The Professional Medical Journal

Frequency of uncontrolled hypertension and associated risk factors attending cardiac outpatient department Sindh Institute of medical sciences Shahdadpur.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To determine the frequency of uncontrolled hypertension and its associated risk factors at Outpatient department of Sindh Institute of Medical Sciences Shahdadpur (SIMS). Study Design: Descriptive Cross-sectional study. Setting: Cardiac OPD of SIMS Shahdadpur. Period: 2023 to February, 2024. Methods: The sample size was 300 participants of both gender and were selected by convenience sampling. Data was collected on a designed questionnaire containing sociodemographic information, medical history, dietary habits, lifestyle, after taking informed consent from the participants who were fulfilling the inclusion criteria. Data was then analysed by hand sorting techniques, MS office and SPSS version 27.0. Ethical rules of the university were followed. Results: The research included 300 patients, with frequency of Uncontrolled Hypertension was concluded 62.6 %. A significant proportion had a history of irregular blood pressure check-ups (78.3%), while only 20.7% reported drug compliance. The education rate was relatively low, 66% were illiterate, and overweight and obesity were prevalent in 80.3% of the patients. Smoking was reported by 39.4% of the participants, and a majority (59.6%) belonged to a lower socioeconomic class and in rural residents (72.3%). Conclusion: Study's findings suggest that frequency of uncontrolled hypertension is more than half of the total Uncontrolled hypertension is more prevalent among rural residents, among females than males. Risk increase with age above 50years, Illiteracy, low socioeconomic groups, lack of physical activity, increase BMI, high salt diet, smoking, non-compliance to drugs, irregular checkup, stress and family history of hypertension.

Demographic and clinical patterns of cutaneous leishmaniasis in patients reporting to a Tertiary Care Hospital in Quetta, Balochistan.

Saima Ali Khan, Fareeha Imran, Najia Ahmed, Maira Wajahat — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To investigate the demographic profile and clinical patterns of cutaneous leishmaniasis (CL) patients presenting to a tertiary care hospital in Quetta. Study Design: Retrospective Cross-sectional study. Setting: Department of Dermatology, Combined Military Hospital (CMH), a Tertiary Care Hospital in Quetta, Balochistan, Pakistan. Period: June 1^st, 2024, to May 31^st, 2025. Methods: All confirmed cases of CL attending the outpatient department for the first time during the study period were included in the study. Incomplete records and repeat visits were excluded. Parameters including age, gender, occupation, month of presentation, duration of disease, number and site of lesions, and clinical morphology were recorded. Statistical analysis was performed using Statistical Programme for Social Sciences (SPSS) version 29. Continuous variables (age, duration of lesions) were presented as mean ± standard deviation (SD). Categorical variables (gender, lesion type, location, diagnostic method) were presented as frequencies and percentages. Seasonal variation was assessed by mapping monthly distribution trends. Results: A total of 360 confirmed CL cases were recorded during the study period. The mean age of the patients was 30.1 ± 6.2 years, with a range from 2 to 78 years. The most frequently affected age group was 21-40 years. The gender distribution showed that 89.44% of the patients were male and 10.56% were female. The mean duration of lesion was 2.3 ±1.1 months. The majority of the patients had single lesion, mostly on lower limbs. The clinical presentation exhibited a spectrum of manifestations. The predominant morphological pattern was nodulo-ulcerative, accounting for 66.67% of cases. The monthly distribution of cases demonstrated a distinct seasonal pattern, with higher number of cases in winter season. Conclusion: This retrospective study highlights the unique demographic profiles, clinical patterns, and seasonal trends of cutaneous leishmaniasis cases reported from a tertiary care hospital in Quetta. The findings offer valuable insights into disease patterns that are often underrepresented in regional datasets and can inform localized control strategies.

The impact of metabolic syndrome on morbidity in patients undergoing Coronary Artery Bypass Graft (CABG) surgery.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To compare the post-operative morbidity in patients undergoing coronary artery bypass graft surgery with versus without metabolic syndrome. Study Design: This study was a quasi-experimental study. Setting: Department of Cardiac Surgery, Faisalabad Institute of Cardiology Faisalabad. Period: 30/03/2022 to 29/03/2023 (12 month study). Methods: The present study involved 200 both male and female patients aged 30-65 years undergoing coronary artery bypass grafting assimilated into two equal groups containing 100 cases for each group i.e. with and without metabolic syndrome. Standard departmental protocols were adopted to manage these cases. Outcome variables were mean intubation time, mean ICU and hospital stay duration, as well as post-operative atrial fibrillation, respiratory complications and wound infection which were noted and compared between the groups. Results: The average age of the study participants was 51.4 ± 9.4 years, with a male predominance of 7:1. Among them, 60.5% had hypertension, and 35.5% were diagnosed with diabetes. When comparing outcomes between groups, patients with metabolic syndrome experienced significantly longer intubation times (21.35 ± 2.70 vs. 16.35 ± 1.70 hours; p=0.001), prolonged ICU stays (63.85 ± 7.81 vs. 50.38 ± 4.38 hours; p=0.001), and extended hospital stays (9.70 ± 1.92 vs. 7.17 ± 1.78 days; p=0.001) compared to those without it. Additionally, the incidence of postoperative atrial fibrillation (19.0% vs. 2.0%; p=0.001), respiratory complications (16.0% vs. 0.0%; p=0.001), and wound infections (20.0% vs. 3.0%; p=0.001) was remarkably higher among CABG recipients diagnosed with metabolic syndrome. Conclusion: Among patients undergoing CABG, the presence of metabolic syndrome was linked to increased post-operative morbidity, including prolonged intubation time, extended ICU and hospital stays, and a higher risk of atrial fibrillation, respiratory complications, and wound infections, irrespective of age, gender, and diabetic status. This underscores the need for routine metabolic syndrome screening in CABG candidates to enable early detection and proactive management, ultimately improving patient outcomes.

Evaluating the impact of neutrophil-to-lymphocyte ratio on disease severity in acute ST-segment elevation myocardial infarction.

