Coronary Calcium Scoring and Modifiable Coronary Risk Factors

Introduction: Non-invasive coronary calcium scoring predicts earliest atherosclerotic changes in the coronary arteries on the basis of amount of calcium deposited in the coronary arteries. This study was done to analyze calcium scores in patients with different risk factors for coronary artery disease (CAD). Methods: This was a cross sectional study conducted from 1st November 2015 to 30th April 2016 at Kathmandu Medical College Teaching Hospital. Patient with cardiovascular risk factors were included in the study. These patients underwent coronary calcium scoring. Calcium scores were then compared with the presence of risk factors. Results: Total 467 participants were included in the study. There were 309 (62.2%) males and 158 (33.8%) females. Mean age of patient was 56.6 year (SD = 12.7). The difference in the scores observed with presence or absence of risk factors were statistically significant for gender, smoking, and hypertriglyceridemia (p<0.05) but not significant for impaired fasting glucose, hypertension, and body mass index. Conclusion: This study suggested that presence of traditional risk factors does not necessarily indicate high coronary calcium level

Coronary Calcium Scoring and Modifiable Coronary Risk Factors

Introduction: Non-invasive coronary calcium scoring predicts earliest atherosclerotic changes in the coronary arteries on the basis of amount of calcium deposited in the coronary arteries. This study was done to analyze calcium scores in-patient with different risk factors for coronary artery disease (CAD). Methods: This was a cross sectional study conducted from 1st November 2015 to 30th April 2016 at Kathmandu Medical College Teaching Hospital. Patient with cardiovascular risk factors were included in the study. These patients underwent coronary calcium scoring. Calcium scores were then compared with the presence of risk factors. Results: Total 467 participants were included in the study. There were 309 (62.2%) males and 158 (33.8%) females. Mean age of patient was 56.6 year (SD = 12.7). The difference in the scores observed with presence or absence of risk factors were statistically significant for gender, smoking, and hypertriglyceridemia (p<0.05) but not significant for impaired fasting glucose, hypertension, and body mass index. Conclusion: This study suggested that presence of traditional risk factors does not necessarily indicate high coronary calcium level

Performance of ChatGPT on USMLE: Unlocking the Potential of Large Language Models for AI-Assisted Medical Education

Artificial intelligence is gaining traction in more ways than ever before. The popularity of language models and AI-based businesses has soared since ChatGPT was made available to the general public via OpenAI. It is becoming increasingly common for people to use ChatGPT both professionally and personally. Considering the widespread use of ChatGPT and the reliance people place on it, this study determined how reliable ChatGPT can be for answering complex medical and clinical questions. Harvard University gross anatomy along with the United States Medical Licensing Examination (USMLE) questionnaire were used to accomplish the objective. The paper evaluated the obtained results using a 2-way ANOVA and posthoc analysis. Both showed systematic covariation between format and prompt. Furthermore, the physician adjudicators independently rated the outcome's accuracy, concordance, and insight. As a result of the analysis, ChatGPT-generated answers were found to be more context-oriented and represented a better model for deductive reasoning than regular Google search results. Furthermore, ChatGPT obtained 58.8% on logical questions and 60% on ethical questions. This means that the ChatGPT is approaching the passing range for logical questions and has crossed the threshold for ethical questions. The paper believes ChatGPT and other language learning models can be invaluable tools for e-learners; however, the study suggests that there is still room to improve their accuracy. In order to improve ChatGPT's performance in the future, further research is needed to better understand how it can answer different types of questions.Comment: 12 pages, 4 Figues, 4 table

