[The spring of artificial intelligence: AI vs. expert for internal medicine cases]

INTRODUCTION

The "Printemps de la Médecine Interne" are training days for Francophone internists. The clinical cases presented during these days are complex. This study aims to evaluate the diagnostic capabilities of non-specialized artificial intelligence (language models) ChatGPT-4 and Bard by confronting them with the puzzles of the "Printemps de la Médecine Interne".

METHOD

Clinical cases from the "Printemps de la Médecine Interne" 2021 and 2022 were submitted to two language models: ChatGPT-4 and Bard. In case of a wrong answer, a second attempt was offered. We then compared the responses of human internist experts to those of artificial intelligence.

RESULTS

Of the 12 clinical cases submitted, human internist experts diagnosed nine, ChatGPT-4 diagnosed three, and Bard diagnosed one. One of the cases solved by ChatGPT-4 was not solved by the internist expert. The artificial intelligence had a response time of a few seconds.

CONCLUSIONS

Currently, the diagnostic skills of ChatGPT-4 and Bard are inferior to those of human experts in solving complex clinical cases but are very promising. Recently made available to the general public, they already have impressive capabilities, questioning the role of the diagnostic physician. It would be advisable to adapt the rules or subjects of future "Printemps de la Médecine Interne" so that they are not solved by a public language model.

Oral health in Alzheimer's disease: a multicenter case-control study

OBJECTIVES

The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer's patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health.

MATERIALS AND METHODS

A total of 70 Alzheimer's patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed.

RESULTS

Alzheimer's patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%).

CONCLUSIONS

After taking into account the influence of age, Alzheimer's patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality.

CLINICAL RELEVANCE

Clinicians should be aware of the implications of Alzheimer's disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.

The role of personality traits in self-rated oral health and preferences for different types of flawed smiles

Symmetric, aligned and luminous smiles are usually classified as 'beautiful' and aesthetic. However, smile perception is not strictly governed by standardised rules. Personal traits may influence the perception of non-ideal smiles. We aimed to determine the influence of personality traits in self-rated oral health and satisfaction and in the aesthetic preference for different strategically flawed smiles shown in photographs. Smiles with dark teeth, with uneven teeth, with lip asymmetry and dental asymmetry were ordered from 1 to 4 as a function of the degree of beauty by 548 participants, of which 50·7% were females with a mean age of 41·5 ± 17·6 years (range: 16-89 years). Self-assessment and oral satisfaction were recorded on a Likert scale. Personality was measured by means of the Big Five Inventory (extraversion, agreeableness, conscientiousness, neuroticism and openness), and the Life Orientation Test was used to measure optimism and pessimism. Of the four photographs with imperfect smiles, dental asymmetry was the most highly assessed in 63% of the sample, and the worst was lip asymmetry, in 43·7% of the sample. Some personality traits (above all conscientiousness and openness) were significantly correlated with the position assigned to the photographs with dental and lip asymmetry or with misaligned teeth. The extraversion, agreeableness and openness traits were correlated with the self-perceptions of oral health and aesthetics of the participants. Dental asymmetry seems to be better tolerated than lip asymmetry. Personality traits are weakly but significantly correlated with the aesthetic preference and oral health values, conscientiousness and openness being the most relevant domains in this sense.

Influence of Er:YAG and Ti:sapphire laser irradiation on the microtensile bond strength of several adhesives to dentin

The aim of the present study was to evaluate the influence of erbium:yttrium-aluminum-garnet (Er:YAG) and Ti:sapphire laser irradiation on the microtensile bond strength (MTBS) of three different adhesive systems to dentin. Flat dentin surfaces from 27 molars were divided into three groups according to laser irradiation: control, Er:YAG (2,940 nm, 100 μs, 2.7 W, 9 Hz) and Ti:sapphire laser (795 nm, 120 fs, 1 W, 1 kHz). Each group was divided into three subgroups according to the adhesive system used: two-step total-etching adhesive (Adper Scotchbond 1 XT, from now on XT), two-step self-etching adhesive (Clearfil SE Bond, from now on CSE), and all-in-one self-etching adhesive (Optibond All-in-One, from now on OAO). After 24 h of water storage, beams of section at 1 mm(2) were longitudinally cut from the samples. Each beam underwent traction test in an Instron machine. Fifteen polished dentin specimens were used for the surface morphology analysis by scanning electron microscopy (SEM). Failure modes of representative debonded microbars were SEM-assessed. Data were analyzed by ANOVA, chi-square test, and multiple linear regression (p < 0.05). In the control group, XT obtained higher MTBS than that of laser groups that performed equally. CSE showed higher MTBS without laser than that with laser groups, where Er:YAG attained higher MTBS than ultrashort laser. When OAO was used, MTBS values were equal in the three treatments. CSE obtained the highest MTBS regardless of the surface treatment applied. The Er:YAG and ultrashort laser irradiation reduce the bonding effectiveness when a two-step total-etching adhesive or a two-step self-etching adhesive are used and do not affect their effectiveness when an all-in-one self-etching adhesive is applied.

Comparative validity of the OIDP and OHIP-14 in describing the impact of oral health on quality of life in a cross-sectional study performed in Spanish adults

OBJECTIVES

We aimed to compare the utility and validity of two popular socio-dental indicators (OIDP and OHIP-14) for describing the impact of oral conditions on quality of life applied simultaneously.

