Student evaluation of a Learning Enhancement in Anatomy Program (LEAP) during the COVID-19 pandemic: A retrospective study

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.

Evaluation of modified thiel soft-embalmed cadavers as a novel teaching model for musculoskeletal ultrasound and anatomy among rehabilitation medicine residents

Objective@#This study aimed to determine the perceptions of rehabilitation medicine resident trainees on using modified Thiel soft-embalmed cadavers as a learning tool in acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy. @*Methods@#This descriptive cross-sectional study used total enumeration to recruit residents in training under the rehabilitation medicine department of a tertiary referral hospital. An online survey tool was self-administered to determine their perceptions on the use of MSK-UTZ on Thiel-embalmed cadavers. Pre- and post-test scores were compared to determine if their knowledge has improved. @*Results@#Fifteen participants were recruited, who answered the pre- and post-test, and the online survey. The mean pre-test score of participants was 5.87 (±1.68), and the mean post-test score was 6.87 (±2.00). There was no statistically significant difference (P = 0.20) using a paired t-test. At an arbitrary passing rate of 70%, only 5/15 participants passed the pre-test while 10/15 passed the post-test. A chi-square test of independence showed that there was no significant association between the number of participants who passed or failed on the pre- and posttest, X2 (1, N = 15) = 3.3, p = .0.068. Most of the perceptions of the participants were positive in terms of the use of modified Thiel soft-embalmed cadavers as a learning tool, its relevance in the training of a rehabilitation medicine resident, and the overall experience on its use. @*Conclusion@#Thiel-embalmed cadavers as a learning tool was well-accepted, having generally positive perceptions from the participants mainly in terms of perceived enhancement of the understanding of the anatomical basis of musculoskeletal ultrasound, perceived improvement in skills in performing musculoskeletal ultrasound, and most even recommended that it be part of their training as rehabilitation medicine residents. In terms of acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy, no significant improvement in knowledge was noted. Further studies with larger sample sizes are recommended to yield more statistically significant improvement in knowledge and to observe trends in the perceptions of participants.

Fear, anxiety, and depression among employees of the Department of Rehabilitation Medicine-Philippine General Hospital amidst Changes from the COVID-19 pandemic: A cross-sectional study

Objective@#This study described levels of fear, anxiety, depression, and contributing factors among health providers and administrative staff of the Department of Rehabilitation Medicine, Philippine General Hospital (PGH-DRM) during the COVID-19 pandemic. @*Methods@#The cross-sectional study was conducted from August to November 2020. We recruited 71 participants who were working in the premises of the hospital and those who were working from home by purposive sampling. The fear numerical rating scale and Hospital Anxiety and Depression Scale were used to determine the presence of fear, anxiety, and depression. The 36-Item Short Form Survey (SF-36) was used to determine the baseline level of physical and mental wellness among participants. @*Results@#Seventy-three percent of the full-time, permanent employees of the PGH-DRM unit joined the study. Majority of the respondents were health providers (86%) but only one hospital staff had high-risk contact with patients with COVID-19. Most participants (63%) did a combination of on-site work and home-based work and three (4%) worked entirely from home. Moderate to severe levels of fear was reported by 54% of the participants. Fear levels were highest among those who worked on-site. Anxiety was borderline in 32%, and abnormal in 30%, while depression was borderline in 21%, and abnormally high in 34% of the participating employees. Feelings of anxiety were higher among those who worked on-site and who worked both on-site and from home, while depression was highest among those who worked from home. The SF-36 Physical Health Summary score (x̄ = 72.49) was higher than the Mental Health Summary score (x̄ = 55.45). Employees who worked from home had the highest SF-36 summary scores for both mental and physical health. @*Conclusion@#The employees of the DRM had low-risk contact work assignments when the PGH transitioned to a tertiary level COVID-19 referral hospital. Half of the employees experienced fear, anxiety, and depression and had low SF-36 summary scores in mental health. Further studies are needed to determine the key factors that affect their mental health and well-being during the pandemic. A relevant mental health and wellness program is strongly recommended.

