Objectives: This study was performed to evaluate the utilization patterns of acid suppressants following the withdrawal of ranitidine in Korea. Methods: Health Insurance Review & Assessment Service (HIRA) data from January 2016 to May 2023 were utilized to assess the usage of histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) for acid-related diseases. Drug utilization was calculated for each agent based on the defined daily dose (DDD). To evaluate changes in utilization following the ranitidine recall, an interrupted time series analysis was conducted using segmented linear regression and an autoregressive integrated moving average model. Results: Before the withdrawal of ranitidine, the DDD per 100 000 inhabitants per day was increasing by 6.9 (95% confidence interval [CI], 4.7 to 9.0) for H2RAs and by 19.3 (95% CI, 16.9 to 21.8) for PPIs each month. After the recall, H2RA utilization immediately declined by -1041.7 (95% CI, -1115.8 to -967.7), followed by a monthly increase of 6.6 (95% CI, 3.7 to 9.6) above the previous trend. PPI utilization temporarily surged by 235.2 (95% CI, 149.1 to 321.3), then displayed a monthly increase of 4.1 (95% CI, 0.7 to 7.6) on top of the pre-recall trend. Among PPIs, esomeprazole and rabeprazole demonstrated notable increases, representing the most commonly used acid suppressants in 2023. Conclusions PPI usage rose prominently following the withdrawal of ranitidine from the market. Considering the potential adverse effects of PPIs, further research is necessary to evaluate the public health implications of shifts in the utilization of acid suppressants.

Background: Since the World Health Organization’s pandemic declaration in March 2020, Korea has witnessed shifts in lifestyle behaviors, impacting habits tied to socioeconomic status and contributing to metabolic syndrome (MetS). To investigate this issue, the current study aimed to investigate changes in MetS prevalence, particularly based on income levels before and after the coronavirus disease 2019 (COVID-19) pandemic. Methods: This study used data from the 8th Korea National Health and Nutrition Examination Survey (2019–2020). A total of 6,840 individuals aged 30–65 years were included in this study. Household income was divided into high (≥75th percentile), middle (25–75th percentile), and low (≤25th percentile). A multivariable logistic regression analysis was performed to explore the interaction between this association before and after the COVID-19 pandemic. Results: A statistically significant difference was found in the prevalence of MetS before and after the COVID-19 pandemic (26.7% to 30.2%, P=0.001). These changes differed based on income levels. The increase in the prevalence of MetS was statistically significant in the low- and high-income groups but not in the middle-income group (low: 8.0%p increase [P=0.039], middle: 1.0%p increase [P=0.522], high: 6.4%p increase [P<0.001]). The interaction between household income and the COVID-19 pandemic on MetS was statistically significant (P for interaction=0.032). Conclusion This study revealed that P for interaction between household income, MetS, and the period before and after the COVID-19 pandemic was significant. Changes in physical activity and eating habits during the COVID-19 pandemic may have contributed to these differences.

Objectives: Assessing medical disputes requires both medical and legal expertise, presenting challenges for patients seeking clarity regarding potential malpractice claims. This study aimed to develop and evaluate a chatbot based on a chain-of-thought pipeline using a large language model (LLM) for providing medical dispute counseling and compare its performance with responses from human experts. Methods: Retrospective counseling cases (n = 279) were collected from the Korea Medical Dispute Mediation and Arbitration Agency’s website, from which 50 cases were randomly selected as a validation dataset. The Claude 3.5 Sonnet model processed each counseling request through a five-step chain-of-thought pipeline. Thirty-eight experts evaluated the chatbot’s responses against the original human expert responses, rating them across four dimensions on a 5-point Likert scale. Statistical analyses were conducted using Wilcoxon signed-rank tests. Results: The chatbot significantly outperformed human experts in quality of information (p < 0.001), understanding and reasoning (p < 0.001), and overall satisfaction (p < 0.001). It also demonstrated a stronger tendency to produce opinion-driven content (p < 0.001). Despite generally high scores, evaluators noted specific instances where the chatbot encountered difficulties. Conclusions A chain-of-thought–based LLM chatbot shows promise for enhancing the quality of medical dispute counseling, outperforming human experts across key evaluation metrics. Future research should address inaccuracies resulting from legal and contextual variability, investigate patient acceptance, and further refine the chatbot’s performance in domain-specific applications.

