Instructor factors associated with medical students’ lecture evaluation: a longitudinal analysis / 한국의학교육

Purpose@#This study identified factors that affect lecture evaluation by analyzing sophomores from Dankook University, examining each cluster’s characteristics, and comparing differences among trajectories. @*Methods@#This study identified factors that affect lecture evaluation by analyzing sophomores from Dankook University, examining each cluster’s characteristics, and comparing differences among trajectories. @*Results@#The lecture evaluation score decreased as the teaching hours per instructor in a year increased by an hour, and the number of instructors per lecture increased by one individual. During trajectory analysis, the first trajectory had lower lecture evaluation scores overall but relatively high appropriateness of the textbook and punctuality of class, whereas the second trajectory had higher lecture evaluation scores overall for all four items. @*Conclusion@#The two trajectories showed differences in teaching methods (understanding of lecture content and usefulness of the lecture) rather than in external factors (appropriateness of the textbook and punctuality of class). Therefore, to improve lecture satisfaction, enhancing instructors’ instructional competencies through lectures and adjusting the teaching hours by assigning an adequate number of instructors per lecture are recommended.

Ischemic Vaso-occlusive Retinopathy as Initial Presentation in Pediatric Systemic Lupus Erythematosus: A Case Report

Ischemic vaso-occlusive retinopathy as an initial manifestation is rare in pediatric systemic lupus erythematosus (pSLE). A 13-year-old girl presented with two months’ history of papules and crusts with fatigue, weight loss, and abrupt hair loss. Pancytopenia and findings compatible with SLE, including positive direct Coombs’ test, antinuclear antibody (Ab), anti-double stranded DNA Ab, anti-Smith Ab, anti-ribonucleoprotein Ab, lupus anticoagulant, anti-β2 glycoprotein Immunoglobulin G, and anti-cardiolipin Ab, were detected. Bi-nasal hemianopsia was detected. Initial visual acuity was hand motion in the right eye and 15/20 in the left. Fundoscopy showed massive exudation around the optic disc with macular edema, vascular sheathing with perivascular hemorrhage in the whole retina, and ghost vessels in the peripheral retina. Intravitreal triamcinolone injection and dexamethasone implant injection were administered. Visual symptoms improved but did not recover. Methylprednisolone therapy and photocoagulation improved visual acuity and fever. Early intervention for retinopathy in pSLE can help prevent vision-loss.

Analysis and suggestions on medical educators’ roles / 한국의학교육

Purpose@#This study aimed to investigate the differences in the perception between professors and students regarding medical educators’ roles and discuss their desirable roles. @*Methods@#A survey was administered to 116 professors and 379 students of the medical colleges from Dankook University and Hallym University. The subjects were given a self-created questionnaire designed to measure their perception of medical educators’ roles. @*Results@#First, “student performance management” for professors and “teaching skill development” for students were recognized as the most essential medical educators’ role. Second, females students perceived the roles to be more important than males in eight of 10 roles. @*Conclusion@#First, “student performance management” for professors and “teaching skill development” for students were recognized as the most essential medical educators’ role. Second, females students perceived the roles to be more important than males in eight of 10 roles.

Clinical significance of anti-dense fine speckled 70 antibody in patients with fibromyalgia

BACKGROUND/AIMS@#Fibromyalgia (FM) is a common rheumatologic disease characterized by chronic widespread pain, along with various clinical manifestations including atypical autoimmune characteristics. Despite its high prevalence, there remain no approved laboratory tests to identify specific manifestations of FM, or to rule out FM from other rheumatic diseases. Anti-dense fine speckled 70 (anti-DFS70) antibodies were initially identified as a form of anti-nuclear antibodies in a patient with interstitial cystitis. Anti-DFS70 antibodies are found in ≤ 10% of healthy individuals, but have suggestive negative association with autoimmune diseases; however, the clinical significance of these autoantibodies in FM patients remains poorly understood.@*METHODS@#We examined 39 patients with FM, along with 17 patients with systemic lupus erythematosus (SLE), and 19 healthy individuals (HI). Patients were compared based on physical measurements, disease duration, tender point counts, FM Impact Questionnaire (FIQ) scores, visual analog scale (VAS) for pain, somatic symptoms, and anti-DFS70 antibodies.@*RESULTS@#Levels of anti-DFS70 antibodies were significantly higher in the FM and HI groups than in those with SLE. Both anti-DFS70 antibodies and VAS scores were positively correlated with FM. Within the FM group, patients with arthralgia had higher anti-DFS70 antibody values compared to those without arthralgia (p = 0.024); antibody levels were also higher in patients with sleep disturbances relative to those without sleep issues (p = 0.024). In contrast, there were no correlations between anti-DFS70 antibodies and age, body mass index, disease duration, tender point counts, FIQ, short-form health survey results, or other clinical manifestations.@*CONCLUSIONS@#Anti-DFS70 antibodies may represent a useful biomarker for differentiating between FM and other autoimmune diseases. The levels of anti-DFS70 antibodies were also significantly higher among patients with arthralgia and sleep disturbances. Further investigations are necessary to evaluate the relationships between anti-DFS70 antibodies and other cytokines as a predictive marker for pain.

