The Experience and Perplexities of the COVID-19 Situation in Pakistan

The COVID-19 pandemic has provided unprecedented times for people from all walks of life. For the medical student community it is no different. This global health emergency has presented students with circumstances that have required flexibility and constant adaptation with regard to formal medical education. This short commentary draws on personal experience and aims to elucidate the numerous challenges faced by medical students within the context of a low-middle-income country (LMIC) (Pakistan), whilst also highlighting surprising positives that have emerged from an otherwise overwhelming situation

Sarcoidosis presenting as vocal cord palsy: An unusual presentation and literature review

We report the case of a 60-year-old woman, presenting with left vocal cord paralysis (VCP). Diagnostic evaluation revealed sarcoidosis to be the underlying pathology. Computed tomography (CT) scans exhibited enlarged subcarinal, pretracheal, and prevascular lymph nodes as the possible mechanism of left VCP through compression of the left recurrent laryngeal nerve. Initial treatment with oral prednisolone and azathioprine led to remission of symptoms; however, tapering of dosage led to relapse of cough without any signs of VCP. The dosage of prednisolone was further boosted, leading to complete remission. A review of literature reveals 20 cases have been reported to date, with all but one involving the left vocal cord. This is the first reported case, with a relapse of the disease without a relapse of VCP, indicating the rarity of sarcoidosis-associated VCP

Peer-taught virtual research workshops for surgical residents: Protocol for a novel and sustainable solution to improving surgical research in Pakistan

Objective: To generate a protocol describing the methodology for a study assessing the effectiveness of a comprehensive series of peer-taught online research workshops for surgical residents across Pakistan in terms of improving research-related knowledge and skills, and long-term research involvement and output.Methods: The quasi-experimental study will consist of a series of six online research workshops conducted over Zoom for surgical residents across Pakistan. An online sign-up form will be circulated on social media to current surgical residents throughout Pakistan. Curricular content covered in the workshops will be developed in collaboration with experienced research faculty at the Departments of Surgery and Community Health Sciences at the Aga Khan University Hospital, Karachi. Facilitators of the workshops will be current surgical residents with a solid track record of research involvement at the hospital. Improvement in research-related knowledge and skills will be assessed through pre- and post-tests for each workshop. A post-series feedback form will assess satisfaction with the organisation, content relevance, peer-teaching and online delivery of the workshops. Long-term research involvement and output will be assessed by follow-up surveys at 6 months and 1 year post-workshop. All data-collection will be done via Google Forms. For ethical purposes, informed consent will be taken from participants prior to enrolment; data will be collected using a unique identifier number to maintain anonymity; and the only incentive provided to participants will be a Certificate of Completion for the research workshop series.Results: We expect that surgical trainees participating in the series of six research workshops will demonstrate a highly significant percentage improvement (p80%) to rate the overall organisation, effectiveness of online mode of instruction, and relevance to surgical training of the workshops as excellent/good. We also expect that most participants (\u3e80%) would strongly agree/agree that peer-education is an effective model of teaching in research workshops. Finally, we expect statistically significant improvement (pConclusions: In light of the ever-growing need for academic surgeons in Pakistan, this research protocol details a comprehensive strategy for research capacity-building among surgical trainees across the country. By equipping trainees with the knowledge and skills to conduct high-quality research, virtual research workshops provide a novel, grassroots-level and sustainable solution for addressing the surgical research crisis in Pakistan

Diagnosis of endometriosis in the light of prevalent theories

Endometriosis is a gynecological condition recognized by the existence of ectopic endometrial tissue outside the uterus. It is predominantly present in females of reproductive age group and is one of the main causes of infertility. Even with a predictable prevalence of 11% in females and considerable historical explanations adopted from the seventeenth century, the diagnosis of endometriosis still remains doubtful. The conventional concepts on histological basis of endometriosis are explained by a number of theories. Medical signs of endometriosis contain prolonged pelvic ache, dyspareunia, repeated menstrual discomfort and chronic pelvic pain which can severely affect the excellence of life and health of the patient. In this review we will discuss the prevalent theories for the diagnosis of endometriosis and suggestions to identify the condition well in time for better control and management

