Search

Objective Methods Results Conclusion To explore the potential and accuracy of the generative dialogue artificial intelligence tool GPT‐4.0 in answering questions related to paediatric emergency appendicitis.A cross‐sectional observational study design was used. We collected 134 appendicitis‐related questions from authoritative websites, such as Mayo Medical and APSA, covering all aspects of appendicitis, including simple and complex questions. These questions were answered by GPT‐4.0, and then evaluated by three paediatric surgical experts using a quality score ranging from 0 to 5. The answers were generated by GPT‐4.0 and then similarly evaluated by three experts for accuracy.We found that GPT‐4.0 could achieve a high accuracy rate on simple questions with a quality score of 4.65 (standard deviation 0.51). For complex questions, the average score was 3.77 (standard deviation 0.68), and there was a significant difference between the two (P < .05). On clinical questions, the accuracy score of GPT‐4.0 was 4.00 (standard deviation 0.21). When answering actual questions from families of children with appendicitis, the accuracy score was 4.12 (standard deviation 0.59). Its accuracy lies between simple questions and complex questions, and it can basically meet the accuracy requirements of clinical questions. It's worth noting that GPT‐4.0 demonstrated empathy in answering some questions, which might further enhance patient satisfaction.GPT‐4.0 showed its potential and accuracy in handling paediatric appendicitis questions, especially in simple and clinical questions. However, improvements are still needed in handling complex questions and updating information. Despite the limitations, this model is expected to improve the quality of medical services and enhance patient satisfaction. [ABSTRACT FROM AUTHOR]

Aim. To determine the factors that contribute to the prediction of the volume of pulmonary lesion in patients with systemic scleroderma (SSc).Materials and methods. The analysis included patients with SSc observed in the Registry of Myositis, systemic sclerosis and mixed connective tissue disease (REMISSIS), who underwent high-resolution computed tomography (HRCT) of the lungs. For the immunological characteristic, all patients were tested for anti-topoisomerase (anti-Scl-70), and anti-centromeric (anti-CENP-B) antibodies, and anticentromere antibodies (anti-Pm-Scl).Results. The study included 79 patients with SSc. There was 94.9 % women. Average age – 64.4 ± 11.5 years. Signs of interstitial lung disease (ILD), according to HRCT were detected in 50 patients. The largest extent of lung injury was noted in patients with SSc sine scleroderma (32.7 ± 29.3 %), a smaller extent in patients with diffuse form SSc (16.9 ± 17.1 %) and the lowest in patients with limited SSc (8.5 ± 14.2 %). In addition to the type of disease, the extent of lung injury in patients with SSc-ILD was statistically significantly higher in patients with arthralgia, dyspnea and the presence of antibodies to topoisomerase I and combined autoantibodies. Also, a statistically significant feedback was established with all indicators of the test with a 6-minute walk and forced vital capacity and a direct relationship with indicators of pulmonary artery systolic pressure. When evaluating the correlation between the extent of lung injury and the degree of dyspnea according to Borg, it was found that in patients who assessed dyspnea less than 3 points, the extent of lung injury was less than 25 %. Due to the high degree of correlation, a regression formula was created for the dependence of the extent of lung injury on the distance in the test with a 6-minute walk: extent of lung injury = (52.7–0.1) × distance 6MWT. A multivariate model was also obtained for predicting the extent of lung injury in SSc, in which the patient’s immunotype, distance in the 6-minute walk test, saturation after the 6-minute walk test, and the presence of dyspnea became the most effective.

