Metastasis of Clear Cell Renal Cell Carcinoma to the Parotid Gland: A Case Report.

Parotid gland metastases from distant primary malignancies are uncommon and present diagnostic challenges for clinicians. We present the case of a 65-year-old male with a history of clear cell subtype of renal cell carcinoma who presented with a painless swelling in the right parotid region. His medical history was significant for a right-sided renal cell carcinoma, for which he had undergone a radical nephrectomy five years ago. The patient's physical examination revealed a firm, non-tender mass in the right parotid gland region. Imaging studies, including ultrasound and contrast-enhanced computed tomography, confirmed the presence of a solid-enhancing lesion within the parotid gland. Fine-needle aspiration biopsy provided histological evidence of malignant cells with features consistent with a clear renal cell carcinoma cell subtype. This is consistent with diagnosing metastatic renal cell carcinoma to the parotid gland. This case highlights the significance of considering metastatic disease in the differential diagnosis of parotid swellings, particularly in patients with a history of remote malignancy. Systemic targeted therapy, with a tyrosine kinase inhibitor, emerged as an effective treatment option, emphasizing the importance of personalized approaches in managing rare clinical scenarios. Tailored management is crucial in optimizing outcomes for patients with parotid gland metastases, improving their overall prognosis and quality of life.

Carotid Body Tumor: A Case Report of a Rare Neuroendocrine Neoplasm.

Carotid body tumors are rare neuroendocrine tumors originating from paraganglionic cells in the carotid body. Although these tumors are typically slow-growing and benign, their location and vascularity present unique challenges in management. Here, we present a case study of a 58-year-old male who presented with a painless, gradually enlarging neck mass over a six-month period. Physical examination revealed a non-tender, pulsatile mass measuring approximately 3 cm in the left carotid triangle. Imaging studies, including ultrasound and contrast-enhanced computed tomography, confirmed the presence of a well-defined, hypoechoic mass at the left carotid bifurcation, displacing adjacent vessels. A multidisciplinary team planned surgical resection, guided by imaging, resulting in the successful removal of the tumor. Histopathological examination confirmed the diagnosis of a carotid body tumor. This case report underscores the significance of accurate diagnosis, a multidisciplinary approach, and advanced imaging techniques in managing carotid body tumors. Surgical resection, guided by imaging, aims to achieve complete excision while preserving vital structures. Long-term follow-up is crucial to detect potential recurrence or progression early.

Crystalloid fluids and delayed graft function in kidney transplant: A cohort study.

Background: Normal saline is commonly used in the perioperative kidney transplant period; its high chloride content can cause hyperchloremic metabolic acidosis giving a possible advantage to balanced electrolyte solutions due to their lower chloride content. The evidence regarding the best practices in fluid management during kidney transplantation and its effect on the incidence of delayed graft function (DGF) is still limited. Materials and Methods: One hundred thirty-eight patients were included and followed up for seven days after surgery. Administered crystalloid type and volume were compared among patients with and without DGF, along with additional patient and surgical variables. To investigate whether intraoperative fluid type/amount influence DGF, patients were categorized into three groups: those who received mainly (>50%) lactated Ringer's solution, normal saline, or plasmaLyte. A logistic regression analysis was used to define variables independently correlated with DGF, and odds ratios (OR) with a 95% confidence interval (CI) were reported. Results: The incidence of DGF was 8.7%. Cold ischemia time independently increased the odds of DGF (OR = 1.006 (95% CI: 1.002-1.011) while fluid type (saline versus PlasmaLyte OR = 5.28, 95% CI: 0.76-36.88) or amount (OR = 1.00, 95% CI: 1.00-1.01) did not significantly modify the odds of DGF. Central venous pressure, systolic blood pressure, and mean arterial pressure were higher in the non-DGF group, but this was not statistically significant (P > 0.05). Significant intraoperative acidosis developed in patients who received normal saline compared to those in PlasmaLyte and lactated Ringer's groups; however, acid-base balance and electrolytes did not vary significantly between the DGF and non-DGF groups. Conclusion: DGF was primarily influenced by surgical factors such as cold ischemia time, whereas intraoperative fluid type or amount did not affect DGF incidence.

Psychometric appraisal of the Readiness for Interprofessional Learning Scale (RIPLS) Arabic-version.

