Medical knowledge of ChatGPT in public health, infectious diseases, COVID-19 pandemic, and vaccines: multiple choice questions examination based performance.

Background: At the beginning of the year 2023, the Chatbot Generative Pre-Trained Transformer (ChatGPT) gained remarkable attention from the public. There is a great discussion about ChatGPT and its knowledge in medical sciences, however, literature is lacking to evaluate the ChatGPT knowledge level in public health. Therefore, this study investigates the knowledge of ChatGPT in public health, infectious diseases, the COVID-19 pandemic, and its vaccines. Methods: Multiple Choice Questions (MCQs) bank was established. The question's contents were reviewed and confirmed that the questions were appropriate to the contents. The MCQs were based on the case scenario, with four sub-stems, with a single correct answer. From the MCQs bank, 60 MCQs we selected, 30 MCQs were from public health, and infectious diseases topics, 17 MCQs were from the COVID-19 pandemic, and 13 MCQs were on COVID-19 vaccines. Each MCQ was manually entered, and tasks were given to determine the knowledge level of ChatGPT on MCQs. Results: Out of a total of 60 MCQs in public health, infectious diseases, the COVID-19 pandemic, and vaccines, ChatGPT attempted all the MCQs and obtained 17/30 (56.66%) marks in public health, infectious diseases, 15/17 (88.23%) in COVID-19, and 12/13 (92.30%) marks in COVID-19 vaccines MCQs, with an overall score of 44/60 (73.33%). The observed results of the correct answers in each section were significantly higher (p = 0.001). The ChatGPT obtained satisfactory grades in all three domains of public health, infectious diseases, and COVID-19 pandemic-allied examination. Conclusion: ChatGPT has satisfactory knowledge of public health, infectious diseases, the COVID-19 pandemic, and its vaccines. In future, ChatGPT may assist medical educators, academicians, and healthcare professionals in providing a better understanding of public health, infectious diseases, the COVID-19 pandemic, and vaccines.

Evaluating the Clinical Effectiveness and Safety of Semaglutide in Individuals with Uncontrolled Type 2 Diabetes. Real-World Evidence from Saudi Arabia: The Observational, Multicenter, 15-Month EVOLUTION Study.

INTRODUCTION: This study aimed to assess the safety and effectiveness of semaglutide, administered either by weekly subcutaneous (SC) injection or orally, in real-life practice in Saudi Arabia in individuals with type 2 diabetes mellitus (T2DM). METHODS: A retrospective chart review study was conducted at 18 Saudi Arabia centers. An accredited centralized institutional review board approved the study. Medical records were included for individuals of any age ≥ 18 years with uncontrolled T2DM. The primary outcome measure was the laboratory glycated hemoglobin (HbA1c) level. Secondary measures included fasting blood glucose (FBG), weight, and hypoglycemia. All variables were checked after 6 and 12 months of semaglutide initiation. RESULTS: The analysis of this study included 1223 patients with uncontrolled T2DM (HbA1c > 7%). The mean (SD) baseline HbA1c was 10.02% (1.17). HbA1c was reduced by an average of 3.02% (0.84) and 3.17% (0.84) at 6 and 12 months, respectively. Results of a repeated measure analysis of variance (ANOVA) indicated significant differences in HbA1c (p value < 0.001). HbA1c levels at 6 and 12 months were significantly lower, 7.00% (0.70) and 6.85% (0.69), than at baseline, 10.02% (1.17). About 193 patients (56.4%) of the 295 patients having HbA1c < 9% achieved HbA1c of 5.7% or less. The frequency of hypoglycemia events was 4.60 (1.10) in the 3 months before semaglutide was initiated. The frequency of hypoglycemia events in the last 3 months was 2.30 (0.80) events and 0.80 (0.50) events at 6-month and 12-month follow-up visits, respectively. The percent reduction in body mass index (BMI) was an average of 13.07% (1.53) and 19.89% (4.07) at 6 and 12 months, respectively. Lipid profile and blood pressure were improved at 6 and 12 months. CONCLUSION: Semaglutide, administered either by SC injection or orally, provided substantial glycemic and weight-loss benefits in adults with T2DM.

ChatGPT Knowledge Evaluation in Basic and Clinical Medical Sciences: Multiple Choice Question Examination-Based Performance.