Background: Since the World Health Organization’s pandemic declaration in March 2020, Korea has witnessed shifts in lifestyle behaviors, impacting habits tied to socioeconomic status and contributing to metabolic syndrome (MetS). To investigate this issue, the current study aimed to investigate changes in MetS prevalence, particularly based on income levels before and after the coronavirus disease 2019 (COVID-19) pandemic. Methods: This study used data from the 8th Korea National Health and Nutrition Examination Survey (2019–2020). A total of 6,840 individuals aged 30–65 years were included in this study. Household income was divided into high (≥75th percentile), middle (25–75th percentile), and low (≤25th percentile). A multivariable logistic regression analysis was performed to explore the interaction between this association before and after the COVID-19 pandemic. Results: A statistically significant difference was found in the prevalence of MetS before and after the COVID-19 pandemic (26.7% to 30.2%, P=0.001). These changes differed based on income levels. The increase in the prevalence of MetS was statistically significant in the low- and high-income groups but not in the middle-income group (low: 8.0%p increase [P=0.039], middle: 1.0%p increase [P=0.522], high: 6.4%p increase [P<0.001]). The interaction between household income and the COVID-19 pandemic on MetS was statistically significant (P for interaction=0.032). Conclusion This study revealed that P for interaction between household income, MetS, and the period before and after the COVID-19 pandemic was significant. Changes in physical activity and eating habits during the COVID-19 pandemic may have contributed to these differences.

Purpose: To evaluate the refractive outcomes of FineVision multifocal intraocular lens (IOL) implantation after vitrectomy for retinal detachment in eyes that had undergone myopia-correcting refractive surgery. Methods: This study involved 27 eyes from 27 patients who received FineVision multifocal IOL implantation due to nuclear cataract following vitrectomy for retinal detachment. All patients had previously undergone myopia-correcting refractive surgery. Preoperative and postoperative visual acuity and manifest refraction were measured. Prediction errors were compared between 8 eyes with axial length (AL) ≥ 26 mm and 19 eyes with AL < 26 mm, as well as between 9 eyes with macula-involved retinal detachment and 18 eyes without macula involvement. Results: Six months postoperatively, the mean uncorrected distance visual acuity was 0.12 ± 0.14 logarithm of the minimal angle of resolution (logMAR), and near visual acuity was 0.08 ± 0.14 logMAR. The postoperative spherical equivalent (SE) was within ± 0.50 diopters (D) in 9 eyes (33.3%) and within ± 1.00 D in 19 eyes (70.4%). All eyes had SE within ± 1.50 D. Prediction errors did not significantly differ between eyes with AL ≥ 26 mm and those with AL < 26 mm, nor between macula-involved and non-involved groups up to 6 months postoperatively. Conclusions FineVision multifocal IOL implantation resulted in SEs close to the preoperative expected refraction in eyes with previous vitrectomy and myopia-correcting refractive surgery, with all eyes within ± 1.50 D.

