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Objectives: To evaluate the risks of neoplasm and malignancy in surgically treated cystic parotid masses compared with solid or mixed lesions and to evaluate the performance of fine-needle aspiration (FNA) in parotid cysts.Study Design: Retrospective cross-sectional study.Setting: Single-institution academic tertiary care center.Subjects and Methods: Patients without a history of human immunodeficiency virus or head and neck cancer who underwent parotidectomy for parotid masses and had preoperative imaging to characterize lesions as cystic, solid, or mixed (ie, partially cystic and partially solid). We assessed the risks of neoplasia and malignancy, adjusting for age, sex, race/ethnicity, facial nerve weakness, and history of malignancy. We also evaluated the sensitivity and specificity of FNA.Results: We included 308 patients, 27 of whom had cystic parotid masses (5 simple and 22 complex). Cystic masses were less likely to be neoplastic compared to solid or mixed masses (44% vs 97%; odds ratio [OR], 0.03; 95% confidence interval [CI], 0.01-0.07); however, there was no difference in the risk of malignancy (22% vs 26%; OR, 0.81; 95% CI, 0.32-2.10). Cystic masses were more likely to yield nondiagnostic FNA cytology results, but for diagnostic samples, FNA was 86% sensitive and 33% specific for diagnosing neoplasia and 75% sensitive and 83% specific for diagnosing malignancy.Conclusion: In our population, cystic masses undergoing surgery were less likely to be neoplastic but had a similar risk of malignancy as solid masses. The risk of malignancy should be considered in the management of cystic parotid masses. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in adults and significantly increases the risk of stroke. While vitamin D deficiency is associated with AF risk factors, retrospective studies of association with AF have shown mixed results. The primary objective of this study was to determine the efficacy of vitamin D supplementation for AF prevention in a randomized trial. Methods: We performed a secondary analysis of the Women's Health Initiative trial on calcium and vitamin D (CaD). Patients were randomized to either receive both 1,000 mg per day of calcium and 400 IU per day of vitamin D3, or placebo. Baseline serum 25-hydroxyvitamin D [25(OH)D] was measured for a subset of participants. We linked participants to their Medicare claims when available in order to ascertain incident AF. Results: We included 16,801 participants with available Medicare data. There were 1,453 (8.6%) cases of incident AF over an average of 4.5 years. We found no significant difference in incident AF rates between the CaD and placebo groups (hazard ratio [HR] 1.02 for CaD vs. placebo, 95% confidence interval [CI] 0.92-1.13). CaD supplementation appeared to be protective against AF in patients with severe vitamin D deficiency [<10 ng/mL 25(OH)D], but this was not statistically significant (HR 0.72, 95% CI 0.31-1.66). We found no significant interaction between treatment assignment and age (interaction P=0.99), vitamin D deficiency (P=0.34) or background vitamin D supplementation (P=0.51). After adjusting for multiple confounders including age, body mass index, hypertension, diabetes, and baseline vitamin D intake, there was no significant association between baseline 25(OH)D serum levels and incident AF (HR 0.98 for lowest quartile vs. highest quartile, 95% CI 0.72-1.32). Conclusion: We present the first analysis of a large randomized trial of vitamin D supplementation for AF prevention. We found that CaD supplementation had no effect on incidence of AF in WHI CaD trial participants. While there was a suggestion that supplementation may be protective against AF in the most vitamin D-deficient subgroup, this did not reach statistical significance. We also found that baseline serum 25(OH)D level was not predictive of long-term incident AF risk. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 has rapidly spread across the globe and infected hundreds of millions of people worldwide. As our experience with this virus continues to grow, our understanding of both short-term and long-term complications of infection with SARS-CoV-2 continues to grow as well. Just as there is heterogeneity in the acute infectious phase, there is heterogeneity in the long-term complications seen following COVID-19 illness. The purpose of this review article is to present the current literature with regards to the epidemiology, pathophysiology, and proposed management algorithms for the various long-term sequelae that have been observed in each organ system following infection with SARS-CoV-2. We will also consider future directions, with regards to newer variants of the virus and their potential impact on the long-term complications observed.