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ABSTRACT Background Methods Results Conclusions In January 2016, the American Thyroid Association (ATA) published an update to the guidelines concerning the management of adult patients with thyroid nodules and well‐differentiated thyroid cancers. One of the revised recommendations states that lobectomy is a reasonable surgical approach for low‐risk patients. This systematic review compares the rates of completion thyroidectomy surgeries before and after the publication of the recent ATA guidelines.A systematic review was conducted according to the PRISMA guidelines of the preferred reporting items for systematic reviews and meta‐analyses. PubMed and Embase databases were searched to find articles which demonstrate the rates of completion thyroidectomy surgeries in the last 6 years, before and after the recent ATA guidelines publication. Overall, 8744 titles and abstracts were screened, and 964 articles were fully assessed for eligibility. Eventually, 40 studies were included for data extraction. More than 48 000 patients with thyroid malignancy were included in the review, and were divided into three time periods according to the publication date of 2015 ATA guidelines.We found that the rate of completion thyroidectomy was 51.8% before 2016 and 43.1% after the 2015 ATA guidelines publication. We observed a 17% reduction of early completion thyroidectomy surgeries since the 2015 ATA guidelines publication relative to previous periods, among patients with malignant pathology.Apparently, more centres worldwide implemented the new guidelines and prefer a conservative surgical approach as compared to the pre‐ATA 2015 era. [ABSTRACT FROM AUTHOR]

Graves' disease (GD) can be managed by antithyroid drugs (ATD), radioactive iodine (RAI) and surgery. Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching <1% for primary disease and <25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence‐based approach to the clinicians' preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up‐to‐date data. [ABSTRACT FROM AUTHOR]

The inherent variability in performing specific surgical procedures for head and neck cancer remains a barrier for accurately assessing treatment outcomes, particularly in clinical trials. While non-surgical modalities for cancer therapeutics have evolved to become far more uniform, there remains the challenge to standardize surgery. The purpose of this review is to identify the barriers in achieving uniformity and to highlight efforts by surgical groups to standardize selected operations and nomenclature. While further improvements in standardization will remain a challenge, we must encourage surgical groups to focus on strategies that provide such a level. [ABSTRACT FROM AUTHOR]

Flow-cytometry (FC) is a powerful tool that can assist in lymphoma diagnosis in lymph node (LN) specimens. Although lymphoma diagnosis and classification are mainly based on tumor cell characteristics, surrounding cells are less employed in this process. We retrospectively investigated alterations in the ploidy status, proliferative cell fraction (PF) and the percentages of surrounding immune cells in 62 consecutive LN specimens with B-Cell Non-Hodgkin Lymphoma (B-NHL) that were submitted for FC evaluation between 2019–2022. Compared with indolent B-NHLs, aggressive B-NHLs show increased DNA aneuploidy and PF, increased monocytes, immature-granulocytes, mature granulocytes, CD8+ T-cells, Double-Negative-T-cells and Double-Positive-T-cells, and decreased total CD45+ cells, total lymphocytes, CD4+ T-cells and CD4/CD8 ratio. Receiver operating characteristic analysis determined PF > 6.8% and immature-granulocytes > 0.9% as optimal cutoffs with highest specificity and sensitivity in differentiating aggressive and indolent B-NHLs. These findings further strength the diagnostic value of DNA content analysis by FC and suggest the utilization of tumor surrounding immune cells in NHL diagnosis and classification. [ABSTRACT FROM AUTHOR]

Context: Thyroid nodules of indeterminate cytology can be subjected to molecular testing such as the Afirma Genomic Sequencing Classifier (GSC), thereby minimizing the number of unnecessary diagnostic surgeries. Objective: This work aimed to evaluate and compare the cost of routine GSC testing of indeterminate thyroid nodules in different countries. Design, Patients and Main Outcome Measures: The cost of diagnostic hemithyroidectomy of indeterminate thyroid nodules was calculated by performing a Monte Carlo simulation cost analysis on a Markov decision‐analytic model and then compared to that of GSC testing in the UK, Australia, USA, and Israel. Results: Assuming that patients are treated by surgical resection and routine GSC testing is performed for all nodules of indeterminate significance, we found the GSC test to be more cost effective compared with diagnostic hemithyroidectomy when malignancy rates of thyroid nodules are less than 22.6%‐37.1%, depending on the country where the test is performed. Given the cost of a thyroidectomy in the UK, Australia and Israel, performing routine GSC tests on all Bethesda IV nodules is more expensive than routine diagnostic hemithyroidectomy and becomes cost effective for Bethesda III when the GSC cost is below 3,031‐3,087 USD. In comparison, in the USA, higher cost of thyroidectomy makes the GSC test cost effective for Bethesda III nodules at its current cost, but not for Bethesda IV nodules where it becomes cost effective under the price of 3,031 USD. Conclusions: Different molecular testing and surgical costs in different countries should be considered when performing cost analysis. In addition, since different medical centres have different malignancy rates, personalized in‐house assessment of cost‐effectiveness is warranted. [ABSTRACT FROM AUTHOR]

