Prescription-based cost analysis of medicines for cardiovascular risk factors at Indian Council of Medical Research-Rational Use of Medicine Centre Hospitals of India.

OBJECTIVES: India has taken several initiatives to provide health care to its population while keeping the related expenditure minimum. Since cardiovascular diseases are the most prevalent chronic conditions, in the present study, we aimed to analyze the difference in prices of medicines prescribed for three cardiovascular risk factors, based on (a) listed and not listed in the National List of Essential Medicines (NLEM) and (b) generic and branded drugs. MATERIALS AND METHODS: Outpatient prescriptions for diabetes mellitus, hypertension, and dyslipidemia were retrospectively analyzed from 12 tertiary centers. The prices of medicines prescribed were compared based on presence or absence in NLEM India-2015 and prescribing by generic versus brand name. The price was standardized and presented as average price per medicine per year for a given medicine. The results are presented in Indian rupee (INR) and as median (range). RESULTS: Of the 4,736 prescriptions collected, 843 contained oral antidiabetic, antihypertensive, and/or hypolipidemic medicines. The price per medicine per year for NLEM oral antidiabetics was INR 2849 (2593-3104) and for non-NLEM was INR 5343 (2964-14364). It was INR 806 (243-2132) for generic and INR 3809 (1968-14364) for branded antidiabetics. Antihypertensives and hypolipidemics followed the trend. The price of branded non-NLEM medicines was 5-22 times higher compared to generic NLEM which, for a population of 1.37 billion, would translate to a potential saving of 346.8 billion INR for statins. The variability was significant for sulfonylureas, angiotensin receptor blockers, beta-blockers, diuretics, and statins (P < 0.0001). CONCLUSION: The study highlights an urgent need for intervention to actualize the maximum benefit of government policies and minimize the out-of-pocket expenditure on medicines.

Effect of hybrid drying on the quality attributes of formulated instant banana-milk powders and shakes during storage.

The present research aimed to evaluate the effect of microwave-assisted conventional drying (hybrid drying) on the physico-chemical and functional characteristics of formulated instant banana-milk powders (IBSPs), and organoleptic attributes of banana-milk shakes during storage. The instant powders were prepared from ripe (IBSP1 (control) and IBSP2) and overripe (IBSP3) bananas using hot-air drying (control) and hybrid (microwave assisted hot-air) drying. The water holding capacity, water solubility index, and viscosity of fresh samples, IBSP1, IBSP2, and IBSP3 were 1.97, 1.53 and 0.60 g/g dry sample, 69.48, 75.21 and 76.62 g/mL and 82.29, 86.29 and 72.55 mPas, respectively. A significant (p < 0.05) increase in moisture content, water activity (aw), acidity, and non-enzymatic browning was observed in all the variants/samples during storage. Among various treatments, the shakes prepared by reconstitution (IBSP: water ratio, 1:4) of IBSP2 formulation rated highest organoleptically (significant, p < 0.05).

In vitro antioxidant and antimicrobial activities of clove extract and its effectiveness in bio-composite film on storage stability of goat meat balls.

