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Background Mutations involving BRAF and TERT are important predictors of disease severity in thyroid cancer, but molecular testing is limited by cost and lack of adequate tissue sample. This study aimed to assess the utility of BRAFV600E and TERT testing using droplet digital PCR (ddPCR) as a diagnostic and prognostic tool for thyroid fine needle aspirate biopsy (FNAB). Methods Patients with thyroid nodules were prospectively enrolled from March 2015 to September 2018. Pre-operative FNAB was collected for standard cytology and molecular testing. BRAFV600E and TERT levels were analyzed by ddPCR. Cytology (Bethesda system) and ddPCR results were correlated to surgical pathology. Results A total of 222 patients were enrolled, of which 124 received thyroid surgery. Pre-operative cytology alone with Bethesda ≥5 was 100% specific and 70% sensitive for malignancy on final surgical pathology. BRAFV600E positivity or TERT overexpression was 100% specific and 60.0% sensitive. Combining cytology (Bethesda ≥5) with BRAFV600E and TERT testing increased the sensitivity of a malignant diagnosis to 80.0%. High TERT levels and/or BRAFV600E was associated with aggressive or advanced stage pathology. Conclusions Combining cytology with ddPCR analysis of BRAFV600E and TERT can improve the diagnostic accuracy of thyroid FNAB, and help predict aggressive pathology.

A male in his 50s presented to the hospital with preauricular tenderness, trismus and dysphagia. He had intramuscular stimulation of his left temporomandibular joint region performed 4 days prior and described worsening pain and swelling since. A CT scan revealed an abscess involving the left masticator space. Incision and drainage of the abscess was performed, and the patient was discharged home on oral antibiotics 11 days later. This is the first report of masticatory space abscess following intramuscular stimulation of the temporomandibular joint area. Acupuncture and intramuscular stimulation are common complementary medicine therapies that are generally considered safe; however, adverse events such as deep neck space infection have been reported in the literature. Current regulation of training requirements and licensure for needling therapies is highly variable. Standardisation of training and practice guidelines may help mitigate the risk of adverse events related to needling therapies in the future.

Objectives: Otolaryngology—head and neck surgery (OHNS) training has been found to be underrepresented in medical school curricula. The study aimed to assess (i) students’ clinical OHNS exposure, (ii) their confidence managing OHNS conditions, and (iii) the correlation between OHNS exposure and confidence managing OHNS conditions. Methods: Fourth-year medical students at two Canadian Universities completed a survey assessing baseline characteristics, OHNS training, and confidence managing OHNS conditions. Results: Of 87 returned surveys, 46 students had no clinical OHNS exposure, while 29 felt there was adequate OHNS exposure. The majority of students lacked confidence recognizing conditions requiring emergent referral. Students with greater OHNS training had greater confidence managing OHNS conditions ( r = 0.267, P = .012). Conclusion: The majority of medical students have minimal OHNS exposure. Students with greater OHNS exposure have greater confidence managing OHNS conditions. A review of Canadian medical school curricula is warranted to ensure adequate OHNS exposure.

Background Much has been published about the effect of obesity on adverse outcomes after cardiac operations, yet little is known regarding the effect of obesity on intensive care unit (ICU) resource utilization. This study examined the effect of obesity on ICU resource utilization after cardiac operations. Methods All patients with a body mass index (BMI) of 18.5 kg/m 2 or higher who underwent a cardiac surgical procedure between 2006 and 2013 were stratified into the following weight categories: normal (BMI 18.5 to 24.99 kg/m 2 ), preobese (BMI 25 to 29.99 kg/m 2 ), obese class I (BMI 30 to 34.99 kg/m 2 ), obese class II (BMI 35 to 39.99 kg/m 2 ), and obese class III (BMI ≥40 kg/m 2 ). Comparisons between weight categories were done, and the risk-adjusted effect of weight category on prolonged ICU stay, prolonged ventilation, and ICU readmission was determined. Results Of the 5,365 included patients, 1,948 were obese. Patients with greater obesity experienced longer ICU time, longer ventilation time, and increased ICU readmission. After adjustment, increasing obesity remained independently associated with greater likelihood of prolonged ICU stay (obese class II: odds ratio [OR], 2.4; 95% confidence interval [CI], 1.55 to 3.61; obese class III: OR, 4.1; 95% CI, 2.38 to 7.05), prolonged ventilation (obese class III: OR, 3.4; 95% CI, 1.57 to 7.22), and ICU readmission (obese class II: OR, 3.0; 95% CI, 1.70 to 5.31; obese class III: OR, 2.9; 95% CI, 1.32 to 6.36). Conclusions Increasing obesity was associated with a significant increase in ICU resource utilization after cardiac operations. Further study is needed to determine the mechanisms underlying this association and how the adverse effects of obesity may be mitigated.