Present work is a prospective cohort study that deciphers the alteration in stress marker and blood profile among trainee medicos during pre and post cardiac catherization procedure. Total 25 medicos were enrolled, only 10 were able to complete the criteria for the whole set of study, free from anxiety and were not on any medication before enrollment of study. Cortisol and white blood cells (WBC) count showed a significant difference in pre and post catherization procedures. Significant (PË‚0.05) linear correlation was found between pre and post values for heart rate, WBC, electrolytes, blood urea nitrogen (BUN), cortisol, tri-iodothyronine, thyroxine, thyrotropin and Vit D in paired sample correlation. WBC counts measured before and after intervention were 5.81±1.12 and 5.19±0.98 respectively, which showed a significant fall in the WBC count and increase in cortisol after intervention. These alternations suggest to review and redesign the curricular or assigning duties to medicos under training.
Short Communication · Volume 54, Issue 6, 23 September 2022 · Open Access
Alteration in Blood Stress Marker and Other Vitals of Saudi Medicos in Pre- and Post-Real Time Cardiac Catheterization Procedure
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Affiliations & Notes ⌄
- 1Department of Biochemistry, Faculty of Science, King Abdulaziz University, King Fahad Medical City, Saudi Arabia. 2King Saud University College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia 3Department of Anaesthesia and Critical Care, AIIMS, Jodhpur, India 4Department of Biochemistry, Faculty of Science, King Abdulaziz University, Saudi Arabia 5Department of Pharmaceutical Sciences, Shalom Institute of Health and Allied Sciences, Sam Higginbottom University of Agriculture
Article Info ⌄
- Journal:
- Pakistan Journal of Zoology
- Published:
- 23 September 2022
From the article
- Only cortisol and WBC count showed a significant different in their values both in pre-and post-catherization process carried out by the medicos (Table I).
- A significant (P˂0.05) linear correlation was found between pre and post values for HR (0.046), WBC (0.003), Na (0.045), Cl (0.001), K (0.036), BUN (0.007), COR (0.02), FT3 (0.018), FT4 (0.001), TSH (0.001) and VitD (0.012), (Supplementary Table I).
- There was a significant fall in the WBC a significant increase in the COR after intervention.
- Increase in WBC count is another parameter which have drastically altered in medicos after the process of catherization.
Selected from the article's own text.
Abstract
Materials and methods
This is a prospective cohort pilot study from King Saud University College of Medicine. King Saud University Medical City, Riyadh and King Abdulaziz University, Jeddah. The study was approved by Institutional Review Board (IRB number. E-18-3448). Health Sciences Colleges Research on Human Subjects, King Saud University College of Medicine. All the fellows enrolled in study were from King Saud University College of Medicine for the year 2019 (n=15) but only 7 fulfilled the criteria. Residents enrolled for study were informed and the consent to participate in study was obtained to record their biochemical blood profiling at pre and post cardiac catherization procedure. The data was collected from the medicos who were willing to cooperate in the study without any prejudice. All the selected medicos were free from anxiety and were not on medication before going for the sample collection. The sample collection technique was followed with modification of resuscitation assessment tool (RAT) .
The medicos were subjected to cardiac catheterization procedure that helps them to diagnose and treat heart related problem. The medicos were allowed to relax and the blood sample were collected before going to catherization lab. Once they were again relaxed the medicos were allowed to enter the cardiac catheterization laboratory to perform the real time catherization technique under the supervision of expert. Once the cardiac catheterization procedure was over the medicos were allowed to relax for ten minutes and then the blood sample was again collected from them.
Standard Kits were utilized for analysis of blood profile with respect to HR, SBP and DBP WBC, RBC, HGB, PLT, CHOL, Na+, Cl-, K+, BUN, COR, FT3, FT4, TSH and VitD
The data were arranged and tabulated in Microsoft excel spread sheet. SPSS 18 was used to analyze the data. Normality was tested using Kolmogorov Smirnov test. Normally distributed continuous variables were presented as mean±SD and analyzed using paired’ test.
Average or mean entrustment score were computed for each of the fellow trainee (FT) before and after the catherization procedure. The outcome was compared using Pearson product movement correlation coefficient to determine the linear relationship between mean value in pre and post result data followed by t test to know any variation in the data of paired sample. Further, any internal reliability among the samples were calculated to observe any variation in the results of pre and post catherization process . Any unwanted missing link or data were excluded from the study of analysis. All the samples were coded for using inductive thematic analysis .
