A comparative study on the knowledge of medical students at Al-Sham University regarding the symptoms and treatment of anaphylactic shock

A comparative study on the knowledge of medical students at Al-Sham University regarding the symptoms and treatment of anaphylactic shock | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A comparative study on the knowledge of medical students at Al-Sham University regarding the symptoms and treatment of anaphylactic shock Jamil Alo, Prof. Samar Kabbani MD This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4632263/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To compare the knowledge of human medicine students at Al-Sham University regarding the symptoms and treatment of anaphylactic shock. Methods and materials: A cross-sectional study, in which a structured questionnaire consisting of 46 questions was created that assessed students' knowledge of anaphylactic shock and its treatment. It was directed to medical students in all years at Al-Sham Private University. Subjects were asked to answer the questionnaire and voluntary participation was considered as informed consent. Results: Among 208 students, the percentage of those who had good knowledge of the symptoms and management of anaphylaxis was 16.7%, the percentage of those who had moderate knowledge was 23.1%, and those who had weak knowledge was 70.2%. The average knowledge score was 25.35, with a standard deviation of 11.2. The percentage of knowledge was higher among fifth-year students. Sixth, those with good and moderate income, residing in the city, unmarried, and male participants. Conclusion: Knowledge regarding the management and symptoms of anaphylaxis was inadequate in almost all medical students studied. Improving education and training for students is essential to improve the diagnosis and management of anaphylaxis. Anesthesiology & Pain Medicine comparison management treatment diagnosis medical students Al-Sham Private University Introduction An allergy is an acute, potentially life-threatening, type 1 hypersensitivity reaction that involves the sudden release of immunoglobulin E-related inflammatory mediators (IgE: Immunoglobulin E) such as histamine from mast cells and basophils in response to a stimulus (e.g., food, insect stings, pharmaceutical). Anaphylactic reactions (a type of pseudo allergy) are IgE-independent reactions that result from direct activation of mast cells (eg, response to opioids); Clinical manifestations and management are the same as for anaphylaxis. Typical signs and symptoms of both reactions include acute onset of urticarial rash, angioedema, stridor, dyspnea, bronchospasm, circulatory insufficiency (distributive shock), vomiting, and diarrhea. Diagnosis is clinical and based on a set of typical symptoms, as well as the presence of a known or suspected cause. Early diagnosis and treatment are key to preventing death due to airway obstruction, respiratory insufficiency, or cardiovascular collapse. Management involves initial resuscitative measures focusing on intramuscular administration of epinephrine, removal of inciting agents, securing the airway, and administration of intravenous fluids, which take priority over adjuvant therapy such as steroids and antihistamines. Methods and materials Objectives of the study Due to the lack of studies locally and their scarcity globally that study students’ knowledge about anaphylactic shock, this study aimed to compare the extent of knowledge of human medicine students at the University of Damascus regarding the symptoms and treatment of anaphylactic shock, and to highlight the importance of the study in urging good education of this type of disease to facilitate its diagnosis and management. Methods and tools The research design is an observational, descriptive, cross-sectional study. This type of study is easy and quick to implement and can be used to evaluate several exposures and outcomes. It allows determining the burden of disease in the community, in addition to allowing descriptive analyzes and the creation of hypotheses. Since the sample of this research is a random sample selected from the community, the results drawn from this research are generalizable and reflect the general situation of the community from which the sample was taken. Study group Samples were collected at Al-Sham Private University and the samples were analyzed daily during official working hours. Since the questionnaires will be distributed randomly to medical students at Al-Sham Private University, the sample selection method is convenience sampling. The size of our required sample was 208 students who meet the inclusion and exclusion criteria, including: The research design is a cross-sectional study. The sample size was determined taking into account the margin of error ± 5% and the confidence interval 95%. Exclusion criteria Students who did not give us sufficient or illogical information were excluded, and students from other colleges at the university were excluded. Inclusion criteria Medical students at Al-Sham Private University of all ages, depending on the standard of living and year of study. Males and females were included, and all ages were included without excluding anyone. Sampling difficulties There was difficulty in delivering electronic questionnaires to participants, so we had to interview students individually in order to obtain sufficient information for the study. Mechanism of Action The method used to collect data is personal interviews and administering electronic questionnaires. In addition to conducting the interviews, the electronic questionnaire was sent to groups of medical students. The questionnaire was placed in the social networking groups of the College of Medicine students, in addition to the part related to conducting personal interviews. The answers to the questionnaire questions were taken by The research team carried out the data collection process during the period from 2/15/2024 to 6/7/2024, and then the data was entered and analyzed using the statistical program SPSS statistics V26. Statistical methods The data collected through