Background: Appendicitis is a common surgical emergency that has a spectrum of mild cases of inflammation, gangrene, and perforation. Systemic inflammatory markers could play a significant role in predicting disease severity before surgery. Objectives: To determine the relationship between the healthcare objective of appraising systemic inflammatory physiology and the severity of appendicitis in patients who have undergone appendectomy. Methods: A cross-sectional study was conducted on 89 patients who underwent appendectomy. Preoperative laboratory investigations, including TLC, neutrophil count, CRP, ESR, PCT, NLR, and PLR—along with clinical examination and imaging findings were documented. The severity of appendicitis was categorized intraoperatively and histopathologically into simple, suppurative, gangrenous, and perforated types. Associations between inflammatory biomarkers and disease severity were assessed using statistical comparisons and correlation analyses. Results: The majority of patients (64%) reported within 24-48 hours of symptom onset. The distribution of severity of appendicitis was straightforward (36.0%), suppurative (30.3%), gangrenous (20.2%), and perforated (13.5%). CRP, PCT, NLR, PLR, and TLC demonstrated a progressive tendency in increasing by the severity. A correlation was greater with CRP (r = 0.71, p < 0.001) than with PCT (r = 0.66), NLR (r = 0.62), and TLC (r = 0.54). Conclusion: CRP, PCT, and NLR are systemic inflammatory biomarkers with strong associative relationships to the severity of appendicitis and can be useful predictors of complicated disease. By introducing these parameters into clinical assessment, early detection, risk assessments, and operations could become better and more notable in resource-limited environments.

Background: The dysfunction of the autonomic nervous system is a major pathophysiologic agent in essential hypertension and potentially a factor in insufficient blood pressure management despite pharmacological therapy. Non-invasive indicators of autonomic cardiovascular regulation include heart rate variability (HRV) and baroreflex sensitivity (BRS); nevertheless, their role in blood pressure management in non-acute clinical life has not been studied well enough. Objectives: To determine the relationship between heart rate variability and baroreflex sensitivity with blood pressure regulation in essential hypertension patients. Methods: This was a cross-sectional study that took place between May 2024 and May 2025 and involved 100 adults with essential hypertension. Standardized procedures were employed in measuring blood pressure, and the respondents were divided into two groups, namely controlled and uncontrolled hypertension. HRV measurements were made in both time and frequency domains through short-term electrocardiograph recordings, whereas baroreflex sensitivity was measured under a non-invasive spontaneous sequence approach. These were done by using comparative and correlation analyses in order to explore the relationship between the autonomic parameters and blood pressure levels. Results: Of the 100 participants, 46% had controlled hypertension and 54% had uncontrolled hypertension. Uncontrolled hypertension patients recorded much lower HRV indices, such as SDNN and RMSSD, as well as high-frequency power, and a much higher LF/HF ratio (p < 0.001). In the state of uncontrolled, baroreflex sensitivity was significantly lower (p < 0.001). There were strong negative relationships between systolic and diastolic blood pressure variables and HRV parameters and baroreflex sensitivity. Multivariate regression analysis has revealed that reduced baroreflex sensitivity and lower SDNN are the independent predictors of poor blood pressure control. Conclusion: Impaired autonomic regulation, reflected by reduced heart rate variability and baroreflex sensitivity, is strongly associated with uncontrolled essential hypertension. Assessment of autonomic function may enhance risk stratification and support more individualized management of hypertensive patients.

Background: Over-the-counter (OTC) painkiller tablets are commonly used for self-medication without clinical supervision. Long-term or frequent use, particularly of non-steroidal anti-inflammatory drugs (NSAIDs), is associated with gastrointestinal (GI) and renal adverse effects. In populations with high rates of unsupervised medication use, understanding these risks is essential. Objectives: To assess the prevalence of GI and renal side effects among adults using OTC painkillers for more than three months and to examine the relationship between analgesic use patterns and adverse outcomes. Methods: A cross-sectional clinical study was conducted among 100 adults with OTC painkiller use exceeding three months. Structured interviews documented the type, duration, and frequency of analgesic intake. Clinical and laboratory assessments, including serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), urinalysis, and stool occult blood testing, were performed to detect adverse effects. Statistical analyses evaluated associations between analgesic use patterns and complications. Results: Participants had a mean age of 38.6 ± 12.4 years, and 57% were female. Paracetamol was the most frequently used analgesic (62%), followed by ibuprofen (48%) and diclofenac (31%). GI symptoms occurred in 68% of users, with dyspepsia (42%) and abdominal pain (36%) being the most common. Renal abnormalities were observed in 34% of participants, including elevated serum creatinine (19%) and reduced eGFR (17%). Longer duration and higher frequency of use were significantly associated with both GI and renal complications (p < 0.05). Conclusion: Long-term OTC painkiller use, especially NSAIDs, is strongly associated with gastrointestinal and renal adverse effects. Public education, responsible self-medication, and periodic clinical monitoring are essential to minimize preventable harm.

