BACKGROUND: The increasing incidence of papillary thyroid carcinoma (PTC), particularly among women, has prompted an investigation into possible associated factors. The effect of oral contraceptive pill (OCP) usage is debatable, with varying and often conflicting results. It is not confirmed whether OCPs have a protective effect against thyroid cancer or an increased risk.
OBJECTIVE: The objective of this study is to investigate the prevalence of OCP usage among females diagnosed with PTC at a tertiary hospital in Saudi Arabia.
METHODS: The study included females aged 18 and above diagnosed with PTC. An OCP user was defined as a female exposed to OCPs for at least one month. Data collection involved chart reviews and phone interviews, and statistical analyses were conducted using Excel and SPSS.
RESULTS: Among 58 female patients diagnosed with PTC, 29.3% (n=17) reported using OCPs, and 70.7% (n=41) were non-users. The ages of OCP users ranged from 26 to 56 years, with a median age of 44 years. The duration of OCP usage varied from 1 to 72 months, with a median duration of seven months. Additionally, for the non-users of OCPs, the age range was from 21 to 85 years, with a mean age of 46.4 years. The median ages for the total sample, OCP users, and non-users were 43.5, 44, and 43 years respectively. The timing of OCP usage among users varied from 1 to 35, with a mean timing of 13.
CONCLUSIONS: The study found about one-third 29.3% (n=17) of patients diagnosed with PTC reported using OCPs. These results contribute to the ongoing debate within epidemiological studies regarding the association between PTC and various reproductive factors, including OCP use. Further research is needed to clarify this relationship and its implications on public health.

