Jordan Medical Journal

Envisioning the Future of ChatGPT in Healthcare: Insights and Recommendations from a Systematic Identification of Influential Research and a Call for Papers

Malik Sallam — 2024-02-19

Background and Aims: ChatGPT represents the most popular and widely used generative artificial intelligence (AI) model that received significant attention in healthcare research. The aim of the current study was to assess the future trajectory of the needed research in this domain based on the recommendations of the top influential published records.

Materials and Methods: A systematic search was conducted on Scopus, Web of Science, and Google Scholar (27–30 November 2023) to identify the top ten ChatGPT-related published records in healthcare across the three databases. Classification of the records as “top” denoting high influence in the field was based on citation counts.

Results: A total of 22 unique records from 17 different journals representing 14 different publishers were identified as the top ChatGPT-related publications in healthcare subject. Based on the identified records’ recommendations, the following themes appeared as important areas to consider in future ChatGPT research in healthcare: improving healthcare education, improved efficiency of clinical processes (e.g., documentation), addressing ethical concerns (e.g., patient privacy and consent), supporting research tasks (e.g., data analysis, manuscript preparation), mitigating ChatGPT output biases, improving patient education and engagement, and developing standardized assessment protocols for ChatGPT utility in healthcare.

Conclusions: The current review highlighted key areas to be prioritized in assessment of ChatGPT utility in healthcare. Interdisciplinary collaborations and standardizing methodologies are needed to synthesize robust evidence in these studies. Based on these recommendations and the promising potential of ChatGPT on healthcare, JMJ launched a call for papers for a special issue entitled “Evaluating Generative AI-Based Models in Healthcare”.

Prevalence and clinical characteristics of pediatric cystinuria in Ahvaz, southwest of Iran

Mohsen Fathi — 2024-02-18

Objective: This retrospective hospital-based study is aimed at investigating the 6-year prevalence and clinical characteristics of pediatric cystinuria in Ahvaz, southwest of Iran.

Method: Demographic and clinical data belonging to children with kidney stone disease (KSD) who referred to nephrology wards were obtained from the medical records. Then, data were statistically analyzed and compared between the two groups of children with non-cystine kidney stones and those with cystinuria.

Results: From a total of 415 patients with KSD, 45 cases (10.8%) had cystinuria and 370 cases (89.2%) had non-cystine kidney stones. Overall, the incidence rate of KSD was higher in boys (53.7%) than girls (46.3%, p=0.03). However, no significant difference in age and gender was observed between the two groups (p>0.05). Parental consanguinity [OR (95%):4.1(2.15_7.8), p=0.0001] and bilateral renal involvement [OR (95%):2.38(1.25_4.53), p=0.01] were more frequent among children with cystinuria. The number and size of cystine stones were significantly higher than non-cystine stones [p=0.0001]. Hypercalciuria (60.72%) and hyperuricosuria (40.1%) were the most frequent metabolic disorders, which were significantly more frequent in patients with non-cystine stones (p<0.01). The rate of complete recovery in cystinuria patients was significantly lower than in patients with non-cystine stones (51% vs 83.2%, p=0.0001).

Conclusion:

Parental consanguinity may increase the risk of cystinuria development. Also, notable prevalence of symptomatic cystinuria at younger ages highlights importance of metabolic assessment in early childhood. Bilateral renal involvement, high number/size of cystine stones and their recurrent nature may make cystinuria patients more vulnerable to renal parenchymal damage and more resistant to treatments.

COVID-19 in Patients with Different Hematological Malignancies: Treatment Strategy and Outcome: An Iraqi Experience

