HbA1C variability was associated with insulin use (OR = 4.1, p < 0.001), with age (OR = 0.939, p < 0.001), and Ischemic heart disease (OR = 1.258, p = 0.03). BMI ≥ 30 was almost statistically significant (OR = 1.206, p = 0.063). Gender was statistically insignificant. Conclusions: In conclusion, HbA1C variability might be used as an additional marker in Diabetes Mellitus type 2, reflecting the disease complexity characteristics and the patient’s lifestyle profile.

Background. The number of elderly people living in the community who are limited in daily activities is increasing worldwide. This generates prolonged care, which usually falls on one family member, the family caregiver. Caregivers sometimes develop psychosocial and physical symptoms. As a result, the World Health Organization (WHO) issued a clear directive to assess and support these caregivers. The present study focuses on providing preventive solutions by primary care physicians (PCP) to caregivers. Methods. Data were collected from a convenience sample of 201 PCP interviewed with specifically structured questionnaires. Results. The participants’ mean age was 48.5±11.2 years and 53.5% were female. Only 48.5% were Israel medical graduates and 72% were board-certified family physicians. Nearly 34% had formally been primary caregivers of family members. Most physicians (83.6%) were aware of the primary caregiver's high-risk for morbidity and mortality, and recommended preventive care. On a multivariate regression, awareness of the risk, country of medical school and board certification were considered to be of great significance in relation to providing preventive care. However, being a primary caregiver for a sick family member neither contributed significantly to the doctors’ awareness to caregiving risks nor to their preventive care.Conclusion. Although a high percentage of physicians were aware and concerned about caregivers’ welfare, their preventive care activities were relatively passive. PCPs should take a more active and preventive role.