Introduction: Parathyroid carcinoma is a rare endocrine malignancy found in 1–5% of patients with primary hyperparathyroidism. It commonly presents with severe hypercalcemia and markedly elevated parathyroid hormone (PTH) levels. We report a challenging case of parathyroid carcinoma presenting with refractory hypercalcemia with incidental papillary thyroid microcarcinoma. Case: A 63-year-old female with hypertension, diabetes mellitus, dyslipidemia, and ischemic heart disease had been followed for primary hyperparathyroidism since 2014 (PTH5.5 pmol/L, calcium range 2.3–4.7 mmol/L). Initial neck ultrasound was suggestive of parathyroid adenoma over left side, but parathyroid scintigraphy failed to localize a lesion. She refused surgical intervention initially until April 2025, then she later agreed. Re-evaluation prior to operation revealed PTH level 76 pmol/L, and repeated parathyroid scintigraphy showed mild sestamibi avid uptake on left thyroid nodule. While awaiting surgery, she was admitted with a hypercalcemic crisis (serum calcium 3.7–5.38 mmol/L), complicated with acute kidney injury. Repeated ultrasound neck revealed extrathyroidal lesion adjacent to inferior pole of left thyroid (1.6 × 1.7 × 1.2 cm). She required aggressive intravenous hydration, intravenous pamidronate, calcitonin, and Denosumab to optimize her calcium level peri-operatively. She underwent left neck exploration with en-bloc left inferior parathyroidectomy, left hemithyroidectomy, and central neck dissection in November 2025. Histopathological examination confirmed parathyroid carcinoma (pT3N1) with nodal metastasis (1/4 lymph nodes positive) and an incidental papillary thyroid microcarcinoma measuring 1 mm (pT1a). Conclusion This case highlights the challenges of perioperative hypercalcemia management in parathyroid carcinoma. Effective preoperative control often requires multiple treatment modalities. Severe refractory hypercalcemia and high PTH level should raise a high index of suspicion for malignancy. Early complete resection is the cornerstone of treatment and is associated with optimal outcomes.
Papillary Thyroid Microcarcinoma ; Calcium ; Parathyroid Neoplasms

Field trials of Wolbachia-transinfected mosquitoes, as a biological approach to curb dengue transmission, have been initiated. This study aimed to determine the knowledge regarding dengue fever (DF), practice of vector control, and acceptance of Wolbachia as a dengue control method among Universiti Kebangsaan Malaysia Medical Centre (UKMMC) healthcare staff. A questionnaire assessing knowledge regarding DF, vector control practices, and acceptance of Wolbachia was conducted among 330 UKMMC healthcare staff via convenience sampling. More than 70% of the respondents had good knowledge regarding DF, good vector control practice, and good acceptance of Wolbachia. Being female and having household income >MYR3000 had higher odds of having good knowledge regarding DF [(aOR 2.40; 95%CI 1.13, 5.12) and (aOR 3.86; 95%CI 1.91, 7.80)]. Having household income >MYR3000 had higher odds of having good vector control practice (aOR 2.33; 95%CI 1.20, 4.54) while academicians were three times (1-0.24) less likely to have good vector control practice than non-academicians (aOR 0.24; 95%CI 0.13, 0.48). Good acceptance of Wolbachia was associated with being academicians (aOR 8.83; 95%CI 2.60, 29.96) and having good knowledge regarding DF (aOR 6.07; 95% CI 2.89, 12.74). Gender, different income level and type of occupation have significant association with either good knowledge regarding DF or practice on vector control. Different type of occupation and level of knowledge also were notably significantly associated with good acceptance on Wolbachia as dengue biological control. These factors may be the focus for future plan to enhance the knowledge, acceptance and practice regarding DF and its control.
Wolbachia ; Dengue, Aedes ; Knowledge ; Practice ; Acceptance ; Questionnaire ; Healthcare staff