Background: With the rapid growth of an aging global population and proportion, the prevalence of frailty is constantly increasing. Therefore, finding a frailty assessment tool suitable for clinical application by physicians has become the primary link in the comprehensive management of frailty in elderly patients. This study used the (fr) AGILE scale to investigate the frailty status of elderly patients from internal medicine wards and identified relevant factors that affect the severity of frailty. Method: In this study, 408 elderly inpatients in internal medicine departments of Qilu Hospital of Shandong University from May 2021 to August 2022 were enrolled as research subjects, and a cross-sectional observational study was conducted. Researchers evaluated the frailty based on the (fr)AGILE scale score. The general condition, past medical history, physical examination, laboratory examination, nutrition control score, intervention and treatment measures and other elderly patient information was collected. Logistic regression analysis was used to analyze the relevant factors that affect the severity of frailty and hospitalization costs. Results: According to the (fr)AGILE scale score, the elderly patients were divided into groups to determine whether they were frail and the severity of the frailty. Among them, 164 patients were in the prefrailty stage, which accounted for 40.2%. There were 188 cases of mild frailty that accounted for 46.1%, and 56 cases of moderate to severe frailty that accounted for 13.7%. Decreased grip strength, elevated white blood cell levels, and low sodium and potassium are independent risk factors affecting the severity of frailty. As the severity of frailty increases, the proportion of sodium, potassium, albumin supplementation as well as anti-infection gradually increases. Conclusion: Frailty is a common elderly syndrome with a high incidence among elderly patients in internal medicine departments. The main manifestations of frailty vary with different severity levels. Inflammation, anemia, and poor nutritional status can lead to an increase in the severity of frailty as well as blood hypercoagulability, myocardial damage, and additional supportive interventions. This ultimately leads to prolonged hospitalization and increased hospitalization costs. [ABSTRACT FROM AUTHOR]

In patients with systemic sclerosis (SSc), interstitial lung disease (ILD) is a factor in the decline of functional capacity up to disability and is also the leading cause of death. Therefore, one of the most important tasks in the treatment of this group of patients is not only to detect involvement of respiratory system, but also to predict the likelihood of its development.Objective: to study the possibility of predicting the development of ILD and advanced ILD in patients with SSc.Material and methods. The study included 79 patients with SSc (mean age 64.4±11.5 years; 94.9% women) from the Registry of myositis, SSc and Mixed Connective Tissue Diseases (РЕМИССиС) who underwent high-resolution computed tomography (HRCT) of the lungs. Classification trees (CTr) were constructed to predict the development of widespread ILD using the CHAID algorithm (exhaustive). All patients were tested for antibodies against Scl-70 (anti-Scl-70), CENP-B (anti-CENP-B), and PmScl (anti-PmScl).Results and discussion. ILD signs according to HRCT were detected in 53 patients. Fibrotic (34.2%) and cellular (15.2%) types of nonspecific interstitial pneumonia were the most common, and common interstitial pneumonia was less frequent (11.4%).The presence of ILD and advanced ILD (involvement of more than 20% of the lung parenchyma) were significantly associated with the detection of any autoantibodies, except anti-centromere antibodies, an increase in pulmonary artery systolic pressure, a decrease in forced vital capacity, diffusing capacity of the lungs, blood oxygen saturation at rest, and all parameters of six-minute walk test (6MWT), and complaints of shortness of breath. In addition, the presence of extensive ILD was also significantly associated with diffuse SSc and with SSc without skin manifestations.In establishing the CTr, it was found that the development of widespread ILD was unlikely in individuals who were able to walk more than 440 m in 6MWT and had neither anti-Scl-70 nor anti-PmScl.Significant associations were also found between the radiological pattern of ILD and the types of disease-specific antibodies.Conclusion. The 6MWT data in conjunction with the results of testing for SSc-specific autoantibodies provide a very accurate prediction of the presence and extent of ILD. It is advisable to include these indicators in the algorithm for screening and monitoring patients with SSc.

Introduction: Diabetes and hypertension are two major non-communicable diseases that commonly coexist and increase the risk of cardiovascular and renal complications. Objectives: to evaluate the prescribing pattern of antihypertensive drugs in diabetic patients with hypertension at a tertiary care center. Methods: This was a cross-sectional observational study conducted at a tertiary care center in suryapet over six months. The study included all diabetic patients with hypertension who visited the outpatient department during the study period. The data were collected through patient interviews and medical records. Demographic and clinical data were recorded, including age, gender, duration of diabetes, and blood pressure. The antihypertensive drugs prescribed were recorded, along with the dose and frequency of administration. Results: A total of 250 diabetic patients with hypertension were included in the study. The majority of the patients were male (56%). The mean age was 58.6 years (SD=10.2), and the mean duration of diabetes was 9.8 years (SD=5.2). The most commonly prescribed antihypertensive drugs were angiotensin-converting enzyme inhibitors (ACEIs) (57%), followed by calcium channel blockers (CCBs) (29%) and angiotensin receptor blockers (ARBs) (27%). The most commonly prescribed combination therapy was ACEIs and CCBs (23%). The average number of antihypertensive drugs prescribed per patient was 1.9 (SD=0.7).Conclusion: This study showed that ACEIs were the most commonly prescribed antihypertensive drugs in diabetic patients with hypertension at the tertiary care center. Combination therapy with ACEIs and CCBs was the most commonly prescribed. The findings suggest the need for improved adherence to evidence-based guidelines in the management of hypertension in diabetic patients. [ABSTRACT FROM AUTHOR]

