Blood Cortisol Levels Research Articles

Severe reversible cardiomyopathy associated with adrenal crisis caused by isolated adrenocorticotropin deficiency: a case report

Adrenal crisis, also known as acute adrenal insufficiency, is an endocrine emergency that is associated with high mortality rates. Reversible cardiomyopathy with severe heart failure is a rare complication of adrenal crisis. Isolated adrenocorticotropin deficiency (IAD) is a rare condition of pituitary adrenal insufficiency. In this case report, we describe a 74-year-old male patient who was in good physical health and was admitted to our hospital with a sudden onset of fever and confusion that was complicated by hyponatremia and hypotension. Cardiac ultrasound showed significantly reduced left ventricular ejection fraction (LVEF; 10%). The patients was initially diagnosed with “septic shock” because of elevated inflammatory indicators and treated with mechanical circulatory support, antibiotics, fluid resuscitation, and intravenous administration of 50 mg hydrocortisone every 6 h for 2 days (400 mg in total). The symptoms of the patient improved significantly by this treatment in 6 days. The LVEF improved from 10% to 40%. However, the initial treatment did not alleviate hypotension and confusion. Therefore, the status of adrenal function was analyzed using blood and urine cortisol tests. Blood and urinary cortisol levels were significantly reduced, but concurrent increase in the ACTH levels were not observed. This indicated adrenal crisis. Subsequently, the patient was initially administered intravenous injection of hydrocortisone (50–150 mg/day) for 5 days, and then transitioned to a physiological supplement dose orally. The LVEF value improved further to 52%. Finally, the patient was diagnosed with adult isolated ACTH deficiency. The patient was prescribed regular oral hydrocortisone. The patient has not shown any signs of heart failure during follow up for more than half a year. In summary, we described a rare and severe case of adrenal crisis complicated with reversible cardiomyopathy that was caused by isolated ACTH deficiency. In such a case, conventional guideline directed medical therapy (GDMT) for heart failure was not considered suitable because of the underlying hypotension, hypoglycemia, and hyponatremia. Our study showed that timely supplementation of glucocorticoids achieved better therapeutic effects in patients with adrenal crises complicated by severe cardiomyopathy.

The Effect of Hyperbaric Oxygen in Reducing Blood Cortisol Levels in Patients with Sleep Disorders

Sleep disorders disrupt normal sleep patterns, including timing, duration, and quality, often linked to elevated cortisol levels and high nerve metabolism requiring oxygen. Hyperbaric oxygen therapy (HBO), delivering pure oxygen in high-pressure settings (≥1.4 ATA), may alleviate hypoxia and reduce cortisol, offering potential treatment for sleep disorders. This research uses a quasi-experimental design with a randomized pre-post control group design. The population studied was male sleep disorder sufferers, aged 25-40 years at the psychiatric poly of Dr. Ramelan Surabaya Hospital, with a sample of 9 members of the Indonesian Navy who met the inclusion and exclusion criteria. This research is related to development research in the field of health and maritime, with a focus on diving and hyperbaric oxygen therapy, which is expected to be published in the International Journal indexed Shinta 2. This research has the potential to enrich the understanding of the effects of Oxygen Hyperbaric (OHB) therapy in overcoming sleep disorders, as well as contributing to the health and maritime sectors. The research concluded that OHB therapy in sleep disorder patients resulted in a slight reduction in mean cortisol levels (from 79.09 ng/ml to 76.38 ng/ml). Although the majority of patients (56%) experienced a decrease in cortisol levels after therapy, there was no statistically significant effect of OHB therapy on cortisol levels in sleep disorder patients.