Munir Ahmad, Muhammad Yasir, Ahmad Salman, Farah Naz, Jasia Shahid, Bazgha Niaz — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To evaluate the impact of NLR on disease severity and clinical outcomes presenting with acute STEMI. Study Design: Cross-sectional study. Setting: Faisalabad Institute of Cardiology (FIC). Period: March 2024 to August 2024. Methods: A quantitative, cross-sectional study was conducted at the Faisalabad Institute of Cardiology over six months. A total of 385 patients with confirmed STEMI were included through stratified random sampling. Data on demographics, comorbidities, laboratory parameters, and clinical outcomes were collected. The TIMI risk score and the left ventricular ejection fraction (LVEF) were used to assess disease severity. Experiments, statistical analyses include t tests, chi square tests, correlation, and logistic regression were implemented with SPSS. Results: Patients with NLR > 5 demonstrated significantly worse outcomes, including higher TIMI risk scores (5.4 ± 1.5 vs. 3.8 ± 1.2, p < 0.001) and lower LVEF (44.3 ± 5.7% vs. 52.2 ± 5.8%, p < 0.001). Strongly associated with adverse events including cardiogenic shock, recurrent myocardial infarction, and 30 days’ mortality (21.9% vs. 4.4%, p < 0.001), increased NLR levels were. NLR over 5 (OR 3.75, p < 0.001) and LVEF < 45% (OR 4.12, p < 0.001) were identified using the multivariate analysis. Conclusion: The patients with elevated NLR have been shown to be reliable markers of increased disease severity and adverse outcomes in STEMI patients. An addition of NLR to routine clinical assessment would improve risk stratification and could guide management strategies. The integration of NLR with other biomarkers can improve predictive accuracy, and further researches should be performed.

Association of long duration of cardiopulmonary bypass with adverse outcomes in patient undergoing coronary artery bypass grafting.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To investigate the association between long duration of cardiopulmonary bypass and various adverse postoperative outcome in patients undergoing coronary artery bypass grafting for coronary artery disease. Study Design: Cohort study. Setting: Department of Cardiac Surgery, Azra Naheed Medical College, Lahore. Period: January’2023 to June’2023. Methods: Non-probability consecutive sampling done for 180 cases; 90 cases in each group is calculated with 80% power of test, 5% level of significance and taking expected percentage of ARF i.e. 1.3% in patients having short duration of surgery while 12.5% in patients having long duration of surgery. The in-hospital mortality in two groups was 2% vs. 12.9% (p=<0.001) exposed vs non-exposed. Results: According to study renal failure and mortality was significant among patients who had longer bypass time. According to chi square test p value was 0.014 with high significance of renal failure in group 46-75years and strong association of Age with ARF RR of 2.16. According to chi square test p value was 0.039 in male group with high significance of mortality in 27-30 BMI group and strong association of gender with mortality RR of 6.3. Conclusion: Longer CPD in patients undergoing CABG significantly associated with increased risk of postoperative renal failure and mortality. Key risk factors include Age >46 years and Male gender with BMI 27-30. Prolonged bypass time should be considered a predictor of adverse outcomes, warranting closer monitoring in high-risk patients.

Induction mortality and remission rate after 1st cycle of standard 7+3 regimen chemotherapy in patients of acute myeloid leukemia.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To determine the remission rate, mortality rate, and induction failure after standard 7+3 induction chemotherapy in patients with AML in Pakistan. Study Design: This study utilized a descriptive design. Setting: The study was conducted at the Armed Forces Bone Marrow Transplant Centre Rawalpindi. Period: August 2018 to May 2021. Methods: The study cohort comprised 88 patients aged 15 to 55 years, inclusive of both genders, diagnosed with acute myeloid leukemia (AML). All participants received standard induction chemotherapy. Remission status was evaluated either upon hematologic recovery or on Day 42 of treatment, whichever occurred first. Patients who died prior to initiating induction chemotherapy or discontinued hospitalization before completing the induction course were excluded from the analysis. Written informed consent was obtained from each enrolled patient. Results: A total of 88 patients were enrolled, with a mean age of 29.18±10.6 years. Sixty-one percent of the patients were 30 years or younger, while the remaining 38.6% were aged between 31 and 55 years. Among the patients, 50 (57%) were male and 38 (43%) were female, resulting in a male-to-female ratio of 1:1.3. The mean blast percentage in the diagnostic bone marrow was 75±21.9%. The majority of patients belonged to the AML M2 subtype (50%), followed by AML M4 (15.9%), AML M1 (13.6%), and AML M0, M5, and AML-MRC (6.8% each). Remission was achieved in 71.6% of the total patients, while 4.5% were not assessed for remission due to death, and 23.9% were refractory to the first cycle of chemotherapy. The frequency of induction mortality in our study was 4.5%. Conclusion: The 7+3 regimen is an effective intensive induction chemotherapy for fit patients to achieve remission with an acceptable treatment-related mortality rate.

The relationship of patent infarct-related artery with time to thrombolysis in patients with ST-Segment Elevation Myocardial Infarction.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To find out the spectrum of TIMI flow in the infarct-related artery amongst the patients who are thrombolysed in different time zones from pain to thrombolysis. Study Design: Prospective, Comparative study. Setting: Department of Cardiology, Ayub Medical Teaching Institute. Period: August 2022 to January 2023. Methods: A total of 122 consecutive patients with their first STEMI thrombolysed within 12 hours of pain were included in the study. Data on demographics, medical history, and physical examination findings were collected using a specially designed proforma. Patients were assessed for the success or failure of thrombolysis according to our prespecified criteria. All patients underwent coronary angiography as per our institutional protocol. TIMI flow in the infarct-related artery was documented. Results were analyzed using SPSS statistical software version 21.0. Results: 77% were male, 43% were hypertensives, one-third of patients were smokers, and 26% were diabetic. Anterior STEMI was seen in 38% of patients, while 57% had inferior STEMI. 46% of patients were thrombolysed within 3 hours, 33% within 3 to 6 hours, 10% between 6 to 9 hours, and 11% between 9 to 12 hours. The rate of TIMI III flow was the highest (89%) in patients thrombolysed within 3 hours, 85% in patients thrombolysed between 3 to 6 hours, 83% in patients thrombolysed between 6 to 9 hours, and 78% in patients thrombolysed between 9 to 12 hours. There were significantly more patients with ≥70% resolution of ST-segment elevation amongst those thrombolysed within 3 hours since the onset of pain, compared to those thrombolysed after 9 hours since the onset of pain. Conclusion: The highest frequency of TIMI III flow was seen when patients were thrombolysed within 3 hours. The rate of TIMI III flow decreased as the time to thrombolysis increased from less than 3 hours to 12 hours. However, the differences in TIMI III flow were not statistically significant. There was a statistically significant relationship between the degree of ST-segment resolution and time since pain to thrombolysis.