Google Form was recoded, and after adding the data collected via the personal interview, it was entered and processed using the statistical package SPSS-28. To describe the basic features of the data in the study through frequencies and percentages, the chi-square test (χ2) and the One test were used. Anova to find the relationship between the level of knowledge (poor - moderate - good) and socio-demographic variables, P-value < 0.05 was adopted as a statistically significant value. Results The number of students participating in the study was 208 students with an average age of 23.46 years, with a standard deviation of 9.26 years, and their ages ranged within the field from 18 to 34 years. The percentage of males was 61.5%, and the percentage of females was 38.5%. Most of the participants were second-year students, at a rate of 22.6%, followed by Fourth-year students, with a percentage of 21.6%, followed by third, fifth, sixth, and first-year students with percentages of 18.8%, 17.3%, 11.1%, and 8.7%, respectively. The percentage of the city population is 76.9%, while the percentage of the rural population is 23.1%. Most of the students have a good income, and more than half of them are unemployed. Are related or married. When asking students about the average time for the effects of some anaphylaxis-inducing substances to begin, we found that: 61.5% of the students answered that the effects of food begin after half an hour, 65.9% answered that the effects of an insect sting begin after 15 minutes, and 52.9% answered that medications It takes effect after 5 minutes. When asking students about clinical manifestations in the skin and mucous membranes, we found that: only 50.5% of students answered erythema, 38.9% of students answered urticaria, 31.7% of students answered eyelid edema, and only 27.4% of students answered eyelid edema, 41.3% of the students answered sneezing, and 45.2% of the students answered nasal congestion. When asking students about clinical manifestations in the respiratory system, we found that: 48.1% of students answered cough, 33.7% of students answered hoarseness, only 28.4% of students answered pain in the chest wall, and 31.7% of students answered dyspnea. 38.5% of the students answered tachypnea, 38.5% of the students answered stridor, 24.5% of the students answered wheezing, 25% answered lack of oxygen saturation, and 38% of the students answered cyanosis. When asking students about clinical manifestations in the digestive system, we found that: 49% of students answered nausea, only 39.4% answered vomiting, 28.8% answered abdominal pain, and 30.8% answered diarrhea. When asking students about clinical manifestations in the cardiovascular system, we found that: 47.1% of students answered hypotension less than 90 mmhg, 32.2% of students answered hypotension more than 30% of basal pressure, 35.6% of students answered tachycardia, and only 23.1% responded. They answered weak peripheral pulse, 39.9% of students answered altered consciousness, 37% answered syncope, only 16.8% of students answered decreased urinary output, only 14.4% of students answered anuria, 44.7% of students answered skin changes, and 31 7% of students reported hypothermia, 20.2% of students reported increased capillary refill time, and 26% of students reported croup chest pain. When asking students about the diagnosis of anaphylaxis, we found that: 48.4% of the students answered that laboratory tests are routinely performed to prove the diagnosis of anaphylaxis, 31.3% of the students answered that proper laboratory tests deny the presence of anaphylaxis, and 26.4% of the students answered that the source of the allergen is known. With a drop in blood pressure, it is a confirmed diagnosis of anaphylaxis, and 39.4% of the students answered that skin or mucous membrane manifestations, along with the presence of cardiovascular and thoracic manifestations, are a confirmed diagnosis of anaphylaxis, and 42.3% of the students answered that skin or mucous membrane manifestations, along with the presence of thoracic manifestations, are a confirmed diagnosis of anaphylaxis. And 23.1% of the students answered that skin or mucous membrane manifestations, along with the presence of chest symptoms, confirmed the diagnosis of anaphylaxis, and 24.5% of the students answered that the source of the allergen was suspected, with the presence of two of the following (digestive, cardiac, chest, or skin symptoms, confirming the diagnosis of anaphylaxis). When asking students about the treatment of anaphylaxis, we found that: 62.5% of the students answered that adrenaline is the first drug used to treat anaphylaxis, and 50.5% of the students answered that its dose is 0.01 mg/kg, and 61.1% of the students answered that adrenaline is given by Muscle, and 54.8% of the students answered that the anterolateral side of the thigh is the preferred place to administer adrenaline, and only 30% of the students answered that the patient should be monitored after anaphylaxis occurs for 4–6 hours. When asking students about life-threatening signs, we found that: 43.3% of students answered stridor, and only 33.7% of students answered signs of respiratory distress, 27.9% of students answered wheezing, 21.2% of students answered fatigue, and 43.8% of students answered. Of the students who answered blue, 44.2% of students answered low oxygen saturation, 30.3% of students answered low blood pressure/shock, and only 25.5% answered decreased consciousness. When asking students about the basics of management, we found that: 51.9% of the students answered, “Manage the airway with intubation,” and only 31.7% of the students answered, “You should consult an otologist or anesthesiologist for intubation in case of airway obstruction.” And 34.6% of the students answered, “You should consult an otologist or anesthesiologist for intubation in the event of airway obstruction.” And 34.6% of the students answered, “It is used.” In the management of intravenous fluids, 30.3% of the students answered that the patient should be advised to avoid the inciting substance, and 42.8% of the students answered