Randomized Trial of Remote Assessment of Patients After an Acute Coronary Syndrome.

BACKGROUND: Telemedicine programs can provide remote diagnostic information to aid clinical decisions that could optimize care and reduce unplanned readmissions post-acute coronary syndrome (ACS). OBJECTIVES: TELE-ACS (Remote Acute Assessment of Patients With High Cardiovascular Risk Post-Acute Coronary Syndrome) is a randomized controlled trial that aims to compare a telemedicine-based approach vs standard care in patients following ACS. METHODS: Patients were suitable for inclusion with at least 1 cardiovascular risk factor and presenting with ACS and were randomized (1:1) before discharge. The primary outcome was time to first readmission at 6 months. Secondary outcomes included emergency department (ED) visits, major adverse cardiovascular events, and patient-reported symptoms. The primary analysis was performed according to intention to treat. RESULTS: A total of 337 patients were randomized from January 2022 to April 2023, with a 3.6% drop-out rate. The mean age was 58.1 years. There was a reduced rate of readmission over 6 months (HR: 0.24; 95% CI: 0.13-0.44; P < 0.001) and ED attendance (HR: 0.59; 95% CI: 0.40-0.89) in the telemedicine arm, and fewer unplanned coronary revascularizations (3% in telemedicine arm vs 9% in standard therapy arm). The occurrence of chest pain (9% vs 24%), breathlessness (21% vs 39%), and dizziness (6% vs 18%) at 6 months was lower in the telemedicine group. CONCLUSIONS: The TELE-ACS study has shown that a telemedicine-based approach for the management of patients following ACS was associated with a reduction in hospital readmission, ED visits, unplanned coronary revascularization, and patient-reported symptoms. (Telemedicine in High-Risk Cardiovascular Patients Post-ACS [TELE-ACS]; NCT05015634).

Prevalence and Characteristics of Knee Osteoarthritis Among the General Public in Saudi Arabia.

Background Knee osteoarthritis (OA) is a chronic and progressive knee joint condition that is influenced by multiple factors. This research aims to examine the prevalence and characteristics of knee OA among the general public in Saudi Arabia. Methodology This cross-sectional online survey was conducted in September 2023 in Saudi Arabia. This research used a previously developed questionnaire to validate the diagnosis of OA, which was performed in accordance with the diagnostic criteria established by the American College of Rheumatology (ACR). The Western Ontario and McMaster Universities Arthritis Index questionnaire (WOMAC) was used to examine the severity and characteristics of knee OA patients. A binary logistic regression analysis was conducted to determine the variables that influence the severity of knee OA and the likelihood of developing OA. Results A total of 1,019 individuals participated in this study. Around one-third of the participants (34.5%) fulfilled the ACR criteria for knee OA diagnosis. Overall, the mean WOMAC score was 34.1 (18.8) out of 96, which represents 35.5% of the maximum obtainable score and demonstrates a low degree of knee OA severity. The mean pain sub-scale score was 7.4 (3.8) out of 20, which represents 37.0% of the maximum obtainable score and demonstrates a low level of pain intensity. The mean stiffness sub-scale score was 2.7 (1.8) out of 8, which represents 33.8% of the maximum obtainable score and demonstrates a low degree of stiffness in joints. The mean physical function sub-scale score was 24.0 (14.0) out of 68, which represents 35.3% of the maximum obtainable score and demonstrates a low level of physical function difficulty. Females, older participants (above 40 years), those with high body mass index (28.8 kg/cm2 and higher), non-smokers, those with comorbidities, those who did not practice daily physical activity, those who had a family history of knee OA, and those who suffered from flat feet, rheumatoid arthritis, gout, lupus, or back or hip pain were more likely to develop knee OA and have severe OA (p < 0.05). Conclusions The findings of this study demonstrated a significant prevalence rate of knee OA and highlighted a discrepancy between the rates obtained by diagnostic criteria and those determined through clinical diagnosis. Several significant factors that contribute to the development of OA encompass lifestyle choices such as food and exercise, familial predisposition, genetic influences, and the presence of comorbidities. To effectively tackle this intricate matter, it is imperative to adopt a patient-centered strategy and prioritize early intervention.

Parents' digital skills and their development in the context of the Corona pandemic.