Background: Smog is a critical social health concern on the country, and the pollution exposes millions of the population to dangerous events including PM2.5, nitrogen oxides, sulfur dioxide, carbon monoxide, and ozone. The effect of these pollutants is very negative to the respiratory system. Objectives: To evaluate the effects of smog exposure on the respiration health outcomes of people in Lahore. Methods: A cross-sectional clinical study was carried out on 100 individuals who were recruited at different hospitals in Lahore in the smog season (October -December 2024). Structured questionnaires on the symptoms, duration of exposure, and preventive practices were used to collect the data. Spirometry was used to assess the lung functioning. The analysis of data was performed with the help of SPSS 26, and a p value under 0.05 was estimated as significant. Results: Most participants (72) spent an average of over 2 hours out every day, and 64% did not use protective masks. Airflow symptoms were also very common with cough (78) out of throat irritation (73) out of eye irritation (64) out of shortness of breath (59) out of wheeze (42) out of chest tightness (48). Spirometry showed that 28% of them had a pattern of obstruction and 20% had restrictive pattern and only 52% had the normal lung functionality. Conclusion: The level of smog is closely linked to the development of respiratory symptoms and poor lung functioning in the officials of Lahore. There is need to increase on the population health awareness, preventive actions, and tightening of the environmental control to cut the respiratory burden due to smog.

Background: Chronic migraine (CM) is a very disabling neurological disorder that goes beyond recurrent headache attacks, to include some important neuropsychiatric comorbidities. The depression, anxiety, sleep disturbance, and cognitive dysfunction are becoming recognized as innate characteristics of CM phenotype but there is a paucity of data on South Asian populations. Objectives: The aim of the study is to determine the prevalence and clinical correlation of neuropsychiatric manifestations in chronic migraine patients who reported to the tertiary care hospital in Pakistan. Methods: This observational cross-sectional study was conducted in the Department of Neurology, Mayo Hospital, Lahore, Pakistan, from March 2024 to June 2025. A total of 120 patients aged 18–60 years diagnosed with chronic migraine as per the International Classification of Headache Disorders-3 (ICHD-3) criteria were recruited through consecutive non-probability sampling. Neuropsychiatric assessments were performed using validated scales: the Patient Health Questionnaire-9 (PHQ-9) for depression, Generalized Anxiety Disorder-7 (GAD-7) for anxiety, Pittsburgh Sleep Quality Index (PSQI) for sleep quality, and Montreal Cognitive Assessment (MoCA) for cognitive function. Data were analyzed using SPSS v26.0, applying Chi-square tests for categorical variables and Pearson correlation analysis for inter-domain associations. A p-value <0.05 was considered statistically significant. Results: The age of 36.4 above and below was 9.7 that represented the mean age and females 68.3 that represented the percentage of the females. Depression was found in 46.7, anxiety in 41.6, and inappropriate sleep quality in 55.8 percent of patients, and 30.8 percent of patients had been found to be cognitively impaired. Depression and anxiety rates were much greater among females than among males (p<0.05). The longer the duration of migraine, the more likely that they impaired cognition (p=0.03). There was a significant relationship between sleep disturbance and depressive symptoms (r=0.54, p<0.001). Conclusion: The neuropsychiatric symptoms are very common in CM patients, especially in sleep disturbance, depression, and anxiety. These results underline the necessity to use integrated neuropsychiatric screening and multidisciplinary management to enhance the outcome of this susceptible group.

