RocScholar (Rochester Regional Health)
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TCL-1314: Central Nervous System T-Cell Lymphoma Secondary to Mycosis Fungoides: Diagnostic and Management Challenges—A Case Report
No full textABCL-890: Aggressive Presentation of Mediastinal Gray Zone Lymphoma as Pericardial Effusion
No full textEvaluating Artificial Intelligence-Driven Responses to Acute Liver Failure Queries: A Comparative Analysis Across Accuracy, Clarity, and Relevance
No full textINTRODUCTION: Recent advancements in artificial intelligence (AI), particularly through the deployment of large language models (LLMs), have profoundly impacted healthcare. This study assesses 5 LLMs-ChatGPT 3.5, ChatGPT 4, BARD, CLAUDE, and COPILOT-on their response accuracy, clarity, and relevance to queries concerning acute liver failure (ALF). We subsequently compare these results with ChatGPT4 enhanced with retrieval augmented generation (RAG) technology.
METHODS: Based on real-world clinical use and the American College of Gastroenterology guidelines, we formulated 16 ALF questions or clinical scenarios to explore LLMs\u27 ability to handle different clinical questions. Using the New Chat functionality, each query was processed individually across the models to reduce any bias. Additionally, we employed the RAG functionality of GPT-4, which integrates external sources as references to ground the results. All responses were evaluated on a Likert scale from 1 to 5 for accuracy, clarity, and relevance by 4 independent investigators to ensure impartiality.
RESULTS: ChatGPT 4, augmented with RAG, demonstrated superior performance compared with others, consistently scoring the highest (4.70, 4.89, 4.78) across all 3 domains. ChatGPT 4 exhibited notable proficiency, with scores of 3.67 in accuracy, 4.04 in clarity, and 4.01 in relevance. In contrast, CLAUDE achieved 3.04 in clarity, 3.6 in relevance, and 3.65 in accuracy. Meanwhile, BARD and COPILOT exhibited lower performance levels; BARD recorded scores of 2.01 in accuracy and 3.03 in relevance, while COPILOT obtained 2.26 in accuracy and 3.12 in relevance.
DISCUSSION: The study highlights Chat GPT 4 +RAG\u27s superior performance compared with other LLMs. By integrating RAG with LLMs, the system combines generative language skills with accurate, up-to-date information. This improves response clarity, relevance, and accuracy, making them more effective in healthcare. However, AI models must continually evolve and align with medical practices for successful healthcare integration
Genome-Wide Association Studies of PET Neuroimaging Identify the Genetic Mechanisms of Alzheimer\u27s Disease Pathophysiology
No full textImpact of Maternal Diabetes on the Incidence of Critical Congenital Heart Disease in the United States
No full textBACKGROUND: Critical congenital heart disease (CCHD) represents a significant subset of congenital heart disease (CHD). While the association between maternal diabetes mellitus and offspring CHD is well established, the specific relationship between maternal diabetes and CCHD remains underexplored.
OBJECTIVES: This study aims to investigate the association between maternal diabetes and the incidence of offspring CCHD.
METHODS: We analyzed natality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) from 2016 to 2021. The data set included information on maternal and paternal attributes, pregnancy history, prenatal care, and congenital anomalies among newborns. We included all live births in the United States, focusing on single births at a gestational age of ≥20 weeks. Multivariable logistic regression was used to explore the relationship between gestational diabetes, pregestational diabetes, and CCHD.
RESULTS: Among 22,646,079 live births, 13,533 cases of CCHD were identified, with an incidence of 6 per 10,000 live births. Pregestational diabetes was associated with a 4.33-fold higher risk of CCHD (aOR: 4.33; 95% CI: 3.93-4.76), and gestational diabetes with a 1.47-fold higher risk (aOR: 1.47; 95% CI: 1.38-1.57). Additional risk factors included pregestational hypertension, gestational hypertension, and late initiation of antenatal care. A longer gestational age was associated with a lower risk of CCHD.
CONCLUSIONS: Maternal diabetes, both pregestational and gestational, significantly increases the risk of CCHD. These findings highlight the need for targeted interventions and monitoring of diabetic mothers to mitigate the risk of CCHD in their offspring
SAT-424 From Hypothyroidism to the Adrenal Crisis: A Rare Case of Isolated Secondary Adrenal Insufficiency
No full textSuperiority of frailty over age in predicting outcomes among clostridium difficile patients: Evidence from national data
No full textBackground: Clostridium difficile infection (CDI) has become a significant healthcare issue with increasing morbidity and mortality in the US and Europe. Frailty, characterized by reduced physical reserves and resistance to stressors, is linked to poor outcomes but its impact on CDI patients remains underexplored. This study seeks to address this gap through a nationwide analysis.
