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Background/Objectives: The diagnosis of vestibular migraine (VM) and Meniere’s disease (MD) is based mainly on clinical criteria. The aim of this study is to systematically review and investigate the potential role of the video Head Impulse Test (vHIT) in the differential diagnosis between VM and MD. Methods: A systematic review of the English-language literature was conducted, including studies from database inception to November 2023, in accordance with PRISMA guidelines. Medline (via PubMed), Cochrane Database and Scopus were reviewed. The review included studies involving adult patients diagnosed with VM, MD, or healthy control individuals who underwent vHIT and reported data on vHIT abnormalities, gain, and refixation saccades. The AXIS tool was applied for risk of bias assessment in all cross-sectional studies. A random-effects meta-analysis was performed to compare vHIT gains between individuals with VM and those with MD. Results: Eleven cross-sectional observational studies with a case–control comparison design were included, comprising a total of 362 patients with VM, 307 patients with MD, and 135 healthy control subjects. All studies applied the same diagnostic criteria for VM; however, varying criteria were used for the diagnosis of MD. Four studies evaluated the duration of vestibular symptoms, two assessed migraine duration, and six provided a rationale for excluding individuals with overlapping VM and MD diagnoses. Criteria for defining an abnormal vHIT result were specified in six studies. Seven studies reported vHIT gain values for the lateral semicircular canal, while eight presented data on saccade incidence and characteristics. Additionally, four studies were included in the meta-analysis, which yielded a mean difference in the vHIT gain of −0.0203 (95% CI: −0.0789 to 0.0383; p = 0.4968), indicating no statistically significant difference between patients with VM and those with MD. Conclusions: In this review, vHIT gain did not differ significantly between VM and MD groups, suggesting that vHIT gain alone has limited utility in their differential diagnosis. Combined saccade patterns may still prove clinically useful as more robust and consistent data become available.

Spontaneous splenic rupture (SSR) is a relatively rare but potentially lethal complication of infectious mononucleosis (IM). While SSR is extremely rare in patients with proven IM, it is the most lethal complication of the infection (9% mortality rate) and can present completely asymptomatically or with abdominal pain and hemodynamic instability. As adolescents and young adults are the most affected population group, with this case report, we intend to raise the vigilance of any doctor treating those patients in the emergency department. We present the case of a 16-year-old patient with an atraumatic splenic rupture and hemoperitoneum secondary to an Epstein–Barr virus (EBV) infection. The patient underwent an exploratory laparotomy, and a splenectomy was performed. This case demonstrates that, even if SSR in patients with IM is extremely rare, it should always be considered in a patient with a relevant clinical presentation.

(1) Background: Ménière’s disease (MD) is a disease of the inner ear, presenting with episodes of vertigo, hearing loss, and tinnitus.The aim of this study is to examine the role of multifrequency tympanometry (MFT) in the diagnosis of MD. (2) Methods: A systematic review of MEDLINE (via PubMed), Scopus, Google Scholar, and the Cochrane Library was performed, aligned with the PRISMA guidelines. Only studies that directly compare ears affected by Ménière’s disease with unaffected or control ears were included. Random-effects model meta-analyses were performed. (3) Results: Seven prospective case-control studies reported a total of 899 ears, 282 of which were affected by Ménière’s disease (affected ears—AE), 197 unaffected ears in patients with MD (UE), and 420 control ears (CE) in healthy controls. No statistically significant differences between the groups were observed regarding resonant frequency (RF). The pure tone audiometry average of the lower frequencies (PTA basic) was significantly greater in affected ears when compared with unaffected ears. The conductance tympanogram at 2 kHz revealed a statistically significantly greater G width of 2 kHz in the affected ears when compared to both unaffected and control ears, while control ears had a statistically significant lesser G width of 2 kHz compared to both the other two groups. (4) Conclusions: MFT, and specifically G width at 2 kHz, could be an important tool in the diagnosis of MD.