We investigate parents' and guardians' digital skills and the extent of their development in the context of the spread of the Corona epidemic. In addition, we sought to explore the differences in digital skills between parents and their employment status, age, and responsibility in teaching children. We sought to rely on the descriptive-analytical approach and prepared a scale of eight theoretical dimensions with the participation of 250 students' Saudi parents. The application of the study was by online submission form (via Edit Submission). Our findings showed that there was a discrepancy in the performance of the sample, which was very high in the dimensions of operational skills, instrumental skills, and cognitive constructivism skills. There were also differences between the effect of computers on the instrumental skills and cognitive constructivism skills of the parents. Parents' dependence on alternative digital sources in exploring for information, formulating knowledge, manipulating it, and criticizing. The learner can reach the cognitive level in a more flexible manner, which allows him to gain learning objectives. The knowledge navigation can be developed because of different online outdoor exercises and software familiar. This requires self-organization to search for appropriate knowledge to use in the renewal of the cognitive structure.

Adverse Childhood Experiences and Their Effect on Irritable Bowel Syndrome Among Saudi Arabian Adults.

Background Adverse childhood experiences (ACEs) are traumatic events that occur before 18 years of age. ACEs have been associated with many negative health problems, including the development of chronic diseases, such as irritable bowel syndrome (IBS), a functional gastrointestinal disorder characterized by abdominal pain. We investigated the prevalence of ACEs among patients with IBS, identified the types of ACEs commonly related to patients with IBS, and further assessed the impact of ACEs on IBS severity. Methodology A cross-sectional study was performed. The study targeted patients with IBS aged ≥ 18 years who were recruited from gastroenterology outpatient clinics at King Abdulaziz University Hospital. Adults were contacted and invited to take part in the study by completing a survey. Data were collected using two validated questionnaires, the ACE questionnaire for adults and the IBS symptom severity scoring system. Results The study included 109 patients with IBS (59.6% females). The prevalence of ACEs (patients with IBS exposed to at least one ACE) was 63.3%. The most prevalent type was emotional abuse (34.9%), followed by both physical abuse and emotional neglect (28.4%). Females reported significantly more ACEs (p = 0.035) than males. The overall IBS symptoms (r = 0.195, p = 0.043) and abdominal pain (r = 0.240, p = 0.012) severity were significantly correlated with total ACEs score. Conclusions Our findings point to a probable association between ACEs exposure and IBS, demonstrating their long-term impacts on symptoms severity. Further studies are needed to acquire a better understanding of the potential impact of ACEs on IBS.

Contamination Assessment of Mangrove Ecosystems in the Red Sea Coast by Polycyclic Aromatic Hydrocarbons.

Mangroves are known as a naturally based solution for climate mitigation and adaptation. Mangroves are at a potential risk of degradation by contaminants such as polycyclic aromatic hydrocarbons (PAHs). In this study, sixteen priority PAHs were analyzed and characterized in forty samples of mangrove seawater and mangrove sediments collected from two coastal areas (i.e., Sharm and Khor Rabigh) along the Red Sea Coast of Rabigh city in August 2013. We found that the average concentration of total PAH in mangrove sediments in the Sharam area (22.09 ng/kg) was higher than that in the Alkhor area (6.51 ng/kg). However, the average concentration of the total PAH in the mangrove seawater in the Alkhor area (9.19 ng/L) was double that in the Sharam area (4.33 ng/L). Phenanthrene and pyrene were the major components in both the mangrove seawater and sediment in all the investigated areas. We observed that the abundance of PAHs with 2-3 aromatic rings was dominant in sediment samples collected from both study areas. This abundance was also observed in seawater from the Sharam area. However, seawater samples from the Alkhor area had abundant PAHs with four aromatic rings. The majority of PAHs in sediment samples of both study areas originated from petrogenic sources, whereas the majority of PAHs in seawater samples originated from pyrogenic sources.

A cautionary signal from the Red Sea on the impact of increased dust activity on marine microbiota.