Background: Antibiotic treatment guidelines for common infectious diseases enable proper diagnosis and treatment and avoid unnecessary antibiotic treatment, preventing both financial expenditure and antimicrobial resistance to antibiotics. Methods: The aim of our study was to investigate whether community physicians referring patients to the medical centre and whether emergency department (ED) physicians diagnose and treat acute pharyngitis according to these guidelines. We conducted a retrospective study. Data were collected on 99 patients admitted with the diagnosis of acute pharyngitis. The patients were admitted to the medical centre between 2015 and 2014. The physicians' adherence to antibiotic guidelines for indication, type and duration of treatment for acute pharyngitis was examined. Results: The adherence of community physicians regarding the indication for antibiotic treatment was low (16%). The adherence of community and ED physicians regarding the type of treatment was high (96% and 99%, respectively). The adherence of ED physicians regarding the duration of treatment was higher than the adherence among community physicians (58% and 13.3%, respectively, Wilcoxon signed‐rank test, P <.001). Interns tended to adhere to the guidelines more than seniors (36.4% versus 12.0%, respectively, Fisher's exact test, P =.07). Conclusions: There is a lack of compliance with the guidelines among community physicians regarding the diagnosis and antibiotic treatment of acute pharyngitis, which is characterized by excessive antibiotic treatment. Therefore, ways to increase awareness and adherence to clinical guidelines, and to allow the conditions in the clinics to fulfil the guidelines should be investigated. [ABSTRACT FROM AUTHOR]

Objectives: The accuracy of a cytological diagnosis obtained by fine needle aspiration is influenced by several factors including the technique used and the experience of both the aspirator as well as the cytologist. In this project we planned to evaluate the interobserver differences of thyroid nodule cytopathology in our medical centre. Methods: The study was conducted using retrospective pathology reports from a single academic centre from August 2013 to September 2017. We compared the sensitivity, specificity, negative and positive predictive values, malignancy rates, and accuracy of two cytopathologists who evaluated thyroid nodules. Results: We included 287 fine needle aspirations of thyroid nodules in the study. Approximately one fifth (18.5%) of patients had surgery and the rate of malignancy was 40%. There was a similar frequency of use of all thyroid Bethesda system (TBS) categories with the exception of TBS 3 (8.0% and 21.2%, P =.01). As a consequence, the malignancy rate was different in TBS 3 category (40% vs 17%, P =.545). Conclusions: There are interobserver differences in the evaluation of thyroid nodules. Clinicians should be aware of such differences because they affect the malignancy rate in each TBS category. In this retrospective study we compared the sensitivity, specificity, negative and positive predictive values malignancy rates, and accuracy between two cytopathologists who evaluated thyroid nodules. There was a similar frequency of use of all thyroid Bethesda system categories with the exception of category 3, and as a consequence, the malignancy rate was different in this category. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcomes of surgery to repair tracheoesophageal fistula (TEF) caused by mechanical ventilation. Method: Case series and review of all cases reported in English literature. Only reports of TEF following mechanical ventilation and containing description of surgical repair and outcomes were included. Results: A total of 41 studies comprising 143 patients met the inclusion criteria. Most studies had incomplete information on important variables such as co-morbidity and fistula size. Tracheal resection anastomosis (TRA) was the most common approach, performed in 91 (63.6%) patients (including three newly reported here). Lateral approach repair (LA) was done in 45 (31.5%) patients. The former had a higher incidence of pre-existing tracheal stenosis [53 (89.8%) vs. 7 (35%) cases; p < 0.001]. Flap interposition to augment the repair was done in 49 (53.9%) and 40 (88.9%) cases, respectively (p < 0.001). Successful and durable healing of the fistula were achieved in 90 (98.9%) cases in TRA and 39 (88.6%) cases in LA. Conclusion: In carefully selected cases of TEF caused by mechanical ventilation, TRA is the most preferred approach, delivering successful healing in almost all cases. Where TRA is not indicated or preferred, LA appears to be a good alternative. Future studies should explicitly report all of the known co-variables, so that the exact indications for choosing a particular surgical approach could be better elucidated. [ABSTRACT FROM AUTHOR]

