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Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It continues to be one of the most common causes of death in adults across all countries. It is found to be relatively lower in North America. When aerosol droplets that contain Mycobacterium tuberculosis are inhaled, it can deposit in the respiratory tract, particularly in the patient's lungs. Following this deposition, one of the four outcomes can take place. These include clearance of the organism immediately, primary disease, latent infection, and reactivation disease. Unhindered bacterial growth after primary infection can lead to a hematogenous spread of bacilli to produce disseminated TB. Esophageal involvement causing esophageal TB can be primary or secondary esophageal TB.We present a unique case of secondary esophageal TB with symptoms of dysphagia and odynophagia with primary TB focus on the lung. Computed tomography (CT) of the chest noted diffuse bilateral miliary lung disease. TB QuantiFERON gold and sputum culture were positive for TB. Mycobacterial culture for identification with high-performance liquid chromatography showed isoniazid-resistant TB. The patient was started on antitubercular therapy with rifampin, ethambutol, moxifloxacin, and pyrazinamide for a total of nine months. Esophagogastroduodenoscopy (EGD) reported severe ulcerations of the oropharynx and focal ulceration in the proximal to the mid esophagus. Histopathology revealed active ulcerative and granulomatous esophagitis with mycobacterial organisms. After EGD she was started on a full liquid diet and advanced as tolerated. After discharge, she followed with the Health Department and had three negative sputum cultures after the completion of therapy.

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Period poverty is the lack of access to menstrual supplies, hygiene education, and waste management which can lead to severe health outcomes. In developing countries like Pakistan, menstruation and menstrual practices still face many social, cultural, and religious restrictions, which form a barrier to menstrual hygiene management and creating awareness, especially in less privileged areas of the country. However, in the present condition of catastrophic floods in Pakistan that has affected 33 million people leaving 1 million homeless 1 has exposed women to more vulnerable sexual reproductive and health items. A survey which was held to check the resources used by women during current conditions of flood showed that women are using leaves, torn pieces of cloth, dirty rugs, and even cans instead of sanitary pads to manage their bleeding 2Moreover, food and water is given more priority over basic needs of women like sanitary pads, which are considered luxurious items. By reviewing the literature, we found that lack of menstrual hygiene is one of the main causes of lower reproductive tract infections that can lead to morbidity and severe health conditions.3 Another cross-sectional study also shows same results that the more women use these unhygienic methods to manage their bleeding the more they are exposed to the risk of lower reproductive tract infections4 In 2017, a similar UNICEF supported study conducted in Pakistan t showed that 49%of women in rural areas had no menstrual knowledge prior to their menarche and 44% didn’t have access to basic menstrual hygiene needs5 All the aforementioned studies raise the question: Is sanitary pads a luxury or a necessity? The circumstances caused by flood can be taken as an opportunity by the government to bring long-term changes by suggesting certain plans by to eradicate period poverty permanently from society. Lack of access to period products can occur mainly due to financial and physical barriers. The government should start an awareness program, and make the basic resources accessible at cheaper costs especially in less privileged and rural areas of the country that can also help to break the social taboo of not considering period products as important as food and water.