Neurological Cases Research Articles

Survival and clinical characteristics of patients with disorders of consciousness in a developing country between 2002 and 2018

ABSTRACT Objective Describe the survival, sociodemographic and clinical characteristics of subjects with disorders of consciousness in a reference rehabilitation center, in a developing country. Methods Patients with disorders of consciousness (DoC) caused by acquired neurological injuries, admitted between the years 2002–2018 in a neurorehabilitation center. Extracted data covered demographics, clinical details, survival time, and discharge information. Cox proportional hazard model and Kaplan-Meier analysis were used to reveal, associations with survival. Result Out of 5064 neurological cases, 159 patients were diagnosed with DoC. The demographic data showed a male dominance (65%), with an average injury age of 42 years. The most common causes were traumatic (41%), anoxic (36%), and vascular (10%), with traffic accidents accounting for 71% of traumatic injuries. The study found that 75% of patients remained in a vegetative state (VS), and 25% in a minimally conscious state (MCS), with an average survival of 2110 days. Conclusion There were no significant differences in survival days between patients in MCS and VS. Patients with traumatic injuries showed a higher survival rate than those with non-traumatic injuries. Age and etiology were identified as factors associated with a higher risk of death.

Medical practice in classical Greece : The neurological and psychiatric case reports of the Hippocratic Corpus

Which theoretical and practical competences do the neurological and psychiatric case histories of the Hippocratic Corpus convey? The 431 Hippocratic case histories have been studied for reports and communication on the diagnostics, treatment and prognosis of single persons and groups of patients suffering from neurological and psychiatric diseases. In the 7books of the Hippocratic Epidemics, atotal of 128 patients with neurological and psychiatric symptoms are described. Epidemic fever and its variants were the leading predisposing conditions and the main symptoms were delirium, coma, insomnia, headache, speech disorders and convulsions. Anumber of patients with phrenitis and opisthotonos are also reported. The majority of the sick persons were male, were teenagers or adults and 47of them are mentioned by name. The patient's information about the course is often just as informative as the doctor's observations. Treatment was limited to physical and dietary measures. The Hippocratic physician diagnosed and attempted to treat alarge number of neurological and psychiatric diseases. The often almost continuous observations of the patients led to astonishingly precise predictions of the course and the prospects of recovery. Numerous symptoms described in the case studies, including carphologia and opisthotonus, have entered the neurological vocabulary. The retrospective etiological analysis of the reports leads to the almost explicit identification of neurosyphilis and encephalitis lethargica. The therapeutic measures described by the author were, as the changeable course of the diseases shows, only of limited effectiveness despite a very differentiated application over time, both against the underlying diseases and the neurological and psychiatric complications.

The flow pattern of neuro-pediatric emergency visits during COVID-19 pandemic

BackgroundCOVID-19 is a global pandemic that has highly impacted the healthcare system and patients, especially patients with epilepsy, due to the fact that the success of their treatment depends on obtaining sustainable access to medical professions, diagnostic services, facilities, and medications. The epidemiology and presence of neuro-pediatric emergencies in the setting of COVID-19 in XXX have not been thoroughly described. This is a barrier to planning and providing quality emergency care within the local health systems. The objective of this study is to provide a comprehensive description of the epidemiology of neurological cases encountered in the pediatric emergency unit.MethodsThis is a retrospective study to analyze the flow pattern of Emergency Department (ED) visits among pediatric patients with neuro-related complaints. Participants were filtered, and a total of 108,000 visits were reduced to 960 patients with a neurological provisional diagnosis. Patients were grouped into pre- and post-pandemic visits according to their age group. We identified demographic and clinical variables.ResultsThe study included 960 patients with a provisional neurological diagnosis, consisting of 542 (56.5%) males and 418 (43.5%) females. The mean age of admission was 5.29 ± 4.19 years. The majority of patients were triaged as “priority 1—resuscitation” (n = 332, 34.6%), and seizures were the most frequent chief complaint (n = 317, 33.0%). Statistical significance was observed for patients with vascular issues (p = 0.013) during the pre-COVID-19 period after adjusting for odds ratio. The most common outcome was discharge (n = 558, 58.1%). The mean length of stay during the pre-COVID-19 pandemic was 16.48 ± 33.53 h, which was significantly longer compared to a mean length of stay of 7.76 ± 7.27 h during the COVID-19 pandemic (P < 0.001).ConclusionWe presented a new epidemiology of pediatric patients with neuro-related ED visits. An increase in seizure diagnosis was observed, as were significant shifts in the length of stay. Demographic changes were less evident in the two periods. Understanding such variation aids in managing this vulnerable population during critical periods.