The role of diffusion weighted (DWI) MRI and apparent diffusion coefficient (ADC) in assessment of diabetic kidney disease.

Jawairia Warriach, Zeeshan Nawaz Bandesha, Asim Shaukat — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To evaluate the diagnostic value of ADC derived from DW-MRI in staging and assessing progression of DKD. Study Design: Cross-sectional Validation study. Setting: Department of Radiology, Allied Hospital Faisalabad. Period: [6/12]-month period between January and July 2025. Methods: Using a 1.5-Tesla MRI scanner a total of 120 adult patients with DKD and 20 age- and sex-matched healthy volunteers were enrolled. All subjects underwent renal DW-MRI and ADC mapping. ADC values were measured from multiple regions of interest in both kidneys. Clinical and laboratory parameters, including serum creatinine and eGFR, were recorded for correlation. Results: Mean ADC values were significantly reduced in DKD patients compared with controls (2.1 ± 0.3 × 10⁻³ mm²/s vs 2.4 ± 0.1 × 10⁻³ mm²/s; p < 0.001). A progressive decline in ADC was observed with advancing disease stage, showing inverse correlation with serum creatinine and positive correlation with eGFR. Conclusion: ADC values derived from DW-MRI reliably reflect renal dysfunction and disease progression in DKD. ADC may serve as a noninvasive biomarker for staging and early detection, potentially guiding therapeutic decisions and improving prognostic evaluation.

Safety of transesophageal echocardiography (TEE)-A 10 year experience at a tertiary care cardiac institute.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To assess the safety profile, major and minor complications, and risk mitigation strategies associated with TEE. Study Design: Retrospective observational study. Setting: Rehmat-ul-lil-Alameen postgraduate institute of Cardiology (RAIC), PESSI, Lahore. Period: Ten-year data focusing on TEE procedures (September 2014 to March 2025) was utilized. Methods: A total of 358 procedures were studied, carried out by 02 consultant cardiologists. In addition to demographic data, variables including indications and complications of TEE were studied. Statistical analysis was performed using SPSS Version 22. Results: TEE is proved to be generally safe, with major complications occurring in 0.2% of cases. There was no procedure related mortality. Minor complications, such as odynophagia, throat discomfort and minor pharyngeal bleed, were also uncommon (5.02%). The most common indication of diagnostic TEE was assessment of atrial septal defect 102(31.0%) while in case of intraoperative TEE, the most common indication was minimally invasive cardiac surgery 20(66.0%). The most common TEE complication (minor) was odynophagia that occurred in 1.3% of the population. Conclusion: While TEE has an excellent safety profile, clinicians must remain vigilant to prevent and promptly manage complications. Proper patient selection, adherence to guidelines, and operator expertise are crucial for ensuring patient safety. Future advancements in probe design and sedation protocols may further reduce risks.

Impact of demographic and clinical factors on stroke incidence and recovery outcomes.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To examine demographic characteristics, comorbidities, treatment patterns, and recovery outcomes among stroke patients, with a focus on associations between stroke type, recurrence, and pharmacological interventions. Study Design: Retrospective Observational study. Setting: Allama Iqbal Teaching Hospital, Dera Ghazi Khan. Period: May 2025. Methods: Using hospital records from 72 confirmed stroke patients admitted demographic data, comorbidities, stroke type, recurrence, treatment, and recovery outcomes were analyzed using SPSS version 23, with statistical significance set at p < 0.05. Results: Results reveal that ischemic stroke was more prevalent (76%) than hemorrhagic (24%). Stroke was most common in patients aged over 70 years. Recurrent strokes were more frequent in ischemic stroke (36%) than hemorrhagic (6%) (p = 0.016). Diabetes was significantly associated with ischemic stroke (p = 0.001), while hypertension was common across both types. Patients without hypertension or diabetes had the best recovery rates, while those with both had poorer outcomes and higher mortality (72%). Comorbidities significantly affected recovery outcomes (p = 0.010). Ischemic strokes were significantly more prevalent among older patients, whereas hemorrhagic stroke were more common in younger individuals (p = 0.032). Anti-platelets and statins were effective in ischemic stroke, whereas anti-convulsants and osmotic diuretics were used more in hemorrhagic cases. Conclusion: Patients without comorbidities had shorter hospital stays, while those with both hypertension and diabetes had longer stays, and higher mortality. Ischemic stroke, more common in older adults and linked to diabetes, showed higher recurrence, whereas hemorrhagic stroke was less frequent, largely non-recurrent, and seen more in younger patients. Anti-platelets and statins were effective in ischemic stroke, while anticonvulsants and osmotic diuretics were more beneficial in hemorrhagic stroke.

Efficacy of rituximab (RTX) versus cyclophosphamide (CTX) in the treatment of steroid dependent minimal change disease (MCD) in adult population of Islamabad, Pakistan.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To determine the efficacy of rituximab (RTX) versus cyclophosphamide (CTX) in the treatment of steroid dependent MCD in adult population of Islamabad, Pakistan. Study Design: Randomized Controlled Trial. Setting: Department of General Medicine, PAF Hospital, Islamabad. Period: One and Half Year November 2022 to April 2024. Methods: A total number of 60 patients’ ≥ 18 years of age with steroid dependent MCD were selected for the study and divided in 2 groups of 30 patients each using block randomization. In RTX group, patients were given two doses of injectable RTX in a dose of 1000 mg two weeks apart. While in CTX group, oral CTX was given in a dose of 2–2.5mg/kg/d for 8 weeks. Efficacy was determined in terms of incidence of relapse, steroid withdrawal and making patient drug-free. Results: The mean age of patients in this study was 41.11±13.5 years. The results showed that RTX was significantly more effective than CTX in reducing the incidence of relapse (12 Vs 21 patients, p-value=0.02), in steroid withdrawal (27 Vs 16 patients, p-value=0.002) and in making patients drug free compared to CTX (27 Vs 12 patients, p ˂0.0001). Conclusion: RTX is more effective in reducing the relapse of nephrotic syndrome in adults with steroid dependent MCD compared to CTX and helps in making the patient drug free.