Collision versus loss-of-control motorcycle accidents: Comparing injuries and outcomes

Objective: Motorcycles are a common mode of transport, especially in low-middle-income countries like Pakistan. The pattern and severity of injuries in motorcycle trauma depends on the mechanism of accident, which may be classified as collision accidents (CAs) or loss-of-control accidents (LOCAs). In this study, we aimed to investigate patterns of trauma due to motorcycle CAs and LOCAs, with a focus on injuries, management, complications, and outcomes.Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital (AKUH), Pakistan (a level 1 trauma facility), enrolling all patients presenting with motorcycle trauma between January 2018 and March 2019.Results: The most common sites of major injury were the lower limb (40.9%), head and neck (38.1%), and upper limb (27.5%). A significantly higher percentage of CA victims had head and neck injuries (43.4% vs. 30.5%), abdominal injuries (5.5% vs. 1.1%), pelvic fracture (5.9% vs. 0%), and polytrauma (22.8% vs. 11.1%). Compared to LOCA victims, CA victims had a significantly higher incidence of acute kidney injury (AKI; 25.7% vs. 15.8%; P \u3c .011), longer hospital lengths of stay (LOSs; 3 [2-6] days vs. 2.5 [2-4] days; P = .019), and long-term disability (P = .002). When adjusted for age and gender on multivariable logistic regression with mechanism of accident as the dependent variable, CA was significantly associated with male gender (odds ratio [OR] = 2.045, 95% confidence interval [CI] [1.038-4.026]), abdominal injury (OR = 5.748, 95% CI [1.285-25.702]), head and neck injury (OR = 1.492, 95% CI [1.007-2.211]), polytrauma (OR = 2.368, 95% CI [1.383-4.055]), AKI (OR = 1.937, 95% CI [1.183-3.171]), and LOS (OR = 1.041, 95% CI [1.004-1.079]).Conclusions: Though both motorcycle CAs and LOCAs stress trauma systems in developing countries, the dynamics of CAs mean that they result in worse injuries and outcomes. Specific measures to reduce CAs and LOCAs are urgently indicated in developing countries to reduce the burden of morbidity and mortality of motorcycle accidents

Diagnostic value of bronchoscopy in Sars-Cov-2 infection: a systematic review

Objective: To investigate the diagnostic performance of bronchoscopy in patients with coronavirus disease 2019 infection. Method: The systematic review was conducted in April 2021 and comprised search of published articles and preprint servers for original articles assessing diagnostic performance of bronchoscopy in patients with suspected coronavirus disease 2019 infection. The primary outcome of interest was diagnostic sensitivity of bronchoalveolar lavage in the patients The quality of each study was assessed using the Quality Assessment, Data Abstraction and Synthesis-2 tool. Results: Of the 29 full-text articles assessed for eligibility, 4(13.8%) were included collectively comprising 209 patients who had undergone bronchoalveolar lavage. Mean sensitivity of bronchoalveolar lavage was 83.5% +/- 10.63 (range: 68.2-940%). Overall, the 4 studies had an unclear or low risk of bias. Conclusion: Limited data suggested that bronchoscopy with bronchoalveolar lavage did not have reliably higher diagnostic sensitivity than that reported for either nasopharyngeal or oropharyngeal swabs. Key Words: Bronchoscopy and interventional techniques, COVID-19, Diagnostic techniques

Atypical presentation of a rare gestational trophoblastic neoplasm: a case report

A 34-year-old woman had a history of 3 miscarriages and presented with symptoms of an unproductive cough and rising serum beta-human chorionic gonadotropin (B-hCG) levels. There were no gynaecological symptoms. A diagnosis of Choriocarcinoma with pulmonary metastasis was made. In Pakistan, the incidence of Choriocarcinoma remains exceedingly rare, accounting for less than 0.3% of all gynaecologic tumours. Though rare, if managed appropriately, it has a reasonably good prognosis, as demonstrated by the outcome of the current case. Keywords: Choriocarcinoma, EMA-CO Chemotherapy, Pulmonary Metastasis, Thoracotom