Meridian (Russia)

INTRODUCTION: ChatGPT-4.0, the most readily available model to date, has shown promise in generating medical documents, but its capacity to meet clinical documentation standards in obstetrics remains underexplored. This study assesses the completeness of cesarean birth operative notes generated by ChatGPT-4.0 based on standard surgical documentation requirements. METHODS: Twenty cesarean birth operative notes were generated using ChatGPT-4.0. Each note was evaluated for the presence of essential elements, including date of surgery, patient identifiers, surgeon and assistants’ names, anesthesia provider, preoperative and postoperative diagnoses, procedure, and additional procedural details. RESULTS: All 20 notes contained the date of surgery, names of the surgeon and assistants, the name of the anesthesia provider, the procedure performed, and estimated blood loss. A majority of notes included type of anesthesia (95%), method of abdominal access (95%), postoperative diagnosis (80%), skin preparation and draping (80%), patient identifiers (75%), preoperative diagnosis (75%), and specimens sent (70%). However, fewer notes included dressings (45%) and patient position (35%). Significant gaps were found in the documentation of date of dictation (20%), irrigation (5%), and sponge/instrument counts (0%). CONCLUSIONS/IMPLICATIONS: Although ChatGPT-4.0 successfully generated cesarean birth operative notes containing much of the essential documentation elements, notable deficiencies were observed, particularly in dictation dates, irrigation, and sponge/instrument counts. These findings highlight the need for further refinement to ensure that artificial intelligence–generated notes meet clinical documentation standards in obstetrics. Further research is warranted to address these gaps and enhance its utility in medical documentation.

2583 Background: Epstein−Barr virus (EBV) and human papillomavirus (HPV) are considered human oncoviruses. In contrast, the torque teno virus (TTV) is not associated with any disease but its detection in circulation is associated with the status of the immune system. In this study, we examine the prevalence of active EBV, HPV and TTV viral RNA in patients treated for solid tumors or hematologic neoplasms. In addition, we compared differential expression of selected immune and inflammatory biomarkers between Virus positive (V+) and Virus negative (V-) cases using peripheral blood cell-free RNA (cfRNA). Methods: cfRNA was extracted from the peripheral blood of 581patients with a diagnosis of hematologic neoplasms and 558 patients with solid tumor. cfRNA was sequenced by NGS using a targeted RNA panel of 1600 genes and the viral RNA of TTV, EBV and HPV. Two thirds of the samples were used for training and one third for testing machine learning (ML) system (Bayesian/Random Forest) and exploring the presence of specific inflammatory profiles distinguishing V+ from V- patients. Results: RNA testing was selected to ensure that only active and proliferating viruses were detected. We detected TTV in 52/1139 (4.6%), EBV in 251/1139 (22%), and HPV in 68/1139 (6.0%). TTV with EBV codetection was observed in 11 samples (1%), and with HPV in 4 patients (0.4%). Co-detection of EBV with HPV was observed in 13 patients (1.1%). Using 90 biomarkers in ML algorithm can reliably distinguish V+ from V- with AUC of 0.725 (CI: 0.658-0.791) in the testing set. Significantly higher levels of B-cell markers are noted in V+ patients. PD-L1 mRNA was significantly (P <0.001) higher in V+ patients, which suggests that these patients may be more responsive to checkpoint immune therapy. CD70 is also detected at high level in V+ patients (P<0.0001). Upon comparing between the V+ groups (TTV, EBV, and HPV), there was no statistical difference between the three groups after adjusting for multiple testing. However, some difference in cytokine levels was noted between TTV-positive patients and HPV-positive patients. CD36, IFNA2 and IL17A were higher in TTV-positive cases as compared with HPV-positive cases (P-value 0.0003, 0.005 and 0.004, respectively). Conclusions: Globally, detectable active viruses in plasma of patients with cancer is relatively high (29%) and this detection is associated with a specific immune/inflammatory “activation” signature characterized by transcriptomic upregulation of PD-L1 and CD70 and increase in B-cells. There is no specific signature that distinguishes between the V+ subgroups [TTV vs EBV vs HPV]. However, transcriptionally, CD36, IFNA2 and IL17A upregulation distinguished TTV+ and HPV+ cases, a phenomenon that may indicate HPV ability to initiate an immunosuppressive tumor microenvironment.

Observed alterations in seasonal patterns of common pediatric respiratory viruses during and immediately after the COVID-19 pandemic had far-reaching implications for the care of ill children. Here, we quantify the effects of the pandemic and related nonpharmaceutical interventions on the prevalence and seasonality of common pediatric respiratory illnesses. We performed a retrospective chart review within a large health network to identify incidence rates of common respiratory viruses and compared them to historical trends. Time series analyses using seasonal autoregressive integrated moving average models were utilized to identify seasonal patterns for the different virus types and quantify deviations from expected incidence rates. Overall, we noted a steep decline in non-COVID viral infection rates at the onset of the COVID pandemic in March 2020, largely coincident with the institution of mask mandates and lockdown measures. This trend continued until the Spring of 2021, at which time non-COVID infections resurged to rates higher than pre-COVID levels. In addition, the historically observed seasonality of these viruses was significantly disrupted by the pandemic. In particular, the historical peaks for influenza A and human metapneumovirus shifted from February and March, respectively, to bimodal peaks in December 2021 and May 2022; respiratory syncytial virus demonstrated an unprecedented Spring/Summer season in 2021; parainfluenza type 1 was unusually active in 2022, an even-numbered year; and influenza B virtually disappeared during and immediately after the pandemic. Our observations add to the growing body of literature supporting the hypothesis that human interactions are one of the key drivers of pediatric respiratory viral seasonality in addition to climate. Understanding the effect of human interactions on disease spread is crucial for the development of effective mitigation measures for future pandemics while avoiding dangerous spikes of other illnesses once those interventions are lifted.