Diagnostic accuracy of alpha-fetoprotein at various cut-off levels in hepatocellular carcinoma: A study in a tertiary health care centre, Peshawar.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To evaluate the diagnostic accuracy of alpha-fetoprotein (AFP) at various cutoff levels in detecting hepatocellular carcinoma (HCC) and to determine the optimal AFP value for HCC diagnosis. Study Design: Cross-sectional study. Setting: Department of Interventional Radiology, Rehman Medial Institute. Period: May 2016 to Dec 2023. Methods: Utilising a dataset of 882 participants, among whom 707 were HCC positive and 175 HCC negative. The values obtained from the AFP measurements were classified into several ranges. Effectiveness of diagnostic test at various AFP cut-off points (10µg/L, 20µg/L, 100µg/L and 200µg/L) were calculated in terms of sensitivity, specificity and positive and negative predictive values. Results: The best sensitivity of 79.5% was obtained through the use of an AFP threshold of ≥10 ng/mL. However, this resulted in the true negative rate of 21.7%. The most sensitive cut-off value was ≥100 ng/mL for 84.2%, and the highest specificity and PPV was obtained in the cut-off at ≥200 ng/mL for 97.1% and 95.4%, respectively. This is because the AFP accuracy is not constant and varies from level, therefore, should be used in combination with other diagnostic tools. Conclusion: It was found that the diagnostic accuracy of AFP is different with different cut-off levels which make it appropriate for either screening or confirming diagnosis in different ways. The low cut-offs are suitable for screening, whereas the high cut-offs fit the purposes of diagnosis confirmation. Studying the correlations and combination of AFP with other diagnostic biomarkers and imaging modalities should be the direction of future studies for HCC diagnostic models.

Frequency of fetomaternal complications among instrumental vaginal deliveries.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To see the frequency of fetomaternal complications among women who have undergone instrumental vaginal delivery. Study Design: Descriptive Cross-sectional study. Setting: Department of Gynaecology and Obstetrics Unit 2 in Civil Hospital Karachi. Period: 1st October 2020 to 30th March 2021. Methods: The sample size was calculated using OpenEpi version 3, which estimated a requirement of 94 participants with a 95% confidence interval and 5% confidence limit, based on a prevalence of 93.25%. Non-probability consecutive sampling was employed to recruit participants. Results: A total of 94 patients underwent instrumental vaginal deliveries. The average age of the patients was 25.98±4.52 years. The frequency of first-degree perineal tear was found to be 4.3% and second-degree perineal tear were also seen in 4.3% cases, while 3rd degree perineal tears were seen in 1.1% cases, and fourth degree tears were also found in 1.1% cases. The frequency of vaginal tears was 2.1% and cervical tears were seen in 3.2% cases. Retention of urine was observed in 2.1% of cases and postpartum haemorrhage was found in 4.3% cases. Paraurethral tears were observed in 1.1% cases, paravaginal hematoma and extension of episiotomy was observed in 0.3% and 10.6% respectively. As for the foetal complications, shoulder dystocia had occurred in 2.1%, cephalhematoma was seen in 3.2% babies and facial palsy in 1.1% however 17% babies were admitted to NICU. Conclusion: We conclude that Instrumental vaginal deliveries were found to be safer than caesarean section as they needed less expertise and had fewer chances of maternal morbidity. Forceps deliveries needed more skills and expertise to prevent maternal complication.

Obstacles and challenges encountered by undergraduate medical and dental students in pursuing research in a public sector university.

Hina Shah, Mohsin Rizvi, Marium Irshad, Dua Ayoub, Ifra Urooj, Karina Lakhani — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To identify the common challenges obstructing undergraduate medical and dental students in pursuing research at Jinnah Sindh Medical University (JSMU), Karachi. Study Design: Cross-sectional survey. Setting: Jinnah Sindh Medical University. Period: October to December 2024. Methods: Study was conducted among 322 undergraduate medical and dental students from Sindh Medical College (SMC) and Sindh Institute of Oral Health Sciences (SIOHS). Data were collected through a structured questionnaire after informed consent. Descriptive statistics and chi-square tests were performed using SPSS v26. Results: Of the 322 participants, 64.9% were females and 27% had a GPA of 4.0. While most students (83.5%) expressed interest in research and 95.3% acknowledged its importance, only 55.6% had ever participated in a project, and just 15.8% had published their work. The most frequently reported barriers were lack of research skills (65.2%) and difficulty in selecting a topic (52.8%). No significant associations were observed between demographic variables and reported barriers. Conclusion: Despite positive attitudes toward research, undergraduate medical and dental students at JSMU face substantial challenges, particularly inadequate research skills and difficulties in topic selection. Universities should strengthen structured mentorship programs, provide research training workshops, and allocate institutional funding to foster a sustainable research culture in undergraduate education.

Smartphone use and its relationship with addiction, depression, and anxiety among undergraduate medical students in Nawabshah, Pakistan: A cross-sectional study.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: 1. To investigate smartphone use and severity of addiction, anxiety and depression. 2. To find out the relationship between smartphone use with addiction, anxiety and depression. Study Design: Cross-sectional study. Setting: At MBBS and Allied (DPT, Pharmaceutical Sciences, Public Health & Nursing) Departments of Peoples University of Health Sciences for Women, Shaheed Benazirabad, Pakistan. Period: from August 2023 to January 2024. Methods: Among undergraduate medical students aged 18 to 25 the study's sample size was 350, and a multistage random sampling technique was used to select the participants from the Peoples University of Medical and Health Sciences for Women. After approval by the institution, data were collected from the medical students using validated tools, including smartphone addiction (SAS scale), depression (PHQ-9), and anxiety (GAD-7). The data were analyzed using SPSS software version 25. A chi-square test was used to identify the association between smartphone usage and addiction, depression, and anxiety, and a p-value of <0.05 was considered statistically significant. Results: The findings revealed that half the students (49.7%) spent more than 6 hours per day on their mobile screens. (49.1%) of medical students reported having a high prevalence of smartphone addiction, (48.6%) reported having moderate to severe depression, and (55.8%) reported having moderate to severe anxiety. Addiction, depression, and anxiety scores were higher among the excessive smartphone use group than in the low smartphone users. A statistically positive association was found between smartphone usage and the addiction level, depression level, and anxiety level scores. Conclusion: This study highlights the overdependence on smartphones among medical students and the positive association between smartphone usage and mental health outcomes like addiction, anxiety and depression among PUMHSW medical students in Pakistan. Excessive screen time can impact students' academic performance, sleep quality, and eating behaviors.