Outcomes in Patients With COVID-19 Disease and High Oxygen Requirements

Background: Approximately 19% of people infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) progress to severe or critical stages of the coronavirus disease 2019 (COVID-19) with a mortality rate exceeding 50%. We aimed to examine the char- acteristics, mortality rates, intubation rate, and length of stay (LOS) of patients hospitalized with COVID-19 disease with high oxygen re- quirements (critically ill). Methods: We conducted a retrospective analysis in a single center in Brooklyn, New York. Adult hospitalized patients with confirmed COVID-19 disease and high oxygen requirements were included. We performed multivariate logistic regression analyses for statistically significant variables to reduce any confounding. Results: A total of 398 patients were identified between March 19th and April 25th, 2020 who met the inclusion criteria, of which 247 (62.1%) required intubation. The overall mortality rate in our study was 57.3% (n = 228). The mean hospital LOS was 19.1 ± 17.4 days. Patients who survived to hospital discharge had a longer mean LOS compared to those who died during hospitalization (25.4 ± 22.03 days versus10.7 ± 1.74 days). In the multivariate analysis, increased age, intubation and increased lactate dehydrogenase (LDH) were each independently as- sociated with increased odds of mortality. Diarrhea was associated with decreased mortality (OR 0.4; CI 0.16, 0.99). Obesity and use of vaso- pressors were each independently associated with increased intubation. Conclusions: In patients with COVID-19 disease and high oxygen requirements, advanced age, intubation, and higher LDH levels were associated with increased mortality, while diarrhea was associated with decreased mortality. Gender, diabetes, and hypertension did not have any association with mortality or length of hospital stay

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Factors Influencing Customer Satisfaction. Case MOMO & MORE Oy

This thesis investigates the significance of customer satisfaction within the highly competitive business environment of the case company, Momo & More. Recognizing the limitations of customer expectations, the study aims to measure the current level of customer satisfaction and understand customers' needs to enhance customer service specifically for Momo & More. The research also analyzes the factors that influence customer satisfaction within the context of the case company. The theoretical background provides a comprehensive definition of customer satisfaction and emphasizes its importance. The primary focus of the study is to explore effective methods for measuring customer satisfaction and improving customer service and quality, with the goal of maximizing customer satisfaction for Momo & More. The findings of this research hold valuable insights for Momo & More in their pursuit of elevating customer satisfaction levels and enhancing overall business performance. A mixed research methodology, bounding qualitative and quantitative approaches, has been employed in this study. The research outcomes provide practical and tailored recommendations specifically for Momo & More, aimed at improving customer service quality and driving overall customer satisfaction. The business plan of Momo & More revolves around the objective of augmenting customer satisfaction, and this study serves as a guide to achieve that objective

Babesia in a Nonsplenectomized Patient Requiring Exchange Transfusion

Babesiosis is a tick born zoonosis caused by red blood cell parasites of the genus Babesia. It is caused predominantly by B. microti and B. divergens, microti being more common in the US. The parasites are transmitted by Ixodes tick to their host but infection can also spread by blood transfusion and perinatally. Clinical manifestations vary from subclinical infection to fulminating disease depending upon the immune status of the patient. About half of patients, hospitalized with babesiosis, develop complication with fatality rates of 6 to 9% which increase up to 21% among those with immunosuppression. A case of 58-year-old previously healthy man, infected by B. microti, was reported on 2000 who presented with severe disease characterized by severe anemia, DIC, and renal and respiratory failure. First case of overwhelming septic shock without respiratory involvement due to babesiosis in a healthy patient with an intact spleen was published in a case report on 2011. Since our patient here is an immunocompetent healthy male with intact spleen presenting with severe babesiosis requiring exchange transfusion, this presentation of Babesia is rare and warrants further study

Advanced Biventricular Heart Failure due to Left Ventricular Noncompaction Cardiomyopathy Leading to the Formation of a Gastric Bezoar: The Implications of Heart Failure on the Gastrointestinal Tract

Congestive heart failure (CHF) is a chronic disease process affecting multiple organ systems and is associated with significant morbidity and mortality. We report a case of a 43-year-old male with a history of unspecified cardiomyopathy who presented to the hospital with abdominal pain, distention, and nausea for 4 months. He was diagnosed with left ventricular noncompaction and gastroparesis. While symptoms of dyspnea, orthopnea, or increasing peripheral edema are the first that come to mind when thinking of a CHF exacerbation, we must broaden our scope to include such things as nausea, vomiting, abdominal pain, and bloating which can also indicate worsening cardiac function. This case report highlights the significant yet often forgotten gastrointestinal (GI) symptoms that result from advanced biventricular heart failure, with emphasis on impaired gastric and intestinal motility