BACKGROUND: COVID-19 vaccine uptake is cardinal in the control of COVID-19 pandemic. COVID-19 vaccine uptake is hindered by misinformation, conspiracy theory, and religious beliefs globally. This has posed a threat in curbing the spread of this highly infectious virus. Hence, knowledge of COVID-19 vaccine uptake predictors would help mitigate the burden of COVID-19 disease.
OBJECTIVE: To determine the predictors of COVID-19 vaccine uptake at the Federal Medical Centre, Makurdi.
METHODS: The study was a descriptive crosssectional study over 3 months from January to March 2022. The sample size was 384 at 50% prevalence. A self-administered questionnaire was employed using convenience sampling. Data analysis was done using SPSS version 23. The level of statistical significance was set at p<0.05.
RESULTS: The mean age of the participants was 39.97±5.56. The majority were aged 21-40 (52.9%, n=203). There were more males (57.6%, n=221). The proportion of COVID-19 uptake was 21.6%. There was a statistically significant relationship between taking the COVID-19 vaccine and age, marital status, education, occupation, job discipline, monthly income, type of family, place of residence, childhood vaccination, immunization as an adult, and family members/close contact with COVID-19. In addition, COVID-19 vaccine uptake was also significantly associated with the belief that the COVID-19 vaccine has not been thoroughly tested, that they could rely on the vaccine to stop severe disease and that pharmaceutical companies use COVID-19 to make money. The predictors of COVID-19 vaccine uptake were marital status (p-value= 0.001, aoR=0.286, 95% CI= 0.146-0.563), family type (p-value= 0.001, AoR=6.346, 95% CI= 2.700-14.912), those residing in an urban area (p-value= 0.024, AoR= 3.130, 95% CI= 1.164-8.416) and those who believe COVID 19 vaccine could stop the severe form of the disease (p-value= 0.001, AoR= 2.448, 95% CI= 1.560-3.841).
CONCLUSIONS: The COVID-19 vaccine uptake rate was low. The predictors of COVID-19 vaccine uptake were married respondents in a nuclear setting, residing in urban areas and believing that COVID 19 vaccine could stop the severe form of the disease.
BACKGROUND: L\'adoption du vaccin COVID-19 est essentielle pour contrôler la pandémie de COVID-19. L\'adoption du vaccin COVID-19 est entravée par la désinformation, les théories du complot et les croyances religieuses dans le monde entier. Cela constitue une menace pour endiguer la propagation de ce virus hautement infectieux. Par conséquent, la connaissance des prédicteurs de l\'adoption du vaccin COVID-19 aiderait à réduire le fardeau de la maladie COVID-19.
OBJECTIVE: Déterminer les prédicteurs de l\'adoption du vaccin COVID-19 au Centre Médical Fédéral de Makurdi.
UNASSIGNED: L\'étude était une étude descriptive transversale sur une période de 3 mois, réalisée de janvier à mars 2022. La taille de l\'échantillon était de 384 avec une prévalence de 50 %. Un questionnaire auto-administré a été utilisé en utilisant un échantillonnage de commodité. L\'analyse des données a été effectuée à l\'aide de SPSS version 23. Le niveau de signification statistique a été fixé à p<0.05.
UNASSIGNED: L\'âge moyen des participants était de 39,97±5,56 ans. La majorité avait entre 21 et 40 ans (52,9 %, n=203). Il y avait plus d\'hommes (57,6 %, n=221). La proportion d\'adoption du vaccin COVID-19 était de 21,6%. Il existait une relation statistiquement significative entre la prise du vaccin COVID-19 et l\'âge, l\'état matrimonial, le niveau d\'éducation, l\'occupation, la discipline professionnelle, le revenu mensuel, le type de famille, le lieu de résidence, la vaccination infantile, la vaccination à l\'âge adulte, les membres de la famille ou les contacts proches ayant contracté le COVID-19. De plus, l\'adoption du vaccin COVID-19 était également significativement associée à la croyance que le vaccin COVID-19 n\'a pas été suffisamment testé, qu\'ils pouvaient compter sur le vaccin pour éviter une forme grave de la maladie et que les compagnies pharmaceutiques utilisaient le COVID-19 pour gagner de l\'argent. Les prédicteurs de l\'adoption du vaccin COVID-19 étaient l\'état matrimonial (p-value=0,001, aoR=0,286, IC à 95 %=0,146-0,563), le type de famille (p-value=0,001, AoR=6,346, IC à 95 %=2,700-14,912), ceux résidant en zones urbaines (p-value=0,024, AoR=3,130, IC à 95 %=1,164-8,416) et ceux croyant que le vaccin COVID-19 pouvait éviter les formes graves de la maladie (p-value=0,001, AoR=2,448, IC à 95 %=1,560-3,841).
CONCLUSIONS: Le taux d\'adoption du vaccin COVID-19 était faible. Les prédicteurs de l\'adoption du vaccin COVID-19 étaient les répondants mariés vivant dans un cadre nucléaire, résidant en zones urbaines et croyant que le vaccin COVID-19 pouvait éviter les formes graves de la maladie.
UNASSIGNED: COVID-19, Prédicteurs, Hôpital tertiaire, Adoption du vaccin.

UNASSIGNED: Shared decision-making (SDM) on antibiotic therapy may improve antibiotic use in tertiary hospitals, but hospitalised patients are apprehensive about being involved in it. Understanding the facilitators and barriers to SDM can inform the design and implementation of interventions to empower these patients to engage in SDM on their antibiotic therapies.
UNASSIGNED: We conducted qualitative interviews with 23 adult patients purposively sampled with maximum variation from the three largest tertiary-care hospitals in Singapore (April 2019─October 2020). Thematic analysis was conducted using the Theoretical Domains Framework and Capability, Opportunity, Motivation, Behaviour (COM-B) model to identify areas for intervention.
UNASSIGNED: Hospitalised patients lacked comprehensive knowledge of their antibiotic therapies and the majority did not have the skills to actively query their doctors about them. There was a lack of opportunities to meet and interact with doctors, and patients were less motivated to engage in SDM if they had a self-perceived paternalistic relationship with doctors, trusted their doctors to provide the best treatment, and had self-perceived poor knowledge to engage in SDM. To empower these patients, they should first be educated with antibiotic knowledge. Highlighting potential side effects of antibiotics could motivate them to ask questions about their antibiotic therapies. Environment restructuring, as facilitated by nurses and visual cues to nudge conversations, could create opportunities for interactions and motivating patients into SDM on their antibiotic therapies.
UNASSIGNED: Education and environmental restructuring should be explored to empower hospitalised patients to engage in SDM on their antibiotic therapies.

