Rib fractures are a frequent consequence of blunt chest trauma and are associated with significant morbidity and mortality, particularly in cases of flail chest or multiple displaced fractures. While conservative management remains the traditional approach, surgical stabilization of rib fractures (SSRFs) has gained increasing attention for its potential to improve outcomes. This prospective comparative cohort study, conducted between April 2018 and August 2023, compared the effectiveness of SSRF with that of nonoperative management. A total of 114 patients with respiratory compromise from unstable rib fractures were enrolled, 57 of whom underwent SSRF via custom-made titanium plates and screws (Group A) and 57 of whom received conservative treatment (Group B). Baseline demographics and associated injuries were comparable between the groups, although flail chest was more common in the surgical cohort (40.4% vs. 19.3%, p = 0.012). By discharge, patients in the SSRF group reported significantly lower pain scores (3.6 vs. 7.5, p < 0.001) and demonstrated superior pulmonary function at follow-up (FEV₁ at 3 months: 2.84 ± 0.40 L vs. 2.06 ± 0.36 L, p < 0.001). Oxygen dependence was shorter in the surgical group (2.5 ± 0.7 vs. 5.1 ± 0.8 days, p < 0.001), and fewer patients required ventilatory support (12.3% vs. 29.8%, p = 0.022). Among ventilated patients, 50% in the SSRF group were weaned within 3 days, whereas none were weaned in the conservative group (p < 0.001). The length of hospital stay was nearly halved with surgery (4.4 ± 1.5 vs. 9.4 ± 2.3 days, p < 0.001). Mortality was lower in the surgical group (5.3% vs. 15.8%), although this difference was not statistically significant (p = 0.062). Importantly, return-to-work rates at one month were markedly higher following SSRF (62.96% vs. 12.50%, p < 0.001). Compared with conservative management, SSRF offers significant benefits in terms of pain control, respiratory recovery, and functional outcomes. These findings support broader adoption of SSRF, particularly in patients with flail chest or multiple displaced rib fractures, and highlight the feasibility of custom-made implants in resource-limited settings.

Timely diagnosis and treatment delays among tuberculosis (TB) patients remain among the major challenges for controlling and eradicating the disease globally. Delayed health-seeking behavior among TB patients may either contribute to undetected and untreated TB cases or lead to poor treatment outcomes when patients are eventually diagnosed. Managing these delayed TB consultations becomes even more challenging in lower-middle-income countries (such as Pakistan), where TB incidence and transmission rates are high, but limited evidence is available on patient and health system delays in seeking and initiating TB treatment. This study aimed to assess the time delays of patients attending pharmacies managed by TB referral initiatives in Pakistan. A case detection approach utilizing a public‒private-mix (PPM) partnership was developed and fully protocolized for use; this approach involved participation in pharmacies to assess and provide a formal written referral to patients presenting with symptoms indicative of TB. Ranges of pharmacy referral implementation delay as well as diagnostic and treatment delay of TB patients were defined. Among the 500 pharmacies trained in PPM partnerships, 427 (85%) were active in providing referrals. The median pharmacy referral implementation delay was found to be 46 days. Among the 547 TB cases identified through the community pharmacy-referral network, the median diagnostic delay and treatment delay were found to be 4 days and 1 day, respectively. Time delays among TB patients diagnosed through the community pharmacy referral network in Pakistan were relatively low for diagnosis and treatment; however, delays related to the implementation of pharmacy referrals were at times longer than those reported in local, regional, and global settings.