The aim of this study was to find out clove extract's antimicrobial and antioxidant properties, as well as its efficacy as a bioactive ingredient in the development of bio-composite films to increase the storage stability of goat meat balls stored at 4 ± 1°C. The clove extracts (CLEs) were prepared in ethanol, hydroethanol (1:1), and water and evaluated for antioxidant and antimicrobial potential. In vitro assays of CLEs revealed more susceptibility for gram-positive bacteria than gram-negative bacteria. Among the different extracts, the clove ethanol extract (CLEE) had the highest antimicrobial activity against tested microorganisms as well as total phenolics (1.14 mg GAE/g), flavonoids (8.50 µg catechin/g), and DPPH assay (39.59%). Further, the concentration-dependent effect of CLEE (p < 0.05) on thickness and color values and antimicrobial properties of the bio-composite film were observed. The storage qualities of the product T1 (with film; 450 µl CLEE) such as pH (6.45 ± 0.01), TBARS (0.87 ± 0.06 mg malonaldehyde/kg) value, free fatty acid (0.193 ± 0.001% oleic acid), total mesophilic count (4.98 ± 0.05 log10 CFU/g), and sensory attributes (overall acceptability score: 5.67 on 8-point scale) were better (p < 0.05) than T0 (without film; control) on day 20 of storage. Thus, the ethanolic clove extract has a superior antioxidant and antimicrobial potential. Its inclusion in the bio-composite film prolonged the storage stability of goat meat balls by controlling lipid oxidation and microbial growth. Practical Application Today's consumers are more attracted towards meat products added with natural ingredients having preservative effects. Clove extract is a classic example of a natural preservative and has excellent antimicrobial and antioxidant potential. The present study revealed that by wrapping the ethanolic clove extract-based bio-composite film on goat meat balls extended the storage stability of the product due to controlled lipid oxidation and microbial growth. Thus, such bio-composite films can be successfully applied on goat meat balls that function as a antimicrobial packaging for providing optimum organoleptic quality and better shelf life.

Citrinin Mycotoxin Contamination in Food and Feed: Impact on Agriculture, Human Health, and Detection and Management Strategies.

Citrinin (CIT) is a mycotoxin produced by different species of Aspergillus, Penicillium, and Monascus. CIT can contaminate a wide range of foods and feeds at any time during the pre-harvest, harvest, and post-harvest stages. CIT can be usually found in beans, fruits, fruit and vegetable juices, herbs and spices, and dairy products, as well as red mold rice. CIT exerts nephrotoxic and genotoxic effects in both humans and animals, thereby raising concerns regarding the consumption of CIT-contaminated food and feed. Hence, to minimize the risk of CIT contamination in food and feed, understanding the incidence of CIT occurrence, its sources, and biosynthetic pathways could assist in the effective implementation of detection and mitigation measures. Therefore, this review aims to shed light on sources of CIT, its prevalence in food and feed, biosynthetic pathways, and genes involved, with a major focus on detection and management strategies to ensure the safety and security of food and feed.

Trichothecenes in food and feed: Occurrence, impact on human health and their detection and management strategies.

Trichothecenes (TCNs) are the mycotoxins produced by many fungal species such as Fusarium, Myrothecium, and Stachybotrys and pose a considerable health risk. Based on their characteristic functional moieties, they are divided into four categories: Type A (T-2, HT-2, diacetoxyscirpenol (DAS), harzianum A, neosolaniol (NEO) and trichodermin), Type B (deoxynivalenol (DON), nivalenol (NIV), trichothecin and fusarenon X), Type C (crotocin) and Type D (satratoxin G & H, roridin A and verrucarin A) with types A and B being the most substantial. TCNs cause growth retardation in eukaryotes, suppress seedling growth or regeneration in plants and could be a reason for animal reproductive failure. Due to the increased frequency of occurrence and widespread distribution of TCNs in food and feed, knowledge of their sources of occurrence is essential to strategise their control and management. Hence, this review provides an overview of various types and sources of TCNs, the associated biosynthetic pathways and genes responsible for production in food and feed. Further, various processing and environmental effects on TCNs production, detection techniques and management strategies are also briefly outlined.

Prevalence and approaches to manage iron deficiency anemia (IDA).

Iron is a vital micronutrient required for growth and development at all stages of human life. Its deficiency is the primary cause of anemia that poses a significant global health problem and challenge for developing countries. Various risks are involved during iron deficiency anemia (IDA), such as premature delivery, low birth weight, etc. Further, it affects children's cognitive functioning, delays motor development, hampers physical performance and quality of life. It also speeds up the morbidity and mortality rate among women. The major reasons accountable are elevated iron demand in diet, socio-economic status, and disease condition. Various strategies have been adopted to reduce the IDA occurrence, such as iron supplementation, iron fortificants salts, agronomic practices, dietary diversification, biofortification, disease control measures, and nutritional education. Usually, the staple food groups for fortification are considered, but the selection of food fortificants and their combination must be safe for the consumers and not alter the finished product's stability and acceptability. Genetically modified breeding practices also increase the micronutrient levels of cereal crops. Therefore, multiple strategies could be relied on to combat IDA.

