Background Globally, populations afflicted by armed conflict are known to have high rates of mental health disorders. Aims This meta-analysis aims to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive symptoms among civilians residing in armed conflict-affected regions. Methods This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search employing MEDLINE(R), Embase Classic+Embase, APA PsycINFO, Ovid Healthstar, Journal@Ovid Full Text, Cochrane, PTSDpubs and CINAHL was conducted from inception until 19 March 2024 to identify relevant studies. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, and a Comprehensive Meta-Analysis was used to conduct the statistical analysis. Results The search yielded 38 595 articles, of which 57 were considered eligible for inclusion. The included studies comprised data from 64 596 participants. We estimated a prevalence of 23.70% (95% CI 19.50% to 28.40%) for PTSD symptoms and 25.60% (95% CI 20.70% to 31.10%) for depressive features among war-afflicted civilians. The subgroup analysis based on time since the war and the country’s economic status revealed the highest prevalence for both PTSD and depressive symptoms was present during the years of war and in low/middle-income countries. Conclusions The results of this study provide conclusive evidence of the detrimental impacts of armed conflict on mental health outcomes. Hence, it is crucial to emphasise the significance of both physical and mental health in the aftermath of war and take appropriate humanistic measures to overcome challenges in the management of psychiatric illnesses. PROSPERO registration number CRD42023416096.

Natural disasters, characterized by their ferocity and unpredictability, can cause a lot of damage to people's lives. These effects can last for many years and affect entire communities. After these huge events, the healthcare system faces numerous challenges. Smart planning and timely, clear actions are important to reduce and eventually overcome the bad effects of the events. It's particularly important to acknowledge the status of the healthcare system in low- and middle-income countries (LMICs). These countries have a tough time because their economies are often limited, with limited finances and resources. Hence, natural disasters can damage their healthcare system more. This review looks closely at how various natural disasters have caused big problems for LMICs and their healthcare systems. We carefully look at what happens after these disasters and how they worsen existing problems in these economies. The review also highlights how communities work hard to improve after these events. By showing how natural disasters affect healthcare systems in LMICs, this paper tries to make more people aware of these issues. It encourages everyone to work together to strengthen these important systems against nature's strong forces.

The global vaccination drive against severe acute respiratory syndrome coronavirus-2 is being pursued at a historic pace. Unexpected adverse effects have been reported following vaccination, including thrombotic thrombocytopenia, myocarditis, amongst others. More recently, some cases of tinnitus are reported post-vaccination. According to the Vaccine Adverse Events Reporting System (VAERS), 12,247 cases of coronavirus post-vaccination tinnitus have been reported till September 14, 2021. To the best of our knowledge, this is the first review evaluating any otologic manifestation following vaccine administration and aims to evaluate the potential pathophysiology, clinical approach, and treatment. Although the incidence is infrequent, there is a need to understand the precise mechanisms and treatment for vaccine-associated-tinnitus.

Background: Primary healthcare (PHC) plays a crucial role in improving health outcomes and reducing healthcare burden, especially in low-to-middle-income countries (LMICs). However, PHC has not received adequate attention in Pakistan despite its recognized importance. This study aims to examine the current state of PHC in Pakistan, identifying factors compromising its quality and effectiveness. Methods: To find relevant data, the authors conducted a thorough literature search on PubMed, Google Scholar, and Cochrane Library from inception till 2 July 2022, without any language restriction. The following keywords were employed during the literature search, separated by Boolean operators AND, OR: “Primary Healthcare”, “PHC”, “Healthcare primary”, “Primary Health”, and “Pakistan”. Results: Pakistan’s PHC infrastructure shows promise, with a considerable number of healthcare facilities in place. However, various factors hinder its effectiveness and compromise the quality of care provided. Insufficient investment, resource constraints, inadequate training of healthcare providers, lack of oversight, and limited access to essential medicines and equipment are some of the key challenges observed. Improving PHC in Pakistan is vital for addressing the population’s healthcare needs, particularly in rural areas. Adequate investment, enhanced training programs, improved oversight mechanisms, and increased availability of essential resources are necessary to strengthen the PHC system. By prioritizing PHC and addressing the identified challenges, Pakistan can enhance healthcare access, reduce healthcare burden, and improve overall health outcomes for its population. Conclusion: It is high time LMICs like Pakistan recognize PHC as the most economically feasible pathway toward accomplishing healthcare targets and adopt adequate measures to elevate its standards.

Introduction and aim. Industrialization and elevated greenhouse gas emissions pose significant threats to the environment, raising atmospheric carbon dioxide levels and leading to climate change. Climate change may impact human health either directly via increasing extreme weather frequency and altering disease patterns or indirectly via social institutions and disrupted global supply chain resulting in consequences like undernutrition Material and methods. This review conducted a comprehensive literature search on PubMed, Google Scholar, and Cochrane Library, from inception to September 2022, using relevant keywords. Analysis of the literature. Massive flooding in South Asia is leading to a surge in water-related diseases. Cholera outbreaks have occurred in countries like Pakistan, India, and Bangladesh following floods, and waterborne diseases like typhoid, rota virus, hepatitis A, and leptospirosis are prevalent in flood-affected regions. Additionally, Cryptosporidium, Campylobacter, Shigella, and Polio outbreaks are reported. Water-scarce diseases, including scabies, impetigo, and cellulitis, are also on the rise in flood-affected areas. Water-based diseases, such as dracunculiasis, schistosomiasis, and Leishmaniasis, pose significant risks. Vector-borne diseases, including malaria, dengue, and Leishmaniasis, are becoming more prevalent due to flooded areas providing breeding grounds for disease vectors like mosquitoes and sandflies. These diseases are now more common in flood-af fected regions, affecting millions of people. Conclusion. Urgent measures are needed, including early warning systems, resilient infrastructure, drainage maintenance, and stricter land-use regulations, to reduce the impact of these natural disasters. International cooperation and immediate action at national and global levels are essential to mitigate the health crises caused by flooding and other natural disasters.

Remimazolam is made by combining midazolam and remifentanil as an alternative to conventional sedatives. To evaluate the efficacy of remimazolam for sedation in patients undergoing colonoscopy, we conducted a systematic review and meta-analysis of the available randomized controlled trials (RCTs) comparing remimazolam and midazolam. A search was conducted using PubMed, Cochrane Library, and clinicaltrial.gov from inception till December 26, 2021, for RCTs that investigated the efficacy of remimazolam during the above-mentioned procedure. There was no restriction of language. A quality assessment was performed using the Cochrane Risk-of-Bias tool. The data were pooled, and a meta-analysis was completed. The systemic review was conducted in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guideline statement. Three randomized controlled trials involving 539 patients were included in the meta-analysis. Compared with midazolam during colonoscopy, remimazolam results in reduced need for top-up doses (RR= 3.45, 95% CI=1.07 to 11.14; P=0.04, I²=84%). The need for rescue medication was reduced with remimazolam as compared to midazolam (RR=2.42, 95%CI=1.04 to 5.61; P=0.04, I²=96%). There was no significant difference observed between the two drugs on completion of colonoscopy and the overall procedural sedation, but the sensitivity analysis favored remimazolam over midazolam for procedural sedation (RR=4.08, 95%CI=2.35 to 7.09; P<0.00001, I²=39%). This analysis demonstrates the advantages of remimazolam over other agents and sets a platform for relevant future studies.