BACKGROUND: This study aimed to assess the impact of coronavirus disease 2019 (COVID-19) on hospital service utilization and revenue in Chinese tertiary hospitals and develop an optimal pandemic control strategy (OPCS) for the peak period of the Omicron wave.
METHODS: Retrospective data from three Chinese tertiary hospitals (provincial, city, and county level) were analyzed for three phases: pre-outbreak (Jan-Apr 2019), outbreak (Jan-Apr 2020), and post-outbreak (Jan-Apr 2021). OPCS was developed under the guidance of the China government pandemic control policy during post-break phase of COVID-19. A decision-tree model was constructed to compare OPCS to strict pandemic control strategy during outbreak phase for the hospital service utilization and hospital revenue in a provincial tertiary hospital during the Omicron wave.
RESULTS: Outpatient, emergency room (ER) visits, hospitalizations, and intensive care admissions dropped by 33.8-53.4% during the outbreak, with the provincial hospital being the most affected. Hospital revenue also declined, especially for the provincial hospital (40.1%). Post-outbreak, most services recovered, but ER visits remained lower (11.6% decrease for provincial hospital, 46.5% for county hospital). Total income and expenditure decreased, with the provincial hospital experiencing the most significant revenue reduction (45.7%). OPCS showed greater utilization of medical services (31.6 times more outpatient visits; 1.7 times more inpatient days; 3.4% more surgery volume) and higher revenue (¥220.8 million more) compared to the strict pandemic control strategy.
CONCLUSIONS: COVID-19 measures were associated with less hospital service utilization and revenue in Chinese tertiary hospitals. The developed OPCS in Chinese tertiary hospitals, focusing on isolating infected inpatients but not shutting down the hospital facilities exposed to virus, could be effective in optimizing hospital service utilization and hospital revenue during the Omicron wave.

BACKGROUND: Transitioning to end-of-life care and thereby changing the focus of treatment directives from life-sustaining treatment to comfort care is important for neurological patients in advanced stages. Late transition to end-of-life care for neurological patients has been described previously.
OBJECTIVE: To investigate whether previous treatment directives, primary medical diagnoses, and demographic factors predict the transition to end-of-life care and time to eventual death in patients with neurological diseases in an acute hospital setting.
METHODS: All consecutive health records of patients diagnosed with stroke, amyotrophic lateral sclerosis (ALS), and Parkinson\'s disease or other extrapyramidal diseases (PDoed), who died in an acute neurological ward between January 2011 and August 2020 were retrieved retrospectively. Descriptive statistics and multivariate Cox regression were used to examine the timing of treatment directives and death in relation to medical diagnosis, age, gender, and marital status.
RESULTS: A total of 271 records were involved in the analysis. Patients in all diagnostic categories had a treatment directive for end-of-life care, with patients with haemorrhagic stroke having the highest (92%) and patients with PDoed the lowest (73%) proportion. Cox regression identified that the likelihood of end-of-life care decision-making was related to advancing age (HR = 1.02, 95% CI: 1.007-1.039, P = 0.005), ischaemic stroke (HR = 1.64, 95% CI: 1.034-2.618, P = 0.036) and haemorrhagic stroke (HR = 2.04, 95% CI: 1.219-3.423, P = 0.007) diagnoses. End-of-life care decision occurred from four to twenty-two days after hospital admission. The time from end-of-life care decision to death was a median of two days. Treatment directives, demographic factors, and diagnostic categories did not increase the likelihood of death following an end-of-life care decision.
CONCLUSIONS: Results show not only that neurological patients transit late to end-of-life care but that the timeframe of the decision differs between patients with acute neurological diseases and those with progressive neurological diseases, highlighting the particular significance of the short timeframe of patients with the progressive neurological diseases ALS and PDoed. Different trajectories of patients with neurological diseases at end-of-life should be further explored and clinical guidelines expanded to embrace the high diversity in neurological patients.