Prevalence of pes planus and pes cavus and its association with risk of fall, activities of daily living and muscular discomfort among school teachers of Hayatabad, Peshawar. A cross sectional study.

Seema Gul, Aqsa Khan — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To determine the prevalence of pes planus and pes cavus and its association with risk of fall, activities of daily living and muscular discomfort. Study Design: Multi-center Cross-sectional study. Setting: Hayatabad Public and Private Schools. Period: August 2024 to January 2025. Methods: This was multi-center cross-sectional study; conducted on school teachers of Hayatabad, Peshawar. Total 113 school teachers (mean age 29.42± 6.07) were included in the study through convenience sampling technique. Demographic details were obtained from all the study participants. Navicular drop test was used to assess arch of the foot. Risk of fall and activities of daily living were assessed using Efficacy Scale International and Foot and Ankle Ability Measure respectively. Cornell Musculoskeletal Discomfort Questionnaire is used for muscular discomfort. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. Results: The sample in this study consisted of 47.8% male and 52.2% female school teachers. The results of this study showed that pes planus is slightly more prevalent (19.16%) than pes cavus (16.93%). The baseline variables like gender, age and Body Mass Index (BMI) and functional outcomes like risk of fall and activities of daily living were strongly associated with type of foot (p<0.05). Conclusion: This study found that foot arch deviations, such as pes planus and pes cavus, are highly prevalent and show strong associations with age, gender, and BMI. These deviations also have a significant impact on functional outcomes.

Molecular basis of beta thalassaemia intermedia in Pakistan.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To investigate the primary β-globin gene mutations and their association with secondary genetic modifiers—Xmn-1 polymorphism and BCL11A variant—in patients diagnosed with β-thalassemia intermedia in Pakistan. Study Design: Descriptive Cross-sectional study. Setting: Fauji Foundation Hospital, Islamabad. Period: June 2021 to January 2022. Methods: Seventy patients with β-TI were enrolled. DNA was extracted using the Chelex method, and molecular analysis was performed using PCR-RFLP and ARMS-PCR to detect BCL11A (rs11886868) and Xmn-1 polymorphisms, respectively. Statistical analysis was carried out using SPSS version 17. Results: The most frequent primary mutations included Cd-15 (14.3%), IVSI-5 (11.4%), and Fr 8-9 (12.9%). Xmn-1 and BCL11A polymorphisms were identified in 37.1% and 71.4% of patients, respectively. Statistically significant associations were found between certain primary mutations (e.g., IVSI-5 and IVSI-5/cap +1) and both secondary modifiers (p < 0.001 and p = 0.005, respectively). Dual modifier presence was observed in 26% of patients. Conclusion: This study reveals considerable molecular diversity in β-thalassemia intermedia in Pakistan. The significant association between specific β-globin mutations and secondary genetic modifiers highlights the complex genotype-phenotype interplay. These findings underscore the need for larger, multi-centric genetic studies to enhance predictive accuracy for clinical management and personalized therapy in thalassemia.

Capillary electrophoresis-based screening for haemoglobinopathies in Sindh and Balochistan, Pakistan: A cross-sectional study.

Kanwal Shafiq, Munazza Rashid, Intezar Hussain, Hafiza Sidra — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To assess the frequency and spectrum of haemoglobinopathies in Sindh and Balochistan using the Sebia Capillarys 3 Octa capillary electrophoresis system, and evaluate its diagnostic utility in routine clinical practice. Study Design: Descriptive Cross-sectional study. Setting: Department of Hematology, Chughtai Laboratory, Karachi, Pakistan. Period: June 2023 to June 2024. Methods: A total of 1,340 patients referred for hemoglobinopathy screening were included using consecutive non-probability sampling. Capillary electrophoresis (CE) was performed using the Sebia Capillarys 3 Octa system to detect hemoglobin variants and quantify HbA2. A cut-off value of HbA2 >3.5% was used to identify β-thalassemia trait. Complete blood counts and peripheral smears were also evaluated. Patients with recent transfusions or incomplete data were excluded. Results: Out of 1,340 patients, 344 (25.7%) were diagnosed with haemoglobinopathies. β-thalassemia trait was most frequent (59.9%), followed by elevated HbF cases (13.9%). Females comprised 61.7% of the study population, with the 18–35 years age group most affected. Karachi reported the highest number of cases. CE showed high analytical performance in identifying common and rare hemoglobin variants. Conclusion: CE using the Sebia Capillarys 3 Octa system is a reliable and efficient tool for hemoglobinopathy screening. The high prevalence of β-thalassemia trait highlights the need for regional screening and prevention strategies.

Significance of New Index Matos and Carvalho Index in differentiation of iron deficiency anemia and beta thalassemia trait.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To assess the value of the Matos and Carvalho index (MCI) in detecting beta thalassemia traits in patients with microcytic hypochromic anemia. Study Design: Retrospective study. Setting: Department of Hematology, CHK Central Laboratory Dr Ruth KM Pfau Civil Hospital Karachi, Pakistan. Period: 1^st July to 31^st December 2022. Methods: All newly diagnosed cases of iron deficiency and Beta Thalassemia trait were included. 297 patients with an age range of 1–60 years were evaluated. We calculated 4 discrimination indices in all patients with hemoglobin (Hb) values of <10 g/dL. The patient groups were evaluated according to red blood count; the Mentzer index (MI); the Srivastava index (SI) and Matos and Carvalho index (MCI). In this study complete blood counts for red cell indices were processed on a Hematology analyzer (XN-1000), HPLC was done on Arkray HA-8108T and serum ferritin was done on a chemistry analyzer (COBAS 501). Results: 297 patients were included in the present study with hypochromic, microcytic anemia for beta thalassemia trait (BTT) and iron deficiency anemia (IDA). HPLC detected 141 patients with BTT, while 156 were diagnosed with IDA. The average age of Patients with BTT was 14.5 years, whereas the average age of IDA patients was 20.6 years. The Mentzer index correctly identified patients at 64.6%, followed by MCI and SI at 63.2%, 62.2%, and 55.2%, respectively. Conclusion: The Matos & Carvalho Index offers an easy and accessible way to enhance thalassemia detection and iron deficiency anemia by the simple test of CBC at the frontline. In this study Srivastava index (SI) demonstrated the most robust reliability levels when distinguishing between beta thalassemia trait and Iron deficiency anemia. However, the absence of red cell indices and methods that possess 100% specificity, efficacy, and sensitivity hinders the differentiation of BTT from other hypochromic microcytic anemia.

