Fatigue and ammonia levels of capillary blood in medical students

Objective. To evaluate the frequency and factors associated with the development of fatigue among students of a medical university.

Materials and methods. Fatigue Assessment Scale (FAS) was used to identify and quantify fatigue. To determine the level of active attention, the electronic number test was used. Assessment of students’ physical activity was carried out according to the degree of energy costs. Capillary blood ammonia levels were evaluated using a Pocket Chem BA PA 4140 handheld analyzer.

Results. The median severity of fatigue according to the FAS questionnaire for students of the 5–6 year medical university was 23,0 (21,0–29,0) points. All students were divided into two groups depending on the level of scores on the FAS questionnaire. Pathological fatigue syndrome was identifi ed in 26 (65%) students. In 14 (35%) students, the FAS value was less than 22 points. in men, the level of fatigue corresponded to 21,0 (14,0–29,0) points, in women 23,0 (21,0–29,0) points, without reaching statistical signifi cance (p = 0,321). Among students of the fi rst group (FAS <22 points), the level of physical activity of the middle level was signifi cantly more likely to occur (p = 0,015). In this case, students with low physical activity diff ered signifi cantly higher values of both physical (14,0 (12,0–18,0)) and mental (11,0 (9,00–14,0)) FAS coefficients (p = 0,001 and p = 0,007). A decrease in BMI of less than 18.8 kg / m2 is associated with an increase in the risk of pathological fatigue among medical students by 0,283 (95% CI 0,087–0,927), and a low level of physical activity by 0,179 (95% CI 0,042–0,753). Additionally, a correlation analysis revealed a negative relationship between the values of the FAS test and the
level of the average student achievement score. The median ammonia concentration was 74,0 (66,0–99,0) μmol/L. Among students with capillary blood ammonia levels of more than 100 μmol/L, students with pathological fatigue predominated according to the FAS questionnaire (in 83,3% of cases), and there were no people with average physical activity (p = 0,062).

Conclusions. 1. Students of the 5–6th year of a medical university in 65% of cases have a high level of fatigue, which inversely correlates with academic performance.
2. Factors associated with pathological fatigue in senior medical students are body mass index less than 18,8 kg/m2 (RR0,283 (95% CI 0,087–0,927)) and low level of physical activity (RR0,179 (95% CI) 0,042–0,753)).
3. For senior students of a medical university included in the study, the median concentration of ammonia of capillary blood was 74,0 (66,0–99,0) μmol / L; no signifi cant relationship was found between the concentration of ammonia of capillary blood and the level of fatigue.

1. Tiesinga L.J., Dassen T. W., Halfens R. J. DUFS and DEFS: development, reliability and validity of the Dutch Fatigue Scale and the Dutch Exertion Fatigue Scale. Int J Nurs Stud, 1998, Vol. 35(1–2), pp.115–23. DOI: 10.1016/s0020–7489(98)00005–4.

2. Aaronson L.S., Teel C. S., Cassmeyer V., Neuberger G. B., Pallikkathayil L., Pierce J., Press A. N., Williams P. D., Wingate A. Defi ning and measuring fatigue. Image J Nurs Sch, 1999, Vol.31(1), pp.45–50. DOI: 10.1111/j.1547–5069.1999.tb00420.x

3. National Library of Medicine. 2016. Medical Subject Headings. Available at http://www.ncbi.nlm.nih.gov/mesh/ 68005221 (accessed on 07 May 2016).

4. Berger P.J., McCutcheon L., Soust M., Walker A. M., Wilkinson M. H. Electromyographic changes in the isolated rat diaphragm during the development of fatigue. Eur J Appl Physiol Occup Physiol, 1991, Vol.62(5), pp.310–6. DOI: 10.1007/bf00634965

5. Gibson H., Edwards R. H. Muscular exercise and fatigue. Sports Med, 1985, Vol.2(2), pp.120–32. DOI: 10.2165/00007256–198502020–00004

6. Ciurana A., Berthel M., Berrebi A., Wemeau J. L., Callis A., Vanuxem P. The role of the practitioner in the fatigue position. Russian Medical Journal, 1997, no. 16, 1.P.

