A Double-Edged Sword: Quality and Credibility of Colon Cancer Screening Content on YouTube.

Introduction Colorectal cancer (CRC) remains a significant public health challenge globally, with its pathogenesis involving the transformation of benign adenomas into malignant carcinomas. Despite advancements in screening and early detection significantly improving outcomes, the rise of digital platforms like YouTube for disseminating health information presents new challenges. Concerns over the accuracy and reliability of content underline the necessity for rigorous evaluation of these digital health education tools. Methods Our study was conducted at Nassau University Medical Center, East Meadow, New York. We meticulously analyzed YouTube videos on "colon cancer screening awareness," employing strict selection criteria to ensure both relevance and quality, focusing on English-language content with pertinent audio. Videos were evaluated for their quantitative and qualitative attributes-views, subscriber counts, likes/dislikes, comments, and content type, classifying them as scholarly or personal. We assessed video credibility through scientific accuracy using the DISCERN instrument, Global Quality Score (GQS), and Patient Education Materials Assessment Tool (PEMAT), ensuring consistency in quality and reliability evaluation among seven researchers via the intraclass correlation coefficient. These tools - DISCERN for assessing reliability and quality, GQS for evaluating overall quality, and PEMAT for understandability and actionability - facilitated a comprehensive evaluation framework. Our analysis, leveraging descriptive and inferential statistics, scrutinized differences in content quality between academic and private institutions, employing t-tests to identify statistically significant disparities. The study utilized Microsoft Excel (version 16.73, Microsoft Corporation, Redmond, Washington, United States) and IBM SPSS Statistics for Windows, version 29.0 (released 2022; IBM Corp., Armonk, New York, United States). for robust data processing and analysis, confirming the educational value and trustworthiness of the examined YouTube content. Results Our study of 156 YouTube videos on educational content, split between academic (68 videos) and private sources (88 videos), revealed significant quality differences. Using the DISCERN, PEMAT, and GQS metrics, academic videos consistently outperformed private ones, with significant margins: DISCERN (54.61 vs. 34.76), PEMAT (3.02 vs. 2.11), and GQS (3.90 vs. 2.02), supported by low p-values indicating a statistically significant superiority. These findings suggest that the source of content-academic versus private-plays a crucial role in determining the quality and reliability of educational materials on platforms like YouTube, highlighting the academic sector's commitment to higher educational standards. Conclusion The study emphasizes the critical role of credible sources in enhancing the quality of health education content on YouTube, particularly concerning CRC screening. The superiority of academic institutions in providing high-quality content suggests a need for viewers to critically assess the source of information. It also calls for enhanced regulatory oversight and measures to ensure the accuracy and reliability of health information online.

Understanding the Landscape: The Emergence of Artificial Intelligence (AI), ChatGPT, and Google Bard in Gastroenterology.

Introduction Artificial intelligence (AI) integration in healthcare, specifically in gastroenterology, has opened new avenues for enhanced patient care and medical decision-making. This study aims to assess the reliability and accuracy of two prominent AI tools, ChatGPT 4.0 and Google Bard, in answering gastroenterology-related queries, thereby evaluating their potential utility in medical settings. Methods The study employed a structured approach where typical gastroenterology questions were input into ChatGPT 4.0 and Google Bard. Independent reviewers evaluated responses using a Likert scale and cross-referenced them with guidelines from authoritative gastroenterology bodies. Statistical analysis, including the Mann-Whitney U test, was conducted to assess the significance of differences in ratings. Results ChatGPT 4.0 demonstrated higher reliability and accuracy in its responses than Google Bard, as indicated by higher mean ratings and statistically significant p-values in hypothesis testing. However, limitations in the data structure, such as the inability to conduct detailed correlation analysis, were noted. Conclusion The study concludes that ChatGPT 4.0 outperforms Google Bard in providing reliable and accurate responses to gastroenterology-related queries. This finding underscores the potential of AI tools like ChatGPT in enhancing healthcare delivery. However, the study also highlights the need for a broader and more diverse assessment of AI capabilities in healthcare to leverage their potential in clinical practice fully.

An Adult With Undifferentiated Embryonal Sarcoma of the Liver: A Case Report of a Rare Encounter.

