This is a case of pulmonary cement embolism in a young non-osteoporotic patient who sustained a burst fracture of L1. Bone cement augmentation was done for the fractured vertebra as well as over other segments where pedicle screws were inserted. The procedure eventually led to pulmonary cement embolism. The pathway for cement to reach the pulmonary vasculature from within the vertebral body is shown thru a series of imaging studies with the CT Scan done for the patient showing the route taken by the cement as it proceeds towards the pulmonary artery. This is rarely, if ever, shown in published literature. The literature is reviewed further to provide a rational management strategry for such a potentially life threatening condition.

Human ; Male ; Adult ; Pedicle Screws ; Bone Cements ; Pulmonary Artery ; Spinal Fractures ; Pulmonary Embolism ; Spine ; Tomography, X-ray Computed

OBJECTIVE: This cross-sectional study aims to determine the accuracy of using a surface electrode compared with using a needle electrode in the determination of the latency, amplitude, and duration of the compound motor action potential and nerve conduction velocity of the radial nerve.
METHODS: A cohort of 42 males and 30 females consisting of patients from the Philippine General Hospital referred for electrodiagnostic studies of the upper extremity and healthy volunteers were included in the study. The compound motor action potential of the radial nerve in each participant was determined using the surface electrode technique and the mono polar needle technique, and the results were compared. The man outcome measures were: compound motor action potential amplitude, latency, duration, and nerve conduction velocity; sensitivity; specificity; and agreement between the two techniques under investigation.
RESULTS: When all parameters in the nerve conduction studies were considered, the sensitivity of the surface electrode compared with the mono polar needle electrode in determining radial nerve abnormalities was 46.14% (95% Confidence Interval (CI) 0.27 - 0.65), with a specificity of 82.61% (95% CI 0.72 - 0.94) and an overall diagnostic accuracy of 69.44%. When the parameters were taken individually, analysis of the latency showed sensitivity of 60% (95% CI 0.17 - 1.03), and specificity of 100%, with overall diagnostic accuracy of 97.22%. The test for amplitude yielded sensitivity of 50% (95% CI 0.1 - 0.90) and specificity of 100%. The overall diagnostic accuracy was 95.83%. Analysis of the duration showed a sensitivity of 71.43% (95% CI 0.38 - 1.05) and specificity of 100%, with overall diagnostic accuracy of 97.22%. The nerve conduction velocity alone showed sensitivity of 55% (95% CI 0.33 - 0.77), specificity of 84.61% (95% CI 0.75 - 0.94), and overall diagnostic accuracy of 76.39%. The kappa test revealed a fair association or agreement when all the parameters of the compound motor action potential were taken into consideration (k=0.30), moderate association between the surface and the needle electrode in nerve conduction velocity (k=0.40), a substantial association in nerve conduction velocity (k=0.40), a substantial association in amplitude (k=0.65) and latency (k=0.74), and a high association between the two techniques for the duration (k=0.81).
CONCLUSIONS: In the comparison of the surface electrode and the mono polar needle electrode techniques in the determination of the compound motor action potential of the radial nerve, the parameters have high specificity and a high probability of a negative test in individuals who are disease-free. The kappa test indicated a fair association between the two techniques. When the parameters of compound motor action potential are taken separately, the latency, amplitude, duration and nerve conduction velocity of the radial nerve have a high probability of positive test results in people with disease and a high probability of negative test results in people with no disease. The study showed that the surface electrode technique is a fair to good alternative to the needle electrode when conducting a radial motor nerve study.

Human ; Male ; Female ; Action Potentials ; Confidence Intervals ; Cross-sectional Studies ; Electrodes ; Evoked Potentials ; Healthy Volunteers ; Hospitals, General ; Needles ; Neural Conduction ; Outcome Assessment (health Care) ; Philippines ; Probability ; Radial Nerve ; Sensitivity And Specificity ; Electrodiagnosis