Relationships of mitochondrial DNA mutations and select clinical diagnoses in perinatally HIV- and ART-exposed uninfected children

The prevalence of pathogenic mutations within mitochondrial (mt) DNA of youth who were perinatally exposed to HIV and ART but remained uninfected (YHEU) were assessed relative to phenotypic clinical indicators of mitochondrial dysfunction (MtD). This was a cross-sectional, nested case-control study. A total of 144 cases met at least one clinical MtD definition and were matched with up to two controls each (n = 287). At least one risk mutation was present in nearly all YHEU (97 %). No differences in mutation frequencies were observed between metabolic or neurodevelopmental cases and respective controls; however, higher frequencies were found in controls versus respective neurologic or growth cases.

Spinal arteriovenous fistula leading to acute paraplegia after a lumbar nerve root block: Successful embolization with complete neurological recovery-a case report.

Spinal arteriovenous fistulas (SAVFs) are the most common type of vascular malformation of the spine in adult patients. They can lead to acute or progressive myelopathy due to venous congestion of the medullary veins. While most SAVFs are acquired, their pathophysiology remains unclear. The natural history of the disease and its clinical presentation are highly influenced by the location of the fistula and various factors may trigger sudden neurological decline. We present a case of a patient who developed a complete spinal cord injury after a lumbar nerve root block, likely due to an undiagnosed SAVF. The patient underwent endovascular embolization, resulting in a complete recovery of neurological function.

Radiological abnormalities of the cervicothoracic vertebrae in Warmblood horses with primary neck-related clinical signs versus controls.

Radiological observations at the cervicothoracic junction in horses with or without related clinical signs have not been comprehensively described. The aim was to evaluate the seventh cervical (C7) to second thoracic (T2) vertebrae in horses with neck-related clinical signs (neck pain and/or stiffness, neck-related forelimb lameness, or general proprioceptive [spinal] ataxia) and control horses. This prospective analytical cross-sectional study included 127 control horses and 96 cases, examined using standardized clinical and radiological protocols. Univariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) to identify factors associated with radiological abnormalities. Severe modeling of the articular processes at C7-T1 was more likely in cases compared with controls, OR, 4.25; CI, 1.04-17.36; P=.04. Cases were more likely to have spondylolisthesis at C7-T1 than controls, OR, 3.61; CI, 1.75-7.44; P<.001. There was a lack of uniformity of disc space width at C6-C7, despite normal alignment of the vertebrae, in five (5.2%) cases and no control horses. Discospondylosis was seen in 9 (9.4%) horses at C7-T1 and 10 of 64 (15.6%) at T1-T2. The sagittal ratio for T1 was smaller for horses with neck-related forelimb lameness (P<.0002), neck pain/ stiffness (P=.04), or neurological cases (P<.001) than controls. The prevalence of radiological abnormalities at C7-T1 and T1-T2 highlights the importance of careful evaluation of the cervicothoracic junction in horses with neck-related signs.