Nutritional significance and therapeutic potential of Moringa oleifera: The wonder plant.

Moringa oleifera is a multi-purpose plant and a comprehensive source of dietary components such as proteins, essential amino acids, vitamins, antioxidants, etc. The plant is also a rich source of other bioactive components, including flavonoids, glucosinolates, isothiocyanates, alkaloids, terpenoids, phenolics, etc. Incorporating M. oleifera in diet can improve the nutritional status of pregnant and nursing mothers and helps to combat malnutrition and iron deficiency anemia (IDA) among children. The phytochemicals and secondary metabolites, especially the polyphenolic compounds from Moringa, have a significant free-radical scavenging effect attributed to this plant's therapeutic potential. Investigations targeting to explore M. oleifera for its nutritional makeup, novel bioactive components, and analysis of their health-promoting attributes have received much attention. This review demonstrates an overview of recent (past ten years) advancements and patenting activity in discovering different parts of M. oleifera plant for providing adequate nutritive and bioactive components. The pharmacological potential and action mechanisms of M. oleifera in many diseases like diabetes mellitus, cancer, hypertension, ulcer, etc., are also discussed. PRACTICAL APPLICATIONS: Moringa oleifera is a vital plant that has a varied set of nutritional and therapeutic properties. The indigenous components of Moringa can treat humankind of its diseases and contribute to overall health. The qualitative and functional characteristics of its components indicate possible commercial exploitation of this high-value plant by utilizing its plant parts in many proprietary medicines and nutraceuticals. In conclusion, the Moringa plant needs to be used commercially. It can lead to tremendous economic development if the industries and researchers exploit its potential for highly nutritional super food and therapeutic application by undertaking further research to corroborate earlier studies.

Modelling and optimization of process parameters for production of desiccated Chhana-murki (Indian cottage cheese-based dessert).

In the present study, process parameters were optimized for the production of desiccated chhana-murki (Indian cottage cheese-based dessert). Response Surface Methodology (RSM) was employed to explore the mutual effects of coagulation temperature (CT) of milk (70-90 °C), % fat level in milk (3.5%-5.5%), and sugar-to-paneer cube (SP) ratio (0.6-0.9) on instrumental hardness (N), water activity (aw), yield (%), sensory sweetness and overall acceptability (on 100-point intensity scale) of chhana-murki. The resulted responses were evaluated by analysis of variance (ANOVA), and the second-order polynomial response surface equations were fitted using multiple regression analysis. Determination coefficients (R 2) were equal to 80% or higher for individual responses stated that the developed models were well fitted to the experimental results. The optimized product was prepared using CT 79.22 °C, milk fat 4.8%, and SP ratio 0.7. Confirmatory experiment values for instrument hardness, water activity (aw), yield (%), sensory sweetness and overall acceptability were 105.05 N, 0.85, 115.2%, 61.2 and 78.8, respectively.

pH-Controlled Efficient Conversion of Hemicellulose to Furfural Using Choline-Based Deep Eutectic Solvents as Catalysts.

