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Impact of Perceived Stress on White Blood Cell Count, Erythrocyte Sedimentation Rate and Lipid Profile Among First MBBS Students in a Medical College of West Bengal

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Impact of Perceived Stress on White Blood Cell Count, Erythrocyte Sedimentation Rate and Lipid Profile Among First MBBS Students in a Medical College of West Bengal International Journal of Research and Review www.ijrrjournal.com E-ISSN: 2349-9788; P-ISSN: 2454-2237 Original Research Article Impact of Perceived Stress on White Blood Cell Count, Erythrocyte Sedimentation Rate and Lipid Profile among First MBBS Students in a Medical College of West Bengal Dr. Arunima Chaudhuri1, Dr. Debdut Banerjee2 1Associate Professor, Department of Physiology, Rampurhat Government Medical College and Hospital (Affiliated to West Bengal University of Health Sciences), Rampurhat, West Bengal, India. 2Assistant Professor, Gynaecology and Obstetrics, Burdwan Medical College and Hospital, West Bengal, India. Corresponding Author: Dr. Debdut Banerjee ABSTRACT Background: Psychoneuroimmunology is a scientific field dealing with the relationships between the mind, the brain and the immune system and focuses on how these relationships affect health and susceptibility to disease. Aims: To study impact of perceived stress on white blood cell count, erythrocyte sedimentation rate and lipid profile among first MBBS students in a medical college of West Bengal. Materials and methods: This cross‑sectional study was conducted in a medical college of eastern India. Approval from the institutional ethics committee and informed consent of the subjects was taken before conduction of this pilot project. On the first appointment, histories of the subjects were carefully recorded and general physical examination was done. BMI, Pulse, Blood Pressure were recorded. One hundred and twenty‑one subjects were finally selected. The stress level in the subjects was assessed according to the presumptive life event stress scale (PSLES). Accordingly, they were categorized into two groups: 41–200 less/moderate stress; more than 200 severe stress. The perceived stress scale (PSS) of Cohen et al. was used for assessing perceived stress levels. Fasting blood sample were drawn for analysis of lipid profile, ESR and total count of white blood cells (WBC), Hb% were estimated. Statistical analysis: Data were analyzed using software SPSS version16; Unpaired t test was used. Results: One hundred and twenty-one subjects participated in the present study. Seventy- five subjects were male and forty-six were female. All subjects were on non-vegetarian diet. Sixty-six subjects had PSLES scores above 200 and fifty-five subjects had scores less than 200. There was no significant difference in age between the two groups: 18.4±1.02 vs. 18.8±1.2; P value 0.2. Results showed significant difference in WBC count, ESR, Hb%, Total Cholesterol, Triglyceride, LDL, HDL level, PSLES and PSS scores, but no significant difference in VDL level between the two groups. There was significant difference in BMI, Pulse and blood pressure between the two groups. Conclusions: The prevalence of stress was found to be high during the initial years of study among MBBS students. Physical problems were associated with high stress levels. Results of the present study showed significantly higher WBC count, ESR, Hb%, Total Cholesterol, Triglyceride, LDL, PSLES and PSS scores, BMI, Pulse and blood pressure values in subjects with higher stress scores and decrease in values of HDL. All these factors may increase the risk of cardiovascular diseases. Preventive mental health services, therefore, should be made an integral part of routine clinical services for medical students, especially in the initial academic years, to prevent such occurrence. International Journal of Research & Review (www.ijrrjournal.com) 220 Vol.5; Issue: 12; December 2018 Keywords: Perceived stress, WBC count, ESR and lipid profile. INTRODUCTION marital unhappiness, and burden of Medical education is perceived as caregiving. Although stressors trigger being stressful, and a high level of stress events, it is less clear that stress “causes” may have a negative effect on cognitive the events. [6-7] functioning and health of students in a Cardiovascular diseases claim more medical school. The prevalence of stress has lives worldwide than any other. been found to be higher during the initial Etiologically, the dominant trajectory three years of study. [1-6] The seven leading involves atherosclerosis, a chronic causes of death in the general population inflammatory process of lipid-rich lesion are: diseases of the heart, cancer, growth in the vascular wall that can cause intracranial lesions of vascular origin life-threatening myocardial infarction (MI). (cerebrovascular), accidents, nephritis, Leukocytes - white blood cells - are pneumonia and influenza, and tuberculosis. important participants at the various stages These