UNASSIGNED: Gastro-duodenal perforation is a common surgical emergency that remains a formidable health burden worldwide with significant morbidity and mortality. Ulcer disease remains the most common cause of gastro-duodenal perforation. Diagnosing the presence of H. pylori can help eradicate the infection from the community at large and thereby reduce the chances of gastro-duodenal perforation.
UNASSIGNED: To assess the clinical presentation of gastro-duodenal perforation patients and to evaluate the detection of Helicobacter pylori infection by available investigations.
UNASSIGNED: A descriptive observational study was conducted among 80 patients presenting with clinical features suggestive of gastro-duodenal perforation and confirmed by clinical, radiological basis and operative findings admitted at a rural tertiary care hospital during 2019-2020. Detailed history was taken from the patient/party, clinically examined, and blood/tissue samples were investigated. The patients were managed with standard treatment modality in the studied institute. Data were collected, compiled, and entered MS Excel and analyzed using appropriate software. Descriptive analysis was done in the form of proportion for categorical variables, mean or median for continuous variables.
UNASSIGNED: Cases of gastro-duodenal perforations were more among middle to later age of life, mostly affecting married male patients hailed from rural area and unskilled workers. History of intake of spicy food, prolonged starvation, history of NSAID use were common among them. Majority of the patients had history of pain abdomen in the past suggesting of PUD and history of taking variety group of acid reducing agents. Most of them presented with epigastric pain, vomiting, abdominal distension along with other signs of peritonitis. Obliteration of liver dullness and free gas under right dome of diaphragm was also noted in large proportion among them. Majority of cases were found positive for H. pylori on Histology (85%), followed by rapid urease test (RUT) (80%) and a positivity of 72.5% and 68.8% on serum IgG and IgA antibody respectively. Rapid Urease Test was more sensitive as well as specific in diagnosing of H. pylori than antibody detection test.
UNASSIGNED: Early detection of H. pylori infection and treatment with potent anti H. pylori therapy postoperatively has been found to be adequate.

UNASSIGNED: Early presentation, high rate of successful non-operative treatment, low morbidity and mortality in childhood intussusception is common in High and Upper Middle-Income Countries but not in many Lower middle- and Low-income countries.
UNASSIGNED: To assess the trends in the profile, treatment modalities and outcomes of intussusception in our hospital.
UNASSIGNED: Retrospective study over a 12-year period divided into two 6-year periods. Data entry/analysis was done using SPSS and various indices were compared between these two periods. Two-tailed t-test for two independent means was used to compare means while two-tailed Fisher exact tests were used to compare categorical variables. Results were presented as tables, means, ranges, percentages and a p-value less than 0.05 was deemed statistically significant.
UNASSIGNED: There was a significant increase in the proportion of successful non-operative treatment (18.6% vs 34%, p=0.03), reduction in the incidence of operative manual reduction (27.1% vs 12.8%; p=0.026), reduction in operative treatment (78.5% vs 63.9%, p=0.034), increased utilization of pre-intervention ultrasound (75% vs96.7%, p<0.0001) and reduction in hospital stay duration (10.47 ±7.95days vs 7.24±4.86 days; p=0.004).
UNASSIGNED: Contribution of successful non-operative treatment to the overall treatment of intussusception significantly increased while that of operative manual reduction significantly reduced and bowel resection showed no change. Preoperative utilization of ultrasonography significantly increased while mean duration of admission reduced significantly, but late presentation, morbidity and mortality rates had no significant changes.

