Assessment of Primary Healthcare Providers' Knowledge and Practices in Addressing Asymptomatic Hyperuricemia and Gout in the Asir Region of Saudi Arabia.

Introduction and aim Gout, the most common form of inflammatory arthritis, arises from hyperuricemia, a condition where elevated levels of uric acid lead to the deposition of monosodium urate (MSU) crystals in the joints. Nevertheless, it's important to note that not all cases of hyperuricemia result in gout. Methodology This cross-sectional study was conducted in the Asir region of Saudi Arabia, targeting primary healthcare physicians (PHPs) specializing in family medicine and general practice. The study utilized a modified electronic questionnaire, inspired by similar studies and aligned with recent guidelines, to assess PHPs' knowledge and practices concerning asymptomatic hyperuricemia (AH) and gout. The questionnaire encompassed the PHPs' demographic data and their knowledge and practices for AH and gout management. Results Out of 201 participating PHPs, the majority were male (68.2%), predominantly aged 25-34 years (73.1%), and practicing as general practitioners (61.2%). A significant proportion of PHPs had less than five years of experience (63.7%). In terms of education, 36.8% attended continuing medical education (CME) on AH or gout, and 66.7% were aware of the related management guidelines. The study revealed that the total knowledge score among PHPs averaged 5.18 out of seven, indicating a moderate level of knowledge. However, their practice level was moderate, with a mean practice score of 6.75 out of 12. The study also found no significant differences in knowledge scores based on gender, age, or years of experience, but significant variations were noted based on medical specialty. Conclusion There is a moderate level of knowledge and practice among PHPs in managing AH and gout in the Asir region. Despite adequate knowledge levels, there appears to be a gap in implementing this knowledge into practice, particularly in long-term management strategies. The findings emphasize the need for ongoing medical education and specialized training programs to bridge these gaps. The study provides a valuable framework for identifying and addressing similar challenges in other regions and medical practices.

The Neuronal Cotransmission: Mechanistic Insights From the Autonomic Nervous System.

It is now scientifically accepted that neurons have the ability to release multiple transmitter substances simultaneously, yet, cotransmission's functionality is still limited to the scientific community. Acetylcholine is released by the noradrenergic neurons, and then the acetylcholine works prejunctionally in the promotion of the noradrenaline release. This hypothesis significantly challenged the previous idea of autonomic transmission as being a simple process that had a single transmitter. Norepinephrine was thought to be the single transmitter at the sympathetic neurovascular junction according to "Dale's principle". However, more evidence of the involvement of other neurotransmitters has been shown by many researchers in conjunction with Dale's principle and established terms such as adrenergic, purinergic, and peptidergic nerves. With the discovery of cotransmission, we now understand the existence of more than one neurotransmitter at a sympathetic neurovascular junction.