Alaadin Sahham Naji — 2024-02-18

Background: Patients with hematological malignancies may have higher rates of morbidity and mortality due to SARS-COVID-19 than those in the general population. Objectives: To evaluate the outcome of SARS-COVID-19 in patients with different hematological malignancies undergoing active or modified therapy. Settings: This was a retrospective cohort, multicenter study conducted on 167 patients diagnosed with SARS-COVID-19. The selected patients had been diagnosed with different hematological malignancies and had received treatment (chemotherapy or immunosuppressive). The study was carried out in different centers across Iraq between 1 December 2020 and 1 December 2021. Patients and Methods: This study was conducted in seven hematology centers across Iraq with 167 patients; of these, this study showed that 88 (52.7%) were males and 79 (47.3%) were females (mean age 51.9 ± 18.3 years). All patients had had a COVID-19 infection confirmed through RNA-specific fragments by real-time reverse transcriptase polymerase chain reaction (RT-PCR) of the nasopharyngeal swab specimens, and by computed tomography (CT) of the chest. Demographic data were obtained from patient files, which included the type of hematological malignancy, treatment (chemotherapy, immunotherapy, supportive), severity of COVID-19, modification of treatment and disease outcome for patients, whether alive or not. Patients identified as having benign or non-hematological malignancies were excluded. Results: The treatment protocol was modified in 124 patients (74.3%), while 43 patients (25.7%) continued on the same protocol. Regarding treatment outcomes, 77.2% of patients were alive at the end of the study and 22.8% had died. The survival of COVID-19 patients did not change significantly when the treatment protocol was modified compared to those who continued on treatment as per protocol. The death rate was significantly higher among patients with severe disease compared to those with mild and moderate disease (61.4% v. 0% and 5.0%, respectively) (p<0.001). Conclusions: The management of patients with hematological malignancies during the COVID-19 pandemic may be challenging, with higher mortality in patients with concurrent hematological malignancies and COVID-19. The survival of COVID-19 patients did not change significantly when treatment was modified. Age groups, sex, type of hematological malignancy, and disease status did not affect the survival of these patients. The death rate was significantly higher among patients with hematological malignancies and severe COVID-19 compared with mild or moderate disease.

Impact of the COVID-19 Pandemic on the Incidence of Complicated Appendicitis in a Tertiary Medical Center, Amman, Jordan. A retrospective cohort.

Marzouq Amarin — 2024-02-18

Abstract

Objective: To assess the incidence of complicated appendicitis during the COVID-19 pandemic in Jordan University Hospital.

Materials and Methods: in this cohort study, we retrospectively investigated data on acute appendicitis cases, two groups were established, the first group was the pandemic group, which includes patients who presented to the hospital during the period of acute restrictions and shutdowns extending from the 17th of March to the 6th of June 2020, and the pre-pandemic group which represents the same period in the previous year. These two groups were compared in terms of clinical characteristics and the prevalence of complicated appendicitis.

Results: A total of 45 patients were included in the study, 24 in the pandemic group and 21 in the pre-pandemic group. Gender distribution was not significant between the two periods (P-value>0.05). Rates of occurrence of overall complications, preoperative complications, and intraoperative complications were similar indicating no significant difference between the two groups (P-value=0.526, 0.835, and 0.547, respectively). The duration between symptoms and admission and ALVARADO score were not significantly different between the two study groups. Also, the duration of in-hospital stay was numerically but not significantly lower in the 2019 (March-June) group compared to 2020 (March-June).

Conclusion: In our study, there was no significant difference in the incidence of complicated appendicitis between pandemic and pre-pandemic groups.

Complications after Thyroidectomy; a Comparison Among Seven Different Surgical Procedures and the Impact of Central Compartment Lymph Nodes Sampling: a Cohort Study

Ayman Mismar — 2024-02-18

Introduction: Thyroid nodules are commonly encountered in medical practice. The relation between the magnitude of thyroid surgery and its complications is not settled.

Objectives: Our aim is to examine the incidence of recurrent laryngeal nerve injury and hypoparathyroidism after thyroid surgery in different thyroid procedures including local lymph nodes control.

Methods: The records of 345 patients who underwent thyroidectomy at the Jordan University Hospital from January 2010 to December 2016 were reviewed. They were divided into seven groups (total thyroidectomy, near-total thyroidectomy, hemithyroidectomy, completion thyroidectomy, redo surgery, hemithyroidectomy with completion, and near-total thyroidectomy with completion). A comparison among the groups was done. Ninety-one patients who underwent central lymph nodes biopsy were identified. They were divided into three groups (pre-tracheal lymph nodes excision, central neck dissection, and central neck sampling) and then compared.

Results: Transient hypocalcemia was significantly higher with total thyroidectomy in comparison to near-total thyroidectomy and hemithyroidectomy with or without completion. All groups were comparable regarding permanent hypocalcemia and recurrent laryngeal nerve palsy. No significant relationship between the type of dissection and complication rate was found.

Conclusion: Near-total thyroidectomy is a safe alternative to total thyroidectomy with a lower early complication rate. Redo surgery and central dissection are not associated with higher morbidity.

