Online medical education and examinations during COVID-19: Perspectives of a teaching associate

The novel coronavirus disease 2019 (COVID-19) pandemic has not only challenged global health systems but also social, economic, and educational systems. In this short communication, our focus is on its impact on medical education in Pakistan. We discuss the structure of undergraduate medical education in Pakistan; and how it has evolved in the wake of COVID-19. We describe our role as teaching associates (TAs) at the Aga Khan University (AKU); and how it has enabled us to be a part of the transition to online medical education, with a specific focus on online examinations in medical schools

Management of arachnoid cysts: A comprehensive review

Arachnoid cysts are non-neoplastic, intracranial cerebrospinal fluid (CSF)-filled spaces lined with arachnoid membranes. Large arachnoid cysts are often symptomatic because they compress surrounding structures; therefore, they must be treated surgically. As several surgical management options exist, we explore the best approach according to each major type of arachnoid cyst: middle cranial fossa cyst, suprasellar cyst, intrahemispheric cyst, and quadrigeminal cyst

A rare case of primary midgut volvulus necessitating extensive bowel resection in an adult

A cause of acute intestinal obstruction in adults, midgut volvulus can be categorized into two types: primary type with no identifiable underlying cause, and secondary type that occurs in the presence of a predisposing condition such as, postoperative adhesions. Primary midgut volvulus can lead to bowel ischemia and necrosis, making an extensive bowel resection imminent. A potential consequence of bowel resection is short-bowel syndrome - a failure of digestion and absorption by the intestines, leading to malnutrition and other complications. As such, we report the diagnosis and management of primary midgut volvulus - a rare entity in adults - occurring in an adult patient

Dabrafenib in BRAFV600E mutant pilocytic astrocytoma in a pediatric patient

Pilocytic astrocytomas (PAs) are the most common pediatric central nervous system tumors. They constitute around 30% of all primary central nervous tumors in the pediatric age group. Their clinical behavior may vary but most of them are indolent and do not undergo malignant transformations compared with their adult counterparts. PAs are primarily treated with surgery and in cases of progression; chemotherapy may be needed. They usually carry a good prognosis, with a 10-year survival rate of 90%. BRAFV600E mutations have been identified in approximately 9-15% of patients with PA. These relatively high mutation frequencies in PA open avenues for treatment using targeted therapies such as BRAFV600E inhibitors (e.g., dabrafenib). There have been a few published case reports and case series showing clinical benefits with BRAF inhibitors in BRAF-positive tumors. We report a case of successful treatment of BRAFV600E immunopositive optic pathway PA in a child with dabrafenib

Acute orbital pseudomeningocele due to traumatic fracture in an infant

Paediatric orbital trauma is uncommon, but it can be associated with significant morbidity. Traumatic pseudomeningocele is an infrequent complication of orbital trauma; it occurs due to an extradural collection of cerebrospinal fluid (CSF) that develops after a dural tear. Herein, we report a case of a seven-month-old male child who presented with eye swelling and suspicion of orbital cellulitis, along with a history of a road traffic accident. He was later diagnosed with traumatic orbital pseudomeningocele and underwent a left frontal craniotomy and duroplasty along with repair of medial orbital pseudomeningocele. Postoperatively, the child remained stable and resolution of proptosis was observed

Paediatric choroid plexus carcinoma : A retrospective case series from Karachi

The objective of this study is to report clinical, radiological, and histopathological characteristics of three paediatric patients diagnosed as Choroid plexus carcinoma seen at our hospital, between 2015 and 2020. Three patients were diagnosed with choroid plexus carcinomas between 2015 and 2018. The mean age at diagnosis was 1.3 years (range 8 months to 1.5 years). All the three patients had subtotal resection and received adjuvant chemotherapy. One patient also received adjuvant radiotherapy. Despite these treatment measures, residual disease was noted in all three patients and two patients were subsequently treated on palliative care grounds. The average duration of follow-up after the first surgery for all three patients was approximately 33 months. Attaining satisfactory outcome in patients with CPC is challenging. Our case series reflects the difficulty in achieving gross total resection and ensuring that the disease does not recur

