Comparing the Performance of ChatGPT-4 and Medical Students on MCQs at Varied Levels of Bloom's Taxonomy.

Introduction: This research investigated the capabilities of ChatGPT-4 compared to medical students in answering MCQs using the revised Bloom's Taxonomy as a benchmark. Methods: A cross-sectional study was conducted at The University of the West Indies, Barbados. ChatGPT-4 and medical students were assessed on MCQs from various medical courses using computer-based testing. Results: The study included 304 MCQs. Students demonstrated good knowledge, with 78% correctly answering at least 90% of the questions. However, ChatGPT-4 achieved a higher overall score (73.7%) compared to students (66.7%). Course type significantly affected ChatGPT-4's performance, but revised Bloom's Taxonomy levels did not. A detailed association check between program levels and Bloom's taxonomy levels for correct answers by ChatGPT-4 showed a highly significant correlation (p<0.001), reflecting a concentration of "remember-level" questions in preclinical and "evaluate-level" questions in clinical courses. Discussion: The study highlights ChatGPT-4's proficiency in standardized tests but indicates limitations in clinical reasoning and practical skills. This performance discrepancy suggests that the effectiveness of artificial intelligence (AI) varies based on course content. Conclusion: While ChatGPT-4 shows promise as an educational tool, its role should be supplementary, with strategic integration into medical education to leverage its strengths and address limitations. Further research is needed to explore AI's impact on medical education and student performance across educational levels and courses.

Successful treatment of recurrent visceral leishmaniasis relapse in an immunocompetent adult female with functional hypopituitarism in Bangladesh.

BACKGROUND: Currently available treatment options are mostly effective in achieving long-term cure in visceral leishmaniasis (VL) patients. However, there have been reports of recurrence of this illness in both immunosuppressed and immunocompetent patients. CASE PRESENTATION: We report the first case of recurrent VL relapse in a 19-year-old immunocompetent female with functional hypopituitarism (hypogonadotropic hypogonadism with central hypothyroidism) from Bangladesh, who has been treated three times previously with optimal dosage and duration- liposomal amphotericin B (LAmB) alone and in combination with miltefosine. We treated the patient successfully with a modified treatment regimen of 10 mg/kg body weight LAmB for two consecutive days along with oral miltefosine for seven days as loading dose. For secondary prophylaxis, the patient received 3 mg/kg body weight LAmB along with oral miltefosine for seven days monthly for five doses followed by hormonal replacement. The patient remained relapse free after 12 months of her treatment completion. CONCLUSION: In the absence of protective vaccines against Leishmania species and standard treatment regimen, this modified treatment regimen could help the management of recurrent relapse cases.

Obesity Differs from Diabetes Mellitus in Antibody and T Cell Responses Post COVID-19 Recovery.

Obesity and type 2 diabetes (DM) are risk factors for severe COVID-19 outcomes, which disproportionately affect South Asian populations. This study aims to investigate the humoral and cellular immune responses to SARS-CoV-2 in adult COVID-19 survivors with obesity and DM in Bangladesh. In this cross-sectional study, SARS-CoV-2-specific antibody and T cell responses were investigated in 63 healthy and 75 PCR-confirmed COVID-19 recovered individuals in Bangladesh, during the pre-vaccination first wave of the COVID-19 pandemic in 2020. In COVID-19 survivors, SARS-CoV-2 infection induced robust antibody and T cell responses, which correlated with disease severity. After adjusting for age, sex, DM status, disease severity, and time since onset of symptoms, obesity was associated with decreased neutralising antibody titers, and increased SARS-CoV-2 spike-specific IFN-γ response along with increased proliferation and IL-2 production by CD8+ T cells. In contrast, DM was not associated with SARS-CoV-2-specific antibody and T cell responses after adjustment for obesity and other confounders. Obesity is associated with lower neutralising antibody levels and higher T cell responses to SARS-CoV-2 post COVID-19 recovery, while antibody or T cell responses remain unaltered in DM.

Psychosocial Factors Behind Deliberate Self-Poisoning in a Tertiary Care Hospital of Bangladesh: A Cross-Sectional Study.

