INTRODUCTION: Todd paralysis (TP) is a rare postictal condition characterized by weakness following an epileptic seizure. TP includes both motor and non-motor entities including altered cognition, psychiatric symptoms, automatic behavior, and aphasia. The etiology is unknown. The reported duration of TP varies between half-an-hour to 36 hours. METHODS: A 33-year-old G6P5005 at 37 weeks with past medical history of epilepsy controlled with Levetiracetam, presented with right-sided weakness and elevated blood pressure following a generalized tonic-clonic seizure. Preeclampsia workup was performed and negative. Secondary to post-ictal paralysis Neurology was consulted with the conditional diagnosis of acute stroke. Motor examination showed paralysis on her right side. Cranial Magnetic Resonance Imaging revealed significant diffusion restriction in the territory of the left Middle Cerebral Artery involving the distal branches and watershed segments. After reviewing the clinical manifestations and neuroimaging findings, the diagnosis was established as TP and antiepileptic therapy was initiated. Routine electroencephalography showed slowed left frontal-parietal activity. Patient's weakness gradually improved with recovery to her premorbid status after 48 hours. The cranial Magnetic Resonance Angiography subsequently showed no significant stenosis or occlusion of the intracranial cerebral arteries. CONCLUSION: The nature, duration, and severity of TP are not related to the duration or severity of the seizures nor the presence of lesions or changes on electroencephalogram. Although stroke is the leading differential diagnosis in patients with neurologic deficits; in pregnancy, TP should be included in the differential if convulsive activity is coupled with paralysis. A misdiagnosis of stroke can lead to unnecessary and potential harmful interventions.
INTRODUCTION: The Council on Resident Education in Obstetrics and Gynecology (CREOG) is an objective measurement of medical knowledge. A score below 200 may identify those at risk for failing the American Board of Obstetrics and Gynecology (ABOG) Qualifying Exam. The aim of this study is to evaluate if there is a correlation between the Step 1, 2 (CK) and CREOG scores collectively with the passage of the ABOG Qualifying Exam on the first attempt and to identify a threshold score for passage. METHODS: IRB approval was waived and data collected from twenty-seven residents over a ten year period. For each resident, the STEP 1, STEP 2, annual CREOG scores and self-reported passage of the ABOG Qualifying Exam were collected. Residents with missing data (n=2) were excluded. Simple logistic regression was used to investigate the effect of a single test score on predicting the likelihood of pass or fail on the ABOG Qualifying Examination. The associations between the examinations were evaluated using Spearman's rank correlation coefficient. RESULTS: USMLE Step 1 and Step 2 examinations had no significant effect on the outcome of the ABOG Qualifying examination (P<0.125 and P<0.544) respectively. PGY2 was a better predictor when compared to the PGY1 scores (P<.079) vs (P<.611). The mean score was 178.444 for PGY 3 and was the most significant factor in predicting passage or failure of the Qualifying Examination (P<.031). CONCLUSION: A score of 170 or higher on the last two years of residency might be a good indicator of success on the ABOG Qualifying Examination.
INTRODUCTION: The Robert Wood Johnson Foundation Center for Health Policy (RWJF-CHP) at Meharry Medical College (MMC) partnered with a local high school to create a pipeline program that trains minority students enrolled in the Community Health Academy (CHA). The program provided clinical training to successfully pass the certified clinical medical assistant (CCMA) exam that allows trained professionals to perform clinical duties and assist providers in the healthcare setting. It is expected that these students will enroll in an undergraduate institution affiliated with MMC and ultimately matriculate into one of MMC's Professional Schools. METHODS: Twenty-five students were selected from 100 applicants by the CHA committee to participate in the one year pilot study. Students submitted resumes, personal statements, and were interviewed. Parental consents were obtained. The RWJF-CHP implemented clinical and educational training which included Science Symposiums, Clinical Internships, Medical Simulation Training, and Tutoring by Meharry faculty, residents, and students. RESULTS: Prior to 2017, 25/25 took the CCMA exam and did not pass it. In 2018, 20/25 passed the exam on their first attempt. The current passage rate for students after implementation of this pilot pipeline program for one year was 80%. CONCLUSION: Through this pipeline opportunity, students learned clinical skills and earned a certification necessary to work in the medical field. This project demonstrated that the pipeline model is effective in increasing minorities in the healthcare field. Further implications are to expand the model to include other high schools in the Nashville area.
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