Background And Objective: Childhood pneumonia remains a leading cause of morbidity and mortality, particularly in resource-limited settings such as Pakistan. This study aimed to determine the risk factors influencing the severity of community-acquired pneumonia in children under five years of age in Punjab Province, Pakistan. Methods: A case-control study was conducted at Mayo Hospital, Lahore, Pakistan, involving 126 children aged 2–59 months, including 63 cases diagnosed with community-acquired pneumonia and 63 controls. Data were collected through structured interviews and medical record reviews covering clinical, environmental, and socio-demographic variables. Logistic regression analysis was performed using SPSS version 26 to identify factors associated with pneumonia severity. Statistical significance was set at p < 0.05. Results: Out of 126 participants, several factors were significantly associated with severe pneumonia. These included low family income (adjusted odds ratio [AOR] = 3.97, p = 0.006), prematurity (AOR = 10.6, p < 0.001), male gender (AOR = 3.59, p = 0.010), severe stunting (AOR = 1.24, p = 0.007), and household overcrowding (AOR = 9.1, p < 0.001). Exclusive breastfeeding showed a modest association (AOR = 1.58). Interestingly, older children from relatively higher-income households also demonstrated increased odds of severe pneumonia, suggesting a complex interaction of socioeconomic and environmental determinants. Prior healthcare utilization and nutritional status further contributed to disease severity. Conclusion And Implications For Translation: The study highlights that severe childhood pneumonia is influenced by a combination of biological, nutritional, and socioeconomic factors. Early identification of high-risk children, improved nutrition, reduction of household overcrowding, and strengthened care-seeking behaviors are essential to reduce disease burden. These findings support the need for targeted public health interventions and context-specific preventive strategies to improve child health outcomes in Pakistan.

Background: Allergic rhinitis (AR), a chronic allergy disease caused by dust and pollen, causes sneezing and nasal congestion, increasing the risk of mood disorders and negatively impacting mental health, productivity, and sleep, necessitating medication and allergen avoidance for effective treatment. Objective: To determine the association between allergic rhinitis, sleep quality, and depression in patients attending public health facility in Lahore, Pakistan. Method: The cross-sectional study was carried out in the Department of Otorhinolaryngology at Services Hospital in Lahore between July and October of 2024. A total of 351 individuals were surveyed about allergic rhinitis, sleep quality, and depressed symptoms using non-probability convenience sampling. The data was analyzed using t-test and chi-square tests. Results: The survey showed that the average age was 32.71 +/- 12.478, and the majority (68.9%) was males. According to the present study, 52.7% ofpatients suffer from allergic rhinitis and 82 (44.3%) and 23 (13.8%) allergic rhinitis (AR) patients reported difficulty sleeping and depression, respectively. Allergic rhinitis (AR) was significantly associated with educational status, sleep difficulty, and depressed symptoms (p-value:0.05). Conclusion: Allergic rhinitis significantly impacts sleep disturbance and depressive symptoms in participants, affecting their overall health. This condition is a significant factor in these symptoms, emphasizing the need for effective therapies to improve sleep and depression among afflicted patients.

Bullying among school-aged children and adolescents remains a major public health and educational concern worldwide. This systematic review aimed to determine the global prevalence, common types, and associated factors of bullying among secondary school students to inform effective prevention strategies. A comprehensive literature search was conducted across PubMed, Scopus, Google Scholar, Web of Science, Embase, Pakmedinet, and PsycINFO for studies published between January 2000 and December 2024. Of the 1,609 articles initially identified, 160 met the inclusion criteria, and 52 studies were ultimately included in the final analysis. Data were extracted on study design, geographic distribution, prevalence rates, forms of bullying, and identified factors. The findings revealed that bullying is highly prevalent worldwide, with particularly high rates reported in lower-middle-income and high-income countries and among students attending public secondary schools. Verbal bullying emerged as the most common form across regions, followed by physical and relational or psychological bullying, while cyber-bullying and sexual bullying were reported less frequently. The review highlights significant regional and socio-economic variations in bullying patterns and emphasizes the persistent nature of this problem. Overall, bullying remains a widespread issue affecting the well-being of children and adolescents globally, underscoring the need for coordinated, culturally sensitive, and evidence-based prevention efforts involving schools, families, healthcare providers, and policymakers to mitigate its impact and promote safer school environments.