Multispecialty perspective on intradural disc herniation: diagnosis and management - A case report -

Intradural disc herniation (IDH) is a very rare and challenging diagnosis, with an estimated incidence of less than 1.5%. The pathogenesis of IDH remains uncertain. Definitive management remains surgical; however, some cases may initially be managed non-surgically. Case: A middle-aged male with presented with acute right-sided lumbar radiculopathy following heavy lifting. History was significant for prior lumbar disc herniation managed non-surgically. Lumbar MRI demonstrated a large disc herniation. The patient was initially treated non-surgically with epidural steroid injections. At 4-months, he re-injured and follow-up images demonstrated the herniated disc penetrating the dura and the diagnosis of intradural disc herniation. Conclusions: The present case is rare because the IDH occurred at the L3-4 level and resulted in unilateral radiculopathy without cauda-equina symptoms and occurred in the absence of prior surgery. This patient was initially treated non-surgically with satisfactory relief, however, reinjury led to progression of IDH with new neurological deficits necessitating surgery.

Impact of COVID-19 on Endoscopy Training: Perspectives from a Global Survey of Program Directors and Endoscopy Trainers

Background/Aims@#The coronavirus disease of 2019 (COVID-19) pandemic has impacted the training of medical trainees internationally. The aim of this study was to assess the global impact of COVID-19 on endoscopy training from the perspective of endoscopy trainers and to identify strategies implemented to mitigate the impact on trainee education. @*Methods@#Teaching faculty of gastroenterology (GI) training programs globally were invited to complete a 36-question web-based survey to report the characteristics of their training programs and the impact of COVID-19 on various aspects of endoscopy training, including what factors decisions were based on. @*Results@#The survey response rate was 52.6% (305 out of 580 individuals); 92.8% reported a negative impact on endoscopy training, with suspension of elective procedures (77.1%) being the most detrimental factor. Geographic variations were noted, with European programs reporting the lowest percentage of trainee participation in procedures. A higher proportion of trainees in the Americas were allowed to continue performing procedures, and trainers from the Americas reported receiving the greatest support for endoscopy teaching. @*Conclusions@#This study demonstrated that the COVID-19 pandemic has had a significant negative impact on GI endoscopy training internationally, as reported by endoscopy trainers. Focus-optimizing endoscopy training and assessment of competencies are necessary to ensure adequate endoscopy training.

Impact of COVID-19 on Endoscopy Training: Perspectives from a Global Survey of Program Directors and Endoscopy Trainers

Background/Aims@#The coronavirus disease of 2019 (COVID-19) pandemic has impacted the training of medical trainees internationally. The aim of this study was to assess the global impact of COVID-19 on endoscopy training from the perspective of endoscopy trainers and to identify strategies implemented to mitigate the impact on trainee education. @*Methods@#Teaching faculty of gastroenterology (GI) training programs globally were invited to complete a 36-question web-based survey to report the characteristics of their training programs and the impact of COVID-19 on various aspects of endoscopy training, including what factors decisions were based on. @*Results@#The survey response rate was 52.6% (305 out of 580 individuals); 92.8% reported a negative impact on endoscopy training, with suspension of elective procedures (77.1%) being the most detrimental factor. Geographic variations were noted, with European programs reporting the lowest percentage of trainee participation in procedures. A higher proportion of trainees in the Americas were allowed to continue performing procedures, and trainers from the Americas reported receiving the greatest support for endoscopy teaching. @*Conclusions@#This study demonstrated that the COVID-19 pandemic has had a significant negative impact on GI endoscopy training internationally, as reported by endoscopy trainers. Focus-optimizing endoscopy training and assessment of competencies are necessary to ensure adequate endoscopy training.

Correlation between incidence of dengue and climatic factors in the Philippines: An ecological study / The Health Sciences Journal

INTRODUCTION@#Dengue continues to be a major health concern in the Philippines. This study aimed to establish trends and correlations between the incidence of dengue and rainfall, humidity and temperature, respectively, in the different regions.@*METHODS@#Using 2018 records obtained from DOH and PAGASA, correlations were made between monthly measurements of climatic factors and the incidence of dengue using Pearson’s r, while maps and interpolations were generated using quantum geographical information system software.@*RESULTS@#There was a significant positive but weak correlation between the incidence of dengue and rainfall (r = 0.379, 95% CI 0.255, 0.491; p < 0.001) and humidity (r = 0.215, 95% CI 0.080, 0.342; p = 0.002). There was a significant negative but weak correlation between the incidence of dengue and temperature (r = -0.145, 95% CI -0.277, -0.008; p = 0.039). A strong positive correlation was noted between the incidence of dengue, and rainfall and humidity, respectively, in several regions. Multiple regression indicates that rainfall, humidity and temperature are poor predictors of the incidence of dengue (R2 = 0.1436, 0.0461 and 0.0209, respectively).@*CONCLUSION@#This study showed overall a significant but weak correlation between an increased incidence of dengue and heavy rainfalls and high relative humidity, and a weak negative correlation for temperature. A high positive correlation of an increased incidence of dengue and heavy rainfalls and high relative humidity was observed in several regions.

