Prophylactic Oral Calcium Reduces Symptomatic Hypocalcemia in Patients undergoing Total or Subtotal Thyroidectomy: a Randomized Controlled Trial

Objectives: Prophylactic oral calcium supplement has been proposed in patients undergoing thyroidectomy in order to decrease incidence of postoperative hypocalcemia, and the duration of hospital stay. This study aimed to assess the effects of prophylactic oral calcium in patients undergoing total or subtotal thyroidectomy.Methods: Forty three patients who were scheduled for total and subtotal thyroidectomy, were randomly allocated to the case (n=23) and control (n=20) groups. Oral calcium carbonate (1 gram q 8 hours) was given to the patients in the case group starting 12 hours before surgery till 7 days post thyroidectomy. Clinical symptoms of hypocalcemia and postoperative calcium levels were compared between the two groups.Results: The mean postoperative calcium level 12 hours after surgery was not statistically different between the two groups (8.9±0.5 vs. 8.5±0.7, p=0.092); while after 24 hours, calcium level was significantly lower in the control group (8.9±0.5 vs. 8.4±0.8, p=0.037). The number of patients who had paresthesia was significantly higher in the control group than case group, at both 12 hours (p=0.02) and 24 hours postoperatively (p=0.04). Duration of hospitalization was significantly lower in the case group compared to the control group (p=0.006).Conclusions: Prophylactic oral calcium supplementation decreases the hypocalcemia related paresthesia after thyroidectomy and shortens duration of hospital stay

Comparison of adrenalectomy with conservative treatment on mild autonomous cortisol secretion: a systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis was conducted to compare the benefits of adrenalectomy and conservative treatment for comorbidities associated with mild autonomous cortisol secretion (MACS) in patients diagnosed with MACS.BackgroundMACS is the most common benign hormone-secreting functional adrenal incidentaloma. Overproduction of cortisol is observed in MACS patients, resulting in a variety of long-term health issues, including arterial hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and osteoporosis; however, the classic clinical manifestations of Cushing’s syndrome (CS) are not present.MethodsA systematic search was conducted using MEDLINE, Embase, Web of Sciences, and Scopus databases on December, 2023. Two reviewers independently extracted data and assessed the quality of the included articles. A meta-analysis was performed to compare the beneficial effects of adrenalectomy versus conservative management for MACS-related comorbidities.ResultsFifteen articles were included in this study, which evaluated 933 MACS patients (384 Adrenalectomy and 501 Conservative treatment, and 48 excluded due to incomplete follow-up duration). MACS diagnosis criteria were different among the included articles. All studies, however, stated that there must be no overt CS symptoms. Meta-analysis demonstrates the overall advantage of adrenalectomy over conservative treatment for MACS-related comorbidities (Cohen’s d = -0.49, 95% CI [-0.64, -0.34], p = 0.00). Subgroup analysis indicated that the systolic blood pressure (pooled effect size = -0.81, 95% CI [-1.19, -0.42], p = 0.03), diastolic blood pressure (pooled effect size = -0.63, 95% CI [-1.05, -0.21], p = 0.01), and BMD (pooled effect size = -0.40, 95% CI [-0.73, -0.07], p = 0.02) were significantly in favor of adrenalectomy group rather than conservative treatment but no significant differences between the two treatment groups in other MACS-related comorbidities were reported.ConclusionDespite the limited and diverse data, this study demonstrates the advantage of adrenalectomy over conservative treatment for MACS-related comorbidities

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.Peer reviewe

Upper Quarter Functional Stability in Female Volleyball Players with and without Anterior Shoulder Instability, with Consideration of Arm Dominance