Pain intensity and stress indicators after cemented total knee replacement with epidural application of morphine: prospective randomized study

The objective to perform the objective assessment of the intensity of pain syndrome after cemented total knee replacement with epidural analgesia with 0.2% ropivacaine solution and epidural analgesia with a combination of 0.2% ropivacaine solution with morphine was performed.Materials and methods. The study included 60 patients who underwent cemented total knee replacement for gonarthrosis under combined spinal-epidural anesthesia. In patients of the control group (n = 30), postoperative anesthesia was performed with 0.2% ropivacaine solution epidural through a catheter at the L2–3–L1–2 level in the form of a bolus followed by constant infusion. In patients of the main group (n = 30), analgesia was performed according to the same technique, but using a morphine solution of 1% – 0.3 ml (3mg) as part of a bolus of 0.2% ropivacaine solution epidural. The hemodynamics of the patients, the volume of intraoperative blood loss, and infusion therapy were homogeneous due to the carefully developed surgical procedure, had no significant differences and were not taken into account when publishing the data. The level of glycemia and cortisol in venous blood on the day of surgery (1 hour before surgery and 4 hours after surgery), age, and pain intensity on a numerical rating scale (NRS) were studied. Statistical processing was performed by MedCalc Software Ltd.Results. In the postoperative period, the level of venous blood cortisol in patients of the main group was 486.2 [470.6; 494.5] nmol/l, and in patients of the control group – 876.8 [803.7; 918.7] nmol/l (p < 0.001 according to the Mann–Whitney U-criterion); pain intensity on the numerical rating scale in the main group was 1 [1; 1.5] score, in the control group was 4 [3; 5] scores (p < 0.001, U–Mann–Whitney criterion). There was also a correlation between the value of glycemia and the pain intensity by NRS in the postoperative period (Spearman’s coefficient r = 0.669, 95% CI = 0.499–0.789, p < 0.0001).Conclusions. As a result of the study, it was found that epidural analgesia with morphine leads to a lower increase in glucose and cortisol levels in the postoperative period, lower pain intensity when subjectively assessed using the numerical rating scale, which indicates a high quality of anesthesia.

Placental nanoparticle-mediated IGF1 gene therapy corrects fetal growth restriction in a guinea pig model.

Fetal growth restriction (FGR) caused by placental insufficiency is a major contributor to neonatal morbidity and mortality. There is currently no in utero treatment for placental insufficiency or FGR. The placenta serves as the vital communication, supply, exchange, and defense organ for the developing fetus and offers an excellent opportunity for therapeutic interventions. Here we show efficacy of repeated treatments of trophoblast-specific human insulin-like 1 growth factor (IGF1) gene therapy delivered in a non-viral, polymer nanoparticle to the placenta for the treatment of FGR. Using a guinea pig maternal nutrient restriction model (70% food intake) of FGR, nanoparticle-mediated IGF1 treatment was delivered to the placenta via ultrasound guidance across the second half of pregnancy, after establishment of FGR. This treatment resulted in correction of fetal weight in MNR + IGF1 animals compared to sham treated controls on an ad libitum diet, increased fetal blood glucose and decreased fetal blood cortisol levels compared to sham treated MNR, and showed no negative maternal side-effects. Overall, we show a therapy capable of positively impacting the entire pregnancy environment: maternal, placental, and fetal. This combined with our previous studies using this therapy at mid pregnancy in the guinea pig and in two different mouse model and three different human in vitro/ex vivo models, demonstrate the plausibility of this therapy for future human translation. Our overall goal is to improve health outcomes of neonates and decrease numerous morbidities associated with the developmental origins of disease.

Effect of illumination on the movement of rainbow trout <i>Oncorhynchus</i> (<i>Parasalmo</i>) <i>mykiss</i> (Salmonidae) juveniles in water flow and the level of thyroid hormones and cortisol in their blood

Long-term influence (53 days) of long-term constant illumination (100 and 1000 lux illuminance) on the behavior of rainbow trout Oncorhynchus (Parasalmo) mykiss juveniles and the level of thyroid hormones and cortisol in their blood has been experimentally recorded. At 100 lux illuminance, the fish moved equally upstream and downstream; i.e., their behavior was to stay in the current habitat. At 1000 lux illuminance, the fish more often moved upstream; i.e., their behavior was to leave the current habitat. The experimental illumination regimes did not affect the thyroid hormones and cortisol levels in the fish blood.

Physiological and Psychological Stress Reactivity in Narcolepsy Type 1.