Prevalence of Obsessive-Compulsive Personality Disorder in Medical Students

Mohammad Al-Na’she — 2024-02-18

Objective: Obsessive-compulsive personality disorder (OCPD) is a cluster C personality disorder, and the most prevalent one. It is mainly characterized by perfectionism and can cause distress and functional impairment in the individual. This study aimed to determine the prevalence of OCPD in medical students, investigate the effect of this disorder on students’ academic performance, and discover any possible related factors.

Methods: This cross-sectional observational study consisted of 508 medical students enrolled at the University of Jordan in 2021. It utilized a questionnaire that enquired about their sociodemographic information, academic information, and study habits. It also contained questions about the diagnostic criteria of OCPD from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and questions from the Personality Inventory for the DSM-5 (PID-5) to assess the presence of the rigid perfectionism personality trait.

Results: Fifty-one percent of the studied sample either fulfilled the DSM-5 criteria or showed moderate or high expression of rigid perfectionism, according to the PID-5. More than two-thirds of the students able to be diagnosed with OCPD reported being overwhelmed with anxiety and stress at times of exams, and 41.5% stated that they skip sleep before exams even though they have finished studying.

Conclusion: The reported prevalence of 51.18% in medical students is ten times the prevalence of OCPD in the general population. There was no association between OCPD and the students’ gender or academic performance. Students affected by OCPD seem to experience overwhelming amounts of stress and may need mental health support in the form of regular check-ups and counseling services.

Lineage Switching from Acute Myeloid Leukemia associated with Systemic Mastocytosis to B-Acute Lymphoblastic Leukemia: A Diagnostic Dilemm

Marne Abdullah — 2024-02-18

Relapse acute leukemia is defined as the reappearance of more than 5% blast in the bone marrow. In most
instances, blast expresses the specific lineage (myeloid or lymphoid), similar to a diagnosis. However, it rarely
converts to a different lineage, either myeloid shifting to lymphoid or vice versa, during relapse. Thus, it is labelled
as switching lineage acute leukemia, after excluding the criteria for mixed phenotypic acute leukemia, which can
be a challenge to diagnose. We describe a 24-year-old gentleman with a known case of acute myeloid leukemia
associated with systemic mastocytosis (SM); eight months later and after two complete cycles of chemotherapy,
relapse occurred with a switched lineage to B-acute lymphoblastic leukemia. The laboratory investigation
approaches and the challenges in the diagnosis are also discussed in this case report

The Value of Axial Imaging to Check Reduction after Anterior Approach Open Reduction for Developmental Dysplasia of the Hip

Saeed Al-Naser — 2024-02-18

Background: There are still many controversies regarding the diagnosis and management of developmental dysplasia of the hip (DDH). Axial imaging is routinely used after closed or open reduction to confirm reduction has occurred. In this study, we aimed to determine the rate of early re-dislocation or failure of reduction after anterior approach open reduction (AOR), to establish whether there is a true need for routinely performing post-operative axial imaging.

Methods: We retrospectively reviewed radiographs, operation notes and post-operative CT scan images of our AOR cases from September 2018 to June 2020. The CT scan images were reviewed to check the post-operative reduction and congruency. The ‘posterior neckline’ and the ‘modified Shenton line’ were used to assess reduction. The related literature was also reviewed.

Results: Thirty patients were included. The post-operative CT scans confirmed that all cases had reduced congruent hips. The CT scans did not change future treatment plans for any patient in this cohort and did not predict late re-dislocation.

Conclusions: The rate of early re-dislocation or failure of reduction after AOR was negligible. Traditional routine axial imaging after this operation is therefore unjustified and has no value in predicting possible late re-dislocations. It also comes at the cost of extra radiation to the child and expense for the health system. We recommend stopping the routine use of post-operative axial imaging and using it selectively for specific indications, including teratologic and neuromuscular hips, bilateral DDH, and after revision surgery, in addition to closed reductions and medial approach open reduction.

