Assessing ChatGPT 4.0's test performance and clinical diagnostic accuracy on USMLE STEP 2 CK and clinical case reports.

While there is data assessing the test performance of artificial intelligence (AI) chatbots, including the Generative Pre-trained Transformer 4.0 (GPT 4) chatbot (ChatGPT 4.0), there is scarce data on its diagnostic accuracy of clinical cases. We assessed the large language model (LLM), ChatGPT 4.0, on its ability to answer questions from the United States Medical Licensing Exam (USMLE) Step 2, as well as its ability to generate a differential diagnosis based on corresponding clinical vignettes from published case reports. A total of 109 Step 2 Clinical Knowledge (CK) practice questions were inputted into both ChatGPT 3.5 and ChatGPT 4.0, asking ChatGPT to pick the correct answer. Compared to its previous version, ChatGPT 3.5, we found improved accuracy of ChatGPT 4.0 when answering these questions, from 47.7 to 87.2% (p = 0.035) respectively. Utilizing the topics tested on Step 2 CK questions, we additionally found 63 corresponding published case report vignettes and asked ChatGPT 4.0 to come up with its top three differential diagnosis. ChatGPT 4.0 accurately created a shortlist of differential diagnoses in 74.6% of the 63 case reports (74.6%). We analyzed ChatGPT 4.0's confidence in its diagnosis by asking it to rank its top three differentials from most to least likely. Out of the 47 correct diagnoses, 33 were the first (70.2%) on the differential diagnosis list, 11 were second (23.4%), and three were third (6.4%). Our study shows the continued iterative improvement in ChatGPT's ability to answer standardized USMLE questions accurately and provides insights into ChatGPT's clinical diagnostic accuracy.

Lipid-Polymer Hybrid Nanosystems: A Rational Fusion for Advanced Therapeutic Delivery.

Lipid nanoparticles (LNPs) are spherical vesicles composed of ionizable lipids that are neutral at physiological pH. Despite their benefits, unmodified LNP drug delivery systems have substantial drawbacks, including a lack of targeted selectivity, a short blood circulation period, and in vivo instability. lipid-polymer hybrid nanoparticles (LPHNPs) are the next generation of nanoparticles, having the combined benefits of polymeric nanoparticles and liposomes. LPHNPs are being prepared from both natural and synthetic polymers with various techniques, including one- or two-step methods, emulsification solvent evaporation (ESE) method, and the nanoprecipitation method. Varieties of LPHNPs, including monolithic hybrid nanoparticles, core-shell nanoparticles, hollow core-shell nanoparticles, biomimetic lipid-polymer hybrid nanoparticles, and polymer-caged liposomes, have been investigated for various drug delivery applications. However, core-shell nanoparticles having a polymeric core surrounded by a highly biocompatible lipid shell are the most commonly explored LPHNPs for the treatment of various diseases. In this review, we will shed light on the composition, methods of preparation, classification, surface functionalization, release mechanism, advantages and disadvantages, patents, and clinical trials of LPHNPs, with an emphasis on core-shell-structured LPHNPs.

Role of 3 Tesla Magnetic Resonance Imaging in the Assessment of Infiltrative Cardiomyopathies.

BACKGROUND: The aim of the present study was to assess the role of 3 Tesla (3T) magnetic resonance imaging (MRI) in the assessment of infiltrative cardiomyopathy (ICM). METHODS: Cardiac MRI was performed on a 3T MRI machine for 15 patients who had clinical or echocardiographic signs of infiltrative cardiomyopathy. Each scan was assessed on a set of anatomical and functional parameters. The patterns of left ventricular (LV) late gadolinium enhancement (LGE) were also analyzed. RESULTS: Bi-atrial dilatation was noted in 14 patients, consistent with a restrictive phenotype. All 15 patients had diastolic dysfunction with reduced LV diastolic ventricular filling and prolonged peak filling times. Eleven patients had a decreased peak filling rate. Twelve patients had systolic dysfunction with reduced ejection fraction (EF). Ten patients had contractile dysfunction in the form of global LV hypokinesia. On delayed contrast imaging, four patients showed no abnormal LGE. Two patients showed diffuse subendocardial enhancement. Two patients showed patchy subendocardial enhancement. Six patients showed patchy mid-myocardial enhancement. One patient showed diffuse mid-myocardial enhancement. Three patients showed patchy subepicardial enhancement. Two patients showed patchy transmural enhancement. Three patients showed reversed myocardial nulling. All 15 patients received a provisional diagnosis of infiltrative cardiomyopathy on the basis of cardiac MRI findings. Sarcoidosis was given as a probable cause in four patients, amyloidosis in three patients, an infectious cause in two patients, and drug-induced cardiomyopathy in one patient. In five patients, no obvious cause could be identified. CONCLUSION: Infiltrative cardiomyopathies, although relatively uncommon, pose significant challenges in diagnosis and treatment. Cardiac MRI has become the gold standard for non-invasive diagnosis of all infiltrative cardiomyopathies.

