Objective: This study aimed to determine the prevalence and severity of major depressive disorder, generalized anxiety disorder, and the level of perceived stress of the Physician Licensure Exam (PLE) takers during the COVID-19 pandemic. Method: We conducted a cross-sectional descriptive survey among the Physician Licensure Exam takers using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Perceived Stress Scale (PSS). Results: Seven hundred thirty-two (732) Physician Licensure Exam takers participated in the survey, 423 (57.8%) were November takers and 309 (42.2%) were March takers who will be completing the exam on September 2020. The prevalence rates of major depression and generalized anxiety disorder among the PLE takers were 44.1% and 50.3%, respectively. November takers have a higher rate of depression (60.1%) and anxiety (52.7%) compared to the March takers (54.4% and 46.6%, respectively). The majority of the takers have moderate levels of depression (26.6%), anxiety (37.8%), and perceived stress (70.2%). There was a significant difference in the prevalence of major depression between the March and November takers (p-value <0.00001) but not with generalized anxiety disorder (p-value: 0.05155). There was also no significant difference in the severity of depression (p value=0.527878), anxiety (p-value=0.883558), and levels of perceived stress (p- value=0.2476) between the March and November takers. Conclusions There was a high prevalence of major depression and generalized anxiety disorder among the PLE takers during the COVID19 pandemic. Majority of the PLE takers experienced moderate levels of depression, anxiety, and perceived stress.
Covid-19 ; Pandemics

OBJECTIVES: Glioblastoma multiforme (GBM) is a highly malignant primary brain tumor in which the reported frequency of extracranial metastasis is only 0. 44%. We report a patient with lymph node and liver metastasis from a left parieto-occipital  GBM approximately 30 months from diagnosis. To the best of our knowledge, this is the first documented report of extracranial metastasis from a GBM in the Philippines.

CASE REPORT: The patient is a 51-year-oid, male witin GBM,left parieto-occipital area post gross total excision followed by concomitant radiotherapy plus Temozolomide and adjuvant Temozolomide for 6 months. Eleven months after diagnosis, he was enrolled in a Clinical Trial of lmmunotherapy Peptide Vaccine and received a total of 3 doses of the said vaccine but went of study because of a presumed recurrence. Another craniotomy and excision of the mass was performed. He continued to receive Temozolomide on a metronomic schedule. He remained well with a Karnofsky Performance Score (KPS) of 100 until 20 months post diagnosis when he developed another recurrence and underwent another craniotomy followed by Erlotinib (Tarceeva) and Carboplatin chemotherapy. He again remained well for 10months unti 30 months post-diagnosis when a left cervical mass was noted. No other extracranial lesion was seen on PET CT Scan. A biopsy of the mass had immuno-histochemical staining showing positive immunoreactivity for glial fibrillary acid protein(GFAP), CK, CK7, S 100 and Vimentin. Thirty-six months post- diagnosis, multiple enhancing ring lesions in the liver were found on CT scan. A liver biopsy was consistent with metastatic GBM.

CONCLUSION: The patient's clinical presentation and course, biopsy & Immuno-histochemical analysis ofthe lymph node and liver nodules confirmed a metastasis of GBM.

Human ; Glioblastoma

BACKGROUND AND OBJECTIVES: Dysphagia is a common problem after stroke and has been identified as an independent predictor of morbidity and mortality. This study was aimed to determine the incidence of dysphagia and associated pulmonary compromise and morbidity in patients with acute stroke. To the authors' knowledge, there is no published local study evaluating the correlation of dysphagia and clinical outcomes in acute stroke.

Study Design: Descriptive, Retrospective study

METHODS: Data was extracted, collated, and presented descriptively. All patients with acute stroke admitted either to the Acute Stroke Unit (ASU) or Neurocritical Care Unit (NCCU). within the period of May 2006 to February 2009 who underwent a bedside Dysphagia Screening test were included. Data on demographic characteristics, co morbid conditions, stroke tone and location, GCS on admission, presence of pneumonia, and length of hospital stay were obtained from hospital charts. RESULTS: A total of 560 patients underwent dysphagia screening during the study period. Of these, 316 (56.4%) had an acute stroke. Seventy-one patients (22%) failed in the dysphagia screening or were found to be at risk for dysphagia while 245 (78%) passed the evaluation. Patients who failed in the dysphagia screening had a significantly longer average length of stay (ALOS) of 26 days as opposed to 12 days ALOS of those who passed. Those who failed had a significantly higher rate of developing pneumonia (19.7%) as compared to those who passed (2.4%). Linear regression analysis showed that having impaired voice (p=0.006), flattened nasolabial fold (p
Human ; Deglutition Disorders ; Acute Disease ; Stroke ; Morbidity ; Mortality ; Pneumonia