Undifferentiated embryonal sarcoma of the liver (UESL) is a rare, aggressive tumor mainly found in children but can also appear in adults. Its diagnosis in adults remains a conundrum; it is often identified late due to its non-specific symptoms and resemblance to benign lesions. A comprehensive treatment regimen involving surgical intervention, chemotherapy, and possibly radiation significantly boosts survival rates. Imaging often yields inconclusive outcomes, further complicating the diagnostic process. Here, we report the case of a 28-year-old female diagnosed with UESL, emphasizing the need for timely intervention. Undifferentiated embryonal sarcoma of the liver requires differentiation from a variety of hepatic tumors in adults. Though there are no distinctive characteristics to differentiate UESL from other hepatic masses, its morphology and immunohistochemical profiles significantly vary. The staging often reveals UESL as a large, well-defined mass with the potential for diverse differentiation. Its prognosis has been considerably improved with the advent of multidisciplinary treatment. Surgical resection remains a cornerstone, often combined with chemotherapy. While pediatric cases exhibit better overall survival rates than adults, outcomes heavily depend on the chosen treatment regimen. A combination of chemotherapy and complete tumor removal has been found to significantly elevate survival chances. Disease recurrence remains a challenge and is influenced by treatment strategy. In conclusion, the diagnosis and treatment of UESL are fraught with challenges, particularly in adults. A multidimensional approach, combining various therapies, is paramount for better outcomes. Continuous research and enhanced awareness are crucial for improving diagnostic precision and treatment outcomes for UESL patients.

Unpacking the Racial Gap: Helicobacter pylori Infection Clearance Among Different Racial Groups.

Introduction Helicobacter pylori (H. pylori) is a bacteria causing chronic stomach infections, influenced by various factors, including host traits and bacterial virulence. It uses both urease-dependent and independent mechanisms to survive acidic gastric environments. Management entails diagnosis, treatment, and eradication verification. Combining drugs is key to overcoming resistance and ensuring bacteria elimination, thus preventing recurrence and complications. H. Pylori eradication mitigates gastric cancer risk and alleviates symptoms. Racial disparities persist despite declining H. pylori and gastric cancer incidence in the United States (US). African Americans (AA) have higher gastric cancer risks than non-Hispanic Whites. Addressing these disparities is crucial to protect high-risk populations. Methods This study retrospectively compiled H. pylori infection data from 2009 to 2022, categorized by race. Propensity score matching balanced initial group characteristics before analysis. Chi-squared and odds ratio tests were used on the cohort, with Kaplan Meier and Log Rank methods evaluating disease clearance in ethnic groups. Data were extracted from the Sunrise Electronic Medical Record software, including patient demographics, health details, and treatment specifics. Patients aged 18-65 with H. pylori infection at Nassau University Medical Center, who followed their treatment, were selected. Data were processed using Statistical Package for the Social Sciences (SPSS) and RStudio software. Results The study initially included 10,040 H. pylori-diagnosed patients, with 9,288 meeting the study's criteria after attrition. Predominantly female (64.7%), the cohort was racially diverse. A longer disease clearance time was noted among Hispanics (p=0.044). Binomial logistic regression analysis identified influential factors like high school graduation rates, poverty level income, and language proficiency on disease clearance. An odds ratio analysis further emphasized language barriers (HR 0.346, p=0.043) and education status (HR 0.756, p=0.025) as primary covariates impacting disease clearance, underlining the role of socio-economic factors and language proficiency in health outcomes. Conclusion The study highlights racial disparities in H. pylori clearance rates, particularly among Hispanics, necessitating culturally sensitive interventions. It advocates for improved diagnostics, increased healthcare access, and social determinants of health-focused initiatives. It identifies socio-economic status and language proficiency as key factors impacting health outcomes, calling for actions to bridge these disparities. Addressing these differences can decrease healthcare inequalities and economic burden, improving overall health outcomes and reducing costs associated with H. pylori clearance.

Navigating the Esophagus: Effective Strategies for Foreign Body Removal.

