Dual Diagnostic Dilemma: Gitelman Syndrome and Incidental Neuroendocrine Tumor in a Young Adult With Refractory Hypokalemia.

We report the first documented case of Gitelman syndrome coexisting with a metastatic pancreatic neuroendocrine tumor in a 19-year-old male, presenting with severe refractory hypokalemia (K⁺ 1.4-1.7 mmol/L), metabolic alkalosis, and hypomagnesemia.

Association Between Sleep Quality and Cognitive Complaints Among Young Adults With Migraine.

Aim Migraine is widely recognized as one of the most disabling neurological conditions, often accompanied by recurrent headache attacks along with disruptions in sleep and cognitive function. While previous studies have assessed sleep deficits and mental impairments in individuals with migraine, limited attention has been given to the intricate relationship between these variables, particularly in young adults. This study explores the association between sleep quality and cognitive complaints in individuals experiencing migraine, alongside an evaluation of migraine severity and caffeine consumption.

Borderline Resectable Pancreatic Cancer: Neoadjuvant Chemotherapy, Stereotactic Body Radiotherapy (SBRT), and Surgery.

Pancreatic adenocarcinoma remains a highly fatal cancer, especially when classified as borderline resectable, characterized by limited involvement of surrounding major blood vessels that challenges but does not absolutely preclude curative surgical resection. We report the case of a 65-year-old male with a history of smoking who presented with progressive, painless jaundice, pruritus, and weight loss over 15 months. Imaging revealed intrahepatic biliary dilation, a distal common bile duct stricture, and a mass in the pancreatic head with peripancreatic lymphadenopathy.

The Great Mimicker: Pancreatic Tuberculosis Masquerading as a Pancreatic Neoplasm.

Pancreatic tuberculosis is a rare manifestation of extrapulmonary tuberculosis, often mimicking pancreatic cancer clinically and radiologically. We report a 26-year-old immunocompetent farmer from a tuberculosis-endemic area presenting with a two-month history of fever, night sweats, and significant weight loss. Although malignancy was suspected, contrast-enhanced computed tomography of the abdomen showed a complex lesion in the pancreatic body with central necrosis and an enlarged lymph node.

Optimizing Anticoagulation Strategies in Patients With Atrial Fibrillation and Valvular Heart Disease: A Comprehensive Evidence-Based Review.

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, significantly increases the risk of thromboembolism and stroke. Its coexistence with valvular heart disease (VHD) further complicates management due to elevated risks of thromboembolism, bleeding, and mortality. This review explores the pathophysiology of AF and its interaction with VHD, focusing on diagnostic tools like echocardiography and risk stratification scores such as CHA2DS2-VASc and HAS-BLED.

Prevalence and Clinical Features of Uterine Isthmocele Following Cesarean Sections: An Observational Study at Rabia Balkhi Hospital in Afghanistan.

Background Uterine isthmocele, a defect in the uterine wall at the cesarean scar, is increasingly recognized due to the rising rate of cesarean deliveries. Often asymptomatic, it may lead to complications such as abnormal bleeding, chronic pelvic pain, secondary infertility, or uterine rupture during subsequent pregnancies. Objective This study aimed to assess the prevalence, clinical features, and associated risk factors of uterine isthmocele among women with previous cesarean scars over four years (2019-2023) at Rabia Balkhi Hospital, Afghanistan.

Outcomes of Fenestration of Lamina Terminalis for Hydrocephalus following Clipping of Ruptured Aneurysms of Anterior Circulation.

Objectives: To evaluate the Outcomes of Fenestration of Lamina Terminalis for Hydrocephalus following Clipping of Ruptured Aneurysms of Anterior Circulation.

Methods: A retrospective case series study was conducted at the Punjab Institute of Neurosciences, Lahore from August 2022 to July 2023. Seventy seven patients meeting the inclusion criteria of age group 20-65 years, ruptured saccular aneurysm of anterior circulation with or without lamina terminalis fenestration during clipping, were enrolled through non-probability convenience sampling.

The Management of Osteoporosis in Chronic Kidney Disease: A Review of Diagnostic and Therapeutic Approaches.