that the patient should be recommended to see a doctor specializing in allergic diseases after leaving the hospital, and 42.3% of the students answered that oxygen is used in Management: 31.1% of students responded that salbutamol or bronchodilators are usually used for management. The average knowledge score among the students was 25.35 degrees, with a standard deviation of 11.22 degrees, and the knowledge scores ranged between 12 and 54 degrees, where 70.2% of the students had weak knowledge, 23.1% of the students had average knowledge, and only 16.7% of the students had good knowledge. Through conducting statistics and One Anova test, it was found that the average age of those with good knowledge is 27.35 years, the average age of those with average knowledge is 23.43 years, and the average age of those with poor knowledge is 22.18 years (P = 0.027). Through conducting statistics and testing (X2), we found that the percentage of those with good knowledge was higher among males by 4.8% (p = 0.031). Through conducting statistics and testing (X2), we found that the percentage of those who have good knowledge is higher among students in the fifth and sixth years (P = 0.000). Through conducting statistics and testing (X2), we found that the percentage of those who have good knowledge is higher among students who live in the city (P = 0.021). Through conducting statistics and testing (X2), we found that the percentage of those with good knowledge is higher among students with average and good income (P = 0.036). Through conducting statistics and testing (X2), we found that the percentage of those who have good knowledge is higher among unmarried students (p = 0.772). Discussion The knowledge scores were divided into 3 categories: weak knowledge when answering less than 25 questions correctly (146 students), average knowledge when answering 26–41 questions correctly (48 students), and good knowledge when answering more than 41 questions correctly. True, there are 14 students. The average age of those with good knowledge is higher than the rest of the groups (P = 0.027). This may be due to the accumulation of information among participants of an older age and the acquisition of higher skills and experience than those with a lower average age. Good knowledge is higher than it is among females (P = 0.031), and the degree of good knowledge is higher among fifth- and sixth-year students (P = 0.000), due to the broadening of horizons and scientific knowledge due to the accumulation of information and various academic courses in general in addition to the anesthesia course, in addition to Developing scientific vision and scientific research and increasing clinical experiences among final-year students. The degree of knowledge is higher among students residing in the city (P = 0.021). The reason may be the greater knowledge and use of the Internet in terms of social level, and that living in the city exposes people to allergic factors more than living in the city, and thus allergies and their symptoms become more widespread. The degree of good knowledge is higher among students with average and good income (P = 0.036), perhaps due to working and being busy with work other than studying to secure living expenses. The degree of good knowledge is higher among students who are not married or in a relationship (P = 0.027), perhaps because family obligations are greater and thus hinder the process of gaining experience and knowledge. In a study in Mexico entitled Knowledge of healthcare providers in the management of anaphylaxis, in which 1,023 healthcare providers, medical, nursing and dental students participated in the year 2021, it was found that the knowledge of those with years of experience is greater than that of those without experience, and the knowledge of healthcare providers and medical students and allergists are higher than the rest of the study categories. ( 4 ) In a study in India 2020 entitled Knowledge, Attitude, and Practice regarding Anaphylaxis among Pediatric Health Care Providers in a Teaching Hospital in which 125 health care providers participated (24), it was found that the knowledge scores of faculty members, residents, and trainees were much higher than those of nurses, while they did not There was no significant difference between faculty, residents, and trainees. The majority of participants had a positive attitude toward anaphylaxis. Incorrect practice is followed by most of the participants. The extent of knowledge about anaphylaxis among pediatric health care providers is moderate but management skills remain suboptimal. Therefore, appropriate training, through continuing medical education and programs to improve the ability to recognize and manage anaphylaxis, is crucial. In a study published as a preliminary version in Research Square entitled Level of Knowledge About Anaphylaxis and Its Management Among Doctors on 85 doctors in 2022, it was found that out of the eighty-five participants, 8 participants were general practitioners, twenty-six participants were resident doctors, and fifty-one participants were from specialized doctors. Seventy-one participants reported having experienced anaphylaxis before. Nine of the participants reported that there was no training in anaphylaxis in medical school. Only 4 participants correctly answered the diagnostic criteria for anaphylaxis. Seventy-two participants did not consider cardiovascular and gastrointestinal system symptoms and signs as diagnostic criteria for anaphylaxis. Sixty-five participants chose both intravenous and intramuscular adrenaline, 4 participants chose intravenous adrenaline, and 4 participants chose both intravenous and intramuscular adrenaline for their first-line treatment of anaphylaxis. After anaphylactic shock, sixty-nine participants reported that the patient should be kept under observation for 8–24 hours. ( 5 ) In a study conducted in Turkey in 2013 entitled Level of knowledge about anaphylaxis among health care providers, 1,172 health care providers participated. ( 6 ) Where 84.7% of participants answered questions related to the symptoms of anaphylaxis