The relationship between classical item characteristics and item response time on computer-based testing / 한국의학교육

PURPOSE@#This study investigated the relationship between the item response time (iRT) and classic item analysis indicators obtained from computer-based test (CBT) results and deduce students' problem-solving behavior using the relationship.@*METHODS@#We retrospectively analyzed the results of the Comprehensive Basic Medical Sciences Examination conducted for 5 years by a CBT system in Dankook University College of Medicine. iRT is defined as the time spent to answer the question. The discrimination index and the difficulty level were used to analyze the items using classical test theory (CTT). The relationship of iRT and the CTT were investigated using a correlation analysis. An analysis of variance was performed to identify the difference between iRT and difficulty level. A regression analysis was conducted to examine the effect of the difficulty index and discrimination index on iRT.@*RESULTS@#iRT increases with increasing difficulty index, and iRT tends to decrease with increasing discrimination index. The students' effort is increased when they solve difficult items but reduced when they are confronted with items with a high discrimination. The students' test effort represented by iRT was properly maintained when the items have a 'desirable' difficulty and a 'good' discrimination.@*CONCLUSION@#The results of our study show that an adequate degree of item difficulty and discrimination is required to increase students' motivation. It might be inferred that with the combination of CTT and iRT, we can gain insights about the quality of the examination and test behaviors of the students, which can provide us with more powerful tools to improve them.

The relationship between classical item characteristics and item response time on computer-based testing / 한국의학교육

PURPOSE: This study investigated the relationship between the item response time (iRT) and classic item analysis indicators obtained from computer-based test (CBT) results and deduce students' problem-solving behavior using the relationship. METHODS: We retrospectively analyzed the results of the Comprehensive Basic Medical Sciences Examination conducted for 5 years by a CBT system in Dankook University College of Medicine. iRT is defined as the time spent to answer the question. The discrimination index and the difficulty level were used to analyze the items using classical test theory (CTT). The relationship of iRT and the CTT were investigated using a correlation analysis. An analysis of variance was performed to identify the difference between iRT and difficulty level. A regression analysis was conducted to examine the effect of the difficulty index and discrimination index on iRT. RESULTS: iRT increases with increasing difficulty index, and iRT tends to decrease with increasing discrimination index. The students' effort is increased when they solve difficult items but reduced when they are confronted with items with a high discrimination. The students' test effort represented by iRT was properly maintained when the items have a 'desirable' difficulty and a 'good' discrimination. CONCLUSION: The results of our study show that an adequate degree of item difficulty and discrimination is required to increase students' motivation. It might be inferred that with the combination of CTT and iRT, we can gain insights about the quality of the examination and test behaviors of the students, which can provide us with more powerful tools to improve them.

Long Term Corneal Endothelial Cell Density Loss after Iris-fixed Phakic Intraocular Lens Implantation

PURPOSE: To report three cases of severe endothelial cell density loss after iris claw phakic intraocular lens (Artisan® lens) implantation. CASE SUMMARY: A 32-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 2,556 cells/mm² in the right eye and 2,674 cells/mm² in the left eye. After 4 years, the corneal endothelial cell count was 1,968 cells/mm² in the right eye and 1,997 cells/mm² in the left eye. A 27-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 3,222 cells/mm² in the right eye and 3,122 cells/mm² in the left eye. After 4 years 8 months, the corneal endothelial cell count was 2,729 cells/mm² in the right eye and 2,488 cells/mm² in the left eye. A 39-year-old woman underwent phakic intraocular lens implantation in other clinic, and the lens of left eye was removed the same day because of elevated intraocular pressure. She underwent iris claw intraocular lens implantation in the left eye. Preoperative corneal endothelial cell count was 2,500 cells/mm² in the left eye, which decreased to 1,873 cells/mm² after 8 years. Six months after intraocular lens removal and cataract surgery, her cornea endothelial cell count was 1,412 cells/mm². CONCLUSIONS: Although iris-fixed intraocular lens implantation is safe and effective for correcting myopia, at least 4 years of long-term observation for evaluating corneal endothelial cell density maybe necessary.

