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Euglycemic Diabetic Ketoacidosis When Reducing Insulin Dosage in Patients Taking Sodium Glucose Cotransporter 2 Inhibitor.

Woo Jin YI ; Soo Kyung KIM ; Sun Ung YOUN ; Namkyu KANG ; Myung Won LEE ; Seok O PARK

The Ewha Medical Journal.2017;40(1):55-58. doi:10.12771/emj.2017.40.1.55

Sodium glucose cotransporter 2 (SGLT2) inhibitor has been recently reported of diabetic ketoacidosis due to accumulation of ketone bodies in patients with severe dehydration caused from such like diarrhea even though the patient had normal glucose level. This is a case of ketoacidosis in normal glucose level as production of ketone bodies is stimulated in liver with increased secretion of glucagon by stimulation of α cells in pancreas due to increase of lipolysis caused from reducing insulin and by SGLT2 inhibitor among patients who are under concurrent insulin and SGLT2 inhibitor. Thus, insulin dosage reduction requires caution in order to control blood glucose level on combined treatment of SGLT2 inhibitor in a patient who is administering insulin because the patient may be caused ketoacidosis in normal blood glucose level.
Blood Glucose ; Dehydration ; Diabetic Ketoacidosis* ; Diarrhea ; Glucagon ; Glucose* ; Humans ; Insulin* ; Ketone Bodies ; Ketosis ; Lipolysis ; Liver ; Pancreas ; Sodium*

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Bisacodyl Induced Severe Rectal Ulcer with Proctitis.

Hye Jin CHO ; Jae Uk SHIN ; Su Sin JIN ; Hyeon Jeong KANG ; Ho Wook JEON ; Joon Yub LEE

The Ewha Medical Journal.2017;40(1):50-54. doi:10.12771/emj.2017.40.1.50

Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.
Abdominal Pain ; Administration, Rectal ; Adult ; Aged, 80 and over ; Bisacodyl* ; Child ; Colitis ; Constipation ; Diarrhea ; Female ; Gastrointestinal Motility ; Humans ; Mucous Membrane ; Proctitis* ; Rectum ; Ulcer*

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The Effects of Peer Assessment and Peer Feedback in Writing Education for Premedical Students.

Claire Junga KIM

The Ewha Medical Journal.2017;40(1):41-49. doi:10.12771/emj.2017.40.1.41

OBJECTIVES: There are several problems which hamper the successful teaching of writing in medical education. To deal with these problems, teachers should be conscious of two general questions; what to teach in writing class for premedical students; and how to utilize the writing class time. This paper examines the value of peer assessment and peer feedback in dealing with those questions. METHODS: This paper reviews a subject in premedical education, Logical Thinking and Writing, from the perspective of peer assessment and peer feedback. RESULTS: Students accomplished the learning objectives and they recognized the value of peer assessment and feedback. CONCLUSION: Peer assessment and peer feedback foster students' participation in class and accelerate the learning process. This strategy reminds students of the fact that they are writing an essay for an audience.
Education* ; Education, Medical ; Education, Premedical ; Humans ; Learning ; Logic ; Medical Writing ; Students, Premedical* ; Thinking ; Writing*

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Implementation of Outcome-Based Medical Education Theory into the Pre-existing Curriculum.

Young Sun HONG ; Jae Jin HAN ; Claire Junga KIM ; Hee Jung CHOI ; Joo Chun YOON ; Hye Kyung JUNG ; Han Su KIM

The Ewha Medical Journal.2017;40(1):35-40. doi:10.12771/emj.2017.40.1.35

OBJECTIVES: This paper aims to describe an outcome-based curriculum development process at a medical school that has difficulty in advancement from the higher stage outcomes to the individual lesson outcomes, and to propose a way to implement it practically. METHODS: We reviewed the objectives, strategies and previous products of the school's taskforce activities and suggested the principle of bidirectional approaches of outcome based curriculum development. RESULTS: The developing strategy identified such as firstly, the evaluation of present curriculum and then, the review of the outcomes developed previously with considering the nation-wide environmental change in medical education. Then, we selected one example course which was focused the resources of the school to, and finally the product of the example course was propagated to the other courses with central monitoring. CONCLUSION: Bidirectional model of ‘Top-down’ plus ‘Bottom-up’ approaches could be an efficient way to develop the outcome-based curriculum in a medical school, which has difficulties to advance the developing process due to various reasons including limited resources.
Curriculum* ; Education ; Education, Medical* ; Humans ; Schools, Medical

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Hereditary Nonpolyposis Colorectal Cancer.

Bo Young OH

The Ewha Medical Journal.2017;40(1):29-34. doi:10.12771/emj.2017.40.1.29

Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common hereditary colorectal cancer syndrome and accounts for about 5% of colorectal cancer. It is inherited as autosomal dominant type and is caused by germline mutations in mismatch repair genes such as MLH1, MSH2, MSH6, and PMS2. Patients with HNPCC are characterized by a high level of microsatellite instability. They commonly develop colorectal cancer at young age and increase risk of extra-colic malignancies, especially endometrial cancer. They also show better oncologic outcomes compared to sporadic colorectal cancer. Several tools are used in diagnosis of HNPCC, including history taking, microsatellite instability test, immunohistochemistry for mismatch repair protein, and gene test. Affected patients and their families should get genetic counseling and regular surveillance for cancers, which can improve their survival rate.
Colorectal Neoplasms ; Colorectal Neoplasms, Hereditary Nonpolyposis* ; Diagnosis ; DNA Mismatch Repair ; Endometrial Neoplasms ; Female ; Genetic Counseling ; Genetic Testing ; Germ-Line Mutation ; Humans ; Immunohistochemistry ; Microsatellite Instability ; Survival Rate

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Gut Microbiota in Health and Probiotics in Functional Bowel Disease.

