19.06.2024

Special Edition: Women in Medicine

Review Articles

Screening for Abdominal Aortic Aneurysm in Women: A Systematic Review

Jamela Abu-Ayada (1), Yael Fenakel (2), Maysam Shehab MD (3,4) 8-16
Background: An abdominal aortic aneurysm (AAA) is defined as a ≥ 50% increase in aortic diameter compared to normal. AAAs are often asymptomatic, but rupture is a critical surgical emergency, resulting in high mortality rates. AAA screening has been strongly recommended for all men at age 65. However, the European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines suggest revising this robust (Class I) recommendation and advocate a broader recommendation for the screening of high-risk groups to prevent aneurysm-related deaths. Population screening of women is not recommended yet due to its low prevalence. Women experience faster growth rates and higher rupture risks, questioning the adequacy of current screening and management strategies. This review aims to evaluate evidence regarding AAA screening in women.
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Methods: A systematic search for English-language reports was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by two investigators. The search terms included AAA, screening, prevalence, women/female/gender/sex, gender/ sex differences, and population.
Results: We examined 18 studies focusing on the prevalence of AAA in women identified via screening, primarily using ultrasound with a ≥30 mm diameter threshold for AAA diagnosis. Of the 3,593,189 women screened, 11,992 (0.33%) were diagnosed with AAA, yielding a median prevalence of 0.74% (range: 0-5.9%). Of these, six studies detailed comorbidities for a total of 298 females; 139/298 (46.7%) had a history of smoking, 115/283 (40.6%) had hypertension, and 97/175 (55.43%) had hyperlipidemia.
Conclusions: This systematic review delves into current data on AAA screening in women, emphasizing associated comorbidities. Despite low prevalence, the significant number of women diagnosed with AAA, coupled with its high risks, stresses the urgency for large-scale studies to identify and possibly screen high-risk women, aiming for tailored approaches for this group.

Cardiovascular Complications of Patients Undergoing Chimeric Antigen Receptor T-Cell Therapy - A Contemporary Literature Review

Adi Ben Michael BMSc (1), Adi Gershon BMSc (1), Osnat Itzhaki Ben Zadok MD MSc (2,3) 17-23
Background: Chimeric Antigen Receptor T-cell (CAR T-cell) therapy is a key intervention strategy for relapsed or refractory hematologic malignancies. Despite its therapeutic value, this treatment is associated with notable adverse effects, primarily cytokine release syndrome (CRS). Among these complications, cardiotoxicity is a significant concern, encompassing arrhythmias, new-onset left ventricular dysfunction, heart failure and acute coronary syndrome.
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Methods: This paper reviews recent retrospective cohorts and pharmacovigilance studies investigating cardiovascular complications associated with CAR T-cell therapy in adults. This paper discusses the CAR T-cell procedure and its associated CRS. We also discuss current evidence regarding the most appropriate pre-infusion cardiovascular risk stratification and the management of cardiovascular complications.
Results: The prevalence of cardiovascular adverse events in patients treated with CAR T-cell therapy ranges between 10.3% to 21%, with arrhythmias being the most prevalent. Predisposing risk factors include dyslipidemia, hypertension, obstructive coronary artery disease, known heart failure, prior history of atrial fibrillation, older age, and higher grade CRS.
Conclusions: CAR T-cell therapy is effective for refractory hematologic malignancies but poses risks of cardiotoxicity, including arrhythmias, heart failure, and acute coronary syndrome. High-grade CRS, older age, and baseline cardiovascular risk factors increase the likelihood of cardiac adverse events. Early CRS management and thorough cardio-oncology assessments are crucial to mitigate these risks.

Statins to Mitigate Cardiotoxicity Risk of Anthracycline Treatment: A Comprehensive Review

Yael Botkovsky BMSc (1), Noam Zrubavel Yaaron BMSc (1) and Inbar Nardi Agmon MD (1,2) 24-28
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Women in Otolaryngology: a Scoping Review of the Literature Over the Last Two Decades Regarding Women as Patients and as Physicians

Maya Libster (1), Noy Yehiel BMSc (2), Idit Tessler MD MPH (3) 29-36
Background: The field of otolaryngology is evolving regarding the involvement of women as physicians and the attention given to female patients in the clinic and in research.
Objectives: This review examines the role of gender in otolaryngology, aiming to provide a clearer understanding of gender-specific issues in otolaryngology, contributing to better practices and policies for female patients and physicians.
Methods: A systematic review followed PRISMA guidelines, examining top otolaryngology journals from the past two decades for articles on female-related topics. Categorization included two groups: (1) Female-specific otolaryngology pathologies, and (2) Topics related to female otolaryngologists, further divided by sub-specialties.
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Conclusions: This review underscores how gender significantly shapes otolaryngology, impacting conditions, treatment outcomes, and professional dynamics in the field. From the effects of pregnancy on various specialties to disparities in symptoms and life experiences between genders, it emphasizes the necessity for tailored patient care. Moreover, the differences in research, career paths, and representation among gender groups were highlighted.