BACKGROUND: Global climate change together with growing desertification is leading to increased dust emissions to the atmosphere, drawing attention to possible impacts on marine ecosystems receiving dust deposition. Since microorganisms play important roles in maintaining marine homeostasis through nutrient cycling and carbon flow, detrimental changes in the composition of marine microbiota in response to increased dust input could negatively impact marine health, particularly so in seas located within the Global Dust Belt. Due to its strategic location between two deserts and unique characteristics, the Red Sea provides an attractive semi-enclosed "megacosm" to examine the impacts of large dust deposition on the vastly diverse microbiota in its exceptionally warm oligotrophic waters. RESULTS: We used culture-independent metagenomic approaches to assess temporal changes in the Red Sea microbiota in response to two severe sandstorms, one originated in the Nubian Desert in the summer 2016 and a second one originated in the Libyan Desert in the spring 2017. Despite differences in sandstorm origin and meteorological conditions, both sandstorms shifted bacterial and Archaeal groups in a similar mode. In particular, the relative abundance of autotrophic bacteria declined while those of heterotrophic bacteria, particularly Bacteroidetes, and Archaea increased. The changes peaked within six days from the start of sandstorms, and the community recovered the original assemblage within one month. CONCLUSION: Our results suggest that increased dust emission with expanding desertification could lead to undesirable impacts in ocean function, enhancing heterotrophic processes while reducing autotrophic ones, thereby affecting the marine food web in seas receiving dust deposition.

Air Quality of Work, Residential, and Traffic Areas during the COVID-19 Lockdown with Insights to Improve Air Quality.

This study investigated the concentrations of air pollutants (NO, NO2, NOx, SO2, CO, O3, PM10, and PM2.5) at three sites with different traffic loads (work, residential, and traffic sites) before, during, and after the COVID-19 lockdown. The main objective of this study was to evaluate the effects and associated potential pollution control implications of the lockdown on the quality of ambient air at three selected sites in the urban area of Riyadh City. The average concentrations of NO, NO2, NOx, and CO decreased during the lockdown period by 73%, 44%, 53%, and 32% at the work site; 222%, 85%, 100%, and 60% at the residential site; and 133%, 60%, 101%, and 103% at the traffic site relative to the pre-lockdown period, respectively. The average concentration of O3 increased by 6% at the work site, whereas the concentration of SO2 increased by 27% at the residential site and decreased by 6.5% at the work site. The changes in PM10 and PM2.5 varied and did not exhibit a clear pattern. The air quality index (AQI) results indicated that the contribution to "undesired" air quality by O3 was 35.29% of the lockdown period at the work site while contributions to undesired air quality by PM10 and PM2.5 were 75.6% and 100% at the work site, 94.5% and 100% at the residential site, and 96.7% and 100% at the traffic site, respectively. The findings of this study are useful for devising effective urban pollution abatement policies. Applying control measures comparable to the lockdown measures over one week will result in a decrease of approximately 19% and 15% in CO mean concentration and 25% and 18% in NO2 mean concentration at residential and traffic sites, respectively.

Impact of different sources on the oxidative potential of ambient particulate matter PM10 in Riyadh, Saudi Arabia: A focus on dust emissions.

In this study, we employed Principal Component Analysis (PCA) and Multi-Linear Regression (MLR) to identify the most significant sources contributing to the toxicity of PM10 in the city center of Riyadh. PM10 samples were collected using a medium-volume air sampler during cool (December 2019-March 2020) and warm (May 2020-August 2020) seasons, including dust and non-dust events. The collected filters were analyzed for their chemical components (i.e., water-soluble ions, metals, and trace elements) as well as oxidative potential and elemental and organic carbon (EC/OC) contents. Our measurements revealed comparable extrinsic oxidative potential (P-value = 0.30) during the warm (1.2 ± 0.1 nmol/min-m3) and cool (1.1 ± 0.1 nmol/min-m3) periods. Moreover, we observed higher extrinsic oxidative potential of PM10 samples collected during dust events (~30% increase) compared to non-dust samples. Our PCA-MLR analysis identified soil and resuspended dust, secondary aerosol (SA), local industrial activities and petroleum refineries, and traffic emissions as the four sources contributing to the ambient PM10 oxidative potential in central Riyadh. Soil and resuspended dust were the major source contributing to the oxidative potential of ambient PM10, accounting for 31% of the total oxidative potential. Secondary aerosols (SA) were the next important source of PM10 toxicity in the area as they contributed to about 20% of the PM10 oxidative potential. Results of this study revealed the major role of soil and resuspended road dust on PM10 toxicity and can be helpful in adopting targeted air quality policies to reduce the population exposure to PM10.

Bariatric Surgery in Patients with a History of Nephrolithiasis: 24-h Urine Profiles and Radiographic Changes After Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy.