7. Plotnikova E. Yu., Makarova M. R., Gracheva T. Yu. The effect of impaired nitrogen metabolism on the morphofunctional state of the body and the possibility of using l-ornithine in sports medicine. Sports medicine: science and practice, 2016, Vol. 6, no. 4, pp. 43–51.

8. Plotnikova E. Yu., Sukhikh A. S. Different variants of hyperammonemia in clinical practice. Medical advice, 2018, no. 14, pp.34–42.

9. Bueverov A. O. Ammonia as a neuro- and hepatotoxin: clinical aspects. Medical advice, 2015, no. 13, pp. 80–85.

10. Ilchenko L. Yu., Nikitin I. G. Hyperammonemia in patients at the docirotic stage: clinical reality? The Russian Archives of Internal Medicine, 2018, № . 3, pp.186–193.

11. Akhramovich A. P., Sovalkin V. I. Blood ammonia in chronic liver diseases: clinical and pathogenetic significance. Kazan medical journal, 2013, no. 94 (5), pp.600–604.

12. Morozova T. S. Hepatic encephalopathy: pathogenesis issues, diagnostic methods (literature review). Ural Medical Journal, 2019, no. 2 (170), pp. 64–82.

13. Karpovich A. V., Grigoriev P. E., Luskova Yu. S. Biomedical and psychosomatic aspects of chronic fatigue syndrome in medical students. Bulletin of the Physico-Technical Institute of the Crimean Federal University named after V. I. Vernadsky, 2017, no. 2, pp. 85–94.

14. Akhapkina V. I., Fedin A. I., Avedisova A. S., Akhapkin R. V. The effectiveness of phenotropil in the treatment of asthenic syndrome and chronic fatigue syndrome. Recipe, 2008, no. 5 (61), pp. 79–84.

15. Chernaya N. A., Poplavskaya O. V., Filonsky G. O., Kovalev V. A. The prevalence of asthenia among students of a medical university. Volgograd Medical Journal, 2016, no. 4 (52), pp. 35–37.

16. Bikbulatova L. F., Kutlubaev M. A., Akhmadeeva L. R. Fatigue assessment scale (translation into Russian), adaptation and assessment of psychometric properties in hospitals of neurology and therapy clinics. Medical Bulletin of Bashkortostan, 2012, Vol. 7, no. 1, pp. 37–42.

17. Bueverov A . O., Bogomolov P. O., Maev I. V., Matsievich M. V., Uvarova O. V. The possibilities of therapeutic correction of hyperammonemia and minimal hepatic encephalopathy in patients with chronic hepatitis C at the docirrotic stage. Therapeutic Archive, 2019. Vol. 91, no. 2, pp. 52–58.

18. Pavlov Ch.S., Damulin I. V., Ivashkin V. T. Hepatic encephalopathy: pathogenesis, clinical features, diagnosis, therapy. Russian Journal of Gastroenterology, Hepatology, Coloproctology, 2016, Vol. 26, no. 1, pp. 44–53.

19. Ilchenko L. Yu. Hepatic encephalopathy. Sat Proceedings: Selected chapters of clinical gastroenterology (under the editorship of LB Lazebnik). M .: Anaharsis. 2005. pp. 209–218.

20. Bubnova M. G., Aronov D. M., Boytsov S. A. Ensuring physical activity in citizens with health restrictions. Guidelines, Moscow, 2015.

21. Alekseenko S. A., Ageeva E. A., Polkovnikova O. P. Modern approaches to the diagnosis and treatment of hyperammonemia in patients with chronic liver disease at the pre-cirrhotic stage. Medical almanac, 2019, no. 1 (58), pp. 57–59.

22. https://lab-medica.ru/biohimicheskie nalizatory/pocket chem_ba.

