Hamdard University

This study presents a comprehensive retrospective analysis of 300 simulated mass casualty incidents (MCIs) in Pakistan from 2010 to 2024, aiming to evaluate emergency preparedness and response strategies. It is structured across four analytical domains: descriptive statistics, exploratory data analysis (EDA), inferential statistics, and predictive modeling. Findings reveal that terrorist attacks (n=115, 38.3%) and natural disasters (n=98, 32.7%) were the most common MCI types. Rural areas (n=104, 34.7%) experienced the highest mortality rate (mean = 17.2%) and morbidity burden (mean = 45%) due to prolonged EMS response times (mean = 39 minutes) and limited hospital infrastructure. EDA showed a moderate positive correlation between time to definitive care and mortality (r = 0.52), and between triage time and hospital stay duration (r = 0.43). Inferential tests confirmed significant associations between triage protocols and fatality outcomes (χ² = 14.23, p < 0.001). A linear regression model (adjusted R² = 0.61) identified time to care (β = 0.18), infrastructure status (β = 0.15), triage type (β = 0.12), and surge capacity gap (β = 0.17) as key predictors of mortality. Logistic regression showed that incidents under ICS or Unified Command (n=225, 75%) were 2.4 times more likely to lead to policy reform (p < 0.01), and those with post-incident reviews (n=156, 52%) had 1.8 times the likelihood of reform implementation. These results underscore the importance of structured command systems, standardized triage, and rural infrastructure investment in reducing MCI fatalities and strengthening system resilience.

Advancements in fracture fixation have significantly reshaped orthopedic trauma management by improving mechanical stability and promoting biological healing. This retrospective observational study assessed clinical and biomechanical outcomes in 500 patients who underwent surgical fixation for radiologically confirmed fractures. Patients were categorized into two groups: Group A received conventional fixation methods (e.g., standard plates and screws), while Group B was treated with advanced systems, including locking plates, intramedullary nails, minimally invasive percutaneous osteosynthesis (MIPO), and bioresorbable implants. Data analysis included 50 variables spanning demographics, clinical profiles, imaging, laboratory results, implant details, and postoperative outcomes. Statistical methods such as t-tests, chi-square, Mann-Whitney U, Kruskal-Wallis, Kaplan-Meier survival analysis, and multiple regression models were performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2019; IBM Corp., Armonk, NY, US). The study found that advanced fixation techniques resulted in significantly faster healing (12.4 vs. 14.9 weeks, p < 0.001), earlier mobilization (p = 0.003), and better three-month functional outcomes, with 80.1% in Group B achieving good to excellent recovery compared to 58.2% in Group A (p < 0.001). The complication rate was notably lower in the advanced group (10.8% vs. 20.4%, p = 0.003). Regression analysis identified implant type, vitamin D levels, and diabetes status as key predictors of healing duration, complication risk, and functional recovery. Predictive models demonstrated strong performance: a linear regression model for healing time (R² = 0.38, p < 0.001), a logistic regression model for complications (accuracy = 71.6%), and an ordinal regression model for functional outcomes (Nagelkerke R² = 0.41, p < 0.001). These findings support the clinical benefits of modern fixation systems and highlight the importance of integrating biomechanical choices with patient-specific health indicators to enhance fracture management outcomes.

Respiratory failure is a complication of pneumonia known to contribute substantially to worldwide morbidity and mortality, given that, in most cases, it necessitates ventilatory support to maximize oxygenation and prevent deterioration of the patient's clinical status. Noninvasive ventilation (NIV) has emerged as a possible alternative to invasive mechanical ventilation (IMV) with noteworthy advantages, including reduced ICU admissions, lower intubation rates, and fewer ventilator-associated complications. This retrospective study aims to analyze the efficacy of NIV in promoting clinical outcomes in pneumonia patients suffering from acute respiratory failure (ARF). A total of 840 patients were analyzed. The mean age was 52.62 years (SD = 21.08), with equal distribution concerning gender. There was a mean distribution of 2.53 comorbidities (SD = 1.66), with an average duration of symptoms of 15.21 days (SD = 8.13) before admission. Oxygenation parameters increased significantly following NIV intervention, with a mean SpO₂ post-treatment of 90.31% (SD = 5.68) and a mean PaO₂ of 74.64 mmHg (SD = 14.69). Clinical outcomes showed that NIV achieved an average decrease in ICU admission of 49.3% and an average decrease in intubation rates of 50.7%. The mortality rate remained very high at 49.7%, while the readmission rate stood at 50.0%, suggesting a continuing clinical hazard even after the patient recovered for some time. Quality-of-life scores averaged 5.74 on a 10-point scale, indicating moderate improvement after treatment. There was also evidence that more than half of the patients required rehabilitation support after discharge from the hospital. This highlights the paramount need for structured post-acute care. NIV has drawbacks, as it was not efficacious for all patients, and patient selection criteria, timing of intervention, and severity of illness heavily influenced the outcomes of treatment. There is a definite promise for NIV to be used as the first-line intervention for ARF associated with pneumonia, as it improves oxygenation, reduces the necessity for IMV, and assists recovery post-treatment. Further studies are required to standardize ventilatory regimens, triage patients, and investigate long-term outcomes. Therefore, because of its advantages in clinical care, NIV should be considered a critical management modality for treating respiratory failure due to pneumonia.