Knowledge and Attitude of the General Population About Do Not Resuscitate (DNR) in the Western Region, Saudi Arabia.

BACKGROUND: A do-not-resuscitate (DNR) order is a medical order issued by a doctor. It directs medical professionals to refrain from performing cardiopulmonary resuscitation (CPR) if a patient's breathing or heartbeat ceases. Patients can refuse CPR in an emergency if they have a DNR order. The DNR order includes precise directives about CPR. Instructions for extra therapies like nourishment, other drugs, or painkillers are not included. AIM: The aim of the study is to learn more about the western region's general population's knowledge and attitudes toward DNR orders and identify any challenges that may arise when dealing with DNR patients. METHODOLOGY: A cross-sectional study was conducted in 2023 in the western region of Saudi Arabia. An online, self-administered questionnaire was distributed randomly from April 8, 2023 to June 6, 2023. The estimated sample size was 384, and 604 were the collected responses. RESULTS: A total of 383 (63.4%) participants were females, and 221 (36.6%) were males. Regarding the knowledge and attitude of the general population about DNR orders in the western region of Saudi Arabia, 276 (45.7%) study participants had satisfactory knowledge and awareness, while 328 (54.3%) had inadequate knowledge. A total of 343 (56.8%) participants thought that DNR is important; 255 (42.2%) felt that the DNR has reduced the pain of their relatives, and 181 (30%) believed that it has reduced the stress felt by the patient's families. Of participants aged 20-30 years, 58.4% had satisfactory knowledge about DNR orders compared with those aged 50 and above; 76.1% of healthcare workers had satisfactory knowledge versus 26.5% of unemployed participants (P=.001). CONCLUSION: We recommend increasing awareness and knowledge about DNR by conducting educational events about the concept and how to deal with patients who choose to acquire a DNR order.

The effect of intra-articular vanilloid receptor agonists on pain behavior measures in a murine model of acute monoarthritis.

Arthritis is the most common cause of disability in the US, and the primary manifestation of arthritis is joint pain that leads to progressive physical limitation, disability, morbidity, and increased health care utilization. Capsaicin (CAP) is a vanilloid agonist that causes substance P depletion by interacting with vanilloid receptor transient receptor potential V1 on small unmyelinated C fibers. It has been used topically for analgesia in osteoarthritis with variable success. Resiniferatoxin (RTX) is an ultra potent CAP analog. The aim of this study was to measure the analgesic effects of intra-articular (IA) administration of CAP and RTX in experimental acute inflammatory arthritis in mice. Evoked pain score (EPS) and a dynamic weight bearing (DWB) device were used to measure nociceptive behaviors in a murine model of acute inflammatory monoarthritis. A total of 56 C57B16 male mice underwent EPS and DWB testing - 24 nonarthritic controls and 32 mice with carrageenan-induced arthritis. The effects of pretreatment with 0.1% CAP, 0.0003% RTX, or 0.001% RTX were measured. Nociception was reproducibly demonstrated by increased EPS and reduced DWB measures in the affected limb of arthritic mice. Pretreatment with 0.001% RTX resulted in statistically significant improvement in EPS and DWB measures when compared with those observed in carrageenan-induced arthritis animals. Pretreatment with IA 0.0003% RTX and IA 0.01% CAP resulted in improvement in some but not all of these measures. The remaining 24 mice underwent evaluation following treatment with 0.1% CAP, 0.0003% RTX, or 0.001% RTX, and the results obtained were similar to that of naïve, nonarthritic mice.

Mitochondrial myopathy presenting as fibromyalgia: a case report.

INTRODUCTION: To the best of our knowledge, we describe for the first time the case of a woman who met the diagnostic criteria for fibromyalgia, did not respond to therapy for that disorder, and was subsequently diagnosed by biochemical and genetic studies with a mitochondrial myopathy. Treatment of the mitochondrial myopathy resulted in resolution of symptoms. This case demonstrates that mitochondrial myopathy may present in an adult with a symptom complex consistent with fibromyalgia. CASE PRESENTATION: Our patient was a 41-year-old Caucasian woman with symptoms of fatigue, exercise intolerance, headache, and multiple trigger points. Treatment for fibromyalgia with a wide spectrum of medications including non-steroidal anti-inflammatory drugs, antidepressants, gabapentin and pregabalin had no impact on her symptoms. A six-minute walk study demonstrated an elevated lactic acid level (5 mmol/L; normal < 2 mmol/L). Biochemical and genetic studies from a muscle biopsy revealed a mitochondrial myopathy. Our patient was started on a compound of coenzyme Q10 (ubiquinone) 200 mg, creatine 1000 mg, carnitine 200 mg and folic acid 1 mg to be taken four times a day. She gradually showed significant improvement in her symptoms over a course of several months. CONCLUSIONS: This case demonstrates that adults diagnosed with fibromyalgia may have their symptom complex related to an adult onset mitochondrial myopathy. This is an important finding since treatment of mitochondrial myopathy resulted in resolution of symptoms.

Metabolic myopathy presenting with polyarteritis nodosa: a case report.

INTRODUCTION: To the best of our knowledge, we describe for the first time a patient in whom an unusual metabolic myopathy was identified after failure to respond to curative therapy for a systemic vasculitis, polyarteritis nodosa. We hope this report will heighten awareness of common metabolic myopathies that may present later in life. It also speculates on the potential relationship between metabolic myopathy and systemic vasculitis. CASE PRESENTATION: A 78-year-old African-American woman with a two-year history of progressive fatigue and exercise intolerance presented to our facility with new skin lesions and profound muscle weakness. Skin and muscle biopsies demonstrated a medium-sized artery vasculitis consistent with polyarteritis nodosa. Biochemical studies of the muscle revealed diminished cytochrome C oxidase activity (0.78 µmol/minute/g tissue; normal range 1.03 to 3.83 µmol/minute/g tissue), elevated acid maltase activity (23.39 µmol/minute/g tissue; normal range 1.74 to 9.98 µmol/minute/g tissue) and elevated neutral maltase activity (35.89 µmol/minute/g tissue; normal range 4.35 to 16.03 µmol/minute/g tissue). Treatment for polyarteritis nodosa with prednisone and cyclophosphamide resulted in minimal symptomatic improvement. Additional management with a diet low in complex carbohydrates and ubiquinone, creatine, carnitine, folic acid, α-lipoic acid and ribose resulted in dramatic clinical improvement. CONCLUSIONS: Our patient's initial symptoms of fatigue, exercise intolerance and progressive weakness were likely related to her complex metabolic myopathy involving both the mitochondrial respiratory chain and glycogen storage pathways. Management of our patient required treatment of both the polyarteritis nodosa as well as metabolic myopathy. Metabolic myopathies are common and should be considered in any patient with exercise intolerance. Metabolic myopathies may complicate the management of various disease states.