INTRODUCTION: Deliberate self-poisoning (DSP) is an important cause of hospital admissions and subsequent mortality. We conducted a cross-sectional observational study in a tertiary-level teaching hospital situated in the northeastern part of Bangladesh to analyze the psychosocial factors responsible for DSP. METHODS: This cross-sectional observational study was carried out among patients with DSP admitted to the medicine ward from January to December 2017, irrespective of gender, except for cases involving poisoning due to spoiled food, food contaminated by infectious organisms, poisoning by venomous animals, and street poisoning (commuter or travel-related poisoning). Consultant psychiatrist in accordance with the Diagnostic & Statistical Manual of Mental Disorder - IV (DSM-IV) confirmed psychiatric disorders. Data were analyzed by SPSS (Statistical Package for social sciences) version 16.0 (IBM Corp., Armonk, NY). RESULTS: Total 100 patients were enrolled. Among them, 43% were male and 57% were female. The majority (85%) of the patients were young, aged below 30 years. The mean age of male patients was 26.2 years and that of females was 21.69 years. Most of the DSP patients were from the lower economic class (59%). The population sample was remarkable for students (Prevalence 37%). The highest percentage of patients (33%) had their educational status at the secondary level. The common reasons for DSP were a family problem in 31% patients, quarrel with boy/girlfriend in 20%, quarrel with a spouse in 13%, quarrel with parents or other family member in 7%, failure in examination in 6%, poverty in 3%, and unemployment in 3%. Prescription medication was the most common poison material (38%), followed by insecticides (36%), household cleaners (17%), and rodenticides (8%). Seven (7%) patients reported previous deliberate self-harm events and co-morbid psychiatric disorder was present in 30% patients among them major depressive disorder was found in 60%, and schizophrenia in 23.3% cases. CONCLUSION: DSP remains a problem mainly for the young with gender ratio-favoring females. The majority of DSPs were educated up to secondary level, unmarried, residents of rural areas, student, and belonged to the lower class. Familial disharmony and quarrel with spouse or friends were the common reason behind DSP. Prescription medication and insecticides were commonly used for DSP. Psychiatric disorders, primarily depressive disorder, and schizophrenia were common in cases of DSP.

Advances in micro and nanoengineered surfaces for enhancing boiling and condensation heat transfer: a review.

Liquid-vapor phase change phenomena such as boiling and condensation are processes widely implemented in industrial systems such as power plants, refrigeration and air conditioning systems, desalination plants, water processing installations and thermal management devices due to their enhanced heat transfer capability when compared to single-phase processes. The last decade has seen significant advances in the development and application of micro and nanostructured surfaces to enhance phase change heat transfer. Phase change heat transfer enhancement mechanisms on micro and nanostructures are significantly different from those on conventional surfaces. In this review, we provide a comprehensive summary of the effects of micro and nanostructure morphology and surface chemistry on phase change phenomena. Our review elucidates how various rational designs of micro and nanostructures can be utilized to increase heat flux and heat transfer coefficient in the case of both boiling and condensation at different environmental conditions by manipulating surface wetting and nucleation rate. We also discuss phase change heat transfer performance of liquids having higher surface tension such as water and lower surface tension liquids such as dielectric fluids, hydrocarbons and refrigerants. We discuss the effects of micro/nanostructures on boiling and condensation in both external quiescent and internal flow conditions. The review also outlines limitations of micro/nanostructures and discusses the rational development of structures to mitigate these limitations. We end the review by summarizing recent machine learning approaches for predicting heat transfer performance of micro and nanostructured surfaces in boiling and condensation applications.

Evaluation of Short-Term Side Effects Following the First Dose of COVID-19 Vaccines Among Physicians and Dentists: A Cross-Sectional Study from India.

