Construction of the theoretical framework of burnout among primary caregivers of stroke patients: a grounded theory study / 中国实用护理杂志

Objective:To construct a conceptual framework of burnout among primary caregivers of stroke patients based on grounded theory.Methods:According to the characteristics of age, gender, relationship with patients, length of care and other characteristics of purpose sampling method, from December 2021 to March 2022, 31 primary caregivers of stroke patients were selected for semi-structured interviews in two second-class hospitals, a first-class hospitals and a community health service station in Wuzhong city and Yinchuan city. The data were analyzed in procedural grounded theory method.Results:A total of 29 primary categories and 9 secondary categories were formed. The conceptual framework of burnout among primary caregivers of stroke patients was finally established, which consisted of four main categories (role burnout, physical burnout, psychological burnout and social burnout) and a core category (burnout of primary caregivers of stroke patients).Conclusions:The conceptual framework of burnout among primary caregivers of stroke patients constructed in this study elaborates the connotation of burnout of primary caregivers of stroke patients from four aspects, which can provide a basis for the development of assessment tools and the formulation of intervention measures in the future.

A hospital based cross sectional study on clinical profile of patients with hypothyroidism

Background: Comorbidities and complications are more in patients with hypothyroidism compared to other people. hence early diagnosis and early treatment for hypothyroidism can prevent a lot of complications in patients with hypothyroidism and this is very true for subclinical hypothyroidism. Objective was to study the clinical profile of patients with hypothyroidism.Methods: A hospital based cross sectional study was carried out among 40 clinically diagnosed and biochemically confirmed hypothyroid cases of age group 21-60 years of age. Detailed clinical history was taken to note down the presenting symptoms. Thorough clinical examination was done to ascertain the clinical features and confirm. Data was analyzed using proportions.Results: The mean age of males was slightly more than females 36.8 years vs. 35.13 years. Total number of male patients was much lower i.e. only 10(25%) compared to 30(75%) female patients. The most common age group affected in either sexes was 31-40 years followed by 21-30 years. Among all the symptoms with which the patients presented, the most common symptom was weight gain which was seen in 29(72.5%) of the cases. The most common presenting sign was BMI >25 kg/m2 in 27 cases i.e. 67.5% of the cases followed by dry skin in 25 cases i.e. 62.5%.Conclusions: Any patient presenting with weight gain, lethargy, dry skin, hoarseness, dyspnoea, constipation, cold intolerance, depression, menstrual abnormalities, overweight, obesity, bradycardia, non-pitting edema, hypertension, pallor should be suspected of hypothyroidism and thyroid profile should be done to rule hypothyroidism.

Physical exercise-induced fatigue: the role of serotonergic and dopaminergic systems

Brain serotonin and dopamine are neurotransmitters related to fatigue, a feeling that leads to reduced intensity or interruption of physical exercises, thereby regulating performance. The present review aims to present advances on the understanding of fatigue, which has recently been proposed as a defense mechanism instead of a "physiological failure" in the context of prolonged (aerobic) exercises. We also present recent advances on the association between serotonin, dopamine and fatigue. Experiments with rodents, which allow direct manipulation of brain serotonin and dopamine during exercise, clearly indicate that increased serotoninergic activity reduces performance, while increased dopaminergic activity is associated with increased performance. Nevertheless, experiments with humans, particularly those involving nutritional supplementation or pharmacological manipulations, have yielded conflicting results on the relationship between serotonin, dopamine and fatigue. The only clear and reproducible effect observed in humans is increased performance in hot environments after treatment with inhibitors of dopamine reuptake. Because the serotonergic and dopaminergic systems interact with each other, the serotonin-to-dopamine ratio seems to be more relevant for determining fatigue than analyzing or manipulating only one of the two transmitters. Finally, physical training protocols induce neuroplasticity, thus modulating the action of these neurotransmitters in order to improve physical performance.

Bilateral Paramedian Thalamic Infarction due to Occlusion of Artery of Percheron

The thalamic vascular supply is categorized into the anterior, paramedian, inferolateral, and posterior territories. The artery of Percheron (AOP), a solitary trunk that is an uncommon anatomic variant, provides bilateral arterial supply to the paramedian thalami and the rostral midbrain. Occlusion of this artery results in bilateral thalamic and mesencephalic infarctions. The case described herein is of a patient with AOP who presented with the sudden onset of lethargy.