Background: We assessed/compared the evolution of tobacco and e-cigarette experimentation and use among French adolescents of the Loire department aged 15–16 years. Methods: A descriptive, cross-sectional/observational study conducted in 2018–2020 among 7,950 Year 11 pupils attending 27 public secondary schools of the Loire department, France. Results: From 2018 to 2020, 66.18% of adolescents were “non-vapers and non-smokers”, 19.76% were “vapers and smokers”, 7.90% were “non-vapers and smokers” and 6.15% were “vapers and non-smokers”. E-cigarette experimentation was more prevalent than tobacco experimentation (44.92% vs 41.67%), and daily vaping was less prevalent than daily smoking (5.40% vs 10.24%). More boys than girls were daily vapers or daily smokers. A decrease was observed in tobacco experimentation (from 41.22% in 2018 to 39.73% in 2020) and e-cigarette experimentation (from 50.28% in 2018 to 41.25% in 2020). Current vaping remained stable, with an increase in daily vaping. French adolescent vapers frequently use e-liquids with little or no nicotine or with fruit or sweet flavours. Conclusions: Adolescents used e-cigarettes mainly for experimental and/or recreational purposes, with no intention of progression to daily smoking. Although the design of this study is not longitudinal and caution must be exercised, from our cross-sectional observational study data, it appears that the proportion of “non-vapers and non-smokers” tended to increase. “Smokers” tended to progress to the dual use of vaping and smoked tobacco, with the likely intention to reduce or quit smoking.

Abstract Background We sought to report the prevalence of fragility fracture patients who were screened at high falls risk using a large provincial database, and to determine the characteristics associated with being screened at high falls risk. Methods The study population included fragility fracture patients 50+ years of age who were screened at 35 hospital fracture clinics in Ontario over a 3.5 year period. The outcome was based on two screening questions measuring the risk of falling, both adapted from the STEADI (Stopping Elderly Accidents, Deaths & Injuries) tool. Multivariable associations of sociodemographic, fracture-related, and health-related characteristics were evaluated using logistic regression. Results Of the sample, 9735 (44.5%) patients were classified as being at high falls risk, and 12,089 (55.3%) were not. In the multivariable logistic regression, being 80+ years of age (vs. 50–64 years of age), non-community dwelling (vs. living with spouse, family member, roommate), having a mental/physical impairment (vs. none), and taking multiple medications, were all strongly associated with being screened at high falls risk. Conclusions Living in a non-community dwelling and taking 4+ medications were the variables most strongly associated with being screened at high falls risk. These are potentially modifiable characteristics that should be considered when assessing falls risk in fragility fracture patients, and particularly when designing interventions for preventing subsequent falls. Ongoing work to address the higher risk of falls in the fragility fracture population is warranted.

Background: We sought to report the prevalence of fragility fracture patients who were screened at high falls risk using a large provincial database, and to determine the characteristics associated with being screened at high falls risk.Methods: The study population included fragility fracture patients 50+ years of age who were screened at 35 hospital fracture clinics in Ontario over a 3.5 year period. The outcome was based on two screening questions measuring the risk of falling, both adapted from the STEADI (Stopping Elderly Accidents, Deaths & Injuries) tool. Multivariable associations of sociodemographic, fracture-related, and health-related characteristics were evaluated using logistic regression.Results: Of the sample, 9735 (44.5%) patients were classified as being at high falls risk, and 12,089 (55.3%) were not. In the multivariable logistic regression, being 80+ years of age (vs. 50-64 years of age), non-community dwelling (vs. living with spouse, family member, roommate), having a mental/physical impairment (vs. none), and taking multiple medications, were all strongly associated with being screened at high falls risk.Conclusions: Living in a non-community dwelling and taking 4+ medications were the variables most strongly associated with being screened at high falls risk. These are potentially modifiable characteristics that should be considered when assessing falls risk in fragility fracture patients, and particularly when designing interventions for preventing subsequent falls. Ongoing work to address the higher risk of falls in the fragility fracture population is warranted. [ABSTRACT FROM AUTHOR]

