Acute calculus cholecystitis during pregnancy represents the second most prevalent cause of non-obstetric abdominal pain in this population. Clinically, it manifests as upper abdominal pain, with ultrasonography serving as the primary imaging technique for diagnosis. Management strategies for acute calculus cholecystitis in pregnant patients can be categorized into non-operative approaches, which include the administration of intravenous antibiotics and analgesics, and laparoscopic cholecystectomy, which is feasible across all three trimesters of pregnancy. Both therapeutic modalities are associated with potential maternal complications and fetal loss. This review aims to examine the diagnostic and therapeutic approaches for acute calculus cholecystitis in pregnancy. We will explore the roles of both conservative treatment and cholecystectomy in managing this condition, as well as the potential application of gallbladder drainage in pregnant patients with acute calculus cholecystitis.

The occurrence of COVID-19 in the context of autoimmune or autoinflammatory disease prompts practitioners involved in the management of these conditions to investigate the pathophysiological, clinical, therapeutic, and evolutionary implications. The patients with autoimmune and autoinflammatory diseases that contract COVID-19 present both acute infectious systemic inflammatory process and chronic non-infectious systemic inflammatory process, which raise the interesting research question: is there an over-risk for severe exacerbation? In-deepth understanding of these pathophysiological implications, may allow practitioners involved in the management of these conditions to update and refine their knowledge, enable researchers to pursue the therapeutic targets research, and help health policy makers to adjust and improve prevention and treatment strategies. To provide a relevant synthesis on the interface and the overlap that can exist between these two conditions: acute infectious systemic inflammatory process (COVID-19) and chronic non-infectious systemic inflammatory process (autoimmune and autoinflammatory diseases), we conducted a literature review of the literature. Therefore, this literature review has six objectives. First, to present the etiological factor of COVID-19, the etiopathogenic factors of COVID-19, the pathophyiological factors of COVID-19 and the subsequent clinical expressions. Second, to expose the etiological factor of autoimmune and autoinflammatory diseases, the etiopathogenic factors of autoimmune and autoinflammatory diseases, the pathophyiological factors of autoimmune and autoinflammatory diseases, and the resulting clinical expressions. Third, to analyze the relationship between acute infectious systemic inflammatory process (COVID-19) and chronic non-infectious systemic inflammatory process (autoimmune and autoinflammatory diseases).

Managing urinary tract infections (UTI) in people living with dementia presents a mortality paradox: clinicians must balance the risks of antibiotic overuse against the dangers of delayed treatment in high-risk phenotypes. Standard diagnostic criteria often rely on classic, localizing markers like fever and dysuria. However, these gatekeeper signs are frequently absent or blunted in dementia care due to age-associated immune dysregulation and immunosenescence. Consequently, infections often manifest as nonspecific neurobehavioral changes, leading to predictable misclassification and harmful diagnostic delays. This paper reframes UTI management in dementia as a clinical pathway and measurement architecture problem. We propose a verification-first service pathway that replaces symptom-first heuristics with objective diagnostic certainty and closed-loop follow-up. The model incorporates physiologic stability triage, risk stratification for vulnerable phenotypes, and a standardized confirmation bundle. To ensure operational reliability, the pathway is linked to four auditable key performance indicators focused on verification completion, avoidable antibiotic starts, time-to-action, and stewardship follow-up. By treating diagnostic infrastructure as a system property, this approach aims to reduce "sticky empiricism" and improve safety in the face of clinical ambiguity.

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.