BACKGROUND: To evaluate the differences in 24-h urine profiles, radiographic imaging, and stone events post-Roux-en-Y gastric bypass versus sleeve gastrectomy in patients with a history of nephrolithiasis. METHODS: A retrospective review was conducted on 102 patients with a history of nephrolithiasis who then underwent bariatric surgery at our tertiary academic center. Computed tomography imaging and 24-h urine profile values were performed pre-operatively and at 1-year follow-up. RESULTS: A total of 60 patients underwent Roux-en-Y gastric bypass and 42 had sleeve gastrectomy. The Roux-en-Y gastric bypass group had significant increases in oxalate and decreases in citrate (p = 0.009 and 0.003, respectively), while the sleeve gastrectomy group had decreases in oxalate and stable citrate (p = 0.013 and 0.906, respectively). Roux-en-Y gastric bypass was the only significant predictor of post-operative hyperoxaluria (OR 7.1 [95% CI 2.3-21.3], p = 0.001). Radiographically, 38.3% of the Roux-en-Y gastric bypass group and 26.2% of the sleeve gastrectomy group had an increase in stone burden, and post-operative stone procedure rate was 10.0% and 7.1%, respectively. CONCLUSIONS: At 1-year post-bariatric surgery, patients who underwent Roux-en-Y gastric bypass had exacerbated lithogenic urinary profiles, while those in sleeve gastrectomy patients improved. Although not statistically significant, stone burden increase and stone procedure rate were higher post-Roux-en-Y gastric bypass and will likely worsen at a longer follow-up due to the group's lithogenic 24-h urine profiles. These findings support pre-bariatric counseling and urinary monitoring in patients with a history of kidney stones who undergo RYGB, with a multi-disciplinary approach between urologists and general surgeons.

Firefighter exposures to organic and inorganic gas emissions in emergency residential and industrial fires.

The gas emissions generated from fires could cause mortalities and diseases in firefighters. Gas emissions from fire contain a mixture of a wide range of organic and inorganic gases, depending on several elements that are not currently known. In this study, firefighters were equipped with portable gas detectors to measure selected organic and inorganic gases in 26 emergency fire incidents. The fire incidents were categorized as industrial or residential based on their source. The exposure of firefighters to volatile organic compounds (VOCs) in residential fires was double that in industrial fires. This is probably due to the contents of the houses, as more VOCs are released from textiles and furniture. The concentration of toluene, which is widely used in cosmetics and paints in housing, was fifteen-fold higher in residential fires than industrial fires. The exposure of firefighters to inorganic gases was much higher in industrial fires than residential fires. The concentration of hydrogen chloride, which is generated from the combustion of chlorinated plastics, such as industrial pipes and cables, in industrial fires was 18-fold higher than that in residential fires. Additionally, in this study, we found that the concentration of VOCs that poses cancer and non-cancer health risk to firefighters increases in residential fire incidents to almost three times that in industrial fire incidents. Hydrogen sulfide and sulfur dioxide concentrations were higher in industrial fire incidents than in residential fire incidents. The level of hydrogen sulfide and sulfur dioxide were 19-fold and 8-fold higher, respectively, in industrial fire incidents than in residential fire incidents. This study reveals that gas emissions vary widely between industrial and residential fires.

Assessing the response of five tree species to air pollution in Riyadh City, Saudi Arabia, for potential green belt application.

Tree species (including Eucalyptus camaldulensis, Ziziphus spina-christi, Albizia lebbeck, Prosopis juliflora, Pithecellobium dulce, and Ficus altissima) were investigated to elucidate their appropriates for green belt application. Leaf samples were collected from four different locations in Riyadh: (1) residential; (2) dense traffic; (3) industrial; and (4) reference sites located approximately 20 km away from the city of Riyadh. Leaves collected from the industrial site showed the highest leaf area reduction. The smallest reduction of leaf areas was observed for F. altissima (11.6%), while the highest reduction was observed for P. juliflora (34.8%). Variations in the air pollution tolerance index (APTI) coupled with the anticipated performance index (API) for each species were examined. The APTI value of Z. spina-christi was highest (58.5) at the industrial site while the lowest APTI value was for P. juliflora (14) at the reference site. Correlation coefficient and linear regression analyses determined that the correlation between the ascorbic acid content and APTI is positive and significantly strong. Our findings indicate that urban green planning in Riyadh should include growing F. altissima on roadsides as well as in heavy industrial locations followed by Z. spina-christi and A. lebbeck according to their API and APTI performances.

