Kosin Medical Journal

Volume 38(3); September 2023

Editorial

Omega-3 fatty acids: promising therapeutic agents for combating kidney injuries: Hee-Jae Cha; Kosin Med J. 2023;38(3):157-158. Published online September 7, 2023; DOI: https://doi.org/10.7180/kmj.23.135

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Review articles

Do we need Moodle in medical education? A review of its impact and utility: Seri Jeong, Hyunyong Hwang; Kosin Med J. 2023;38(3):159-168. Published online September 22, 2023; DOI: https://doi.org/10.7180/kmj.23.139

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Abstract PDF PubReader ePub: Various learning management systems (LMSs) are available to facilitate the development, management, and distribution of digital resources for both face-to-face and online instruction. In recent decades, these methods have shown potential for greater efficiency compared to traditional "chalk and talk" approaches. Additionally, they have paved the way for the establishment of ubiquitous learning environments, marking a new era in education. In a trend accelerated by the coronavirus disease 2019 pandemic, LMSs have been increasingly adopted to overcome the restrictions inherent to in-person education. In medical education, LMSs such as Moodle, Canvas, Blackboard Learn, and others have been introduced and used to support teaching, learning, and assessment activities. Of these, Moodle stands out as the most popular choice for many medical schools and institutions, primarily due to its flexibility, functionality, and user-friendliness. The learning environment is gradually transforming from traditional in-person teaching to a hybrid educational approach, driven by the need to fulfill diverse educational demands. Numerous research studies have examined the usability of Moodle in medical education, demonstrating its effectiveness in addressing challenges related to adaptive personalized learning, collaborative learning, blended learning, and more. Consequently, Moodle has emerged as a valuable solution for medical educators seeking a versatile and robust platform to enhance their teaching methodologies. The present review focuses on the practical utilization of Moodle in medical education and the advantages it offers to this field.

Gut microbiota and nonalcoholic fatty liver disease: Boyeon Kim, Bukyung Kim; Kosin Med J. 2023;38(3):169-175. Published online September 22, 2023; DOI: https://doi.org/10.7180/kmj.23.138

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Abstract PDF PubReader ePub: The gut microbiota has been reported to exert a significant influence on various physiological responses of hosts. Extensive evidence has recently emerged linking metabolic and cardiovascular disorders to the gut microbiota. Nonalcoholic fatty liver disease (NAFLD) is the most common underlying metabolic disorder, and its prevalence is increasing worldwide. In this study, we aim to review the relationship between the gut microbiota and NAFLD, and explore the potential of the gut microbiota as a novel target for NAFLD treatment.

Application of Raman spectroscopy in breast cancer surgery: Yikeun Kim, Sung Ui Jung, Jinhyuk Choi; Kosin Med J. 2023;38(3):176-183. Published online September 14, 2023; DOI: https://doi.org/10.7180/kmj.23.129

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Abstract PDF PubReader ePub: The incidence of breast cancer is increasing worldwide. As cancer screening has become more widespread, the rate of early breast cancer detection has increased and treatment methods have changed. Partial mastectomy is performed more often than total mastectomy for the surgical treatment of early breast cancer, and sentinel lymph node biopsy plays an important role. A high level of accuracy is necessary for the intraoperative examination of surgical margins and sentinel lymph nodes to identify malignancies. Therefore, several examination techniques, including Raman spectroscopy, that replace or supplement the currently used frozen-section methods are being studied. Raman spectroscopy has the ability to diagnose cancer in normal tissue by providing in real time a chemical fingerprint that can be used to differentiate between cells and tissues. Numerous studies have investigated the utilization of Raman spectroscopy to identify cancer in the margins of resected tissues and sentinel lymph nodes during breast cancer surgery, showing the potential of this technique for clinical applications. This article introduces and reviews the research on Raman spectroscopy for breast cancer surgery.