Evans syndrome diagnosed after traumatic subdural hemorrhage

No abstract available.

Greater Lymph Node Retrieval Improves Survival in Node-Negative Resected Gastric Cancer in the United States

PURPOSE: Guidelines in western countries recommend retrieving ≥15 lymph nodes (LNs) during gastric cancer resection. This study sought to determine whether the number of examined lymph nodes (eLNs), a proxy for lymphadenectomy, effects survival in node-negative disease. MATERIALS AND METHODS: The US National Cancer Database (2003–2011) was reviewed for node-negative gastric adenocarcinoma. Treatment was categorized by neoadjuvant therapy (NAT) vs. initial resection, and further stratified by eLN. Kaplan-Meier and Weibull models were used to analyze overall survival. RESULTS: Of the 1,036 patients who received NAT, 40.5% had ≤10 eLN, and most underwent proximal gastrectomy (67.8%). In multivariate analysis, greater eLN was associated with improved survival (eLN 16–20: HR, 0.71; P=0.039, eLN 21–30: HR, 0.55; P=0.001). Of the 2,795 patients who underwent initial surgery, 42.5% had ≤10 eLN, and the majority underwent proximal gastrectomy (57.2%). In multivariate analysis, greater eLN was associated with improved survival (eLN 11–15: HR, 0.81; P=0.021, eLN 16–20: HR, 0.73; P=0.004, eLN 21–30: HR, 0.62; P30: HR, 0.58; P<0.001). CONCLUSIONS: In the United States, the majority of node-negative gastrectomies include suboptimal eLN. In node-negative gastric cancer, greater LN retrieval appears to have therapeutic and prognostic value, irrespective of initial treatment, suggesting a survival benefit to meticulous lymphadenectomy.

Upper extremity temporospatial parameters and kinematics of Filipino track and field paralympians during wheelchair Propulsion: An analysis using a Kinect-based markerless motion analysis system

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The potential of a low-cost, novel Kinect?-based markerless motion analysis system as a tool to measure temporospatial parameters, joint and muscle kinematics, and hand trajectory patterns during the propulsion and recovery phase of wheelchair propulsion (WCP) was determined.</p><p style="text-align: justify;"><strong>METHODS:</strong>Twenty (20) adult male track and field paralympians,(mean age = 36 ± 8.47) propelled themselves on a wheelchair ergometer system while their upper extremity motion was recorded by two Kinect? cameras and processed.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The temporospatial parameters, joint kinematics, and hand trajectory patterns during the propulsion and recovery phase of each participant's WCP cycle were determined and averaged. Average cycle time was 1.45s ± 0.19, average cadence was 0.70 cycles/s ± 0.09, and average speed was 0.76m/s ± 0.32. Average shoulder flexion was 30.99° ± 28.38, average elbow flexion was 24.23° ± 12.25, and average wrist flexion was 12.82° ± 26.78. Eighty five percent (85%) of the participants used a semicircular hand trajectory pattern.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The low-cost, novel Kinect?-based markerless motion analysis system had the potential to obtain measurable values during independent wheelchair propu

Preoperative Embolization of Extra-axial Hypervascular Tumors with Onyx

OBJECTIVE: Preoperative endovascular embolization of intracranial tumors is performed to mitigate anticipated intraoperative blood loss. Although the usage of a wide array of embolic agents, particularly polyvinyl alcohol (PVA), has been described for a variety of tumors, literature detailing the efficacy, safety and complication rates for the usage of Onyx is relatively sparse. MATERIALS AND METHODS: We reviewed our single institutional experience with pre-surgical Onyx embolization of extra-axial tumors to evaluate its efficacy and safety and highlight nuances of individualized cases. RESULTS: Five patients underwent pre-surgical Onyx embolization of large or giant extra-axial tumors within 24 hours of surgical resection. Four patients harbored falcine or convexity meningiomas (grade I in 2 patients, grade II in 1 patient and grade III in one patient), and one patient had a grade II hemangiopericytoma. Embolization proceeded uneventfully in all cases and there were no complications. CONCLUSION: This series augments the expanding literature confirming the safety and efficacy of Onyx in the preoperative embolization of extra-axial tumors, underscoring its advantage of being able to attain extensive devascularization via only one supplying pedicle.