Narcolepsy type 1 (NT1) is a chronic sleep-wake disorder, characterized by a loss of hypocretin production. Unexpectedly, in post-mortem tissue of people with NT1 there is a loss of corticotrophin-releasing hormone (CRH) in the paraventricular nucleus. CRH is known as activator of the hypothalamic-pituitary-adrenal (HPA) axis in response to stress. This activation results in the release of the stress hormones adrenocorticotropic hormone (ACTH) and cortisol. We hypothesize an altered physiological and psychological stress response in NT1. Participants were people with NT1 (n=14) and matched healthy controls (n=12). The Trier Social Stress Test for Groups (TSST-G), a validated socially evaluated stress test in controlled settings, induced acute stress. We measured ACTH and cortisol levels in blood before and at three timepoints after the TSST-G. We also measured subjective stress and heart rate levels. In both groups, acute stress led to increases in ACTH (p=0.006), cortisol (p<0.001), heart rate (p<0.001) and subjective stress (p<0.001). Subjectively, people with NT1 experienced more stress than controls (p<0.001). No differences were found in heart rate, cortisol, and ACTH between people with NT1 and controls at any timepoint. Secondary analyses showed that men with NT1 had lower cortisol levels immediately after stress induction than men in the control group (p=0.002). People with NT1 show an increased subjective stress response, but no changes in their endocrine or cardiovascular stress reactivity. Further research is required to determine the impact of reduced CRH production and gender in NT1.

Association of Lameness Prevalence and Severity in Early-Lactation Cows with Milk Traits, Metabolic Profile, and Dry Period

This study investigated the prevalence and severity of lameness in dairy cow herds, focusing on its relationship with milk traits, metabolic profile, and dry period management. Lameness was evaluated in 4221 multiparous Holstein dairy cows during early lactation (up to 60 days postpartum) using a 1-to-5 scale. The average lameness score was 1.67, with a prevalence of 10.66% (scores 3 to 5) and 4.55% classified as severe (scores 4 to 5). Severe lameness was associated with energy-corrected milk losses of −11.00 kg/day (p &lt; 0.001) and a decrease in milk lactose concentration by −0.16 percentage points (p &lt; 0.001), alongside a rise in somatic cell scores by +0.11. The incidence of cows with a milk fat-to-protein ratio below 1.2 increased by 21.7 percentage points, while those with a ratio above 1.4 rose by 19.1 percentage points as lameness worsened. Additionally, non-esterified fatty acid concentrations increased by 1.46 times as lameness severity intensified (p &lt; 0.001). Cows without lameness had blood cortisol levels 1.86 times lower than affected cows, with cortisol tripling in those with the highest scores. A dry period of 30 to 60 days was correlated with more healthy cows, whereas periods over 90 days resulted in 1.586 times higher odds of lameness (p &lt; 0.05). This research underscores the need for improved management strategies to enhance dairy cow welfare and productivity.

Effects of gestational age on blood cortisol and prolactin levels during pregnancy in malaria endemic area.

