Parathyroid hormone measurement in prediction of hypocalcaemia following thyroidectomy

To determine the risk of postthyroidectomy hypocalcaemia by measuring parathyroid hormone [PTH] level after thyroidectomy. Cross-sectional study. Baqiyatallah Hospital, Tehran, Iran, from March 2008 to July 2010. All included patients were referred for total or near bilateral thyroidectomy. Serum Calcium [Ca] and PTH levels were measured before and 24 hours after surgery. In low Ca cases or development of hypocalcaemia symptoms, daily monitoring of Ca levels were continued. Data were analyzed using SPSS 20 software [SPSS, Chicago, IL, USA]. A p-value less than 0.05 were considered statistically significant. To assess the standard value of useful predictive factors, we used receiver operating characteristic [ROC] curves. Of total 99 patients who underwent bilateral thyroidectomy, 47 patients [47.5%] developed hypocalcaemia, out of them, 12 [25.5%] became symptomatic while 2 patients developed permanent hypoparathyroidism. After surgery, mean rank of PTH level within the normocalcaemic and hypocalcaemic patients was 55.34 and 44.1 respectively, p=0.052. Twenty four hours after surgery, 62% drop in PTH was associated with 83.3% of symptomatic hypocalcaemic. For diagnosis of symptomatic hypocalcaemia, 62% PTH drop had sensitivity and specificity were 83.3% and 90.80%. The area under the ROC curve for the PTH postoperative and PTH drop for diagnostic symptomatic hypocalcaemia were 0.835 and 0.873 respectively. Measuring PTH levels after 24 hours postthyroidectomy is not reliable factor for predicting hypocalcaemia itself. For predicting the risk of hypocalcaemia after thyroidectomy it is more reliable to measure the serum PTH level before and after operation and compare the reduction level of percentage of PTH drop for predicting the risk of hypocalcaemia

[Comparison of "Read-Rives" and ''Lichtenstein'' repair for treatment of unilateral inguinal hernia]

''Lichtenstein'' tension-free mesh repair is the most common surgical techniques used for inguinal hernia repair." Read-Rives" method is tension-free, too, but here prosthesis is placed just over the peritoneum, and there is no weak area. The aim of this study was to compare the results of "Read- Rives" and Lichtenstein method in the hernioplasty. In this prospective randomized clinical trial 126 patients who had unilateral inguinal hernia were examined: 64 patients operated with Lichtenstein and 62 patients operated with Rives method. They evaluated for early post-operative complications, duration of surgery and hospital stay, return to normal activity, and then they followed for recurrence of hernia. Postoperative pain was significantly lower and the return to normal activity was shorter in Rives group. Duration of surgery and hospital stay and recurrence rate was equal, lower postoperative wound infection was found within Rives method. Although the ''Read-Rives'' method is not technically as simple as ''Lichtenstein'' method, but this procedure is easy to learn, so it is recommended because of its better final outcome in comparison with Lichtenstein repair

role of performing life support courses in rural areas in improving pre-hospital physiologic conditions of patients with penetrating injuries

To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. Experimental study. This study was carried out in Mehran city and its neighbouring rural districts in western part of Iran from 2002 to 2004. Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group [226 patients] consisted of those who received this cares by the trained group and second group [245 patients] were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score [PSS] was calculated to determine the physiologic condition of patients in both groups. The most prevalent cause of trauma in both groups was car accidents [61.6%]. Controlling of hemorrhage was the most frequent provided initial medical care [40.6%]. A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group [7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9]. The mortality rates of the first and second group of patients were 3% and 7.3%, respectively [p=0.051]. Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries

[Prehospital emergency service for internal medicine problems in pediatrics; causes, time indices and outcomes]

Although pediatric pre-hospital emergency medical services [EMS] are a main challenge of health care systems, few data exists over it. Current study of ambulance calls for medical causes relating to children in Tehran was conducted with the following aims: 1] assessment of the frequency of causes of EMS call, 2] assessment of time indices of service providing by EMS, and 3] to assess the correlation between outcomes and time indices. In this retrospective study, all calls to Tehran EMS system [Dial 115] for medical causes of children=<15 years old in Tehran between December 2005 and May 2006 were extracted. Demographic variables, accident type, patient outcome before hospital arrival, and ambulance time indices [response time, scene time, total run time, total run time hospital, transport time, round trip time] were registered. 1052 [15.5%] calls were for children. From these, 717 [68%] were due to problems of medic problems. The most frequent problem was epilepsy [26.8%], unconsciousness [18.1%] and respiratory disorders [15.2%]. 12 [5. 6%] subjects died before ambulance arrival, but no one died between scene and hospital arrival. Mean [SD] delay time, response time and scene time were 3.8 +/- 1.8, 15.1 +/- 6.9, and 23.5 +/- 10.9, respectively. The pre-hospital mortality was not correlated with any of the time intervals. One of six ambulance calls in Tehran is related to pediatric patients, most of them with a medical cause. Epilepsy, unconsciousness and respiratory disorders as the most frequent causes for EMS calls for medical problems highlights the need for planning for training of the EMS personnel with these problems. There is still a need for further improvement in time intervals of EMS services, which may be possible by proper management and equipping by more ambulances