A COVID-19 Case: Isolated and Persistent Headache

COVID-19 effects many systems such as respiratory, nervous, renal and hematologic system. Third of patients have experienced neurological symptoms such as headache, anosmia, ageusia, and dizziness. Headache has been reported as the most common neurological manifestation but cases just headache are extremely rare. This case is a Covid-19 case with no symptoms other than sudden onset headache. The result of the nasal swab PCR sampling was negative however local infiltration areas with ground glass density in the periphery of the middle lobe, lateral segment of the both lungs were detected in the thorax CT.

Altered expression of human myxovirus resistance protein A in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder. The etiology of sporadic ALS (sALS) has not yet been clarified. An increasing body of evidence suggests the involvement of viral infections and interferons (IFNs). Human myxovirus resistance protein A (MxA) is an IFN-induced dynamin-like GTPase that acts as a potent antiviral factor. This study examined MxA expression in ALS patient spinal cords using immunohistochemistry. Thirty-two cases of sALS (pathologically proven ALS-TDP), 10 non-ALS, other neurological disease control cases were examined. In most ALS cases, MxA cytoplasmic condensates were observed in the remaining spinal anterior horn neurons. The ALS group had a significantly higher rate of MxA-highly expressing neurons than the non-ALS group. Colocalization of MxA cytoplasmic condensate and transactive response DNA-binding protein 43 kDa (TDP-43)-positive inclusions was rarely observed. Because MxA has antiviral activity induced by IFNs, our results suggest that IFNs are involved in the pathogenesis of ALS in spinal cord anterior horn neurons. Our study also suggests that monitoring viral infections and IFN activation in patients with ALS may be critically important.

P.070 Using AI to revolutionize clinical training through OSCE-GPT: a focused exploration of user feedback on otolaryngology and neurology cases

Background: OSCE-GPT (https://learnmedicine.ca/) is an AI-based app that integrates history, physical exam, and relevant components for case guidance across medical disciplines to help trainees improve clinical skills. With global users across 60+ countries, this preliminary quality improvement study gathers user feedback on neurology and otolaryngology cases. Methods: A survey was distributed to users at the University of Ottawa and Cumming School of Medicine. Participants provided insights on the app’s use, perceived benefits, and suggested improvements. Results: Using 5-point Likert scales, 13 respondents, 9 of which evaluated an otolaryngology case, rated the overall usefulness of the learning tool 4.57± 0.51 (1=very poor, 5=very good), with a score of 4.00±0.65 relative to other teaching methods, such as didactic lectures or grand rounds (1=much worse, 5=much better). Users noted realistic interactions and self-paced learning as beneficial factors. Areas for improvement included a more fluid transition between physical exams and history, geographic variations in cases, and the addition of elements such as non-verbal patient cues or emotional. Conclusions: This study demonstrates utility of OSCE-GPT for medical trainees, particularly for otolaryngology and neurology cases. As cases continue to be added, feedback will be implemented to further improve user experience.

P.013 Accuracy of clinical assessments with virtual care in outpatient neurological setting

Background: Virtual neurological assessments were increasingly used and an important viable option during the COVID-19 pandemic. However, the accuracy of such assessments is unknown. Methods: Clinical records were reviewed in a predominant multiple sclerosis outpatient clinic at an academic teaching hospital from March 23rd 2020 to March 23rd 2021 during the COVID-19 pandemic. Patients assessed during this period were analyzed with an initial virtual assessment compared to subsequent in person evaluations. Results: 1036 patients were included. 27.8% (n=288) of consultations were video and 72.2% (n=748) telephone. A total of 13.8% (n=143) of virtual consultations revealed clinical disparities, specifically 13.5% (n=39) video and 13.9% (n=104) telephone consultations. Of all the 1036 cases, 2.32% (n=24) patients stated they were stable but significant changes were seen on the exam, changing the clinical impression. 11.5% (n=119) stated they were deteriorating virtually but not confirmed when examined in person, with an alternative explanation found. Conclusions: Virtual assessments were accurate in over 85% of the outpatient neurological cases during the pandemic. However, it should be noted that the in person neurological exam led to a change in clinical opinion in 13.8% of assessments. 2.32% patients described clinical stability, but different clinical management plans resulted when significant exam findings were identified.

