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

INTRODUCTION

COVID-19 is a pandemic that shut down businesses and industries worldwide. The spread of the disease changed social behavior as residents around the world were obliged to endure lockdown and quarantine measures, reducing their physical activity.

OBJECTIVE

To determine the level of physical activity before and during the pandemic among physicians.

METHODS

A cross-sectional study was carried out on 422 qualified physicians of the Philippine General Hospital, University of the Philippines Manila. The data was obtained from a self-administered questionnaire.

RESULTS

Results of the study revealed a shift of lifestyle from physically active to sedentary in 42.4-57.11% of the respondents during the pandemic. There was no change between the activity levels at work before and during COVID while there was a change in the travel and recreational activities. The results also showed that significant factors including lack of energy, fear of injury, lack of skill, resources, social influences, support seeking activities, and positive alternatives affected their activity levels.

CONCLUSION

During the pandemic, overall physical activity level decreased. Similarly, factors that motivate health workers to be physically active or sedentary during the COVID-19 pandemic can affect their physical activity levels. Based on this study, the hospital can create guidelines to ensure physical activity among its doctors, especially during a pandemic.

Human ; Covid-19 ; Physical Activity ; Exercise

BACKGROUND AND OBJECTIVE

COVID-19 is a novel disease primarily affecting the respiratory system. Of those infected, approximately 20% require management in a hospital-setting which may lead to deconditioning. Measures implemented to control spread of the virus also restricted mobility both in the hospital and community setting. The goal of this study was to describe the patient characteristics (age, sex, comorbidities), hospitalization (length of hospital stay, ICU stay, referral to Rehabilitation Medicine), and long-term functional outcome of patients who have clinically recovered from moderate to critical COVID-19 in terms of participation in activities of daily living.

METHODS

This was a descriptive prospective cohort study conducted at a tertiary government hospital with participant recruitment from September 2020 to February 2021 consisting of clinically recovered adult patients managed as COVID-19 Confirmed via rRT-PCR with moderate, severe, or critical risk status. Descriptive statistics were obtained and multiple regression analysis was done to determine associations between patient demographics and their Barthel Index Scores on follow-up at discharge, one month post-discharge, and six months post-discharge.

RESULTS

A total of 63 patients were recruited to our study with an average age of 52.4 years. More recovered patients had fulfilled the criteria of moderate illness (46%), with the most common comorbidity being chronic lung disease (42.1%) and diabetes (42.1%). Almost all had total independence pre-morbidly with better baseline functional scores for the COVID-19 severe population. Majority of the patients (63.5%) were not referred for Rehabilitation services. Across all patients, Barthel Index Score at discharge indicated a significant decline from slight dependence to moderate dependence in performing activities of daily living with the pre-morbid status significantly predicting scores at discharge (β = 0.621, p = 0.001) on multiple regression analysis. Patient demographics, hospitalization and ICU stay and outcome, and referral to Rehabilitation Medicine were not found to be significant factors. In the course of follow up, a high dropout rate was observed across the population and by the end of the study, 57.1% of the participants were alive while among those lost to follow up, 20.6% had expired and the remaining 22.2% had an unknown status.

CONCLUSION

COVID-19 significantly affects the functional outcome of patients in terms of activities of daily living as measured by the Barthel Index. Preliminary data gathered from our study and the high dropout rate supports the need for better follow-up and selecting a tool that is better able to describe the non-demographic factors affecting functionality and participation in activities of daily living.

Covid-19 ; Patient-relevant Outcome ; Treatment Outcome ; Activities Of Daily Living ; Rehabilitation ; Cohort Studies

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 AND OBJECTIVES

Physical activity (PA) and fitness level are considered key factors in public health promotion, and as such, healthcare workers (HCW) need to be physically well because they are not only responsible for themselves, but of their clients as well. Therefore, we aim to determine the PA and health-related fitness (HRF) level of HCW in a tertiary hospital, disaggregated to age, sex, work assignments, and job tenure.

METHODS

A cross-sectional research design was utilized to assess HCW from the administrative, medical, nursing, and paramedical cohorts. ALPHA-FIT Test Battery was used to assess cardiorespiratory fitness, muscular strength, lower extremity power and strength, upper body muscle endurance, balance, and body composition.

RESULTS

Our study concurred with the results of previous studies on HCW yielding lower PA levels compared with the general population. We tested 282 participants (administrative: 97; medical: 36; nursing: 55; paramedical: 94), mean age 37.4 years, 64.54% females, 52.13% perceived average health status. Ninety percent of the HCW had PA levels below the World Health Organization’s recommended levels. The ALPHA-FIT mean score per category revealed: one-legged stance, 2.67/3; figure-of-8 run, 2.45/3; shoulder-neck mobility, 4.58/5; modified push-up, 2.05/4; hand-grip strength, 2.5/5; jump and reach, 4/4; dynamic sit-up, 2.62/3; six-minute walk test, 475.38 meters covered. There were no significant differences in PA and HRF levels across cohorts except for modified sit-ups (p < 0.001) and figure-of-8 run (p = 0.012). The results showed significant inverse correlation between balance and shoulder-neck mobility and age (p < 0.001), and modified push ups (p = 0.004). Males had significantly higher sit-up scores (p < 0.001), one-legged stance scores (p = 0.001), and faster figure-of-8 run (p = 0.011), while females had better jump and reach scores (p < 0.001).

CONCLUSION

Physical activity levels of HCW did not meet the World Health Organization’s recommended PA levels. Healthcare professionals who are expected to be aware of the benefits of PA and HRF have shown low to midfit levels of grip strength, upper extremity endurance, core strength, and cardiorespiratory endurance. Information on PA and HRF may aid in policy making on employee wellness that could highly impact health service delivery.

Human ; Physical Activity ; Exercise ; Health Personnel ; Healthcare Workers ; Health Promotion

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

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