Methods: Using the National Readmission Database from 2016 to 2020, we employed the International Classification of Diseases, 10th revision, Clinical Modifications codes to identify adult patients admitted with CDI. We further stratified CDI hospitalizations based on frailty. Utilizing a regression model, we assessed the impact of frailty on CDI outcomes.
Results: We included 144,611 CDI patients of whom 98,167 (67.88 %) were frail. Multivariate analysis showed that frail CDI patients had significantly higher mortality (adjusted odds ratio (aOR) 4.87), acute kidney injury requiring dialysis (aOR 9.50), septic shock (aOR 14.23), and intensive care unit admission (aOR 6.80). CDI-specific complications were more likely in frail patients, including toxic megacolon (aOR 10.22), intestinal perforation (aOR 2.30), need for colectomy (aOR 3.90) and CDI recurrence (aOR 3.65). Resource utilization, indicated by hospitalization charges, length of stay, and 30-day readmission rates, was greater among frail patients.
Conclusion: Our study underscores the significant association between frailty and various critical endpoints of CDI, including its incidence, mortality, and recurrence. Additionally, frailty independently predicts higher resource utilization and elevated 30-day readmission. Recognizing frailty as a determinant of CDI outcomes can aid clinicians in risk stratification and guide tailored interventions for this population
Enfortumab vedotin induced cutaneous manifestations
Full text linkEnfortumab vedotin(EV) comprises of an anti–nectin-4 monoclonal antibody bound to the chemotherapeutic agent called monomethyl auristatin E, forming an antibody-drug conjugate. It is currently approved for the treatment of locally advanced or metastatic urothelial carcinoma after disease progression on two prior lines of therapy including chemotherapy and immunotherapy. Since nectin-4 is also expressed on the surface of keratinocytes, cutaneous adverse effects are common. Our clinical image depicts a cutaneous adverse reaction to EV and its resolution after discontinuation of EV
One Center\u27s Experience of Pulmonary Embolism after COVID-19: Impact of Vaccination Status
Full text linkBackground: The incidence of pulmonary embolism (PE) has increased since the outbreak of the COVID-19 pandemic and may be due to the observed hypercoagulable state. There is conflicting evidence that thromboembolism risk increases after vaccination and that vaccines decrease the probability of having a thromboembolic event. This study aimed to explore how vaccination status impacts occurrence of PE after a positive COVID-19 test. The hypothesis was that vaccinated, immunocompetent patients have a lower incidence of PE after COVID-19 compared to unvaccinated patients.
Methods: This was a retrospective chart review at a teaching hospital in New England from 1/01/2021 to 3/31/2023 to identify the impact of vaccination status on the incidence of PEs after a positive COVID-19 test in immunocompetent patients. IRB exclusion was obtained. Subjects aged 12 to 80 years old who had PEs within 6 months of testing positive for COVID-19 were included; excluded were outside the age range, without documentation of PE and COVID-19 within 6 months, had orthopedic surgery within three months, chest trauma, thrombophilias, or immunodeficiency; received vector vaccine; and had multiple visits for a PE. Subjects were separated into vaccinated and unvaccinated groups. Charts were reviewed for age, sex, race, documented PE and positive COVID-19 test within 6 months, brand and number of vaccines, and exclusion criteria. Statistics used t-test with p-value 0.05.
Results: Fifty subjects were coded for PE and COVID-19; 23 were excluded, leaving 27 subjects. Ages ranged from 12 to 80 years, with a mean of 63.8. Nineteen were male, 8 female; 23 white and 4 non-white. There were 12 unvaccinated, 15 vaccinated; T-value 1.37, p=0.183. There was no significant difference between development of a PE within six months of a positive COVID-19 test result regardless of vaccination status, which failed to reject the null hypothesis. These results were limited by small sample size.
Discussion: This study found no correlation between vaccination status and PE within 6 months of COVID-19, which neither confirmed nor negated prior studies regarding the relationship between vaccines, PEs, and COVID-19. Further studies may serve to clarify the relationship
Murder Mystery Solved! Unmasking Multi-Generational Familial Death As a Result of Brugada Syndrome
Full text linkBrugada syndrome is an inherited condition that has an increased risk of developing ventricular arrhythmias and sudden cardiac death. This condition can be diagnosed by using the Shanghai Scoring System. Here, we present a patient with an incidental finding of Type 1 Brugada pattern on electrocardiogram amidst atypical neurological findings on presentation to the emergency department and a history of cardiac-related familial deaths of uncertain etiology