Objective: The aim of this study was the comparison of the functional stability of dominant and non-dominant shoulder in female volleyball players with and without anterior shoulder instability, using YBT-UQ. Materials and methods: In this descriptive study, 28 female university volleyball players (age=20 to 25 years) were categorized into healthy (n=14) and anterior shoulder instability (n=14) group. Upper quarter y balance test (YBT-UQ) was used for measuring functional stability of both dominant and non-dominant shoulder. After checking the normal distribution of the results with 1-s Kolmogorov-Smirnov, paired sample t-test and independent sample t-test were used for comparing the dominant and non-dominant shoulder’s functional stability and for comparing the results between groups, respectively. Results: Higher YBT-UQ composite score was observed in non-dominant shoulder and dominant shoulder of the healthy group and the non-dominant shoulder and dominant (injured) shoulder of shoulder instability group, respectively. No significant difference was observed between functional stability of both shoulders of the healthy group (p=0.144), while the functional stability of the non-dominant shoulders of the instability group was significantly higher than the dominant unstable shoulders (p=0.001). The results of functional stability of the unstable shoulders of the injured group were significantly lower than the results of the dominant shoulders of the healthy group, while in non-dominant side, all directions but the Superolateral direction showed significant difference. Conclusion: Based on the results of this study, functional stability of the unstable shoulder of female university volleyball players is lower than the functional stability of their non-dominant side or the functional stability of the healthy subjects therefore, we suggest that the upper extremity stabilization exercises, specially the closed kinetic chain exercises should be added to the shoulder rehabilitation programs

Electromyographic Analysis of Shoulder Girdle Muscles in Volleyball Throw: A Reliability Study

Study aim: The aim of this study was to investigate the reliability of the electromyographic activity of selected shoulder girdle muscles during the overhead volleyball throw

Peripheral Lymphadenopathy: Approach and Diagnostic Tools

Peripheral lymph nodes, located deep in the subcutaneous tissue, clean antigens from the extracellular fluid. Generally, a normal sized lymph node is less than one cm in diameter. Peripheral lymphadenopathy (LAP) is frequently due to a local or systemic, benign, self-limited, infectious disease. However, it could be a manifestation of underlying malignancy. Seventy-five percent of all LAPs are localized, with more than 50% being seen in the head and neck area. LAP may be localized or generalized. Cervical lymph nodes are involved more often than the other lymphatic regions. Generally, it is due to infections, but most of the supraclavicular lymphadenopathies are associated with malignancy. Based on different geographical areas, the etiology is various. For example, in tropical areas, tuberculosis (TB) is a main benign cause of LAP in adults and children. Complete history taking and physical examination are mandatory for diagnosis; however, laboratory tests, imaging diagnostic methods, and tissue samplings are the next steps. Tissue diagnosis by fine needle aspiration biopsy or excisional biopsy is the gold standard evaluation for LAP. We concluded that in patients with peripheral LAP, the patient’s age and environmental exposures along with a careful history taking and physical examination can help the physician to request step by step further work-up when required, including laboratory tests, imaging modalities, and tissue diagnosis, to reach an appropriate diagnosis

Retrograde Trans-Femoral Approach for Successful Per- cutaneous Angioplasty in a Diabetic Patient with Ischemic Hand Ulcer: A Case Report

Hand ischemia is a rare complication of diabetes and some other chronic vascular diseases. Critical hand ischemia causes painful limbs and disability and requires urgent revascularization. There have been a few reports of successful trans-brachial percutaneous angioplasty in the upper extremity in the radial or ulnar artery. Herein, we report the results of the endovascular treatment of a 68-year-old diabetic patient with an ischemic hand ulcer due to the severe stenotic lesions of the infra-brachial arteries. The patient underwent successful angioplasty via the retrograde trans-femoral technique to avoid the drawbacks. At the first week of post-procedural follow-up, the patient’s finger was warm with a well–healing wound and reduced pain. In the next two months, he had no complaint of pain or active ulceration; the ulcer was well healed, and the hand was warm. The present case shows that history taking and physical examination should be followed by upper-extremity arteriography for the evaluation of hand ischemia. The trans-femoral approach enabled us to perform percutaneous catheterization for both diagnostic and interventional purposes. Not only is this strategy useful even for the severe stenotic disease of the distal parts of below-the-elbow arteries but also it avoids the unpleasant complications of antegrade brachial cannulation

Unusual Ectopic Parathyroid Adenoma: A Case Report

An ectopically placed parathyroid in the mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism. They are rarely in a huge size. We report a case of a 70-year-old man with a history of total parathyroidectomy and thymectomy presented with a lack of appetite, nausea, and generalized bone pain, polydipsia and a calcium level of 14.4 mg/dl. 99mTc-sestamibi scintigraphy with single-photon emission computerized tomography (SPECT) showed a focal zone of radiotracer accumulation in the midline of anterior chest wall (xiphoid level). The mass excised from our patient surgically was 75 grams. This weight and location of the tumor is a very rare finding in parathyroid adenomas