Natural hazards are dynamic and unpredictable events that are a continuous threat to global socio-economic development. Humans’ reactions to these catastrophes are influenced by their proximity to the hazards and their ability to anticipate, resist, cope with, and recover from their consequences. Due to climatic changes, the risk of multiple natural hazards is expected to increase in several regions of Pakistan. There is a pressing need to understand the spatial discrepancies of natural hazards due to climate change and identifying the regions that require special measures to increase resilience, achieve adaptation, and sustainable development goals. This paper synthesizes the related literature to understand spatial variations of natural hazards due to climate changes across Pakistan. The Emergency Events Database (EM-DAT), National Aeronautics and Space Administration Global Landslide Catalog (NASA-GLC), National Disaster Management Authority (NDMA), and Pakistan Meteorological Department (PMD) are utilized to analyze spatial discrepancies and vulnerabilities to natural hazards. This study unveils that Pakistan’s current risk analysis and management strategies seem to be obsolete compared to global trends. Because of spatial variations of hazards, most research work on hazard risk assessments and risk management focuses on a single hazard, neglecting the co-occurrence impact of different natural hazards. Very limited studies are included in comprehensive multi-hazard risk strategies. Therefore, in Pakistan, risk management would require integrated multi-hazard risk assessment approaches to detect, analyze, measure, and evaluate various natural hazards, their effects, and interconnections. Moreover, the Pakistan governmental institutes dealing with natural hazards should focus on pre-disaster mitigation and resilience techniques instead of investing only in post-disaster relief activities.

Due to the rapid increase in population and urbanization, municipal solid waste (MSW) generation is increasing. Sri Lanka, in particular, faces serious difficulties in finding new sites for MSW disposal, due to the lack of available space; therefore, the rehabilitation of existing MSW dumping sites and the extension of their services are required to achieve sustainable urban development. To examine suitable rehabilitation techniques, it is essential to identify the physicochemical and mechanical properties of dumped MSW, fully considering climatic conditions, waste composition, and the time since the waste was dumped. In this study, therefore, the physicochemical and mechanical properties of dumped MSW were investigated; the dumped MSW was taken from existing MSW dumping sites in three climate zones in Sri Lanka, namely the Karadiyana site in the wet zone, Udapalatha in the intermediate zone, and Hambantota in the dry zone, and it was taken at different times after being dumped. The results showed that the waste composition and biodegradation of organic materials affected the physicochemical and mechanical properties of the dumped waste. The measured compaction parameters of the “old” sites at Udapalatha and Hambantota were higher compared to the “new” sites. Compaction parameters at the Karadiyana site, on the other hand, were low, at even >20 years since being dumped, probably due to the high amount of scarcely compacted materials. In direct shear tests, both strain hardening and softening of the waste samples were observed, depending on the difference in vertical stress. Based on the Pearson correlations among measured physicochemical and mechanical parameters, it was found that the loss on ignition (LOI) would be a good indicator to quickly assess the mechanical parameters of “new” and “old” waste materials, due to the small sensitivities to waste age and climate conditions in Sri Lanka. In particular, LOI correlated well to measured specific gravity and compaction properties, and the r2 values of correlations exceeded |0.80|.

Generation of large amounts of waste material reduces the capacity of landfill disposal sites. To make effective use of drinking water sludge (DWS) and DWS blended with crushed concrete (CC) and incineration ash (IA) as geotechnical materials, the geotechnical properties of DWS for suitability of a road subgrade were examined. A series of laboratory tests measuring compaction, California bearing ratio (CBR), undrained triaxial compression, and consolidation was conducted by changing the mixing proportions of tested materials. The compaction test showed that maximum dry density and optimum water content have a unique linear relationship with the proportion of CC/IAs mixed with DWS. Measured CBR values of mixtures of CC/IA blended with DWS at both low energy (600 kJ/m 3 ) and high energy (1800 kJ/m 3 ) showed linear relationships, and an empirical equation was newly proposed in terms of mixing fraction and maximum dry density at low energy compaction. The result of the consolidated undrained triaxial compression test showed that the blend of CC/IA with DWS increased friction angles but did not contribute to an increase in the undrained shear strength. The results of consolidation tests showed that the blend of CC reduced the compressibility of DWS highly, especially samples that contained a proportion of CC and CC/IA greater than 50%. Overall, the blend of CC raised the compaction property of DWS accompanying an increase in bearing capacity, compressibility and can be effective to improve geotechnical properties of DWS for application as a road subgrade.

Objective: To assess the frequency of intra-abdominal hypertension and its relationship with outcomes among patients of laparotomy admitted to the intensive care unit. Study Design: Comparative cross-sectional study Place and Duration of Study: Combined Military Hospital ,Rawalpindi Pakistan, from Apr to Sep 2021. Methodology: Two-hundred patients who underwent laparotomy admitted to the intensive care unit of Combined Military Hospital were recruited in our study. Intra-abdominal pressure was measured after every 8 hours for 72 hours after admission to the intensive care unit. In addition, patients were followed up for two weeks from admission in the intensive care unit to assess the outcome. Results: Out of two hundred patients, 150(75%) had good outcomes, while 50(25%) had poor outcomes. The mean age of patients who underwent the surgery was 40.63±9.448 years. 171(85.5%) patients did not have raised intra-abdominal pressure, while 29(14.5%) had intra-abdominal hypertension. High Body mass index and poor outcome had a significant association with the presence and severity of intra-abdominal hypertension among study participants (p-value<0.05). Conclusion: Considerable number of patients had intra-abdominal hypertension during their stay in the critical care unit after laparotomy. A high grade of intra-abdominal hypertension was associated with poor outcomes in our study participants.

End-stage renal disease (ESRD) patients are mostly managed with maintenance hemodialysis (MHD). ESRD patients on MHD also present with many complications, such as anemia, hyperparathyroidism, and hepatitis prevalence. This study depicts the real-world scenario of anemia among MHD and end-stage renal disease patients in the Pakistani population. A retrospective, multicentric, and real-world data analytical study was conducted at 4 dialysis centers in Pakistan. The study had a sample size of n = 342 patients on maintenance hemodialysis. The data were gathered from the medical records of patients. Data analysis was performed using STATA Version 16. Statistical significance was gauged at a 0.05 level of significance. According to our results, the mean age of the patients was 45 (±15) years. Most of the patients were male (n = 234, 68.4%), whereas 58.1% of the patients were maintained on twice-weekly hemodialysis. The most commonly reported comorbidities were hypertension and diabetes mellitus. The frequency of dialysis ( P  < 0.01) and comorbidities ( P  = 0.009) had a significant association with anemia in MHD patients. The majority of the patients had hyperparathyroidism (52%) with anemia. Upon performing binary logistic regression, multivariate analysis displayed a similar odds value for having anemia in patients with every additional month in the duration of hemodialysis (OR 1.01, P  = 0.001), the odds of anemic patients having a positive antihepatitis-C antibody (OR 2.22, P  = 0.013), and the odds of having anemia in patients in the age category below 45 years (OR 1.93, P  = 0.013). In conclusion, the study results depict that every additional month in the duration of hemodialysis, age (<45 years), and positive anti-HCV antibody status, these variables were more likely to have anemia in our study MHD patients. While in our final multivariate model, no statistically significant association was observed between hyperparathyroidism and anemia.