23. PocketChemTM BA PA-4140 Руководство по эксплуатации /arkray/inc.PocketChemTM BA PA-4140 Instruction Manual /arkray / inc.

24. Soloviev O. N. Application of the technology of “dry chemistry” in laboratory diagnostics. Magazine Remedium Volga, 2015, No. 8 (138), 37 Р.

25. Banerji A. Medical statistics in plain language: an introductory course. Moscow: Pract. the medicine, 2007, 287 Р.

26. Murtagh J. Patient education. Chronic fatigue syndrome. Aust Fam Physician, 1995, no.24(7), 1297 Р.

27. Antokhin E. Yu. Gender aspects of psychogenic depressions: clinical features, approaches to therapy. In the book: Psychiatry at the turn of the century in the writings of Orenburg psychiatrists anthology. Editors: V. G. Budza, E. Yu. Antokhin, P. O. Bomov. Orenburg, 2014, pp. 225–25.

28. Batsukova N. L., Found D. O., Borschenskaya T. I. The prevalence of symptoms of chronic fatigue syndrome among students and young teachers. Health and the environment, 2013, no. 23, pp. 182–184.

29. Sapfirova V. A., Guseva E. V., Zusman A. A. Chronic fatigue syndrome. Almanac of clinical medicine. 2005, no. 8–3, pp. 202–204.

30. Vorobyev O. V. Chronic fatigue syndrome (from symptom to diagnosis). Difficult patient, 2010, Vol. 8, No. 10, pp. 16–21.

31. Pleshcheva A. V., Pigarova E. A., Dzeranova L. K. Chronic fatigue syndrome in middle-aged women: the role of carbohydrate metabolism disorders. Obesity and metabolism, 2014, Vol. 11, No. 3, pp. 37–41.

32. Joustra M. L., Zijlema W. L., Rosmalen J. G. M., Janssens K. A. M. Physical Activity and Sleep in Chronic Fatigue Syndrome and Fibromyalgia Syndrome: Associations with Symptom Severity in the General Population Cohort LifeLines. Pain Res Manag, 2018 Nov4, 2018:5801510. DOI: 10.1155/2018/5801510. eCollection 2018.

33. Pigarova E. A., Pleshcheva A. V., Dzeranova L. K., Rozhinskaya L. Ya. Chronic fatigue syndrome: current understanding of etiology. Obesity and metabolism, 2010, Vol. 7, No. 3, pp. 8–13.

34. Kuratsune H., Yamaguti K., Takahashi M., Misaki H., Tagawa S., Kitani T. Acylcarnitine deficiency in chronic fatigue syndrome. Clin Infect Dis. 1994, no.18, pp. 62–67.

35. Plioplys A. V., Plioplys S. Amantadine and L-carnitine treatment of chronic fatigue syndrome. Neuropsychobiology, 1997, no.35, pp. 16–23.

36. Vertkin A. L. L-carnitine in medical practice: proven effects. Consilium Medicum, 2012, No. 1, pp. 3.

37. Kamyshnikov V. S. Clinical and laboratory diagnosis of liver diseases, M.: MEDpress-inform, 2013. pp. 96.

38. Shavkuta G. V., Shnyukova T. V., Kolesnikova E. S., et al. Increased ammonia levels and its relationship with visceral obesity and insulin resistance. Experimental and clinical gastroenterology. 2019;169 (9):75–79. DOI: 10.31146/1682–8658-ecg-169–9–75–79

39. Kizova E. A., Potekhina Yu. P. Effect of l-ornithine-l-aspartate therapy on the level of hyperammonemia and the results of the number-binding test in patients with non-alcoholic fatty liver disease. Experimental and clinical gastroenterology, 2019;169 (9);80–84. DOI: 10.31146/1682–8658-ecg-169–9–80–84

40. Welsh E., Kucera J., Perloff M. D.Iatrogenic hyperammonemia after anorexia. Arch Intern Med, 2010;8;170(5):486–8. DOI: 10.1001/archinternmed.2009.549.