Diarrhea is caused by bacteria, viruses, or parasites, a major contributor to morbidity and mortality in children below 5 years of age. This randomized placebo-controlled trial evaluated effectiveness of folic acid supplementation for acute watery diarrhea (AWD) in children below 5 years of age. The study was conducted at the Department of Pediatric Medicine, Mayo Hospital, Lahore, and enrolled and randomized 324 pediatric patients in a 1:1 ratio to two groups. Children in Group A were given folic acid for 5 days while children in Group B were administered distilled water as a placebo for the same period. Clinical proformas were used to record and monitor the frequency of loose stools and stool consistency across both groups, on daily basis. Results of the study revealed that, compared with placebo group, folic acid supplementation did not significantly decrease frequency of loose stools, improve stool consistency, or shorten the duration of diarrhea. The average change in the number of loose stools from presentation to day 5 was similar in both groups [Group A: median = 7 (IQR = 4) versus Group B: Median = 7 (IQR = 4); p = 0.704]. The average duration of diarrhea was not significantly different between Group A [median = 4 (IQR = 2)] and Group B [median = 5 (IQR = 3)] (p = 0.530). The maximum duration of diarrhea was 11 days in Group A and 10 days in Group B. The study concluded that folic acid supplementation in AWD was not effective in reducing the frequency of loose stools, improving stool consistency, or decreasing the duration of illness among children under 5 years of age. Future studies should explore additional adjunctive therapies to help reduce diarrhea-related complications and mortality.

Depression is a public health problem affecting both males and females and is contributed by multiple social, demographic, and economic factors. However, scientific evidence comparing depressive symptoms among working women and homemakers in Pakistan remains limited. This community-based comparative study compared the proportion of depressive symptoms among working women and homemakers and determined their associations with sociodemographic characteristics. The study included 350 women aged 20–60 years residing in Hirabad, Hyderabad, Sindh, Pakistan, comprising 175 working women and 175 homemakers, and were selected using stratified random sampling. Data were collected using a structured questionnaire, and the Center for Epidemiologic Studies Depression Scale (CES-D) score and depressive symptoms were defined as a CES-D score > 23. The results showed that 137 (39.1%) participants had depressive symptoms, and the proportion of depressive symptoms was greater among homemakers than working women (42.9% vs. 35.4%); however, the difference was not statistically significant (χ² = 2.027, df = 1, p = 0.155). Depressive symptoms were significantly associated with age (p = 0.030), marital status (p = 0.014), educational attainment (p = 0.010), and socioeconomic status (p = 0.005), whereas no significant associations were observed with employment status or area of residence (p > 0.05). The study concluded that depressive symptoms were common among both working women and homemakers. Although a nonsignificant higher proportion of depressive symptoms was observed among homemakers. Sociodemographic factors, rather than employment status, were significantly associated with depressive symptoms in this study population.

Breast cancer poses a significant economic burden on affected households, especially in low- and middle-income countries where healthcare services rely mainly on out-of-pocket expenditures. This analytical study determined the associations between the socioeconomic and clinical characteristics of breast cancer patients and different elements of the cost of illness (COI). The study included 200 women with breast cancer receiving healthcare services at two public tertiary care hospitals in Lahore, Pakistan. Demographic, clinical, and household cost data were collected from patients through face-to-face interviews using a pretested questionnaire. COI was categorized into direct medical, direct nonmedical, indirect nonmedical, and overall costs according to the World Health Organization framework. Our study results highlighted that the mean age of the patients was 43.87 ± 9.67 years; most were married (84.5%), were housewives (73.0%), and had stage III breast cancer (54.0%). Direct medical costs differed significantly according to patient education, the education level of the husband, and monthly household income (all, p < 0.05). Direct nonmedical costs differed significantly by patient age, location, and marital status, whereas indirect nonmedical costs differed by patient age and prediagnosis occupation (all, p < 0.05). The overall COI was significantly associated with patient age, level of education, level of education of the husband, and monthly household income (all, p = 0.05). Multivariable analysis showed that the level of education of the husband (p = 0.022), location (p = 0.022), self-employment (p = 0.011), employment status (p = 0.049), stage II breast cancer (p = 0.013), and family history of breast cancer (p = 0.047) were independently associated with the overall cost of disease. The study concluded that the household economic burden of patients with breast cancer varies according to their socioeconomic and clinical characteristics, with multiple factors affecting individual cost elements and the overall cost of disease treatment.