correctly, although 62.6% of the group correctly knew the steps for treating anaphylaxis, 44.7% of them agreed to give epinephrine if they suspected the presence of a person with an allergy. Excessive, one-third of the group indicated the appropriate route of administration of epinephrine, 85.2% of participants agreed to refer the patient to the allergy clinic even though 33.7% of the group did not know where the nearest allergy clinic was located. Only 20.3% of participants had heard of an epinephrine auto injector. Conclusions • To our knowledge, this is the first study of its kind locally examining students’ knowledge about symptoms and measures for anaphylaxis • Most students (70.2%) had generally poor knowledge of anaphylaxis, clinical manifestations and management. • The degree of good knowledge is higher among fifth and sixth year students. • The degree of knowledge is higher among students residing in the city. • The degree of good knowledge is higher among students with average and good income. • The degree of good knowledge is higher among students who are not married or in a relationship. Declarations Ethical approval: The Research Ethics Committee at Al-Sham Private University approved the study protocol, and all procedures performed in studies with human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or ethical standards. Consent for publication: Not applicable. Availability of data and materials: All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request. Conflict of interest: The authors declare that they have no Conflict of interest: Funding: This research received no specie grant from ASPU or any other funding agency in the public, commercial or nonprofit sectors. Acknowledgments: We are thankful to the management of AL-Sham Private University for their support in the eld of medical training and research. We would also like to thank Dr. Rawnak ALmidani for his help and supervision in the paper. References Fernandez-Caldas. Relationship of Dust Mites and Crustaceans. https://www.worldallergy.org/ask-the-expert/answers/relationship-of-dust-mites-and-crustaceans-fernandez-caldas. Updated July 13, 2013. Accessed April 17, 2019 Luskin, Luskin. Anaphylaxis and Anaphylactoid Reactions: Diagnosis and Management. American Journal of Therapeutics.; 3(7): pp. 515–520. pmid: 11862283. Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010; 126(6 Suppl): pp. S1–58. doi: 10.1016/j.jaci.2010.10.007. Drupad HS, Nagabushan H. Level of knowledge about anaphylaxis and its management among health care providers. Indian J Crit Care Med. 2015 Jul;19(7):412-5. doi: 10.4103/0972-5229.160288. PMID: 26180434; PMCID: PMC4502494. González-Díaz SN, Villarreal-González RV, Fuentes-Lara EI, Salinas-Díaz MDR, de Lira-Quezada CE, Macouzet-Sánchez C, Macías-Weinmann A, Guzmán-Avilán RI, García-Campa M. Knowledge of healthcare providers in the management of anaphylaxis. World Allergy Organ J. 2021 Nov 9;14(11):100599. doi: 10.1016/j.waojou.2021.100599. PMID: 34820048; PMCID: PMC8591458. https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0040-1720955.pdf https://www.researchsquare.com/article/rs-1986181/v1.pdf @article {Bacciogl–LevelOK, title= {Level of knowledge about anaphylaxis among health care providers. author= {Ayse Baccioglu and Elif Yılmazel Uçar}, journal= {Tuberkuloz ve toraks}, year= {2013}, volume= {61 2}, pages={140-6rl={https://api.semanticscholar.org/CorpusID:45870811} Additional Declarations The authors declare potential competing interests as follows: not thing Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4632263","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318502620,"identity":"e70d912c-3be5-4d6c-b8f4-f3c8e525f784","order_by":0,"name":"Jamil Alo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACxgYGhgMPGCwY+PmbDz4ACvDwEaUlgUGCQXLGsWQDkBY2oqwCaTE4kGMmAeIQ1MLcfjrxQEKNhBzDgQNmlV9z7GTYGJgfPrqBz2E9uRsOJByTMGZsbki7LbstGegwNmPjHLx+AWlhk0hsZjhw7LbkNmagFh42abxa+t8CtfyTSGxjSGwrltxWT4SWGUBbEtskEnsYktkYP247TIwWoC2JfRLGEhLHmKUZtx3nYWMm4BfD/tzNHz58s5GzP9//8ePPbdX2/OzNDx/j1dKAxGHmAZN4lIOAPIorfxBQPQpGwSgYBSMTAAAYKUxw2OErlAAAAABJRU5ErkJggg==","orcid":"","institution":"Faculty of medicine, Al-Sham Private University, Damascus, Syria","correspondingAuthor":true,"prefix":"","firstName":"Jamil","middleName":"","lastName":"Alo","suffix":""},{"id":318502621,"identity":"c6bf3d03-897f-457d-812f-2d616f66ff34","order_by":1,"name":"Prof. Samar Kabbani MD","email":"","orcid":"","institution":"Anesthesia, ICU, and Pain Management Department, Damascus university, Vice dean of medical college, Al_Sham Private University","correspondingAuthor":false,"prefix":"","firstName":"Prof.","middleName":"Samar","lastName":"Kabbani","suffix":"MD"}],"badges":[],"createdAt":"2024-06-24 20:50:02","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4632263/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4632263/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59074783,"identity":"c32fa86d-74cb-4c20-8537-7d4a62363743","added_by":"auto","created_at":"2024-06-26 05:47:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":260804,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4632263/v1/a6f17a79-1033-42dc-9d26-04bf4f98b132.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: not thing","formattedTitle":"\u003cp\u003e\u003cstrong\u003eA comparative study on the knowledge of medical students at Al-Sham University regarding the symptoms and treatment of anaphylactic shock\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAn allergy is an acute, potentially life-threatening, type 1 hypersensitivity reaction that involves the sudden release of immunoglobulin E-related inflammatory mediators (IgE: Immunoglobulin E) such as histamine from mast cells and basophils in response to a stimulus (e.g., food, insect stings, pharmaceutical).\u003c/p\u003e \u003cp\u003eAnaphylactic reactions (a type of pseudo allergy) are IgE-independent reactions that result from direct activation of mast cells (eg, response to opioids); Clinical manifestations and management are the same as for anaphylaxis.