Introduction: Only in 2005 was a product labeling law passed in Israel that requires food companies to mark a choking hazard. We wished to investigate the influence of the hazard warning on the number of foreign body aspirations (FBA) in Israel, as well as the racial differences in the prevalence of and death rates from FBA. Materials and Methods: All the medical records of patients under the age of 14 who arrived at our center's emergency department between the years 2007 and 2015 with suspected FBA were retrospectively reviewed. Population data was extracted from the Central Bureau of Statistics. Results: Overall, 90 children arrived at the hospital with suspected FBA during 2007–2015. Forty-six (51%) of the patients were males, the mean age was 3.5 years. Seventy-one bronchoscopies were performed due to high suspicious presence of a foreign body. The most common objects aspirated were different types of nuts and seeds. In all cases, the patient's parents witnessed the aspiration of the foreign body. Most children (77, 86%) were of Arab ethnicity. The yearly prevalence of FBA in children 0–4 years of Arab ethnicity was 16.6:100,000 compared to 6.0:100,000 in the non-Arab population (p < 0.001). Conclusion: FBA is still a common injury in our region. Since most cases are preventable, efforts should be targeted among the population at higher risk, which are parents of children under the age of 4 and parents of Arab ethnicity. We believe that national effort and support for preventive education are needed. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate the disease spectrum of thyroid cytopathology and correlation of the Bethesda reporting system with final histopathology in our medical centre. Methods: This retrospective study was conducted from histopathology reports from Galilee Medical Center between August 2013 and September 2017. Results: A total of 287 thyroid fine needle aspirations were included in the study. The majority (55.1%) of these were benign (B2). Surgery was performed on 53 cases and the total malignancy rate was 39.6%. Our study had a favourable accuracy rate of 70%. A B4 Bethesda category had a higher malignancy rate (50%) than previously reported. Conclusion: We found a higher malignancy rate (50%) based on the Bethesda B4 category of the fine needle aspirations in our series, yet it is based on a small sample. The differences in malignancy rates between centres have an important impact on clinical decisions. In this retrospective study we reviewed thyroid fine needle aspirations and compared them to final pathology. We found an accuracy rate of 70%, and a higher Bethesda 4 category malignancy rate than previously reported. [ABSTRACT FROM AUTHOR]

Background and aims: The two most common commercial percutaneous dilation tracheotomy (PDT) sets apply different techniques. Our aim was to investigate the biomechanical properties of these two techniques on an animal model, that simulate a human trachea. Subjects and methods: Biomechanical properties of the different steps of the Ciaglia Blue Rhino® and Griggs Portex® techniques were measured on 20 pig cadavers. Results: We found that the use of the two different devices created equal sized openings in the trachea (p >0.05). The force needed to insert the Griggs forceps was 1.8 kg average compared to 2.51 kg using the Ciaglia dilator (p <0.00001). The calculated total energy expenditure in the Ciaglia Blue Rhino® kit was 1.46 times greater than the Griggs Portex® kit (p <0.0001). This was mainly due to the amount of energy required during the final dilator stage, which was 4 times more using the Ciaglia Blue Rhino® dilator than the Portex® Griggs-dilator forceps. Conclusion: We conducted a series of biomechanical properties experiments on an animal model of PDT using two popular commercial kits -- Griggs Portex® guidewire dilating forceps by Smiths Medical and Ciaglia Blue-Rhino® by Cook Medical. The Ciaglia technique required almost 50% more energy to perform a PDT (p <0.0001), mainly because of the force exerted during the final dilator insertion stage compared to the Griggs forceps. Further research is needed to examine if these properties are related to some of the PDT complications. [ABSTRACT FROM AUTHOR]

Objective: We examined the factors that influence medical school graduates' choices for the place of internship, so that they can guide policy‐makers to attract interns to rural hospitals. Design: A national survey. Setting: Rural and metropoles of Israel. Participants: Three‐hundred‐and‐thirty‐nine interns who did their internships during the years 2016‐2018. Main outcome measure: The participants completed a web survey. We used the results of this survey to deduce which factors were influential in helping the interns choose a hospital for their year of internship. Result s : We received 339 questionnaires from medical school graduates of years 2015‐2017. We found that the most influential factors in attracting interns to rural hospital internships are the availability of desired residency and exposure to a rural curriculum in medical school. This far outweighed any economic or life quality incentives. In addition, we found that the exposure to rural hospitals during the medical school years increases the likelihood of choosing an internship in a rural hospital. Conclusions: The most important factor for choosing a hospital for internship is the availability of lucrative residencies. Thus, we believe the best way to attract good interns would be to make the desired residency positions available for them. Furthermore, it might be more successful to target either students who have studied in a university affiliated with rural hospital rotations or graduates of universities outside of the country. [ABSTRACT FROM AUTHOR]

Osteitis of the nasal bones is a rare disease; when it occurs, it usually has a known etiology. To the best of our knowledge, idiopathic nasal bone osteitis (NBO) has not been described before. We conducted a study to analyze the behavior of idiopathic NBO and its outcome and to determine a cutoff level for diagnosis using technetium-99m-methylene-diphosphonate (Tc-MDP) bone scanning. This retrospective, controlled analysis involved 9 women (mean age: 44 yr) who had been admitted to an otolaryngology department in Israel with idiopathic NBO over a 5-year period. Clinical evaluation, isotopic evaluation, and computed tomography were done. A lesion-to-nonlesion ratio was calculated between an area of interest on the nasal bone and a reference point (L/R ratio). The same ratio was calculated for a control group of 20 subjects. All the Tc-MDP scans in the study group were suggestive of osteitis. Intravenous antibiotic treatment was effective in all cases. A high degree of accuracy was achieved with cutoff L/R ratios of 2.05 for planar views and 2.34 for single-photon emission computed tomography views. [ABSTRACT FROM AUTHOR]