Background: Health disparities are pervasive in surgical care. Particularly racial and socioeconomic inequalities have been demonstrated in emergency general surgery outcomes, but less so in elective abdominal wall reconstruction (AWR). The goal of this study was to evaluate the disparities in referrals to a tertiary hernia center. Methods: A prospectively maintained hernia database was queried for patients who underwent open ventral hernia (OVHR) or minimally invasive surgical (MISR) repair from 2011 to 2022 with complete insurance and address information. Patients were divided by home address into in-state (IS) and out-of-state (OOS) referrals as well as by operative technique. Demographic data and outcomes were compared. Standard and inferential statistical analyses were performed. Results: Of 554 patients, most were IS (59.0%); 334 underwent OVHR, and 220 underwent MISR. IS patients were more likely to undergo MISR (OVHR: 45.6% vs. 81.5%, laparoscopic: 38.2% vs. 14.1%, robotic: 16.2% vs. 4.4%; p < 0.001) when compared to OOS referrals. Of OVHR patients, 44.6% were IS and 55.4% were OOS. Patients\' average age and BMI, sex, ASA score, and insurance payer were similar between IS and OOS groups. IS patients were more often Black (White: 77.9% vs. 93.5%, Black: 16.8% vs. 4.3%; p < 0.001). IS patients had more smokers (12.1% vs. 3.2%; p = 0.001), fewer recurrent hernias (45.0% vs. 69.7%; p < 0.001), and smaller defects (155.7 ± 142.2 vs. 256.4 ± 202.9 cm2; p < 0.001). Wound class, mesh type, and rate of fascial closure were similar, but IS patients underwent fewer panniculectomies (13.4% vs. 34.1%; p < 0.001), component separations (26.2% vs. 51.4%; p < 0.001), received smaller mesh (744.2 ± 495.6 vs. 975.7 ± 442.3 cm2; p < 0.001), and had shorter length-of-stay (4.8 ± 2.0 vs. 7.0 ± 5.5 days; p < 0.001). There was no difference in wound breakdown, seroma requiring intervention, hematoma, mesh infection, or recurrence; however, IS patients had decreased wound infections (2.0% vs. 8.6%; p = 0.009), overall wound complications (11.4% vs. 21.1%; p = 0.016), readmissions (2.7% vs. 13.0%; p = 0.001), and reoperations (3.4% vs. 11.4%; p = 0.007). Of MISR patients, 80.9% were IS and 19.1% were OOS. In contrast to OVHR, MISR IS and OOS patients had similar demographics, preoperative characteristics, intraoperative details, and postoperative outcomes. Conclusion: Although there were no differences in referred patients for MISR, this study demonstrates the racial disparities that exist among our IS and OOS complex, open AWR patients. Awareness of these disparities can help clinicians work towards equitable access to care and equal referrals to tertiary hernia centers.

UNASSIGNED: To assess the perception of medical students at Alfaisal University College of Medicine (AUCOM) of their learning environment at a referral-based tertiary hospital in Riyadh, Saudi Arabia.
UNASSIGNED: The validated Dundee Ready Educational Environment Measure (DREEM) questionnaire was administered to all year 4 and year 5 students during the academic year 2020-2021. Scores were analyzed using the descriptors provided by the questionnaire developers and compared across different students\' cohorts using SPSS.
UNASSIGNED: The overall DREEM score was 120.45/200, which can be described as a \"more positive than negative environment\", indicating a positive perception with a potential for improvement. All domain scores were on the positive side except the \"students\' social self-perception\" which had a score indicating a problematic area. Female students had a statistically significant more positive score in the domain \"students\' perception of learning\" than male students. Scores for individual questions were persistently on the positive side except for eight questions that pointed to problematic areas in the curriculum. When compared between student cohorts, five questions had statistically significant difference in scores between students in both academic years, but only two of those had scores indicating concerning areas.
UNASSIGNED: Referral-based tertiary hospitals can be perceived positively by students as a learning environment in undergraduate medical education. We identified some areas of concern in our curriculum to be targeted by future research.

(1) Objectives: This study aimed to assess the 5-year prevalence and clinical profile of attention deficit hyperactive disorder (ADHD) among adult patients seeking care in a tertiary care hospital in Oman. (2) Methods: The data were analysed using descriptive and inferential statistics and standardised prevalence estimates were calculated. (3) Results: Of the 39,881 hospital visits, 1.77% were made by adults with ADHD. This is equivalent to 17.8 visits per 1000 outpatients. The year 2021 saw the highest prevalence among the five years considered, while 2020 had the lowest prevalence. Although the age distribution indicated that the age group \'under 20\' had the highest prevalence, the gender distribution showed that ADHD was more common among adult men. Among the various subtypes of ADHD, inattention was the most common. (4) Conclusions: This study specifically compared the prevalence and associated factors between an adult cohort with ADHD and those other psychiatric clinic attendees during the same period. The study offers important information on the prevalence and clinical profile of adults with ADHD in the population under consideration.