Effectiveness of hemi-thyroidectomy in relieving compressive symptoms in cases with large multi nodular goiter.

INTRODUCTION AND IMPORTANCE: This case series describe the efficacy of hemi-thyroidectomy to relieve the compressive symptoms of cases having large multi-nodular goiter with preservation of the thyroid gland function. It's considered as an education tool for surgeons to perform safe hemi thyroidectomy to patients indicated for total removal of the gland. Compressive symptoms like mild/severe dysphagia or dyspnea associated with both benign and malignant thyroid disease. Although total thyroidectomy is currently considered the standard of care, hemi thyroidectomy is another surgical option with more benefits. CASE PRESENTATION: This case series was performed in a tertiary university hospital in Riyadh, Saudi Arabia. It included 35 females and 3 males above the age of 18 (mean age 42 years). All the operations were elective hemi-thyroidectomies performed by one surgeon, during 2019. Patients were complaining of; Voice Change, Neck Swelling, Dysphagia, Chocking, SOB, and Orthopnea. 20 of them were medically free and 18 patients had multiple associated comorbidities. CLINICAL FINDINGS AND INVESTIGATIONS: Demographic data, baseline co-morbidities, TSH levels prior to surgery, thyroid gland size, FNA results and pre-operative symptoms were recorded. In addition, compressive symptomatology outcomes from two weeks to two years were recorded. Thirty-two of them (84%) had their symptoms resolve completely and did not need a completion surgery. Out of the 6 who had persistent symptoms, only two needed a completion surgery. Furthermore, only 34.2% required thyroid hormone replacement, 31.6% were euthyroid and 2.6% were hypothyroid preoperatively. INTERVENTIONS AND OUTCOME: Hemi thyroidectomy was chosen to avoid the risk of hormone replacement, and hypocalcemia. Our results revealed that compressive symptoms were effectively relieved in the majority of our patients. Only 2 patients had to undergo completion thyroidectomy due to compressive symptoms with no perioperative or postoperative complications. RELEVANCE AND IMPACT: We would recommend hemi thyroidectomy for cases of large multi nodular goiter due to its positive implication on patient outcome particularly if the patient refuse hormonal replacement.

Community knowledge and awareness of colorectal cancer and screening tools: Community-based survey of 1,912 residents of Riyadh.

BACKGROUND: Participation in Colorectal cancer (CRC) screening programs is low in Saudi Arabia. Public awareness of CRC and knowledge of available screening tools are crucial for improving screening uptake. This study aimed to examine the level of awareness and knowledge of CRC among the Saudi population. MATERIALS AND METHODS: A survey-based study was conducted on 1912 residents of Riyadh, Saudi Arabia. The survey comprised 20 questions; these concerned the definition of the colon and rectum; the function of the colon; the incidence, risk factors, symptoms, screening methods, prevention methods, and treatment methods for CRC; and the value of early detection of CRC. RESULTS: Of the 1912 participants who completed the survey, only 51.7% knew that the colon was the large intestine, while 57% knew that the rectum was the end of the large intestine. Colonoscopy was the preferred screening tool (72.8%). Most respondents believed early detection of CRC through colonoscopy is associated with high survival rates. However, 65.7% of the participants reported that they would not like to undergo a CRC screening. Higher education level was also associated with knowledge that CRC can develop asymptomatically, with postgraduates most likely to know this (P = 0.032). CONCLUSIONS: There is a lack of knowledge regarding CRC among certain demographic groups in Saudi Arabia, and education and screening programs should target populations with the most limited knowledge.

Using the Health Belief Model to Predict the Uptake of Mammographic Screening Among Saudi Women.

Background Breast cancer (BC) is known to be the second leading cause of cancer deaths after lung cancer in Saudi Arabia. Early detection using screening methods can improve disease outcomes. In Saudi Arabia, the rates of BC screening are very low although it is a country that provides free healthcare services. This discrepancy between the availability of free healthcare services and women not utilizing these services necessitates an in-depth understanding of the health-related beliefs and barriers towards BC screening among Saudi women.  Objective We aimed to use the Health Belief Model (HBM) to predict the uptake of mammographic screening among Saudi women. The secondary objective was to determine the knowledge, attitudes, and practices related to BC and mammography screening. Research methodology  This was an analytical cross-sectional study using a self-administered questionnaire, which consisted of sociodemographic data, family history of BC, general information about BC, and the Champion's Health Belief Model Scale (CHBMS). The study was conducted among Saudi women visiting the King Khalid University Hospital in Riyadh from September 2018 to February 2019. The data were analyzed using SPSS Statistics software version 26.00 (IBM, Armonk, NY). Results A total of 401 females participated in the study; the median age of the subjects was 49 years [interquartile range (IQR): 43-53 years]. Among them, 69.6% were married and 21.1% had a family history of BC. There was a statistically significant association of younger age, marital status, and a positive family history of BC with women undergoing mammographic screening (p<0.05). Of the participants, 61.6% knew about the warning signs of BC, while only 59.9% were aware of the risk factors associated with it. The binary logistic regression did not show any significant association between CHBMS and mammogram screening. We concluded that the CHBMS components cannot be used in isolation to predict the risk of not undergoing mammogram screening. However, barriers and motivation components along with the knowledge and other factors can be used to predict mammogram screening. Conclusion Among our cohort of Saudi women, 62.1% had general awareness about BC, and younger age, marital status, and positive family history of BC were significantly associated with women undergoing mammography screening. The CHBMS components cannot be used in isolation to predict the risk of not undergoing mammogram screening, while barriers and motivation components along with the knowledge and other factors can be used to predict mammogram screening.