Introduction The thyroid gland displays numerous variations in its anatomy. Understanding the variations that occur can benefit diagnosis of thyroid disorders and improve management. The aim of this study was to investigate how factors such as age and sex may influence variations in the thyroid. Methods Twenty cadavers (10 males & 10 females) with a mean age of 78 were dissected. Variations in anatomy and vasculature were examined. Correlation between age and thyroid size was tested for significance using GraphPad prism 7. Results Most cadavers, 65%, had the superior thyroid artery originating from the external carotid artery, while 25% were from the bifurcation and 10% from the common carotid. The average weight for thyroids was 19.9 g in males and 13.9 g in females. A significant negative correlation was found between age and thyroid size. Discussion Thyroid gland variations, such as pyramidal lobes which affected 30% of cadavers, could impact medical interventions. Evidence from this study has confirmed the high incidence of such variations emphasising the requirement for preoperative imaging.

Objective Sudden sensorineural hearing loss is considered idiopathic in up to 90 per cent of cases. This study explored the role of blood tests as biomarkers for the diagnosis and prognosis of sudden sensorineural hearing loss. Method Two researchers filtered 34 papers into the final review. This review was pre-registered on the Prospero database and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Results Raised inflammatory markers are almost universal in sudden sensorineural hearing loss, suggesting an inflammatory or autoimmune process. The most useful biomarkers are neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and fibrinogen level. Focused investigations should be deployed on a case-by-case basis to identify underlying metabolic, infective and autoimmune conditions. Conclusion A full blood count and coagulation screen (fibrinogen) is recommended in all cases of sudden sensorineural hearing loss. These are inexpensive, accessible and offer as much diagnostic and prognostic information as any other biomarker. There is emerging evidence regarding specific biomarkers for sudden sensorineural hearing loss prognosis, with heat shock protein-70, anti-endothelial cell antibody and prestin demonstrating potential; investigation of their validity through prospective, controlled research is recommended.

We appreciate the work accomplished by Haider et al 1 in analysing the role of Multiple Mini Interviews (MMIs) and recognising the challenges in the search for an effective process in medical school admissions. In this letter, we present our comments on certain aspects of this study. The article acknowledges the need for additional student follow-up by comparing MMI scores to academic performance. Objective Structured Clinical Examinations (OSCEs) are used throughout medical schools in the UK to test communication skills as well as clinical knowledge. The use of MMIs in medical school admissions was deemed vital in preparing students for OSCEs; previous research established a positive correlation between MMI scores and OSCE performance. However, in this article there is no mention of the use of OSCEs which could be key in comparing performance to the previous cohort. It will be interesting to see if the cohort that underwent MMIs would feel better prepared for tackling their OSCEs. 2 In assembling the stations, the authors took into account the non-cognitive attributes assessed by MMIs and the importance of these skills. The extent to which these were assessed or how they were performed was not discussed. The authors also make it clear that timing proved to be a limiting factor when assessing certain key skills, such as problem solving and teamwork. Alternatively, stations that explore personal statements and extracurricular activities can be used to look for evidence of these skills. This can also highlight candidates with a greater drive to pursue a career in medicine. 3 Furthermore, the authors propose that MMIs allow institutions to identify specific areas of improvement to target these skills in the student's curriculum. Banjeree et al proposed a simulation-based curriculum to tackle this. A similar targeted approach could be used for these students over the next six years, therefore utilising the ability of MMIs to identify specific weaknesses in the cohort. 4 Additionally, the main appeal of using MMIs as opposed to traditional interviewing is the ability to standardise the admission process. Consequently, we feel this demonstrates a need for interviewer training to also be standardised, ensuring reliability in assessing students. Investigating the effectiveness of MMI training sessions proved to be helpful in preparing examiners and improving knowledge regarding the overall process. This was explored by comparing the interviewer's perceptions of MMIs post-training and after completion of the MMIs. These