Chronic kidney disease (CKD) has shown a growing association with osteoporosis, comprising part of the broader CKD-mineral and bone disorder (CKD-MBD). CKD-MBD is marked by alterations in calcium, phosphorus, parathyroid hormone (PTH), and vitamin D metabolism, significantly elevating fracture risk. While traditional osteoporosis treatments such as bisphosphonates, denosumab, and teriparatide have been adapted for CKD patients, recent innovations have introduced agents aimed at enhancing bone mass and reducing fracture incidence.

Mifepristone's Efficacy for Symptomatic Relief and Size Reduction in Uterine Fibroids: A 2023 Prospective Observational Study at Rabia Balkhi Hospital, Afghanistan.

Background Uterine fibroids (leiomyomas) are common benign tumors, affecting 70-80% of women by age 50, and can cause symptoms such as heavy bleeding, pelvic pain, and pressure, significantly impacting the quality of life. In severe cases, fibroids may lead to infertility or miscarriage, making their management a key healthcare challenge. Traditional treatments, including hysterectomy, may not be suitable for women wishing to preserve fertility or avoid surgery.

Acute Onset Budd-Chiari Syndrome in the Postpartum Period: A Case of Missed Diagnosis Leading to Rapid Deterioration.

Budd-Chiari syndrome (BCS), a rare hepatic vein obstruction condition, poses significant risks during gestation and the postpartum period. We present the case of a 30-year-old primigravida at 32 weeks gestation admitted with weakness and lethargy, which was diagnosed with impending uterine rupture, HELLP syndrome, and intrauterine fetal demise. An emergency cesarean section was performed, delivering a stillborn baby and uncovering 700 milliliters of blood clots in her abdominal cavity.

THE DICHOTOMY BETWEEN HEAT SHOCK PROTEIN-27 AND MICROALBUMIN: COVARIATE OF EARLY DIABETIC NEPHROPATHY.

Background: Heat shock protein-27 is the microprotein released from renal parenchyma during diabetic oxidative stress, while microalbumin is the plasma protein that appears in urine in diabetic nephropathy.

Methods: This case-control study was conducted from Jan to Sep 2021 in the Physiology department, BMC, BMCH, Quetta. The current study included 105 patients with an age range from 30-50 years and was divided into three groups: i) a control group of healthy participants, ii) a diabetic risk group: participants without signs of diabetic nephropathy and diabetic duration from 1-5 years, iii) diabetic nephropathy group: participants having >30 mg/dl of v microalbumin in urine and diabetic duration from 5-10 years.

Evolving Horizons in Pediatric Leukemia: Novel Insights, Challenges, and the Journey Ahead.

Pediatric leukemia, encompassing acute lymphoblastic leukemia (ALL) and acute myeloid leukemia, remains a formidable challenge despite significant treatment advancements. This review examines recent developments in immunotherapy, chemotherapy, and bone marrow transplantation for pediatric leukemia through a comprehensive analysis of recent literature, focusing on critical studies and clinical trials. Immunotherapy, including monoclonal antibodies, such as blinatumomab and inotuzumab ozogamicin, and chimeric antigen receptor T-cell therapies, such as tisagenlecleucel and brexucabtagene autoleucel, have demonstrated promising results in relapsed or refractory B-cell ALL (B-ALL), achieving notable remission rates with manageable side effects.

A Complex Case of Obstructive Jaundice in a Septuagenarian: Diagnostic Challenges and Therapeutic Strategies.

Obstructive jaundice occurs when an obstruction in the bile duct system prevents bile from flowing from the liver into the intestine, accumulating bilirubin in the blood. This condition can result from various causes, including gallstones, tumors, or inflammation of the bile ducts. The management of obstructive jaundice depends on the underlying cause (malignant obstructions such as cholangiocarcinoma or pancreatic cancer), indicating the need for surgical intervention.

Prevalence and Severity of Sensorineural Hearing Loss in Diabetic and Hypertensive Patients: A Comparative Cross-Sectional Study.