Bilateral Paramedian Thalamic Infarction due to Occlusion of Artery of Percheron

The thalamic vascular supply is categorized into the anterior, paramedian, inferolateral, and posterior territories. The artery of Percheron (AOP), a solitary trunk that is an uncommon anatomic variant, provides bilateral arterial supply to the paramedian thalami and the rostral midbrain. Occlusion of this artery results in bilateral thalamic and mesencephalic infarctions. The case described herein is of a patient with AOP who presented with the sudden onset of lethargy.

Association among daytime sleepiness,serum tnlnor necrosis factor-α levels and microarousal in patients with obstructive sleep apnea hypopnea syndrome / 中国医师进修杂志

Objective To investigate the association among daytime sleepiness,serum tumor necrosis factor(TNF)-α levels and microarousal in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Forty male patients with OSAHS conformed by apnea hypopnea index(AHI)during sleep monitoring of polysomnography were selected as OSAHS group,15 healthy subjects were selected as control group.The level of serum TNF-α was measured by ELISA.The Epworth sleepiness(EP)scale was used in two groups.Results The level of serum TNF-α in OSAHS group[(18.42±6.23)ng/L]was significantly higher than that in control group[(9.75±3.12)ng/L],P＜0.01.The EP scale and micmarousal index were signifieand yhigher in OSAHS group than those in control group[(16.9±4.7)acores vs(4.5±2.3)dcores,(33.6±16.9)times/h vs(11.3±7.3)times/h,P＜0.01].The EP scale in OSAHS group was positively correlated with the levels of serum TNF-α(r=0.461,P＜0.01),AHI(r=0.443,P＜0.01)and microarousal index(r=0.751,P＜0.01)respectively.The levels of serum'INF-α in patients with OSAHS were also positively correlated with microarousal index(r=0.373,P＜0.01).Conclusions The levels of serum TNF-α and mieroarousal index are increased in patients with 0SAHS.The microarousal related to OSAHS plays an important role on the daytime sleepiness,the unusual levels of serum TNF-α maybe lead to interferen of sleepiness.

Sleep disorders in patients with obstructive sleep apnea-hypopnea syndrome / 中华神经科杂志

Objective To analyze the characteristics and influencing factors of sleep disorders and nocturnal hypoxemia of patients with different degrees of obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Four hundred and twenty-five patients with snoring were scored by Epworth Sleepiness Scale ( ESS), and monitored by polysomnography (PSG). The possible correlations between sleep structure, hypoxia parameters, ESS and clinical features were analyzed and compared in those patients. Results Four hundred and twenty-five patients were divided into 4 groups according to the apnea-hypopnea index (AHI). There were 65 primary snoring patients (15.3%) and 360 OSAHS patients (84. 7% ) including 187 patients (44. 0% ) in severe OSAHS group. ESS was increased as aggravation of OSAHS. There were significant statistical differences in ESS among each group. Compared with primary snoring group, sleep efficiency, NREM1 + 2, oxygen desaturation index ( ODI), time with pulse oxygen saturation below 90% (T(SpO2 <90% ) ) were significantly higher in the OSAHS groups, and NREM3 +4, lowest pulse oxygen saturation level ( LSpO2 ) were lower. ESS was correlated positively with AHI (r= 0. 474,P <0. 01 ). They were both correlated positively with ODI, T (SpO2 <90% ) and NREM1 + 2( ESSr =0. 392, 0. 356,0. 194;AHI r = 0. 714, O. 682, 0. 365, all P < 0. 01 ), and correlated negatively with LSpO2, NREM3 + 4 ( ESS r = - 0. 414, - 0. 196; AHI r = - 0. 740, - 0. 385, both P < 0. 01 ). LSpO2, ODI and T (SpO2 < 90% ) were the primary influencing factors. Common clinical presentations and subjective symptoms were presented including daytime sleepiness, impaired memory, fatigue, dry mouth, oppressive wake and morning headache, etc. Percentage of individuals with daytime sleepiness in the severe OSAHS group was 73. 3% (137/187). These had serious impact on the patients' quality of life, leading to difficulty concentrating, poor memory and cognitive impairment. Conclusions Sleep disorders are found in the patients with different degrees of OSAHS. The excessive daytime sleepiness interrelated partly with the structure of sleep, and totally with hypoxia parameters. The more severity the patients have, the more nocturnal hypoxia, sleep disorders and higher ESS are found.