\u003c/p\u003e \u003cp\u003eTypical signs and symptoms of both reactions include acute onset of urticarial rash, angioedema, stridor, dyspnea, bronchospasm, circulatory insufficiency (distributive shock), vomiting, and diarrhea.\u003c/p\u003e \u003cp\u003eDiagnosis is clinical and based on a set of typical symptoms, as well as the presence of a known or suspected cause.\u003c/p\u003e \u003cp\u003eEarly diagnosis and treatment are key to preventing death due to airway obstruction, respiratory insufficiency, or cardiovascular collapse.\u003c/p\u003e \u003cp\u003eManagement involves initial resuscitative measures focusing on intramuscular administration of epinephrine, removal of inciting agents, securing the airway, and administration of intravenous fluids, which take priority over adjuvant therapy such as steroids and antihistamines.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003eObjectives of the study\u003c/p\u003e \u003cp\u003eDue to the lack of studies locally and their scarcity globally that study students\u0026rsquo; knowledge about anaphylactic shock, this study aimed to compare the extent of knowledge of human medicine students at the University of Damascus regarding the symptoms and treatment of anaphylactic shock, and to highlight the importance of the study in urging good education of this type of disease to facilitate its diagnosis and management.\u003c/p\u003e \u003cp\u003eMethods and tools\u003c/p\u003e \u003cp\u003eThe research design is an observational, descriptive, cross-sectional study.\u003c/p\u003e \u003cp\u003eThis type of study is easy and quick to implement and can be used to evaluate several exposures and outcomes. It allows determining the burden of disease in the community, in addition to allowing descriptive analyzes and the creation of hypotheses.\u003c/p\u003e \u003cp\u003eSince the sample of this research is a random sample selected from the community, the results drawn from this research are generalizable and reflect the general situation of the community from which the sample was taken.\u003c/p\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003cp\u003eSamples were collected at Al-Sham Private University and the samples were analyzed daily during official working hours. Since the questionnaires will be distributed randomly to medical students at Al-Sham Private University, the sample selection method is convenience sampling. The size of our required sample was 208 students who meet the inclusion and exclusion criteria, including: The research design is a cross-sectional study. The sample size was determined taking into account the margin of error\u0026thinsp;\u0026plusmn;\u0026thinsp;5% and the confidence interval 95%.\u003c/p\u003e \u003cp\u003eExclusion criteria\u003c/p\u003e \u003cp\u003eStudents who did not give us sufficient or illogical information were excluded, and students from other colleges at the university were excluded.\u003c/p\u003e \u003cp\u003eInclusion criteria\u003c/p\u003e \u003cp\u003eMedical students at Al-Sham Private University of all ages, depending on the standard of living and year of study. Males and females were included, and all ages were included without excluding anyone.\u003c/p\u003e \u003cp\u003eSampling difficulties\u003c/p\u003e \u003cp\u003eThere was difficulty in delivering electronic questionnaires to participants, so we had to interview students individually in order to obtain sufficient information for the study.\u003c/p\u003e \u003cp\u003eMechanism of Action\u003c/p\u003e \u003cp\u003eThe method used to collect data is personal interviews and administering electronic questionnaires. In addition to conducting the interviews, the electronic questionnaire was sent to groups of medical students. The questionnaire was placed in the social networking groups of the College of Medicine students, in addition to the part related to conducting personal interviews. The answers to the questionnaire questions were taken by The research team carried out the data collection process during the period from 2/15/2024 to 6/7/2024, and then the data was entered and analyzed using the statistical program SPSS statistics V26.\u003c/p\u003e \u003cp\u003eStatistical methods\u003c/p\u003e \u003cp\u003eThe data collected through Google Form was recoded, and after adding the data collected via the personal interview, it was entered and processed using the statistical package SPSS-28. To describe the basic features of the data in the study through frequencies and percentages, the chi-square test (χ2) and the One test were used. Anova to find the relationship between the level of knowledge (poor - moderate - good) and socio-demographic variables, P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was adopted as a statistically significant value.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe number of students participating in the study was 208 students with an average age of 23.46 years, with a standard deviation of 9.26 years, and their ages ranged within the field from 18 to 34 years. The percentage of males was 61.5%, and the percentage of females was 38.5%. Most of the participants were second-year students, at a rate of 22.6%, followed by Fourth-year students, with a percentage of 21.6%, followed by third, fifth, sixth, and first-year students with percentages of 18.8%, 17.3%, 11.1%, and 8.7%, respectively. The percentage of the city population is 76.9%, while the percentage of the rural population is 23.1%. Most of the students have a good income, and more than half of them are unemployed. Are related or married.\u003c/p\u003e \u003cp\u003eWhen asking students about the average time for the effects of some anaphylaxis-inducing substances to begin, we found that: 61.5% of the students answered that the effects of food begin after half an hour, 65.9% answered that the effects of an insect sting begin after 15 minutes, and 52.9% answered that medications It takes effect after 5 minutes.\u003c/p\u003e \u003cp\u003eWhen asking students about clinical manifestations in the skin and mucous membranes, we found that: only 50.5% of students answered erythema, 38.9% of students answered urticaria, 31.7% of students answered eyelid edema, and only 27.4% of students answered eyelid edema, 41.3% of the students answered sneezing, and 45.2% of the students answered nasal congestion.