Background The COVID-19 pandemic has disrupted the daily life and academic trajectory of many students. The objectives of this study were to evaluate the effect of the pandemic on perceived stress levels among medical students. Methods Comparative pre-pandemic and pandemic surveys were conducted among samples of undergraduate medical students. Students responded to a questionnaire including personal and academic data, and Cohen’s Perceived Stress Scale (PSS). Results Overall, the prevalence of high perceived stress during the pandemic (20.6%) was significantly higher (p = 0.001) than pre-pandemic (11.6%). A multivariable analysis revealed that the independent factors associated with high perceived stress were: participation in the study during the pandemic (aOR = 1.79, 95% CI: 1.22–2.63), female sex (aOR = 1.74, 95% CI: 1.23–2.47), younger age (aOR = 1.62, 95% CI: 1.04–2.55) and lower family income (aOR = 1.50, 95% CI: 1.12–2.03). PSS score was negatively correlated with increasing age, family income, and academic level. PSS score was positively correlated with: worries about the possible disruption of education or exams, excessive news exposure, worries about the possibility of COVID-19 infection, and the effects of mandatory isolation and social distancing. Conclusion The COVID-19 pandemic increased the level of stress among medical students. Female students, younger students, and those in lower academic grades are the most at risk of having high stress. Worries about possible academic disruptions due to the pandemic are significant stressors. The implementation of online stress management programs is recommended.

The COVID-19 pandemic at its peak compelled students to stay home and adapt to the distance learning system. The world has gone through phases of fear and respite in the recent years. There have been a number of studies related to student learning via online teaching during the pandemic. Now, as the vaccination coverage picks up and the pandemic appears to have achieved a plateau, it is time to take a view of students’ perceptions of online learning and its effectiveness in skill development during the COVID-19 pandemic. This study assesses the students’ preferences and perceptions regarding offline and online learning post-COVID-19 lockdown and with the resumption of offline classes. A cross-sectional study was conducted at King Khalid University, Aseer region, from the period of 1 January 2022 to 30 January 2022. A convenience sampling technique was utilized to collect data from female students. Data analysis was conducted by using SPSS version 22.0. A total of 480 students participated in the study, their mean age was 19.79 ± 1.48. More than half of the students (64%) still fear getting COVID-19 as they continue with the in-person or offline classes despite having completed their doses of vaccination. Almost half of the students have difficulty in waking up after the recommencement of offline classes. The majority (77%) felt tired after starting offline classes, and 63% felt unhappy after starting offline classes again. The majority of students believe that, with offline classes, they have difficulty in time management and concentration. The majority of students believed that, with online classes, they are more comfortable in gaining knowledge and learning, more alert, more satisfied, and gain higher scores in exams. The majority of students preferred the online mode of learning, with about 72% of students wishing to continue online learning in the future. This research underlines the influence of fear of getting COVID-19 after the commencement of face-to-face learning amongst the students. Students were more inclined to continue with online classes because of fear of getting COVID-19, despite having full doses of the vaccination in Saudi Arabia. There is a need for a better understanding of students’ motivations and coping mechanisms during the pandemic.

IntroductionAzathioprine (AZA) interferes with the activation of T and B lymphocytes, which are the main cells involved in the pathogenesis of Graves’ disease (GD). The aim of this study was to investigate the effectiveness of AZA as an adjuvant therapy to antithyroid drugs (ATDs) for moderate and severe GD. In addition, we conducted an incremental cost-effectiveness analysis of AZA to determine its cost-effectiveness.MethodsWe conducted a randomized, open-label, and parallel-group clinical trial. We randomized untreated hyperthyroid patients with severe GD into three groups. All patients received 45-mg carbimazole (CM) as the starting dose and propranolol 40–120 mg daily. The first group (AZA1) received an additional 1 mg/kg/day AZA, the second group (AZA2) received an additional 2 mg/kg/day AZA, and the third group (control group) received only CM and propranolol. We measured thyroid-stimulating hormone (TSH) and TSH-receptor antibody (TRAb) levels at baseline and every 3 months, while free triiodothyronine (FT3) and free thyroxine (FT4) levels were measured at the time of diagnosis, 1 month after initiation of therapy, and every 3 months thereafter until 2 years after remission. Thyroid volume (TV) was assessed by ultrasound at baseline and 1 year after remission.ResultsA total of 270 patients were included in this trial. By the end of follow-up, there was higher remission rate in the AZA1 and AZA2 groups compared with controls (87.5% and 87.5% vs. 33.4%, p = 0.002). Throughout the course of follow-up, FT3, FT4, TSH, and TRAb were significantly different between the AZA groups and the control group, but there was no significant difference regarding TV. The decline in the concentrations of FT4, FT3, and TRAb was significantly faster in the AZA2 group than in the AZA1 group. The relapse rate during the 12-month follow-up was insignificantly higher in the control group than in either the AZA1 or AZA2 group (10, 4.4, and 4.4%, p = 0.05, respectively). The median relapse time was 18 months for the control group and 24 months for the AZA1 and AZA2 groups. The incremental cost-effectiveness ratio for the AZA group compared with the conventional group was 27,220.4 Egyptian pounds per remission reduction for patients using AZA as an adjuvant for ATDs.ConclusionAZA could be a novel, affordable, cost-effective, and safe drug offering hope for patients with GD to achieve early and long-lasting medical remission.Trial registryThe trial is registered at the Pan African Clinical Trial Registry (Registration number: PACTR201912487382180).

The widespread misconception that tonsillectomy leads to a decrease in immunity may lead to fear and avoidance of the operation. This can result in a deterioration of the situation, such as sleep-related breathing issues, frequent infections, and an increase in complications. The current research was conducted to assess the awareness and perception with respect to the impact of tonsillectomy on the immune system and to assess the awareness and perception of the relationship between autoimmune diseases and tonsillectomy. This 6-month descriptive cross-sectional online questionnaire survey was conducted among individuals who were 18 years and above living in Abha city, Saudi Arabia. Out of the 800 study subjects, 104 (13%) had undergone tonsillectomy. Statistically significant associations were found between age group, education, income, and occupation among those who had undergone tonsillectomy. Multivariate logistic regression analysis showed that ages 18–30 years and 31–40 years (OR: 2.36, 95% CI: 1.18–4.71, and OR: 1.46, 95% CI: 0.53–3.97) and education levels of high school, bachelors, and above (OR: 8.30, 95% CI: 3.05–22.58 and OR: 10.89, 95% CI: 4.23–28.05) were found to be associated with tonsillectomy status of the subjects. On the contrary, income levels of 5000–9000 and >9000 (OR: 0.65, 95% CI: 0.36–1.17 and OR: 0.78, 95%CI: 0.42–1.42) and male gender (OR: 0.79, 95% CI: 0.52–1.19) were found to be associated with non-tonsillectomy status of subjects. Almost 36% of study subjects thought that tonsillectomy affects immunity. Only 18% of study subjects thought that there is a relationship between tonsillectomy and autoimmune diseases. About one-third of the respondents had received this information from community members and social media. A small number of study subjects relied on public awareness programs. Therefore, social media can play a vital role in the community to remove misconceptions regarding tonsillectomy and its effect on immunity and autoimmune disease. Further educational interventional studies are required to see the correction to the public perception of tonsillectomy and its effect on immunity and autoimmune diseases.

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