Contamination and risk levels of metals associated with urban street dust in Riyadh, Saudi Arabia.

Urban street dust was collected from 22 locations in Riyadh, Saudi Arabia, and nine metals (Pb, Cr, Zn, Co, Cu, Al, Fe, Mn, and Ni) were investigated. The concentrations of these metals were employed in several common contamination evaluation indices to examine the contamination and the health risk caused by metals. Evaluation of these indices showed that they had variable degrees of contamination sensitivity. For individual contaminating elements (Pb, Cr, Zn, Co, Cu, and Ni), the sensitivities of the contamination of contamination factor (CF), the potential ecological risk (Ei), and geo-accumulation index (Igeo) were very similar. Therefore, these indices should yield very similar results. However, enrichment factor (EF) exhibited a different sensitivity pattern for determining the contamination caused by metals compared with the contamination level indicated by the other indices used in this study. Therefore, to avoid potential false indication of contamination, it is not recommended to use EF alone for determining contamination level. As indicated by four contamination evaluation indices (CF, Ei, Igeo, and EF), Riyadh was mainly contaminated by Pb. However, the health risk assessment results revealed that the Pb contamination level did not exceed the significant risk level for non-cancer effects. The cancer risk values indicated a negligible cancer risk to inhabitants of Riyadh exposed to metals associated with street dust. Considering the comprehensive contamination evaluation indices, the ecological risk index (RI) showed that about 77% of the sampling locations featured high ecological risk of which approximately 41% also featured high contamination indicated by pollution load index (PLI).

Testicular ischemia secondary to epididymo-orchitis: A case report.

Testicular infarction is a common urological emergency in clinical practice, it is still underreported when it results from other than spermatic cord torsion. It rarely arises from other pathological processes like vasculitis and infectious disease. We report a case of 18-year-old with epididymo-orchitis complicated by testicular ischemia. This case accentuates the need for a high index of suspicion to rule out concomitant testicular ischemia secondary to epididymo-orchitis that might be salvaged in the future with immediate surgical intervention. Testicular infarction is a devastating complication from epididymo-orchitis that is difficult to predict and distinguish from more common presentations of acute scrotum.

Influence of Different Urban Structures on Metal Contamination in Two Metropolitan Cities.

The influence of urban structures and land use patterns of metropolitan cities on the distribution of contaminants is not well understood. In this study, two metropolitan cities [Jeddah (a typical corridor city) and Madinah (a typical compact city)], featuring different spreading patterns and urban structures, were selected to investigate the contamination level and potential risk caused by metals (i.e., Pb, Zn, Co, Fe, Al, Cr, Cu, Ni, and Mn) associated with urban dust. The findings of this study show that a metropolitan city with a limited variety of activities and a polar center (e.g., Madinah) displays a typical distribution pattern of metals, i.e., concentrations of metals increase gradually toward the center of the city. In contrast, a metropolitan city with multiple major activities (e.g., Jeddah) displays a different distribution pattern, controlled by multiple key actors (e.g., seaports, oil refineries, and desalination/power plants) able to shift the location of highest contamination away from the city center. The above findings are supported by the results of several contamination and health indices. In Jeddah, the highest Pb contamination was found near an oil refinery based on geoaccumulation index (Igeo), contamination factor (CF), enrichment factor (EF), and ecological risk (Ei) values; whereas, the highest Zn contamination was found near a seaport, based on EF, CF, and Ei values. However, in Madinah, the contamination indices indicate that the most contaminated locations are near the city center. The highest non-carcinogenic health risk in Jeddah was found near an oil refinery and in the city center; whereas in Madinah, it was found mainly in the city center. Although there is no significant risk of cancer due to metals associated with dust in the two cities, Cr, representing a health risk contribution of >24%, was the major contributor of non-carcinogenic health risk in the two metropolitan cities.

Metal contamination decrease with new legislation: A decade of metal risk assessment in urban dust.