Subacute Combined Degeneration Caused by Chronic Atrophic Gastritis with Spurious Elevation of Vitamin B12 Level

We report a patient who was diagnosed as subacute combined degeneration (SCD) with elevated homocysteine and methylmalonic acid levels in the situation of a spurious elevation of the vitamin B12 concentration. A false-positive elevation of the vitamin B12 level could lead to a delayed diagnosis and cause irreversible changes in the nervous systems. We therefore suggest that the homocysteine and methylmalonic acid levels should be checked in patients with a normal or elevated vitamin B12 level for whom there is a high clinical suspicion for vitamin B12 deficiency, as a further evaluation for SCD.

The revision of the ethical codes and guidelines of the Korean Medical Association

No abstract available.

The Association between Dehydroepiandrosterone Sulfate (DHEA-S) and Bone Mineral Density in Korean Men and Women

BACKGROUND: The relationship between dehydroepiandrosterone sulfate (DHEA-S) and bone mineral density (BMD) is controversial. And findings of most studies that have investigated this relationship are restricted to postmenopausal women. In this study, we investigated the relationship between serum DHEA-S and BMD in both men and women. METHODS: This cross-sectional study evaluated a total of 294 healthy Korean participants through a medical examination program. And a subgroup of 154 participants was subjected to a longitudinal analysis. We measured BMD by dual energy X-ray absorptiometry and assayed DHEA-S by a chemiluminescent immunoassay. RESULTS: We evaluated the association between serum DHEA-S concentration and BMD at the femur trochanter after adjusting for cofounders such as age, body mass index, lifestyle factors, serum cortisol level, serum insulin-like growth factor 1 (IGF-1) level, and sex. Through our longitudinal study, we found that the changes in BMD at the total spine, at the femur neck, and at the femur trochanter were all smaller in the ΔDHEA-S 0 group. CONCLUSIONS: We found that there was a positive correlation between serum DHEA-S and femur BMD, which suggests that controlling serum DHEA-S levels may retard age-related BMD reduction in Koreans.

A Case of Surgical Diagnosis and Treatment of Idiopathic Orbital Myositis with Sudden Vision Loss

PURPOSE: We report a case of idiopathic orbital myositis with sudden onset of unilateral visual loss and hypertrophy of the lateral rectus muscle at the apex of the orbit that was diagnosed using orbital biopsy and treated with intravenous corticosteroids. CASE SUMMARY: We examined a 20-year-old woman who complained of decreased visual acuity and binocular diplopia for 2 weeks. She showed 40-prism diopter left esotropia at the primary position. Her visual acuity with eyeglasses was 0.7 and 0.2 in the right and left eyes, respectively. Brain magnetic resonance imaging (MRI) revealed a round mass on the left lateral rectus muscle at the apex of the orbit with optic nerve compression. We planned orbital biopsy to exclude orbital lymphoma and other biopsy-requiring diseases. After 3 weeks, the visual acuity of her left eye decreased to 0.02. Repeated MRI revealed enlargement of all extraocular muscles on the left orbit. With biopsy showing several lymphocytes infiltrating muscle fibers, we made a diagnosis of idiopathic orbital myositis. Intravenous injection of corticosteroids was administered during hospitalization. After 2 weeks of corticosteroid therapy, the visual acuity of her left eye was improved to 0.63, the esotropia disappeared, and the enlargement of the left lateral rectus muscle was improved on orbital MRI. CONCLUSIONS: For non-specific idiopathic orbital myositis located at the apex of the orbit and enlargement of the extraocular muscle in a short period with decreased visual acuity, administration of intravenous injection of corticosteroids before orbital biopsy could help restore vision.

