どのようにbing AIを使えばよいかわからないというひとでも使ってみれば実感が得られると思う。実際に使ってみた例を示す。「対話型」なので ちょっと長いけど我慢して読んでね。
コロナ罹患後におしりの痛みと両下肢のしびれ、咳をしたときに両足に強い痛みが走るという患者さんの例。
前のブログで書いたように患者さんの症状の経過を書いて、それを英語に翻訳してbingに張り付ける。
入力： A woman in her 40s. She contracted COVID-19 on May XX. On May YY（9日後）, she suddenly developed pain in her sacrum and buttocks and numbness in both her lower extremities, as well as severe neuropathic pain in both lower extremities when coughing. What kind of condition should be considered?
Bing： Based on web search results, one condition that should be considered is COVID-19-related neuropathic pain. Neuropathic pain is a common symptom in long COVID and has been reported as a complication of COVID-1912. The pooled prevalence of COVID-19-related neuropathic pain was 6.7% for hospitalized patients during the acute phase and 34.3% for long COVID patients1. However, it is important to consult with a medical professional for an accurate diagnosis and treatment plan.
詳細情報:
1. ncbi.nlm.nih.gov 2. ncbi.nlm.nih.gov 3. ncbi.nlm.nih.gov— （アンダーライン部分はbing回答そのまま）
入力： この症状がCOVID-19と無関係だとしたら、どのような疾患を考えるべきか？
（「COVID関連」で症状をひとくくりにされてしまったので、聞き直してみた。2回目の質問からは日本語でも bingが勝手に英語での検索を続けてくれる。）
Bing: If the symptoms are unrelated to COVID-19, there are several conditions that could be considered. One possibility is sacroiliitis, which is a painful condition that affects one or both sacroiliac joints. These joints sit where the lower spine and pelvis meet. Sacroiliitis can cause pain and stiffness in the buttocks or lower back, and the pain might go down one or both legs1. Another possibility is peripheral neuropathy, which is a result of damage to the nerves located outside of the brain and spinal cord (peripheral nerves) and often causes weakness, numbness, and pain, usually in the hands and feet2. It is important to consult with a medical professional for an accurate diagnosis and treatment plan.
詳細情報:
1. mayoclinic.org 2. mayoclinic.org 3. bing.com 4. mayoclinic.org
入力： この患者は両側の下肢に同じようにしびれと疼痛を感じている。どのような疾患を考えるべきか？
（両側性の症状なんだけどそれでいいの？と聞き直した）
Bing: If the patient is experiencing numbness and pain in both lower extremities, one condition that could be considered is peripheral neuropathy. Peripheral neuropathy is a result of damage to the nerves located outside of the brain and spinal cord (peripheral nerves) and often causes weakness, numbness, and pain, usually in the hands and feet1. It is important to consult with a medical professional for an accurate diagnosis and treatment plan.
詳細情報:
1. mayoclinic.org 2. bing.com 3. aafp.org 4. mayoclinic.org
入力： この患者は臀部の痛みが強い。これも両側性で、持続的な痛みである。それに対して両側下肢の痛みは咳嗽時のみであり、稲妻が走るような痛みである。どのような疾患か？
Bing: If the patient is experiencing strong bilateral buttocks pain that is persistent and lightning-like pain in both lower extremities when coughing, one condition that could be considered is piriformis syndrome. Piriformis syndrome is a rare neuromuscular disorder that occurs when the sciatic nerve is compressed by the piriformis muscle in the buttocks. The sciatic nerve is the longest nerve in the body and runs from the lower back, through both sides of the waist, buttocks, legs, and feet1. It is important to consult with a medical professional for an accurate diagnosis and treatment plan.
詳細情報:
1. bing.com 2. mayoclinic.org 3. mayoclinic.org 4. mayoclinic.org
入力： piriformis syndromeは両側の臀部と下肢に対称性の症状を出現させるか？
（piriformis syndromeという病名を出してきた。これも再度両側性はあるの？と聞き直している。我ながらしつこい）
Bing: Piriformis syndrome can cause pain or numbness in the buttock and down the back of the leg. It can happen on one side of the body or both1. It occurs when the piriformis muscle presses on the sciatic nerve. The condition may be caused by injury, swelling, muscle spasms or scar tissue in the piriformis1. It is important to consult with a medical professional for an accurate diagnosis and treatment plan.