Depression Among Medical Students at West Bank Universities

Mayar Idkedek — 2024-02-18

This study investigated the propensity for medical students to experience symptoms of depression, relative to other students, at West Bank Palestinian universities. In addition, the study evaluated the socio-demographic or academic factors that might influence this propensity. A quantitative, cross-sectional study was conducted on 714 medical and non-medical students from Al-Quds and Al-Najah Universities. Data were generated through a questionnaire that included sociodemographic parameters and academic status, and measured depression using the Beck Depression Inventory. The data were analyzed using SPSS (v. 20). About a third of the sample’s medical students suffered from some form of depression. Moderate depression appeared to be relatively high among medical (18.7%) and non-medical students (25.5%). At all depression levels, there was a significantly lower prevalence of depression among medical students compared to non-medical, with the exception that the medical students suffered a higher rate of mild mood disturbances (25.1%) than the non-medical (14.6%). Furthermore, there were significant correlations (α ≤0.05) between a higher prevalence of depression and being female, lower grade point average (GPA), lower economic status, and a lack of psychological support. Other variables, such as accommodation and year of study, showed insignificant relationships with depression. Depression was highly prevalent among the students, regardless of their university or field of study, which probably reflects the high depression rates in the wider Palestinian society. Nevertheless, the lower prevalence of depression among the medical students may be attributed to the fact that higher quality students are accepted by medical schools and their level of adaptation to stress and hard work. Finally, our results challenge the perception of a higher depression rate among medical students.

Quality of Life among Individuals with Stroke in Jordan

Somaya Malkawi — 2024-02-18

Abstract

Background and aims: Stroke has long-term consequences for the functional performance of daily activities. Evaluating the impact of stroke on health and wellbeing is essential in designing stroke-specific programs supporting home and community participation. This study described the impact of stroke on quality of life as reported by stroke survivors. Additionally, this study examined the effect of different personal and clinical characteristics on the quality of life among adults with stroke. Materials and Methods: This cross-sectional study encompassed a sample of 64 adults with stroke (mean age 58.9 years) who are currently receiving rehabilitation services after stroke onset. Outcome measures included the Stroke Impact Scale (SIS) and its subdomains to assess the self-perceived disability following a stroke. The data analysis plan included MANOVA, followed by ANOVA of main effects and post-hoc analyses. Results: Jordanian individuals with stroke had a mean SIS total score of 59.9 (SD ±15.4, Range 25.8– 94) indicating moderate levels of quality of life following stroke. Furthermore, patients reported that hand function, strength, activities of daily living (ADL), participation, and emotions domains received lower mean scores of SIS in these areas. Participants with a higher number of previous strokes had significantly lower emotional subdomain scores on the SIS (p=0.001). Participants with aphasia had significantly lower scores in the memory (p< 0.001) and communication subdomains (p=0.0001). Conclusion: Individuals with stroke reported moderate levels of disability after stroke onset. Having aphasia, and an increased number of previous strokes were associated with greater challenges in quality of life following stroke.

Keywords: Stroke, Quality of Life, Performance, Rehabilitation.

Serum Cytokeratin-18 as a Non-invasive Biomarker and its Association with Biochemical Parameters in the Diagnosis of Non-alcoholic Fatty Liver Disease

Ali Albeltaji — 2024-02-18

Objective: Nonalcoholic fatty liver disease (NAFLD) is one of the chronic silent diseases in which its therapeutic options and noninvasive markers of disease activity and severity remain limited. We aimed in this study to assess cytokeratin-18 (CK18) as a new non-invasive biomarker to distinguish between NAFLD stages and its correlation with some biochemical parameters.

Methods: A case control study was conducted on a sample of 90 subjects aged 12-79 years, categorized into three groups (nonalcoholic steatohepatitis "NASH", steatosis and controls). CK18, fasting blood glucose (FBG), lipid profile parameters, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine were determined. Low destiny lipoprotein-cholesterol (LDL-C), and body mass index (BMI) were calculated in addition to performing complete blood count (CBC).

Results: The results indicate that the mean level of serum CK18 in NASH cases was significantly higher than steatosis and control groups. CK18 has a positive correlation with triglycerides (TG) total cholesterol (TC), ALT, AST, FBG, urea, creatinine, age, BMI, and LDL-C, and a negative correlation with high density lipoprotein-cholesterol HDL-C. Finally, ROC curve showed that the sensitivity of CK18 test is 77.1% and specificity is 96.6%. The cut-off value for CK18 test is 161 U/L.

Conclusions: In this study, a significant relationship was observed between CK18, hepatic enzymes, and NAFLD degrees. CK18 has good accuracy, sensitivity, and specificity in diagnosing NASH.