Objective: Nasal obstruction is a common complaint. The Nasal Obstruction Symptom Evaluation scale (NOSE) is a reliable validated tool used to assess the quality of life of patients with nasal obstruction. The purpose of this study is to validate the Hebrew version of the NOSE scale (He‐NOSE). Methods: A prospective instrument validation was conducted. The NOSE scale was translated primarily from English to Hebrew and then back from Hebrew to English according to the accepted guidelines of the cross‐cultural adaptation process. The study group included surgery candidates suffering from nasal obstruction due to a deviated nasal septum and/or inferior turbinate hypertrophy. The study group completed the validated He‐NOSE questionnaire twice prior to the surgery and once again, a month post‐surgery. A control group of individuals with no history of nasal complaints or surgeries was asked to complete the questionnaire once. Reliability, internal consistency, validity, and responsiveness to change of the He‐NOSE were evaluated. Results: Fifty‐three patients and 100 controls were included in this study. The scale showed excellent ability to discriminate between the study and the control group, exhibiting significantly lower scores in the control group (73.8 and 7 average scores respectively, p <.001). Good internal consistency (Cronbach's alpha.71 and.76) and test–retest reliability (Spearman rank correlation r =.752, p <.0001) were measured. Moreover, the scale revealed remarkable responsiveness to change (p <.00001). Conclusion: The translated and adapted He‐NOSE scale can be a useful tool to be applied in both clinical and research fields when assessing nasal obstruction. Level of evidence: N/A. [ABSTRACT FROM AUTHOR]

Background: The anatomical relations between the neck skin crease and the thyroid gland isthmus and cricoid cartilage are important for surgical planning.Methods: Between 2016 and 2018 anatomical measurements were performed on 118 participants during a presurgical ultrasound exam and were verified during surgery. The data were stratified according to age, sex, patient's body mass index (BMI), and height.Findings: The cricoid cartilage was found to be lower than the second skin neck crease by 0.2 ± 0.9 cm on average and the thyroid isthmus lower by 0.9 ± 1 cm from the second neck crease. No correlation was found to subjects' age, BMI, or height. Patient satisfaction, measured by the dermatologic life quality index, was high.Conclusions: A surgical incision made along the second neck crease will allow for a predicted and proper exposure in thyroid surgeries. The possibility of concealing the surgical scar in the natural neck skin crease can increase patients' aesthetic satisfaction. [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate the incidence of tonsil and adenoid malignancy in pediatric patients in Israel compared to the known literature and to revisit the common practice of routine histopathologic examination of tonsils and adenoids. Methods Analysis of the Israel National Cancer Registry data on pediatric tonsil and adenoid malignancies between the years 2005 and 2015, and a systematic literature review of all relevant articles that reported on malignancies amongst pediatric patients who underwent tonsillectomy with or without adenoidectomy. Results Only seven cases of tonsillar malignancies were documented out of 152,352 (0.0052%) surgeries in the pediatric population. All malignancies were lymphoproliferative and mainly Burkitt's lymphoma. In our medical center no malignancy was found in 2165 patients in the same age groups and time period. We found the incidence of tonsillar malignancy in Israel to be significantly lower (p = 0.013) compared to the previously described literature. Conclusion The incidence of malignancy in routine histopathological examination of tonsils and adenoids is Israel is very low when compared to the known literature. According to these results, we suggest that routine histopathological examination of all such samples is not clinically justified. [ABSTRACT FROM AUTHOR]

Simple Summary: Local recurrences, isolated regional recurrences, and loco-regional recurrences are frequent after treatment for advanced stage head and neck squamous cell carcinoma. Salvage surgery may be possible in selected patients, taking into account the location and stage of the recurrent disease, patient age and comorbidities, tumor HPV status, and functional sequelae in relation to initial therapy. Results vary according to these parameters. Adjuvant treatments after salvage surgery are under investigation. The aim of this review is to present current knowledge concerning the incidence and management of recurrent head and neck squamous cell carcinoma and current data concerning survival and morbidity after salvage surgery. Surgery with adjuvant chemoradiotherapy or chemoradiotherapy is the mainstay in treatment for advanced stage head and neck squamous cell carcinoma; however, locoregional recurrences are frequent. Salvage surgery could be proposed in selected patients to improve local control, disease-free, and overall survival. Factors for improved disease-free and overall survival in patients treated with salvage surgery include age, tumor location, the initial T stage, HPV status, resection margins, and the time elapsing from the initial treatment. Clinical trials with adjuvant therapies have shown promise after salvage surgery in terms of tolerance and response, but clinical guidelines for using these adjuvant treatments are currently lacking. The aim of this review is to present current knowledge concerning the incidence and management of recurrent head and neck squamous cell carcinoma and current data concerning survival and morbidity after salvage surgery. [ABSTRACT FROM AUTHOR]

