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.

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.

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.

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.