詳細情報:
1. my.clevelandclinic.org 2. bing.com 3. ncbi.nlm.nih.gov 4. ninds.nih.gov+2 その他
入力： この患者は整形外科と神経内科のうちどちらの診療科を受診すべきだろうか？
Bing: It would be a good idea for the patient to consult with both an orthopedist and a neurologist. An orthopedist specializes in the treatment of the musculoskeletal system, including bones, joints, muscles, tendons, and ligaments. A neurologist specializes in the treatment of disorders of the nervous system, including the brain, spinal cord, and nerves. Both specialists can provide valuable insights and work together to diagnose and treat the patient’s condition.
患者とふたりで迷った末、整形外科もある総合病院の神経内科に紹介状を書いた。神経内科を受診した結果、市中の整形外科医院に行けと言われて紹介状を渡されたとのことで、整形外科を受診せずに当方に戻ってきた。
患者の尻を触ると両側の梨状筋のあたりに左右対称に圧痛があったので、両側性のpiriformis syndromeと考えて（どの程度珍しい疾患なのかわからないが）、今度はbingにその治療法について聞いてみた。あたらしく聞くことになるので、英文になおして質問。
入力： A woman in her 40s. She contracted COVID-19 on May XX. On May YY, she suddenly developed pain in her sacrum and buttocks and numbness in both her lower extremities, as well as severe neuropathic pain in both lower extremities when coughing. She initially complained of pain around the sacrum, but now has tenderness around bilateral piriformis, so we diagnosed her with piriformis syndrome. Her symptoms for now are bilateral pain around piriformis, numbness in bilateral lower extremities, and neuropathic pain while coughing in bilateral lower extremities. Please give us five treatment options for her.
Bing: According to the current web page context, a woman has been diagnosed with piriformis syndrome. Some treatment options for piriformis syndrome that I found from web search results include:
1. Rest: Taking a few days of rest can help alleviate symptoms1.
2. Physical therapy: Physical therapy that focuses on stretching and strengthening the piriformis muscle can help improve mobility in the hip and reduce pain1.
3. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants can help relieve pain1.
4. Massage: Massage therapy can be used as a complementary treatment to help alleviate pain1.
5. Home exercises: Performing home exercises to stretch or strengthen the piriformis muscle can also help alleviate symptoms1.
It’s important to consult with a healthcare provider to determine the best course of treatment for the individual case.
詳細情報:
1. my.clevelandclinic.org 2. bing.com 3. pubmed.ncbi.nlm.nih.gov 4. spine-health.com+2 その他
入力： Is there a relationship between her symptoms and COVID infection?
Bing: I’m sorry, but I couldn’t find any information from my web search results that suggests a direct relationship between COVID-19 and piriformis syndrome. It’s important to consult with a healthcare provider for more information on this topic.
詳細情報:
1. frontiersin.org 2. journals.physiology.org 3. verywellhealth.com 4. ncbi.nlm.nih.gov+2 その他
もう一度COVIDとの関係についてbingに聞いてみたが、わからないという反応だった。よく聞くと、彼女は両手のしびれもあると言っていたので、すべての症状を一元的に説明しようとするとやはりCOVIDとの関係を考えるべきではないかと思う。
最後にダメ押し質問
入力： Tell me five treatment options for numbness in both legs, one of her symptoms.
Bing: According to my web search results, some treatment options for long-term numbness in the legs and feet include:
1. Antidepressants: Some antidepressants, such as duloxetine and milnacipran, have been approved for the treatment of fibromyalgia1.
2. Corticosteroids: Corticosteroids can help reduce inflammation and alleviate symptoms1.
3. Gabapentin and pregabalin: These medications can help relieve nerve pain1.
4. Physical therapy: Physical therapy can help improve mobility and reduce pain2.
5. Self-care: Practicing good posture, avoiding sitting for long periods of time, and engaging in regular exercise can help alleviate symptoms1.
It’s important to consult with a healthcare provider to determine the best course of treatment for the individual case.
詳細情報:
1. medicalnewstoday.com 2. hopkinsmedicine.org 3. healthgrades.com+1 その他
最終的に今回の診断が正しいかはわからない。けど、いい線いっているのではないだろうか。彼女には、しばらくの安静を指示するとともに、ＮＳＡＩＤｓとmuscle relaxants、神経因性疼痛に対する治療薬、それとＣＯＶＩＤ後の慢性炎症に効果を示す薬（すこし薬剤の種類が多くなってしまったが）を処方した。その後、症状はかなり良くなったと言われた。
たぶん一つ一つの症状からネット検索していたらここまでたどり着けない。2年前まで呼吸器内科の患者しか診ていなかった医者としては上出来。
Bingは、毎度のようにこれはプロの判断ではないからね、きちんと専門家にコンサルトしなさいよ、と言ってくる。こちらもそのようにbingの情報を扱わなければならない。
しかし、いまやbingなしの診療はあり得ない。ということがお判りいただけたと思う。
