Positive attitude and self-evaluation are necessary for medical students and doctors. To explore how best to integrate physiology teaching in our Thai medical curriculum, we investigated relationships between student’s academic performance, their attitude, self-evaluated knowledge, and proportion of physiology taught in an organ-system integrated block. We organized 13 physiology laboratory classes, during which students self-rated attitude and knowledge. Academic performance was measured by formative and summative assessments. One hundred thirty-six participants were categorized into most proactive (Most PA), more proactive (More PA), less proactive (Less PA), and least proactive (Least PA) attitude groups by self-preparation questionnaire. Eighty participants were categorized into high (HighE), moderate (ModerateE), and low (LowE) self-evaluation rating groups. Mean formatives score in the Most PA group was significantly higher than in the other PA groups ( P = 0.003, P = 0.001, and P < 0.001, respectively). Mean summative score in the Most PA group was significantly higher than the Less PA and the Least PA groups ( P = 0.017 and P = 0.015 respectively). There was no significant difference in mean assessment scores among HighE, ModerateE, and LowE groups. Proportion of teaching time dedicated to physiology positively correlated with student attitude ( r = 0.84, P = 0.001) and negatively correlated with self-evaluation rating ( r = −0.73, P = 0.007). Thai medical students may benefit from a proactive attitude to studying physiology, contrasting with traditional didactic expectations of Thai education. Proportion of teaching time dedicated to physiology does not influence academic performance; therefore, future adjustments to curriculum integration may incorporate classes that facilitate self-directed learning. Future study should explore other influences on learning and assessment performance.

Russell's viper bite is an important public health problem of tropical countries including Thailand. Common manifestations after Russell's viper bite are local tissue swelling, coagulopathy, and nephrotoxicity. Cardiac manifestation and cerebral infarction rarely occur. Herein, we reported two cases of cardiac arrest with evidence of large vessel complication following Russell's viper bite. The first case was a 52-year-old man who presented with cardiac arrest due to acute myocardial infarction. His coronary angiography result showed 95% stenosis of the mid left anterior descending artery and a drug-eluting stent was successfully placed. The second case was a 46-year-old female who developed cardiac arrest followed by an acute ischemic stroke. Antivenom was given and her symptom improved. We hypothesized that our patients developed a prothrombotic state associated with consumptive coagulopathy, causing large vessel thrombosis. The exact mechanism to explain these complications, however, is still inconclusive. Nonetheless, early recognition of these events and prompt treatment may reduce morbidity and mortality.

BackgroundGastrointestinal stromal tumor (GIST) was the most common mesenchymal tumor of the gastrointestinal tract predominately occurring in the stomach. Although GIST was a rare disease, it was considered to be a life-threatening malignancy.ObjectiveTo explore the current status of gastric GIST in Thai patients.MethodThe medical records of patients who were diagnosed with histologically proven gastric GIST from 2012 to 2016 in King Chulalongkorn Memorial Hospital were reviewed.ResultsOf 22 patients, there were 14 (63.6%) females and 8 (36.4%) males with the mean age of 62.6 ± 14.8 years. The average duration before the first presentation was 12 weeks. The initial symptoms were upper gastrointestinal bleeding (50.0%) followed by abdominal pain (31.8%). Tumor mostly located at the proximal part (fundus and cardia) in 20 (90.9%) patients. At the time of the diagnosis, three patients (13.6%) had distant metastasis. Of this group, 77.3% underwent surgical treatment.DiscussionAlthough gastric GIST was an uncommon disease, early diagnosis and prompt treatment could save the lives of many patients.