OBJECTIVES

Bickerstaff brainstem encephalitis (BBE) is an uncommon disease characterized by the occurrence of ataxia, ophthalmoplegia, sensorial disturbance, and pyramidal tract signs such as hyperreflexia and toe extensor response. In Asia, preponderance of cases has been reported in Japan. It has not been previously reported in the Philippines. This will describe the clinical symptoms, laboratory features and diagnostic criteria and treatment of this rare disease.

CASE REPORT

A 31- year old Vietnamese-American from Makati City presented with a 3-week history of diarrhea and flu-like symptoms followed by dizziness, gait instability, diplopia, generalized weakness and rapidly progressive sensorial deterioration. Neurologic findings included ataxia, bilateral external ophthalmoplegia, ocular bobbing, hyperreflexia, bilateral toe extensor response and altered sensorium. Cranial MRI, Complete CSF Analysis, EMG-NCV and RNS were unremarkable. Brainstem auditory evoked potential indicated failed conduction between the lower and upper pons. Blink reflex study indicated failed conduction along the medullary interneuronal pathway. Plasmapheresis and intravenous corticosteroid therapy were instituted. Patient's condition improved from a comatose state and was discharged ambulatory with minimal residual neurologic deficits after 38 days of hospitalization. Serum Anti-ganglioside antibody assay were positive for GM1b lgG and GQ 1DG.

CONCLUSION

The clinical characteristics, laboratory features and course of this patient were consistent with Bickerstaff's Brainstem Encephalitis.

Human ; Male ; Adult: 25-44 Yrs Old ; Encephalitis ; ; Antibodies ; ; Amino Acids, Peptides, And Proteins ; ; Blood Proteins ; ; Immunoproteins ; ; Immunoglobulins ; ; Diarrhea ; ; Adrenal Cortex Hormones ; ; Pyramidal Tracts ; ; Ophthalmoplegia ; ; Ataxia ; ; Plasmapheresis

OBJECTIVES

Bickerstaff brainstem encephalitis (BBE) is an uncommon disease characterized by the occurrence of ataxia, ophthalmoplegia, sensorial disturbance, and pyramidal tract signs such as hyperreflexia and toe extensor response. In Asia, preponderance of cases has been reported in Japan. It has not been previously reported in the Philippines. This will describe the clinical symptoms, laboratory features and diagnostic criteria and treatment of this rare disease.

CASE REPORT

A 31- year old Vietnamese-American from Makati City presented with a 3-week history of diarrhea and flu-like symptoms followed by dizziness, gait instability, diplopia, generalized weakness and rapidly progressive sensorial deterioration. Neurologic findings included ataxia, bilateral external ophthalmoplegia, ocular bobbing, hyperreflexia, bilateral toe extensor response and altered sensorium. Cranial MRI, Complete CSF Analysis, EMG-NCV and RNS were unremarkable. Brainstem auditory evoked potential indicated failed conduction between the lower and upper pons. Blink reflex study indicated failed conduction along the medullary interneuronal pathway. Plasmapheresis and intravenous corticosteroid therapy were instituted. Patient's condition improved from a comatose state and was discharged ambulatory with minimal residual neurologic deficits after 38 days of hospitalization. Serum Anti-ganglioside antibody assay were positive for GM1b lgG and GQ 1DG.

CONCLUSION

The clinical characteristics, laboratory features and course of this patient were consistent with Bickerstaff's Brainstem Encephalitis.

Human ; Male ; Adult: 25-44 Yrs Old ; Encephalitis ; ; Antibodies ; ; Amino Acids, Peptides, And Proteins ; ; Blood Proteins ; ; Immunoproteins ; ; Immunoglobulins ; ; Diarrhea ; ; Adrenal Cortex Hormones ; ; Pyramidal Tracts ; ; Ophthalmoplegia ; ; Ataxia ; ; Plasmapheresis