Foreign body ingestion is a common medical emergency that can affect individuals of all ages and can be caused by various factors, including accidental ingestion, psychiatric disorders, intellectual disabilities, and substance abuse. The most common site for foreign body lodgment is the upper esophagus, followed by the middle esophagus, stomach, pharynx, lower esophagus, and duodenum. This article provides a case report of a 43-year-old male patient with a history of schizoaffective disorder and an indwelling suprapubic catheter who presented to the hospital due to foreign body ingestion. After examination, a metal clip from his Foley catheter was found lodged in his esophagus. The patient was intubated for the procedure, and an emergent endoscopic removal was performed to remove the metallic Foley component. No postoperative complications were observed, and the patient was successfully discharged. This case highlights the importance of considering foreign body ingestion in patients with chest pain, dysphagia, and vomiting. Prompt diagnosis and treatment are crucial to prevent potential complications such as perforation or gastrointestinal tract obstruction. The article also emphasizes the need for healthcare providers to know the different risk factors, variations, and common sites for foreign body lodgment to optimize patient care. Furthermore, the article highlights the importance of multidisciplinary care involving psychiatry and surgery to provide comprehensive care to patients with psychiatric disorders who may be at higher risk for foreign body ingestion. In conclusion, foreign body ingestion is a typical medical emergency that requires prompt diagnosis and treatment to prevent complications. This case report highlights the successful management of a patient with foreign body ingestion and emphasizes the importance of multidisciplinary care to optimize patient outcomes.

A Mass in the Thorax: A Rare Presentation of Gastrointestinal Stromal Tumor.

Gastrointestinal stromal tumors (GIST) can occur anywhere in the gastrointestinal tract, with the primary site being the stomach. GISTs are often discovered incidentally on imaging due to the non-specific symptoms they present at the presentation. They can be distinguished from other mesenchymal tumors by immunohistochemistry staining. These tumors can range from benign to highly malignant, with surgical resection as the main treatment modality. Here, we present a case of a large GIST found not in the stomach, but in the mediastinum, incidentally on imaging, in a middle-aged male.

Toxic Megacolon: Background, Pathophysiology, Management Challenges and Solutions.

Toxic megacolon (TM) is one of the fatal complications of inflammatory bowel disease (IBD) or any infectious etiology of the colon that is characterized by total or partial nonobstructive colonic dilatation and systemic toxicity. It is associated with high morbidity and mortality, and surgical management is necessary for the majority of the cases. An accurate history and physical examination, plain radiographs of the abdomen, sigmoidoscopy, and, most important of all, awareness of the condition facilitate diagnosis in most cases. Operative intervention is warranted when massive hemorrhage, perforation, or peritonitis complicate the clinical scenario or medical therapy fails to control the disease. We sought to review the management challenges of TM and its possible management strategies in this article.

Nationwide Analysis of Resource Utilization and In-Hospital Outcomes in the Obese Patients With Lower Gastrointestinal Hemorrhage.

GOALS: The goal of this study was to evaluate the impact of obesity on the outcomes of patients with lower gastrointestinal hemorrhage (LGIH). BACKGROUND: Obesity is considered as an independent risk factor for LGIH. We sought to analyze in-hospital outcomes and characteristics of nonobese and obese patients who presented with LGIH, and further, identify resource utilization during their hospital stay. MATERIALS AND METHODS: With the use of National Inpatient Sample from January 2005 through December 2014, LGIH-related hospitalizations (age≥18 y) were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes. Patients were stratified into the nonobese and obese groups depending on their body mass index (>30 kg/m). The statistical analyses were performed using SAS 9.4. RESULTS: Of the total 482,711 patients with LGIH-related hospitalizations, 38,592 patients were found to be obese. In a propensity-matched analysis, the in-hospital mortality was higher in the nonobese patients (4.2% vs. 3.8%, P=0.004), however, the mean length of hospital stay and mean cost was higher in the obese group which could be due to a higher number of comorbidities in the obese group. Secondary outcomes such as the need for mechanical ventilation vasopressor use and colonoscopy was significantly higher in the obese group. CONCLUSIONS: The study results demonstrate that 'obesity paradox' do exist for LGIH-related hospitalizations for mortality. LGIH hospitalizations in the obese patients are associated with higher resource utilization as evidenced by the longer length of stay and higher cost of hospitalizations as compared with the nonobese patients.

Predictors of blood transfusion and in-hospital outcomes in patients with gastric antral vascular ectasia (GAVE): a nationwide population-based analysis.