Background: Antenatal care is critical for the health of pregnant women and their newborns. However, many underdeveloped nations do not adhere to the World Health Organization's recommended schedule of trimester visits. Objective: To determine the frequency and factors associated with delay in antenatal care services at public health care institution in Lahore, Pakistan. Methods: A cross-sectional study comprising 232 adult pregnant women aged 18-45 from a tertiary care hospital in Lahore was done using non-probability convenience sampling. A structured questionnaire was used to gather data, which was then analyzed with SPSS version 25. Descriptive statistics and Chi-square test were used, and a p-value less than 0.05 were considered statistically significant. Results: The patients' average age was 29.38 +/- 6.57 years. The study showed that 133(57.3%) of respondents arrived late for their initial antenatal care appointment, with characteristics such as age, education level, work status, area of residence, and monthly income strongly associated with the delay in prenatal care (p-value <0.001). Conclusion: The study showed a significant frequency of prenatal care delays, which was associated to respondents' age, education, occupation, residence, and income. It encourages coordination between health facilities, the Minister of Health, and other stakeholders to begin follow-up within the required timeframe.

Background Childhood immunization programs in underdeveloped nations can improve children's growth and nutritional status and prevent growth delays while protecting against infectious diseases and meeting growth norms. This study aimed to assess the impact of vaccination status on the anthropometric indices of children aged 12-18 months at an Expanded Programme on Immunization vaccination center and compare the anthropometric indices of growth in children with complete and incomplete vaccination statuses. Methodology This study was conducted at the rural health center in Kala Shah Kaku, Pakistan, from November 2023 to December 2023. Children aged 12-18 months were enrolled and their vaccination status was recorded. Height and weight were measured using World Health Organization growth charts. The data were analyzed using descriptive statistics and chi-square and Fisher's exact tests. A p-value <0.05 was considered statistically significant. Results The mean age of the 110 children who visited the vaccination site for this study was 16.36 months +/- 2.415. There were 28 (25.5%) stunted children. In the study, 17.6 (16%) participants were underweight, and 15.95 (14.5%) were wasted. Of the children, 79% had received all recommended vaccinations. A statistically significant (p < 0.05) association was found between vaccination and nutritional status. Conclusions This study emphasizes the significance of vaccination in promoting child health and nutrition, reducing stunting risk, and ensuring equitable access to vaccination services and comprehensive healthcare interventions. This can help mitigate the malnutrition burden and promote optimal growth, contributing to global health and development goals.

Diabetes mellitus (DM) is linked to poor clinical outcomes and high mortality in Coronavirus patients. The primary objective of this systematic review was to determine the prevalence, clinical features, glycemic parameters, and outcomes of newly diagnosed diabetes in individuals with COVID-19 in developing and developed countries. By searching PubMed, Medline, Scopus, Embase, Google Scholar, and PakMediNet databases, an online literature search was conducted from March 2020 to November 2021. Guidelines for reporting systematic reviews and meta-analyses (PRISMA) were used. There were 660 publications found, of which 27 were original studies involving 3241 COVID-19 patients were selected. In the COVID-19 patients with new-onset diabetes, mean age was 43.21±21.00 years. Fever, cough, polyuria, and polydipsia were the most frequently reported symptoms, followed by shortness of breath, arthralgia, and myalgia. The developed world reported (109/1119) new diabetes cases (9.74%), while the developing world reported (415/2122) (19.5%). COVID-19 new-onset diabetic mortality rate was 470/3241 (14.5%). Key Words: COVID-19, New onset diabetes mellitus, SARS-CoV-2, Prevalence, Clinical outcomes, Developing countries, Developed countries.

