Role of Intact Parathormone Levels as Early Predictor of Asymptomatic Hypocalcaemia after Total Thyroidectomy.

Asymptomatic hypocalcemia is one of the complications of total thyroidectomy. The symptoms of low calcium levels are sometimes evident only after about 48-72 hours after surgery. Serum calcium levels are not reliable in identifying these patients, because a large number of them are only those with transient hypocalcemia. This study was carried out to evaluate the role of intact parathormone levels in predicting asymptomatic hypocalcemia.METHODSThis cohort study was carried out among 43 patients, who underwent total or completion thyroidectomy. The serum ionized calcium & creatinine levels were measured preoperatively, to rule out pre-operative hypoparathyroidism. Following surgery (one-hour post operatively), the patients’ serum PTH levels and serum ionized calcium levels were measured. Simultaneously, hypocalcemia was clinically evaluated.RESULTSOut of 43 patients, 30 patients had low hypocalcemia (<1.1 mmol/l) one hour postoperatively. The incidence of initial asymptomatic hypocalcaemia post-surgery was 70.5%. All patients with low iPTH, except one, also had hypocalcaemia initially. The patient with normal calcium subsequently had hypocalcaemia at 6 hours.CONCLUSIONSWith the prediction of asymptomatic hypocalcemia in the early post-operative period, it is possible to start timely treatment and thereby prevent the complications of hypocalcemia.

Usefulness of Modified Alvarado Score in Acute Appendicitis Incorporating Ultrasound.

Acute appendicitis affects human beings irrespective of age, nationality and region. Acute appendicitis is the most common surgical cause of emergency laparotomy. Considering the difficulties and challenges involved in accurate clinical diagnosis, there is a need for a validated, objective protocol for enabling the diagnosis. This study was carried out to validate the modified Alvarado score (MASS) and correlate with ultrasound and post-operative histopathological examination.METHODSThis cohort study was carried out among 100 patients who were suspected with acute appendicitis. Upon clinical evaluation and ultrasound evaluation, Modified Alvarado Score was computed, and patients were taken up for laparotomy/ laparoscopic surgery. The resected specimens were sent for histopathological examination.RESULTSMajority of the participants had a score >7 (74%) of which 51 were males, 21 were females and two were children. Ultrasound detected positive cases in 90% of the participants, while acute appendicitis by histopathology was present in 54% of the participants. There was a statistically significant correlation with Modified Alvarado score (p<0.0001). Negative appendicectomy was prevalent in 21% of the participants.CONCLUSIONSModified Alvarado Scoring system is ideal for the diagnosis of acute appendicitis since it is simple to use, easy to apply and relies only on history, clinical examination and basic lab investigations.