Introduction: Hypertension is a global health challenge frequently exacerbated by poor adherence to pharmacological and restrictive dietary interventions. Low-Sodium Salt Substitutes (LSSS) offer a palatable alternative to traditional salt restriction. This case series evaluates the clinical impact of LSSS on blood pressure (BP) and body weight in a cohort of hypertensive patients. Methods: A retrospective analysis was conducted on five adult patients (n=5) with essential hypertension managed in an outpatient setting. Participants were transitioned from standard table salt to LSSS as an adjuvant to optimized antihypertensive pharmacotherapy. Longitudinal data on BP, body weight, and renal parameters (serum electrolytes, urea, and creatinine) were collected over six bi-weekly clinical visits. Results: The implementation of LSSS resulted in a mean systolic BP reduction of 16 mmHg and a mean weight loss of 6.7 kg over eight weeks. Significant improvements in renal clearance were observed, with mean serum creatinine decreasing from 1.48 mg/dL to 1.04 mg/dL. Serum potassium remained stable (mean: 3.98 mmol/L), demonstrating the safety of the intervention even in high-risk profiles, including a post-nephrectomy patient. Conclusion: LSSS is a highly effective, low-cost intervention that synergizes with pharmacotherapy to achieve rapid BP stabilization and sustained weight loss. These findings support the integration of salt substitutes into primary care protocols to improve therapeutic adherence and cardiovascular outcomes.

Gallbladder diseases are among the most common gastrointestinal conditions encountered in outpatient settings, with some evidence suggesting a higher prevalence among individuals with diabetes mellitus. This cross-sectional study aimed to identify risk factors associated with gallbladder diseases, particularly cholelithiasis and cholecystitis, and to evaluate the relationship between type 2 diabetes mellitus and gallbladder disease in symptomatic patients. The study was conducted over six months across multiple tertiary care hospitals in Rawalpindi and Islamabad and included 254 symptomatic patients presenting to surgical departments. Data were collected using a structured questionnaire, and statistical analysis was performed using SPSS version 27. The majority of participants were female (72.8%) and over 45 years of age (53.1%), with 53.9% having a normal body mass index. Type 2 diabetes mellitus was present in 24.8% of patients, and gallbladder disease was detected on ultrasound in 82.3% of cases. A significant association was observed between gallbladder disease and the use of estrogen–progestin medications (p = 0.010). No significant associations were found with diabetes mellitus, age, gender, body mass index, smoking status, physical activity, hypertension, lipid-lowering medication use, family history of diabetes, or parity. The findings indicate that type 2 diabetes mellitus is not significantly associated with gallbladder disease among symptomatic patients in this regional population, while hormonal medication use may represent an important risk factor.

The surgical management of acute calculus cholecystitis involves performing a cholecystectomy, and laparoscopic cholecystectomy is the current gold standard in the management of acute calculus cholecystitis. Laparoscopic cholecystectomy can be divided into early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy, and early laparoscopic cholecystectomy is increasingly being performed. Delayed laparoscopic cholecystectomy is now performed for patients who have failed to undergo early laparoscopic cholecystectomy. Single incision laparoscopic cholecystectomy and robotic -assisted laparoscopic cholecystectomy are new procedures that have been included for the surgical management of acute calculus cholecystitis. In this review, we will investigate the role of conventional laparoscopic cholecystectomy, single-incision laparoscopic cholecystectomy, and robotic -assisted laparoscopic cholecystectomy in the management of acute calculus cholecystitis.

The menstrual cycle is a vital indicator of a woman’s reproductive health. A typical cycle ranges between 21–35 days and is regulated by the Hypothalamic–Pituitary–Ovarian (HPO) axis. However, several internal and external factors can disrupt this cycle, leading to irregularities such as delayed menstruation. One of the most common causes of menstrual irregularities is stress. Stress is the body's response to emotional, physical, or environmental pressures. It triggers physiological reactions such as increased cortisol production, elevated heart rate, and hormonal imbalance. Stress is one of the most common psychological and physiological challenges faced by university students. Academic pressure, financial constraints, relationship issues, inadequate sleep, and environmental changes can significantly affect students’ health, including their menstrual cycle. Delayed menstruation (also called oligomenorrhea) is a common menstrual disorder characterized by cycles longer than the usual 21–35 days. Stress is the body’s response to any demand or challenge. It triggers the release of stress hormones such as cortisol and adrenaline, which can disturb normal bodily functions. A normal menstrual cycle is regulated by the Hypothalamic–Pituitary–Ovarian (HPO) Axis. Any disturbance in this axis especially hormonal imbalance may lead to delayed menstruation, missed periods and irregular cycles. This study is aim to evaluate the Stress as a Predictor of Menstrual Delay Among Students in Tertiary Institutions In South-South Nigeria. This was a cross-sectional study involving 250 women. A well-structured questionnaire was administered to participants. The study lasted for a period of 2 months. Statistical analysis was done using SPSS version 25.0 and p < 0.05 was significant. The results revealed that 75% of the participants had high academic workload, 64% are facing overcrowding living conditions, 72% are facing financial constraints, 68% are having environmental and security concerns and 86% are facing noise and distractions around campus. These factors increase psychological stress, potentially affecting menstrual health.

