ChatGPT in Iranian medical licensing examination: evaluating the diagnostic accuracy and decision-making capabilities of an AI-based model.

INTRODUCTION: Large language models such as ChatGPT have gained popularity for their ability to generate comprehensive responses to human queries. In the field of medicine, ChatGPT has shown promise in applications ranging from diagnostics to decision-making. However, its performance in medical examinations and its comparison to random guessing have not been extensively studied. METHODS: This study aimed to evaluate the performance of ChatGPT in the preinternship examination, a comprehensive medical assessment for students in Iran. The examination consisted of 200 multiple-choice questions categorised into basic science evaluation, diagnosis and decision-making. GPT-4 was used, and the questions were translated to English. A statistical analysis was conducted to assess the performance of ChatGPT and also compare it with a random test group. RESULTS: The results showed that ChatGPT performed exceptionally well, with 68.5% of the questions answered correctly, significantly surpassing the pass mark of 45%. It exhibited superior performance in decision-making and successfully passed all specialties. Comparing ChatGPT to the random test group, ChatGPT's performance was significantly higher, demonstrating its ability to provide more accurate responses and reasoning. CONCLUSION: This study highlights the potential of ChatGPT in medical licensing examinations and its advantage over random guessing. However, it is important to note that ChatGPT still falls short of human physicians in terms of diagnostic accuracy and decision-making capabilities. Caution should be exercised when using ChatGPT, and its results should be verified by human experts to ensure patient safety and avoid potential errors in the medical field.

Effects of ondansetron, metoclopramide and granisetron on perioperative nausea and vomiting in patients undergone bariatric surgery: a randomized clinical trial.

INTRODUCTION: Post-operative nausea and vomiting (PONV) is a common problem after sleeve gastrectomy. In recent years, following the increase in the number of such operations, special attention has been paid to preventing PONV. Additionally, several prophylaxis methods have been developed, including enhanced recovery after surgery (ERAS) and preventive antiemetics. Nevertheless, PONV has not been completely eliminated, and the clinicians are trying to reduce the incidence of PONV yet. METHODS: After successful ERAS implementation, patients were divided into five groups, including control and experimental groups. Metoclopramide (MA), ondansetron (OA), granisetron (GA), and a combination of metoclopramide and ondansetron (MO) were used as antiemetics for each group. The frequency of PONV during the first and second days of admission was recorded using a subjective PONV scale. RESULTS: A total of 130 patients were enrolled in this study. The MO group showed a lower incidence of PONV (46.1%) compared to the control group (53.8%) and other groups. Furthermore, the MO group did not require rescue antiemetics, however, one-third of control cases used rescue antiemetics (0 vs. 34%). CONCLUSION: Using the combination of metoclopramide and ondansetron is recommended as the antiemetic regimen for the reduction of PONV after sleeve gastrectomy. This combination is more helpful when implemented alongside ERAS protocols.

Laparoscopic relief of reduction en-masse in an inguinal hernia: A case report.

INTRODUCTION AND IMPORTANCE: Reduction en-masse is an extremely rare condition that usually develops in prolonged hernias. Spontaneous or iatrogenic reduction of this type of hernia may lead to disastrous consequences such as obstruction, gangrene, or peritonitis. According to the reports so far, surgical management is the only choice for this condition. PRESENTATION OF CASE: In this paper, we report a 48-year-old man who presented with vague abdominal pain and a history of inguinal hernia for years and had reduced his hernia five days earlier. Computed tomography (CT) and ultrasonography confirmed the diagnosis, and the patient was taken to the operating room to relieve the bowel loop utilizing laparoscopy. CONCLUSION: Laparoscopic relief could be an effective tool in diagnosis and surgery of reduction en-masse. Transabdominal preperitoneal repair is the best choice due to its capability to explore the intraabdominal organs and its low risk of recurrence.

Gastric pneumatosis and concurrent aeroportia due to gastric outlet obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Gastric pneumatosis with concurrent hepatic portal vein gas is an extremely rare condition in the adult population. It can be idiopathic or associated with well-known etiologies. Gastric outlet obstruction can progressively inflate the stomach and cause pneumatosis. Regarding abdominal signs and the presence of acute abdomen, management varies from just conservative to emergent surgical interventions. CASE PRESENTATION: We introduce an adult patient who presented to our hospital with weakness and dyspnea. After initial measures, unexpectedly we found intraabdominal free gas, concurrent gastric pneumatosis, and aeroportia. Due to the absence of positive abdominal signs, the patient was treated successfully without any surgical or endoscopic interventions. DISCUSSION: Gastric outlet obstruction is a well-known cause of gastric pneumatosis. Progressive dilation of the stomach due to pyloric stenosis is well-described both in infants and adult populations. CONCLUSION: In stable patients, gastric drainage and correction of electrolyte disturbance are the only required treatment. However endoscopic and surgical interventions should be considered in unstable patients or those developing acute abdomen.