The hormonal shift occurring in pregnant women is crucial for the outcome of pregnancy. We conducted a study in pregnant women living in a malaria endemic area to determine the potential effect of gestational age on the modulation of the endocrine system by cortisol and prolactin production during pregnancy. Primigravidae and multigravidae with a gestational age between 16-20 weeks were included in the study and followed up to delivery and 6-7 weeks thereafter. Venous blood was collected at scheduled visit: Visit 1 (V1; 16-20 weeks of amenorrhea), Visit 2 (V2; 28 ±1 weeks of pregnancy), Visit 3 (V3; 32 ±1 weeks of pregnancy), Visit4 (V4; delivery) and Visit5 (V5; 6-7 weeks after delivery). In addition, a cord blood sample was also collected during labour at delivery. Nulliparous and primiparous/multiparous non-pregnant women were enrolled in the control group. Cortisol and prolactin plasma concentrations were measured using ichroma II and i-chamber apparatus. Light microscopy was used to detect Plasmodium falciparum infections. A linear mixed-effects regression (LMER) model was used to assess the association between the variation of cortisol titres and prolactin levels during the pregnancy and the post-partum. Results showed that cortisol and prolactin levels in the peripheral blood were globally up-regulated during pregnancy. Concentrations of cortisol during follow-up was significantly higher in primigravidae than in multigravidae during the whole pregnancy (p<0.024). Moreover, the level of prolactin which was higher before delivery in primigravidae reversed at delivery and postpartum visit, but the difference was not statistically significant during the follow-up (V1 to V5) (p = 0.60). The cortisol level in peripheral blood at delivery was higher than that in the cord blood, and conversely for prolactin. Cortisol and prolactin levels decreased after delivery, though the level of prolactin was still higher than that at enrolment. An increase of one unit of prolactin was associated with the decrease of the average concentration of cortisol by 0.04 ng/ml (p = 0.009). However, when cortisol increases with one unit, the average concentration of prolactin decreases by 1.16 ng/ml (p = 0.013). These results showed that the up-regulation effects of cortisol and prolactin are related to gestational age. A The downward regulation effect that both hormones have on each other during the pregnancy when each increase to 1 unit (1.0 ng/ml) was also reported.

The 24-Hour Urinary Cortisol/Urinary Creatinine Ratio Helps Differentiate Cushing's Syndrome from Simple Obesity

BackgroundCushing's syndrome (CS) is a condition caused by an increase in blood cortisol levels, leading to elevated blood sugar, osteoporosis, neuropsychiatric disorders, and weight gain and abnormal fat distribution. Its diagnostic process is cumbersome, and the process of clinical confirmation is influenced by many factors. ObjectivesIn this study, we investigated the relationship between the 24-hour urinary cortisol/urinary creatinine ratio (24hUCor/Cr) and other relevant biological markers associated with CS in an attempt to find novel ways to diagnose the disease. MethodsThis cross-sectional study included 395 hospitalized patients. Urinary cortisol and creatinine were measured by retaining a 24-hour urine sample. Multivariate binary logistic regression analysis was used to test the correlation between the 24hUCor/Cr and CS. All patients diagnosed with CS underwent a standardized diagnostic process. ResultsOf the 395 subjects, 94 (23.8%) were diagnosed with CS. In the unadjusted model, the likelihood of subjects having CS increased with increasing 24hUCor/Cr (odds ratio: 2.05, 95% confidence interval: 1.56–2.71; P<0.001). In the fully adjusted model, the risk of patients developing CS increased by 74% for each standard deviation increase in the 24hUCor/Cr (95% confidence interval: 1.02–2.97; P<0.05). Based on the subject working characteristic curve analysis and Youden’s index, the sensitivity and specificity of the 24hUCor/Cr for predicting CS were 88.3% and 91.7%, respectively, in all subjects (cutoff value: 52.3554, AUC: 0.942; P<0.001) ConclusionA higher 24hUCor/Cr helped to identify CS with an optimal cutoff value of 52.3554.

Healing of chronic wounds at the remodeling stage: the ratio of hormonal and immune parameters

Background. Both patients and healthcare systems around the world experience the negative consequences of chronic wounds. Chronic wounds often precede serious events such as amputation and premature death. Objective: to study the relationship between endocrine factors (insulin and cortisol) and bioactive molecules (interferon-γ (IFN-γ) and transforming growth factor-β1 (TGF-β1)), influencing the development of reparative processes of chronic wounds at the remodeling stage in an experiment, and to analyze the features of the histostructure of rat skin in the area of chronic wound healing. Materials and methods. The study was conducted on 12 white rats. Animals were randomized into intact and experimental groups, with 6 participants in each group. Chronic wounds were induced in the experimental group. Rats were euthanized on the 28th day of the experiment. In the blood serum, the insulin, cortisol, IFN-γ, and TGF-β1 levels were determined by enzyme immunoassay. Histological examination was carried out using generally accepted methods. Results. It was shown that the concentrations of insulin, cortisol, and TGF-β1 in animals of the experimental group were almost doubled compared to intact rats. The level of IFN-γ in animals with wounds was 1.2 times lower than in intact rats. Microscopic examination showed that the wounds were at the stage of remodeling. At the same time, signs of inflammation are partially preserved, which may indicate chronicity of the reparative process. Conclusions. Understanding the mechanisms of reparative processes during wound healing will allow for the development of clinical protocols to improve care for patients with injuries.