Background The ability to perceive sound is crucial for effective communication and environmental awareness. This study aimed to assess sensorineural hearing loss (SNHL) in patients with both diabetes mellitus (DM) and hypertension (HTN). Materials and methods A total of 120 participants of both genders were divided into three groups: Group I consisted of diabetic patients (n=40, 22 males and 18 females), Group II included hypertensive individuals (n=40, 16 males and 24 females), and Group III served as controls (n=40, 15 males and 25 females).

The Synergistic Relationship Between Atrial Fibrillation and Diabetes Mellitus: Implications for Cardiovascular and Metabolic Health.

Type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF) are widespread chronic conditions that profoundly impact public health. While the intricate mechanisms linking these two diseases remain incompletely understood, this review sets out to comprehensively analyze the current evidence about their pathophysiology, epidemiology, diagnosis, prognosis, and treatment. We reveal that T2DM can influence the electrical and structural properties of the atria through multiple pathways, including oxidative stress, inflammation, fibrosis, connexin remodeling, glycemic variability, and autonomic dysfunction.

Overlapping Autoimmune Diseases: A Case Report and Review of Eosinophilic Granulomatosis With Polyangiitis and Mixed Connective Tissue Disease.

We describe a rare case of concurrent eosinophilic granulomatosis with polyangiitis and mixed connective tissue disease in a 27-year-old man who presented with pulmonary, renal, cardiac, and skin manifestations. We confirmed the diagnosis based on clinical, histopathological, and serological criteria. We treated the patient with corticosteroids, methotrexate, cyclophosphamide, and hydroxychloroquine, achieving early remission.

Smoking and Pancreatic Cancer: Smoking Patterns, Tobacco Type, and Dose-Response Relationship.

Pancreatic cancer (PC) is the primary cause of cancer death in the United States and Europe. Despite remarkable advances in the molecular understanding of PC and advances in new therapeutic approaches, PC remains a disease with a poor prognosis. Although evidence indicates that long-term smoking is a major cause of PC, the molecular pathways behind smoking-induced PC pathogenesis are not fully understood.

CT Colonography and Colorectal Carcinoma: Current Trends and Emerging Developments.

Colorectal carcinoma is the third most malignant and second leading cause of death from cancer. The cruelty of this entity is that it takes decades to be symptomatic and is known to be detected late in its timeline by a screening technique. The fatality of this carcinoma only means heightened importance of screening guidelines to be laid down and strict follow-ups by the healthcare providers.

Alzheimer's Disease and Stroke: A Tangled Neurological Conundrum.

A neurodegenerative disorder, Alzheimer's disease (AD), is characterized by dementia in which there is an age-related decline in cognition and higher functions. Stroke is a cerebrovascular disorder that frequently presents in old age and is a known risk factor for AD development. However, the association that AD can be a risk factor for stroke is not well-studied.

Congenital Anomalies in Infant With Congenital Hypothyroidism: A Review of Pathogenesis, Diagnostic Options, and Management Protocols.

Thyroid hormones (TH) regulate growth, nervous system myelination, metabolism, and physiologic functions in nearly every organ system. Congenital hypothyroidism (CH) is one of the most common endocrinopathies in children and has potentially devastating neurologic and developmental consequences. The etiology and clinical manifestations of hypothyroidism in children differ from adults.

Depression and Vitamin D: A Peculiar Relationship.

Depression is a psychiatric disorder characterized by various symptoms that can impact one's quality of life. Vitamin D, a fat-soluble vitamin, is well-known for its role in bone health, and research on its effects on mental health has only recently emerged. Vitamin D deficiency is widespread worldwide, and it has been linked to an increased risk of depression.

Assessment of knowledge and attitude trends towards antimicrobial resistance (AMR) among the community members, pharmacists/pharmacy owners and physicians in district Sialkot, Pakistan.

Background: Antimicrobial resistance (AMR) is an emerging threat to public health worldwide. A significant evidence has suggested that the knowledge and attitude trends among the community, pharmacists and physicians can play a critical role in managing the ever increasing threat of AMR.

Methods: A cross-sectional survey was performed using three specific self-administered questionnaires for community members, pharmacists/pharmacy owners and physicians on a randomly selected sample population of 473, 424 and 308 respectively.