Background Geriatric populations face heightened vulnerability due to aging, socioeconomic challenges, and marginalization. In 2023, 18.1% of Germans over 65 were at risk of poverty, with women and those aged 80 + disproportionately affected. The SARS-CoV-2 pandemic (2020–2022) exacerbated these issues, restricting healthcare access. This study investigates geriatric head and neck trauma trends (2018–2024) across pre-pandemic, pandemic, and post-pandemic periods. Methods Conducted at a level 1 trauma centre, data were sourced from the Dortmund Maxillofacial Trauma Registry (14,500 + cases, 2007–2024). Fractures were categorized per AO guidelines, and demographic analyses, fracture distribution and other medical conditions were presented. Results This study analysed 973 geriatric head and neck trauma cases (2018–2024). Falls were predominant (82.6%), with significant comorbidities (2.6 per patient), including hypertension (64%). Males experienced a 73% decrease in case numbers in 2021. Injuries primarily affected the midface, with 52% requiring surgery. Pandemic disruptions influenced trends, highlighting geriatric trauma complexity and care demands are detailed analysed. Discussion Our study presents comprehensive data on geriatric head and neck traumatology, analyzing 65–75 y.o. and > 75 y.o. groups. Male predominance was significant at 65–70 y.o. ( p  < 0.001) but reversed above 75 y.o., with significant female dominance. Since the SARS-CoV-2 pandemic, case numbers showed extreme volatility, with a 30% rise in females and 90% in males in 2021, followed by a record low in 2022. Cerebral injuries occurred in 49.3% of patients, with 2.6 comorbidities per capita and 52% requiring surgery. Anticoagulant therapy was frequent (≈ 74% antiplatelet, 26% anticoagulant). Falls caused 82% of injuries, predominantly affecting the nasal bone, zygomatic bone (218), and orbital floor (262), indicating high vulnerability in this population. Conclusion Our study reveals volatility in case numbers post-SARS-CoV-2, with males disproportionately affected. A high proportion of elderly patients take anticoagulants. Among the injured, there is a high rate with cerebral injury. Most fractures occur in exposed facial regions. Ongoing surveillance is essential to address increasing geriatric vulnerability.

Purpose: The purpose of this study is to determine the magnitude of change that is clinically meaningful in the EORTC QLQ-C30 and EORTC QLQ-HN35 instruments in head and neck cancer patients. Methods: Two hundred and twenty-two patients completed the EORTC QLQ-C30 and EORTC QLQ-HN35 at baseline and follow-up one to two months later. Minimal clinically important differences (MCIDs) were calculated through anchor- and distribution-based methods for improvement and deterioration. Karnofsky Performance status (KPS) was used as the anchor to determine meaningful change. Results: In the group of patients who deteriorated, more scales and symptoms demonstrated statistically significant meaningful change. EORTC QLQ-C30 meaningful change values for deterioration with KPS anchor ranged from 7.2 (physical functioning) to 16.7 units (Global Health Status), and for improvement ranged from 10.0 (role functioning) to 16.7 units (Global Health Status). Conclusions: We report—for the first time, to the best of our knowledge—MCID for EORTC QLQ-C30 and QLQ-HN35 in head and neck cancer patients. Knowledge of meaningful change in these questionnaires allows physicians to assess patient change over time, along with evaluating the impact of treatment on quality of life.

Background: Workplace stress and burnout in the Greek healthcare system had been considered severe even before the high pressure of the COVID-19 pandemic. We aimed to investigate occupational quality of life and burnout effects on workplace errors among the administrative staff in the Greek healthcare system. Methods: We enrolled 120 administrative healthcare employee participants between April and May 2019. Occupational burnout was assessed using the Maslach Burnout Inventory—Human Services Survey and the Hospital Anxiety and Depression Scale. Findings: Inadequate staffing, a low sense of well-being, exhaustion, and low family income were associated with workplace errors. Increased workload and staff shortages were associated with occupation related quality of life. Conclusions: Targeted interventions supporting healthcare staff mental health are warranted. Application to Practice: Wellness and professional burnout can affect professional efficiency and are associated with workplace errors in the healthcare sector. Targeted interventions are warranted to support the mental health of healthcare staff during work and to prevent incidents of post-traumatic stress. Shortages of staffing may lead to an increase in the cost of the provided services.

