Esophageal leiomyoma within an epinephric diverticulum.

Epinephric diverticula are distal esophageal pouches protruding from the epithelial lining of the esophagus while esophageal leiomyomas are benign smooth muscle lesions that constitute a significant percentage of all gastrointestinal leiomyomas. Epinephric diverticula and esophageal leiomyomas are common individually but their co-existence is rare. Moreover, they present asymptomatically but can occasionally present with complains of dysphagia and weight loss. In this paper, we present a 58-year-old Asian man with three months history of indigestion and progressive weight loss. Preoperatively, CT Scan with IV Contrast showed a large soft tissue mass appearing on the right distal esophageal wall, with its lumen communicating with the esophageal lumen, likely representing an epinephric diverticulum. Biopsy and immunohistochemistry stains confirmed the diagnosis of smooth muscle neoplasm, likely a leiomyoma. Later, the patient underwent a two-stage esophagectomy. The postoperative biopsy was consistent with the initial one: therefore, supporting the diagnosis of a leiomyoma. Postoperatively, the recovery remained uneventful.

Ensuring competence of essential skills: clinical examination for final year medical students.

OBJECTIVE: To ensure competence of essential skills of final year medical students in clinical examination by identifying essential skills and by revisiting and practising them before the examination. Methods: The cross-sectional study was conducted at the Aga Khan University, Karachi, from February to November, 2019, and comprised final year medical students and internal examiners from various academic disciplines. An overview of the organisational context, exam structure and process was noted. RESULTS: There were 96 medical students. The four key areas highlighted were development of the list of essential skills across five years of undergraduate medical curriculum with consensus from all disciplines, student motivation for attendance in practice sessions, unfamiliarity of examiners with the assessment tool, and the need for capacity-building. The key areas were based on the feedback received from all the stakeholders, and post-hoc analysis. Conclusion: This form of assessment would enable a thorough analysis of the preparedness of the students to function as independent physicians as undifferentiated doctor at the start of their careers as interns, and improve the quality of subsequent exams based on feedback and suggestions of faculty and students.

Experience of Telemedicine in Gastroenterology Out-Patient Practice During the COVID-19 Pandemic: Experiences from a Tertiary-Care Hospital in a Developing Country.

Objective: Telemedicine is being widely implemented in the COVID-19 pandemic to avoid infection risk. However, its effectiveness has not been evaluated, especially in developing countries, where it is invaluable for healthcare access. This study assesses physicians' and patients' perspectives of the usefulness and challenges of telemedicine in the gastroenterology department to identify its pitfalls. Methods: A cross-sectional telephonic survey was conducted on patients presenting to the gastroenterology department at a tertiary care hospital in Pakistan. An online survey was sent to physicians in the department. Results: A total of 160 patients participated, with a mean age 49.8 years, and 42.8% (n=68) males. There were 23.8% (n=38) initial visits and 76.3% (n=122) follow-ups. More than 85% of patients agreed telemedicine saved cost and time, 46.5% (n=74) said it improved healthcare access, and 76.3% (n=122) wanted to use it again. More than 80% were satisfied with the physician-patient interaction. Of the 7 physicians who participated, most felt telemedicine was inadequately facilitated, but felt comfortable with technology. Most felt it did not negatively affect healthcare, but thought it was complex for patients and that lack of physical interaction is a limitation. Nearly half were in favor of continuing its use after the pandemic. Conclusion: Telemedicine is an effective alternative to in-person visits. Patients find it convenient, with adequate interaction. Physicians have reservations that need addressal, such as poor administration. Most patients and half of physicians are welcome to using telemedicine in the post-COVID era.