Jai Hyun RHYOU

The Ewha Medical Journal.2017;40(1):22-28. doi:10.12771/emj.2017.40.1.22

Microorganisms coexist in the human body and its function is essential to maintain normal physiology and homeostasis. Microbiota refers to the entire population of microorganisms that colonizes a particular location; includes not just bacteria but also other microbes. Gut microbiota is vast and complex. It could be changed dynamically according to the variable factors. Well balanced host-microbial symbiotic state is a harmonious ecosystem in the stable individual. But, dysbiosis is a state of deviation in composition or function from the usual gut microbiota. It has been found that this condition is associated with many gastrointestinal, metabolic, allergic and the other diseases. Dysbiosis plays an important role in the pathophysiology of functional bowel disease, such as irritable bowel syndrome and functional constipation. Probiotics is microorganism which, when administrated in adequate amounts, confer a health benefit on the host. Probiotics have beneficial effects to reduce several symptoms of functional bowel diseases. Currently, complementary and alternative medicine therapies with probiotics is recommended for symptomatic relief from functional bowel disease.
Bacteria ; Colon ; Complementary Therapies ; Constipation ; Dysbiosis ; Ecosystem ; Gastrointestinal Microbiome* ; Homeostasis ; Human Body ; Insurance Benefits ; Irritable Bowel Syndrome ; Microbiota ; Physiology ; Probiotics*

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Anticancer Effect of Selenium.

Joohyun WOO ; Woosung LIM

The Ewha Medical Journal.2017;40(1):17-21. doi:10.12771/emj.2017.40.1.17

Selenium is an essential microelement in animals including human. Selenium plays an important role in cellular functions such as deoxygenation and detoxification. Also, it can be used in treatment of cardiac disease, hepatic disease, AIDS and various cancers. Recent meta-analysis showed that high selenium exposure was associated with decreased risk of several cancers. Selenium has an effect on anticarcinogesis through several mechanisms, which are regulation of cell cycles, apoptosis, DNA damage and repair, inhibition of cellular adhesion and migration, anti-angiogenesis and immune modulation. Even though many laboratory studies have provided convincing evidence of these mechanisms, results from epidemiologic and clinical studies of selenium does not coincide with each other. Well-designed trials considering dosage and chemical form of selenium supplement as well as confounding factors and long-term follow-up of them would be needed to use selenium in chemoprevention and therapy of cancers.
Animals ; Apoptosis ; Cell Cycle ; Chemoprevention ; DNA Damage ; Follow-Up Studies ; Heart Diseases ; Humans ; Selenium*

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Statistical Methods: Reliability Assessment and Method Comparison.

Kyoung Ae KONG

The Ewha Medical Journal.2017;40(1):9-16. doi:10.12771/emj.2017.40.1.9

The reliability of clinical measurements is critical to medical research and clinical practice. Newly proposed methods are assessed in terms of their reliability, which includes their repeatability, intra- and interobserver reproducibility. In general, new methods that provide repeatable and reproducible results are compared with established methods used clinically. This paper describes common statistical methods for assessing reliability and agreement between methods, including the intraclass correlation coefficient, coefficient of variation, Bland-Altman plot, limits of agreement, percent agreement, and the kappa statistic. These methods are more appropriate for estimating reliability than hypothesis testing or simple correlation methods. However, some methods of reliability, especially unscaled ones, do not clearly define the acceptable level of error in real size and unit. The Bland-Altman plot is more useful for method comparison studies as it assesses the relationship between the differences and the magnitude of paired measurements, bias (as mean difference), and degree of agreement (as limits of agreement) between two methods or conditions (e.g., observers). Caution should be used when handling heteroscedasticity of difference between two measurements, employing the means of repeated measurements by method in methods comparison studies, and comparing reliability between different studies. Additionally, independence in the measuring processes, the combined use of different forms of estimating, clear descriptions of the calculations used to produce indices, and clinical acceptability should be emphasized when assessing reliability and method comparison studies.
Bias (Epidemiology) ; Methods* ; Reproducibility of Results

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Past, Present, and Future of Ewha Medical Care.

Koo Young JUNG ; Sang Jin SHIN

The Ewha Medical Journal.2017;40(1):1-8. doi:10.12771/emj.2017.40.1.1

Historically, Ewha University Medical Center roots from Boguyeogwan, which was founded by missionaries in 1887 as the first women's hospital. Inheriting the spirit of missions, Ewha Medical Care (EMC) is an official missionary activity of Ewha Womans University that provide regular mission trips to offer medical services in underdeveloped countries. The first EMC trip was to Nepal in 1989 at the request of Nepalese Sakura Rajbhandary, a graduate of Ewha Womans University Medical School. Mission trips continued to Nepal from 1989 to 2001, and since 2003 mission fields were changed to Cambodia, Vietnam, and Uzbekistan. Since 2014, EMC has sent 3 mission teams to each countries, Cambodia, Vietnam, and Uzbekistan, every year. The final mission of EMC in the future is to establish a missionary hospital in the third world where medical service is in need as Boguyeogwan was established by missionaries to protect and save poor Korean women in the past.
Academic Medical Centers ; Cambodia ; Female ; Humans ; Missionaries ; Nepal ; Religious Missions ; Schools, Medical ; Uzbekistan ; Vietnam

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Primary Pulmonary Hodgkin Lymphoma Associated with Primary Sjögren's Syndrome.

Masashi OHE ; Satoshi HASHINO ; Katsura NAGAI ; Atsuo HATTORI ; Ken FURUYA

The Ewha Medical Journal.2016;39(3):95-98. doi:10.12771/emj.2016.39.3.95

No abstract available.
Hodgkin Disease*

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