Role of Postoperative Intact Parathyroid Hormone Levels in Predicting Hypocalcaemia after Thyroidectomy.

OBJECTIVE: To determine the sensitivity and specificity of intact parathyroid hormone (iPTH) levels in predicting hypocalcaemia after thyroidectomy. STUDY DESIGN: A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa International Hospital and Shifa Foundation, Islamabad, from May 2021 to 2022. METHODOLOGY: The sample size was calculated to be 205 with consecutive non-probability sampling. Serum iPTH levels and serum calcium levels were measured postoperatively at 6 hours and 24 hours and recorded in a proforma for analysis. After collection, the data were entered and analysed using SPSS version 24.0. RESULTS: Among 205 patients, 157 (76.6%) were females and 48 (23.4%) were males. At 6 hours postoperatively, 121 (59%) patients had normal iPTH levels and 123 (60%) patients had normal serum calcium levels (p = 0.15). At 24-hour, 130 (63.4%) patients had normal iPTH levels and 92 (44.9%) patients had normal serum calcium levels (p = 0.001). Overall, 8 (3.9%) patients developed symptomatic hypocalcaemia (p = <0.001). The sensitivity and specificity of iPTH levels at ≤15 pg/ml were 100% and 70%, respectively, but at 24 pg/ml cut-off level, the specificity increased to 90% with sensitivity of 100%. CONCLUSION: Low serum iPTH levels at 6 hours after surgery can predict hypocalcaemia in patients undergoing thyroidectomy, even if serum calcium levels appear normal at that time. KEY WORDS: Parathyroid hormone, Serum calcium, Hypocalcaemia, Total thyroidectomy, Calcium homeostasis.

Late Presentation of Acute Limb Ischemia: Causes and Outcomes.

OBJECTIVE: To determine the causes of interventions in patients with acute limb ischemia (ALI), the time lapse of presentation, and the outcome. STUDY DESIGN: An observational study. METHODOLOGY: All delayed acute limb ischemia cases (presenting later than 6 hours after the onset of symptoms) were included in the study. Cases of ALI secondary to accidental trauma were excluded except those of iatrogenic trauma like patients with intravenous drug abuse and intra-arterial accidental drug infiltration. Patients' demographic data, clinical history, aetiology, examination findings, and treatment data; including type of surgery, level of amputation, adjunctive treatment were recorded. RESULTS: Total number of delayed ALI cases was 147. Mean age was 59.52 ±17.77 years. Seventy-five (51%) were females while 72(49%) were males. The right lower limb was involved in 56(38%) cases. A hundred (68%) thromboembolectomies were successful and limbs were saved, while 19(12.9%) had failure after the procedure. Three (2%) patients expired within 24 hours of thromboembolectomy. Twenty-five (17%) had frank gangrene at presentation and ended up in amputations while 122 (82.9%) had questionable viability and underwent limb salvage procedures. CONCLUSION: Delayed presentation of ALI is very common; timely management with effective thromboembolectomies can save limbs in most of the patients. KEY WORDS: Acute limb ischemia (ALI), Treatment, Amputation, Thromboembolectomy, embolism.

Clinicopathological Characteristics of Prostate Cancer in Patients Presenting to a Tertiary Care Private Sector Hospital.

Prostate cancer (PCa) is one of the leading cancers in older males. The aim of this study was to evaluate the clinico-pathological characteristics of prostate cancer and rate of detection of prostate cancer by DRE (digital rectal exam) in patients presenting to a tertiary care private sector hospital in Islamabad, and determine the awareness about PCa in these patients. There were 226 patients who presented from December 2009 to December 2015 having mean age of 68.63 ±8.76 years and median Prostate Specific Antigen (PSA) value of 19.12 ng/mL (IQR=35.8). Median prostatic volume was 49 (IQR=22) gram/cc in the subjects. DRE was abnormal in 164 (72.56%) patients and normal in 62 (27.43%) patients only. Majority of patients presented relatively late, which may be due to lack of screening programme or public awareness.