ChatGPT and Artificial Intelligence in Medical Writing: Concerns and Ethical Considerations.

Artificial intelligence (AI) language generation models, such as ChatGPT, have the potential to revolutionize the field of medical writing and other natural language processing (NLP) tasks. It is crucial to consider the ethical concerns that come with their use. These include bias, misinformation, privacy, lack of transparency, job displacement, stifling creativity, plagiarism, authorship, and dependence. Therefore, it is essential to develop strategies to understand and address these concerns. Important techniques include common bias and misinformation detection, ensuring privacy, providing transparency, and being mindful of the impact on employment. The AI-generated text must be critically reviewed by medical experts to validate the output generated by these models before being used in any clinical or medical context. By considering these ethical concerns and taking appropriate measures, we can ensure that the benefits of these powerful tools are maximized while minimizing any potential harm. This article focuses on the implications of AI assistants in medical writing and hopes to provide insight into the perceived rapid rate of technological progression from a historical and ethical perspective.

Evaluating Patterns of Injectate Spread After Rectus Sheath Block: A Cadaveric Dissection Study.

INTRODUCTION: This cadaveric dye study assesses the effect of volume and number of injections on the spread of solution after ultrasound-guided rectus sheath injections. In addition, this study evaluates the impact of the arcuate line on solution spread. MATERIALS AND METHODS: Ultrasound-guided rectus sheath injections were performed on seven cadavers on both sides of the abdomen, for a total of 14 injections. Three cadavers received one injection of 30 mL of a solution consisting of bupivacaine and methylene blue at the level of the umbilicus. Four cadavers received two injections of 15 mL of the same solution, one midway between the xiphoid process and umbilicus and one midway between the umbilicus and pubis. RESULTS: Six cadavers were successfully dissected and analyzed for a total of 12 injections, while one cadaver was excluded due to poor tissue quality that was inadequate for dissection and analysis. There was a significant spread of solution with all injections caudally to the pubis without limitation by the arcuate line. However, a single 30 mL injection showed inconsistent spread to the subcostal margin in four of six injections, including in a cadaver with an ostomy. A double injection of 15 mL showed consistent spread from xiphoid to pubis in five of six injections, except in a cadaver with a hernia. CONCLUSIONS: Injections deep to the rectus abdominis muscle, using the same technique as an ultrasound-guided rectus sheath block, achieve spread along a large and continuous fascial plane without limitation by the arcuate line and may provide coverage of the entire anterior abdomen. A large volume is necessary for complete coverage and spread is improved with multiple injections. We suggest that two injections with a total volume of at least 30 mL per side may be needed to achieve adequate coverage in the absence of preexisting abdominal abnormalities.

Metabolic profile and outcome of pre- and post-ampullary gastrointestinal obstruction in children: Conventional or unconventional wisdom.

BACKGROUND: Conventionally, it is well accepted that the intestinal obstructions in children, especially gastric outlet obstruction are associated with significant metabolic derangement which has impact on its outcome. The study aimed to compare the metabolic profile and treatment outcome of pre- and post-ampullary gastrointestinal obstruction in children at a tertiary care setting. MATERIALS AND METHODS: A prospective observational study was conducted on 30 children with intestinal obstruction and categorised into Group 1 (pre-ampullary, n = 11) and Group 2 (post-ampullary, n = 19) as per their anatomical site of pathology. Patients were evaluated at both pre- and post-operative period (Day 1 and 10) with haematological, biochemical and blood gas. The pre- and post-operative metabolic profile, resuscitative time and outcome were compared in two groups. RESULTS: Except mild leucocytosis (Group II > I), rest of the pre-operative and post-operative haematological parameters were within normal range and statistically comparable among groups. Although the pre-operative sodium values were within the normal limit in both groups, it was relatively higher in Group I (Group I = 137.82 ± 4.238 vs. Group II = 134.26 ± 4.653), (P = 0.04). The mean bicarbonate values were within the normal limit in both groups (22.49 and 19.34), but the difference was statistically significant (P = 0.031). Mean partial pressure of carbon dioxide level was higher than normal range in Group I (38.464 ± 20.6493) but was comparable with Group II (P = 0.15). The time required for pre-operative resuscitation was 16.6 versus 24.87 h in Group I versus Group II (P = 0.02). In Group I, all children were improved, whereas four children expired in Group II. CONCLUSION: Metabolic profile in both pre- and post-ampullary intestinal obstruction was found to be normal in majority of the scenario. Children with post-ampullary obstruction need extensive pre-operative resuscitation and have relatively poor outcome.

