Acalypha indica is a tropical herb found in Asia. The entire plant, especially the leaves, is used in herbal medicine for several therapeutic purposes. Acute intravascular haemolysis and methaemoglobinaemia have been reported in patients who consume this herb. We present a case of a previously healthy middle-aged man who ingested boiled leaves of A. indica. The patient developed clinical symptoms and signs of intravascular haemolysis 7 days after ingestion. Peripheral blood smear showed typical findings of glucose-6-phosphate dehydrogenase (G6PD) deficiency with acute haemolysis. The G6PD activity was low during active haemolysis. The G6PD level, however, returned to normal after 4 months of follow-up. The patient was further tested for common G6PD gene mutations in Southeast Asia and was negative. Ingestion of A. indica may induce transient G6PD deficiency, which in this patient led to acute haemolysis and methaemoglobinaemia.

Objective: In order to cultivate and maintain empathy during medical school, an experiential learning program, "A Patient as a Human Being", was designed to promote empathy in second-year medical students through interviews with patients focusing on their suffering and the difficulties arising from their illnesses and hospital stays. Methods: The second-year medical students were divided into groups of three and four. Each group was assigned a patient to interview under close supervision. The selected patients were informed beforehand about the interview and voluntarily agreed to participate. The Thai version of the Jefferson Scale of Physician Empathy-Student Version (JSPE-SV) was used to assess the students' empathy levels. Results: The baseline JSPE-SV score (n = 310) was 114.10±10.20. After the interview, the scores significantly increased (1.19 [0.21-2.18], P = 0.009). Students in the lower-half group of baseline scores showed a higher improvement (2.64 [1.14-4.15], P < 0.001) than those in the upper-half group. The difference coefficient by multivariate analysis of the improved JSPE-SV scores between the two groups was 3.03 [1.08-4.98] (p = 0.002), accompanied by a correlation between the pre-activity empathy score and the improved score (p =-0.21, P-value < 0.01). Conclusion: The patient interviews improved the empathy levels of the preclinical medical students, especially those with lower baseline empathy levels.

Background: Systemic sclerosis may affect male and female fertility. Premature ovarian failure has been reported in female systemic sclerosis patients, but the effects on male fertility in systemic sclerosis have not been studied. Objectives: We aimed to determine the prevalence and clinical associations with primary hypogonadism among male systemic sclerosis patients. Methods: This was a cross-sectional pilot study, including 30 adult male systemic sclerosis patients attending the Scleroderma Clinic, Khon Kaen University. Testosterone deficiency symptoms were assessed using the Aging Males’ Symptoms Rating Scale, urological examination, and blood testing (for total testosterone, free testosterone, follicle-stimulating hormone, and luteinizing hormone). We excluded patients with congenital hypogonadism and any acquired disorders of the testes and genitalia. The definition of primary hypogonadism was based on the International Society for the Study of the Aging Male 2015 diagnostic criteria for hypogonadism. Results: Seven patients met the definition of primary hypogonadism—a prevalence of 23.3% (95% confidence interval: 9.9–42.3). The respective mean age and mean systemic sclerosis duration was 59.4 ± 11.9 and 5.5 ± 4.7 years. Older age at onset, high triglyceride level, and older age starting corticosteroid treatment were significantly associated with primary hypogonadism ( p = 0.02, 0.02, and 0.03, respectively). Systemic sclerosis subset, disease severity, and immunosuppressant use were not associated with primary hypogonadism among Thai male systemic sclerosis patients. Conclusion: Around one-quarter of male systemic sclerosis patients had primary hypogonadism. Elderly onset of systemic sclerosis, hypertriglyceridemia, and late corticosteroid treatment were risk factors for developing primary hypogonadism.