The valorization of hemicellulose isolated from lignocellulosic biomass (wheat straw, rice husk, and bagasse) to furfural was achieved by pH-controlled acid catalysis using choline-based Brønsted acidic (BA) and natural acidic (NA) deep eutectic solvents (DES) serving both as catalyst and solvent. The effect of pH variation on the catalytic activity of various BADES and NADES prepared in 1 : 1 molar ratio was observed, and choline chloride/p-toluene sulfonic acid (ChCl/p-TSA) was found to be the best with lower pH value of 1.0. The yield of furfural decreased from 85 to 51 % with increase in pH from 1.0 to 3.0. The molar ratio of hydrogen bond donor to acceptor components was varied from 1 : 1 to 1 : 9 to achieve the lowest possible pH values of the DESs and to increase the furfural yield. Further optimization of reaction conditions was also done in terms of DES loading, time of reaction, and temperature using the model DES to achieve higher furfural yield. The best results were obtained using 5 mmol DES at pH 1.0 in 1.5 h at 120 °C. ChCl/p-TSA and ChCl/oxalic acid among BADES and ChCl/levulinic acid among NADES investigated in this work yielding 85 % furfural were found to be most efficient. The reported methodology is advantageous in terms of using bio-based green solvents, mild reaction conditions, and efficient scale-up of the reaction. The DESs were found to be efficiently recyclable up to five consecutive runs for the process.

Patulin in food: A mycotoxin concern for human health and its management strategies.

The mycotoxin patulin is primarily produced as a secondary metabolite by numerous fungal species and predominantly by Aspergillus, Byssochlamys, and Penicillium species. It is generally associated with fungal infected food materials. Penicillium expansum is considered the only fungal species liable for patulin contamination in pome fruits, especially in apples and apple-based products. This toxin in food poses serious health concerns and economic threat, which has aroused the need to adopt effective detection and mitigation strategies. Understanding its origin sources and biosynthetic mechanism stands essential for efficiently designing a management strategy against this fungal contamination. This review aims to present an updated outline of the sources of patulin occurrence in different foods and their biosynthetic mechanisms. It further provides information regarding the detrimental effects of patulin on human and agriculture as well as its effective detection, management, and control strategies.

Optimization of ingredients for preparation of low calorie fiber enriched chhana balls-Sandesh like product.

The present study aimed to optimize the relative proportion of roasted flax seed flour as dietary fiber ingredient (DFI) and jaggery:stevia percent in preparation of chhana balls. Response surface methodology (RSM) was used to determine the optimum DFI proportion and jaggery:stevia percent. Thirteen experimental runs were conducted with varying levels of independent variables viz. dietary fiber ingredient (4.0-8.0%) and jaggery:stevia :: 1:1 (22.5-27.5%), as generated by central composite design. The responses investigated were pH, cooking yield, water activity (aw), Hue angle, Chroma value and sensory attributes of chhana balls. The RSM results showed that the experimental data could be adequately fitted to a second-order polynomial model with a satisfactory Coefficient of determination (R2 > 50%). The study revealed that the effect of all the factors were significant on the studied responses. The optimum formulation obtained using desirability function was 5.92 and 26.42% for DFI proportion and jaggery:stevia respectively. The values of responses at optimum formulation were 6.36 pH, 91.80 cooking yield (%), 0.9481 water activity (aw), - 22.62 Hue angle, 8.71 Chroma value, 6.89 sweetness and 7.10 overall acceptability. These predicted values were validated with experimental values and found be not significantly different.

Evaluation of quality changes in nutritionally enriched extruded snacks during storage.

The aim of this study was to evaluate changes in the physical, chemical and sensory properties of a low fat-high protein, fiber enriched extruded snack. It was packed in metalized polypropylene/polyethylene (PP/PE) laminate pouches, under modified atmosphere packaging (MAP) with nitrogen flushing and without nitrogen flushing (control) and stored for a period of 22 weeks at 37 ± 1 °C and 80% RH. MAP had significant impact on the moisture content, aw, TBA value, Hunter L* value and crispiness of the extruded snacks during storage. The moisture content of the snack significantly increased from 3.68 to 5.16% in control and from 3.66 to 4.31% in MAP. The oxidative rancidity in terms of TBA value of control sample increased from 0.02 to 0.07 while the product packaged under MAP, the value increased to 0.056. The sensory scores for flavour, color and appearance, texture and overall acceptability (OA) of the product significantly decreased during storage, but the product stored under MAP had better flavor (6.51) and OA scores (6.85) compared to control (5.58 and 6.04, respectively), after 22 weeks of storage. Thus, MAP tended to retard the storage induced changes and it could suitably be utilized for the delivery of low fat-high protein, fiber enriched extruded snacks to the consumer, while keeping the sensorial acceptance of the product for 5 months.