Interprofessional education within healthcare has been shown to have many benefits, however, it is a relatively new educational concept within the Arabic setting. Although the Readiness for Interprofessional Learning Scale is a commonly utilised tool to examine student attitudes, there is a lack of evidence for use of an Arabic translated version. The aim of this study was to develop and psychometrically evaluate an Arabic language version of the Readiness for Interprofessional Learning Scale with Saudi nurses. Two independent translators, proficient in both English and Arabic languages, completed a forward-backward translation of the original English version of the Readiness for Interprofessional Learning Scale. Subsequently, this Readiness for Interprofessional Learning Scale-Arabic version was used to collect data from undergraduate nursing students enrolled at a number of Saudi Arabian universities. Exploratory and Confirmatory Factor Analyses were then performed on the scale. Six hundred and fifty-two participants were recruited. Exploratory Factor Analysis of the Readiness for Interprofessional Learning Scale-Arabic version resulted in a 15-item, three-factor model. Subsequent analysis with Confirmatory Factor Analysis and the resultant final 13-item model demonstrated a poor fit between the hypothesized model and the data. Although our three-factor model is supported by previous studies, the proposed model did not perform well on Confirmatory Factor Analysis assessment. This suggests that there may be issues of applicability of the Readiness for Interprofessional Learning Scale-Arabic version within the current cohort. The present study of the Readiness for Interprofessional Learning Scale-Arabic version has demonstrated some psychometric inadequacies and thus it is possible that this scale may not be appropriate for use with Saudi nurses. However further research with different professional groups is suggested to fully explore its utility within the Saudi setting.

Adductor canal blockade versus continuous epidural analgesia after total knee joint replacement: A retrospective cohort study.

BACKGROUND: Total knee arthroplasty is associated with intense pain postoperatively. Thus, adequate pain relief is essential in the immediate postoperative period to enable ambulation, initiation of physiotherapy, and prevention of postoperative complications. The objective of this study was to compare the effectiveness and early outcomes of adductor canal blockade (ACB) and continuous epidural analgesia (CEA) in patients who underwent a unilateral total knee replacement (TKR). MATERIALS AND METHODS: This is a retrospective cohort study that was conducted in Riyadh with 80 patients receiving a unilateral total knee arthroplasty from August 2017 to July 2018. Forty patients received ACB, and 40 received CEA exclusively. The primary outcomes measured were the degree of knee flexion and extension in physiotherapy sessions on postoperative day 1 and discharge, how soon patients walked after surgery, length of hospital stay (LOS), local anesthetic and total opioid consumption, postoperative blood drainage output, incidence of nausea and vomiting, and pain scores. RESULTS: Significantly more patients receiving ACB could flex their knee in the first 24 h postoperatively (P < 0.05), and the total drain output was also significantly less (P < 0.05). Pain in the first 8, 24, and 48 h was less in the ACB group using a Visual Analog Scale (P < 0.05). In addition, LOS, total opioid consumption, postoperative blood drain output, incidence of nausea and vomiting, and pain scores were significantly decreased after using ACB compared with epidural analgesia. CONCLUSION: This study provided evidence that ACB as postoperative analgesia after TKR is associated with better outcomes in terms of facilitating early functional recovery and mobility, and consequently prevents major postoperative complications.

Preference of cognitive approaches for decision making among anesthesiologists' in Saudi Arabia.

AIMS: The aim of this study was to analyze the thinking processes of anesthesia physicians at in Riyadh, Jeddah, and Dammam cities in Saudi Arabia. SUBJECTS AND METHODS: This cross-sectional study was undertaken in the cities of Riyadh, Jeddah, and Dammam in Saudi Arabia. Using a previously published psychometric tool (the Rational and Experiential Inventory, REI-40), the survey was sent through email and social networks to anesthesia physicians working in the targeted hospitals. An initial survey was sent out, followed by a reminder and a second survey to nonrespondents. Analysis included descriptive statistics and Student's t-tests. RESULTS: Most of the participants (69.2%) were males. At the time of the study, 35% of participants were consultants; 9.6% were associate consultants; 19.2% were registrars, fellows, or staff physicians; and 35.8% were senior residents. Anesthesia physicians' mean "rational" score was 3.22 [standard deviation (SD) =0.49)] and their mean "experiential" score was 3.01 (SD = 0.31). According to Pearson's correlation, the difference of 0.21 between these two scores was not statistically significant (P = 0.35). Male anesthesia physicians tended more toward faster, logical thinking. Consultant anesthesia physicians had faster rational thinking than nonconsultant physicians (P = 0.01). Anesthesia physicians with more than 10 years in practice had faster rational thinking than physicians who had worked for fewer than 10 years (P = 0.001). CONCLUSIONS: This study evaluated anesthesia physicians' general decision-making approaches. Despite the fact that both rational and experiential techniques are used in clinical decision-making, male consultants and physicians with more than 10 years' experience and certified non-Saudi board anesthesiologists prefer rational decision-making style.