Original articles

Omega-3 fatty acids upregulate Nrf2 expression and attenuate apoptosis, inflammation, and fibrosis in a rat model of cyclosporine-induced nephropathy: Ji Young Lee, Young Ki Son, Mi Hwa Lee, Su Mi Lee, Seong Eun Kim, Won Suk An; Kosin Med J. 2023;38(3):184-192. Published online July 26, 2023; DOI: https://doi.org/10.7180/kmj.23.112

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Background
Cyclosporine A (CsA)-induced kidney injury is characterized by renal impairment with inflammatory cell infiltrations, apoptosis, fibrosis, and hypoxic injury. It is not clear whether omega-3 fatty acids (O-3 FAs), which have anti-inflammatory and antioxidant roles, affect nuclear factor erythroid 2-related factor 2 (Nrf2) expression. The aim of this study was to investigate whether O-3 FAs affect Nrf2 expression and exert anti-inflammatory, anti-apoptotic, and anti-fibrotic effects in CsA-induced nephropathy.
Methods
Male Sprague-Dawley rats were divided into control, CsA-treated, and CsA-treated with O-3 FA groups. Nrf2 expression was measured by Western blots and immunohistochemical staining.
Results
Kidney function was impaired in the CsA-treated rats compared to the controls. Caspase-3 and caspase-7 were activated in the CsA-treated group, and the Bax/Bcl2 ratio was higher. O-3 FAs attenuated these apoptosis-related changes. ED-1 and inhibition of kappa B (IĸB) protein expression were significantly upregulated in the CsA-treated group. Compared to the control group, O-3 FA supplementation attenuated the increased expression of ED-1 and IĸB related to inflammation. Smad2/3, Smad4, and transforming growth factor-β1 were activated in the CsA group, and O-3 FA treatment prevented these changes related to renal fibrosis. The expression of Nrf2 was reduced in CsA-treated rats, but Nrf-2 was increased by O-3 FA treatment.
Conclusions
We suggest that Nrf2 is a potential mediator induced by O-3 FA supplementation and that it attenuates pro-inflammatory pathways, fibrotic processes, and apoptosis. Further studies are needed to elucidate the crosstalk between Nrf2 expression and signals related to O-3 FA treatment.

Citations

Citations to this article as recorded by

Omega-3 fatty acids: promising therapeutic agents for combating kidney injuries
Hee-Jae Cha
Kosin Medical Journal.2023; 38(3): 157. CrossRef

The COVID-19 pandemic's impact on prostate cancer screening and diagnosis in Korea: Byeong Jin Kang, Kyung Hwan Kim, Hong Koo Ha; Kosin Med J. 2023;38(3):193-200. Published online August 16, 2023; DOI: https://doi.org/10.7180/kmj.23.116

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Abstract PDF PubReader ePub: Background
The global coronavirus disease 2019 (COVID-19) pandemic, which started in early 2020, has had multiple impacts on cancer care. This study assessed how the COVID-19 pandemic influenced prostate cancer (PCa) screening and diagnosis in South Korea.
Methods
Patients who visited the outpatient clinic at a single institution for PCa evaluation were included in this study and divided into a pre-COVID-19 group and a COVID-19 pandemic group, based on the start of the COVID-19 pandemic and social distancing policies on March 1, 2020. The number of prostate-specific antigen (PSA) tests, patients with elevated PSA levels, and prostate biopsy results were analyzed.
Results
In total, 8,926 PSA tests were administered during the COVID-19 pandemic, compared to 15,654 before the pandemic (p<0.05). Of 2,132 patients with high PSA levels, 1,055 (49.5%) received prostate biopsies before the pandemic and 1,077 (50.5%) did so during the COVID-19 pandemic. The COVID-19 pandemic group had a higher detection rate of PC, and increased rates of Gleason scores (GS) 7 and 9–10, while the rate of GS 6 decreased compared to the pre-COVID-19 group (p<0.05). The rate of clinically significant PCa (csPCa) was also higher during the pandemic (p<0.05). In both magnetic resonance imaging-guided and standard biopsies, the GS 6 rate decreased, and the csPCa rate increased during the COVID-19 pandemic (each, p<0.05).
Conclusions
During the COVID-19 pandemic, the detection rate of prostate biopsies and the rate of csPCa increased significantly. Thus, PCa was diagnosed at a more advanced state in Korea during the COVID-19 pandemic.

