Tolga Demir

Introduction: To assess and compare the knowledge of ChatGPT and Google Gemini in answering public-based and scientific questions about peripheral artery disease (PAD). Methods: Frequently asked questions (FAQs) about PAD were generated by evaluating posts on social media, and the latest edition of the European Society of Cardiology (ESC) guideline was evaluated and recommendations about PAD were translated into questions. All questions were prepared in English and were asked to ChatGPT 4 and Google Gemini (formerly Google Bard) applications. The specialists assigned a Global Quality Score (GQS) for each response. Results: Finally, 72 FAQs and 63 ESC guideline-based questions were identified. In total, 51 (70.8%) answers by ChatGPT for FAQs were categorized as GQS 5. Moreover, 44 (69.8%) ChatGPT answers to ESC guideline-based questions about PAD scored GQS 5. A total of 40 (55.6%) answers by Google Gemini for FAQs related with PAD obtained GQS 5. In addition, 50.8% (32 of 63) Google Gemini answers to ESC guideline-based questions were classified as GQS 5. Comparison of ChatGPT and Google Gemini with regards to GQS score revealed that both for FAQs about PAD, and ESC guideline-based scientific questions about PAD, ChatGPT gave more accurate and satisfactory answers ( p = 0.031 and p = 0.026). In contrast, response time was significantly shorter for Google Gemini for both FAQs and scientific questions about PAD ( p = 0.008 and p = 0.001). Conclusion: Our findings revealed that both ChatGPT and Google Gemini had limited capacity to answer FAQs and scientific questions related with PDA, but accuracy and satisfactory rate of answers for both FAQs and scientific questions about PAD were significantly higher in favor of ChatGPT.

Objectives: This study aims to determine the protective effect of cilostazol on myocardium in obese Wistar rats with induced ischemia-reperfusion injury (IRI). Methods: Four groups with 10 Wistar rats were included: 1] Sham Group: IRI was not established in normal weight-Wistar rats. 2] Control Group: IRI but no cilostazol in normal weight-Wistar rats. 3] Cilostazol in normal weight-Wistar rats: IRI and cilostazol was administered. 4] Cilostazol in obeseWistar rats: IRI and cilostazol was administered. Results: Tissue adenosine triphosphate (ATP) levels were significantly higher and superoxide dismutase (SOD) levels significantly lower in the control group than in the sham group and normal weight cilostazol group (p=0.024 and p=0.003). Fibrinogen levels were 198 mg/dL in the sham group, 204 mg/dL in the control group, and 187 mg/dL in the normal-weight cilostazol group (p=0.046). Additionally, plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in the control group (p=0.047). The level of ATP was significantly lower in the normal-weight cilostazol group than in the obese group (104 vs 131.2 nmol/g protein, p=0.043). PAI-1 level was 2.4 ng/mL in the normal weight cilostazol group and 3.7 ng/mL in the obese cilostazol group (p=0.029). Normal-weight Wistar rats with cilostazol had significantly better histologic outcomes than the control group and obese Wistar rats (p=0.001 and p=0.001). Conclusion: Cilostazol has a protective effect on myocardial cells in IRI models by decreasing inflammation. The protective role of cilostazol was reduced in obese Wistar rats compared with normal-weight Wistar rats.