STUDY DESIGN

We recruited a consecutive sample of 270 healthy Spanish workers visiting the Employment Risk Prevention Centre for a routine medical check-up. OHIP-14 was self-completed before the oral examination and the face to face interview of the OIDP was performed. Both instruments were compared by evaluating its reliability and its validity.

RESULTS AND CONCLUSIONS

The standardised Cronbach alphas for OHIP-14 and OIDP were 0.89 and 0.74 respectively. OIDP showed lower face validity but higher content validity than OHIP-14. Both indicators showed high construct and criterion validity, since individuals perceiving need for dental treatment or having any complaint about their mouth obtained significantly higher total OIDP and OHIP scores than their counterparts. The prevalence of impacts was much higher using the OHIP (80.7%) than the OIDP (27.8%).

The Discovery of Surgical Anesthesia

The suppression of pain during surgical interventions has been a major achievement for humankind. Chronologically, in 1842, William E. Clarke, a chemist in Rochester (NY), provided Elijah Pope with ether for the purposes of tooth extraction. In 1844, in Boston, G.Q. Colton and the dentist Horace Wells used nitrous oxide as an anesthetic for tooth extraction. On the 16th of October, 1846, the American dentist William T.G. Morton became a pioneer within the medical community with respect to anesthesia by inhalation when he used ether as an anesthetic at the Massachusetts General Hospital. In 1847, the Scot James Young Simpson began to use chloroform as an anesthetic for obstetrics in Edinburgh. These events gave rise to several disputes among their users (who are not very well-known today), who strove to claim that they had been the discoverers of surgical anesthesia, with a view to obtaining a series of patents and state sinecures. This article attempts to clarify certain discrepancies about the authorship of surgical anesthesia. The evidence suggests that surgical anesthesia first began to be applied in the field of dentistry.

Validation of two complementary oral-health related quality of life indicators (OIDP and OSS 0-10 ) in two qualitatively distinct samples of the Spanish population

BACKGROUND

Oral health-related quality of life can be assessed positively, by measuring satisfaction with mouth, or negatively, by measuring oral impact on the performance of daily activities. The study objective was to validate two complementary indicators, i.e., the OIDP (Oral Impacts on Daily Performances) and Oral Satisfaction 0-10 Scale (OSS), in two qualitatively different socio-demographic samples of the Spanish adult population, and to analyse the factors affecting both perspectives of well-being.

METHODS

A cross-sectional study was performed, recruiting a Validation Sample from randomly selected Health Centres in Granada (Spain), representing the general population (n = 253), and a Working Sample (n = 561) randomly selected from active Regional Government staff, i.e., representing the more privileged end of the socio-demographic spectrum of this reference population. All participants were examined according to WHO methodology and completed an in-person interview on their oral impacts and oral satisfaction using the OIDP and OSS 0-10 respectively. The reliability and validity of the two indicators were assessed. An alternative method of describing the causes of oral impacts is presented.

RESULTS

The reliability coefficient (Cronbach's alpha) of the OIDP was above the recommended 0.7 threshold in both Validation and Occupational samples (0.79 and 0.71 respectively). Test-retest analysis confirmed the external reliability of the OSS (Intraclass Correlation Coefficient, 0.89; p < 0.001) Some subjective factors (perceived need for dental treatment, complaints about mouth and intermediate impacts) were strongly associated with both indicators, supporting their construct and criterion validity. The main cause of oral impact was dental pain. Several socio-demographic, behavioural and clinical variables were identified as modulating factors.

CONCLUSION

OIDP and OSS are valid and reliable subjective measures of oral impacts and oral satisfaction, respectively, in an adult Spanish population. Exploring simultaneously these issues may provide useful insights into how satisfaction and impact on well-being are constructed.

Effect of Cyclic Loading on the Microtensile Bond Strengths of Total-etch and Self-etch Adhesives

Resin-dentin bonds, which may have an influence on the long-term success of restorations, are prone to deterioration after cyclic loading. The tested one-step self-etching system (Etch&Prime 3.0) provided the least reliable dentin adhesion. After acid etching of dentin, alcohol/based adhesives performed better than those containing acetone as solvent.

[Ursodeoxycholic acid treatment shortens the course of cholestasis in two patients with benign recurrent intrahepatic cholestasis]

INTRODUCTION

Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal-crecessive or sporadic disorder, characterized by repeated episodes of unexplained cholestasis followed by prolonged asymptomatic periods.

CASE REPORT

We present two male patients aged 12 and 15 years old who initially presented cholestasis and who had no family history of liver or biliary disease. Typically, alkaline phosphatase and bilirubin levels were elevated, with a slight increase in transaminases and gamma-glutamyltransferase. In both patients biliary tract disease was ruled out by endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiography while no significant abnormalities of the liver parenchyma were found on liver biopsy. Early treatment with ursodeoxycholic acid (UDCA) reduced the duration of the cholestasis episode compared with that of other episodes in which the patient had received other treatment or the treatment was late (1 or 2 months vs 4 months in patient 1 and 1-3 months vs 5 months in patient 2, respectively).

DISCUSSION

Consensus is lacking on the treatment of BRIC although several treatment have been used. UDCA could be effective in increasing bile acid secretion and in reducing serum bilirubin levels. In the two patients described, the initial dosage was 15 mg/kg/day, which was subsequently maintained at 6 mg/kg/day, which was subsequently maintained 6 mg/kg/day until biochemical parameters returned to normal. Nevertheless, larger studies are required to confirm that UDA shortens episodes of cholestasis in BRIC.