\u003c/p\u003e \u003cp\u003eWhen asking students about clinical manifestations in the respiratory system, we found that: 48.1% of students answered cough, 33.7% of students answered hoarseness, only 28.4% of students answered pain in the chest wall, and 31.7% of students answered dyspnea. 38.5% of the students answered tachypnea, 38.5% of the students answered stridor, 24.5% of the students answered wheezing, 25% answered lack of oxygen saturation, and 38% of the students answered cyanosis.\u003c/p\u003e \u003cp\u003eWhen asking students about clinical manifestations in the digestive system, we found that: 49% of students answered nausea, only 39.4% answered vomiting, 28.8% answered abdominal pain, and 30.8% answered diarrhea.\u003c/p\u003e \u003cp\u003eWhen asking students about clinical manifestations in the cardiovascular system, we found that: 47.1% of students answered hypotension less than 90 mmhg, 32.2% of students answered hypotension more than 30% of basal pressure, 35.6% of students answered tachycardia, and only 23.1% responded. They answered weak peripheral pulse, 39.9% of students answered altered consciousness, 37% answered syncope, only 16.8% of students answered decreased urinary output, only 14.4% of students answered anuria, 44.7% of students answered skin changes, and 31 7% of students reported hypothermia, 20.2% of students reported increased capillary refill time, and 26% of students reported croup chest pain.\u003c/p\u003e \u003cp\u003eWhen asking students about the diagnosis of anaphylaxis, we found that: 48.4% of the students answered that laboratory tests are routinely performed to prove the diagnosis of anaphylaxis, 31.3% of the students answered that proper laboratory tests deny the presence of anaphylaxis, and 26.4% of the students answered that the source of the allergen is known. With a drop in blood pressure, it is a confirmed diagnosis of anaphylaxis, and 39.4% of the students answered that skin or mucous membrane manifestations, along with the presence of cardiovascular and thoracic manifestations, are a confirmed diagnosis of anaphylaxis, and 42.3% of the students answered that skin or mucous membrane manifestations, along with the presence of thoracic manifestations, are a confirmed diagnosis of anaphylaxis. And 23.1% of the students answered that skin or mucous membrane manifestations, along with the presence of chest symptoms, confirmed the diagnosis of anaphylaxis, and 24.5% of the students answered that the source of the allergen was suspected, with the presence of two of the following (digestive, cardiac, chest, or skin symptoms, confirming the diagnosis of anaphylaxis).\u003c/p\u003e \u003cp\u003eWhen asking students about the treatment of anaphylaxis, we found that: 62.5% of the students answered that adrenaline is the first drug used to treat anaphylaxis, and 50.5% of the students answered that its dose is 0.01 mg/kg, and 61.1% of the students answered that adrenaline is given by Muscle, and 54.8% of the students answered that the anterolateral side of the thigh is the preferred place to administer adrenaline, and only 30% of the students answered that the patient should be monitored after anaphylaxis occurs for 4\u0026ndash;6 hours.\u003c/p\u003e \u003cp\u003eWhen asking students about life-threatening signs, we found that: 43.3% of students answered stridor, and only 33.7% of students answered signs of respiratory distress, 27.9% of students answered wheezing, 21.2% of students answered fatigue, and 43.8% of students answered. Of the students who answered blue, 44.2% of students answered low oxygen saturation, 30.3% of students answered low blood pressure/shock, and only 25.5% answered decreased consciousness.\u003c/p\u003e \u003cp\u003eWhen asking students about the basics of management, we found that: 51.9% of the students answered, \u0026ldquo;Manage the airway with intubation,\u0026rdquo; and only 31.7% of the students answered, \u0026ldquo;You should consult an otologist or anesthesiologist for intubation in case of airway obstruction.\u0026rdquo; And 34.6% of the students answered, \u0026ldquo;You should consult an otologist or anesthesiologist for intubation in the event of airway obstruction.\u0026rdquo; And 34.6% of the students answered, \u0026ldquo;It is used.\u0026rdquo; In the management of intravenous fluids, 30.3% of the students answered that the patient should be advised to avoid the inciting substance, and 42.8% of the students answered that the patient should be recommended to see a doctor specializing in allergic diseases after leaving the hospital, and 42.3% of the students answered that oxygen is used in Management: 31.1% of students responded that salbutamol or bronchodilators are usually used for management.\u003c/p\u003e \u003cp\u003eThe average knowledge score among the students was 25.35 degrees, with a standard deviation of 11.22 degrees, and the knowledge scores ranged between 12 and 54 degrees, where 70.2% of the students had weak knowledge, 23.1% of the students had average knowledge, and only 16.7% of the students had good knowledge.\u003c/p\u003e \u003cp\u003eThrough conducting statistics and One Anova test, it was found that the average age of those with good knowledge is 27.35 years, the average age of those with average knowledge is 23.43 years, and the average age of those with poor knowledge is 22.18 years (P\u0026thinsp;=\u0026thinsp;0.027).\u003c/p\u003e \u003cp\u003eThrough conducting statistics and testing (X2), we found that the percentage of those with good knowledge was higher among males by 4.8% (p\u0026thinsp;=\u0026thinsp;0.031).\u003c/p\u003e \u003cp\u003eThrough conducting statistics and testing (X2), we found that the percentage of those who have good knowledge is higher among students in the fifth and sixth years (P\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003cp\u003eThrough conducting statistics and testing (X2), we found that the percentage of those who have good knowledge is higher among students who live in the city (P\u0026thinsp;=\u0026thinsp;0.021).