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Metatarsal tumours are rare lesions that often present diagnostic challenges because of their uncommon anatomical location and broad differential diagnosis. Existing literature has largely been limited to isolated case reports or small case series. This study represents the largest dedicated series of metatarsal tumours reported to date and aims to characterise their epidemiological patterns, demographic features, and diagnostic distribution to support age-based clinical differentiation. A retrospective analysis was performed of 93 metatarsal pathologies. Patient demographics, including age and sex, and final diagnoses classified according to the 2020 World Health Organization (WHO) classification were analysed. To enhance clinical applicability, lesions were stratified using an age threshold of 40 years based on pathophysiological relevance. Statistical analysis was performed using Chi-square and Mann–Whitney U tests. The cohort comprised 50 females (53.8
Introduction: Cleft lip and/or palate (CL/P) is among the most common congenital anomalies globally. Pakistan has one of the highest incidences of CL/P worldwide. This study aims to investigate the clinical variability and ethno-demographic disparities of CL/P in the Islamabad and Upper Punjab region of Pakistan.Methods: An observational, multicenter, cross-sectional study was conducted from 2020 to 2023. Patients with CL/P were recruited from tertiary hospitals, surgical camps, and rural communities. Clinical classification and demographic profiling were performed. Descriptive statistics summarized sample characteristics, and logistic regression was applied to assess associations with demographic variables.Results: A total of 303 patients were enrolled, with a male predominance (55%). The most frequent presentation was cleft lip and palate (CLP, 53%), followed by cleft palate (CP, 28%) and cleft lip (CL, 19%). Complete clefts were more common (67%), and unilateral forms (74%) were predominantly left-sided (62%). Sporadic cases comprised 79%, while parental consanguinity was reported in 64% of the sample. First-parity births accounted for 35%, and isolated clefts were observed in 48%. Syndromic associations (52%) were primarily neurological, sensorineural, and limb anomalies. Most patients were from rural areas (69%), Punjab province (53%), Punjabi-speaking households (40%), and low socioeconomic strata (50%). Significant variation in cleft distribution was observed across demographic subgroups.Conclusion: CL/P in this region exhibits high clinical heterogeneity and striking ethno-demographic disparities, reflecting the interplay of genetic, environmental, and socioeconomic factors. These findings highlight the need for targeted interventions in resource-limited settings, emphasizing the organization of surgical cleft camps in rural areas, the involvement of Non-Governmental Organizations (NGOs) supporting cleft care, and the promotion of health education in communities with high consanguinity and socioeconomic vulnerability.
We used Delphi methodology to provide guidance on gender equality and equity issues in professional life in intensive care, where information is evolving and no clear standard exists. A 12-member Steering Committee (7 women, 5 men) from 7 countries and 46 international panelists [(23 women, 21 men, 2 preferred not to disclose; median age 52 (33–75) years] from 32 countries (43
Airway management is central to the care of critically ill patients, yet it remains one of the most challenging interventions in emergency departments and intensive care units. Patients often present with severe physiological instability, limited cardiopulmonary reserve, and high acuity, while clinicians often work under constraints related to time for preparation, equipment availability, trained workforce, monitoring, and access to advanced rescue techniques. These challenges are particularly pronounced in low- and middle-income countries and other resource-limited or austere environments, where the margin for error is narrow and delays or repeated attempts in airway management may rapidly precipitate hypoxemia, hemodynamic collapse, or cardiac arrest. Although contemporary airway guidelines emphasize structured preparation and rescue pathways, many assume resources that are not consistently available in such settings. This narrative review discusses pragmatic, context-adapted strategies for airway management in constrained environments, with emphasis on physiology-first preparation, appropriate oxygenation and induction techniques, simplified rapid-sequence intubation, and the judicious use of basic airway adjuncts, supraglottic devices, and video laryngoscopy, where available. Adapted difficult airway algorithms, front-of-neck access in the absence of surgical backup, human factors, team training, and ethical considerations are also addressed. This review aims to support safer and effective airway management for critically ill patients in resource-limited emergency and intensive care settings.
Antimicrobial resistance (AMR) is a serious global health threats, and hospital wastewater (HWW) is a significant source of multidrug-resistant (MDR) pathogens. Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) are important clinical aquatic pathogens. This study describes the prevalence, AMR profiles, MDR, and environmental persistence of S. aureus and E. coli in HWW samples in Multan, Pakistan. Resistance patterns were determined through phenotypic susceptibility tests, and persistence was checked through minimum inhibitory concentration (MIC) analysis (>32 mu g/mL). S. aureus demonstrated higher incidence rates (53-60%) than E. coli (33-40%). The greatest levels of resistance in S. aureus were determined as 87.5% against tetracycline and cephalexin, while 83% against chloramphenicol and 67% against CN (aminoglycosides), gentamicin for E.coli. In total, 57% of the isolates were MDR, the highest rate in the effluents from the emergency ward being 71.4%. According to survival analysis, E. coli demonstrated longer persistence of 6.2 days than S. aureus 3.5 days. The main risk factors comprised poor patient compliance, lack of regulation regarding the sale of antibiotics, and biofilm formation. These findings underscore the urgent need for enhanced wastewater treatment, strengthened antimicrobial stewardship, and robust surveillance of hospital effluents in resource-limited settings.