Media coverage of COVID-19 vaccination-associated cerebral venous sinus thrombosis was followed by a surge in emergency presentations due to headache – observations from a university hospital in Germany

Nocebo effects describe all negative outcomes for well-being brought about by negative health-related expectations. Media coverage of drug side effects can fuel nocebo effects and lead to increased symptom reports. This retrospective observational analysis of emergency reports at the neurological emergency room at University Hospital Essen, Germany, examines whether media communication about a cumulation of very rare cases of cerebral venous sinus thrombosis (CVST) after COVID-19 vaccination with the AstraZeneca compound (ChAdOx-1 nCoV-19) was followed by an increase in weekly presentation rates of patients with the main complaint of headache, a symptom commonly occurring as a vaccination reaction but also communicated as a warning symptom for CVST. The rate of headache presentations increased by 171.7% during the five weeks after the first announcement of CVSTs in Germany on 11 March 2021, compared to the five weeks immediately prior. Furthermore, more young women sought consultation for headache, reflecting the communicated at-risk profile for CVST. The increased rate of headache presenters contributed to a 32.1% rise in total neurological emergency cases, causing an increased strain on the emergency facility after the side effect risk was publicized. We discuss a causal role of negative side effect expectations after vaccination with AstraZeneca as a driver for this increase. While transparent communication about benefits and potential side effects is crucial for vaccination acceptance, increased vigilance toward nocebo effects in health-related media communication is needed due to its potential harm to the individual and society, especially when emergency medical resources are stretched thin.

Enhancing clinical management of neurological disorders: Feedback from the healthcare provider perspective

Objectives: Neurological disorders are a global health concern, and their management requires competent health-care professionals (HCPs). This study aimed to evaluate the current state of neurological case management among Indian HCPs by focusing on different aspects such as frequency of encounters, confidence, and upskilling preferences in managing neurological cases. Materials and Methods: A quantitative cross-sectional survey was conducted among 104 HCPs, including general practitioners (GPs) and consulting physicians (CPs). The survey gathered data on the frequency of encountering neurological cases, confidence levels, areas for improvement, preferred upskilling methods, and willingness to seek guidance from neurology experts. Results: Of the 104 HCPs surveyed, 69 (66.35%) HCPs frequently encountered neurological cases in their daily practice. Among them, 70.19% expressed a moderate level of confidence in managing such cases. Nearly, all HCPs (99.04%) showed a keen interest in upskilling their expertise in the field of neurology. The preferred approaches for upskilling included case-based learning (38.38%) and online webinars or lectures (38.38%). In addition, they showed a willingness to engage with neurology experts for guidance. Conclusion: Our study results highlight the high prevalence of neurological cases in the daily practices of HCPs. The findings reveal that HCPs are moderately confident in managing these cases, underscoring the necessity for targeted interventions to enhance their proficiency. Overall, the study emphasizes the importance of tailored neurological interventions to address the specific needs of Indian HCPs in managing neurological cases.

Neuroimaging-guided diagnosis of possible FTLD-FUS pathology: a case report

BackgroundThis case report presents a patient with progressive memory loss and choreiform movements.Case presentationNeuropsychological tests indicated multi-domain amnestic mild cognitive impairment (aMCI), and neurological examination revealed asymmetrical involuntary hyperkinetic movements. Imaging studies showed severe left-sided atrophy and hypometabolism in the left frontal and temporoparietal cortex. [18F]Flortaucipir PET exhibited moderately increased tracer uptake in hypometabolic areas. The diagnosis initially considered Alzheimer’s disease (AD), frontotemporal degeneration (FTD), and corticobasal degeneration (CBD), cerebral hemiatrophy syndrome, but imaging and cerebrospinal fluid analysis excluded AD and suggested fused-in-sarcoma-associated FTD (FTLD-FUS), a subtype of the behavioural variant of FTD.ConclusionsOur case highlights that despite the lack of specific FUS biomarkers the combination of clinical features and neuroimaging biomarkers can guide choosing the most likely differential diagnosis in a complex neurological case. Imaging in particular allowed an accurate measure of the topography and severity of neurodegeneration and the exclusion of AD-related pathology.

