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.

As digital connectivity has become an integral part of daily life, internet addiction has emerged as a significant concern, particularly among adolescents. Therefore, this study aims to estimate the prevalence of internet addiction among adolescents, assess its severity, investigate the associations between sociodemographic factors and internet addiction levels, and examine the correlation between adolescents' age and the severity of internet addiction. This descriptive cross-sectional study involved 200 adolescents from private education institutes in Sargodha, Pakistan. A structured questionnaire was developed to collect data on sociodemographic indicators, and the validated Internet Addiction Test (IAT) questionnaire was adopted to assess the occurrence and severity of internet addiction. The data were analyzed using IBM® SPSS® software. The results revealed that among the 200 participants, 42% were male and 58% female, with nearly half (47.5%) being aged 13–15 years. Most (57.00%) owned a personal mobile device, whereas 47.5% had a laptop. Furthermore, 39.5% of the participants used the internet for one hour or less per day, whereas 30% reported using it for 2–4 hours daily. Only 8 participants stated that they did not use any social media applications. The study highlights significant internet addiction patterns. Many participants stayed online longer than intended (12.5% always, 16.5% often), whereas 34.5% neglected household chores. Internet dependency was evident, with 14.5% preferring online excitement over intimacy and 26.0% receiving complaints about excessive internet use. Sleep disturbances affected 25.0% of the study participants, whereas academic impacts were reported by 14.5% of the participants. The IAT results revealed that 8.5% of the participants had full control, 54.0% had mild, 36.0% had moderate, and 1.5% had severe addiction. Chi-square analysis revealed no significant associations between addiction severity and sex, age, or device ownership (p > 0.05), but the duration of internet use per day was significantly associated with addiction severity (p = 0.030). Age was weakly but significantly correlated with internet addiction (p = 0.04). The study concluded that a significant proportion of adolescents experienced moderate to severe internet addiction. These findings highlight the urgent need to implement measures to promote healthy digital practices among adolescents.

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.

Malnutrition is highly prevalent among patients with gastrointestinal (GI) cancers and has a significant effect on surgical outcomes. Despite the growing recognition of this relationship, standardized nutritional assessment and intervention protocols remain inconsistent across healthcare settings. A prospective cohort study was carried out over a one-year period (June 2023–June 2024) to determine the associations between preoperative nutritional status and postoperative outcomes in patients undergoing major resection for GI malignancies. Consecutive patients who underwent elective major GI cancer resection were enrolled. The study utilized validated tools to assess nutritional status, including serum albumin (ALB), body mass index (BMI), and the Patient-Generated Subjective Global Assessment (PG-SGA). The principal outcomes were major postoperative complications (Clavien–Dindo grade ≥3), length of hospital stay, and thirty-day mortality. Among 294 patients, 128 (43.5%) were identified as nutritionally at risk preoperatively. Patients classified as malnourished experienced significantly higher 30-day mortality, with a rate of 12.5% versus 4.2% in well-nourished patients (p = 0.008). They also had a greater incidence of major postoperative complications, occurring in 35.9% of cases versus 18.1% among their well-nourished counterparts (p < 0.001). In addition, the median length of hospital stay was notably longer in malnourished individuals (14 days) than in those with adequate nutritional status (9 days; p < 0.001). Multivariate analysis revealed severe malnutrition as an independent risk factor for adverse postoperative outcomes, with an odds ratio (OR) of 2.84, a 95% confidence interval (CI) ranging from 1.52 – 5.31, and a p value of 0.001. These findings demonstrate that preoperative malnutrition significantly increases perioperative morbidity and mortality among patients undergoing GI cancer surgery. These findings advocate the integration of routine nutritional screening and tailored interventions into the perioperative care pathway.