Background: Cigarette smoking is a major preventable cause of morbidity and mortality worldwide, contributing significantly to chronic respiratory diseases. Pulmonary function testing using spirometry provides an objective means of assessing smoking-related airway impairment and detecting early subclinical changes. Objective: This study aimed to evaluate pulmonary function changes among smokers compared to non-smokers using spirometry in a tertiary care setting in Punjab, Pakistan. Methods: A Cross-sectional comparison study was conducted at two tertiary care facilities between March 2024 and March 2025. Using purposive sampling, 90 individuals between the ages of 20 and 60 were enrolled, 45 of them were smokers and the remaining 45 were non-smokers. Using a systematic questionnaire, demographic and clinical data, including smoking history, were collected. The American Thoracic Society (ATS) recommendations were followed while doing the spirometry, and the findings were assessed for peak expiratory flow rate (PEFR), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. The Statistical Package for Social Sciences (SPSS) software version 26 was used to analyze the data. Pearson's correlation test was used to determine the relationship between smoking exposure and spirometric indices, and independent t tests were used for group comparisons. Results: Smokers demonstrated significantly reduced mean FEV1 (2.29 ± 0.61 L vs. 3.01 ± 0.55 L, p < 0.001), lower FEV1/FVC ratios (68.5% ± 7.2 vs. 81.1% ± 6.5, p < 0.001), and decreased PEFR (314.6 ± 72.8 L/min vs. 386.2 ± 68.9 L/min, p < 0.001) compared to non-smokers. Obstructive patterns were observed in 42.2% of smokers versus 8.9% of non-smokers. Pack-year analysis showed a significant inverse correlation with both FEV1 (r = –0.41, p = 0.004) and FEV1/FVC ratio (r = –0.38, p = 0.006). Conclusion: Smoking is strongly associated with impaired pulmonary function, particularly obstructive airway changes. Spirometry is a valuable tool for early detection, highlighting the need for routine screening and targeted smoking cessation interventions to prevent progressive lung disease.

Background: Helicobacter pylori (H. pylori) is a major pathogenic factor associated with peptic ulcers, gastric malignancies, and chronic dyspeptic conditions. Its prevalence remains a significant health burden in developing countries such as Pakistan, where epidemiological data stratified by age and gender are limited. Objective: To determine the prevalence of H. pylori among dyspeptic patients in Lahore and to evaluate age- and gender-based differences using manual and automated ELISA methods. Methods: A descriptive cross-sectional study was conducted from June 2022 to April 2023 in three tertiary care hospitals in Lahore. A total of 455 dyspeptic patients aged 15–85 years were enrolled. Serum samples were collected and tested for H. pylori-specific IgG antibodies using both manual and automated ELISA kits. Data were analyzed using SPSS version 21.0, and associations with age and gender were assessed using the Chi-square test, with p < 0.05 considered significant. Results: Out of 455 patients, 102 (22.41%) tested positive for H. pylori. A higher prevalence was observed in males (56.86%) compared to females (43.13%). The highest prevalence occurred in the younger age groups: 15–25 years (28.4%) and 26–35 years (23.5%). A significant correlation was found between younger age and H. pylori positivity (p < 0.05). Conclusion: H. pylori infection remains an important cause of dyspepsia in Lahore, with higher prevalence in males and younger individuals. These findings highlight the need for early screening, timely diagnosis, and targeted treatment strategies in younger populations to prevent long-term complications.

Background: Right-renal-vein agenesis is an exceptionally rare congenital anomaly. Absent the orthotopic vein, renal blood diverts through collaterals and, in rare cases, a single hypertrophied cortical vein draining into the ipsilateral gonadal vein. Unrecognised, it can mimic thrombosis or tumour and, if the solitary channel is injured, cause catastrophic haemorrhage. Objective: To detail the presentation and multimodality imaging cues of right-renal-vein agenesis with exclusive cortical-to-gonadal drainage. Case Presentation: A 43-year-old expatriate man in Dubai reported vague right-flank discomfort and occasional tea-coloured urine. Examination and renal biochemistry were normal; urinalysis showed microscopic haematuria. Multiphase contrast-enhanced CT revealed no right renal vein entering the inferior vena cava; perirenal channels merged into a hypertrophied cortical vein descending to a dilated right gonadal vein. Colour and spectral Doppler demonstrated low-velocity monophasic venous flow, excluding shunt or arteriovenous malformation. The contralateral renal vein and both renal arteries were unremarkable. With preserved renal function and mild symptoms, conservative management was adopted; at one-year review the patient remained asymptomatic and imaging findings were unchanged. Conclusion: Identifying an absent orthotopic vein, dominant cortical collateral, preserved enhancement and venous Doppler waveform prevents misdiagnosis and averts inadvertent ligation during surgery. When blood pressure and renal function are stable, periodic imaging alone ensures a favourable prognosis.