Optical Biopsy of Peripheral Nerve Using Confocal Laser Endomicroscopy: A New Tool for Nerve Surgeons?

Peripheral nerve injuries remain a challenge for reconstructive surgeons with many patients obtaining suboptimal results. Understanding the level of injury is imperative for successful repair. Current methods for distinguishing healthy from damaged nerve are time consuming and possess limited efficacy. Confocal laser endomicroscopy (CLE) is an emerging optical biopsy technology that enables dynamic, high resolution, sub-surface imaging of live tissue. Porcine sciatic nerve was either left undamaged or briefly clamped to simulate injury. Diluted fluorescein was applied topically to the nerve. CLE imaging was performed by direct contact of the probe with nerve tissue. Images representative of both damaged and undamaged nerve fibers were collected and compared to routine H&E histology. Optical biopsy of undamaged nerve revealed bands of longitudinal nerve fibers, distinct from surrounding adipose and connective tissue. When damaged, these bands appear truncated and terminate in blebs of opacity. H&E staining revealed similar features in damaged nerve fibers. These results prompt development of a protocol for imaging peripheral nerves intraoperatively. To this end, improving surgeons' ability to understand the level of injury through real-time imaging will allow for faster and more informed operative decisions than the current standard permits.

Use of Trichoderma fungi in spray solutions to reduce Moniliophthora roreri infection of Theobroma cacao fruits in Northeastern Costa Rica / Uso de aspersión fungicida de Trichoderma para reducir infección de frutos de Theobroma cacao por Moniliophthora roreri en el noreste de Costa Rica

Cacao (Theobroma cacao) is an important cash crop in tropical climates such as that of Latin America. Over the past several decades, the infection of cultivated cacao by Moniliophthora roreri, known commonly as “monilia”, has significantly hindered cacao production in Latin America. Studies have proposed the use of Trichoderma sp. Fungi in biocontrol treatments to prevent and reduce monilia infection, yet tests of Trichoderma-containing spray treatments on cacao agroforests have produced mixed results. Researchers and agricultural workers have suggested that addition of soil, fly ash, or other carbon sources to a Trichoderma spray may improve its efficacy in fighting monilia. To test these suggestions, we designed a series of spray mixtures including Trichoderma cultures, soil, and all necessary controls. We applied the spray mixtures to 80 cacao trees (20 trees for each of four resistant-selected clones to monilia) at the FINMAC organic cacao plantation in Pueblo Nuevo de Guacimo, Limón Province, in northeastern Costa Rica in March-April 2013. Five treatments were applied (control, water, water plus sterilized soil, water plus Trichoderma, and water plus sterilized soil plus Trichoderma). Each treatment was applied to four trees of each clone. We monitored the incidence of moniliainfection under each spray treatment over the course of 35d. We found that spraying entire cacao trees two times with a mixture containing Trichoderma and sterilized soil significantly reduced the incidence of monilia infection by 11% (p<0.05) in only 35d, ascompared to the control. This reduction in loss of cacao pods translates into an increase of plantation mean productivity of 1 500kg dried beans/ha by 198kg/ha up to 1 698kg/ha or by a total increase over the whole 110ha plantation by 21 780kg. We propose that using such an antifungal spray over the whole course of a crop cycle (120 days) would decrease infection incidence even more. Application of this fungal control measure has the potential of revitalizing the production of cacao in the region. Rev. Biol. Trop. 62 (3): 899-907. Epub 2014 September 01.

