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The SARS-CoV-2 virus, which causes coronavirus disease 2019 (COVID-19), has rapidly swept worldwide since its identification in December 2019. As the spread of the disease accelerated both in Wuhan and elsewhere globally, the WHO declared it a pandemic. There is sound evidence to argue that otolaryngologists run high risks of occupational SARS-COV2 among health care workers due to high viral load in upper respiratory examinations. This review article was conducted to determine the effect of the COVID 19 pandemic on the otolaryngology department and residency program in Saudi Arabia. Since the pandemic outbreak, the government of Saudi Arabia has taken severe measures and issued several decisions to limit the spread of the virus. These decisions included operations, procedures, outpatient clinics by prioritizing emergency and time-sensitive cases while rescheduling all electives and routines once. As a result, the residency program was also affected by the substantial reduction of daily surgical activity and preventing endoscopic tests in the clinics, which led to a notable decrease in residents' involvement and risk of procedural skills deterioration which became a concern to many doctors of residency programs. It is difficult to deny that the epidemic will negatively impact. However, adhering to well-prepared guidelines and giving residents an excellent opportunity to overcome the defects will deliver training and patients' care while also protecting safety and health.
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OBJECTIVES: This study investigates the link between low socioeconomic status (SES) and advanced thyroid cancer at the time of detection. It also assesses the socioeconomic variables that may potentially affect the stage of thyroid cancer at presentation. METHODS: This retrospective cohort study was conducted on patients with thyroid cancer between January 2016 and April 2020. The data were collected using the patients' medical records from the hospital information system (BESTcare) and through interview-based surveys. To assess the factors predicting the stage of advanced thyroid cancer, socioeconomic status (SES) predictors like area of residency, educational level, income, and marital status were collected. RESULTS: A total of 220 patients with thyroid cancer were included in this study. Male patients (p = 0.025), older than 55 years (p < 0.001), living in rural areas (p = 0.002), with low educational level (p = 0.021) were found to be significantly associated with advanced-stage thyroid cancer at presentation. Multivariate analysis showed that gender (men) and age (above 55 years) were significant predictors of advanced stage thyroid cancer. However, no association between income and the stage of thyroid cancer has been found in this study. CONCLUSION: This study has shown that even in a country like KSA with a strong government-funded healthcare system, health disparity among people battling thyroid cancer exists. Our study has found that SES factors have a significant impact on the stage of thyroid cancer at the time of presentation, whereas the economic status of the patients had no impact on the stage of thyroid cancer. Furthermore, patients in lower SES groups were diagnosed with more advanced stages at presentation.
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Majority of the chronic kidney disease (CKD) patients undergo hemodialysis (HD) with central venous catheter which has multiple complications. This study aims to identify the physicians' perspectives regarding the reasons of delayed arteriovenous fistula (AVF) creation in the Kingdom of Saudi Arabia to improve the quality of CKD patients' care and prognosis and prevent complications. A cross-sectional descriptive study was conducted on KSA nephrologists using a questionnaire which includes factors associated with delay in AVF creation, which were categorized into patient, physician, and hospital factors. The optimal timing of starting dialysis was also assessed. In a total of 212 participants, 131 (61.8%) were of consultant level, with the largest numbers being from the Central region (52.4%). The most important patient factors associated with delay in AVF creation were denial of kidney disease or the need of AVF (76.4%), dialysis fears and practical concern (75.9%), and patient refusal (73.1%). The most important physician and hospital factors were insufficient conduction of predialysis care and education (63.7%) and late referral to a nephrologist (56.6%). Participants would create AVF when the patient reaches Stage 4 CKD (69.3%) or Stage 5 (27.4%), and 88.7% of the participants would do so 3-6 months before the anticipated start of HD. Over two-thirds of the participants (68.4%) chose patient as the main factor contributing to the delay of permanent vascular access. A validated approach to patient selection, patient-centered predialysis care, and referral to vascular access creation that could be applied on different types of patients in different regions is required.