Ketamine and electroconvulsive therapy: so happy together?

PURPOSE OF REVIEW: Anesthetics, such as thiopental, methohexital, propofol and ketamine have been used to induce unconsciousness for electroconvulsive therapy (ECT), each with its advantages and disadvantages. Only until recently was it discovered that ketamine may have inherent antidepressant effects. We reviewed the side effect profile of ketamine and examined the literature for whether or not ketamine augments the antidepressant effects of ECT. RECENT FINDINGS: Systematic reviews and meta-analyses of randomized controlled trials of the potential benefits of adding ketamine to ECT treatment have generated varied conclusions. Currently there is a lack of clear evidence that ketamine with ECT is more efficacious than ECT alone. SUMMARY: Large, multicenter randomized controlled trials are needed to further investigate the potential advantages of adding ketamine to ECT for patients with severe or refractory depression. The addition of ketamine to ECT treatment may have some early beneficial effect in patients with acute depressive disorders. Most likely, ECT itself is responsible for lasting remission from severe depression. Ketamine's side effect profile may be undesirable in certain patient populations, and so the risks and benefits of the addition of this drug to ECT treatment must be weighed.

Mini-vesicostomy in the management of PUV after valve ablation.

AIM: To determine the usefulness of infra-umbilical mini-vesicostomy in infants with posterior urethral valves (PUV), in developing countries. This new technique facilitates clean intermittent catheterization (CIC) and overnight bladder drainage, which have been effectively used for the treatment of valve bladders in the developed world. METHODS: A retrospective analysis of the records of three infants who underwent a mini-vesicostomy between 2005-2009 was done. All were put on CIC in the neonatal period. Monitoring of renal parameters, bladder function and structural changes in the bladder was done before and after 4 years of CIC. RESULTS: All three showed a decrease in upper tract dilatation, improvement in cortical function and improvement of bladder compliance at the end of 4 years. Two patients are on CIC through vesicostomy and can pass a good stream of urine per urethraly, and in one the vesicostomy has been closed. CONCLUSION: Mini-vesicostomy is a useful option to allow CIC on a long-term basis in children with PUV. There were no complications with this technique in this small group of patients, and it has been well accepted by their families.

Dorsal enteric sinus with spina bifida: a rare form of split notochord syndrome.

Split notochord syndrome is a rare congenital malformation that results in spinal anomalies associated with anomalies of the gastrointestinal tract and central nervous system. This report presents an infrequently described variant of this syndrome. A 9-month-old female presented with a dorsal midline mass since birth which was partially covered by skin, and part of the lesion gave a gross appearance of intestinal mucosa. MRI was suggestive of partial sacral agenesis with spinal dysraphism with tethered cord. Excision of the mass with repair of the spinal defect was done. Histopathology confirmed the presence of gastrointestinal mucosa.

Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children.

Ventriculo-peritoneal (VP) shunting used in the treatment for hydrocephalus is associated with several complications. Mechanical failure of shunt is the commonest complication of all. Visceral/bowel perforation is an unusual but serious complication of VP shunting. This article reports our experience in the management of ten children who had VP Shunt catheter protrusion from anus. This is a retrospective study of ten patients who had VP shunt catheter protrusion from anus, admitted in the department of paediatric surgery between Jan 1996 and Dec 2005. The records of above ten cases were reviewed for their clinical presentation and management, etc. We had performed 398 VP shunt operations in the last 10 years. Two hundred and seventy one (68.09%) VP Shunts were done for congenital hydrocephalus of which 164 were done in infancy/neonatal period and 107 VP shunts were done in the age group of >1-12 years. One hundred and twenty-seven (31.90%) VP shunt operations were done for patients who had hydrocephalus as a complication following tubercular meningitis (TBM). Out of 398 VP shunts, ten patients (2.51%) had protrusion of the distal end of peritoneal catheter from anus without causing/leading to peritonitis. We observed a 08.29% mortality of all VP shunt operations. Protrusion of VP shunt catheter per rectum can occur without producing peritonitis. Formal exploration and localization of entry of VP shunt catheter in bowel is not mandatory. Mini laparotomy and revision of peritoneal part of shunt can be done if there is no shunt infection.