Post-percutaneous core needle biopsy sputum cytology: diagnostic value and factors for positive prediction in diagnosing malignancy: Sang Kyu Lee, Hee Kang, Min Jung Jung, Sekyoung Park, Ki Nam Lee; Kosin Med J. 2023;38(3):201-209. Published online August 16, 2023; DOI: https://doi.org/10.7180/kmj.23.127

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Abstract PDF PubReader ePub: Background
This study evaluated the diagnostic yield and positive predictive factors of post-percutaneous core needle biopsy (PCNB) sputum cytology in diagnosing malignancy.
Methods
This retrospective study included patients who underwent PCNB at a single center from January 2014 to March 2022. Patient demographics, lung lesion characteristics on computed tomography, underlying lung disease, post-PCNB complications, histopathologic results of PCNB, post-PCNB sputum specimens, and final diagnoses were reviewed. The diagnostic yields and related factors were analyzed.
Results
Overall, 177 consecutive patients with sputum specimens obtained after PCNB for intrapulmonary lesions were enrolled. Among them, 152 patients had a final diagnosis of malignancy. Diagnostic sputum specimens with atypical or malignant cells were obtained in 12 patients. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of sputum cytology were 7.89%, 100%, 20.90%, 100%, and 15.15%, respectively. Lesion size, air-bronchogram, lesion multiplicity, and the cell type of squamous cell and adenocarcinoma differed significantly between the groups with diagnostic versus non-diagnostic sputum (p<0.05). The lesion size (odds ratio [OR], 1.035; 95% confidence interval [CI], 1.008–1.064; p=0.013), presence of air-bronchogram (OR, 23.485; 95% CI, 2.532–217.316; p=0.005), and squamous cell carcinoma (OR, 7.397; 95% CI, 1.773–30.865; p=0.006) were significantly associated with a diagnostic sputum specimen post-PCNB.
Conclusions
Although post-PCNB sputum cytology had low sensitivity in diagnosing lung cancer, it showed diagnostic results in some peripheral lung cancer patients who have squamous cell types, relatively large tumors, and air-bronchograms in the lesions.

Case reports

Scrub typhus with complications of acute myocarditis and cardiac tamponade in metropolitan areas: two case reports: Ki-Woon Kang, Wonho Kim; Kosin Med J. 2023;38(3):210-214. Published online June 9, 2023; DOI: https://doi.org/10.7180/kmj.23.111

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Abstract PDF PubReader ePub: Scrub typhus is known as one of the most common seasonal infections in endemic rural areas, but life-threatening cardiac complications in cases of scrub typhus are very infrequent. In addition, scrub typhus infection has been rarely reported among workers assembling pallets using manufactured wood in metropolitan areas. Herein, we present two cases involving myocarditis and cardiac tamponade as complications of scrub typhus. One patient died and the other patient survived. These cases indicate that scrub typhus infection could be an environmental hazard in metropolitan areas, especially in locations with poor hygiene, and highlight the need for timely diagnosis and proper management of severe scrub typhus infections. Therefore, we present these two informative fatal cases of scrub typhus infection presenting with myocarditis and cardiac tamponade as an environmental hazard in metropolitan areas.

