Background and Objective: Neuroanatomy is both terrifying to learn and problematic to teach, and the different methods of neuroanatomical education have their own strengths and weaknesses. In this cross-sectional study, we evaluated the perception of undergraduate medical students towards the combined use of plastinated and formalinpreserved brain specimen in their neuroanatomy course. Methods: A bridging program was designed for students whose medical education was interrupted by the COVID-19 pandemic in order to reinforce the knowledge and understanding of anatomy that they acquired in a virtual environment. A total of 175 first year medical students participated in this learning activity, which included seven stations in neuroanatomy spread across two hours, and covered the anatomy of the circle of Willis, brainstem, cranial nerves, spinal cord, internal cerebrum, and external cerebrum. To evaluate short-term learning, the students were asked to take a quiz containing 10 multiple-choice questions before and after the learning activity. In addition, the students also answered a survey containing 11 Likert-type questions asking about their perception of the learningactivity. Results: Following the learning activity, mean test scores increased from 4.73 (SD 1.74) to 5.32 (SD 1.52; mean difference 0.59, p = 0.008). Majority of the students (mean 81%, range 43-93%) had a neutral or positive perception of plastinated brain specimen, and on factor analysis, plastinated brain specimen were found to be both practical and useful for learning neuroanatomy. However, the participants perceived plastinated brain specimen alone to be insufficient for learning neuroanatomy, and a multimodal approach to learning neuroanatomy is ideal. Conclusion Plastinated brain specimens were found to be an effective complement to formalin-preserved brain, and these should be used by medical schools when designing neuroanatomy learning activities for their students.
Neuroanatomy

Background and Objective: The pandemic acted as an accelerator for the development of online teaching formats in anatomy and histology worldwide. The authors introduce a bridging program that reinforces the knowledge and understanding of gross and correlative anatomy and histology acquired in a virtual environment in preparation for its future clinical application. The study aims to evaluate the Learning Enhancement in Anatomy Program (LEAP) conducted among first-year medical students at the College of Medicine, University of the Philippines Manila. Methods: This descriptive cross-sectional study aims to determine the initial experience of implementing a learning enhancement program and assess areas for its improvement. An internally validated questionnaire was given to students after the program to gauge students’ reactions (Kirkpatrick Level 1 evaluation). Pre- and post-tests were administered to evaluate knowledge acquisition (Kirkpatrick Level 2 evaluation). Short-term behavioral peer evaluation (Kirkpatrick Level 3 evaluation) was also instituted. Results: One hundred fifty-two (152) students participated in the study. General reactions from students to the LEAP were consistently positive, with a steady majority of the students rating ‘5’ or a ‘Strongly Agree’ to positive statements regarding the program. Higher ratings for more traditional teaching methods, such as cadavers, formalinized specimens, and bones, compared to virtual systems were apparent. However, inter-student variation in preference for teaching modalities was observed. All stations of the LEAP were evaluated satisfactorily, with most gross anatomy stations rated higher than histology stations. A significant increase was noted in the total post-test scores compared to pre-test scores. This improvement in test scores was observed in the anatomy and histology subcategories and in six of the seven organ system modules. Perceived behavioral outcomes were also generally positive. Conclusion The LEAP is a worthwhile endeavor, garnering overwhelmingly positive reactions and a significant improvement in test scores. Future studies are necessary to fine-tune teaching and training in a blended learning environment.
Anatomy ; COVID-19 ; Education, Medical ; Program Evaluation

BACKGROUND: Uncontrolled hypertension in acute intracerebral hemorrhages (ICH) may cause hematoma expansion within the first 24 hours, and increase patient mortality. We investigated whether there was an association between ICH location and the difficulty in lowering BP in patients with acute hypertensive non- lobar ICH.

METHODS: This is a retrospective cohort study of adults diagnosed with non-lobar ICH admitted at a tertiary hospital over a 2-year period. We documented the time to attain target mean arterial pressure (MAP) of 110-130 mmHg, as well as the use of antihypertensive medications.