INTRODUCTION: Pregnancy loss is a sensitive topic, and clear, reliable information is crucial. This study compares the readability and accuracy of ChatGPT's responses to ACOG's frequently asked questions (FAQ) sheets on the subject. METHODS: Within the five FAQ sheets under “Pregnancy Loss,” 66 questions were assessed using ChatGPT-3.5. Readability scores, ie, Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog Score, Smog Index, Coleman Liau Index, and Automated Readability Index were computed for each response. The quality of responses were also graded by two maternal–fetal medicine specialists using a 1–4 scale, where 1 represents a comprehensive response and 4 indicates an incorrect response. Statistical analysis utilized a two-tailed t-test. A weighted Cohen’s kappa coefficient evaluated interrater reliability. RESULTS: ACOG attained better readability scores over ChatGPT across all six metrics with statistical significance (P<.001). Among grading, ACOG also outperformed ChatGPT in quality of information with a summative mean of 1.53 (SD 0.60) versus 1.85 (SD 0.90) with statistical significance (P<.001). Grading for ACOG possessed a Cohen's kappa coefficient of 0.493, implying moderate agreement between graders. Grading for ChatGPT possessed a Cohen's kappa coefficient of 0.744, implying substantial agreement between graders. CONCLUSION: The responses by ACOG to frequently asked questions on pregnancy loss were both clearer and more comprehensive than those of ChatGPT with consistent agreement between graders. Although ChatGPT can be a convenient source of medical queries, further improvements ought to be made to these large-language models to provide clear and accurate information regarding pregnancy loss to patients.

Introduction: Post-vaccination arrhythmia is reported as a possible cardiovascular side effect of COVID-19 vaccination. We present a case of ventricular tachycardia (VT) storm in a young healthy man following the 2nd dose of COVID-19 vaccination in the absence of underlying structural heart disease, myocarditis or arrhythmic syndromes. Description: A 38-year-old male with no medical history was admitted after an out-of-hospital cardiac arrest and found to be in VT storm within 24 hours of receiving his 2nd dose of COVID-19 vaccination. He received 4 shocks en route and had another episode of pulseless VT on arrival where Amiodarone was initiated. Laboratory values showed elevated inflammatory markers, and COVID tests were negative. Troponin peaked at 1.5 ng/ml. Initial transthoracic echocardiogram (TTE) revealed normal left ventricular ejection fraction (LVEF) without regional wall motion abnormality. On Day 2, he developed VT storm and was given magnesium sulfate, lidocaine and an additional bolus of amiodarone. Repeat TTE revealed a significant decrease in EF. He became hypotensive requiring inotropes and was emergently taken to the cath lab where intra-aortic balloon pump (IABP) and temporary transvenous pacing (TVP) were placed. Cardiac catheterization revealed normal coronary arteries, elevated left ventricular end diastolic pressure and mildly dilated LV with global hypokinesis and EF of 30%. His condition slowly improved without further occurrences of VT storm. Follow up TTE revealed normal LVEF, IABP and TVP were removed, and he was extubated. Cardiovascular magnetic resonance imaging showed no evidence of myocarditis with normal LV size. An automatic implantable cardioverter-defibrillator was placed. Genetic testing for Brugada syndrome was negative. Discussion: VT storm typically occurs with underlying structural heart disease, inherited arrhythmic syndromes or myocarditis, and is often difficult to identify a specific trigger. Although this is the first case report of VT storm occurring after the COVID-19 vaccine, it is important to note that the lack of a definitive test to diagnose myocarditis such as biopsy is a major limiting factor. This case report also supports the need for structured studies regarding a possible relationship between VT storm and COVID-19 vaccination.

-

A method for evaluating the complexity of arbitrary function of Boolean algebra is examined, based on presenting such a function as a composition of monotone functions. Accurate upper estimates have been received for the complexity of monotone and arbitrary functions depending on a small number of variables.

КОНСТРУКТИВНЫЕ ОСОБЕННОСТИ СЕЯЛОК И ПОКАЗАТЕЛИ ИХ РАБОТЫ ¹Шварц Анатолий Адольфович ¹Шварц Сергей Анатольевич ¹Полушин Иван

в представленной статье исследователем рассматриваются взаимосвязь экономического анализа финансовой отчетности предприятия и аудита. Рассматриваются этапы, методы и инструменты, используемые в экономическом анализе и их использование при аудиторской проверке предприятия.