Molecular Detection of Canine Distemper Virus Among Dogs Showing Neurologic and Non-neurologic Forms of Disease

Background: Canine distemper (CD) is the dogs’ most contagious and lethal viral disease. Despite the widespread use of vaccines to control CD, the prevalence of the CD virus (CDV) has increased at an alarming rate in recent years. Objectives: To identify the genotypes responsible for the neurological and non-neurological clinical forms of CD and to investigate the presence of the virus in the neurological and non-neurological forms of the disease. Methods: In this descriptive-analytical study, the samples were collected from 70 CD suspected unvaccinated dogs with clinical signs of distemper. All cases were tested with rapid tests and separated into 3 groups based on clinical signs and symptoms. Cerebral spinal fluid (CSF), respiratory secretion, and fecal samples of allall 70 cases were examined for reverse transcription polymerase chain reaction (RT-PCR). After sequencing the hemagglutinin gene (H gene), phylogenetic analysis of the gene isolated from CDVs was carried out using MEGA software, version 7. Results: The RT-PCR results showed that the respiratory secretion sample in the non-neurological CDV group (85%) and the neurological CDV group (80%) had the highest level of virus contamination. However, in the non-neurological CDV group, the CSF sample (40%) had a high level of infection. In neurotic groups, cases older than 12 months showed the highest percentage of distemper contamination, and in the non-neurologic CDV group, those between 3 and 6 months were more involved. Sequencing and phylogenetic analysis of the H gene revealed the CDV as a member of the endemic Arctic-like genetic lineage. Conclusion: The genotypic examination of the hemagglutinin gene of the distemper virus reveals that the recent isolates of neurologic and non-neurologic clinical forms of CDV in Iran are similar. In positive rapid test cases, the PCR test of respiratory secretions for virus detection ranks with the highest sensitivity. In neurologic cases with negative rapid test results, PCR of CSF had the highest sensitivity, so it may serve as a diagnostic criterion.

Visual-spatial Intelligence and Learning Modality Preference for Neuroanatomy Comprehension Among Medical Students

Neuroanatomy comprehension, an essential aspect of medical education, is important for understanding and diagnosing neurological cases. However, neuroanatomy is perceived as one of the most difficult subjects, thus contributing to the prevalence of neurophobia among medical students worldwide. This cross-sectional observational analytic study aimed to investigate the association of visual-spatial intelligence (VSI) levels and learning modality preferences with neuroanatomical comprehension levels among 229 freshman medical students of Universitas Sebelas Maret (UNS), Indonesia. VSI level was measured using the Revised Purdue Spatial Visualization Test: Visualization of Rotations (PSVT:R); learning modality preference using the VAK or visual (V), auditory (A), and kinaesthetic (K) learning styles survey; and neuroanatomical comprehension level using neuroanatomy final examination. The results show a significant correlation between VSI and comprehension of neuroanatomy (r = 0.229; p &lt; 0.0001), with notable differences in learning modality preferences. Students with visual preferences (V, VA, VK, and VAK) exhibited higher neuroanatomical comprehension compared to those without visual preferences (A, K, and AK). Visual learning modality preference was a significant predictor of VSI (β = 0.206; p = 0.006) and neuroanatomy comprehension (β = 0.161; p = 0.033), and VSI was a significant predictor of neuroanatomy comprehension (β = 0.305; p &lt; 0.0001). This study highlights the importance of considering VSI and learning modality preference in the context of neuroanatomy comprehension among medical students.