Dermoscopic features of an unusual case of targetoid hemosiderotic nevus: Sun Mun Jeong, Jang Hwan Jung, Do Ik Kwon, Seol Hwa Seong, Ji Yun Jang, Jong Bin Park, Min Soo Jang; Kosin Med J. 2023;38(3):215-218. Published online February 15, 2023; DOI: https://doi.org/10.7180/kmj.22.119

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Abstract PDF PubReader ePub: Targetoid hemosiderotic nevus (THN) is a rare variant of melanocytic nevus, characterized by a sudden development of a targetoid ecchymotic halo around a pre-existing nevus. THN clinically raises concern for malignant transformation due to its abrupt change in color and size. THN should be distinguished from other diseases showing a peripheral halo, including targetoid hemosiderotic hemangioma, halo nevus, and Meyerson nevus. Dermoscopy can help clinicians to differentiate THN from these diseases. The typical dermoscopic features of THN are known to be divided into two distinctive areas: the central melanocytic area and the peripheral ecchymotic area. In our case, dermoscopy revealed a novel bull’s eye pattern composed of a central area with characteristic features of benign melanocytic nevus, an intermediated white circular ring, and a peripheral milky red area. When a sudden change occurs in a pre-existing nodule showing targetoid features, dermoscopy should be considered before conducting a biopsy or surgical intervention.

Central diabetes insipidus following COVID-19 mRNA vaccination: a case report: Min-Young Kim, Jong Ryeal Hahm, Jaehoon Jung, Jung Hwa Jung, Kyoung Young Kim, Hosu Kim, Jong Ha Baek, Hwa Seon Shin, Kee Ryeon Kang, Soo Kyoung Kim; Kosin Med J. 2023;38(3):219-223. Published online June 9, 2023; DOI: https://doi.org/10.7180/kmj.23.105

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Abstract PDF PubReader ePub: The coronavirus disease 2019 (COVID-19) has been a major public health emergency worldwide. Vaccines were rapidly developed and approved to prevent the spread of viral infection. However, various side effects of the COVID-19 messenger RNA (mRNA) vaccines have been reported after their commercialization. A 24-year-old man visited our emergency department with polyuria and polydipsia that occurred after he received a COVID-19 mRNA vaccine 10 days beforehand. The initial laboratory findings showed very low urine osmolality with hyperosmolar hypernatremia. Based on these findings, diabetes insipidus was suspected, and sella magnetic resonance imaging showed an enlarged pituitary gland and the absence of posterior pituitary higher intensity. After 12 hours of using oral desmopressin acetate, urine volume decreased, and after 5 days of administration, serum electrolyte and serum osmolality improved. This case report of diabetes insipidus occurring after vaccination with the BNT162b2 mRNA COVID-19 vaccine is presented as a reminder that close monitoring is necessary for patients with polyuria and polydipsia after vaccination.

Scrub typhus infection in a kidney transplant recipient: a case report: Dongyeon Lee, Joohee Jeon, Jae Sung Ahn, Chung Hee Baek; Kosin Med J. 2023;38(3):224-228. Published online June 9, 2023; DOI: https://doi.org/10.7180/kmj.23.114

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Abstract PDF PubReader ePub: Scrub typhus is a febrile disease that is endemic to Asia and the Pacific region. Its clinical manifestations include fever, myalgia, lymphadenopathy, and a characteristic eschar. The main manifestations of this disease are difficult to differentiate from those of other febrile illnesses; thus, a careful clinical examination and a high index of suspicion are crucial for an early diagnosis. Our case involved a 55-year-old female renal transplant recipient who presented with fever and sore throat in November. Her clinical symptoms did not improve after oral amoxicillin/clavulanate administration for 7 days, after which proteinuria and acute kidney injury were identified. After hospitalization, an eschar was found and immunoglobulin M antibodies against Orientia tsutsugamushi were detected by indirect immunofluorescence. She received oral doxycycline for 7 days and showed improvement in renal function and proteinuria. This is the first case report of scrub typhus infection in a kidney transplant patient in Korea. It is meaningful to report that the renal abnormalities associated with scrub typhus improved in a renal transplant patient through treatment of the disease. This case highlights the importance of examining the social history and symptoms of patients suspected of having scrub typhus in endemic areas. Early diagnosis and treatment are crucial in kidney transplant patients to preserve graft function and prevent fatal complications.

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