El cacao (Theobroma cacao) es un cultivo comercial importante en los climas tropicales como los de América Latina. A lo largo de las últimas décadas la infección de cacao cultivado con Moniliophthora roreri, conocida comúnmente como “monilia”, ha dificultado la producción del cacao en América Latina de manera significativa. Algunos estudios han propuesto el uso del hongo Trichoderma sp. en tratamientos de control biológico para prevenir y reducir la infección por monilia. No obstante, pruebas realizadas con tratamientos por aspersión que contenían Trichoderma en cultivos de cacao agroforestales produjeron resultados diversos. Investigadores y trabajadores agrícolas han sugerido que la adición de tierra, cenizas volantes u otras fuentes de carbón a la aspersión de Trichoderma podría mejorar su eficacia en la lucha contra la monilia. Para probar la validez de estas sugerencias, diseñamos una serie de mezclas para la aspersión que incluían cultivos de Trichoderma, tierra y todos los testigos necesarios. Aplicamos aspersiones a 80 árboles de cacao (20 árboles para cada uno de cuatro clones seleccionados anteriormente por su resistencia a la monilia) en la finca de cacao orgánico FINMAC en Pueblo Nuevo de Guácimo, provincia de Limón, noreste de Costa Rica durante marzo y abril de 2013. Se aplicaron cinco tratamientos (testigo, agua, agua con tierra esterilizada, agua con Trichoderma, y agua con tierra esterilizada y Trichoderma). Se aplicó cada tratamiento a cuatro árboles de cada clon. Medimos la tasa de incidencia de infección por monilia bajo cada tratamiento por aspersión durante 35d. La aplicación de dos aspersiones a los árboles completos con una mezcla de Trichoderma y tierra esterilizada redujo la tasa de incidencia de infección por monilia en 11% (p<0.05) en solo 35d, en comparación con el tratamiento testigo. Esta reducción en la pérdida de frutos de cacao representa un aumento de 198kg/ha de semillas secas sobre la producción media de 1 500kg/ha, o un aumento total de 21 780kg en toda la plantación de 110ha. Proponemos que el uso de tal aspersión fungicida a lo largo de todo el ciclo de cultivo (120d) produciría una disminución aún mayor de la tasa de incidencia de infección. La aplicación de este método de control fungicida tiene el potencial de revitalizar la producción de cacao en la región.

Beach almond (Terminalia catappa, Combretaceae) seed production and predation by scarlet macaws (Ara macao) and variegated squirrels (Sciurus variegatoides) / Producción de semillas y depredación del almendro de playa (Terminalia catappa, Combretaceae) por lapas rojas (Ara macao) y ardillas chizas (Sciurus variegatoides)

Knowledge of ecological impacts of exotic beach almond (Terminalia catappa) in the central Pacific of Costa Rica are little known, but studies have found this species to be a potentially important food source for endangered scarlet macaws (Ara macao). In this study, reproductive phenology and seed predation by variegated squirrels (Sciurus variegatoides) and scarlet macaws were measured during March and April 2011 on beaches of central Pacific coastal Costa Rica. Seed productivity and predation levels were quantified on a weekly basis for 111 beach almond trees to assess the importance of beach almond as a food source for scarlet macaws and the extent of resource partitioning between seed predators. Seed production of the trees was great (about 194 272 seeds) and approximately 67% of seeds were predated by seed predators. Macaws consumed an estimated 49% of seeds while squirrels consumed 18%. Additionally, evidence of resource partitioning between squirrels and macaws was found. Scarlet macaws preferred to feed on the northern side and edge of the canopy while squirrels preferred to feed on the southern and inside parts of the canopy. Both species ate most seeds on the ocean side of the tree. Despite the status of this tree as an exotic species, the beach almond appears to be an important resource for scarlet macaw population recovery. The resource produced by this tree should be taken into account as reforestation efforts continue in Costa Rica. Rev. Biol. Trop. 62 (3): 929-938. Epub 2014 September 01.

El conocimiento de los impactos ecológicos del almendro de playa exótico (Terminalia catappa) en el Pacífico Central de Costa Rica son poco conocidos, pero los estudios han encontrado que esta especie es una fuente de alimento potencialmente importante para la lapa roja (Ara macao), en peligro de extinción. En este estudio, se midieron la fenología reproductiva y la depredación de semillas por las ardillas (Sciurus variegatoides) y lapas rojas durante marzo y abril 2011 en las playas de la costa Pacífica Central de Costa Rica. Los niveles de productividad y depredación de semillas se cuantificaron semanalmente para 111 almendros de playa, para evaluar la importancia del almendro de playa como fuente de alimento para la lapa roja y el grado de repartición de recursos entre los depredadores de semillas. La producción de semillas de los árboles fue alta (cerca de 194 272 semillas) y aproximadamente el 67% de las semillas fueron comidas por los depredadores, las lapas rojas consumen un estimado de 49% de las semillas, mientras que las ardillas consumen el 18%. Adicionalmente, se encontró evidencia de la repartición de recursos entre las ardillas y las lapas. Las lapas rojas prefieren alimentarse en el lado norte y el borde de la copa, mientras que las ardillas prefieren las regiones del sur y el interior de la copa. Ambas especies se comieron la mayoría de las semillas en la parte del árbol con lado al mar. A pesar de la situación de este árbol como una especie exótica, la playa de almendras parece ser un recurso importante para la recuperación de la población de lapas rojas. El recurso que produce este árbol debe tomarse en cuenta para continuar con los esfuerzos de reforestación en Costa Rica.