Results and discussion
The observation phase took almost a year to get the best results from the enrolled medicos. Out of 15 only 7 were able to fulfill the criteria of study. There was no statically significant variation in P-value ˃ 0.05) between the medicos in terms age (36.6±6.9 year), weight (81.9±9.1 Kg) and height (174.7±7.6 cm).
Only cortisol and WBC count showed a significant different in their values both in pre-and post-catherization process carried out by the medicos (Table I).
A significant (P˂0.05) linear correlation was found between pre and post values for HR (0.046), WBC (0.003), Na (0.045), Cl (0.001), K (0.036), BUN (0.007), COR (0.02), FT3 (0.018), FT4 (0.001), TSH (0.001) and VitD (0.012), (Supplementary Table I). There was a significant fall in the WBC a significant increase in the COR after intervention. Further results demonstrate the strong linear association adjusted with catherization process in accordance with the existing literature , confirming the relationship as strong and consistent. Our results provide new insight on the usefulness of differential WBC count as predictors for stress in medicos.
Table I. Vital parameters and blood profiling and vitals in pre and post catherization process.
| Parameter | Pre (Mean±SD) | Post (Mean±SD) |
| HR (per min) | 78.29±20.28 | 70.86±22.89 |
| SBP (mmHg) | 126.14±14.18 | 122.57±12.51 |
| DBP (mmHg) | 72.43±8.1 | 69.71±5.1 |
| SpO2 (%) | 98.26±1.25 | 98.43±0.79 |
| HGB | 15.17±1.3 | 15.29±1.1 |
| WBC | 5.81±1.12 | 5.19±0.98 |
| RBC | 5.44±0.56 | 5.51±0.61 |
| PLT | 239.03±39.04 | 241.24±46.14 |
| CHOL | 5.3±1.12 | 5.39±1.32 |
| Na | 140.14±1.7 | 139.9±1.9 |
| Cl | 104.26±2.22 | 104.86±2.4 |
| Glu | 4.83±0.38 | 5.37±0.88 |
| Crea | 85±8.34 | 86.21±6.93 |
| BUN | 5.14±0.73 | 5.13±0.76 |
| K | 4.17±0.35 | 4.12±0.32 |
| COR | 261.57±110.94 | 342.98±122.29 |
| FT3 | 5.011±0.2 | 5.014±0.3 |
| FT4 | 13.4±2.22 | 13.34±2.01 |
| TSH | 2.12±0.63 | 2.05±0.63 |
| Vit D | 42.07±9.83 | 38.65±6.77 |
WBC, white blood cells; TSH, thyrotropin; FT4, thyroxine; FT3, tri-iodothyronine; CHD, congenital heart disease; RAT, resuscitation assessment tool; Vit D, vitamin D; HR, heart rate; BUN, blood urea nitrogen; COR, cortisol; FT4, thyroxine; TSH, thyrotropin; SBP, systolic blood pressure; DBP, diastolic blood pressure; RBC, red blood cells; HGB, hemoglobin; PLT, platelets; CHOL, cholesterol; Na+, sodium ion; Cl, chloride ions; K+, potassium ions.
The alteration in the cortisol level may be associated with mental fatigue. Our results are in concordance with the previous studies where mental fatigue associated with emotional stimuli ; . The hectic job schedule and constant exposure to stress of patients can be another factor for the elevated level of cortisol .
Conclusion
Present study clearly linked the alteration of cortisol association with mental fatigue of medicos, activities and training in their course of study. Rise in cortisol level is an indication of depressive symptoms that can lead to medical error. Stimulation studies can benefit the medicos before proceeding for real time cardiac catherization process with better output in terms of patient safety and medicos’ health. Increase in WBC count is another parameter which have drastically altered in medicos after the process of catherization. Alteration in WBC is associated with normal cardiac activity of humans.
Acknowledgments
This project was funded by the King Abdulaziz City for Science and Technology (KACST). Riyadh under the grant no. 1-17-03-009-0012.The authors, therefore, acknowledge with thanks KACST for technical and financial support.
Supplementary material
There is supplementary material associated with this article. Access the material online at: https://dx.doi.org/10.17582/journal.pjz/20200420160412
Statement of conflict of interest
The authors have declared no conflict of interest.
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