Background: The rapid integration of Large Language Models (LLMs) into healthcare necessitates a rigorous evaluation of their performance in specialized medical fields. In metabolic bariatric surgery (MBS), LLMs have the potential to revolutionize education and clinical support, yet their accuracy and reliability are not well-established. This study provides a critical assessment of the capabilities of current LLMs in the context of MBS. Methods: This cross-sectional validation study assessed the performance of six LLMs (ChatGPT-3.5, ChatGPT-4o, Gemini, Copilot, GROK, and DeepSeek) in answering 100 evidence-based binary and multiple-choice questions related to MBS. Questions were constructed from international guidelines and categorized into six thematic domains. Expert consensus answers served as the reference standard, with inter-rater reliability measured using Fleiss’ κ. Model outputs were scored for accuracy. Comparisons across LLMs were first assessed using an overall test for differences between multiple related groups. Pairwise comparisons were then conducted between LLMs to identify specific differences in performance. Results: Across the dataset, the mean number of correct LLM responses per question was 3.9 (SD = 1.8). ChatGPT-4o achieved the highest accuracy (66.0%), while DeepSeek recorded the lowest (60.0%). Accuracy varied across domains, highest for indications/contraindications (78.7%) and complications/management (68.0%), and lowest for preoperative preparation (52.0%) and postoperative care (58.4%). Binary questions yielded higher accuracy (69.1%) than multiple-choice questions (62.0%). Inter-expert reliability was substantial (κ = 0.742, 95% CI: 0.71–0.77). Agreement between LLMs and experts ranged from fair (DeepSeek κ = 0.349) to moderate (ChatGPT-4o κ = 0.446). No significant accuracy differences were detected across models (Friedman test, p = 0.662). Conclusion: LLMs represent a promising, yet imperfect, adjunct in MBS education. Their utility is currently limited by inconsistencies in accuracy, particularly in areas requiring nuanced clinical judgment. While these models can supplement traditional learning resources, they are not yet a substitute for expert clinical guidance. This study underscores the need for continued refinement and validation of LLMs to ensure their safe and effective integration into clinical practice.

Point-of-care ultrasonography (POCUS) is increasingly used to confirm endotracheal tube (ETT) placement; however, its overall diagnostic accuracy and speed compared with standard methods in adult emergency and critical care settings remain uncertain. We conducted a systematic review and meta-analysis of observational studies through May 2025 that evaluated POCUS for confirming ETT placement in adults (≥18 years) in emergency departments (EDs) and intensive care units (ICUs). Thirty studies met the inclusion criteria. Point-of-care ultrasonography achieved a pooled sensitivity of 0.91 and a specificity of 0.98. The area under the curve (AUC) was 0.96 [95% confidence interval (CI): 0.88–1.00]. The mean time-to-confirmation was 19.62 seconds for POCUS vs 22.46 seconds for standard methods; however, this finding should be interpreted with caution due to extreme heterogeneity (I² > 99%). Point-of-care ultrasonography is a highly accurate, rapid, and reliable method for confirming ETT placement in adult ED and ICU settings. It demonstrates diagnostic performance comparable to previously reported capnography performance and provides unique advantages as an adjunctive tool, especially in scenarios where capnography may be unreliable. Alsabri M, Elsnhory AB, Hasan MT, McClean CH, Abouelmagd K, Abady E, et al. Diagnostic Accuracy of Point-of-care Ultrasonography for Confirming Endotracheal Tube Placement in Adults: An Updated Systematic Review and Meta-analysis. Indian J Crit Care Med 2026;30(2):155–164.

Background: Rhegmatogenous retinal detachment (RRD) is a vision-threatening ophthalmic emergency requiring prompt surgical intervention. Despite advancements in surgical techniques, recurrence remains a significant challenge, leading to additional surgeries and poorer visual outcomes. This study aimed to evaluate the incidence and risk factors for RRD recurrence following surgical repair in an Egyptian tertiary care setting. Methods: A retrospective cohort study was conducted at Alexandria Main University Hospital, Egypt, including 134 patients who underwent RRD surgery (pars plana vitrectomy [PPV] or scleral buckling [SB]) between March and September 2023. Demographic, clinical, and surgical variables were evaluated. Recurrence was defined as anatomical detachment after initial surgical success within a 6-month follow-up period. Statistical analyses included chi-square tests and multivariate logistic regression to identify independent risk factors. Results: The recurrence rate was 24.6%, with early recurrence (≤ 6 weeks) occurring in 14.9% of cases. PPV had a significantly higher recurrence rate (34.8%) compared to SB (19.3%) (p = 0.049). Univariate analysis identified right eye laterality (p = 0.02), high myopia (p = 0.015), proliferative vitreoretinopathy (PVR) (p < 0.001), and ocular comorbidities (p = 0.018) as significant risk factors. Multivariate analysis confirmed right eye laterality (OR: 3.7, p = 0.016), high myopia (OR: 0.34, p = 0.04), and PVR (OR: 0.15, p = 0.005) as independent predictors. Surgeon experience significantly influenced outcomes in univariate analysis (p = 0.001), but not in adjusted models. Conclusions: RRD recurrence remains prevalent occurring in nearly one-quarter of repaired RRD cases, predominantly within the early postoperative period. Surgical technique, laterality, and ocular characteristics significantly impacted recurrence risk. These findings highlight the need for individualized surgical planning and enhanced surveillance in high-risk patients, particularly during the critical first postoperative weeks.

Background: Acid sphingomyelinase deficiency (ASMD), also known as Niemann-Pick disease types A and B, is a rare autosomal recessive lysosomal storage disorder caused by SMPD1 mutations. It is characterized by sphingomyelin accumulation and a broad clinical spectrum ranging from severe neurodegeneration in type A to a milder visceral phenotype in type B. Intermediate forms (type A/B) show overlapping features of both subtypes. Case presentation: We report a 6-month-old boy with ASMD type A/B who first presented with meningoencephalitis and a single seizure most likely secondary to an intercurrent viral infection rather than a primary disease manifestation. Subsequent evaluation revealed multiple systemic red-flag features including marked hepatosplenomegaly, severe growth failure, a cherry-red spot, macroglossia, dysmorphic facial features, recurrent pneumonia, and bilateral sensorineural hearing loss. Laboratory investigations demonstrated elevated liver enzymes and cerebrospinal fluid abnormalities, while auditory brainstem response confirmed the hearing impairment. Enzyme assay confirmed reduced ASM activity, and targeted SMPD1 genetic sequencing identified a homozygous frameshift mutation classified as pathogenic according to ACMG criteria, establishing the diagnosis of an intermediate ASMD phenotype. Conclusion: This case highlights the diagnostic challenges posed by ASMD type A/B, particularly when the initial presentation mimics an acute infection. The overlap of coincidental infectious illness with systemic red-flag features, the clinical variability of intermediate phenotypes, and the rarity of the disorder all contribute to delayed recognition. These factors underscore the importance of maintaining a high index of suspicion and pursuing early metabolic and genetic testing in atypical pediatric presentations. Trial registration: Not applicable.