Background: Sensitivity‐related trait characteristics involving physical and emotional sensitivities and high trait anxiety personality types have been observed in individuals with nonspecific chronic low back pain (NSCLBP). High trait sensitivity to sensory stimulation combined with interpretation biases based on personality type may contribute to the development of central sensitization (CS) symptoms. To date, there is limited research that has considered both sensitivity levels and personality type in NSCLBP with CS. The purpose of this study was to investigate (1) relationships between trait sensory profiles, trait anxiety, and CS symptoms, and (2) the predictive capacity of sensory profiles, trait anxiety, and personality types on CS symptoms in people with NSCLBP. Methods: This was a cross‐sectional observational study using 4 self‐report measures on adults (N = 165, mean age = 45 ± 12 [standard deviation] years) from physiotherapy clinics in England, Ireland, and New Zealand. Inclusion: NSCLBP > 6 months, age 18 to 64 years, predominant CS pain presentation, no other pathology. Parametric and nonparametric correlation statistics and regression analyses were used. Results: Positive correlations were found between central sensitization inventory (CSI) scores and sensory hypersensitivity profiles and trait anxiety. CSI score increases could be predicted by sensory‐sensitive, low‐registration profiles; trait anxiety scores; and extreme defensive high anxious personality type. Conclusions: Trait sensory hyper‐ and/or hyposensitivity and high trait anxiety–related personality type characteristics predict the extent of CS symptoms in people with NSCLBP. Further investigation is required to establish causality between these characteristics and CS symptoms. [ABSTRACT FROM AUTHOR]

Introduction: In today's society, Instagram (Meta Platforms, Inc., Menlo Park, California, United States) has grown to be a platform of enormous importance. It has completely changed the way we connect, share, and consume content, with several active users. Instagram may be a powerful tool for education, helping to inform and raise public awareness of a range of health conditions, including pneumonia. The present paper aims to evaluate and analyze the type, quality, and reliability of information about pneumonia being shared on Instagram., Methodology: Using the hashtags  #pneumonia, #pneumoniasucks, #pneumoniatreatment, #pneumoniaawareness, #pneumoniaviral, #pneumoniaisnojoke, data regarding the type of post, number of audience reached, and type of uploader was collected from the related Instagram posts. Global Quality Scale (GQS) and DISCERN scores were used to analyze the collected data., Results: A total of 600 posts were initially evaluated, of which only 418 posts (69.67%) met the inclusion criteria. Images (79.7%) were the most common type of post. Hospitals (31.34%) and survivors/patients (18.9%) were the most common uploaders. There was a statistically significant difference in the quality (GQS) of posts uploaded by doctors, hospitals, healthcare organizations, patient survivors, and others (p <0.001).  Conclusions: There is a significant difference in the quality of posts uploaded by healthcare organizations compared to other groups. Government agencies and medical organizations impose tougher rules on the quality and trustworthiness of the type of healthcare-related information transmitted in order to minimize the distribution of low-quality and unreliable information., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sidhu et al.)

Determinants of B-type natriuretic peptide (BNP) plasma levels in the chronic phase after heart transplantation remain unclear. BNP was measured in 105 stable long-term heart transplant recipients with normal left ventricular function by echocardiography and correlated with clinical, demographic and hemodynamic parameters. Multivariate analysis revealed a significant correlation of BNP with female recipient gender ( P = 0.006), time post-transplant ( P =0.006), donor age ( P = 0.007), angiographic signs of transplant vasculopathy (TVP) ( P = 0.03), serum creatinine level ( P = 0.04), and a strong trend for diastolic dysfunction ( P = 0.09). Donor gender, recipient age, cyclosporin A blood levels, rejection history, and pulmonary artery pressure had no independent effect on BNP. BNP after heart transplantation appears to be influenced both by established general determinants (female gender, renal function) and transplant-specific determinants such as time post-transplant, donor age and potentially also TVP. In order to determine the value of BNP as a potential surrogate marker of TVP serial intraindividual measurements appear appropriate. [ABSTRACT FROM AUTHOR]