Caution Ahead: Research Challenges of a Randomized Controlled Trial Implemented to Improve Breast Cancer Treatment at Safety-Net Hospitals.

PURPOSE: To implement and test a Web-based tracking and feedback (T&F) tool to close referral loops and reduce adjuvant breast cancer treatment underuse in safety-net hospitals (SNHs). PATIENT AND METHODS: We randomly assigned 10 SNHs, identified patients with new stage 1 to stage 3 breast cancer, assessed their connection with the oncologist, and relayed this information to surgeons for follow-up. We interviewed key informants about the tool's usefulness. We conducted intention-to-treat and pre- and poststudy analyses to assess the T&F tool and implementation effectiveness, respectively. RESULTS: Between the study start and intervention implementation, several hospitals reorganized care delivery and 49% of patients scheduled to undergo breast cancer surgery were ineligible because they already were in contact with an oncologist. One high-volume hospital closed. Despite randomization of hospitals, intervention (INT) hospitals had fewer white patients (5% v 16%; P = .0005), and more underuse (28% v 15%; P = .002) compared with usual care (UC) hospitals. Over time, INT hospitals with poorer follow-up significantly reduced underuse compared with UC hospitals (INT hospitals, from 33% to 9%, P = .001 v UC hospitals, from 15% to 11%, P = .5). There was no difference in underuse (9% at INT hospitals, 11% at UC hospitals; P = .8). Hospitals with better follow-up (odds ratio, 0.85; 95% CI, 0.73 to 0.98) had less underuse. In settings with poor follow-up and tracking approaches, key informants found the tool useful. The rapidly changing delivery landscape posed significant challenges to this implementation research. CONCLUSION: A T&F tool did not significantly reduce adjuvant underuse but may help reduce underuse in SNHs with poor follow-up capabilities. Inability to discern T&F effectiveness is likely due to encountered challenges that inform lessons for future implementation research.

Bone Health in Patients with Epilepsy: A Community-based Pilot Nested Case-control Study.

BACKGROUND: Antiepileptic drugs (AEDs) adversely affect bone health and there are reports describing association of alternations of bone and mineral metabolism in epileptic patients. OBJECTIVES: This study was undertaken to evaluate the bone profile (bone mineral parameters and bone mineral density [BMD]) of patients with epilepsy and compare them to their age-, gender-, and socioeconomic status-matched healthy controls in a community. MATERIALS AND METHODS: This was a nested case-control study conducted in fifty individuals, which included 25 cases (age above 18 years and on AEDs for at least 3 years) for which 25 controls were selected from the same community. Bone mineral parameters (serum calcium, proteins, phosphorous, alkaline phosphate, parathyroid hormone, and Vitamin D) and BMD were measured. RESULTS: There was significant hypocalcemia (P = 0.003), hypoproteinemia (P = 0.014), hyperparathyroidism (P = 0.048), and increased levels of serum alkaline phosphatase (P = 0.019) in cases as compared to controls. The difference was insignificant in the serum levels of Vitamin D and phosphorous among both the groups. Vitamin D was significantly low in female patients as compared to males (P = 0.043). There was no significant difference in BMD at the lumbar spine and femur neck among both the groups. Mean duration of epilepsy was longest in patients with osteoporosis (23.6 years), and increasing duration of epilepsy was associated with reduction in age- and sex-corrected total BMD mean Z-score anteroposterior spine. There was negative correlation between cumulative drug load and T-score of patients with epilepsy. CONCLUSION: Patients on long-term AED treatment have altered bone profile as evident from biochemical parameters and reduced BMD. There is a need for more extensive research and that too on a larger sample size.