Background: The criteria for admission at the University of the Philippine College of Medicine (UPCM) are sixty
percent premed general weighted average grade (PMGWAG), thirty percent National Medical Admission Test
(NMAT) scores and ten percent Interview Scores. Through the years, because of the highly competitive nature
of the selection process, the admissions cut-offs in PMGWAG and average NMAT has continuously risen.
Objectives: This study that covered a twenty four year period, aimed to determine the correlation and
predictive value between the admissions criteria (%Pre-med GWAG, NMAT and Interview Score) with
academic performance parameters (%Med GWAG and Class Ranking) and Board Rating.
Methods: The pre-admission and academic records of accepted lateral entrants from Class 1990 to Class 2013
were retrieved, reviewed and analyzed. These included the pre-med GWAG (%PMGWAG), NMAT and
Interview Scores, Med GWAG (%MGWAG), Class Ranking and Board Rating. Pearsons Correlation and Multiple
Linear regression analysis were done.
Results: All criteria (%PMGWAG, NMAT, Interview Score) for admissions were correlated with the academic
performance parameters (%MGWAG, Class Rank) and Board Rating. The strongest correlation was observed in
%PMGWAG with %MGWAG and Class Rank. Interview score correlated weakly with the academic
performance. Strong correlations between %MGWAG, Class Rank and Board Rating were likewise observed.
Rank upon admission also correlated strongly with Class Rank upon graduation. On linear regression analysis,
%PMGWAG and NMAT were more predictive of %MGWAG, Class Rank and Board Rating.
Conclusion: The weight distribution of the different admissions criteria should be adjusted accordingly.
Interview score, a weak predictor of academic performance and a measure of non-cognitive traits, should be
treated separately and independently as an admission criteria.

Medical College Admission, Admissions Criteria, Medical Education, Academic Performance, Up College Of Medicine

Background and Objectives: Virtual learning has been utilized in residency programs to continue training amid the COVID-19 pandemic. This study aimed to determine the knowledge, skills, and attitudes of faculty members and residents of the Department of Rehabilitation Medicine of the Philippine General Hospital towards virtual learning. Method: This is a descriptive cross-sectional study. Respectively, residents and faculty members answered the Online Learning Readiness Scale (OLRS) and Faculty Readiness to Teach Online (FRTO) through Google Forms. Results: Twenty (20) residents and 19 faculty members participated in the study. The majority of the residents preferred asynchronous learning (50%), while faculty members preferred the hybrid mode (74%). Residents’ readiness for online learning was generally high, though problems with easy distractibility (60%) and time management (40%) were revealed. Female residents had higher online communication self-efficacy compared to males (p = 0.0367). Faculty members’ perceived attitude was significantly higher than ability in course design (p = 0.00102), time management (p = 0.00159), and technical competence (p < 0.0001). Males had higher perceived ability in course design (p = 0.0320). Older age groups had lower perceived abilities in course design (p = 0.0301) and technical competence (p = 0.0371). Conclusion This study revealed the levels of readiness of residents and faculty for virtual learning. Finding indicate the need to address both issues by developing programs to enhance faculty’s online teaching abilities and observing best practices to minimize problems such as distractibility. Large-scale studies with longer time frames are also recommended.
Physical and Rehabilitation Medicine ; Internship and Residency ; Education, Distance ; Education, Distance

Background: Despite the rigorous and extremely competitive selection process of medical students at the University of the Philippines College of Medicine (UPCM), a few still performed poorly in academics that resulted in delayed graduation or failure to graduate at all. Methodology: Factors potentially associated with delayed graduation and failure to graduate among UPCM medical students were analyzed using univariate and multivariable logistic regression with their demographic and pre-admission academic profiles, namely, Pre-medical General Weighted Average Grade (PGWAG), National Medical Admission Test Scores (NMATs), interview scores, pre-med courses, the school graduated from, and admissions categories as predictors. Objective: The objective of this study was to identify the factors that predict the likelihood of not graduating and delayed graduation among the medical students of 24 classes of the UPCM. Results: The odds of delayed graduation and failure to graduate were increased by lower PMGWAG, NMAT score, interview score, admission through the special categories, being a non-UP graduate, and with BS Psychology as pre-med course. Conclusion The predictors of poor academic performance based on delayed graduation and failure to graduate were the PMGWAG, NMAT, interview scores, admissions category, pre-med course, and the school graduated from. It is recommended that the minimum admissions requirements for PMGWAG be increased particularly among the candidates in the special categories. The selection process in the special categories must put some bearing on the PMGWAGs and NMATs of their applicants.
Education, Medical ; Academic Performance