A Comparative Histopathological Study of Lens Capsule and Epithelial Cells in Various Types of Cataract

PURPOSE: To evaluate the histopathological changes of anterior capsule and lens epithelial cells in various types of cataract. METHODS: Patients scheduled for cataract surgery of phacoemulsification with intraocular lens implantation were enrolled in this study. Anterior capsule tissues sized 5 mm were obtained at the time of continuous curvilinear capsulorhexis during surgery. Histological examination of the obtained tissue was performed by transmission electron microscope. RESULTS: Nuclear cataract showed a uniform cuboidal monolayer of epithelial cells firmly attached to the anterior capsule. But, the mitochondria, Golgi apparatus, and endoplasmic reticulum were damaged and replaced with vacuoles. Anterior subcapsular cataract showed multilayers of epithelial cells with irregular intracellular structures. Epithelial cells of mature cataract were severely damaged and detached from the anterior capsule, accompanied by expansion of intra-cellular space and a large amount of vacuoles. Epithelial cells were irregular and severely damaged, and intracellular structures were hardly observed in traumatic cataract. Deposition of pseudoexfoliation materials on the anterior capsule was observed in pseudoexfoliation cataract. CONCLUSIONS: Changes in epithelial cells caused by fluid accumulation and electrolyte imbalance in the lens attributes more to cataract formation than do changes the in lens capsule.

Clinical Manifestations of Extruded Conjunctival Melanocytic Mass

PURPOSE: To investigate the clinical manifestations and characteristics of extruded conjunctival melanocytic mass. METHODS: A total of 33 patients who had extruded conjunctival melanocytic mass and who underwent excisional biopsy were retrospectively reviewed. RESULTS: Based on the excisional biopsy results, 13 patients (40%) were diagnosed with compound nevus, nine patients (27%) with subepithelial nevus, eight patients (24%) with primary acquired melanosis without atypia, and three patients (9%) with malignant melanoma. Compound nevus was located on the temporal side of the cornea in 54% of affected cases, bulbar conjunctival in 77%, and was partially pigmented (brown) in 61%. The average size of the melanocytic mass was 24 mm when histological analysis showed melanin nevus cells in the conjunctival epithelial layer and subepithelial stromal layer. Subepithelial nevus was located on the temporal side of the cornea (56%) and in the bulbar conjunctival (78%) and had a brown color (78%). The average size of the melanocytic mass was 28 mm when histological analysis showed melanin nevus cells located only in the subepithelial stromal layer and forming nest shapes. Primary acquired melanosis without atypia was located on the temporal side of the cornea (62.5%) and bulbar conjunctival (75%) and had brown color (75%). The average size of melanin nevus cells located only in the basement membrane of the epithelial layer was 30 mm. Three of these masses were malignant melanoma, and all cases were located on the superior side of the cornea and palpebral conjunctiva. All cases were black and had an average size of 53 mm, with malignant cells observed in all layers of the conjunctiva and connective tissue. CONCLUSIONS: A conjunctival melanocytic mass located on the palpebral conjunctiva, extruding onto the surface, and large in size should be suspected as malignant melanoma. In such cases, early biopsy and aggressive resection are required.

Optic Neuritis in a Patient with Bickerstaff's Brainstem Encephalitis

No abstract available.

Reduction of Disease Activity in Patient with Relapsing-Remitting Multiple Sclerosis after Switching to Teriflunomide from Interferon Beta

No abstract available.

Reduction of Disease Activity in Patient with Relapsing-Remitting Multiple Sclerosis after Switching to Teriflunomide from Interferon Beta

No abstract available.

Preoperative Enoxaparin versus Postoperative Enoxaparin Thromboprophylaxis in Hip Fracture Surgery: Is Preoperative Enoxaparin Safe to Use? / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of pre- and postoperative initiation of enoxaparin in treatment of hip fracture. MATERIALS AND METHODS: In this study, we enrolled 629 consecutive patients with hip fracture who Pusan National University Hospital between March 2009 and March 2014. Of these patients, 414 patients (65.8%) met the final inclusion criteria. Enoxaparin was administered subcutaneously at 40 mg once daily starting 48 hours after surgery in 156 patients (group A), and immediately after admission in 258 patients (group B). The incidence of symptomatic venous thromboembolism (VTE) and risk of bleeding during hospitalization period were compared between groups. RESULTS: The incidence of symptomatic VTE during the hospitalization period was 7.1% (11 patients) in group A and 5.4% (14 patients) in group B. No significant difference in the rate of symptomatic VTE was found between the groups (unadjusted odds ratio [OR], 0.756; 95% confidence interval [CI], 0.334–1.710; adjusted OR, 0.554; 95% CI, 0.212–1.449). The incidence of symptomatic deep-vein thrombosis and pulmonary embolism (including fatal and non-fatal) did not significantly differ between groups. However, fatal pulmonary thromboembolism developed in two cases in group A and one patient expired postoperatively due to pulmonary hemorrhage in group B. Major bleeding and all-cause death did not differ between groups. CONCLUSION: Preoperative starting chemical thromboprophylaxis may be considered in the elderly patients with hip fracture who have risk factors for venous thromboembolism.