Middle Meningeal Artery Arising from the Basilar Artery

Various anomalies for the origin of the middle meningeal artery (MMA) have been described in the literature. However, origin of the MMA from the basilar trunk is an extremely rare variant. We report on a 54-year-old female who presented with frequent headaches; magnetic resonance imaging showed a right parietal meningioma. The abnormal origin of the middle meningeal artery from the basilar artery was diagnosed by angiography performed for preoperative embolization of the tumor. We report on the case with a review of the embryologic basis, possible explanations for this aberrant origin, and its clinical implications.

An Unruptured Anterior Communicating Artery Aneurysm with Bilateral Infraoptic Anterior Cerebral Arteries. Case Report and Review of the Literature

Variations of the anterior cerebral artery-anterior communicating artery complex are commonly identified in aneurysm surgery. An infraoptic course of the anterior cerebral artery is exceedingly rare. Robison first described this anomaly from an anatomic dissection in 1959. A unilateral anomalous infraoptic anterior cerebral artery is more common than anomalies of bilateral infraoptic anterior cerebral arteries. We present the case of an unruptured aneurysm at the anterior communicating artery in a patient with bilateral infraoptic anterior cerebral arteries, identified by computed tomography angiography and verified during surgery. Implications for aneurysm formation and surgical treatment are discussed.

Metabolic syndrome and Framingham risk score in obese young adults.

Background: The increase number of the metabolic syndrome (MetS) among young adults was mostly caused by obesity. MetS increases the risk of coronary heart disease (CHD) which can be estimated by Framingham risk score (FRS). The study was aimed to know the prevalence of MetS and FRS in obese young adults and to associate them with the components of MetS. Methods: A total of 70 male and female students aged 18 to 25 years with BMI ≥ 25 kg/m2 in Faculty of Medicine Universitas Indonesia were selected consecutively. The blood samples used to test fasting blood glucose, total cholesterol, high-density lipoprotein, and triglyceride were examined in Department of Clinical Pathology, Cipto Mangunkusumo Hospital after fasting for 14 to 16 hours. International Diabetes Federation (IDF) definition was used to diagnose MetS. Univariate and bivariate analysis were done. Results: The prevalence of MetS based on IDF definition was 18.6% among obese young adults. The most associated MetS components was hypertriglyceridemia (OR 12.13; 95% CI 2.92-50.46; p = 0.001), followed with high blood pressure (OR 9.33; 95% CI 2.26-38.56; p = 0.001), low-HDL (OR 8.33; 95% CI 2.17-32.05; p = 0.003), and impaired fasting glucose (p = 0.03). Four subjects had FRS ≥ 1% and 66 subjects had risk < 1%. Increased FRS was not associated with MetS (p = 0.154). There was no component of MetS associated with increased FRS. Conclusion: Prevalence of MetS in obese young adults was similar with obese children and adolescents. Although no association of MetS and FRS was found, they are significant predictors for CHD which should not be used separately.

Intra-arterial Onyx Embolization of Vertebral Body Lesions

While Onyx embolization of cerebrospinal arteriovenous shunts is well-established, clinical researchers continue to broaden applications to other vascular lesions of the neuraxis. This report illustrates the application of Onyx (eV3, Plymouth, MN) embolization to vertebral body lesions, specifically, a vertebral hemangioma and renal cell carcinoma vertebral body metastatic lesion.

Summary description of 24 cases of neonatal malaria seen at a tertiary health center in Nigeria

Neonatal malaria is a serious cause of morbidity and mortality in sub-Saharan Africa. Diagnosis of neonatal malaria is difficult because of the similarity in clinical presentation with other neonatal infections. This study aim to highlight the clinical presentations and high mortality still associated with neonatal malaria. Twenty four out of 41 neonates seen during a 6 months period were studied. Gestational age, age at presentation, birth weight and other clinical symptoms were documented. Questionnaires were used to collect pertinent pregnancy and perinatal history from the mothers. Data was analyzed using SPSS v18 and results expressed in tables using means, frequencies and percentages. All 24 neonates, 50% of whom were males, had a positive smear for malaria parasite. 29.2% were preterm, 17[70.8%] had congenital malaria, 18[75.0%] mothers used intermittent preventive treatment [IPT] of malaria prophylaxis in the index pregnancy and 1[4.2%] mother had HIV in pregnancy. Fever was the principal presenting symptom and 83.0% responded to treatment with amodiaquine. Neonatal malaria is still an important cause of mortality, a more effective malaria prophylaxis program and routine malaria parasite screening for neonates is recommended