A comparison of pain-reducing effectiveness using laparoscopic-guided transverse abdominal plane block and port site infiltration in laparoscopic cholecystectomy: A randomized controlled trial.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To compare the effectiveness, in terms of pain score and additional analgesia requirement, using laparoscopic-guided transverse abdominis plane block in comparison to port site infiltration in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Surgical Unit 2, Jinnah Hospital, Lahore. Period: Methods: Included 92 patients (46 in each group) undergoing elective laparoscopic cholecystectomy Group A patients received a laparoscopic TA plane block with 40 ml 0.25% bupivacaine, 20 ml in each subcostal region, while group B received 40 ml 0.25% bupivacaine, 10 ml in each port site. The outcomes were assessed at 1^st, 4^th, 12^th, and 24 hours post-operatively. Results: In Group A versus B patients, the mean age was 43.30+10.875 versus 44.22+8.894 years, the mean score at 1 hour was 3.26+0.953 vs 4.09+0.725, at 4 hours was 4.17+0.877 vs 4.87+1.046, at 12 hours was 4.52+0.983 vs 5.35+ 0.822 and at 24 hours 4.52+1.110 vs 5.52+ 1.516, respectively. In Group A vs B, rescue analgesia at 1^st, 4^th, 12^th, and 24 hours was required in 8.7%, 26.1%, 43.5% & 52.1% versus 30.4%, 65.2%, 82.6% & 82.6%, respectively (p<0.05 at all intervals). Conclusion: The laparoscopic-guided transverse abdominal plane block is considerably superior to port site infiltration in terms of pain score and additional analgesia requirement.

Role of erector spinae plane block versus paravertebral block in postoperative pain management of mastectomy.

Noor Fatima, Naseem Ahmed, Komal Mumtaz, Khalid Mahmood — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To determine the role of erector spinae plane block versus paravertebral block by finding the time to need the first rescue analgesia in postoperative pain management of Mastectomy. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Fauji Foundation Hospital Rawalpindi. Period: October 2024 to March 2025. Methods: A total of 220 females (aged 18-65 years) undergoing unilateral modified radical mastectomy with axillary dissection were randomly assigned (1:1) to receive either erector spinae plane block (Group ESPB) or paravertebral block (Group PVB). Under ultrasound guidance at T4-T5, patients in Group ESPB received 20-25mL of 0.25%-0.375% bupivacaine with epinephrine into the erector spinae plane, while patients in Group PVB received the same solution injected into the paravertebral space at multiple levels. The primary outcome was time to first rescue analgesia (triggered at pain score ≥4 on Visual analogue scale 0-10). Secondary outcomes included 24-hour total rescue analgesia consumption, pain scores at 8, 12, and 24 hours. A p-value <0.05, established the statistical significance. Results: The results of primary outcomes established no significant difference between the Group ESPB and Group PVB in terms of time to need first recue analgesia (5.95±0.63 hours Vs 6.11±0.66 hours respectively, p=0.07). Total morphine consumption was comparable between the two groups (7.1±1.61 mg vs. 7.05 ± 1.64 mg, p=0.82). Higher pain scores was observed at 8 hours in the ESPB group compared to Group PVB (6.1 ± 0.88 vs. 5.83 ± 0.78, p=0.02), with no differences at 12 and 24h. Conclusion: Both techniques showed similar time to first rescue analgesia after mastectomy and total morphine use during 24 hours. Paravertebral block provided better early pain control at 8h; analgesia was, however, comparable beyond 12h.

Comparison of effectiveness of pediatric caudal block with ultrasound guidance versus landmark technique.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To compare the efficacy of ultrasound guidance versus landmark technique for performing caudal block in children undergoing infraumbilical surgery. Study Design: Non Randomized Controlled Trial. Setting: Institute of Child Health and Children Hospital, Faisalabad. Period: January 2025 – April 2025. Methods: After institutional ethical approval, 240 children aged 2 to 10 years were randomly assigned to two equal groups: Group USG (ultrasound-guided) and Group LM (landmark technique). Caudal block was administered under general anesthesia in both groups. Primary outcome was success on first attempt; secondary outcomes included performance time, incidence of tachycardia (defined as ≥10% rise in heart rate during skin incision), and number of needle punctures. Data were analyzed using SPSS version 23. Results: No significant difference was found between the groups in terms of age, weight, and gender. The USG group showed a significantly higher success rate on the first attempt (95% vs. 70.83%, p = 0.000) and a lower incidence of tachycardia (10% vs. 32%, p = 0.000). However, time taken was significantly longer in the USG group (110.88 ± 16.11 sec vs. 63.62 ± 13.10 sec, p = 0.000). Conclusion: Ultrasound guidance significantly increases the success rate of pediatric caudal block compared to landmark technique, although it requires more time to perform.

Incidence of keratopathy in vernal catarrh.

Muhammad Firdous, Qamar Farooq, Aftab ur Rehman — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To identify the severity and types of corneal complication of vernal catarrh and the extent of visual impairment caused by them. Study Design: Cross-sectional study. Setting: Margalla Hospital Taxila Cantt. Period: March 2021 to May 2022. Methods: The study included all vernal catarrh cases with informed consent. Slit lamp inspection allowed for the exclusion of patients from the study. The majority of the diagnosis was made based on the history and lab tests. Slit lamp examination and corneal fluorescein staining were carried out in each case. The variables were noted and statistical analysis was performed on them. Inclusion Criteria: All patients between age of 5-20years of VKC were included. Exclusion Criteria: Patients who were difficult to examine on slit lamp or did not agree to informed consent were excluded. Results: The most frequent corneal complication was superficial punctate keratitis (45%). Cases with corneal plaques (8%) and shield ulcers (14% each) had more severe visual impairment. Also observed was a strong association with keratoconus (15%). Hydrops (6%), pseudogentoxon (3%) and corneal opacification (9% each) were also found. Conclusion: In VKC, corneal complications are frequent, potentially dangerous, and can impair vision.