\u003c/p\u003e \u003cp\u003eThrough conducting statistics and testing (X2), we found that the percentage of those with good knowledge is higher among students with average and good income (P\u0026thinsp;=\u0026thinsp;0.036).\u003c/p\u003e \u003cp\u003eThrough conducting statistics and testing (X2), we found that the percentage of those who have good knowledge is higher among unmarried students (p\u0026thinsp;=\u0026thinsp;0.772).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe knowledge scores were divided into 3 categories: weak knowledge when answering less than 25 questions correctly (146 students), average knowledge when answering 26\u0026ndash;41 questions correctly (48 students), and good knowledge when answering more than 41 questions correctly. True, there are 14 students.\u003c/p\u003e \u003cp\u003eThe average age of those with good knowledge is higher than the rest of the groups (P\u0026thinsp;=\u0026thinsp;0.027). This may be due to the accumulation of information among participants of an older age and the acquisition of higher skills and experience than those with a lower average age.\u003c/p\u003e \u003cp\u003eGood knowledge is higher than it is among females (P\u0026thinsp;=\u0026thinsp;0.031), and the degree of good knowledge is higher among fifth- and sixth-year students (P\u0026thinsp;=\u0026thinsp;0.000), due to the broadening of horizons and scientific knowledge due to the accumulation of information and various academic courses in general in addition to the anesthesia course, in addition to Developing scientific vision and scientific research and increasing clinical experiences among final-year students.\u003c/p\u003e \u003cp\u003eThe degree of knowledge is higher among students residing in the city (P\u0026thinsp;=\u0026thinsp;0.021). The reason may be the greater knowledge and use of the Internet in terms of social level, and that living in the city exposes people to allergic factors more than living in the city, and thus allergies and their symptoms become more widespread.\u003c/p\u003e \u003cp\u003eThe degree of good knowledge is higher among students with average and good income (P\u0026thinsp;=\u0026thinsp;0.036), perhaps due to working and being busy with work other than studying to secure living expenses.\u003c/p\u003e \u003cp\u003eThe degree of good knowledge is higher among students who are not married or in a relationship (P\u0026thinsp;=\u0026thinsp;0.027), perhaps because family obligations are greater and thus hinder the process of gaining experience and knowledge.\u003c/p\u003e \u003cp\u003eIn a study in Mexico entitled Knowledge of healthcare providers in the management of anaphylaxis, in which 1,023 healthcare providers, medical, nursing and dental students participated in the year 2021, it was found that the knowledge of those with years of experience is greater than that of those without experience, and the knowledge of healthcare providers and medical students and allergists are higher than the rest of the study categories. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn a study in India 2020 entitled Knowledge, Attitude, and Practice regarding Anaphylaxis among Pediatric Health Care Providers in a Teaching Hospital in which 125 health care providers participated (24), it was found that the knowledge scores of faculty members, residents, and trainees were much higher than those of nurses, while they did not There was no significant difference between faculty, residents, and trainees. The majority of participants had a positive attitude toward anaphylaxis. Incorrect practice is followed by most of the participants.\u003c/p\u003e \u003cp\u003eThe extent of knowledge about anaphylaxis among pediatric health care providers is moderate but management skills remain suboptimal. Therefore, appropriate training, through continuing medical education and programs to improve the ability to recognize and manage anaphylaxis, is crucial.\u003c/p\u003e \u003cp\u003eIn a study published as a preliminary version in Research Square entitled Level of Knowledge About Anaphylaxis and Its Management Among Doctors on 85 doctors in 2022, it was found that out of the eighty-five participants, 8 participants were general practitioners, twenty-six participants were resident doctors, and fifty-one participants were from specialized doctors. Seventy-one participants reported having experienced anaphylaxis before. Nine of the participants reported that there was no training in anaphylaxis in medical school. Only 4 participants correctly answered the diagnostic criteria for anaphylaxis. Seventy-two participants did not consider cardiovascular and gastrointestinal system symptoms and signs as diagnostic criteria for anaphylaxis. Sixty-five participants chose both intravenous and intramuscular adrenaline, 4 participants chose intravenous adrenaline, and 4 participants chose both intravenous and intramuscular adrenaline for their first-line treatment of anaphylaxis. After anaphylactic shock, sixty-nine participants reported that the patient should be kept under observation for 8\u0026ndash;24 hours. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn a study conducted in Turkey in 2013 entitled Level of knowledge about anaphylaxis among health care providers, 1,172 health care providers participated. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Where 84.7% of participants answered questions related to the symptoms of anaphylaxis correctly, although 62.6% of the group correctly knew the steps for treating anaphylaxis, 44.7% of them agreed to give epinephrine if they suspected the presence of a person with an allergy. Excessive, one-third of the group indicated the appropriate route of administration of epinephrine, 85.2% of participants agreed to refer the patient to the allergy clinic even though 33.7% of the group did not know where the nearest allergy clinic was located. Only 20.3% of participants had heard of an epinephrine auto injector.