Background: In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) removed spirometry as a criterion for classifying GOLD risk groups (A-D, low-high risk)., Methods: In this cross-sectional observational study in China, we used the GOLD 2016 (spirometry included) and 2018 (spirometry eliminated) criteria for classifying GOLD risk groups to describe: the proportion of patients with chronic obstructive pulmonary disease (COPD) in each GOLD risk group; disease severity; demographics and comorbidities. Patients aged ≥40 years with a clinical COPD diagnosis for ≥1 year were included. During a single study visit, patients completed the COPD assessment test, modified Medical Research Council (mMRC) dyspnea scale assessment, and spirometry tests. Demographics, medical history, and treatment data were recorded., Results: In total, 838 patients were included. Most patients were male (86.4%), ≥65 years old (58.6%), and current or former smokers (78.5%). By GOLD 2016, the highest proportion of patients were Group D (42.8%), followed by B (28.2%). By GOLD 2018, the highest proportion of patients were Group B (57.3%), followed by A (25.5%). A total of 296 patients (35.3%) were reclassified, either from Group C to Group A or from Group D to Group B. Overall, 36.2% of patients were receiving treatment concordant with GOLD 2016 recommendations; 34.1% were not receiving any inhaled medication., Conclusions: The distribution of COPD severity shifted from a high-risk category (by GOLD 2016) to a low-risk category (by GOLD 2018). The high proportion of patients not receiving maintenance medication reflects a high level of under-treatment of the disease., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-21-255). All authors declare that the present manuscript was supported by GlaxoSmithKline plc. in funding, medical writing, and article processing charges. WJ reports grant from GlaxoSmithKline (China) R&D Company Limited (GlaxoSmithKline plc. study 207136) and the Ministry of Chinese Science and Technology National Key R&D program (2018YFC1311900), outside the submitted work. JZ has participated in advisory boards and speakers’ bureaus for AstraZeneca and Boehringer Ingelheim. At time of study conduct, YL and YW were employees of GlaxoSmithKline plc., reporting personal fees. Editorial support (in the form of writing assistance, collating author comments, assembling tables/figures, grammatical editing, and referencing) was provided by Varkha Agrawal, PhD, of Tata Consultancy Services (India), and Bonnie Nicholson, PhD, of Ashfield MedComms (Macclesfield, UK), an Ashfield Health company, and was funded by GlaxoSmithKline plc., (2021 Journal of Thoracic Disease. All rights reserved.)

Introduction: The anatomy of the vermiform appendix shows variations in its macroscopic dimensions some of which have potential to influence the clinical aspects of the appendix. Anatomical studies on the appendix using people in Bangladesh as a sample are limited and fall short of producing any standardized anthropometric data. This study is predominantly a cross-sectional observational study which also uses some statistical analysis to understand the relationships amongst variables., Material and Methods: Fifty-six adult male postmortem appendices and adnexa were examined for macroscopic features. Possible interrelationships among the variables were assessed through statistical analysis. The age of the samples ranged from 18 to 67 years. The most common position of the appendix was retrocolic (53.57%) followed by pelvic (30.35%), postileal (12.5%), and subcaecal (3.5%)., Results: In most cases (62.5%) the mesoappendix did not reach the tip of the appendix. The appendicular length varied from 6.00 cm to 16.30 cm with mean (± SD) and median value of 10.21 ±2.50 cm and 10.00 cm respectively. The base of the appendix was 1.90 to 3.80 cm away from the ileocaecal junction. The other macroscopic measurements of the appendix were taken at the base, at the midzone and at the tip of the appendix and the mean of the three measurements was considered as the overall value. Thus, the overall external diameter varied between 0.32 cm and 0.83 cm. Assessment of possible correlations amongst different variables revealed a significant negative correlation between the age of the subjects and the length of the appendix., Conclusions: The data of the present study may provide a baseline along with some previous data in the standardization of the anthropometric information regarding the vermiform appendix of Bangladeshi males.