Background: Job performance is a positive emotional condition caused by job appraisal. Poor leadership in industries causes employee dissatisfaction and turnover. Aims: To explores the relationship between transformational and transactional leadership styles and professional performance in the commercial textile sector in Lahore, Pakistan using organizational commitment as a mediator. Study design: Cross-sectional Place and duration of study: University of Lahore from 1st June 2019 to 31st December 2019. Methodology: The structured questionnaire items were answered by 300 participants on a 5-point Likert scale. Result: Most of the participants were males over 30 years and had a bachelor's degree. Most of the respondents had more than five years of experience and were managers. The results showed that the organizational commitment of employees did have mediating effect on the relationship between transformational and transactional leadership styles and job performance. Conclusion: Organizational commitment mediates leadership style and employee performance in this study. Any organization can benefit from a leadership style that can alter with the team's demands. A leader's example is essential for enforcing power. Leadership must emphasize job satisfaction and long-term employee engagement to keep employees satisfied and committed. Keywords: Leadership style, Transformational leadership, Transactional leadership, Job performance,

Background Pakistan is facing a double burden of disease. Nutrition has an impact on nutritionally related non-communicable diseases. Malnutrition in adolescent age continues in adulthood so interventions in this stage can help us fight this emerging problem. Objective: To determine the nutritional status of school-going adolescents and their eating patterns and then compare them between public and private secondary schools of Lahore. Methods This analytical cross-sectional study was done on 372 school-going adolescents from 01.03.2023 to 20.06.2023 (3.5 months). A self-structured questionnaire was filled with interviews by convenience sampling. Weight and height were measured and BMI was plotted on WHO z charts to determine the nutritional status. Data were entered and analyzed by SPSS Version 21. The chi-square test was used to compare BMI and its determinants. Factors found significant were subjected to Binary logistic regression. P-value ≤ 0.05 was taken as significant. Results Out of the 372 school-going adolescent participants had a mean age of 14.86 years SD ± 1.75 (164 males and 208 females). 76(20.43%) were underweight, 201 (54.03%) had normal weight, 66(17.74%) were overweight and 29(7.8%) were obese. Public Schools had higher odds of undernutrition AOR 1.49 and lower odds of overweight and obesity AOR 0.38. Males had a reduced chance of undernutrition AOR 0.59 while the increased odds of overweight/ Obesity AOR 1.81. Age groups 11 to 15 years had reduced odds of undernutrition as compared to 16 to 19 years AOR 0.53 and increased odds of overweight/ obesity as compared to 16 to 19 years AOR 2 .00. Conclusion There is a significant difference in the nutritional status and eating habits of adolescents between public and private schools. Undernutrition is higher in public schools, among females and age 16 to 19 years. Nutritional interventions should be strengthened in school health services

Introduction Renal growth in infancy determines renal function in adulthood and can easily be assessed via infant renal volume. Renal growth is influenced by many endogenous and exogenous factors among which nutrition is of prime importance. Worldwide, infants get their nutrition either from breast milk or formula, both of which have controversial roles in kidney growth and development. Methods A cross-sectional study was done on healthy infants in the Pediatric Nephrology Department of Mayo Hospital, Lahore. These infants were either breastfed or artificially fed and their kidney volumes were noted to determine any significant difference in kidney size. Both informed and written consent was taken before data collection and the data was analyzed using SPSS version 26. Results Out of 80 infants included in our study, 55% were male and 45% were female. The mean age was 8.9 months and the mean weight was 7.6 kg. The mean total kidney volume was 45.38 cm 3 and the mean relative kidney volume was 6.12 cm 3 /kg. No statistical difference in relative renal volume was found between breastfed and artificially fed infants. Conclusion The present study aimed to compare the renal volume and thus renal growth in breastfed versus formula-fed infants. No statistical significance was found in relative renal volume between breastfed and artificially fed infants.