Objectives: To assess the incidence of hearing loss in patients diagnosed with Bell's palsy (BP) and to characterize its clinical features. Design: Patients with BP who underwent audiometry testing in our institute were included. Bone hearing level differences between the ipsilateral and the contralateral ears to the palsied side were calculated for 6 frequencies: 250, 500, 1000, 2000, 4000 and 8000 Hz. Subjects with interaural differences higher than 5 dB in at least one frequency were considered as having ipsilateral unilateral sensorineural hearing loss (uSNHL). Results: Twenty-four cases of subjects with BP who underwent hearing exams were included. Thirteen were women (54.2%) and the average age was 37.4 years. Nine patients (37.5%) were found to have an ipsilateral uSNHL (group A); a maximal interaural difference of 5dB in all the frequencies was found in 15 subjects (62.5%, group B). The interaural maximal difference was found to be significantly higher between the two groups ( p = 0.0295, n = 24). Group A showed a mean of maximal difference of 18.9 ± 9.3 dB compared to 3 ± 2.5 dB in group B ( p < 0.001). A higher difference was calculated in the higher frequencies (2000, 4000, 8000 Hz) (R-spearman = 0.226, p = 0.003). Conclusions: We have demonstrated significant ipsilateral uSNHL in our cohort of patients diagnosed with BP. We, therefore, believe that all patients who are diagnosed with BP should undergo an audiometry examination. Further prospective studies with larger cohorts are necessary to support our observations. [ABSTRACT FROM AUTHOR]

Iatrogenic nasopharyngeal perforations secondary to improper nasogastric tube insertion probably occur more frequently than has been reported. Our review of the literature found very few cases. We report the case of a 79-year-old woman who died of mediastinal complications following the improper insertion of a nasogastric tube that resulted in a nasopharyngeal perforation. We also review the proper technique for inserting these tubes. [ABSTRACT FROM AUTHOR]

Vitamin D (VitD) deficiency has garnered significant attention in contemporary medical research. Although the canonical biological activity of VitD manifests itself mainly in the regulation of calcium-phosphorus metabolism, recent studies show that, thanks to the presence of numerous receptors, VitD may also play an important role in regulating the immune system. VitD deficiency has been demonstrated to impact autoimmune disease, coeliac disease, infections (including respiratory/COVID-19), and patients with cancer. Recent studies also show that VitD plays a significant role in autoimmune thyroid diseases (AITDs). Many studies have shown a correlation between low VitD levels and chronic autoimmune thyroiditis – Hashimoto thyroiditis (HT), Graves' disease (GD), and postpartum thyroiditis (PPT). This review article, therefore, describes the current state of knowledge on the role of VitD in AITDs, including HT, GD, and PTT. [ABSTRACT FROM AUTHOR]

Simple Summary: In non-well differentiated thyroid cancer, the rate of nodal involvement is variable and depends on the histology of the tumor. We aim to highlight the opinions of several experts from different parts of the world on the current management of the less common types of thyroid cancer to provide a consensus on the treatment of regional lymphatics for these entities. The rate of lymph node involvement is variable and depends on the histology of the tumor. Within undifferentiated tumors', there is an established consensus on the treatment of anaplastic carcinoma, medullary carcinoma and poorly differentiated carcinoma of the thyroid. However, treatment of other rarer tumors must be individualized, taking into account both the aggressiveness of the histology and the anatomical distribution of the disease. In general, prophylactic treatment of the neck is not indicated. Lymph node metastases in non-well differentiated thyroid cancer (non-WDTC) are common, both in the central compartment (levels VI and VII) and in the lateral neck (Levels II to V). Nodal metastases negatively affect prognosis and should be treated to maximize locoregional control while minimizing morbidity. In non-WDTC, the rate of nodal involvement is variable and depends on the histology of the tumor. For medullary thyroid carcinomas, poorly differentiated thyroid carcinomas, and anaplastic thyroid carcinomas, the high frequency of lymph node metastases makes central compartment dissection generally necessary. In mucoepidermoid carcinomas, malignant peripheral nerve sheath tumors, sarcomas, and malignant thyroid teratomas or thyroblastomas, central compartment dissection is less often necessary, as clinical lymphnode involvement is less common. We aim to summarize the medical literature and the opinions of several experts from different parts of the world on the current philosophy for managing the neck in less common types of thyroid cancer. [ABSTRACT FROM AUTHOR]

