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Background While gender disparities in surgery are documented worldwide, it is unclear to what extent women consider surgery as a career before embarking on their medical school journey. This study aimed to report the percentage of pre-medical women in Pakistan who intend to eventually specialize in surgery and assess the factors motivating and deterring this decision. Methods An online survey was conducted among female pre-medical (high school) students across Pakistan. Multivariable logistic regression was performed to determine motivating and deterring factors associated with the intention to pursue surgery. Results Out of 1219 female high-school students, 764 (62.7) intended to join medical school. Among these 764, only 9.8% reported an exclusive intent to pursue surgery, while just 20.3% reported considering other specialties in addition to surgery. Significant motivators to pursue surgery exclusively were the intellectual satisfaction of pursuing surgery (adjusted odds ratio: 2.302), having opportunities to travel internationally for work (2.300) and use cuttingedge technology (2.203), interest in the specialty of surgery (2.031), the social prestige of becoming a surgeon (1.910), and considering one's personality well-suited to surgery (1.888). Major deterrents included the lack of interest in surgery (adjusted odds ratio: 3.812), surgical education and training being too difficult (2.440) and lengthy (1.404), and the risk of aggressive behavior from patients (2.239). Conclusion Even before entering medical school, most female pre-medical students have already decided against considering a future surgical career. Deterrents likely stem from women being pressured to conform to deep-seated societal expectations to dedicate their time and energy to domestic responsibilities.

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Introduction Maximizing patients' quality of life (QoL) is a central goal in surgical oncology. Currently, both laparoscopic and robotic surgery are viable options in rectal cancer (RC) resections. The aim of this systematic review was to analyze the differences in postoperative QoL between the two operative modalities. Methodology This review was conducted in adherence to the PRISMA guidelines. MEDLINE, Embase, Scopus, and CENTRAL databases were searched for articles comparing QoL in patients undergoing laparoscopic versus robotic surgery for RC. Seven studies were included (two randomized controlled trials, four prospective cohorts, and one retrospective cohort) out of which six reported data suitable for meta-analysis. Global QoL and QoL subdomains, such as physical and social functioning, were meta-analyzed using a random-effects model. Risk of bias was assessed using the ROBINS-I and Cochrane RoB-2 tools. Results Data on 869 patients (440 laparoscopic and 429 robotic surgery) across six studies were meta-analyzed. There was no significant difference in global QoL (Mean Difference:-0.43 [95% Confidence Interval:-3.49-2.62]). Physical functioning was superior after robotic surgery (1.92 [0.97-2.87]). However, nausea/vomiting, pain, and fatigue did not differ between groups. Perception of body image was worse after laparoscopic surgery (-5.06 [-9.05--1.07]). Other psychosocial subdomains (emotional, cognitive, role, and social functioning) were comparable between groups. Conclusion Laparoscopic and robotic surgery for RC have comparable QoL overall, for both physical and psychological dimensions. Our results may assist the management-related decision-making in surgical treatment of RC.

Climate change has and will continue to lead to unexpected weather patterns worldwide. These threaten to increase the risk of numerous diseases and disasters that negatively impact the health of populations. As a developing country, Pakistan must bolster its preparedness for such weather-related health problems by efficienty allocating resources to preventive measures and proactively implementing them. In recent history, torrential rainfall in areas such as Karachi, which usually receive meagre amounts of annual rainfall, has left many economic and health-related issues that harm the health of the population and disrupt healthcare delivery. For example, the massive accumulation of stagnant water following heavy rainfall acts is a breeding ground for mosquitoes. Thus, urban flooding is often accompanied by an increase in mosquito-related diseases such as dengue and malaria (1,2). Furthermore, the presence of airborne and allergenic fungal spores in the environment is positively correlated with increased amounts of rainfall (3). Heavy rain damages infrastructure, such as roads and electricity lines in urban areas. In addition to the disruption of transport and utilities, such damage leads to numerous hospitalizations and deaths in incidents such as motor accidents, burns, electrocution, falling into exposed gutters, drowning, and other similar tragedies (4). Beyond these direct effects on human health, healthcare delivery and resource mobilization are also hindered (5), further hampering the responsiveness and effectiveness of the healthcare system. While measures like disinfection drives may be useful in decreasing rain-related morbidity and mortality, a reactive approach must become an initiative-taking one. With comprehensive analyses of trends, such as those of hospitalizations during the monsoon season or the frequency of rain-related injury and disease in different areas, more informed preventive measures and “evidence-based anticipation” (5) of health burdens can be devised and deployed. Programmes to promote safety measures and awareness can be tailored to the needs of at-risk communities and burdened health-care centres. The allocation of precious resources can be made to those that need them most ahead of destructive weather. Climate change is a stark reality, as is the shortage of resources in developing countries like Pakistan. It is vital to acknowledge the profound impact of destructive weather on the public’s well-being and to act efficiently and proactively to mitigate it.