Background: Efficacy and safety are fundamental for the development of successful COVID-19 vaccines. Vaccine-associated side effects influence vaccine hesitancy. This study investigated the prevalence, severity, and onset of side effects following the first dose of COVID-19 vaccines among physicians and dentists working in various healthcare settings across India. Methods: A cross-sectional survey collected self-report data from April to June 2021 on side effects following the first dose of the vaccine. An online validated questionnaire using the Google Docs® platform was circulated via email and social media platforms. Results: More than 40% of participants experienced at least one side effect after the first dose of vaccination; the most common were mild and resolved within three days after vaccination. More than 91% of respondents received the Covishield (AstraZeneca) vaccine; the most prevalent adverse effects were soreness of the injected arm (78.9%), tiredness (71.1%), and fever (54.9%). Logistic regression showed that women were almost 60% less likely to report side effects. Conclusion: Findings supported the safety of the first dose of the COVID-19 vaccine based on relatively few self-limiting side effects, mainly soreness of the injected arm and tiredness. Further research is needed to determine the long-term safety of COVID-19 vaccines, especially after booster doses.

Clinical and laboratory characteristics of dengue and COVID-19 coinfected patients in Dhaka, Bangladesh.

BACKGROUND: Dengue-COVID-19 coinfection is one of the greatest emerging challenges in dengue-endemic areas during the continuing pandemic. With coinciding clinical and laboratory pictures, early diagnosis becomes burdensome, with management discrepancy. METHODS: A descriptive study was performed on dengue-COVID-19 coinfected patients during July-August 2021 for an overview of disease progression, severity and outcome. A total of 11 patients who were positive for dengue NS1 and/or antidengue IgM were included in this study. RESULTS: In total, 45.5% patients developed severe COVID-19 disease, 45.5% patients developed group B dengue fever and 9% patients developed group C dengue fever. Concurrent severity of both diseases was seen to be rare, except for in one patient. CONCLUSION: Early diagnosis and compatible management still stand as basic principles to prevent fatality and morbidity.

Stochastic mortality forecasts for Bangladesh.

Mortality forecasts are essential part for policymaking in any aging society. In recent years, methods to model and forecast mortality have improved considerably. Among them, Lee-Carter method is one of the most influential method. In this paper, Lee-Carter method is applied to forecast mortality and life expectancy of Bangladesh. A functional data analysis approach is used to decompose the smoothed log-mortality rates in Lee-Carter framework for higher goodness-of-fit of the models and for longer forecast horizons. Bangladesh has been experiencing a mortality transition and has gained life expectancy in last few decades. The fitted model here showed higher pace of mortality decline for women in Bangladesh than that of men. The forecasts showed continuation of mortality improvement in long run and by 2060 life expectancy at birth is expected to reach over 80 years for both sexes in Bangladesh. The study also predicts the effect of reduction in infant mortality on the life expectancy in Bangladesh.

The mediating role of hope in relation with fear of COVID-19 and mental health: A study on tertiary level students of Rajshahi District.

Background and Aims: The novel coronavirus disease (COVID-19) is influential in all parts of people's lives, specifically psychological states due to the fear related to the pandemic. Thus, this study aimed to investigate the mediating role of hope in the connection between the fear of COVID-19 and mental health among tertiary college students of Rajshahi district during the COVID-19 disease. Method: A cross-sectional survey was conducted among tertiary college students a sample of 498 participants (53.4% females and 46.6% males) ranged between ages 19 and 31 (M = 22.03 ± 1.92) and participants filled out the fear of COVID-19 Scale, Trait Hope Scale, and General Health Questionnaire. Result: In the case of correlation analysis, fear of COVID-19 is reversely correlated with mental health, while lower but positive correlations were found with hope. Findings from the process macro v3.5 by Hayes analysis for the study model indicated that hope mediated in the relationship between the fear of COVID-19 and mental health controlling for gender, and socioeconomic status, and the hypothesized model explained approximately 27% of the variance in mental health. Conclusion: Overall, the findings suggest that a high level of mental health is impacted by a low level of fear of COVID-19. Additionally, a low level of fear of COVID-19 contributes to increasing levels of hope, which enhances mental health.

Microscale Confinement and Wetting Contrast Enable Enhanced and Tunable Condensation.