are not the same as the seven leading of cardiovascular disease progression and causes of death among physicians. [1] For complication. Atherosclerosis is the example, arteriosclerosis, diabetes and pathology that leads to myocardial cirrhosis of the liver each caused more infarction and stroke. Atherosclerosis is a deaths among physicians. Globally, about chronic inflammatory disease driven by 17 million people die of cardiovascular lipids, specifically low density lipoproteins diseases (CVDs) every year and a (LDL) and leukocytes. Lifestyle, age, substantial number of these deaths are hereditary factors, and co-morbidities attributed to major risk factors namely disturb immune, digestive, endocrine, unhealthy diet, physical inactivity, tobacco circulatory, and nervous systems, thereby consumption, alcohol consumption and altering immune function, metabolism, and stress. Doctors and nurses often have a many other processes, while eliciting sedentary lifestyle. [6-7] inflammation, hypercholesterolemia, and A study BY Hedge SKB et al [7] was hypertension. Atherosclerosis develops and aimed at assessing the lifestyle-associated causes myocardial infarction or stroke when risk for CVDs among doctors and nurses in many things go wrong in many different a medical college hospital. A cross-sectional ways. [8] study was conducted among 250 doctors The natural progression of and nurses, selected using a stratified atherosclerosis in the human involves the random sampling, working at a medical acquisition of specific features in the college hospital in Tamil Nadu. It was found growing lesion. A key initiating process of that 31.2% of all study subjects and 49.2% atherosclerosis is the intimal retention of of doctors were at high general risk for apolipoprotein (apo) B-containing CVDs; 30.4% of all study subjects and lipoproteins in regions of disturbed blood 42.1% of doctors were at high physical flow and low shear stress. The existence of activity-related risk for CVDs; 14.4% of all small pools of extracellular lipids in the study subjects and 19.8% of all doctors were intima is a feature of a preatheroma, at high dietary pattern-related risk for whereas an easily discernible core of CVDs. Doctors were found to be at a higher extracellular lipid marks an atheroma. risk for CVDs as compared to nurses as well Increasingly complicated lesions are defined as the general population. [7] by fibrous thickening; the appearance of There is an enormous amount of fissures, hematoma, and thrombi; and literature on psychological stress and calcification. Problems occur if a lesion cardiovascular disease. Studies of chronic interferes with tissue oxygenation when stressors are discussed in terms of job stress, either the lesion’s size reduces blood flow International Journal of Research & Review (www.ijrrjournal.com) 221 Vol.5; Issue: 12; December 2018 Arunima Chaudhuri et.al. Impact of Perceived Stress on White Blood Cell Count, Erythrocyte Sedimentation Rate and Lipid Profile among First MBBS Students in a Medical College of West Bengal or the lesion ruptures and occludes the immunity. Chronic stressors were associated vessel altogether. Of the two, lesion rupture with suppression of both cellular and is far more dangerous. Myocardial humoral measures. infarction and stroke are sudden events that Sympathetic fibers descend from the result from occlusion of vessels that brain into both primary (bone marrow and oxygenate the heart and brain, respectively. thymus) and secondary (spleen and lymph [8] nodes) lymphoid tissues. These fibers can Macrophages are most numerous release a wide variety of substances that among leukocytes in any type of lesion and, influence immune responses by binding to with the possible exception of smooth receptors on white blood cells. Though all muscle cells, the most prominent cellular lymphocytes have adrenergic receptors, contributors to the lesion’s physical bulk. In differential density and sensitivity of response to intimal lipid accumulation, adrenergic receptors on lymphocytes may disturbed blood flow, low shear stress, and affect responsiveness to stress among cell other stimuli, endothelial cells permit subsets. The hypothalamic–pituitary– monocytes - major precursors of adrenal axis, the sympathetic–adrenal– macrophages - passage across the medullary axis, and the hypothalamic– endothelium. Newly-infiltrated monocyte- pituitary–ovarian axis secrete the adrenal derived macrophages recognize and ingest hormones epinephrine, norepinephrine, and lipids that have accrued in the intima as a cortisol; the pituitary hormones prolactin consequence of hypercholesterolemia. and growth hormone; and the brain peptides Macrophages are specialized phagocytes melatonin, β-endorphin, and enkephalin. that rely on different strategies to sense, These substances bind to specific receptors internalize, and process the diverse lipid on white blood cells and have diverse moieties they encounter. Lipoprotein
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