BackgroundNissen fundoplication is considered the cornerstone surgical treatment for hiatal hernia repair. Belsey Mark IV (BMIV) transthoracic fundoplication is an alternative approach that is rarely utilized in today’s minimally invasive era. This study aims to summarize the safety and efficacy of BMIV and to compare it with Nissen fundoplication.MethodsWe searched MEDLINE, Scopus, and Cochrane Library databases for single arm and comparative studies published by March 31st, 2022, according to PRISMA statement. Inverse-variance weights were used to estimate the proportion of patients experiencing the studied outcome and random-effects meta-analyses were performed.Results17 studies were identified, incorporating 2136 and 638 patients that underwent Belsey Mark IV or Nissen fundoplication, respectively. A total of 13.8% (95% CI: 9.6–18.6) of the patients that underwent fundoplication with the BMIV technique had non-resolution of their symptoms and 3.5% (95% CI: 2.0–5.4) required a reoperation. Overall, 14.8% (95% CI: 9.5–20.1) of the BMIV arm patients experienced post-operative complications, 5.0% (95% CI: 2.0–9.0) experienced chronic postoperative pain and 6.9% (95% CI: 3.1–11.9) had a hernia recurrence. No statistically significant difference was observed between Belsey Mark IV and Nissen fundoplication in terms of post-interventional non-resolution of symptoms (odds ratio [OR]: 1.49 [95% Confidence Interval (95%CI):0.6–4.0]; p = 0.42), post-operative complications (OR:0.83, 95%CI: 0.5–1.5, p = 0.54) and in-hospital mortality (OR:0.69, 95%CI: 0.13–3.80, p = 0.67). Belsey Mark IV arm had significantly lower reoperation rates compared to Nissen arm (OR:0.28, 95%CI: 0.1–0.7, p = 0.01).ConclusionsBMIV fundoplication is a safe and effective but technically challenging. The BMIV technique may offer benefits to patients compared to the laparoscopic Nissen fundoplication. These benefits, however, are challenged by the increased morbidity of a thoracotomy.

Objective: The undisputed gold standard of treatment for type A aortic dissections (TAAD) is open surgery. Anecdotal reports have assessed thoracic endovascular aortic repair (TEVAR) as a last resort for highly selected candidates. The present study aims to evaluate endovascular outcomes in TAAD patients who are unsuitable for open surgery whilst having TEVAR-compatible aortic anatomy. Methods: A PRISMA-compliant systematic search of the PubMed, Scopus, and Cochrane databases was performed up to 19 May 2022. Time-to-event data were reconstructed using Kaplan–Meier curves from the source literature. Results: In 20 eligible studies, 311 patients underwent TEVAR for acute, subacute, or chronic TAAD. Mean age at the time of the operation was 60.70 ± 8.00 years and 75.48% (95% Confidence Interval [CI], 60.33–88.46%) of the included patients were males. Mean operative time was 169.40 ± 30.70 min. Overall, 0.44% (95% CI, 0.00–4.83%) of the cases were converted to salvage open surgery. Technical failure, stroke, and endoleaks occurred in 0.22%, 0.1%, and 8.52% of the cohort, respectively. Thirty-day postoperative complication rate was 7.08% (95% CI, 1.52–14.97%), whereas late complications developed in 16.89% (95% CI, 7.75–27.88%) of the patients. One-, three-, and five-year survival rates were estimated at 87.15%, 82.52% and 82.31%, respectively. Reintervention was required in 8.38% of the cohort over a mean follow-up of 32.40 ± 24.40 months. Conclusions: TEVAR seems to be feasible in highly selected patients with TAAD who cannot tolerate open surgery. Overcoming technical limitations and acquiring long-term data are warranted to safely define the place of endovascular treatment in the armamentarium of TAAD repair.