The management of acute appendicitis involves performing an appendectomy, which can be done as an open or laparoscopic method. Since its introduction, laparoscopic appendectomy has been performed for both uncomplicated and complicated appendicitis. Laparoscopic appendectomy is minimally invasive and associated with reduced postoperative complications, early ambulation, and faster recovery. Single incision laparoscopic appendectomy and natural orifice transluminal appendectomy are newer variants of minimally invasive surgery that are being performed for acute appendicitis. In this review, we will investigate the role of laparoscopic appendectomy, single incision laparoscopic appendectomy, and natural orifice transluminal appendectomy in the management of acute appendicitis.

Background: Pulmonary tuberculosis (TB) continues to be a major global health problem, with post-tuberculosis lung disease (PTLD) emerging as an underrecognized sequela. Among its various manifestations, “destroyed lung” represents a progressive, debilitating outcome characterized by irreversible structural damage, recurrent infections, and significant impairment of quality of life. Despite successful completion of anti-tuberculosis therapy (ATT), patients often suffer long-term pulmonary morbidity. This case series highlights two patients with advanced PTLD presenting as destroyed lung, emphasizing the natural history, diagnostic challenges, and therapeutic outcomes. Case Presentation: The first case involves a 48-year-old male with a history of delayed TB diagnosis for three years, during which he was empirically treated for pneumonia, typhoid, and jaundice by various practitioners. Eventually, he was diagnosed with pulmonary TB and treated for eight months at a government center, with treatment deemed successful. However, after eight years of treatment completion, he presented to our center with recurrent respiratory symptoms. Bronchoscopy revealed a necrotic mucosal lumen with suppurative secretions in the left main bronchus extending into both upper and lower divisions. The bronchial anatomy was markedly distorted with dilated, ectatic bronchi. Bronchoalveolar lavage (BAL) cultures demonstrated colonization with Pseudomonas aeruginosa and Klebsiella pneumoniae. BAL GeneXpert MTB/RIF was negative, excluding active TB. He was managed with meropenem, amikacin, nebulized bronchodilators, and supportive care, showing marked clinical improvement after 14 days. The second case is a 51-year-old male with a delayed diagnosis of TB for two years. He too had initially been misdiagnosed and treated empirically for non-specific febrile illnesses. Eventually, he completed one year of ATT at a government center and was declared cured. Ten years later, he presented with persistent and recurrent pulmonary symptoms. Bronchoscopic evaluation revealed necrotic mucosa with purulent secretions in the right main bronchus, involving upper, middle, and lower divisions. The bronchial tree was distorted with extensive ectatic changes. BAL culture grew Pseudomonas aeruginosa and Klebsiella pneumoniae, while GeneXpert MTB/RIF was negative. He was treated with the same regimen as the first case and demonstrated a favorable outcome after two weeks of therapy. Discussion: Both patients highlight the long-term sequelae of delayed TB diagnosis and management. Even after microbiological cure, chronic structural lung damage predisposed them to persistent colonization with pathogenic organisms, recurrent infections, and functional impairment. These cases underline that destroyed lung syndrome is largely preventable with early recognition of TB, timely initiation of ATT, and structured follow-up care. Importantly, both cases reinforce that post-tuberculosis sequelae require comprehensive management beyond TB treatment completion, integrating bronchodilator therapy, infection control, and long-term pulmonary rehabilitation. Conclusion: Destroyed lung as a PTLD manifestation represents the culmination of delayed diagnosis and chronic lung injury rather than treatment failure or reactivation. Early detection, timely treatment, and structured long-term surveillance could prevent this disabling outcome. These cases emphasize the urgent need for public health strategies addressing PTLD to reduce the burden of preventable chronic respiratory morbidity.

Lower lung field tuberculosis (LLFTB) is an uncommon presentation of pulmonary tuberculosis and is often misdiagnosed as bacterial pneumonia or other lower respiratory tract infections. Its atypical radiographic pattern and transient response to empirical antibiotics can delay definitive diagnosis. We report the case of a 50-year-old male who presented with recurrent episodes of acute febrile respiratory illness, each separated by a two-week symptom-free interval. The patient required hospitalization on three occasions. Each episode showed partial remission with empirical antibiotic therapy, but symptoms recurred after antibiotic withdrawal. Chest radiography demonstrated infiltrates confined to the lower lung fields. HRCT (high resolution computerised tomography) imaging’s documented nodular infiltrates in right middle and lower lobe with mild pleural effusion. Given the recurrent nature and incomplete resolution, flexible bronchoscopy was performed as a point-of-care diagnostic tool, revealing endobronchial changes suggestive of tuberculosis and yielding bronchial washings positive for Mycobacterium tuberculosis on GeneXpert MTB/RIF assay. The patient was initiated on standard first-line anti-tubercular therapy with marked clinical and radiological improvement, and no further relapses over a 6-month follow-up. LLFTB can mimic recurrent bacterial pneumonia. Early bronchoscopy at the point of care facilitates timely diagnosis and initiation of specific therapy, preventing repeated hospitalizations and morbidity.