ChatGPT Versus National Eligibility cum Entrance Test for Postgraduate (NEET PG).

Introduction With both suspicion and excitement, artificial intelligence tools are being integrated into nearly every aspect of human existence, including medical sciences and medical education. The newest large language model (LLM) in the class of autoregressive language models is ChatGPT. While ChatGPT's potential to revolutionize clinical practice and medical education is under investigation, further research is necessary to understand its strengths and limitations in this field comprehensively. Methods Two hundred National Eligibility cum Entrance Test for Postgraduate 2023 questions were gathered from various public education websites and individually entered into Microsoft Bing (GPT-4 Version 2.2.1). Microsoft Bing Chatbot is currently the only platform incorporating all of GPT-4's multimodal features, including image recognition. The results were subsequently analyzed. Results Out of 200 questions, ChatGPT-4 answered 129 correctly. The most tested specialties were medicine (15%), obstetrics and gynecology (15%), general surgery (14%), and pathology (10%), respectively. Conclusion This study sheds light on how well the GPT-4 performs in addressing the NEET-PG entrance test. ChatGPT has potential as an adjunctive instrument within medical education and clinical settings. Its capacity to react intelligently and accurately in complicated clinical settings demonstrates its versatility.

Unique diagnostic challenge in surgery: hepatic abscess versus malignancy.

A man in his 30s had presented with a history of abdominal pain, vomiting and high-grade fever. He had tender hepatomegaly with peritonism in the upper abdomen. Investigations revealed a neutrophilic leucocytosis, and contrast-enhanced CT had shown several well-defined peripherally enhancing thick-walled cystic lesions with non-enhancing centres throughout the liver suggestive of pyogenic liver abscess, treated initially with antibiotics. However, ultrasonography-guided fine needle aspiration revealed atypical neoplastic cells, and a trucut biopsy showed squamous cell carcinoma (SCC). He developed acute shortness of breath. CT pulmonary angiogram confirmed pulmonary thromboembolism (PTE). Incidentally, here we saw a solitary nodule in the right middle lobe, probably a neoplastic lesion. His condition deteriorated rapidly secondary to PTE and died. A pathological review was positive for CK7, p40, p63 and CK19 confirming SCC. We concluded the primary was a pulmonary SCC with multiple hepatic metastases. Hepatic metastases can mimic an abscess; trucut biopsy with immunohistochemistry was critical for a definitive diagnosis.

Unusual case of disappearing hepatic hydatid cyst: COVID-19 times.

The larvae of the tapeworm Echinococcus granulosus cause echinococcosis or hydatid disease. Liver is the most commonly involved organ accounting for 60%-80%. Rupture into the biliary radicle through a cystobiliary communication is the most anticipated complication seen in 5%-17%, presenting with obstructive jaundice and cholangitis. We present a young patient who had presented with cholangitis and a tender hepatomegaly. Contrast-enhanced CT (CECT) had revealed a large hepatic hydatid cyst with multiple daughter cysts and significant dilatation of intrahepatic/extrahepatic biliary system. He had undergone an emergency Endoscopic Retrograde Cholangiopancreatography (ERCP) with extraction of the membranes and stenting of the common bile duct. A few cycles of albendazole were given to sterilise before elective laparoscopic surgery. However, a follow-up CECT showed complete resolution of the hepatic hydatid with calcification. In conclusion, medical treatment with a few cycles of albendazole and ERCP with stenting could be a good treatment option.

Protocol for a prospective, observational, deep phenotyping study on adipose epigenetic and lipidomic determinants of metabolic homoeostasis in South Asian Indians: the Indian Diabetes and Metabolic Health (InDiMeT) study.

INTRODUCTION: We describe the rationale and broad study design of the Indian Diabetes and Metabolic Health (InDiMeT) study, a new prospective, observational study incorporating extensive epigenetic (DNA methylation) and lipidomic signatures to examine their association with the dysregulation of adipose de novo lipogenesis (DNL) in South Asian Indians. The InDiMeT study aims to use a case-control design to identify genetic and modifiable-environmental-lifestyle associated determinants of (1) epigenomic (DNA methylome) dysregulation of adipose DNL in type 2 diabetes mellitus (T2DM) adipose tissue, (2) identify correlates of epigenomic (DNA methylome) dysregulation of adipose DNL in peripheral blood mononuclear cells (PBMCs) from T2DM subjects and (3) elucidate plasma lipidomic correlates of adipose DNL in T2DM that can be used as biomarkers of adipose tissue dysfunction. METHODS AND ANALYSIS: The InDiMeT study will involve recruitment of 176 normoglycaemic and T2DM individuals who will be undergoing laparoscopic surgery for clinical conditions. Extensive phenotyping of the subjects will be conducted and DNA methylome and lipidomic measurements will be made. The adipose DNL pathway genes are likely to be hypermethylated in patients with T2DM with corresponding reduction of gene expression. Correlates of epigenomic (DNA methylome) dysregulation of adipose DNL pathway in PBMCs and their adipose and plasma lipidomic signatures in T2DM subjects could act as early markers of development of T2DM. ETHICS AND DISSEMINATION: For the InDiMeT study, ethical approval for addressing the specific aims has been obtained from the Institutional Ethics Committee, St John's Medical College and Hospital, St John's National Academy of Health Sciences, Bangalore. Findings from this study will be disseminated through scientific publications in peer-reviewed journals, research conferences and via presentations to stakeholders, patients, clinicians, public and policymakers through appropriate channels.

A Sporadic Small Jejunal GIST Presenting with Acute Lower Gastrointestinal Hemorrhage: A Review of the Literature and Management Guidelines.

Gastrointestinal stromal tumors (GISTs) represent the majority of primary nonepithelial neoplasms of the digestive tract, most frequently expressing the KIT protein detected by immunohistochemical staining for the CD117 antigen. Jejunal GISTs account for approximately 10 % of GISTs. Patients usually present with abdominal discomfort. Jejunal GISTs may cause symptoms secondary to obstruction or hemorrhage. Pressure necrosis and ulceration of the overlying mucosa may cause gastrointestinal bleeding, and patients who experience significant blood loss may suffer from malaise and fatigue. Literature has classified small-bowel GISTs on the basis of size, and various established guidelines have advised conservative management of small jejunal GISTs (<2 cm). We here report the clinical, macroscopic, and immunohistological features of a small jejunal GIST presenting with acute lower gastrointestinal hemorrhage in a 50-year-old postmenopausal woman necessitating an emergency laparotomy to control the bleed. The management of very small (<2 cm) small-bowel GISTs is controversial. While guidelines are primarily based on the risk of malignancy in GISTs, no guideline predicting the risk of complications in small-bowel GISTs exists. Hence, these tumors should be removed even if incidentally detected.

A rare cause of massive lymphadenopathy.

Rosai Dorfman Disease is a rare disease presenting mainly as painless enlargement of cervical lymph nodes. It is a benign disorder showing unique histological features characterized by reactive proliferation of sinus histiocytes. In 40% of cases, extranodal sites may be involved. The condition has to be differentiated from certain types of B cell lymphoma showing similar features. We report here a 17 year old male presenting with nodal and extranodal involvement of Rosai Dorfman Disease.