Evaluation of online chat-based artificial intelligence responses about inflammatory bowel disease and diet.

INTRODUCTION: The USA has the highest age-standardized prevalence of inflammatory bowel disease (IBD). Both genetic and environmental factors have been implicated in IBD flares and multiple strategies are centered around avoiding dietary triggers to maintain remission. Chat-based artificial intelligence (CB-AI) has shown great potential in enhancing patient education in medicine. We evaluate the role of CB-AI in patient education on dietary management of IBD. METHODS: Six questions evaluating important concepts about the dietary management of IBD which then were posed to three CB-AI models - ChatGPT, BingChat, and YouChat three different times. All responses were graded for appropriateness and reliability by two physicians using dietary information from the Crohn's and Colitis Foundation. The responses were graded as reliably appropriate, reliably inappropriate, and unreliable. The expert assessment of the reviewing physicians was validated by the joint probability of agreement for two raters. RESULTS: ChatGPT provided reliably appropriate responses to questions on dietary management of IBD more often than BingChat and YouChat. There were two questions that more than one CB-AI provided unreliable responses to. Each CB-AI provided examples within their responses, but the examples were not always appropriate. Whether the response was appropriate or not, CB-AIs mentioned consulting with an expert in the field. The inter-rater reliability was 88.9%. DISCUSSION: CB-AIs have the potential to improve patient education and outcomes but studies evaluating their appropriateness for various health conditions are sparse. Our study showed that CB-AIs have the ability to provide appropriate answers to most questions regarding the dietary management of IBD.

Applicability of Online Chat-Based Artificial Intelligence Models to Colorectal Cancer Screening.

BACKGROUND: Over the past year, studies have shown potential in the applicability of ChatGPT in various medical specialties including cardiology and oncology. However, the application of ChatGPT and other online chat-based AI models to patient education and patient-physician communication on colorectal cancer screening has not been critically evaluated which is what we aimed to do in this study. METHODS: We posed 15 questions on important colorectal cancer screening concepts and 5 common questions asked by patients to the 3 most commonly used freely available artificial intelligence (AI) models. The responses provided by the AI models were graded for appropriateness and reliability using American College of Gastroenterology guidelines. The responses to each question provided by an AI model were graded as reliably appropriate (RA), reliably inappropriate (RI) and unreliable. Grader assessments were validated by the joint probability of agreement for two raters. RESULTS: ChatGPT and YouChat™ provided RA responses to the questions posed more often than BingChat. There were two questions that > 1 AI model provided unreliable responses to. ChatGPT did not provide references. BingChat misinterpreted some of the information it referenced. The age of CRC screening provided by YouChat™ was not consistently up-to-date. Inter-rater reliability for 2 raters was 89.2%. CONCLUSION: Most responses provided by AI models on CRC screening were appropriate. Some limitations exist in their ability to correctly interpret medical literature and provide updated information in answering queries. Patients should consult their physicians for context on the recommendations made by these AI models.

Ceftriaxone-Induced Encephalopathy in a Patient With End-Stage Renal Disease on Hemodialysis.

Ceftriaxone-induced encephalopathy is a rare but known adverse effect secondary to neurotoxicity, especially in patients with end-stage renal disease (ESRD) on hemodialysis. The common presenting symptoms include myoclonus, psychosis, and seizures. We are presenting a case of a 77-year-old female patient who presented with confusion and jerky movements of her lips and extremities. Her initial workup was negative for stroke and seizure disorder. A probable diagnosis of ceftriaxone-induced encephalopathy was made using an Adverse Drug Reaction (ADR) probability scale (Naranjo scale) with a Naranjo score of 5. The patient's symptoms resolved after discontinuation of ceftriaxone. Ceftriaxone is a commonly used intravenous antibiotic in the inpatient setting, and thus clinicians should be aware of this rare adverse reaction in patients with ESRD.

The Unseen Danger of Methotrexate Toxicity.

Methotrexate is a commonly prescribed immunosuppressant and chemotherapy agent, which is closely monitored by healthcare providers for its adverse effects. As a result, methotrexate toxicity occurs infrequently. We present a case of a 51-year-old woman with a past medical history of rheumatoid arthritis on methotrexate and prednisone. She presented to the emergency room with altered mental status, jaundice, and mucosal ulceration. She was subsequently admitted to the intensive care unit for septic shock in the setting of severe pancytopenia, acute renal failure and acute liver failure. This case demonstrates the importance of recognizing the signs and symptoms of methotrexate toxicity due to its infrequent presentation.

Metastatic adenocarcinoma of the prostate presenting as a solitary cystic brain mass.

Carcinoma prostate is the second most common cancer in men after skin cancer. It is the most common visceral malignancy in the United States of America. Like any other cancerous lesion, it has the propensity to metastasize to any part of the body; the most common locations being bones, lymph nodes, liver, and thoracic organs. However, it rarely metastasizes to the brain. It is even rarer for brain metastases to manifest as cystic lesions. We describe an unusual case of a metastatic prostate carcinoma presenting as a cystic brain mass.

Spontaneous coronary artery dissection of ramus intermedius in an elderly woman.

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial ischemia commonly seen in younger patients, particularly women. Patients often present similar to those with acute coronary syndrome (ACS); however, they often are missing the classic risk factors that are typically associated with coronary artery disease. Differentiating between SCAD and ACS is vital as they are managed differently with up to 80% of SCAD being managed conservatively. We present a case of 61-year-old woman with no previous cardiac history presenting with chest pain and was found to have spontaneous coronary artery dissection on coronary angiography.

Ruptured Sinus of Valsalva Aneurysm in Apert Syndrome: Case report.

Background: Sinus of Valsalva aneurysm (SOVA) is a rare anomaly of the aorta that can be congenital or acquired. It can be associated with syndromes such as Marfan syndrome and Ehlers-Danlos syndrome. However, to our knowledge, it has never been described in a patient with Apert syndrome. Although it often presents as an incidental finding on imaging, SOVA is associated with the risk of serious complications, including rupture. A possible connection between the conditions might be the FGFR2 gene mutation in Apert syndrome and the influence of a mutation in fibroblast growth factor 2 (FGF2) on heart development. Here we report a case of acute heart failure secondary to rupture of SOVA into the right atrium in a patient with Apert syndrome. Case presentation: A 47-year-old Caucasian woman with a history of Apert syndrome and rheumatoid arthritis presented with shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and progressive bilateral lower extremity edema for 2 weeks. She was diagnosed with acute right heart failure due to ruptured SOVA. The patient underwent surgical repair of the ruptured SOVA. Unfortunately, her postoperative course was complicated by a stroke leading to brain death. Conclusion: Ruptured SOVA is a quite rare but serious condition that can cause life-threatening complications. In this case, SOVA occurred in a patient with Apert syndrome. The case may suggest that these two conditions may be related through the FGFR2 gene mutation associated with Apert syndrome and the related growth factor FGF2 involved in heart development.