Background Fall injuries and trauma-related hospitalizations are the most common causes of injury and in-hospital stay amongst the elderly population. After the age of 65, the severity and frequency of fall-related problems increases; the repercussions are challenging for senior citizens, caregivers, and healthcare professionals. This study aims to determine the injuries and outcomes resulting from falls in elderly patients presenting to Emergency Department of a tertiary care hospital. Methods A cohort study design was used. All elderly patients aged ≥ 60 years who visit the Emergency Department with a history of a fall as a primary complaint presenting to the ED of a tertiary care hospital in Karachi, Pakistan were included. A purposive sampling strategy was used to enroll 318 patients from August 2021 to February 2022. The outcome was risk of mortality. Each individual was followed for 90 days to study the outcome. A multivariable logistic regression was applied to check the association between the outcome and covariates. Crude and adjusted risk ratios were reported. A p-value ≤ 0.05 was considered significant. Results Of the 318 participants, 265 (83.3%) were fall injury patients with comorbidities. More than half of the patients in both groups were female [32 (60.4%) & 146 (55.1%)]. Eyeglasses were used by most of the fall patients both without and with comorbidities [21 (39.6%) & 152 (57.4%) p 0.018]. There were multiple reasons for a fall including imbalance/dizziness, which was reported by one third of participants in both groups [15 (28.3%) & 77 (29.1%)] followed by a fall from stairs/steps/escalator [15 (28.3%) & 44 (16.6%) p 0.005]. At the end of one month, of those who had a comorbidity 20 (7.5%) expired. The risk of mortality among fall related injuries in elderly patients who were more than 80 years was 1.48 times (95% CI: 1.20–2.10) more likely when compared to those patients who were younger than 80 years. Conclusion Efforts should be made to improve management of the underlying etiology of falls to prevent them in future. The factors that contribute to falls should be identified. Strategies and interventions should be planned to mitigate this risk of fall in elderly to improve their quality of life.

Purpose COVID-19 infection resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began to spread across the globe in early 2020. Patients with hematologic malignancies are supposed to have an increased risk of mortality from coronavirus disease of 2019 (COVID-19) infection. From Pakistan, we report the analysis of the outcome and interaction between patient demographics and tumor subtype and COVID-19 infection and hematological malignancy. Patients and methods This multicenter, retrospective study included adult patients with a history of histologically proven hematological malignancies who were tested positive for COVID-19 via PCR presented at the oncology department of 5 tertiary care hospitals in Pakistan from February to August 2020. A patient with any known hematological malignancy who was positive for COVID-19 on RT-PCR, was included in the study. Chi-square test and Cox-regression hazard regression model was applied considering p ≤ 0.05 significant. Results A total of 107 patients with hematological malignancies were diagnosed with COVID-19, out of which 82 (76.64%) were alive, and 25 (23.36%) were dead. The significant hematological malignancy was B-cell Lymphoma in dead 4 (16.00%) and alive group 21 (25.61%), respectively. The majority of the patients in both the dead and alive group were on active treatment for hematological malignancy while they came positive for COVID-19 [21 (84.00%) & 48 (58.54%) p 0.020]. All patients in the dead group were admitted to the hospital 25 (100.00%), and among these, 14 (56.00%) were admitted in ICU with a median 11 (6–16.5) number of days. Among those who had contact exposure, the hazard of survival or death in patients with hematological malignancies and COVID-19 positive was 2.18 (CI: 1.90–4.44) times and 3.10 (CI: 2.73–4.60) times in patients with travel history compared to no exposure history (p 0.001). Conclusion Taken together, this data supports the emerging consensus that patients with hematologic malignancies experience significant morbidity and mortality resulting from COVID-19 infection.

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Background T-CPR has been shown to increase bystander CPR rates dramatically and is associated with improved patient survival. Objective To evaluate the acceptability of T-CPR by the bystanders and identify baseline quality measures of T-CPR in Karachi, Pakistan. Methods A cross-sectional study was conducted from January to December 2018 at the Aman foundation command and control center. Data was collected from audiotaped phone calls of patients who required assistance from the Aman ambulance and on whom the EMS telecommunicator recognized the need for CPR and provided instructions. Information was recorded using a structured questionnaire on demographics, the status of the patient, and different time variables involved in CPR performance. A One-way ANOVA was used to compare different time variables with recommended AHA guidelines. P-value ≤ 0.05 was considered significant. Results There were 481 audiotaped calls in which CPR instruction was given, listened to, and recorded data. Out of which in 459(95.4%) of cases CPR was attempted Majority of the patients were males (n = 278; 57.8%) and most had witnessed cardiac arrest (n = 470; 97.7%) at home (n = 430; 89.3%). The mean time to recognize the need for CPR by an EMS telecommunicator was 4:59 ± 1:59(min), while the mean time to start CPR instruction by a bystander was 5:28 ± 2:24(min). The mean time to start chest compression was 6:04 ± 1:52(min.). Conclusion Our results show the high acceptability of T-CPR by bystanders. We also found considerable delays in recognizing cardiac arrest and initiation of CPR by telecommunicators. Further training of telecommunicators could reduce these delays.

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Background Parent-to-child maltreatment is considered one of the risk factors for Generalized Anxiety Disorder (GAD) symptoms, but this hypothesis has not been adequately tested in Pakistani settings. Aim This study aimed to examine the association between parent-to-child maltreatment and the risk of developing GAD symptoms among adolescents. Methods The association of none to rare, occasionally, and frequently parent-to-child maltreatment with the incidence of GAD symptoms was investigated in a sample of 800 adolescents aged 11–17 years who were followed for two years. Parent-to-child maltreatment was assessed using ICAST-C (International child abuse screening tool). GAD Symptoms were determined by SCARED (Screen for children anxiety-related disorders). Cox Proportional Algorithm was used to estimate risk ratios. Results Among children with both uneducated parents, frequently maltreatment was associated with 7.31 (2.20–24.04) times the risk of GAD symptoms compared to none to rare maltreatment. In contrast, the risk of GAD symptoms in frequently maltreated children was 5.58 times (1.40–21.97) than negligibly maltreated children with either educated parent. Conclusion The frequency of parent-to-child maltreatment is significantly associated with an increased risk of developing GAD symptoms in which parental education plays a crucial role. Parents should be imparted with the awareness of the consequences of child maltreatment. In Pakistani settings the need to have this awareness is even more necessary due to the culturally acceptable disciplinary measures used by parents.

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