Introduction: This study aimed at determining the frequency and association of stress levels with modes of transportation and was likely to reveal the contributing transportation-related factors for stress in medical students. Methods: This was a questionnaire-based, cross-sectional study that included undergraduate medical students of a public sector medical university in Karachi, Pakistan. A total of 573 students participated voluntarily, of which 300 were provided a manual questionnaire and 273 filled it online. The reliability of the questionnaire was assessed using Cronbach’s alpha at 0.791. The collected data were analysed using IBM SPSS Statistics for Windows, version 21.0. Results: Out of 573 participants, 99.3% (n = 298) of students filled the questionnaire manually, whereas 100% of students filled the questionnaire online. Almost two-thirds of students used university transport; more than 90% lived more than 5 km from the university and 56% had a traveling time of more than an hour. Approximately 15.4% of students reported physical trauma and some form of harassment. Sheldon Cohen’s stress scale surprisingly revealed 90% of students to be within the moderate-to-high stress category. Risk factors were associated with stress levels and significant associations were observed with noise exposure (P = 0.023) and sleep quality (P = 0.001). The most common reported stressors associated with commuting included overcrowding, long travel, and air and noise pollution. Noise pollution was the main predictor of stress among commuters. Conclusion: Poor transportation has adverse effects on health and academic performance. Administration in their respective jurisdictions is needed to investigate this matter to make commuting a routine rather than a hassle.

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Introduction and importance A MEST is a rare renal tumor, with stromal as well as epithelial components. It is predominantly benign and local recurrence is not very common. In the majority of the cases, it occurs in females. Its occurrence in a young male makes it a rarity. Case presentation A 24 years old male presented at SIUT with the complaint of left flank pain on and off for one month. CT scan showed soft tissue density mass in left renal pelvis extending from mid-pole calyces to pelviuretric junction, leading to obstruction and ultimately mild uropathy. We found a partially obstructing staghorn calculus with asymmetrical cortical thinning. Left Robot-Assisted Nephro-ureterectomy plus excision of bladder cuff was planned in which 3 × 4 cm mass involving the left renal pelvis was excised. To date, there is no radiologic evidence of disease recurrence. Clinical discussion MEST in young adults is an extremely rare tumor. They have been referred to by many alternate synonyms including ‘adult mesoblastic nephroma’ and ‘cystic nephroma’ with ‘ovarian’ or ‘cellular’ type stroma. Majority of patients with MEST present, with hematuria, abdominal pain, palpable flank mass, recurrent urinary tract infections. Similarly, our patient presented initially with nonspecific pain in the left flank region. Majority of cases in the literature presented with the tumor in benign stage, with localized spread, and without recurrence. Conclusion Mixed epithelial and stromal tumors (MEST) of the kidney are distinct entities of benign kidney tumors. MEST in young males is a very rare entity, and a small number of cases exist. Histopathology plays a very cardinal role in diagnosis, and overall the disease has a promising outcome with conservative surgery.