The Physical and Mental Impact of Sexual Trauma and its Healthcare Implications

Yali Zehavi (1) and Anna Padoa MD (1,2) 37-44
Background: Experiencing trauma is a common aspect of life, with sexual abuse (SA) being a prevalent traumatic event. The repercussions of trauma on one's health are extensive, and there is a well-established connection between childhood trauma and later-life health issues. Healthcare professionals frequently encounter individuals who have experienced trauma but often lack the confidence and training in trauma-informed care (TIC).
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Methods: we have conducted a thorough review of existing literature on trauma, the effect it has on physical and mental health, TIC, healthcare interactions with trauma survivors, and related topics. This involved searching databases for relevant academic papers, books, guidelines, and position statements. Finally, we have synthesized the findings to present a comprehensive overview of SA and TIC, including background information, key principles, research results, and implications for practice.
Results: This review article delves into the intricacies of medical interactions with trauma survivors, emphasizing the urgent need for the universal implementation of TIC in the healthcare system. Studies examining the experiences of both providers and patients reveal that dedicated training programs on TIC enhance the knowledge and self-confidence of healthcare providers. Recent developments have seen health organizations and scientific societies releasing position statements and guidelines on TIC. In Israel, the establishment of the "Israeli Society for Sexual Trauma Treatment and Prevention" within the Israeli Medical Association exemplifies this growing trend.
Conclusions: Overall, the research underscores the critical importance of trauma-informed care in healthcare settings, advocating for its widespread adoption to better support survivors and improve outcomes. The evidence suggests that comprehensive TIC training programs for healthcare providers can lead to more effective care and support for individuals who have experienced trauma. Additionally, the emergence of organizations and guidelines focused on TIC reflects a growing recognition of its significance in addressing the complex needs of trauma survivors within the healthcare system.

Case Articles

commonLife- Threatening Dilemmas in An Isolated Fourth Nerve Palsy Due to A Cavernous Carotid Aneurysm: A Case Report

Shani Davidpur (1), Eyal Aloni MD (2), Shahab Davidpour MD (2), Azaria Simonovich MD (2) and Dua Masarwa MD (2) 45-48
Background: The natural history and clinical presentation of cavernous carotid aneurysms (CCAs) significantly differ from other intracranial aneurysms, primarily due to their low risk of rupture, especially in asymptomatic patients. There is controversy surrounding the management of unruptured, symptomatic CCAs.
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Methods: A 39-year-old pregnant woman presented with vertical double vision since her first trimester. With no prior history of head trauma, strabismus, thyroid disease, or myasthenia gravis symptoms, her examination revealed isolated right fourth nerve palsy. Brain MRI and MRA revealed a laterally directed CCA compressing the right fourth cranial nerve. There was a dilemma regarding her management since a conservative approach fails to address her diplopia, while an interventional approach offers no assurance and carries associated risks. After multidisciplinary consultations, she underwent endovascular aneurysm coiling, which resolved her complaints.
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Conclusions: A laterally displaced CCA can result in a rare isolated fourth nerve palsy presentation. Treatment of the aneurysm substantially improved the patient’s double vision. Decision-making regarding the treatment of symptomatic CCA should consider rupture risk, procedural risks, and anticipated symptoms’ resolution

Perforation of the colon following implantation of ventricular assist device in pediatric patients - two case reports and review of the literature

Shira Haberman (1), Yael Dreznik MD (1,2), Eran Shostak MD (1,3), Ovadia Dagan (1,3), Orit Manor MD (1,3), Yael Feinstein MD (1,3), Ofer Shiller MD (1,3), Elena Dlugy MD (1,2) and Dragan Kravarusic MD (1,2) 49-52
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Feature Articles- Interviews

Interview with Adv. Leah Wapner

Noa Shira Oren MD 54-57
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Interview with Prof. Dina Ben Yehuda

Daniella Federmesser BMSc 58-61
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Interview with Prof. Rivka Carmi

Bar Cohen 62-64
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Interview with Dr. Rinat Yedidya

Shany Avayou 66-69
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Interview with Dr. Roni Postan-Koren

Sharon Temis 70-73
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Interview with DR. Yasmeen Abu-Fraiha

Yaara Cicurel 74-75
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Letters To The Editor

Sex and Gender Biases in Psychiatry; Can Technology Help Bridge the Gap?

Jessica Eve Bendheim MPH, Zippi Frenkel MD 76-78
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Keren Briah: Bridging the Gender Gap in Medical Research and Patient Care

Chesed Kedar, Meital Bonchek, Idit Tessler 79-80
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WoMed Mentorship Program: Advancing female physicians in Israel

Shahar Zifroni Edelstein 81-82
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Epiphany

Letter to Maya

Shani Caspi 8
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Sun

Yael Erez BMSc. 84
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