Organizational Factors Affect Safety-Net Hospitals' Breast Cancer Treatment Rates.

OBJECTIVE: To identify key organizational approaches associated with underuse of breast cancer care. SETTING: Nine New York City area safety-net hospitals. STUDY DESIGN: Mixed qualitative-quantitative, cross-sectional cohort. METHODS: We used qualitative comparative analysis (QCA) of key stakeholder interviews, defined organizational "conditions," calibrated conditions, and identified solution pathways. We defined underuse as no radiation after lumpectomy in women <75 years or mastectomy in women with ≥4 positive nodes, or no systemic therapy in women with tumors ≥1 cm. We used hierarchical models to assess organizational and patient factors' impact on underuse. PRINCIPAL FINDINGS: Underuse varied by hospital (8-29 percent). QCA found lower underuse sites designated individuals to track and follow-up no-shows; shared clinical information during handoffs; had fully integrated electronic medical records enabling transfer of responsibility across specialties; had strong system support; allocated resources to cancer clinics; had a patient-centered culture paying close organizational attention to clinic patients. High underuse sites lacked these characteristics. Multivariate modeling found that hospitals with strong approaches to follow-up had low underuse rates (RR = 0.28; 0.08-0.95); individual patient characteristics were not significant. CONCLUSIONS: At safety-net hospitals, underuse of needed cancer therapies is associated with organizational approaches to track and follow-up treatment. Findings provide varying approaches to safety nets to improve cancer care delivery.

Modified case based learning: Our experience with a new module for pharmacology undergraduate teaching.

OBJECTIVE: The undergraduate teaching in pharmacology has always been a challenging task for medical teachers. Traditional lecture format is monotonous and a passive way of learning. There is a need to shift the educational focus from content centered to case based. In an effort to create interest and further improve the student learning, we have introduced simulated bedside teaching sessions as case based learning (CBL) module (modified CBL-[mCBL]) for 2(nd) professional MBBS students. MATERIALS AND METHODS: A case scenario of a clinical disease condition was prepared in consultation with a clinician. During the session, the case was presented along with discussion on the disease process, its management and rational drug use. Students were encouraged to participate actively. After the session, students were requested to fill the feedback questionnaire anonymously (both open-ended questions and responses on Likert scale). RESULTS: According to the students, factors such as clinical orientation, interactivity and re-enforcement of important points helped them to learn better. Majority of the students (76.09%) found the sessions to be better than theory lectures and tutorials. The fact that the interactive component of departmental feedback (taken at the institutional level) has improved during the last 2 years could be attributed to the introduction of these sessions. CONCLUSION: mCBL (in the presence of departmental faculty and concerned clinician) is a good method of integrating pharmacology with clinical subjects. To make such sessions more reliable, the next planned step is to assess the knowledge gained by the students during such sessions in the future.

The pathological features of surgically managed adrenal cysts: a 15-year retrospective review.

Adrenal cysts are rare. Most are benign but some may contain malignancy. There are no established guidelines for their surgical management. The purpose of this study was to determine the pathological findings and likelihood of malignancy in hormonally inactive adrenal cysts after adrenalectomy. Using the pathology registries at two centers, we identified patients who underwent excision of an adrenal cyst between 1994 and 2009. Hormonally active cysts including pheochromocytomas were excluded. Charts were reviewed for patient demographics, presentation, surgical management, and postoperative course. Of 551 adrenalectomy specimens, 15 (2.7%) contained an inactive adrenal cyst or cystic component. Cysts were more likely to be in women (67%) and right-sided (73%). Three patients (20%) were symptomatic from their lesion. Laparoscopic adrenalectomy was performed in nine patients (60%). Pathology revealed eight hemorrhagic cysts, four lymphangiomas, one hemangioma, one epithelial cyst, and one metastatic pulmonary adenocarcinoma. Laboratory and radiographic workup are essential in determining whether adrenal cysts have hormonal function or a solid tissue component before adrenalectomy. Although nonfunctional adrenal cysts may contain malignancy, most are benign. It is reasonable to observe asymptomatic, nonfunctioning, benign-appearing adrenal cysts in patients in whom follow-up can be ensured.

