Rituximab in practice: Clinical evaluation of patients with pemphigus after rituximab administration.

Pemphigus Vulgaris (PV) is a rare autoimmune blistering disease, which mainly causes mucosal and/or cutaneous lesions. In June 2018, FDA approved Rituximab (RTX)-a B-cell depleting agent-for the management of patients with moderate-to-severe pemphigus. Although the majority of patients respond well to this drug, some do not reach complete remission with a single cycle of RTX. In this review, following an overview of RTX and its clinical outcomes, we have focused on the possible outcomes after RTX therapy in patients with PV. The response is defined into four main categories; complete responders, partial responders, nonresponders, and paradoxical reactions, based on three possibilities of reaching the consolidation phase after 3 months, reaching remission until 6 months, and the ability of corticosteroid tapering in 6 months after RTX administration. Concerning the safety of RTX, three categories of infusion reactions, short and long-term side effects are discussed. Additionally, we have suggested approaches for the evaluation of clinical and serological responses at different critical time-points, including 1, 2, 3, and 6 months after RTX administration. Finally, available markers to predict the response to RTX and research gaps in the field of RTX therapy have been summarized.

Students' concerns about the pre-internship objective structured clinical examination in medical education.

BACKGROUND: Despite several studies on implementation, reliability and validity of the Objective Structured Clinical Examination (OSCE), the perceptions of examinees toward this evaluation tool remain unclear. The aim of the current study was to assess students' perceptions of the OSCE. METHODS: All students in their final year of studies, who participated in the pre-internship OSCE in September 2010, were included in the study. A 16-item questionnaire was designed to assess: Characteristics of respondents; organization, content and structure of the OSCE; and perceptions of validity, reliability and rating of the OSCE with respect to other assessment methods. Questionnaires were administered immediately after all students had finished the OSCE and before leaving the examination venue. RESULTS: Response rate was 86.2%, with 77% of the students indicating the OSCE as a useful learning experience. A majority of the students (62%) agreed that a wide range of clinical skills was covered in this exam. However, 66% had concerns about the wide coverage of knowledge assessed. A total of 81% of students did not prefer the OSCE to multiple choice question exams and 88% found the OSCE intimidating and more stressful than other forms of assessment. DISCUSSION: Our study demonstrates that although the majority of students believe in the reliability and validity of the OSCE, they have concerns about it and report poor acceptance of the OSCE. Further studies are necessary to assess the important concerns of the students and the effectiveness of interventions in improving the acceptability of the OSCE.

Medical students' health-related quality of life: roles of social and behavioural factors.

OBJECTIVES: The long and demanding course of medical education may be accompanied by distress with serious consequences. This study was conducted to assess the multidimensional health-related quality of life (HR-QoL) in medical students in different stages of medical education and its associations with behavioural and social factors. METHODS: A cross-sectional study was conducted in medical students at three medical schools at, respectively, Tehran University of Medical Sciences, Aja University of Medical Sciences and Baghiyatalah Medical School, in November and December 2011 using stratified sampling. Data were obtained on participants' characteristics, including gender, current education stage, living situation, smoking status, physical activity, and membership of associations or teams. Health-related QoL was measured using the Persian version of the 36-item Short Form Health Survey (SF-36), which generates a physical component score (PCS) and a mental component score (MCS). Logistic regression was applied to measure the adjusted associations between variables. RESULTS: Of the 1350 students invited, 1086 individuals completed the survey to give a response rate of 80.4%. Logistic regression showed male gender (odds ratio [OR] = 2.88, p < 0.001), living with family versus in a dormitory (OR = 2.72, p < 0.001) and participation in daily physical activity (OR = 16.96, p < 0.001) to be significantly associated with a higher PCS. Being in an internship versus in the basic sciences stage of medical education showed a significant association with a lower PCS (OR = 0.12, p < 0.001). Similarly, male gender (OR = 1.67, p < 0.05), living with family rather than in a dormitory (OR = 16.91, p < 0.001), daily physical activity (OR = 25.36, p < 0.001), and membership of associations or teams (OR = 3.67, p < 0.001) were associated with a higher MCS. Likewise, studying in internship rather than in the basic sciences stage was accompanied by a lower MCS (OR = 0.12, p < 0.001). CONCLUSIONS: This large, multi-institution study, despite its limitations, indicates that medical students in internships show lower scores in all domains of QoL. Social engagement is an important associate of higher HR-QoL. Further studies should address the efficacy of interventions, such as self-awareness programmes and initiatives to encourage students to be more physically and socially active, in improving students' health.