New scientific discoveries for new applications of materials (e.g., metals) lead to extensive industrial use of these materials, which in turn, has significant negative health and environmental impacts. Governments use legislation as a management tool to control the usage of certain materials to lower contamination. This study investigates the level of metal contamination over a period of 12 years to observe the dynamic changes in response to new legislation or industrial improvements. Metals (i.e., Pb, Zn, Co, Cu) associated with urban roadside dust in 21 sites in Riyadh, Saudi Arabia were analyzed during the period of 2001-2013. Three main conclusions were drawn from this study: 1) Phasing out leaded gasoline was an effective tool to control Pb contamination. The average Pb concentration in the city was 37 times higher in 2001 compared to that in 2013. Twenty-nine percent of the investigated sites were at a significant health risk in 2001 compared to none in 2013. 2) The new substitutes of Zn oxides and new limitations of the Zn content in the rubber industry were effective at controlling the Zn contamination in the urban environment. The average Zn concentration of the city was 8 times higher in 2001 compared to that in 2013. Eighty-one percent of the investigated sites in 2001 were considered to be very highly contaminated (CF > 6) compared to none in 2013. 3) The lack of legislation regarding the Co-content in fossil fuels was probably the main reason for the enhancement of the Co contamination in the whole city, with an increase in the average Co concentration >3 times in 2013 compared to that in 2001. Likewise, the health risk index was increased by ∼3 times from 2001 to 2013. For Cu, the average Cu concentration in 2001 was almost twice that in 2003 and 2013. Legislation has been observe to be an effective management tool for controlling metal contamination.

Bilateral posterior crystalline lens dislocations in an otherwise healthy child.

Introduction: Ectopia lentis is defined as a crystalline lens displacement, either partially or completely, due to zonular abnormalities. It can be a result of trauma, hereditary ocular disease, or part of systemic diseases, like Marfan syndrome and homocystinuria. Case description: We report a case of a medically free 16-year-old girl, who was referred to our hospital complaining of poor vision and a squint in both eyes since childhood. Her history included a traffic accident when she was one-year-old. She was previously diagnosed with alternating esotropia, which was treated with glasses, alternating patching, and bilateral Botox injections. On examination, she had a visual acuity of 6/7.5 with correction in the right eye and 6/6 with correction in the left eye. She had an esotropia of 60 prism diopters, which was partially corrected to 40 prism diopters for near and distance vision. Fundus examination showed myopic changes in each eye and dislocated lenses in the posterior pole at 6 o'clock. Our case was stable, so we used conservative management with contact lenses. Conclusion: Bilateral posterior lens dislocation is very rare. A proper examination is important and early diagnosis can prevent serious complications, such as retinal detachment or pupillary block glaucoma.

Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis.

Scrotal elephantiasis has been a recognized complication of inguinal node irradiation, filarial infection, tumor involvement and surgical lymphatic destruction, but has rarely been reported in association with hidradenitis suppurativa (HS). HS, also known as acne inversa, is a chronic and often debilitating disease primarily affecting the axillae, inframammary regions and perineum. The location of the lesions may lead to social embarrassment and failure to seek medical treatment. Scroto-preineal HS complicated by scrotal elephantiasis is a distressing disease. Excisional surgery with reconstruction is the recommended treatment with a high likelihood of good outcome. We present a 38-year-old male patient with long-standing scroto-perineal HS complicated by giant scrotal elephantiasis.

Malignant peripheral nerve sheath tumor of kidney-A case report.

INTRODUCTION: Malignant peripheral nerve sheath tumors (MPNSTs) are very rare soft-tissue tumors. These tumors originate from Schwann cells or pluripotent perineural cells of the neural crest. An isolated MPNST of the kidney is extremely rare and has been reported in only six cases to date. PRESENTATION OF CASE: A 30-year-old female with an unremarkable past medical and surgical history presented with an enlarging, right-sided abdominal mass for the last 3 months. A CT scan of the abdomen and pelvis showed a large exophytic mass arising from the right kidney. A metastatic work-up was negative, so a right radical nephrectomy was performed. Histopathological and immunohistochemical studies confirmed the diagnosis of an MPNST. DISCUSSION: MPNSTs are rare and aggressive soft-tissue sarcomas that are usually associated with neurofibromatosis type 1 (NF-1) but that also occur post-radiation and sporadically. These tumors are highly malignant neoplasms with a high recurrence rate and distant metastases. Complete surgical excision remains the mainstay of treatment due to the limited response of MPNSTs to both chemotherapy and radiotherapy. CONCLUSION: MPNSTs arising from the kidney are very rare. Complete surgical resection provides the only hope for cure. Postoperative chemotherapy and radiotherapy are still controversial, although postoperative radiotherapy is currently recommended by an oncology consensus group.