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that requires timely diagnosis and intervention. As frontline healthcare providers, family physicians must have a clear understanding of the diagnostic utility of rheumatoid factor (RF) and its limitations to ensure early recognition and appropriate referral of RA patients. This descriptive cross-sectional study was conducted over three months to assess the knowledge of family physicians in Punjab, Pakistan, regarding the diagnostic role and interpretation of RF in RA. Stratified random sampling was used, and a structured questionnaire was distributed to 300 physicians, with responses collected via Google Forms. The questionnaire evaluated demographic variables and knowledge of RA diagnostic criteria, RF specificity, and related clinical interpretation. The knowledge scores were classified as good (≥ 75%), moderate (50–74%), or poor (< 50%). Data analysis was performed via SPSS version 24, with chi-square tests used to examine associations (p < 0.05). The results revealed that only 27.76% of the participants demonstrated good knowledge. Most respondents had moderate (50.95%) or poor (21.29%) knowledge. Significant associations were observed between knowledge level and factors such as physician age, graduation cohort, experience, type of medical college, involvement in RA patient care, and private practice (p < 0.05). This study revealed significant gaps in family physicians’ knowledge regarding RF’s diagnostic value in RA. Targeted educational interventions and updated clinical training are essential to improve early RA detection, enhance referral practices, and improve patient outcomes at the primary care level.

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.

Genetic disorders impose a considerable health burden in low- and middle-income countries, where high consanguinity rates, limited access to services, and low health literacy intensify their impact. This study assessed awareness, knowledge, and misconceptions about genetic disorders among mothers of affected children at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, and examined associated sociodemographic factors. A cross-sectional survey was conducted from April to May 2025 among 100 mothers of children with confirmed genetic disorders via a structured, interviewer-administered questionnaire. The mean participant age was 31.13 ± 6.06 years; 36% were illiterate, and 52% resided in urban areas. While 78% had heard of genetic disorders, only 18% knew of local genetic testing or counseling services, and 24% had received information from healthcare providers. Good awareness was seen in 16% and poor awareness in 78% of the participants; good knowledge was found in 25%, while 66% had poor knowledge. Misconceptions persisted, with 21% attributing genetic disorders to bad luck or punishment and 16% believing they were contagious; 38% demonstrated good understanding, and 46% demonstrated poor understanding. Education and socioeconomic class were significantly associated with awareness (p = 0.011, p = 0.001), knowledge (p < 0.001, p = 0.002), and beliefs (p < 0.001, p < 0.001), whereas age and residence were not significantly associated. The findings highlight a gap between general awareness and functional understanding, emphasizing the need for targeted, literacy-sensitive interventions to improve maternal genetic health literacy and support informed healthcare decision-making.

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.

Excessive and early exposure to digital screens has raised growing concerns about its implications for children’s speech and language development. This study investigated the associations between passive screen exposure and speech and language delays in children aged 5–8 years, focusing on behavioral and clinical risk factors such as screen-use duration, content type, contextual usage, parental awareness, and screen-time mediation strategies. A descriptive cross-sectional study was conducted with 203 parent‒child dyads via a structured questionnaire. Most children were exposed to screens before age two, with more than 57% exceeding two hours of daily screen time. Social media and entertainment content were the most frequently consumed, while only 47.3% engaged with educational content. Parental mediation practices were inconsistent, and only 28.6% reported frequent supervision. Language delay severity was high, with 62.1% classified as having severe delays. Chi-square analysis revealed a significant association between average daily screen time and language delay status (p = 0.001). Binary logistic regression revealed that greater screen time increased the odds of delay (AOR = 2.67, p < 0.001), whereas greater parental awareness [adjusted odds ratio (AOR) = 0.45, p = 0.002], educational content consumption (AOR = 0.40, p = 0.041), and active mediation (AOR = 0.35, p = 0.048) were protective. A modest but significant negative correlation was observed between parental awareness and language delay severity (r = -0.183, p = 0.009). This study revealed that excessive and early screen exposure is strongly linked to speech and language delays in children aged 5–8 years, whereas greater parental awareness, a preference for educational content, and engaged mediation practices are associated with reduced risk. These findings emphasize the pivotal role of parents in shaping digital environments and highlight the need for early, targeted interventions to enhance parental digital engagement, promote content supervision, and guide balanced screen use. Public health efforts and pediatric counseling should collaboratively support families in promoting healthy language development amid evolving digital habits.