Left Atrium Compressed by a Traumatic Focal Aneurysm of the Thoracic Aorta / 대한내과학회지

A 78-year-old woman presented to our hospital with progressive dyspnea (NYHA class I-II) and epigastric discomfort that had developed after a traffic accident. She had a history of hypertension and cerebral infarction, but no history of cardiovascular disease. Her blood pressure was 130/70 mmHg and her heart rate was 66 beats/min and regular. The electrocardiogram showed normal sinus rhythm. The chest X-ray revealed bilateral pleural effusions. Transthoracic echocardiography (TTE) demonstrated an aneurysm of the descending thoracic aorta compressing the left atrium (LA). Left and right ventricular systolic function was preserved. Whole-body computed tomography (CT) angiography revealed that a focal 40-mm-diameter saccular aneurysm in the descending aorta at the level of T7-8, with an intramural hematoma, was compressing the LA and left pulmonary vein. After surgical management, follow-up TTE and CT showed decompression of the LA and left pulmonary vein.

Corrected QT Interval Prolongation during Severe Hypoglycemia without Hypokalemia in Patients with Type 2 Diabetes

BACKGROUND: To evaluate the effects of severe hypoglycemia without hypokalemia on the electrocardiogram in patients with type 2 diabetes in real-life conditions. METHODS: Electrocardiograms of adult type 2 diabetic patients during the episodes of severe hypoglycemia and the recovered stage were obtained and analysed between October 1, 2011 and May 31, 2012. Patients who maintained the normal serum sodium and potassium levels during the episodes of severe hypoglycemia were only selected as the subjects of this study. Severe hypoglycemia was defined, in this study, as the condition requiring active medical assistance such as administering carbohydrate when serum glucose level was less than 60 mg/dL. RESULTS: Nine type 2 diabetes patients (seven men, two women) were included in the study. The mean subject age was 73.2+/-7.7 years. The mean hemoglobin A1c level was 6.07%+/-1.19%. The median duration of diabetes was 10 years (range, 3.5 to 30 years). Corrected QT (QTc) intervals were significantly increased during the episodes of severe hypoglycemia compared to the recovered stage (447.6+/-18.2 ms vs. 417.2+/-30.6 ms; P<0.05). However, the morphology and the amplitude of the T waves were not changed and ST-segment elevation and/or depression were not found during the episodes of severe hypoglycemia. CONCLUSION: In this study, QTc interval prolongation during the episodes of severe hypoglycemia was observed without hypokalemia. Therefore, the distinct alterations in cardiac repolarization during the episodes of severe hypoglycemia may not be associated with hypokalemia.

A Case of Iatrogenic Horner's Syndrome after Video-Thoracoscopic Surgery for Primary Pneumothorax

PURPOSE: To report a case of iatrogenic Horner's syndrome after video-thoracoscopic surgery for primary pneumothorax. CASE SUMMARY: An 18-year-old man with ptosis in the right eye was referred to our clinic. The patient had undergone wedge resection via video-thoracoscopic surgery for primary pneumothorax three weeks previously. On ocular examination, the palpebral fissure width was 7 mm in the right lid and 8 mm in the left lid, the marginal reflex distance 1 (MRD 1) was 2 mm in the right lid and 3 mm in the left lid, and the bilateral levator muscle function was good. Anisocoria was present, and pupil size in a dark room was 2.5 mm in the right eye and 4 mm in the left eye. The patient complained of facial anhidrosis on the right side of the face. CONCLUSIONS: Although iatrogenic Horner's syndrome is rare complication of video-thoracoscopic surgery for primary pneumothorax, diagnosis after surgery of the thoracic cavity should be made carefully.