Dropwise condensation represents the upper limit of thermal transport efficiency for liquid-to-vapor phase transition. A century of research has focused on promoting dropwise condensation by attempting to overcome limitations associated with thermal resistance and poor surface-modifier durability. Here, we show that condensation in a microscale gap formed by surfaces having a wetting contrast can overcome these limitations. Spontaneous out-of-plane condensate transfer between the contrasting parallel surfaces decouples the nanoscale nucleation behavior, droplet growth dynamics, and shedding processes to enable minimization of thermal resistance and elimination of surface modification. Experiments on pure steam combined with theoretical analysis and numerical simulation confirm the breaking of intrinsic limits to classical condensation and demonstrate a gap-dependent heat-transfer coefficient with up to 240% enhancement compared to dropwise condensation. Our study presents a promising mechanism and technology for compact energy and water applications where high, tunable, gravity-independent, and durable phase-change heat transfer is required.

Rhino-Orbital Mucormycosis After COVID-19 Infection in a Patient With Non-Hodgkin's Lymphoma.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be succeeded by a spectrum of complications, including invasive fungal infections (IFIs). Here, we describe a case of rhino-orbital mucormycosis in a recovered coronavirus disease-19 (COVID-19) patient with underlying non-Hodgkin's lymphoma (NHL). Our patient was normotensive, non-diabetic, presenting with multiple non-healing ulcers on different parts of the body. She received high-dose glucocorticoids and antibiotics during her severe COVID-19 illness. Three weeks following COVID-19 detection, she developed progressive rhino-orbital lesion with profuse pus formation, along with pain and redness of the left eye. Histopathology from the lesion revealed mucormycosis. She was treated with Amphotericin B. Unfortunately, the patient died after the first cycle of chemotherapy for NHL. Due to the high chance of mortality, timely clinical suspicion along with microbiological diagnosis is necessary for the early detection of infection. Strong policymaking should also be implicated to revisit the cost effectiveness of available treatments to reduce case fatality.

In-vitro and in-vivo pharmacological screening of Iris Albican.

OBJECTIVE: To evaluate the anti-oxidant, enzyme inhibition, anti-pyretic, anti-inflammatory and anti-diabetic activities of Iris albicans. METHODS: Anti-oxidant assay was evaluated using DPPH (2, 2-diphenyl-1-picrylhydrazyl) radical scavenging and ABTS (2, 2'-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid) inhibitory protocol while enzyme inhibitory assay was evaluated by lipoxygenase and cyclooxygenase-2 inhibitory protocol respectively. Antipyretic, anti-inflammatory and anti-diabetic potential was evaluated using brewer's yeast induced pyrexia, carrageenan induced paw edema and streptozocin induced diabetes protocols respectively. Serum biochemical parameters were monitored for the period of study. RESULTS: The anti-oxidant activity of chloroform fraction of Iris albicans showed the highest scavenging potential against DPPH and ABTS while the maximum inhibitory action recorded against lipo-oxygenase and cyclooxygenase-2 enzymes was shown by n-hexane and chloroform fractions respectively. The anti-pyretic potential of the crude methanolic extract showed dose dependent activity in reducing pyrexia, thereby when the dose was increased the anti-pyretic effect was also enhanced. The anti-inflammatory action of the crude methanolic extract administered at the dose of 300 mg/kg was significant at 1 h after its administration, which was found maintained up to 5 h. Similarly the anti-diabetic effect of the crude methanolic extract administered at the dose of 200 and 300 mg/kg was noted highly significant at day 6 and was found well maintained throughout the study time period up to 10 days. Significant (P < 0.001) improvement appeared in hemoglobin, protein, cholesterol, triglycerides, urea, creatinine, HDL and LDL of extract treated diabetic mice. CONCLUSION: From this data it could be concluded that Iris albicans have significant anti-oxidant, enzyme inhibition, ant-pyretic, anti-inflammatory and anti-diabetic potential.

Detailed approach toward the anti-hyperglycemic potential of Sterculia diversifolia G. Don against alloxan-induced in vivo hyperglycemia model.

