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Introduction Morning report (MR) is an educational activity that uses inpatient case-based teaching. Given the rapid changes taking place in medical practice, it is important to assess the residents’ perspective regarding this teaching method. Objective To establish the perspective of residents in internal medicine on various aspects of MR and propose a format based on our observations.   Study Design Observational cross-sectional study. Place & Duration of Study Data was collected from two groups of residents in the Department of Medicine at the Aga Khan University Hospital, first in July-August 2002 and then later in June-August 2007. Methodology An observational cross-sectional survey on MR was conducted among the residents of the Department of Medicine at Aga Khan University. A 22-item questionnaire was distributed among the residents based on the purpose, format, and contents of the morning report, as well as the most appropriate person to present and conduct it, and how frequently they should be carried out. Analyses were carried out using the statistical software ‘Statistical Package for Social Sciences’ (SPSS) Results 92% of residents believed MR to be an effective teaching activity with 65% of them choosing ‘Improvement in clinical problem-solving ability’ as the primary purpose of MR followed by ‘improving presentation skills’ (62%) and ‘conveying medical knowledge to the residents’ (58%). 79 residents (87%) believed that the junior resident should present the case history. 75 residents (83%) thought that faculty on call at time of patient’s admission should conduct MR. Residents wanted to discuss diagnostic work-up (90%) and management (89%) of specific interesting cases (79%) in MR. Conclusion MR is an effective educational activity and should be an essential component of any post-graduate residency program within the country and outside.

Background : Tuberculous pleural effusion (TPE) occurs in up to 25% of TB patients. Owing to the pauci-bacillary nature of the pleural fluid, the diagnosis of TPE is a challenge. Newer diagnostic tools are required for the rapid diagnosis of TPE. Objectives : To compare the sensitivity and specificity of Xpert MTB/RIF and Geno type MTBDRplus line probe assay (MTBDRplus) for diagnosing TPE.  Methods : A prospective cross-sectional study was performed at Aga Khan University Hospital, Karachi, Pakistan from August 2014 to January 2016. Patients with suspected TPE were recruited on the basis of history, exudative lymphocytic nature of effusion and raised adenosine daminase level. Pleural fluid samples were tested for AFB smear, culture, Xpert MTB/RIFand MTBDR plus . Results :  We enrolled 99 patients with mean age of 50.4±20.3 years. AFB culture was positive in 14 (14.14%) cases. Considering AFB culture as Gold standard, the sensitivity of Xpert MTB/RIF was found to be 57.14% (95% CI: 28.86 – 82.34%) and specificity was 97.65% (95% CI: 91.76 - 99.71%) and the sensitivity of MTBDR plus  was  35.71% (95% CI: 12.76 – 64.86%) and specificity was 98.82% (95% CI: 93.62 - 99.90%).The sensitivity of Xpert MTB/RIF in TPE was higher than MTBDRplus (p 0.013), while specificity was similar. Conclusion :  Xpert MTB/RIF is more sensitive for detecting TPE than MTBDRplus and AFB smear microscopy. A multicenter, large-sample study is needed to evaluate this method for early TPE diagnosis.

Background Angiosarcoma is a rare, vascular malignancy that arises from endothelial cells of blood vessels. This case report aims to create the awareness of its existence in the region and its mode of presentation. Case presentation A 63-year-old Pakistani man presented to the emergency department with sudden bilateral chest pain and shortness of breath for 2 days. On examination, a scalp lesion was seen which had been increasing in size over the last 6 weeks. The lesion was 8 × 10 cm in size with an irregular border, non-tender, violet and dome-shaped in elevation on the right occipito-parietal lobe of the skull. Chest computed tomography (CT) showed multiple cystic lesions on both lungs, patchy areas of ground-glass opacities, nodules of variable sizes and bilateral pneumothorax. Bilateral tube thoracostomy was performed which provided symptomatic relief for shortness of breath. His bronchoalveolar lavage (BAL) was negative for infection. He underwent biopsy of scalp lesion which was positive for aggressive angiosarcoma. Conclusion Bilateral spontaneous pneumothorax can be the initial manifestation of aggressive cutaneous angiosarcoma and frequently leads to respiratory failure. Early recognition is essential to prevent delay in diagnosis and management.