Primary health care (PHC) is crucial for a country's health system, serving as the first point of contact for patients and providing clinical management at a local level. Primary health care (PHC) aims to achieve physical, psychological, and social well-being, facilitating fair interaction with the patient.1 It is the cornerstone of global health systems and requires efficient resource allocation, sustainable financing, and a strong primary healthcare system. Primary health care (PHC) principles include universal access, equitable care provision, prevention, health promotion, and community participation. Balancing social and medical aspects is essential in PHC service provision to meet the needs of its users.2 Primary health care doctors in the UK, Ireland, Australia, and New Zealand provide first-contact care, saving time and money by preventing patients from going to the hospital. This model is increasingly being adopted in countries like Qatar, Saudi Arabia, and the United Arab Emirates.3 Qatar has a government-led Primary Care Health Cooperation, Saudi Arabia invests in primary care, and United Arab Emirates recognizes the importance of preventive medicine for a healthy life. Strengthening primary health care and achieving universal health coverage are crucial global health policy initiatives, aiming to provide accessible, affordable, and high-quality health services to all individuals.4

Psychiatric morbidity commonly coexists with substance abuse and HIV/AIDS around the globe. This review study aimed to determine the available literature on the prevalence of common substance abuse/use and common mental health illnesses among HIV/AIDS patients worldwide to help policymakers design appropriate strategies to limit extensive substance use and prevent common mental and health illnesses. For the comprehensive literature review, Google Scholar, PubMed Central, Medline, and PakMediNet biomedical databases were searched for original and reviewed studies published in English, from January 2000 to September 2021. Selections of studies and extraction of data from the studies were performed based on quality and inclusion criteria. MedCalc Meta-analysis Software Package version 20.009 was used for data analysis. Out of 103,024 HIV/AIDS patients inspected in 30 studies, 6430 HIV/AIDS patients had pooled prevalence of depression 30.31% (95%CI: 26.028 to 34.786), and 6927 study participants reported the overall current pooled prevalence of any substance use was 25.13% (95%CI: 11.526 to 41.897), respectively. Current alcohol consumption and tobacco smoking are the most common substance abuse, and depression and anxiety are the most common mental health disorders among HIV/AIDS patients. There was no significant publication bias, but substantial heterogeneity was observed in the presented studies. The current systematic review and meta-analysis showed a greater prevalence of substance abuse and mental health illnesses among HIV/AIDS patients than the general population at the global level.

BackgroundCOVID-19 household transmissibility remains unclear in Pakistan. To understand the dynamics of Severe Acute Respiratory Syndrome Coronavirus disease epidemiology, this study estimated Secondary Attack Rate (SAR) among household and close contacts of index cases in Pakistan using a statistical transmission model.MethodologyA retrospective cohort study was conducted using an inclusive contact tracing dataset from the provinces of Punjab and Khyber-Pakhtunkhwa to estimate SAR. We considered the probability of an infected person transmitting the infection to close contacts regardless of residential addresses. This means that close contacts were identified irrespective of their relationship with the index case. We assessed demographic determinants of COVID-19 infectivity and transmissibility. For this purpose based on evolving evidence, and as CDC recommends fully vaccinated people get tested 5-7 days after close contact with a person with suspected or confirmed COVID-19. Therefore we followed the same procedure in the close contacts for secondary infection.FindingsDuring the study period from 15th May 2020 to 15th Jan 2021, a total of 339 (33.9%) index cases were studied from 1000 cases initially notified. Among close contact groups (n = 739), households were identified with an assumed mean incubation period of 8.2+4.3 days and a maximum incubation period of 15 days. SAR estimated here is among the household contacts. 117 secondary cases from 739 household contacts, with SAR 11.1% (95% CI 9.0-13.6). All together (240) SAR achieved was 32.48% (95% CI; 29.12-37.87) for symptomatic and confirmed cases. The potential risk factors for SAR identified here included; old age group (>45 years of age), male (gender), household members >5, and residency in urban areas and for index cases high age group. Overall local reproductive number (R) based on the observed household contact frequencies for index/primary cases was 0.9 (95% CI 0.47-1.21) in Khyber Pakhtunkhwa and 1.3 (95% CI 0.73-1.56) in Punjab.ConclusionsSAR estimated here was high especially in the second phase of the COVID-19 pandemic in Pakistan. The results highlight the need to adopt rigorous preventive measures to cut the chain of viral transmission and prevent another wave of COVID-19.