BACKGROUND: Gastric antral vascular ectasia (GAVE) is a rare cause of chronic non-variceal upper gastrointestinal (GI) bleeding and can turn into life-threatening bleed in some patients. Packed red blood cell (PRBC) transfusions are often required in these patients during hospitalization. We aimed to investigate the hospitalization outcomes and predictors of PRBC transfusions in patients with GAVE lesions. METHODS: Using the ICD-9-CM codes (537.82, 537.83), we queried the National Inpatient Sample (NIS) [2010-2014] to recognize hospitalized GAVE patients. A 1:2 random sample was obtained from the non-GAVE cohort and these groups were compared (GAVE vs. non-GAVE). The predictors of PRBC transfusion in GAVE cohort were analyzed with multivariate analysis by using SPSS Statistics 22.0. RESULTS: We included weighted 89,081 GAVE and 178,550 non-GAVE hospitalized patients. The GAVE patients were tended to be older, female and white. Significantly higher proportions of comorbidities such as congestive heart failure, diabetes, hypertension, hypothyroidism, liver disease, renal failure, Sjogren syndrome, systemic sclerosis and portal hypertension, etc. were present in these patients. The all-cause inpatient mortality was found to be 1.4%. The mean hospital charges and length of stay (LOS) per GAVE hospitalization were $36,059 and 4.63±5.3 days, respectively. A total of 6,276 (weighted 31,102) (34.9%) of these patients received at least one PRBC transfusion during hospitalization. Advanced age, multiple comorbidities, non-elective admissions, male gender, and African American race were the independent factors associated with higher chances of receiving PRBC transfusion. CONCLUSIONS: Our analysis showed that hospitalized patients with GAVE lesions had lower overall mortality rate despite having multiple comorbidities. There was no difference in the LOS and hospital charges between the two cohorts. Nearly 35% of the GAVE patients received at least one PRBC transfusion.

Incidence, features, in-hospital outcomes and predictors of in-hospital mortality associated with toxic megacolon hospitalizations in the United States.

Toxic megacolon (TM) is a potentially fatal condition characterized by non-obstructive colonic dilatation and systemic toxicity. It is most commonly caused by inflammatory bowel disease (IBD). Limited data for TM are available demonstrating incidence, in-hospital outcomes and predictors of mortality. We sought to investigate incidence, characteristics, mortality and predictors of mortality associated with it. Data were obtained from the Healthcare Cost and Utilization Project (HCUP)'s Nationwide Inpatient Sample (NIS) database from January 2010 through December 2014. An analysis was performed on SAS 9.4 (SAS Institute Inc., Cary, NC). Patients below 18 years were excluded. A mixed-effects logistic regression model was developed to analyze predictors of mortality. Thus, 8139 (weighted) cases of TM were diagnosed between 2010 and 2014. TM is more prevalent in women (56.4%) than in men (43.6%), with a mean age of onset at 62.4 years, affecting whites (79.7%) more than non-whites. The most common reason for hospital admission included IBD (51.6%) followed by septicemia (10.2%) and intestinal infections (4.1%). Mean length of stay was 9.5 days and overall in-hospital mortality was 7.9%. Other complications included surgical resection of the large intestine (11.5%) and bowel obstruction (10.9%). Higher age, neurological disorder, coagulopathy, chronic pulmonary disease, heart failure, and renal failure were associated with greater risk of in-hospital mortality. TM is a serious condition with high in-hospital mortality. Management of TM requires an inter-disciplinary team approach with close monitoring. Patients with positive predictors in our study require special attention to prevent excessive in-hospital mortality.

Deep Vein Thrombosis of the Left Leg: A Case of May-Thurner Syndrome.

A 56-year-old woman presented with gradually worsening shortness of breath associated with dull left leg pain over 5 days. She denied any recent travel, recent surgeries or immobilization. CT pulmonary angiography and CT venography revealed multiple bilateral pulmonary emboli and extensive left pelvic and left lower extremity deep vein thromboses. Contrast-enhanced CT showed that the right common iliac artery crossed the left common iliac vein and compressed it externally, indicative of May-Thurner syndrome. Catheter-directed thrombolysis of the left lower extremity was performed and heparin infusion was started. The patient also underwent left iliac vein balloon angioplasty with stenting and infra-renal inferior vena cava filter placement via the jugular approach to prevent further embolization. LEARNING POINTS: May-Thurner syndrome (MTS) should be suspected in patients in their second to fourth decade of life presenting with unprovoked deep venous thrombosis of the left leg.An iliac venogram is the diagnostic test of choice for MTS.MTS is treated only when it is symptomatic. The goal of treatment is to remove the clot to prevent post-thrombotic syndrome and to repair the anatomical defect.A stent was successfully deployed in the iliac vein of our patient and restoration of blood flow resulted in a dramatic improvement in the patient's symptoms.