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Spinal epidermoid cysts (ECs) are benign slow-growing spinal tumors. The account for <1% of spinal tumors and are usually found intradural extramedullary. This report is regarding two rare cases of intramedullary white ECs present at the conus medullaris. In the first case, a 32-year-old male presented with a complaint of lower backache for 5 years, which progressively increased in intensity, radiating to the left leg. The patient had left lower limb weakness in the form of difficulty in walking. On examination, power of left knee and ankle was 4/5. Left extensor hallucis longus power was 3/5. Left Babinski sign was extensor. In the second case, a 42-year-old male, presented with a complaint of numbness over the left foot for 5–6 months. On examination, the power of the left ankle was 3/5, left extensor hallucis longus was 3/5. Both patients had EC in conus medullaris, which was hyperintense on T1-weighted magnetic resonance imaging and underwent laminectomy with the evacuation of the cyst with electrocoagulation of cyst epithelial lining. White ECs are extremely rare in the conus medullaris. Electrocoagulation of the cyst wall is like walking on a tight rope. Liberal electrocoagulation can lead to the neurological deficit but decreases the chances of recurrence. On the other hand, conservative electrocoagulation can lead to recurrence but decreases the chance of a new deficit. Recurrence should also lead to suspicion of atypical changes in the cyst wall, which may require adjuvant treatment such as radiotherapy and chemotherapy.

BackgroundTelemedicine has proved its significance in the healthcare system, especially during the coronavirus disease 2019 (COVID-19) pandemic as it assists in the provision of early and effective healthcare to those in distant areas. This study aimed to assess the knowledge and attitude of healthcare professionals toward the use of telemedicine in the rural areas of Sindh, Pakistan.Materials and methodsThe cross-sectional study was conducted with 212 healthcare professionals including physicians, consultants, surgeons, residents, dentists, and house officers working in public sector hospitals. The face-to-face method was used for data collection. Chi-square test and logistic regression analysis were applied to find the association between different variables and knowledge and practice of telemedicine using SPSS V 24.ResultsThe knowledge of participants regarding the usability of telemedicine and various tools used for the provision of medical services (video consultations, conferencing, use of applications, software, and online groups) was good. A total of 52.2% of participants showed agreement when they were questioned about being aware of online healthcare service provision. In this study, 52.8% of the participants practiced telemedicine by delivering healthcare services through online consultations. The majority of the participants were surgeons (25.9%), residents (23.1%), and physicians (18.9%). The internet (42.4%) and public media (25.9%) were the major sources of information for telemedicine. A total of 70.5% of participants suggested that strategies and efforts should be directed toward the enhanced implementation of telemedicine. Training in telemedicine as a source of information [OR = 13.02 (95% CI = 3.9–43.6), p &lt; 0.001)] and awareness regarding the effect of telemedicine in healthcare quality [OR = 10.25 (95% CI = 2.9–35.4), p &lt; 0.001)] remained the predicting factors for the practice of telemedicine among healthcare workers using multivariate regression analysis.ConclusionTelemedicine has technologically revolutionized the medical sciences worldwide. The awareness level and usage of telemedicine were good among healthcare professionals in rural Sindh. Telemedicine should be utilized to provide quality healthcare in underprivileged areas by investing in infrastructure and education.

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