Abstract Introduction: Renal growth in infancy determines renal function in adulthood and can easily be assessed via infant renal volume. Renal growth is influenced by many endogenous and exogenous factors among which nutrition is of prime importance. Worldwide, infants get their nutrition either from breast milk or formula, both of which have controversial roles in kidney growth and development. Methods: A cross-sectional study was done on healthy infants in Pediatric Nephrology Department of Mayo Hospital, Lahore. These infants were either breastfed or artificially fed and their kidney volumes were noted to determine any significant difference in kidney size. Both informed and written consent was taken before data collection and the data was analyzed using SPSS version 26. Results: Out of 80 infants included in our study, 55% were male and 45% were female. Mean age was 8.9 months and mean weight was 7.6 kg. Mean total kidney volume was 45.38 cm3 and mean relative kidney volume was 6.12 cm3/kg. No statistical difference in relative renal volume was found between breast fed and artificial fed infants. Conclusion: The present study aimed to compare the renal volume and thus renal growth in breast fed versus formula fed infants. No statistical significance was found in relative renal volume between breast fed and artificial fed infants.

Background: Despite the availability of antiretroviral therapy (ART), HIV is still responsible for substantial illness and death, especially in developing countries. Early start of treatment (ART) is associated with better therapeutic outcome, reduced transmissibility of HIV, reduction in loss to follow-up, and remarkably reduced death rate. Objectives: To find out the factors associated with early and late Initiation of ART among patients affected by HIV in Lahore, Pakistan Methods: From November 2017 to April 2018, researchers conducted an analytical cross-sectional study on 156 HIV patients aged 18 and older that began antiretroviral therapy (ART) at Jinnah & Mayo Hospital, Lahore's HIV clinics. Samples were selected by non-probability convenience sampling and Univariate and multivariate analyses were performed to assess factors related to early and late Initiation of ART. The p-value of less than

BACKGROUND:Many human immunodeficiency virus (HIV) infected patients suffer from depr-ession, but a little focus is given to detecting and treating depression in primary health care. Detection of depression can be improved by introducing short, reliable, and valid screening instruments.AIM:To determine the psychometric properties of the patient health questionnaire-2 (PHQ-2) and patient health questionnaire-9 (PHQ-9) for depression screening and diagnosis, and the sensitivity and specificity of the PHQ-2 in HIV infected patients.METHODS:A cross-sectional study was conducted on 158 HIV-infected patients aged 18 years and above in Lahore, Pakistan. PHQ-2 was implemented to screen depression. PHQ-9 was implemented to diagnose major depressive disorder as a reference standard. Reliability, Validity tests and receiver operating characteristic curve were computed.RESULTS:The Cronbach's alpha of PHQ-2 and PHQ-9 were 0.732 and 0.759, respectively. The study results showed that the score of 2 on PHQ-2 indicates the highest Youden's index of 0.924, with both sensitivity and specificity of 0.96, and the area under the curve for PHQ-2 was 0.98 (95%CI: 0.953-0.998).CONCLUSION:Good psychometric properties for the PHQ-2 and PHQ-9 indicated their significant potential as tools for depression screening and diagnosis in the HIV-infected population.

The Sustainable Development Goals (SDGs) were adopted globally in September 2015 as a set of universal and transformative goals and targets to be implemented by 2030. The 17 development goals include 169 concise, global, and applicable to all countries; developing and developed—the SDGs address three interconnected dimensions: social, economic, and environmental. Health is interconnected with social, economic, and developmental/environmental determinants. 1 The SDGs include 244 indicators related to the five Ps: People, Planet, Prosperity, Peace, and Partnership. The SDGs are more comprehensive and people-centered than the MDGs, with the commitment to & quot; leave no one behind, & quot; i.e., reach vulnerable populations. Among the SDGs, Goal 3 directs countries to & quot; Ensure healthy lives and promote well-being for all ages & quot;; SDG3 includes 13 targets, four of which address implementation. 2 Thirteen SDGs are related to health and well-being and may be informed by less than 169 indicators. SDG 3 addresses chronic diseases, tobacco, alcohol, narcotics use, mental health, road safety, and pollution. However, health is not solely a component of Goal 3. Throughout the majority of the SDGs, some targets have a direct or indirect effect on health gains and thus require special consideration when developing strategies, policies, and plans to achieve the health goal and monitor progress. 2,3