Comparison of glyceryl trinitrate (GTN) 0.2% with lateral anal sphincterotomy in the management of chronic anal fissure.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: Fissure in ano is a very painful and bothersome condition. The injury occurs while defecating hard stool or stool having hypertonicity causing pain around anal region sometimes with bleeding is the first feature of anal fissure. Study Design: Randomized Control Trial. Setting: Department of Surgery, Gujranwala Medical College and Teaching Hospital, Gujranwala. Period: August 2021 to January 2022. Methods: Sixty (60) patients with age 20 to 60 were included in the study. These were equally distributed randomly into two groups. 1st group underwent lateral anal sphincterotomy and second group receive 0.2% GTN for chronic anal fissure. All these patients were assessed 6 weeks after the start of treatment and were on the basis of control of symptoms per rectum bleed, constipation and pain around perianal region. Results: A total of 60 patients were enrolled and evenly divided into two groups. After 6 weeks of treatment, 90% of patients in the lateral sphincterotomy group achieved complete healing, compared to 50% in the GTN ointment group. Post-treatment perianal pain persisted in only 10% of the surgical group versus 50% in the GTN group. Similarly, per rectal bleeding and constipation were significantly lower in the sphincterotomy group (6.7% each) compared to the GTN group (30% and 46.7%, respectively). The differences between groups were statistically significant (p < 0.05) across all outcome variables. Conclusion: Lateral anal sphincterotomy is significantly more effective than 0.2% glyceryl trinitrate ointment in the treatment of chronic anal fissure. It provides higher healing rates and better symptomatic relief with minimal residual symptoms. Therefore, it should be considered the treatment of choice, especially in patients who do not respond adequately to conservative management.

Influence of pneumoperitoneum pressures in laparoscopic cholecystectomy: A clinical trial.

Sohail Moosa, Hamid Raza, Bilal Ahmed, Muhammad Umar, Muhammad Akram, Ali Tahir — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To compare the severity of postoperative abdominal pain between high (12mmHg) vs low (8mmHg) pressure pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy. Study Design: Prospective, Randomized, Double-blinded Controlled Trial. Setting: Surgical Unit of Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences in Pakistan. Period: Six Months, from 1^st May to 30^th November 2024. Methods: Was carried out involving patients undergoing laparoscopic cholecystectomy (LC) with ethical approval obtained beforehand. Sixty patients participated and were randomly allocated to two groups in equal numbers. Group A underwent LC using high-pressure pneumoperitoneum (12–14 mmHg), whereas Group B had the procedure performed under low-pressure pneumoperitoneum (8–10 mmHg). The level of postoperative pain was assessed using the Visual Analogue Scale (VAS) 24 hours after surgery. Results: The mean age of Group A was 41 ± 9.96 years, and Group B was 38 ± 10.09 years. Group A included 18 (60%) males and 12 (40%) females, whereas Group B had 20 (67%) males and 10 (33%) females. At 24 hours postoperatively, 22 (73%) patients in Group A experienced mild pain, while 8 (27%) reported moderate-to-severe pain. In Group B, 26 (87%) patients had mild pain, whereas only 4 (13%) experienced moderate-to-severe pain. Conclusion: The article concludes that lower pneumoperitoneum pressures used during laparoscopic cholecystectomy reduced post-operative pain in comparison to when higher pressures were used without compromising the operative visibility. Future studies require larger sample size studies to address further the concerns for surgical visibility, operative duration, while also assessing the outcomes.

Comparison of bipolar “button” plasma vaporization of the prostate versus bipolar transurethral resection in saline for benign prostate obstruction.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To determine the differences in outcomes when bipolar button plasma vaporization is used to manage benign prostatic obstruction, compared to bipolar transurethral resection. Study Design: Randomized Controlled Trial. Setting: Department of Urology & Renal Transplant, DHQ Teaching Hospital, Gujranwala. Period: 9-6-2023 to 10-12-2023. Methods: To participate, 62 patients were selected and then randomized by simple random sampling into two groups. Group A received gamma knife BPVP and group B had the procedure known as Transurethral Resection of the Prostate (TURP). Patients stayed in post-surgical wards after the operation until they were allowed to go home. We noted how many days the patients were hospitalized, the time spent using irrigation and if they had a catheter. We also measured the amount of blood lost and how severe the lower urinary tract symptoms were. SPSS version 25 was used to look at the data. Results: The average patient age in group-I was 58.59±4.59 years and 57.67±4.61 years in group-II. BPVP patients had improvements in many perioperative outcomes, with less time for surgery (45.5 versus 69.8 mins), irrigation (9.96 versus 12.87 hours), catheterization (2.83 days versus 4.96 days), hospital length of stay (3.32 days versus 5.96 days) and lower blood loss (109.38 mL compared to TURP’s 197.25 mL) (p < 0.05). Overall and when grouped by age and how long symptoms had lasted, IPSS scores showed no significant differences between the groups (p > 0.05). Conclusion: Initial findings indicate that BPVP is comparatively safer than TURP, extremely efficient, associated with reduced perioperative bleeding, and resulting in a shorter hospital stay.

Comparison of Fistulotomy versus Use of 1% silver nitrate in terms of post-operative pain in low-lying perianal fistula.

