Evaluation of plasma nitric oxide in academic stress in first year medical students

Context: Medical students undergo tremendous stress during various stages of the Bachelor of Medicine, Bachelor of Surgery (MBBS) course. Academic examinations have been considered as one of the most acute stresses experienced by the students. Nitric oxide (NO) is an important physiological messenger and effector molecule in many biological systems. There is evidence that a sustained overproduction of NO via inducible NO synthase (iNOS) is responsible, at least in part, for some of the neurodegenerative changes caused by stress . Aims: To investigate the relationship if any between plasma NO and psychological stress caused by academic pressure in first year MBBS students. Settings and Design: A 2-year prospective longitudinal study. Materials and Methods: A total of 94 first year medical students after informed consent were enrolled in the study. They were evaluated twice during their first year academic program. First evaluation was done 2 months after their joining the MBBS course and second on the day of their first professional university practical exam. On each evaluation, a history was taken, general physical examination done, and a blood sample was drawn for plasma NO, which was measured using Griess reaction. Statistical Analysis Used: For comparison of means of plasma NO values between the two evaluations, the paired Student's 't'- test was used. A 'P' < 0.05 was considered as statistically significant. Results: The mean NO values increased from 14.76 ± 10.30 during first evaluation to 22.07 ± 13.02 during second evaluation. This increase was statistically significant (P = 0.000). Conclusions: Plasma NO showed a statistically significant increase in levels during the time of examination stress. As plasma NO had a positive correlation with stress, this can be considered as a suitable biomarker for academic stress assessment.