OBJECTIVE: To investigate Sterculia diversifolia G. Don for potential anti-diabetic activity in the in vivo mouse model of alloxan-induced hyperglycemia. METHODS: Sterculia diversifolia (S. diversifolia) was subjected to extraction and isolation techniques and structural characterization of the isolated compounds were performed using spectroscopic methods. The acute toxicity test was performed by orally administering S. diversifolia in doses of 500-2000 mg/kg. For the assessment of anti-hyperglycemic activity, S. diversifolia bark and leaves extracts were administered orally in doses of 50, 100, and 200 mg/kg, along with metformin (150 mg/kg, i.p) as positive control, after confirmation of alloxan (150 mg/kg, i.p.) induced hyperglycemia in BALB/c mice. Serum biochemical parameters were monitored for the period of study. RESULTS: The phytochemical studies showed the presence of quercetin and kaempferol in S. diversifolia. The IC50 values in the in vivo acute toxicity study revealed the safety margin of S. diversifolia bark (1166.66 mg/kg) and leaves (683.34 mg/kg) extracts. A significant attenuation of alloxan induced hyperglycemia was produced by S. diversifolia extracts at 50 mg/kg (P < 0.05), 100 mg/kg (P < 0.05, < 0.01), and 150 mg/kg (P < 0.05, < 0.01, < 0.001) during 1-4 h, which was comparable to metformin (P < 0.001). Significant (P < 0.001) improvement appeared in blood hemoglobin, protein, cholesterol, triglycerides, urea, creatinine, HDL, and LDL of the stem bark and leaves extracts treated diabetic mice. CONCLUSION: These findings connote the usefulness of S. diversifolia as an anti-diabetic in traditional medicine and this might be attributed to the presence of quercetin and kaempferol, among other phytochemicals.

Tunable and Robust Nanostructuring for Multifunctional Metal Additively Manufactured Interfaces.

Novel processing phenomena coupled with various alloying materials used in metal additive manufacturing (AM) have opened opportunities for the development of previously unexplored micro-/nanostructures. A rationally devised structure nanofabrication strategy of AM surfaces that can tailor the interface morphology and chemistry has the potential for many applications. Here, through an understanding of grain formation mechanisms during AM, we develop a facile method for tuning micro-/nanostructures of one of the most used AM alloys and rationally optimize the morphology for applications requiring low surface adhesion. We demonstrate that optimized AM structures reduce the adhesion of impaling water droplets and significantly delay icing time. The structure can also be altered and optimized for antiflooding jumping-droplet condensation that exhibits significant enhancement in heat transfer performance in comparison to nanostructures formed on conventional Al alloys. In addition to demonstrating the potential of functionalized AM surfaces, this work also provides guidelines for surface-structuring optimization applicable to other AM metals.

Generalized Pruritus and Gradual Loss of Vision as the Presenting Complaints of Acute HIV Infection: Management Challenges during COVID-19 Pandemic.

BACKGROUND: Although the prevalence of HIV is low in Bangladesh, there is a potential for an increased number of cases. This is because of high cross-border mobility (India and Myanmar) of people and increased injection drug abusers amongst youth in the cities and rural areas, HIV can present in many ways, from asymptomatic to advanced disease, including various atypical (generalized itching) and advanced (loss of vision) manifestations. A high degree of suspicion is required to diagnose HIV in a country like Bangladesh. Early diagnosis and prompt treatment are essential to have a better outcome. METHODS: Here, we report two thought-provoking cases where patients were suffering from generalized itchy lesions (pruritic papular eruption) throughout the body for a long time and gradual loss of vision in another case. RESULTS: Due to lack of suspicion, initially, HIV screening was not done. Both patients visited several health centres, but no diagnosis was made. Moreover, COVID-19 pandemic worsens the situation. Finally, they were diagnosed with HIV; unfortunately, one of them lost her vision due to CMV retinitis and another patient died of other complications. CONCLUSION: Ongoing COVID-19 pandemic put many challenges to ensure optimum care, especially for patients with long-sufferings like HIV. Clinicians have to have a very high degree of suspicion while dealing with patients presented with rare manifestations, particularly in a low endemic clinical setting.

A Middle-Aged Man Presented with Quadriparesis during COVID-19 Pandemic.