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e• To our knowledge, this is the first study of its kind locally examining students’ knowledge about symptoms and measures for anaphylaxis\u003c/p\u003e\n\u003cp\u003e• Most students (70.2%) had generally poor knowledge of anaphylaxis, clinical manifestations and management.\u003c/p\u003e\n\u003cp\u003e• The degree of good knowledge is higher among fifth and sixth year students.\u003c/p\u003e\n\u003cp\u003e• The degree of knowledge is higher among students residing in the city.\u003c/p\u003e\n\u003cp\u003e• The degree of good knowledge is higher among students with average and good income.\u003c/p\u003e\n\u003cp\u003e• The degree of good knowledge is higher among students who are not married or in a relationship.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee at Al-Sham Private University approved the study protocol, and all procedures performed in studies with human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no Conflict of interest:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specie grant from ASPU or any other funding agency in the public, commercial or nonprofit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are thankful to the management of AL-Sham Private University for their support in the eld of medical training and research. We would also like to thank Dr. Rawnak ALmidani for his help and supervision in the paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFernandez-Caldas. Relationship of Dust Mites and Crustaceans. https://www.worldallergy.org/ask-the-expert/answers/relationship-of-dust-mites-and-crustaceans-fernandez-caldas. Updated July 13, 2013. Accessed April 17, 2019\u003c/li\u003e\n \u003cli\u003eLuskin, Luskin. Anaphylaxis and Anaphylactoid Reactions: Diagnosis and Management. American Journal of Therapeutics.; 3(7): pp. 515\u0026ndash;520. pmid: 11862283.\u003c/li\u003e\n \u003cli\u003eBoyce JA, Assa\u0026apos;ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010; 126(6 Suppl): pp. S1\u0026ndash;58. doi: 10.1016/j.jaci.2010.10.007.\u003c/li\u003e\n \u003cli\u003eDrupad HS, Nagabushan H. Level of knowledge about anaphylaxis and its management among health care providers. Indian J Crit Care Med. 2015 Jul;19(7):412-5. doi: 10.4103/0972-5229.160288. PMID: 26180434; PMCID: PMC4502494.\u003c/li\u003e\n \u003cli\u003eGonz\u0026aacute;lez-D\u0026iacute;az SN, Villarreal-Gonz\u0026aacute;lez RV, Fuentes-Lara EI, Salinas-D\u0026iacute;az MDR, de Lira-Quezada CE, Macouzet-S\u0026aacute;nchez C, Mac\u0026iacute;as-Weinmann A, Guzm\u0026aacute;n-Avil\u0026aacute;n RI, Garc\u0026iacute;a-Campa M. Knowledge of healthcare providers in the management of anaphylaxis. World Allergy Organ J. 2021 Nov 9;14(11):100599. doi: 10.1016/j.waojou.2021.100599. PMID: 34820048; PMCID: PMC8591458.\u003c/li\u003e\n \u003cli\u003ehttps://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0040-1720955.pdf\u003c/li\u003e\n \u003cli\u003ehttps://www.researchsquare.com/article/rs-1986181/v1.pdf\u003c/li\u003e\n \u003cli\u003e@article {Bacciogl–LevelOK, title= {Level of knowledge about anaphylaxis among\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ehealth care providers.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eauthor= {Ayse Baccioglu and Elif Yılmazel U\u0026ccedil;ar}, journal= {Tuberkuloz ve toraks}, year= {2013}, volume= {61 2},\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003epages={140-6rl={https://api.semanticscholar.org/CorpusID:45870811}\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"e8a0c443-797b-43e3-afb7-126843f8d412","identifier":"10.13039/100016418","name":"B.K. Kee Foundation","awardNumber":"0996066591","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Al-Sham Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"comparison, management, treatment, diagnosis, medical students, Al-Sham Private University","lastPublishedDoi":"10.21203/rs.3.rs-4632263/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4632263/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo compare the knowledge of human medicine students at Al-Sham University regarding the symptoms and treatment of anaphylactic shock.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods and materials: \u003c/strong\u003eA cross-sectional study, in which a structured questionnaire consisting of 46 questions was created that assessed students' knowledge of anaphylactic shock and its treatment. It was directed to medical students in all years at Al-Sham Private University. Subjects were asked to answer the questionnaire and voluntary participation was considered as informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong 208 students, the percentage of those who had good knowledge of the symptoms and management of anaphylaxis was 16.7%, the percentage of those who had moderate knowledge was 23.1%, and those who had weak knowledge was 70.2%. The average knowledge score was 25.35, with a standard deviation of 11.2. The percentage of knowledge was higher among fifth-year students. Sixth, those with good and moderate income, residing in the city, unmarried, and male participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eKnowledge regarding the management and symptoms of anaphylaxis was inadequate in almost all medical students studied. Improving education and training for students is essential to improve the diagnosis and management of anaphylaxis.\u003c/p\u003e","manuscriptTitle":"A comparative study on the knowledge of medical students at Al-Sham University regarding the symptoms and treatment of anaphylactic shock","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-26 05:47:42","doi":"10.21203/rs.3.rs-4632263/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"430b156f-e81c-4797-aefe-eb78df1121e7","owner":[],"postedDate":"June 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33678519,"name":"Anesthesiology \u0026 Pain Medicine"}],"tags":[],"updatedAt":"2024-06-26T05:47:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-26 05:47:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4632263","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4632263","identity":"rs-4632263","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}