Rapid Vision Loss Due to Multifocal Glioma: A Diagnostic Challenge.

This is a unique case report in medical literature for its detailing of diagnostics of an uncommon presentation of a rapid unexplained bilateral vision loss of a 73-year-old male diabetic patient. This report highlights the crucial role of advanced molecular diagnostics in difficult neurological cases and also elucidates the difficulties involved in diagnosing optic nerve glioblastoma, an exceptionally rare and aggressive tumour. Slow and progressive loss of vision over 2 months, ultimately developing almost complete visual impairment in both eyes and a defect of right eye field of vision conclusively highlighted that the likely etiology was neuro-ophthalmic. Initially, the conditions were suspected to be an extended spectrum of diabetic eye disease complications but further deterioration was a hint towards something more substantive. This entailed in-depth diagnosis processes that included an MRI and the analysis of cerebrospinal fluid. The important discovery was through stereotactic biopsies of the optic nerve revealing a high-grade glial neoplasm. Next generation sequencing confirmed the pathology as IDH-wildtype glioblastoma. Despite management, his vision continued to deteriorate. Hence, an aggressive clinical course was followed. This case highlights the important learning need in considering glioblastoma of the optic chiasm as part of the differential diagnosis of rapid vision loss, which may present as multifocal brain lesions, especially in casesof rapid loss of vision where initial workup is negative. Quite a useful lesson that can be drawn from this case relates to the diagnostic process with advanced molecular profiling, more attention given to clinical suspicion and cutting-edge diagnostic tools applied in atypical presentation of neurological conditions.

Surgical interventions and outcome in a population of canine trauma patients.

To determine signalment, injury type, trauma severity score, and outcome of canine trauma patients undergoing surgical (emergency room [ER] or operating room [OR]) and nonsurgical treatment in addition to time to surgery, specialty services involved, and cost in the OR surgery population. Retrospective evaluation of medical record and hospital trauma registry data on canine trauma cases. University teaching hospital. One thousand six hundred and thirty dogs presenting for traumatic injury between May 2017 and July 2020. None. Demographics and outcome were compared for canine trauma patients undergoing OR surgery (12.8%, 208/1630), ER surgery (39.1%, 637/1630), or no surgical intervention (48.2%, 785/1630). Among the 2 surgical groups, 98.9% (836/845) survived to discharge compared with 92.2% (724/785) of the nonsurgical group (P<0.0001). The OR surgical group had significantly higher median Animal Trauma Triage scores (2vs 1, P<0.0001) and median days in hospital (2vs<1, P<0.0001) compared with the other groups. For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (45.2%, 94/208) and general surgery (26.9%, 56/208). Neurology and general surgery cases required the longest median length of stay in hospital, and ophthalmology and dentistry cases required the shortest. The median cost of visit was highest in neurology ($10,032) and lowest in ophthalmology ($2305) and dentistry ($2404). Surgical intervention in canine trauma patients appears to be associated with higher survival rates, and among the surgery groups, mortality was highest in the ER and general surgery groups. OR surgical intervention, in particular general surgery and neurology, was associated with increased length of hospitalization, increased cost, and higher Animal Trauma Triage scores.

LITERATUR REVIEW : DIAGNOSIS AND TREATMENT OF TRAUMATIC BRAIN INJURY 2022

Abstract&#x0D; Traumatic brain injury (TBI) is one of the leading cause of morbidity and mortality from neurological cases worldwide. TBI can result in cognitive deficits, endocrine, psychiatric disorder and affecting the capacity to work and impair the quality of life of the patients. TBI classified as mild, moderate, and severe according to the Glasgow Coma Scale (GCS). TBI can be detected from neuroimaging. This is a review from a new guideline for diagnosis and treatment of traumatic brain injury: the neuroscience of traumatic brain injury 2022.&#x0D; Keyword : Traumatic brain injury, neuroimaging, management, new guideline