Paediatric choroid plexus carcinoma: a retrospective case series from Karachi

The objective of this study is to report clinical, radiological, and histopathological characteristics of three paediatric patients diagnosed as Choroid plexus carcinoma seen at our hospital, between 2015 and 2020. Three patients were diagnosed with choroid plexus carcinomas between 2015 and 2018. The mean age at diagnosis was 1.3 years (range 8 months to 1.5 years). All the three patients had subtotal resection and received adjuvant chemotherapy. One patient also received adjuvant radiotherapy. Despite these treatment measures, residual disease was noted in all three patients and two patients were subsequently treated on palliative care grounds. The average duration of follow-up after the first surgery for all three patients was approximately 33 months. Attaining satisfactory outcome in patients with CPC is challenging. Our case series reflects the difficulty in achieving gross total resection and ensuring that the disease does not recur

Capacity building for pediatric neuro-oncology in Pakistan- A project by my child matters programme

Background and Aims: The landscape of Pediatric Neuro Oncology (PNO) has changed in Pakistan since 2014, when a PNO twinning program was initiated between the Aga Khan University Hospital (AKUH) and the Hospital for Sick Children (SickKids), Toronto. This twinning initiative identified the dire need of broadening the PNO services in other centers of Pakistan.Methods: The project for the Capacity building of PNO services was initiated in 2019 with the support of a ‘My Child Matters’ grant by the Sanofi Espoir Foundation. The grant\u27s main purpose was to enhance the capacity for PNO services in 13 public and private sector hospitals across Pakistan. Activities included establishment of National PNO tumor boards, educational workshops and fellowship to train and raise awareness of health care professional (HCP), patients and families.Results: Monthly tumor boards were started in 2019 covering all provinces of Pakistan. To date 223 patients have been discussed. Three PNO workshops attended by 154 HCP, 25 lectures as part of a lecture series were delivered by 13 international faculties with \u3e 1800 participants from 48 countries. Most activities were virtual amongst the mayhem of the pandemic. This project also led to the establishment of Pakistan\u27s first Pediatric neuro-oncology fellowship program at AKUH. In addition, Pakistan\u27s National Guidelines for the management of Medulloblastoma were developed endorsed by the Pakistan Society of Pediatric Oncology (PSPO) and the Pakistan Society of Neuro-oncology (PASNO). Lastly AKUH was able to host the Pakistan`s First PNO Virtual Symposium in November 2020 which brought together 29 national and international luminaries in the field of PNO, it was attended by 1126 participants from 58 countries across the globe.Conclusions: This program has shown its capacity to transform the management of pediatric brain tumors in a low middle-income country with a very large pediatric population. Further follow-up is needed to assess the impact on survival

Building the ecosystem for pediatric neuro-oncology care in Pakistan: Results of a 7-year long twinning program between Canada and Pakistan

Background: Low- and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries. Collaboration between institutions in low- and middle-income countries and high-income countries is one of the ways to improve cancer outcomes. Methods: Patient characteristics and effects of a pediatric neuro-oncology twinning program between the Hospital for Sick Children in Toronto, Canada and several hospitals in Karachi, Pakistan over 7 years are described in this article. Results: A total of 460 patients were included in the study. The most common primary central nervous system tumors were low-grade gliomas (26.7%), followed by medulloblastomas (18%), high-grade gliomas (15%), ependymomas (11%), and craniopharyngiomas (11.7%). Changes to the proposed management plans were made in consultation with expert physicians from the Hospital for Sick Children in Toronto, Canada. On average, 24% of the discussed cases required a change in the original management plan over the course of the twinning program. However, a decreasing trend in change in management plans was observed, from 36% during the first 3.5 years to 16% in the last 3 years. This program also led to the launch of a national pediatric neuro-oncology telemedicine program in Pakistan. Conclusions: Multidisciplinary and collaborative efforts by experts from across the world have aided in the correct diagnosis and treatment of children with brain tumors and helped establish local treatment protocols. This experience may be a model for other low- and middle-income countries that are planning on creating similar program