Tuberculosis is the very communal infection found globally and can nearly all parts of the human body can be affected by it, mostly affect the chest. Among the tuberculosis of the skeletal system; 50% of cases affect the spinal cord. Tuberculosis infection of the spinal cord results in Gibbus deformity, edema, involvement of intervertebral discs, epidural abscess, paravertebral abscess and edema with bone destruction and vertebrae collapse in the soft tissue planes. The most valuable diagnostic tool is MRI as it can clearly show all of the above results in the spine tuberculosis affected patients. Aim: The objective of this research was to know the pattern of incidence and to analyzed the several Pott’s spine pathological processes by means of the MRI scan. Study Design: A Retrospective study. Place and Duration: In the Radiology Department of HMC Peshawar and Orthopedic Department of BKMC Swabi from August 2021 to January 2022. Methods: This study analyzed MRI scans of 90 identified patients of spinal tuberculosis performed at the Radiology Department to govern the pattern of the several pathological lesions. Results: This study institute Pott's spine to be more common in the 21-50 age group, mostly among men. The lumbar and dorsal vertebrae are often affected and several vertebrae are affected frequently, with the most common affected is the L3 vertebra. The involvement of Intervertebral disc and para and pre-vertebral collections were communal, with epidural collection happening in > 75 of patients. 13.3% of the patients have cord oedema. Conclusions: MRI is very sensitive in detecting various Potts spine pathological processes, and the occurrence patterns of these findings were assessed in this research. As the prevalence and incidence of tuberculosis depends on several sensitive epidemiologically parameters, this research could deliver a standard conclusion against which further results could be compared in future studies. Keywords: Tuberculous spondylitis, lumbar abscess, Gibbus

Background: The most common and frequent tumors in the children’s are central nervous system tumors (CNS). Objective: For evaluation of the lag time and clinical spectrum of pediatric supratentorial brain tumors from the time of appearance of symptoms in a patient to the time the patient presents to the hospital. Study design: It is an observational and cohort study conducted in the radiology and oncology department of our institute teaching hospital. Material and Methods: This prospective research was conducted at the oncology department of the children hospital ICH Lahore for one year. The study was approved by the IRB. The duration of the study was from March 2021 to March 2022. The sample size was calculated. The patients of age range between 0 months to 17 years were included in the study. SPSS version 24.0 was used for statistical analysis. Data will be stratified to see the effect modulators. Results: This study included 60 patients 30 girls and 30 boys. The average age of the patients at the time they were diagnosed with pediatric supratentorial brain tumor was 7 years. The majority of the patients reported to have type I neurofibromatosis. Some of the most common symptoms that the patients reported were vomiting, oculo-visual issues, motor problems, headache and endocrine dysfunction. Conclusion: The lag time and clinical spectrum of pediatric supratentorial brain tumors from the time of appearance of symptoms in a patient to the time the patient presents to the hospital was reported to be 2-6 months in majority almost 61% of the children. The 71% children visited the two regional area doctors before visiting the tertiary care hospital. The complex interplay of underdiagnoses, unavailability of the neuro-oncology treatments facilities and higher rates of abandonment in the LIMC are the basic reason behind survival gaps of the delayed presented patients. Keywords: Pediatric supratentorial brain tumors, lag time, low/middle income countries (LMIC), Central nervous system (CNS) tumors and intraxial tumors.

Background Down’s syndrome is the most common chromosomal abnormality in humans. It has been associated with central nervous system tumors such as primary acute lymphoblastic leukemia and germinomas, but desmoplastic infantile astrocytoma has not yet been reported with Down’s syndrome. Desmoplastic infantile astrocytoma is a rare intracranial tumor that mostly occurs in the first 2 years of life. It usually presents as a large, aggressive tumor with both solid and cystic components. Genetically, it has been linked to the BRAF V600E mutation. Despite the rapid growth pattern, it usually has a favorable prognosis after neurosurgical excision. The presence of this extremely rare, genetically linked tumor, and its combination with Down’s syndrome, the most common human genetic defect, makes this a very novel clinical presentation. It also raises a very research-worthy question of an undiscovered link between these two genetic disorders. Case presentation In this case, we report a 1-year-old Pakistani origin male child with Down’s syndrome, who presented with progressive macrocephaly and developmental regression over the last 2 months. He was unable to sit by himself, and had lost his handgrip bilaterally. Down’s Syndrome was diagnosed soon after birth, based on typical facial features and presence of palmar crease, and later confirmed karyotypically for Trisomy 21. Upon presentation, initial blood tests did not show any abnormality. Magnetic resonance imaging of the brain was done, and showed a mixed intensity cystic mass with solid dural component posteriorly in the right parieto temporo occipital region. Craniotomy was performed, and about 85% of the tumor mass was excised. Histological examination and immunochemistry confirmed the suspected radiological diagnosis of desmoplastic infantile astrocytoma. After surgical excision, our patient gradually reacquired his previously regressed developmental milestones. Unfortunately, the remaining mass, which could not be excised due to its attachment to the highly vascular dura mater, showed regrowth on repeat brain magnetic resonance imaging. As his parents did not consent to further surgery, chemotherapy was offered as the next treatment option to prevent tumor regrowth. Conclusions This case report highlights the need for more case data and research to understand desmoplastic infantile astrocytoma, and their genetic correlation with Down’s syndrome. From a clinical standpoint, since desmoplastic infantile astrocytoma has a good postresection prognosis in a majority of early-diagnosed clinical cases, pediatricians, radiologists, and pathologists should consider desmoplastic infantile astrocytoma in their initial differential diagnosis in Down’s syndrome patients with macrocephaly and developmental regression during the first 2 years of life.