Ali Iqbal, Muhammad Yaqoob, Shahbaz Ahmad — Wed, 04 Feb 2026 00:00:00 -0800

Objective: To compare the average postoperative pain in patients who received fistulotomy and those who received 1 percent silver nitrate to treat low-lying perianal fistulas. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital II (DHQ Hospital), Faisalabad. Period: 25^th February to 25^th August 2025. Methods: The qualified patients were randomly allocated into two groups. Group A was done under general anesthesia and had fistulotomy, and Group B was done with 1% of silver nitrate to be applied following curettage of the fistula tract. Visual Analog Scale (VAS) was used to evaluate postoperative pain at 12 weeks, and all analysed data were recorded on an organised proforma. Results: Group B (1% silver nitrate) had significantly lower mean pain scores (VAS: 3.37 ± 1.09) than Group A (fistulotomy) did (VAS: 4.30 ± 1.80, p = 0.019) at 12 weeks. Silver nitrate treatment was especially beneficial to younger patients, males, and those who did not have comorbidities. Conclusion: The study concludes that 1% silver nitrate is a less invasive and effective alternative to fistulotomy for the treatment of low-lying perianal fistulas, significantly reducing postoperative pain and promoting better recovery.

Frequency of diplopia in zygomatic maxillary complex fractures in patients presenting to Ayub Teaching Hospital Abbottabad.

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To find out the incidence of diplopia in ZMC fracture patients reporting to the trauma center and maxillofacial outpatient department. Study Design: Cross Sectional study. Setting: Department of Trauma Center and Maxillofacial Outpatient, Ayub Teaching Hospital (ATH), Abbottabad. Period: December 2024 to May 2025. Methods: A total of 113 patients between the ages of 18–60 years with radiologically proven ZMC fractures were recruited using non-probability consecutive sampling. Data regarding age, gender, etiology of trauma, fracture pattern (unilateral/bilateral), and presence/direction of diplopia was obtained on a structured proforma. Diplopia was evaluated clinically by history and nine-gaze examination. Data were analyzed using SPSS version 22. Chi-square test was employed to evaluate associations, with p < 0.05 being statistically significant. Results: Of the 113 patients, diplopia occurred in 32.74% (n = 37). Horizontal diplopia was the most frequent (54.87%), followed by vertical (32.74%) and oblique (12.39%). Both-sided ZMC fractures were strongly related to diplopia (52.17%) than single-sided fractures (27.78%) (p = 0.026). No significant association was found with age, gender, cause of trauma, or direction of diplopia gaze. Conclusion: Diplopia is a relatively frequent ZMC fracture complication, especially in the case of bilateral trauma. Early detection can support ophthalmic referral and improved functional results.

Globe salvage in Group D and Group E retinblastoma after intra arterial chemotherapy (IAC).

Wed, 04 Feb 2026 00:00:00 -0800

Objective: To evaluate the effectiveness of IAC in Group D and E retinoblastoma, with a specific focus on globe salvage, in a tertiary care center in Pakistan. Study Design: Retrospective study. Setting: Lahore General Hospital, Lahore. Period: 20^th June 2025 to 20^th August 2025. Methods: In which patients with group D and E retinoblastoma were included. Demographic and clinical data were retrieved from ophthalmology department of Lahore General Hospital. Patients received six cycles of intravenous chemotherapy followed by IAC. Up to four IAC sessions were administered. Tumor regression was assessed one-month post-IAC, and globe salvage was defined by sustained stability over six months. Results: There were 55 eyes of 55 patients. Mean age was 20.96±14.03 months. Twenty-nine eyes had group D and 26 had group E retinoblastoma. Tumor regression was noted in most of both groups, with no significant difference. Globe salvage with vision was observed more frequently in Group D (44.8%) compared to Group E (19.2%). Enucleation and loss of visual function were more common in Group E. Ischemic toxicity was rare, signifying the relative safety of IAC. Conclusion: Intra-arterial chemotherapy is an effective globe-sparing treatment for retinoblastoma, achieving high rates of tumor regression and globe salvage, even in advanced disease stages.

A case of concomitant iron and folate deficiency in a 26-year-old female with beta thalassemia minor.

Wed, 04 Feb 2026 00:00:00 -0800

We are reporting a known case of a 26-year-old lady with beta thalassemia minor (also called as beta thalassemia trait) who developed severe anemia due to co-existing iron and folate deficiency. The patient showed hypochromic microcytic anemia with markedly reduced mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), along with biochemical features of iron depletion and folate deficiency. The baseline laboratory evaluations showed low values of Hb, serum iron, serum ferritin and transferrin saturation, along with increased TIBC. The patient was treated with intravenous ferrous sulfate (200 mg per week for 4 weeks), oral ferrous sulfate (14 mg/day for 10 weeks), oral folic acid (5 mg daily for 10 weeks), and intramuscular methycobalamine (500 mcg for 7 doses on alternate days). By the end of the 10^th week patient showed a significant improvement in haematological and biochemical parameters. This case highlights the need for screening and treating the nutritional deficiencies in patients with beta thalassemia minor to prevent the worsening of anemia.

Type IV- Reno-Cardiac syndrome in a female child: Heart and kidney dysfunction, intertwined.

Aisha Haleem, Amanullah Lail, Aamina Shaikh, Noor Fatima Suri, Laraib Ghangro — Wed, 04 Feb 2026 00:00:00 -0800

Renal artery stenosis is the major cause of renovascular hypertension, can be found isolated or have association with syndromes or autoimmune conditions. It can be due to atherosclerotic deposition in vessels, autoimmune etiology or fibromuscular dysplasia, the latter is the commonest cause, however, needs biopsy for diagnosis and exclusion of other possible causes. Patients can have diverse presentation, disease may be discovered as incidental finding, with hypertensive crises, Nephropathy or cardiac manifestations. We report a case of 7 years female patient presented with severe respiratory distress, hypertension, Grade 1 BL pitting edema, hepatomegaly, basal crackles in chest and gallop. He had no history of any diagnosed medical condition prior. However, symptoms were evident for last 2 months with Headache, fatigue, cough, exertional dyspnea, edema and decreased urine output. She had no history of arthralgia, frothy urine, hematuria or any skin rashes. Evaluation for Hypertension revealed small sized right kidney with decreased perfusion in segmental arteries. Echocardiography showed Biventricular dilation, dysfunction with Ejection fraction of 40%. She initially managed with iv labetalol infusion later started enalapril and amlodipine then referred to specialty where percutaneous transangioplasty planned abut deferred by pediatrics nephrology as patient responded with medical management and it is considered for resistant hypertension or persistent high renin and aldosterone. The case concluded with diagnosis of Reno cardiac type-iv syndrome, as manifestations are concordant with chronic kidney disease – right SSK due to hypoperfusion that resulted in renovascular hypertension and Cardiac failure.