Objectives: The first Bethesda classification category of thyroid fine-needle aspiration biopsy (FNAB) is nondiagnostic (ND), which indicates that the specimen's cellularity is inadequate for evaluation. This work investigated the effect of needle diameter size on ND rates by comparing diagnostic outcomes of FNAB samples collected with 23-, 25-, and 27-gauge needles.Methods: This was a retrospective analysis of samples collected from patients undergoing FNAB between 2018 and 2021. It was conducted in an otolaryngology department in a university teaching hospital.Results: Of the 699 aspirations, 144, 335, and 220 were performed using 23-, 25-, and 27-gauge needles, respectively. ND rates increased significantly when using 27-gauge compared with 23- to 25-gauge needles (P = .002), and a significantly lower ND rate was found for the 25-gauge needle compared with the 27-gauge needle (P = .001). Furthermore, increased nodule size was associated with reduced ND rate (odds ratio, 0.801; 95% confidence interval, 0.691-0.929).Conclusions: The 25-gauge needles are superior to 27-gauge needles in reducing ND rates of thyroid nodule FNAB specimens. Future prospective studies should be performed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy.PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024.Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests.The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = − 0.87 [(− 1.58, − 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) =  − 0.31 [(− 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) =  − 0.34 [(− 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) =  − 0.85 [(− 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group.Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes.3a.Data sources: To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy.PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024.Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests.The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = − 0.87 [(− 1.58, − 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) =  − 0.31 [(− 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) =  − 0.34 [(− 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) =  − 0.85 [(− 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group.Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes.3a.Review methods: To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy.PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024.Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests.The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = − 0.87 [(− 1.58, − 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) =  − 0.31 [(− 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) =  − 0.34 [(− 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) =  − 0.85 [(− 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group.Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes.3a.Results: To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy.PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024.Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests.The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = − 0.87 [(− 1.58, − 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) =  − 0.31 [(− 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) =  − 0.34 [(− 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) =  − 0.85 [(− 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group.Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes.3a.Conclusions: To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy.PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024.Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests.The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = − 0.87 [(− 1.58, − 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) =  − 0.31 [(− 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) =  − 0.34 [(− 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) =  − 0.85 [(− 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group.Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes.3a.Level of evidence: To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy.PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024.Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests.The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = − 0.87 [(− 1.58, − 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) =  − 0.31 [(− 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) =  − 0.34 [(− 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) =  − 0.85 [(− 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group.Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes.3a. [ABSTRACT FROM AUTHOR]

High frequency jet ventilationis a mechanical lung ventilation method which uses a relatively high flow usually through an open system. This work examined the effect of high-frequency jet ventilation on respiratory parameters of an intubated patient simulated using a high-frequency jet ventilator attached to a ventilation monitor for measurements of ventilation parameters. The series of experiments altered specific parameters each time (respiratory rate, inspiratory-expiratory (I:E) ratio, and inspiratory pressure), under different lung compliances. A reduction of minute ventilation was observed alongside a rise in respiratory rate, with low airway pressures over the entire range of lung compliances. In addition, an I:E ratio of 2:1 to 1:1; and the tidal and minute volumes were directly related to the inspiratory pressure over all compliance settings. To conclude, the respiratory mechanics in high-frequency jet ventilation are very different from those of conventional rate ventilation in a lung model. Further studies on patients and/or a biological model are needed to investigate pCO2 and end-tidal carbon-dioxide during high-frequency jet ventilation. [ABSTRACT FROM AUTHOR]

Albumin is the most abundant protein in the plasma and has a regulatory role in the distribution of body fluids, acid-base physiology, and binding of essential components in the bloodstream. C-reactive protein (CRP) is produced by hepatocytes and is commonly used to assess inflammation. It was previously noted that acute-phase concentrations of proteins, such as CRP, tend to rise in inflammatory conditions, while albumin concentrations tend to decline. This study assessed the correlation between albumin levels and various inflammatory indices (CRP, WBC, PLT) of patients hospitalized at the Galilee Medical Center over a period of 3 months. The study population consisted of 4434 patients, ages 18-107 years (mean: 52 years), of whom 60% were female. A negative correlation between albumin and CRP levels (r = −0.311) was identified, as well as between albumin and white blood cells levels (r = −0.157). Positive correlations were found between albumin and platelets levels (r = 0.084), as well as between albumin and hemoglobin levels (r = 0.513). When considering the three largest departments, the strongest negative correlation between albumin and CRP was identified in the Internal Medicine departments. A linear regression analysis discovered a fairly minor effect of CRP on albumin levels, which only became apparent when CRP levels were extremely high (500 mg/L). The mechanisms underlying this negative correlation still need to be explored. [ABSTRACT FROM AUTHOR]

Sub-clinical hypothyroidism (SCH) is common in heart failure (HF) and advanced renal failure (RF), but it is unclear whether there is a thyroid disease or a transient increase in TSH level. This is a retrospective study of hospitalized patients in medical departments. All patients with SCH and a TSH level up to less than 12 mIU/L were identified. Those who had at least one recurring admission within at least 6 months were included. A change in thyroid function during the last re-admission was determined and classified as an improvement, no change, or worsening of thyroid function. Overall, 126 cases of SCH met the inclusion criteria for re-admission. Analysis of the most recent hospitalization showed that in 100 (79.4%) patients thyroid function improved, in 15 (11.9%) patients thyroid function remained unchanged and only in 11 (8.7%) patients did thyroid function worsen. In most cases, worsening of hypothyroidism was determined by initiation of a low dose levothyroxine treatment. Of the 126 participants, 43 (34.1%) and 22 (17.5%) had a diagnosis of HF and RF (CKD stages 4 and 5), respectively. There was no association between HF or advanced RF and worsening of SCH. No association was found between worsening of hypothyroidism and gender, age, TSH, or creatinine levels in the first hospitalization. A borderline association between elevated CRP levels at first hospitalization and hypothyroidism worsening was found (p = 0.066). Mildly elevated TSH in hospitalized patients with HF and advanced RF is transient and most probably not related to thyroid disease and not associated with age or gender. [ABSTRACT FROM AUTHOR]