Studi Kasus Pasien Dengan Meningitis Tuberkulosis Dalam Pengobatan Tuberkulosis Paru

TB meningitis is the most severe manifestation of tuberculosis infection and causes death and disability in 50% of sufferers. Tuberculosis primarily affects adults at their most productive ages. However, all age groups remain at risk. Tuberculous meningitis is a form of extra-pulmonary tuberculosis with neurological abnormalities that accounts for 70-80% of all neurological tuberculosis cases, 5.2% of all extrapulmonary tuberculosis and 0.7% of all tuberculosis cases. Tuberculous meningitis (TB) is preceded by prodromal symptoms such as headache, anorexia, nausea/vomiting, subfebrile fever, accompanied by behavioural changes, and decreased consciousness. The patient, a 42-year-old male Mr SM, presented with decreased consciousness, a history of seizures and was taking tuberculosis drugs. Meningeal stimulation was found to be rigid, laseque test and kernique test were positive. Motor system impression of lateralisation to the right. Laboratory examination showed leukocytes 13,500/uL, platelets 728,000/uL, sodium 123 mmol, Kgd 135, thoracic X-ray with the impression of pulmonary tuberculosis with pneumonia, cranial CT-scan obtained with the impression of appropriate Tb meningitis, Non Communicating hydrocephalus. Specific treatments given were IVFD NaCL 0.9 % 20 drops / m, Omeprazole vial 2x40 mg, paracetamol infusion 3x1000 mg, Ceftriaxone 1 gram Vial, dexamethason ampoule loading 2 ampoules then 3x5 mg, Phenytoin 3x100 mg, Levofloxacin 750 mg, rifampicin 1x450 mg, isoniazid 1x300 mg, pyrazinamide 1x1000 mg, ethambutol 1x1000 mg, mg, B6 and B12 2x1 tablets.

The Effect of the COVID-19 Pandemic on the Family and Community Medicine Residency Training Program: The Philippine Experience.

The COVID-19 pandemic had a profound impact on medical education, particularly in Family and Community Medicine training programs. This study aimed to assess the impact in the Philippines by comparing the number of cases and procedures before and during the pandemic, as well as the adaptations made by these programs. The objective of this study was to determine the effect of the COVID-19 pandemic on Family and Community Medicine training in the Philippines by comparing the average number of cases and procedures done before and during the pandemic and the changes implemented by the different accredited training programs. A cross-sectional study utilizing an explanatory sequential mixed methods approach was undertaken. The quantitative portion collected data on cases and procedures from the participating institutions' residents using the standardized checklist of the Philippine Academy of Family Physicians. The qualitative portion was done through a focused group discussion (FGD) following a prepared set of FGD questions. Analysis of variation (ANOVA) was used to compare the average cases seen and procedures across the four years and content analysis for the qualitative data. There was a significant decrease in the average number of adult and pediatric cases during the pandemic years (2020-2021) compared to before (2018-2019). Various organ systems cases such as neurology, ophthalmology, dermatology, and gastrointestinal, showed significant differences (p-value <0.05) in the average number of pediatric cases. For adult cases, significant differences (p-value <0.05) were found for several organ system cases when comparing the years before (2018-2019) and during the pandemic (2020-2021), including neurology, ophthalmology, ENT, dermatology, cardiology, gastrointestinal, genitourinary, reproductive health, musculoskeletal, and endocrinology cases. The trainers adjusted training activities to support the hospital's COVID-19 response and that prompted an abrupt shift to online strategies for patient consultations, teaching sessions, and examinations. The COVID-19 pandemic led to a reduction in the variety of cases and procedures in Family and Community Medicine training, impacting the fulfillment of specialty training requirements. However, it also drove innovation through the integration of technology, including online teaching methods. These experiences underscore the importance of resilience and adaptability in medical education and offer valuable lessons for future training programs, potentially leading to improvements in training and patient care through innovative methodologies.