Rabies, a viral illness classified as a neglected tropical disease by the World Health Organization (WHO), causes thousands of people to die annually, primarily in underprivileged communities of Africa and Asia. In the context of a single health framework, one of the primary objectives of this literature review is to examine the major factors and challenges that maintain the endemic status of dog-mediated human rabies in Pakistan. Rabies-endemic countries have an imperative need to work on preventive strategies to lessen the burden of this terrible disease as per guidelines of World Organization for Animal Health (WOAH) and WHO. Lack of public awareness, free-roaming dogs, and cold chain mismanagement of vaccinations are the 3 most significant factors contributing to the increasing number of dog bite injuries and suspected rabies cases in animals and humans. To control dog-mediated rabies, Pakistan must initiate and strongly support a national One Health project, a subsidized supply of human and animal rabies vaccine in public hospitals, and designated rabies prevention centers at an affordable cost. People should be educated regarding responsible pet ownership and follow-up of basic preventive measures. Empowerment of labs equipped with surveillance systems are also additionally required to strengthen rabies control and prevention activities at least in regional levels. This article gives valuable information for scholars and policymakers who wish to comprehend why this disease remains endemic due to multiplex interplay of zoonotic, medical, and anthropological risk factors and transmission chains in animal and human sectors through viral reservoirs. Achieving the 'Zero By 2030' goal in Pakistan requires joint immediate action from the government, society, and all health departments at regional, provincial, and national level.

hospital-acquired infection, also known as nosocomial infection or hospital associated-infection, is defined as any infection that develops within 48 hours after hospitalization. It may develop either from out-patient clinic, indoor hospital setting, nursing homes, diagnostic laboratories or any other clinical settings. It may also occur either in epidemic or endemic form but endemic hospital-acquired infections are most common. According to an estimation, more than 1.4 million patients get affected globally by hospital-associated infections both in developed and underdeveloped countries. At any times, the prevalence of nosocomial infections differs between 3.5 to 12% in developed countries. However, the prevalence of nosocomial infections in developing countries is 5.7% to 19.1% and the average prevalence is significantly higher in contrast to developed countries. In accordance with a recent multicenter study conducted in Europe, the prevalence of hospital-associated infection is 51% in intensive care unit patients and the cumulative incidence is 17 episodes per 1000 patient-days among high-risk adults in developed countries. Though, in developing countries, the prevalence of nosocomial infections in intensive care unit patients is significantly greater (88.9%) with 42.7 episodes per 1000 patient-days that are nearly three times greater in contrast to high-income countries.

Background: Reliable and peer reviewed information is of immense importance for preventive, diagnostic and curative solutions and efforts should be done to minimize inaccurate infodemics among post graduate trainee doctors. Objective: The aim of the study was to access the use of Peer Reviewed and Non-Peer Reviewed Information by post graduate trainee doctors for COVID-19 Pandemic in Pakistan. Methods: The study was analytical cross sectional in design and was conducted in 3193 post graduate trainee doctors employing Electronic Logbook (elog) system of College of Physicians and Surgeons, Pakistan. An online survey included demographic characteristics, year of training, specialty and sources of information used for COVID-19 pandemic. Results: Total 3193 study participants from all provinces of Pakistan were included with mean age of 28.68 years. Majority of participants (58.66%) used both peer reviewed and non-peer reviewed information source for getting updated guidelines and information about COVID-19. According to bivariate analysis results, significant differences were revealed between the source of information and the age (p < 0.001), province (p < 0.001) and gender (p < 0.002). Multivariate logistic regression results showed that the age less than 30 years (AOR = 1.311, 95% (CI: 0.800, 2.146), working in Khyber Pakhtunkhwa province (AOR = 1.549, 95% (CI: 1.210-1.982) and female gender(AOR = 1.551, 95% (CI: 1.303, 1.847). was significantly associated with increased use of social media for getting information. Conclusion: Use of non-peer reviewed information for COVID-19 pandemic by postgraduate trainee doctors is common.