The Chatbot Generative Pre-Trained Transformer (ChatGPT) has garnered great attention from the public, academicians and science communities. It responds with appropriate and articulate answers and explanations across various disciplines. For the use of ChatGPT in education, research and healthcare, different perspectives exist with some level of ambiguity around its acceptability and ideal uses. However, the literature is acutely lacking in establishing a link to assess the intellectual levels of ChatGPT in the medical sciences. Therefore, the present study aimed to investigate the knowledge level of ChatGPT in medical education both in basic and clinical medical sciences, multiple-choice question (MCQs) examination-based performance and its impact on the medical examination system. In this study, initially, a subject-wise question bank was established with a pool of multiple-choice questions (MCQs) from various medical textbooks and university examination pools. The research team members carefully reviewed the MCQ contents and ensured that the MCQs were relevant to the subject's contents. Each question was scenario-based with four sub-stems and had a single correct answer. In this study, 100 MCQs in various disciplines, including basic medical sciences (50 MCQs) and clinical medical sciences (50 MCQs), were randomly selected from the MCQ bank. The MCQs were manually entered one by one, and a fresh ChatGPT session was started for each entry to avoid memory retention bias. The task was given to ChatGPT to assess the response and knowledge level of ChatGPT. The first response obtained was taken as the final response. Based on a pre-determined answer key, scoring was made on a scale of 0 to 1, with zero representing incorrect and one representing the correct answer. The results revealed that out of 100 MCQs in various disciplines of basic and clinical medical sciences, ChatGPT attempted all the MCQs and obtained 37/50 (74%) marks in basic medical sciences and 35/50 (70%) marks in clinical medical sciences, with an overall score of 72/100 (72%) in both basic and clinical medical sciences. It is concluded that ChatGPT obtained a satisfactory score in both basic and clinical medical sciences subjects and demonstrated a degree of understanding and explanation. This study's findings suggest that ChatGPT may be able to assist medical students and faculty in medical education settings since it has potential as an innovation in the framework of medical sciences and education.

Schwannoma Misdiagnosed as Adrenal Adenoma: A Case Report and Review of the Literature.

Schwannoma is a benign neurogenic tumor originating from the neural sheath of Schwann cells. It is an extremely rare cause of adrenal adenoma which is very difficult to diagnose preoperatively. We report the case of a right adrenal schwannoma discovered incidentally in a 62-year-old woman during evaluation of right flank pain. The biochemical and hormonal evaluations were unremarkable. Radiological examination revealed a 4.8 cm lesion keeping with right adrenal adenoma. Surgical intervention was done due to the large size of the tumor, and laparoscopic right adrenalectomy was performed. The postoperative course was uneventful. Histological examination established the diagnosis of schwannoma, which was further confirmed by immunohistochemical staining. In conclusion, adrenal schwannoma is extremely rare and can be misdiagnosed as nonsecreting adrenal adenoma. Complete surgical excision is the treatment of choice which is associated with favorable outcome and also helps in clarifying its histopathological nature.

Lung Metastasis in Pediatric Thyroid Cancer: Radiological Pattern, Molecular Genetics, Response to Therapy, and Outcome.

Context: Lung metastases are common in pediatric thyroid cancer (TC). We present an analysis of a series of lung metastases in pediatric TC. Patients and Methods: Data from 20 patients (16 females, 4 males; median age, 14.5 years; range 10 to 18 years) were analyzed. The tumors included differentiated TC in 19 patients and poorly differentiated TC in 1 patient. Results: Lung metastasis presented with three distinct radiological patterns: lung uptake on diagnostic radioactive iodine whole body scan (DxWBS) only in 3 patients (15%); lung uptake on DxWBS and CT scan as micrometastases (≤1 cm) in 16 patients (80%); and lung uptake on DxWBS and CT scan as macrometastases (>1 cm) in 1 patient (5%). Iodine-131 therapies were administered to all patients (median, three; range one to eight) with a median cumulative administered activity of 317.5 mCi (range, 109 to 682 mCi). None of the patients achieved a complete response but the biochemical response was substantial. During a median follow-up period of 8.2 years (range, 0.75 to 16.3 years), 1 patient (5%) died, 1 patient (5%) had a biochemically incomplete response, 2 patients (10%) had an indeterminate response, 1 patient (5%) had progressive structural disease, and 14 patients (70%) had stable structural disease. Mutational testing of 10 of 20 tumors revealed only two PIK3CA mutations in a single tumor. Conclusions: Lung metastases are common in pediatric TC and present most frequently with bilateral radioiodine-avid micrometastases. Known single point mutations in adult TC are rare in pediatric TC. The biochemical response to iodine-131 can be substantial but resolution of structural abnormalities is rare.

Health care services provided to type 1 and type 2 diabetic patients in Saudi Arabia.

OBJECTIVES: To assess health care services provided to type 1 and type 2 diabetic patients and diabetes health care expenditure in the Kingdom of Saudi Arabia (KSA). METHODS: This study was part of a nationwide, household, population based cross-sectional survey conducted at the University Diabetes Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia between January 2007 and December 2009 covering 13 administrative regions of the Kingdom. Using patients' interview questionnaires, health care services data were collected by trained staff. RESULTS: A total of 5,983 diabetic patients were chosen to assess health care services and expenditure. Approximately 92.2% of health services were governmental and the remaining 7.8% were in private services. The mean annual number of visits to physicians was 6.5±3.9 and laboratories was 5.1±3.9. Diabetic patients required one admission every 3 years with a mean admission duration of 13.3±28.3 days. General practitioners managed 85.9% of diabetic cases alone, or shared with internists and/or endocrinologists. Health care expenditure was governmental in 90% of cases, while it was personal in 7.7% or based on insurance payment in 2.3%. CONCLUSION: Health services and its expenditure provided to diabetic citizens in Saudi Arabia are mainly governmental. Empowerment of the role of both the private sector and health insurance system is badly needed, aside from implementing proper management guidelines to deliver good services at different levels.

