IntroductionNeurological injuries because of trauma and accidents are common but rarely reported or examined in Pakistan. In this study, we will determine the frequency of neurological deficits reported in the emergency unit in patients presenting with acute trauma. MaterialThis study was conducted in an emergency unit of tertiary care setting in Karachi, Pakistan. One hundred patients presenting with mild to moderate trauma were enrolled in the study after informed consent. Patients with severe trauma requiring emergency intervention were excluded from the study. ResultsOut of the 100 patients enrolled in our study, 57% presented with neurological deficits after a road traffic accident (RTA), making RTA the most common cause of trauma. The most prominent site of injury was the lower limb (57%). Upper limb examination revealed that out of the 35% patients presenting with upper limb injuries, ten patients (28.6%) had a decreased biceps reflex, while six patients (10.5%) had tingling in their hands. Out of the 57% of patients presenting with lower limb injuries, ten patients (17.5%) had decreased ankle reflexes and six patients (10.5%) had tingling in their legs. ConclusionNeurological deficit is very common in patients presenting to emergency settings in Pakistan. Neurologists should be present in emergency centers to perform detail neurological examinations of patients coming to emergency centers, and follow-up visits should be arranged in Neurology clinics for patients suffering from any neurological deficits.

Background: Advance directives are legal documents written or drawn when the person has total mental capacity, noting the requirements of health care when/if he loses the ability to make decisions. The concept has not been explored in Pakistan; hence a valid instrument is not available that addresses the needs of an LMIC. We aimed to develop and validate a tool to assess knowledge, Attitude, and perceptions about advance directives of the adult population availing services at tertiary care hospitals in Karachi, Pakistan. Methodology: We carried out a validation study in three tertiary care hospitals in Karachi. The study was initiated by adapting from an American tool, modified following the Pakistani context. An estimated sample size of 389 using a purposive sampling technique was calculated. We checked the tool's relevancy using content validity. STATA software 16 was used for consistency, reliability, and factorial analysis. Results: All the components of the survey performed well with overall good reliability (α = 0.75), and for individuals, main features, including family support decisions (α = 0.64), sociocultural and religious (α = 0.72), physical health awareness experience (α = 0.93), knowledge (α = 0.99), attitude (α = 0.75), and perceptions (α = 0.64). Conclusion: This was the first validation study done in low-and-middle-income countries to develop a reliable and validated tool with the efforts made to make it contextual and comprehensive for both English and Urdu versions.

Background: Advance directives are legal documents written or drawn when the person has total mental capacity, noting the requirements of health care when/if he loses the ability to make decisions. The concept has not been explored in Pakistan; hence a valid instrument is not available that addresses the needs of an LMIC. We aimed to develop and validate a tool to assess knowledge, Attitude, and perceptions about advance directives of the adult population availing services at tertiary care hospitals in Karachi, Pakistan. Methodology: We carried out a validation study in three tertiary care hospitals in Karachi. The study was initiated by adapting from an American tool, modified following the Pakistani context. An estimated sample size of 389 using a purposive sampling technique was calculated. We checked the tool's relevancy using content validity. STATA software 16 was used for consistency, reliability, and factorial analysis. Results: All the components of the survey performed well with overall good reliability (α = 0.75), and for individuals, main features, including family support decisions (α = 0.64), sociocultural and religious (α = 0.72), physical health awareness experience (α = 0.93), knowledge (α = 0.99), attitude (α = 0.75), and perceptions (α = 0.64). Conclusion: This was the first validation study done in low-and-middle-income countries to develop a reliable and validated tool with the efforts made to make it contextual and comprehensive for both English and Urdu versions.