Activation of the Sonic Hedgehog pathway in thyroid neoplasms and its potential role in tumor cell proliferation.

The sonic hedgehog (SHH) pathway is activated in several types of malignancy and plays an important role in tumor cell proliferation and tumorigenesis. SHH binding to a 12-pass transmembrane receptor, Patched (PTCH), leads to freeing of Smoothened (SMO) and subsequent activation of GLI transcription factors. In the present study, we analyzed the expression of SHH, PTCH, SMO, and GLI1 in 31 follicular thyroid adenomas (FTA), 8 anaplastic thyroid carcinomas (ATC), and 51 papillary thyroid carcinomas (PTC) by immunohistochemical staining. More than 65% of FTA, PTC, and ATC specimens stained positive for SHH, PTCH, SMO, and GLI. However, the expression of the genes encoding these four molecules did not correlate with any clinicopathologic parameters, including the age, gender, the status of BRAF gene mutation, tumor stage, local invasion, and metastasis. Three thyroid tumor cell lines (KAT-18, WRO82, and SW1736) all expressed the genes encoding these four molecules. 5-Bromo-2-deoxyuridine labeling and MTT cell proliferation assays revealed that cyclopamine (CP), an inhibitor of the SHH pathway, was able to inhibit the proliferation of KAT-18 and WRO82 cells more effectively than SW1736 cells. CP led to the arrest of cell cycle or apoptosis. Knockdown of SHH and GLI expression by miRNA constructs that target SHH or GLI mRNA in KAT-18 and SW1736 cells led to the inhibition of cell proliferation. Our results suggest that the SHH pathway is widely activated in thyroid neoplasms and may have potential as an early marker of thyroid cancer or as a potential therapeutic target for thyroid cancer treatment.

From Mount Sinai to Mount Scopus: differences in the role and value of fine needle aspiration for evaluating thyroid nodules.

BACKGROUND: Fine needle aspiration is the main diagnostic tool used to assess thyroid nodules. OBJECTIVES: To correlate FNA cytology results with surgical pathological findings in two teaching medical centers across the Atlantic. METHODS: We retrospectively identified 484 patients at Hadassah Hebrew University Medical Center, Jerusalem and Mount Sinai Hospital, New York, by means of both preoperative FNA cytology and a final histopathological report. Results compared FNA diagnosis, histological findings and frozen section results (Mt. Sinai only). RESULTS: The sensitivity value of FNA at Hadassah was 83.0% compared with 79.1% at Mt. Sinai (NS). Specificity values were 86.6 vs. 98.5% (P < 0.05), negative predictive value 78.7 vs. 77.6% (NS) and positive predictive value 89.7 vs. 98.6% (P < 0.05), respectively. "Follicular lesion" was diagnosed on FNA in 33.1% of the patients at Hadassah and in 21.5% at Mt Sinai (P < 0.005) with a malignancy rate of 42.5 vs. 23.1% (P < 0.05), respectively. Frozen section was used in 190 patients at Mt. Sinai (78.5%) with sensitivity and specificity values of 72.3% and 100%. Frozen section results altered the planned operative course in only 6 patients (2.5%). Follicular carcinoma was diagnosed in 12 patients at Hadassah vs. 2 patients at Mt. Sinai (P < 0.05). CONCLUSION: The sensitivity of FNA at the two institutions was comparable. While malignancy on frozen section is highly specific, it should be used selectively for suspicious FNA results. Follicular lesions and the rate of malignancy in such lesions were more common at Hadassah, favoring a more aggressive surgical approach.