Background: Post-thyroidectomy hypocalcemia is a common complication, yet the optimal perioperative markers for identifying high-risk patients and guiding supplementation remain debated. This study aimed to evaluate factors associated with hypocalcemia at 24 h after total thyroidectomy, identify independent predictors, and assess the reliability of early PTH measurement in determining supplementation needs. Methods: We conducted a single-center prospective cohort study including 200 patients undergoing total thyroidectomy at Genesis Hospital, Thessaloniki, between November 2022 and March 2025. PTH was measured preoperatively, 10 min post-resection, and at 24 and 72 h; calcium and phosphorus were measured preoperatively and postoperatively. Results: Independent predictors of hypocalcemia at 24 h were female sex, preoperative calcium, and PTH at 10 min. Age, pathology, incidental parathyroid excision, and extent of surgery were not significantly associated with hypocalcemia. ROC analysis showed that a preoperative calcium cutoff of 9.47 mg/dL yielded an AUC of 0.73, with 70.1% sensitivity and an NPV of 82%. PTH at 10 min with a cutoff of 24.6 pg/mL yielded an AUC of 0.66, with 70.1% sensitivity and an NPV of 79%. For supplementation needs, PTH at 10 min demonstrated excellent discrimination, with a cutoff of 16.3 pg/mL at 24 h and 14.1 pg/mL at 72 h. Conclusions: Preoperative calcium and PTH measured 10 min after thyroid removal are useful markers for predicting hypocalcemia after total thyroidectomy, with early PTH also accurately identifying supplementation needs.

One of the most common procedures in everyday dental surgical practice is the inferior alveolar nerve block anesthesia. The procedure is safe, though various complications may arise. Among them, ophthalmological complications such as temporary loss of vision, amaurosis, diplopia, or ophthalmoplegia are very rare, although they do occur. This case report highlights an inadvertent complication of contralateral temporary diplopia after inferior alveolar nerve block anesthesia that was administrated in a patient who was set to undergo root canal treatment. Anatomical variations of the middle meningeal arteries and maxillary arteries or the sympathetic vasoconstrictor nerve (carrying important sympathetic fibers) along with intravascular administration of the anesthetic may cause uncommon ophthalmological complications such as transient double vision.

Background: Facial angiofibromas (FAs) are common skin manifestations of tuberous sclerosis complex (TSC) that occur in up to 80% of patients. Rapamycin seems to be effective in decreasing FAs. Objective: The aim of our study was to investigate the efficacy and safety of topically applied rapamycin in TSC patients with FAs. Methods: The methods and the results were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. PubMed/MEDLINE, SCOPUS, and Cochrane database were systematically searched until April 21, 2022, using the PICO tool (Patient, Interventions, Comparisons, Outcome). Studies regarding efficacy and/or safety of topical sirolimus for the treatment of FAs in TSC with a published full-text in English were included. Safety was assessed based on adverse effects and sirolimus’ blood levels, and efficacy was documented by clinical improvement and reduction of Facial Angiofibroma Severity Index (FASI). For Meta-analysis, Review Manager (RevMan) 5.4.1 software was used, using random-effects model and standardized mean difference (SMD) with 95% confidence interval (CI). Results: Twenty-one final studies were included. Regarding safety, in the included studies the observed adverse effects were mainly local, while the blood levels of rapamycin were within safe limits, decreasing the likelihood of systemic immunosuppression. The meta-analysis revealed a statistically significant decrease in post-treatment FASI (SMD: -1.31, 95% CI: [-1.85,-0.77], p-value <0.00001). Subgroup and sensitivity analyses indicated similar findings. No publication bias was found to this association. Conclusion: The application of topical sirolimus to FAs can safely decrease their severity in patients with TSC.