Synovial sarcoma of the hard palate: The third case in the medical literature

Synovial sarcoma is a high-grade soft tissue sarcoma that rarely arises in the head and neck region. It affects the parapharyngeal space and the hypopharynx most commonly and it has different presentations based on the affected site. In extremely rare occasions, it involves the hard palate such as in our case where a 24-year-old female patient presented with a mass lesion involving the left hard palate, which was identified clinically and by imaging studies. The histopathological assessment confirmed that it was a monophasic synovial sarcoma which was also confirmed with further molecular studies. The patient underwent surgical excision and postoperative radiotherapy. Her close follow up over a 6-year period that followed her curative treatment has demonstrated no evidence of disease recurrence or distant metastasis. Surgical excision is the mainstay of treatment for synovial sarcoma and adjuvant radiotherapy is advised. Long-term follow up is recommended because of the remote possibility of late recurrence of the tumor.     

An evaluation of consumers’ knowledge, perceptions and attitudes regarding generic medicines in Auckland

Objectives The aim of this project was to evaluate the perceptions, knowledge and attitudes regarding generic medicines. Methods A cross-sectional study, with self administered questionnaires, was conducted to survey consumers visiting pharmacies in four regions of Auckland (North Shore, Waitakere, Central Auckland and South Auckland). Through stratified random sampling, approximately 10% of pharmacies from each region were selected, which turn out to be 30 pharmacies. Every alternate customer coming to the pharmacy, who was eligible to participate in the study, was asked by the researchers to complete the questionnaire. Results A total of 441 questionnaires were included in the analysis. Different response rates were obtained in different regions of Auckland. Of all respondents, 51.6% had previous knowledge of generic medicines. Pharmacists were the main source of information regarding generic medicines followed by doctors and media. A higher level of education had a direct relationship with having correct knowledge of generics (P = .002). Attitude of participants toward the use of generic medicines was determined by their knowledge of generics, whether it was recommended by a pharmacist and their type of illness. Participants were more prepared to change to a generic for a minor illness (79%) than for a major illness (58.7%). Those who had better knowledge were more likely than those with poor knowledge to say they would to use a generic in major illness (P = .001) as well as minor illness (P < .0001). Previous positive experiences with generics also determined consumers’ willingness to use generics. Conclusion Many consumers have misconceptions regarding generic medicines. Having knowledge about generics and the advice by doctors and pharmacists are key indicators to improve the quality use of generic medicines.     

Assessing the readiness of hospitals in Riyadh Province for efficient and timely stroke management: A pilot study

Objectives:To assess the readiness of hospitals in Riyadh to establish acute stroke centers by following the Australian Clinical Guidelines for Stroke Management.Methods:This study was a quantitative cross-sectional observational study conducted among hospitals in the central region of Saudi Arabia (Jan 2018 – April 2018). A self-administered questionnaire/survey tool was adapted from an Australian survey developed by the Stroke Foundation in Melbourne, Australia.The data were analyzed using SPSS version 21.0. Appropriate statistical tests (chi-square and Fisher’s exact test) were used for bivariate analyses.Results:A total of 3932 stroke patient visits were recorded in 37 hospitals in the central region of Saudi Arabia. The most common limitations of acute stroke services were that 25 (67.57%) of the hospitals had no stroke unit and 21 (56.76%) had inadequate clinical staff. Magnetic resonance imaging and computed tomography were available in 32 (86.49%) and 36 (97.30%) hospitals, respectively. Only two-thirds of hospitals 25 (67.57%) followed protocols for rapid Emergency Department (ED) triage.Conclusion:We found that most of our hospitals were not fully prepared to address acute stroke management in a manner that was reasonably consistent with international guidelines. We recommend raising the hospital’s requirements a higher level to be in line with the stroke guidelines.

Stroke is the second leading cause of death and the third leading cause of disability worldwide.¹ The incidence rate of stroke in the Middle East ranges between 22.7 and 250 per 100,000 population per year.² As the young Saudi population ages, the incidence rate of stroke is expected to increase by 57-67% over the next ten years.^3,4 Patients with acute ischemic stroke should be evaluated, treated immediately, and approached as having a life-threatening emergency.⁵ The main goal of the clinical guidelines is to enhance the quality of care provided for patients with stroke. They involve aspects of stroke management across the continuum of care.⁶ Data show that timely administration of intravenous tissue-type plasminogen activator (IV tPA) after stroke improves patient outcomes.⁷ The availability of primary stroke centers, stroke units, and comprehensive stroke centers have been demonstrated to provide greater capacity to respond with intravenous thrombolysis as opposed to general hospital treatments.⁸ A modeling study of stroke in Saudi Arabia showed that the development of an up-to-date comprehensive stroke pathway was associated with an increase in clinical functionality, a decrease in disabling strokes and a cost savings of $602 million over 15 years in a 10-year cohort study.⁹ Approaches to improving stroke management should be conducted through a multidisciplinary system to optimize evidence-based acute stroke management delivery. The system should have a well-functioning synchronized unit comprised of neurologists, emergency physicians, nurses, laboratory technicians, radiologists, intervention neuroradiologists, radiology technicians, and admission officers with emergency medical service involvement to pre notify and activate the stroke team in the appropriate situations.¹⁰ There is no evidence indicating the extent to which evidence-based interventions are provided to acute stroke patients in Saudi Arabian hospitals. Addressing this matter has the potential to identify gaps in current health care services, which could standardize and improve acute stroke management and outcomes for patients with acute stroke. Therefore, this study aimed to assess the readiness of hospitals in Riyadh to establish acute stroke centers that align with the Australian Clinical Guidelines for Stroke Management.¹¹ We chose the Australian Clinical Guidelines for Stroke Management as it had already been adapted in a previous study.⁶