Purpose: To report a case of macular serous retinal detachment and macular thinning associated with optic disc pit maculopathy successfully treated with vitrectomy, fovea-sparing internal limiting membrane (ILM) peeling, and inverted ILM flap technique.Case summary: A 27-year-old male patient presented with a 1-month history of decreased right eye vision. Corrected visual acuity in the right eye was 0.025 at initial visit. Fundus examination revealed an oval, deep-seated defect in the inferotemporal portion of the optic nerve and a chorioretinal coloboma located inferior to the optic nerve with a one-third disc diameter. Optical coherence tomography (OCT) showed severe macular serous detachment and central foveal thinning. Surgical treatment comprised vitrectomy, ILM peeling preserving an amount of ILM equivalent to the diameter of one disc in the central fovea and covering the optic disc pit with an inverted ILM flap from its nasal portion. The flap was fixed with a dispersible viscoelastic material and intravitreal 20% sulfur hexafluoride gas injection. The patient was maintained in a facedown position for 3 days postoperatively. After 15 months, the best-corrected visual acuity of the right eye improved to 0.63. Repeat OCT revealed resolution of retinoschisis and serous retinal detachment, with the ILM flap effectively covering the optic disc pit. Conclusions Fovea-sparing ILM peeling with an inverted ILM flap on the nasal side over the optic disc pit in patients with thin inner retinal layers and excessive serous retinal detachment effectively prevent the occurrence of macular holes and treat optic disc pit maculopathy.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Background: and Purpose The pain lateralization in cluster headache (CH) may be related to the asymmetry in the functions of the brain hemispheres. The right-sided dominance of pain in CH has been found inconsistently across studies, and so we aimed to characterize this and identify the factors influencing pain lateralization during current and previous bouts. Methods: This study enrolled 227 patients from the Korean Cluster Headache Registry between October 2018 and December 2020. We evaluated the side of pain during current and previous bouts, demographic features, and clinical characteristics, including handedness. Multivariable logistic regression analyses were performed to identify factors associated with the side of pain. Results: The 227 patients with CH included 131 (57.7%) with right-sided pain and 86 (37.9%) with left-sided pain during the current bout (p<0.001). The 189 patients with previous bouts of CH included 86.8% who consistently reported the same side of pain throughout multiple bouts (side-locked pain), with a higher prevalence of pain on the right than the left side (55.0% vs. 31.7%, p<0.001). Multivariable analyses revealed that higher age at diagnosis (odds ratio [OR]=1.045, p=0.031) and shorter CH attacks (OR=0.992, p=0.017) were associated with left-side-locked pain. However, handedness was not associated with the lateralization of leftside-locked pain. Conclusions This study has confirmed the predominance of right-sided pain throughout multiple CH bouts. We found that higher age at diagnosis and shorter CH attacks were associated with left-side-locked pain, suggesting that certain clinical factors are associated with the pain laterality. However, the underlying mechanisms linking these factors to lateralized pain remain unclear and therefore require further investigation.

Background: Dental caries is a prevalent public health problem among adolescents that significantly affects their quality of life. The Caries Management by Risk Assessment (CAMBRA) model provides a structured, risk-based approach for caries prevention and management. This study evaluated the effectiveness of the CAMBRA-students mobile application, integrated with an information and communication technology (ICT) based intervention, in modifying caries risk factors in middle school students. Methods: A non-equivalent control group pretest-posttest design was used. A total of 131 middle school students aged 13∼14 years participated. The experimental group (n=68) received a risk-based intervention using the CAMBRA-student mobile application for 1 year, while the control group (n=63) received only standard oral health education and underwent pre- and post-tests. Data on caries risk factors; protective factors; disease indicators; and decayed, missing, and filled teeth rates were collected. Paired and independent t-tests were conducted to analyze changes within and between groups. Results: The rate of change in the caries risk classification before and after the intervention differed between the groups. In the control group, 50% of the low-risk participants were at a high-risk after 12 months. In the intervention group, 90% of the low-risk participants shifted to the high-risk category, and those classified as extremely high-risk moved to the high-risk category. When comparing changes in the caries risk assessment before and after the intervention, both groups demonstrated a significant increase in protective factors (p＜0.001). However, disease indicators increased significantly in the control, whereas no significant change was noted in the intervention group. Conclusion This study evaluated the effectiveness of an ICT-based caries management program for middle school students and confirmed changes in protective factors and specific oral health behaviors through personalized interventions. Future studies should investigate the long-term sustainability of such interventions across diverse populations to further establish their effectiveness.