Endoscopic examination of the nasal cavity is an integral part of the assessment of patients with chronic rhinosinusitis. However, the benefit gained by performing endoscopy with respect to the patient's medical condition has not been completely assessed. We conducted a prospective cohort in an academic medical center. Thirty-nine patients diagnosed with chronic rhinosinusitis, without polyps, whose ailment was managed conservatively with no surgical intervention. All patients underwent nasal endoscopy, a computed tomography (CT) scan rated for Lund-MacKay score, and completed a sino nasal outcome test (SNOT)-20 questionnaire. This same evaluation was repeated 6 weeks following medical treatment. The CT scan and SNOT-20 questionnaire were independent parameters to evaluate the endoscopy score in each nasal passage. Thirty-nine (28 females) patients completed the follow-up period. A total of 156 endoscopic evaluations were performed, in which 74 nasal cavities were found to have significant pathology and 82 were either normal or displayed mild pathology. The correlation with the Lund-MacKay score was poor with a positive predictive value of 68.9% (31.1% false positive and 28% false negative). However, while looking at the SNOT-20 score, corrected for repeated measures, a higher endoscopy score was associated with a higher SNOT-20 score (odds ratio = 3.53, 95% confidence interval = 1.54-8.09, P =.003). Patients with higher endoscopy scores had a greater probability for exhibiting severe symptoms. However, we could not demonstrate a strong correlation between nasal endoscopy findings and CT scan scores. Therefore, with respect to patients with chronic rhinosinusitis without polyps, nasal endoscopy could be utilized as a beneficial objective tool. [ABSTRACT FROM AUTHOR]

Background: Epiphora due to refractory bicanalicular obstructions is typically managed by conjunctivodacryocystorhinostomy (CDCR) with or without the assistance of nasal endoscopy. However, the evidence for its benefit is unclear. Methods: A systematic review of the literature on the treatment of epiphora by CDCR was performed (March 1, 2018). All studies reporting original data on patients suffering from epiphora treated with CDCR surgery were included. Primary outcomes were success and satisfaction rates. Secondary outcomes were CDCR complications. A comparison was made between the results obtained in patients undergoing CDCR with vs without assistance of nasal endoscopy. Results: Fifty‐four studies representing information on 2555 CDCR procedures were included in the systematic review. All the studies are case series, most of them retrospective. Lester Jones tube (LJT) is the most commonly used in CDCR (66.7%). The overall success rate with all studies included (n = 2555) was 88.9%; 90.8% (n = 890) in CDCR with assistance of nasal endoscope and 87.7% (n = 1575) in the non‐endoscopic approach. The overall "tube displacement" rate, the most common complication, was 24.5% (n = 2522), 20.8% (n = 1575) tube displacement in CDCR with assistance of nasal endoscope vs 26.7% (n = 1575) in the non‐endoscopic approach. Only 3 studies (5.5%) used patient‐reported outcome measures (PROMs) to evaluate epiphora improvement. Due to the low level of evidence and the high bias of the studies, a meta‐analysis was not performed. Conclusion: Based on the data available in the literature, CDCR is considered an effective procedure for treating epiphora due to proximal obstruction. Controlled and qualitative studies are needed to clarify the significance of the endoscope's contribution to CDCR. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is a relatively common disease, which significantly affects the patient's quality of life (QoL). Sino‐Nasal Outcome Test–22 (SNOT‐22) is a QoL questionnaire, which allows quantifying patients' complaints. Our aim was to translate and validated the SNOT‐22 into the Russian language. Methods: Translation and validation of SNOT‐22 questionnaire was performed through forward‐backward translation technique. After proper translation, the translated questionnaire was completed by CRS patients before and after endoscopic sinus surgery (ESS) and by healthy individuals as controls. Results: Thirty‐four native Russian‐speaking CRS patients completed the Russian version of the SNOT‐22 questionnaire before and after ESS. The internal consistency for reliability assessment was very good (mean Cronbach's alpha = 0.816 for CRS patients). Mean scores for the preoperative, postoperative and control groups were 67.6, 18.1 and 9.2, respectively (P <.001), showing validity and responsiveness of the questionnaire. Conclusion: The Russian version of the SNOT‐22 questionnaire is a valid outcome measure for patients with CRS. [ABSTRACT FROM AUTHOR]