RESULTS: Of 357 patients admitted for non-lobar ICH,47 patients fulfilled the study criteria. Basal ganglia hemorrhages were the most common (47%), followed by thalamic (34%), cerebellar (11%), and pontine hemorrhages (8%). While there were no significant differences in baseline MAP among the different sites of hemorrhage, those with thalamic ICH had a significantly longer time-to-target MAP (p=0.02) and required three or more classes of oral antihypertensive medications (p

CONCLUSIONS: Acute thalamic intracerebral hemorrhages may require multiple classes of antihypertensives to lower blood pressure to safer levels.

Human ; Male ; Female ; Middle Aged ; .humans ; Adult ; Antihypertensive Agents ; Blood Pressure ; Tertiary Care Centers ; Retrospective Studies ; Basal Ganglia Hemorrhage ; Cerebral Hemorrhage ; Hypertension ; Hematoma

OBJECTIVES: Systemic lupus erythematosus (SLE) is an autoimmune disease of multisystemic involvement. The cardiac and cerebrovascular systems are one of the more commonly involved systems, owing to advanced atherosclerosis in SLE. Risk factors for the development of vascular events in SLE were analyzed in this study. 

METHODS: This is a retrospective case-control analysis of SLE patients admitted in a tertiary hospital in the year 2008. Data were subjected to logistic regression analysis using SPSS v.16.

RESULTS:  Seventy-six charts were retrieved and reviewed. The composite vascular event rate in this cohort was 7.6%. Disease duration and thrombocytopenia were associated with increased risk of vascular events. None of the other traditional risk factors were found to correlate with vascular events in this cohort analysis. Statins showed a trend towards protection against vascular events, however, this was not statistically significant.

CONCLUSION: SLE patients with longer disease duration and have thrombocytopenia are at risk of developing vascular events. Lupus patients may be considered a high-risk group for atherosclerosis and may benefit from statin therapy. traditional risk factors, however, cannot fully account for advanced atherosclerosis seen in SLE patients. Various inflammatory and immunologic factors play a role and warrant further investigation.

Human ; Humans ; Retrospective Studies ; Risk Factors ; Hydroxymethylglutaryl-coa Reductase Inhibitors ; Tertiary Care Centers ; Logistic Models ; Case-control Studies ; Lupus Erythematosus, Systemic ; Lupus Erythematosus, Discoid ; Atherosclerosis ; Immunologic Factors ; Thrombocytopenia

OBJECTIVES

This study aims to describe the demographic factors, clinical and laboratory features and outcomes of adult cryptococcal meningitis and possibly to identify demographic as well as CSF parameters affecting mortality in adult Filipinos with cryptococcal meningitis.

STUDY DESIGN

Retrospective case review

RESULTS

A total of 61 patients were admitted with a diagnosis of cryptococcal meningitis from 1993 to 2005, 60% of which were males (male to female ratio 1.5:1). Ages ranged from 18 to 73 years, with 11 (18%) patients having underlying co-morbidities. The most common presenting complaint was headache (76%) followed by nausea and vomiting (72%) and fever (52%). All patients had lumbar puncture. Of the 18 patients with available complete CSF profiles, all had an elevated opening pressure on initial lumbar tap (mean: 396mmH₂0), 83% had elevated total protein (mean: 120mg/dl), 61% showed hypoglycorrhachia, 83% had CSF WBC count greater than 20 cells/mm³, 70% had a positive India ink test, and 89% had a CSF CALAS titer of at least 1 :8. The mortality rate was 49% and the most common cause of death was found to be brain herniation. Forty nine percent of the patients received treatment, 40% of whom died. The relationship between age, sex, CSF findings and mortality were analyzed using Chi square test or Fisher's exact test. Only the CSF CALAS titer was found to be predictive of subsequent outcome (p=0.0019).

CONCLUSION

Most Filipinos admitted at UP-PGH with cryptococcal meningitis were males, with a mean age of 54 years old. Only 11 patients were found to be immu11ocompromised. The most common presenting complaint was headache, whereas the most common sign was nuchal rigidity. All patients have elevated opening pressure, abnormal CSF profiles, positive India ink and elevated CALAS titers. The mortality rate was found to be 49%. Only a CALAS titer greater than 1 :32 was found to be predictive of outcome.

Human ; Adult: 25-44 Yrs Old ; Meningitis ; Prognostic Factors ; Prognosis