The clinical presentation of COVID-19 is varied: from asymptomatic to severe neurological syndrome like stroke can happen. Guillain-Barré syndrome (GBS) as a manifestation of COVID-19 is not very common. GBS is an acute immune-mediated polyradiculoneuropathy that usually occurs following previous exposure to infection. Here, we are reporting a case of GBS related to COVID-19 infection. The reported case presented with quadriparesis and was diagnosed with GBS after evaluation. At the same time, his RT-PCR for COVID-19 was also positive. Interestingly, this patient suffered from COVID-19 2 months before this presentation. He was successfully treated with intravenous immunoglobulin. The clinician should be aware of severe neurological complications such as GBS as a potentially life-threatening complication related to COVID-19.

In vivo laxative, anti-diarrheal, hepatoprotective and diuretic investigations of Sterculia diversifolia and its isolated compound.

OBJECTIVE: To investigated the laxative, anti-diarrheal, hepatoprotective and diuretic activity of Sterculia diversifolia and its isolated compounds. METHODS: The laxative activity was studied by counting wet stools while anti-diarrheal activity was performed by measuring gastrointestinal tract motility. Hepatoprotective activity was studied by biochemical and histo-pathological analysis while diuretic activity was performed by urine collection protocol. RESULTS: Doses of 30 and 100 mg/kg of crude methanolic extract of Sterculia diversifolia (MESD) stem bark and leaves, significantly (P < 0.05, P < 0.01) produced wet feces in subjects pretreated with atropine while 8-hydroxyquercetin and dihydroquercetin showed highly significant (P < 0.001) results by increasing fecal weight and water contents without producing diarrhea. MESD stem bark and leaves also dose-dependently lowered diarrhea while 8-hydroxyquercetin and dihydroquercetin showed highly significant (P < 0.001) results by producing shaped stools in mice. MESD, 8-hydroxyquercetin and dihydroquercetin offered significant protection against histopathological changes in the liver. Diuretic activity of Crude MESD stem bark and leaves extracts shows highly significant diuretic effect while dihydroquercetin showed better results than 8-hydroxyquercetin. CONCLUSION: It is concluded that Sterculia diversifolia and its isolated compounds bears laxative, anti-diarrheal, hepatoprotective and diuretic effects.

Endemic HBV among hospital in-patients in Bangladesh, including evidence of occult infection.

Bangladesh is one of the top-ten most heavily burdened countries for viral hepatitis, with hepatitis B (HBV) infections responsible for the majority of cases. Recombinant and occult HBV infections (OBI) have been reported previously in the region. We investigated an adult fever cohort (n=201) recruited in Dhaka, to determine the prevalence of HBV and OBI. A target-enrichment deep sequencing pipeline was applied to samples with HBV DNA >3.0 log10 IU ml-1. HBV infection was present in 16/201 (8 %), among whom 3/16 (19 %) were defined as OBI (HBsAg-negative but detectable HBV DNA). Whole genome deep sequences (WGS) were obtained for four cases, identifying genotypes A, C and D. One OBI case had sufficient DNA for sequencing, revealing multiple polymorphisms in the surface gene that may contribute to the occult phenotype. We identified mutations associated with nucleos(t)ide analogue resistance in 3/4 samples sequenced, although the clinical significance in this cohort is unknown. The high prevalence of HBV in this setting illustrates the importance of opportunistic clinical screening and DNA testing of transfusion products to minimise OBI transmission. WGS can inform understanding of diverse disease phenotypes, supporting progress towards international targets for HBV elimination.

Liquid film-induced critical heat flux enhancement on structured surfaces.

Enhancing critical heat flux (CHF) during boiling with structured surfaces has received much attention because of its important implications for two-phase flow. The role of surface structures on bubble evolution and CHF enhancement remains unclear because of the lack of direct visualization of the liquid- and solid-vapor interfaces. Here, we use high-magnification in-liquid endoscopy to directly probe bubble behavior during boiling. We report the previously unidentified coexistence of two distinct three-phase contact lines underneath growing bubbles on structured surfaces, resulting in retention of a thin liquid film within the structures between the two contact lines due to their disparate advancing velocities. This finding sheds light on a previously unidentified mechanism governing bubble evolution on structured surfaces, which has notable implications for a variety of real systems using bubble formation, such as thermal management, microfluidics, and electrochemical reactors.