Introduction: The presence of high-risk HPV in non-malignant tonsil tissues from patients who underwent tonsillectomy in the Galilee area might explain the low incidence of HPV-related oropharyngeal malignancy in the country. The aim of this retrospective study was to study the prevalence of human papillomavirus (HPV) in non-malignant tonsillectomy specimens of adults in the Galilee area. Materials and methods: We conducted a retrospective analysis of all tonsil samples in our medical center. Tonsils from patients over 20 years of age who underwent tonsillectomy for the indication of recurrent tonsillitis and sleep apneas were eligible. Samples of formalin-fixed paraffin-embedded (FFPE) tonsillar tissue were tested for the presence of HPV DNA using polymerase chain reaction and by p16 immunohistochemistry. Results: Of the 71 tonsil samples, age range 20–65, none were positive for HPV DNA. Fifty-two FFPE specimens of tonsil with HPV-positive cancer tested positive by the same method served as positive controls. Conclusions: HPV DNA is rare in non-malignant tonsil tissues of young adults and adults who underwent tonsillectomy in the Galilee area. Further research should be done in larger cohorts. [ABSTRACT FROM AUTHOR]

Post-tonsillectomy pain control is still considered a challenge. Topical agents would seem to be an ideal, safe option. Our objective was to compare the efficacy of mouthwash preparation with anti-inflammatory, anesthetic, and analgesic properties (Tantum Verde®, 0.15% benzydamine hydrochloride) with that of placebo in improving post-tonsillectomy morbidity. A prospective, double blind, randomized clinical trial was performed. Patients older than 12-years-of-age who underwent tonsillectomy were recruited. Participants were randomized into 2 groups to receive either 0.15% benzydamine hydrochloride (TV) mouthwash solution (study arm) or a placebo solution. They were instructed to gargle the intervention they received 3 times a day for 7 days following surgery. Primary outcomes were intensity and duration of post-operative pain (using VAS visual analogue score) during a 2-week follow-up period. Secondary outcomes were pain medication demand, readmission, incidence of post-operative bleeding, hospital stay duration, and time to resume normal solid diet. Thirty-nine patients completed the study, of whom 23 received TV and 16 received placebo. The mean age was 23.1 years. There was no significant difference between the groups in the primary or secondary outcomes. The data suggest that topical treatment with TV mouthwash solution was not found to be superior to placebo in the management of post-tonsillectomy pain, bleeding, and return to a regular solid diet. Further research studies should be designed to investigate the ideal treatment for reducing post-tonsillectomy morbidity. NIH identifier: NCT02190762; IRB NHR002814. [ABSTRACT FROM AUTHOR]

Background: Based on the convenient oral dosing of erlotinib and the promising results of biologic therapy, we undertook a phase II study with 21 patients with locally advanced (T3-4) lesions combining radiation with intra-arterial (IA) cisplatin and oral daily erlotinib for a 7-week therapy. Methods: Treatment for the primary tumor and upper neck was given to a total dose of 70 Gy. Chemotherapy with IA cisplatin (150 mg/m) was given on days 1, 8, 15, and 22 concurrently with radiotherapy. During the 7-week treatment period, patients were given erlotinib 150 mg/day. Results: Overall survival is 63 %, and the relapse/persistent disease rate stands at 36.8 %. A total of 15.2 % of serious adverse event was considered related to erlotinib. Conclusion: Our study and several others now demonstrate the feasibility of combining anti-epidermal growth factor receptor (EGFR) therapy with chemoradiation, hint at improved survival outcomes with reduced distant metastatic rates, and suggest that maintenance therapy with anti-EGFR agent may be beneficial. [ABSTRACT FROM AUTHOR]

Acute otitis externa (AOE), is a common infectious disease affecting children and adults. Its peak prevalence is around the summer months, it involves the external auditory canal and in most cases is due to bacterial agents. This is a retrospective observational analytical case-based study involving all consecutive patients under the age of 18 years old presenting with AOE to a pediatric emergency department. We collected data from 337 patients under 18 years of age with 344 visits to the Emergency Department, between the years 2011–2018. Nearly half of the visits presented during the summer months. Children were divided into two subgroups: hospitalized and non-hospitalized. Median hospitalization time was 3 days. The hospitalized sub-group had higher rates of failed treatment, as well as higher rates of external ear canal edema, systemic fever, canal discharge and auricular edema. On multivariable analysis the following variables had the strongest correlation for hospital admission: auricular edema (OR 27.98), otorrhea (OR 1.82), narrowing of the ear canal by more than 50% (OR 1.91), fever (OR 2.92), and previous systemic treatment (OR 2.53). Pseudomonas aeruginosa (PA) was isolated in 78% of cultures in the hospitalized sub-group. All PA strains were sensitive to ciprofloxacin. This study highlights the main clinical variables which may predict hospitalization among children with AOE as well as the dominant role of sensitive strains of PA in the pathogenesis of this condition in children. [ABSTRACT FROM AUTHOR]