A Rare Case of Frontal Lobe Cavernous Malformation Mimicking Meningioma.

Cavernous venous malformations are benign vascular lesions that commonly occur in the brain parenchyma. These when present in the extra-axial or superficial cortical location can be mistaken for meningioma. Magnetic resonance imaging (MRI) can help in the detection and easy differentiation of the two entities and thus aid in preoperative diagnosis and preventing intraoperative complications. We present a case of an 18-year-old male patient suffering from seizures, which was initially diagnosed as meningioma. However, detailed evaluation with MRI raised a possibility of cavernous malformation and it was considered as a differential.

Physicians' Understanding of Nutritional Factors Determining Brain Development and Cognition in the Middle East and Africa.

PURPOSE: Proper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life. METHODS: The questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions. RESULTS: A total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0-4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development. CONCLUSION: The results of this study show that practicing physicians significantly agree that nutrition plays an important role in brain and cognitive development and function in early childhood, particularly during the last trimester until 18 months postdelivery.

Management of massive haemobilia in an Indian hospital.

INTRODUCTION: Massive haemobilia carries a mortality of 25% in most reports. Although previously it was mainly due to road accidents or homicidal attempts it is now more often due to iatrogenic trauma like percutaneous liver biopsy and biliary drainage. However the management protocol is not established and there have been few reports of this serious condition from India. AIM: To review the causes of massive haemobilia and outline its management in an Indian hospital. PATIENTS AND METHODS: We retrospectively analysed the records of 20 consecutive patients with massive haemobilia (blood requirement more than 1400 ml/day) admitted to our department over six years from a prospectively maintained database. There were 10 males and 10 females who had a mean age of 43 (range 15-65) years. RESULTS: Haemobilia accounted for 9 percent of patients admitted with upper gastrointestinal bleeding who were seen over this period. The commonest cause was iatrogenic (11) including laparoscopic cholecystectomy (6), Whipple's operation, endoscopic retrograde cholangiography (ERC), percutaneous transhepatic cholangiography (PTC), hepatic stone extraction and removal of biliary stent (1 each). The others had accidental trauma (4), visceral aneurysms (2), biliary stones (2) and chronic pancreatitis (1). The commonest clinical presentation was massive gastrointestinal bleeding. The dual phase computed tomography (CT) scan correctly identified the site of bleeding and other associated conditions in all the 11 patients in whom it was done. Conventional angiography was done in 8 patients with transarterial embolisation (TAE) being attempted in 6 and successful in 2 patients. Operations were performed in 18 patients for the following indications - failure of angiographic embolisation (6), failure of endoscopic sclerotherapy (EST) (1), duodenal erosion (2), portal biliopathy (1), haemoperitoneum (1), bile leak (1), pseudocyst (1), liver necrosis (1) and other hepatobiliary conditions (4). The surgical procedures to control bleeding were ligation of aneurysms (8), repair of the hepatic artery (4), right hepatectomy (3), lienorenal shunt, cholecystectomy and under-running of the duodenal papilla (1 each). The overall mortality was 4 patients (20 percent). There was no mortality in patients with bleeding aneurysms; the mortality being significantly higher in patients with non-aneurysmal bleeding (p=0.0049: Fishers' exact test). CONCLUSIONS: In our experience haemobilia was usually due to an iatrogenic cause with a pseudoaneurysm following a diagnostic or therapeutic intervention(most often laparoscopic cholecystectomy) being the commonest aetiology. A dual phase CT scan accurately identified the site of bleeding. Angiographic embolisation often failed to stop bleeding and mortality was significantly higher in patients with non-aneurysmal bleeding. We should perhaps consider early surgery for haemobilia once the bleeding site has been localised by CT scan.