Objective: This study was conducted to identify the diagnostic value of carotid stump pressure for determining the need for a carotid artery shunt in patients undergoing carotid artery endarterectomy. Materials and methods: Carotid stump pressure was prospectively measured in all carotid artery endarterectomies performed under local anesthesia between January 2020 and April 2022. The shunt was selectively used when neurological symptoms appeared after carotid cross-clamping. Carotid stump pressure was compared between patients who needed shunting and those who did not. Demographic and clinical characteristics, hematological and biochemical parameters, and carotid stump pressure of the patients with and without shunts were statistically compared. To determine the optimal cutoff value and diagnostic performance of carotid stump pressure for identifying the patients who need a shunt, receiver operating characteristic analysis was performed. Results: Overall, 102 patients (61 men and 41 women) who underwent carotid artery endarterectomy under local anesthesia were included, with an age range of 51–88 years. A carotid artery shunt was used in 16 (8 men and 8 women) patients. The carotid stump pressure values of the patients with a shunt were lower than those without a shunt (median (min–max): 42 (20–55) vs 51 (20–104), p < 0.0006). In the receiver operating characteristic curve analysis performed to determine the need for a shunt, the optimal cutoff value of carotid stump pressure was ≤48 mmHg, sensitivity was 93.8%, and specificity was 61.6% (area under the curve: 0.773, p < 0.0001). Conclusion: Carotid stump pressure has sufficient diagnostic power to determine the need for a shunt, but it cannot be used alone in the clinical setting. Instead, it can be used in combination with other neurological monitoring methods.

Objective: Current guidelines recommend thromboprophylaxis with low molecular weight heparin (LMWH) in patients with coronavirus disease-2019 (COVID-19). However, there is no current consensus on the routine application of thromboprophylaxis. This study aimed to evaluate the effect of routine application of LMWH on clinical outcomes including mortality and the need for intensive care unit (ICU) admission in hospitalized COVID-19 patients. Material and Methods: All confirmed patients with COVID-19 hospitalized in COVID-19 dedicated wards, from March 15 to May 15, 2020, were included in this retrospective cohort study. Two groups of patients were established, according to the non-routine and routine application of LMWH with therapeutic, weight-based, anticoagulation dosing. Clinical, laboratory and treatment data were collected, analyzed, and compared between the two groups. The initial and extreme values of the laboratory tests were used for analysis. A logistic regression model was developed to assess the factors related to in-hospital adverse outcomes. Results: A total of 1,511 patients (797 men, median age 59.0 years) were retrospectively analyzed [group non-routine LMWH (n=828); group routine LMWH (n=683)]. Multivariate logistic regression analysis showed routine use of LMWH, favipiravir administration, extreme values of white blood cell count, neutrophil lymphocyte ratio, and troponin I as factors independently associated with in-hospital adverse outcomes (odds ratio=0.25, 95% confidence interval: 0.83-0.91; p<0.001 for routine use of LMWH). Conclusion: In hospitalized COVID-19 patients routine treatment with therapeutic LMWH dosage was associated with a 75% decrease in mortality and need for ICU admission compared with the non-routine administration when adjusted for other variables in this study.

Background: Coronavirus disease 2019 (COVID-19) is commonly complicated with coagulopathy presented with venous thromboembolism and arterial thromboses. The aim of this study was to evaluate the effect of routine thromboprophylaxis with low molecular weight heparin (LMWH) on clinical outcomes including mortality and need for intensive care unit (ICU) admission in hospitalized COVID-19 patients. Methods: All confirmed patients with COVID-19 hospitalized to COVID-19 dedicated wards, from March 15 to May 15, 2020, were included in this retrospective cohort study. Two groups of patients were established, according to the non-routine and routine application of LMWH with therapeutic, weight-based, anticoagulation dosing. Clinical, laboratory and treatment data were collected, analyzed and compared between the two groups. A logistic regression model was developed to assess the factors related to in-hospital adverse outcomes. Results: A total of 1511 patients (797 men, median age 59.0 years) were retrospectively analyzed (Group non-routine LMWH (n=828); group routine LMWH (n=683)). Multivariate logistic regression analysis showed routine use of LMWH, favipiravir administration, extreme values of WBC count, NLR, and troponin I as factors independently associated with in-hospital adverse outcomes (OR=0.25, 95% CI: 0.83-0.91; p<0.001 for routine use of LMWH). Conclusion: Routine thromboprophylaxis with LMWH reduced mortality and ICU admission in patients admitted with COVID-19 infection.