Objectives: Perception about Physical and Rehabilitation Medicine provides information about awareness on identifying disabilities and managing their impact on activities of daily living; however, misconceptions about the field continue to exist among both students and physicians. This study aims to describe the perceptions of clinical clerks and interns towards the practice and role of Rehabilitation Medicine in management of patients. Methods: This is a descriptive cross-sectional study. Students from the Learning Unit 6 and 7 of UP College of Medicine answered adapted online survey forms from a previous study and participated in online focus group discussions. Qualitative data were used to infer the perception of medical students towards the specialty. The effect of the respondent’s profile, background and affiliation on their knowledge, attitudes and perceptions were analyzed using One-Way ANOVA (α = 0.05). Qualitative data were analyzed using thematic analysis. Results: Learning Unit 6 and 7 students were found to have a perceived broad level of knowledge with regards the specialty. The students associated the specialty with focus on holistic care, quality of life, interdisciplinary collaboration, and diversity of cases managed. No statistically significant differences were found between the perception among: 1) Learning Unit 6 and 7, 2) those with or without a previous encounter with the specialty, 3) allied medical and non-allied medical undergraduate courses in terms of: a) confidence in the knowledge (p = 0.489), b) familiarity with conditions managed (p = 0.93) and c) interest towards the specialty (p = 0.693). The Organ System Integrated (OSI) curriculum, which promotes horizontal and vertical integration of concepts, provided a wide understanding of the basic concepts related to physiatry. The students’ responses suggest a positive attitude towards Physical and Rehabilitation Medicine, as measured in their level of interest about knowing more regarding the specialty. Most common perceptions were that the specialty was multidisciplinary and holistic. However, the respondents’ perceptions regarding the roles of the Rehabilitation team were limited. Conclusion Learning unit level 6 and 7 students had a broad understanding of the practice and scope of the Physical and Rehabilitation Medicine specialty. Future researches can include other medical students in all year levels, including Learning Units 3, 4 and 5 of UPCM, to observe the development of their perceptions about the specialty throughout medical school.
Perception ; Students, Medical ; Curriculum

Objectives: Perception about Physical and Rehabilitation Medicine provides information about awareness on identifying disabilities and managing their impact on activities of daily living; however, misconceptions about the field continue to exist among both students and physicians. This study aims to describe the perceptions of clinical clerks and interns towards the practice and role of Rehabilitation Medicine in management of patients. Methods: This is a descriptive cross-sectional study. Students from the Learning Unit 6 and 7 of UP College of Medicine answered adapted online survey forms from a previous study and participated in online focus group discussions. Qualitative data were used to infer the perception of medical students towards the specialty. The effect of the respondent’s profile, background and affiliation on their knowledge, attitudes and perceptions were analyzed using One-Way ANOVA (α = 0.05). Qualitative data were analyzed using thematic analysis. Results: Learning Unit 6 and 7 students were found to have a perceived broad level of knowledge with regards the specialty. The students associated the specialty with focus on holistic care, quality of life, interdisciplinary collaboration, and diversity of cases managed. No statistically significant differences were found between the perception among: 1) Learning Unit 6 and 7, 2) those with or without a previous encounter with the specialty, 3) allied medical and non-allied medical undergraduate courses in terms of: a) confidence in the knowledge (p = 0.489), b) familiarity with conditions managed (p = 0.93) and c) interest towards the specialty (p = 0.693). The Organ System Integrated (OSI) curriculum, which promotes horizontal and vertical integration of concepts, provided a wide understanding of the basic concepts related to physiatry. The students’ responses suggest a positive attitude towards Physical and Rehabilitation Medicine, as measured in their level of interest about knowing more regarding the specialty. Most common perceptions were that the specialty was multidisciplinary and holistic. However, the respondents’ perceptions regarding the roles of the Rehabilitation team were limited. Conclusion Learning unit level 6 and 7 students had a broad understanding of the practice and scope of the Physical and Rehabilitation Medicine specialty. Future researches can include other medical students in all year levels, including Learning Units 3, 4 and 5 of UPCM, to observe the development of their perceptions about the specialty throughout medical school.
Perception ; Students, Medical ; Curriculum

Introduction: The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. Objective: This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). Methods: The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. Results: The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. Conclusion The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic.
Health Services Administration ; Telemedicine ; Telecommunications ; Remote Consultation ; COVID-19

In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.
Telerehabilitation ; COVID-19 ; Continuity of Patient Care