Epidemiology of abnormal glucose metabolism in a country facing its epidemic: SAUDI-DM study.

BACKGROUND: Saudi Arabia is a community thrilled by sudden social and economical changes, leading to a sharp increase in the prevalence of abnormal glucose metabolism. Age-specific diabetes and impaired fasting glucose prevalence is the focus of this study with the expected risk factors. METHODS: A nationwide, household, randomized, population based cohort of 18 034 participants aged ≥30 years was selected to test for abnormal glucose metabolism using fasting plasma glucose (FPG) according to American Diabetes Association (ADA) criteria. RESULTS: The prevalence of diabetes was 25.4% with 40.3% being unaware of their disease, while impaired fasting glucose (IFG) affected 25.5% of the total sample. IFG to diabetes ratio was one in this study, decreasing with age and increasing with body weight. Age ≥45 years, hypertension, history of gestational diabetes mellitus (GDM), and high triglycerides are the strongest risk factors in diabetic patients, while history of GDM, dyslipidemia, obesity, and high triglycerides are the most significant risk factors in IFG participants. CONCLUSIONS: Abnormal glucose metabolism has reached an epidemic level in this society, where half of adults and older are affected. Risk factors are behind this epidemic and the quick shift from IFG to diabetes in this society.

Diabetic retinopathy and its risk factors in a society with a type 2 diabetes epidemic: a Saudi National Diabetes Registry-based study.

PURPOSE: To assess diabetic retinopathy prevalence and its risk factors in a society with type 2 diabetes epidemic using the Saudi National Diabetes Registry (SNDR). METHOD: This is a cross-sectional study using patient's clinical data found in SNDR data base. A cohort of 50,464 Saudi patients with type 2 diabetes aged ≥25 years were selected to assess for the prevalence and risk factors for diabetic retinopathy. RESULTS: The overall prevalence of diabetic retinopathy is 19.7%, where 9.1% have non-proliferative diabetic retinopathy (NPDR), 10.6% have proliferative diabetic retinopathy (PDR) and 5.7% have macular oedema (ME). Duration of diabetes and age are the most significant risk factors for diabetic retinopathy with odds ratio (OR) and 95% confidence interval (95% CI) 8.88 (8.30-9.50) and 5.76 (5.10-6.55), respectively. Nephropathy, neuropathy, insulin use, poor glycemic control, hypertension and male gender significantly increased the risk for diabetic retinopathy. Smoking, hyperlipidemia and obesity significantly reduced the risk for diabetic retinopathy among type 2 Saudi diabetic cohort. CONCLUSION: vThe low prevalence of diabetic retinopathy in our registry may be a result of the shortage or absence of well-structured screening programmes. Therefore, many patients with NPDR might have been missed. A prevention programme is needed to reduce the effect of diabetic retinopathy risk factors in this society.

Clinico-laboratory characteristics of diabetic keto acidosis in adults in a tertiary hospital in Saudi Arabia.

OBJECTIVE: The present study is undertaken to evaluate the magnitude of DKA in Saudi population with specific emphasis on clinical laboratory characteristics over 20 years. MATERIAL AND METHODS: A prospective analysis of hospital records of 240 episodes of DKA requiring inpatient admission from December 1985 to December 2005 in adult patients in a tertiary hospital was performed. Besides the demographic data of the patients, the clinico-laboratory parameters relevant to the diabetes and DKA status were thoroughly reviewed. RESULTS: 150 males and 90 females were admitted with DKA with a mean age of 21.77 +/- 7.2 years. 16.6% (n=40) were diagnosed to have DM for the first time and others had a mean duration of DM of 5.02 +/- 4.88 years with an average daily insulin requirement being 45.09 +/- 23.9 units. 80.4% of the DKA episodes occurred in intermediate, secondary school and University level students. The commonest precipitating factors were missed insulin doses (51.2%) and respiratory tract infections (22.5%). The mean duration of stay in the hospital was 6.56 +/- 3.4 days and there were no deaths reported because of DKA. The mean blood sugar on presentation was 23.49 +/- 8.3 mmol/L whereas the mean pH and bicarbonate levels on presentation were 7.21 +/- 0.1 and 14.7 +/- 4.3 meq/L respectively. Blood pH was found to be significantly lower in female patients. Among patients below 20 years of age, females have significantly lower bicarbonate levels (11.7 +/- 6.2). Among patients above 20 years of age females had significantly longer duration of diabetes (8.86 +/- 8.36 years; p < 0.04). CONCLUSIONS: By providing intensive education and increasing the awareness of DKA, a major reduction in morbidity and hospitalizations due to DKA may be expected.