Interaction Between Peroxisome Proliferator-Activated Receptors and Cannabidiol in the Gut of Chickens Applied to Different Challenge Conditions.

Peroxisome proliferator-activated receptors (PPARs) are important targets for cannabidiol (CBD), which mediate many of its biological actions. The hypothesis of the present research assumed that PPARs affect the gut response to different challenge factors in chickens (C. perfringens vs. lipopolysaccharides (LPS) from E. coli), and that CBD can mediate the pathways of this response. The study proved that CBD and the challenge factors significantly affect the expression level of PPARα (p = 0.001) and selected genes determining gut barrier function. A positive correlation was demonstrated between PPARs and genes involved in the formation of tight junctions, immune, and oxidative stress responses in chickens. Dietary supplementation with CBD actively mediated the expression rate of PPARs, but the mechanism of interaction between CBD and PPARs was different depending on the stress factor used. The addition of CBD to the birds' diets did not contribute to reducing intestinal permeability under induced stress conditions nor cause stress, as indicated by the absence of elevated blood cortisol and endotoxin levels. CBD also supported the mechanisms of protecting intestinal cells from the cytotoxic effects in a C. perfringens challenge through the levels of genes involved in oxidative stress. This study indicates the importance of research toward understanding the mechanisms of PPARs as a target for enhancing intestinal barrier function, provides new results on the biological action of CBD in chickens, and shows a constant PPAR association with the jejunum mucosa of birds.

6372 Changes in Blood Steroid Hormone Profile after Switching from Metyrapone to Osilodrostat

Abstract Disclosure: K. Yokozeki: None. H. Kameda: None. A. Miya: None. H. Nomoto: None. A. Nakamura: None. S. Jin: None. K. Matoba: None. T. Atsumi: None. Background: The new steroidogenesis inhibitor osilodrostat has recently been approved for use in Cushing's syndrome. However, there are limited studies on changes in blood steroid hormone profiles after switching from existing drugs including metyrapone. Purpose: To study the changes in steroid hormone profiles with switching from metyrapone to osilodrostat in patients with Cushing's disease and to examine the differences in clinical efficacy. Case 1: A woman in her 40s underwent transsphenoidal pituitary tumor surgery (TSS) for Cushing's disease in X-12, but was not in remission and was treated with 1000 mg/day of metyrapone and oral hydrocortisone. In X-3, the patient complained of masculinization and was started pasireotide LAR 10 mg per month, which was subsequently increased to 30 mg. Despite the addition of 240 mg/day of trilostane in X-2, the patient did not show improvement. Switched the steroidogenesis inhibitors to osilodrostat 4 mg/day in year X, blood cortisol and testosterone levels decreased and the symptoms of virilization disappeared.Case 2: A woman in her 40s experienced edema in her face and limbs, increased appetite and weight gain since Y-13. After endocrinological examination, she was diagnosed with Cushing's disease. TSS was performed and she was in remission. However, she suffered a relapse in Y-4 and was started on metyrapone, which was titrated up to 4,000 mg/day. Due to gastric discomfort, metyrapone was switched to osilodrostat 52 mg/day in year Y, leading to an improvement of her gastric symptoms and stabilized blood cortisol level. Case 3: A woman in her 70s underwent TSS for Cushing's disease in Z-6, but the tumor remained and she was prescribed metyrapone 1,500 mg/day. The disease was stable and complications were under control with metyrapone. In Z-1, the patient developed elevated blood pressure and worsening leg edema, and metyrapone was switched to osilodrostat 3 mg/day in year Z, resulting decreased blood cortisol level and blood pressure. Results: Liquid chromatograph mass spectrometry (LC-MS) analysis of blood steroid hormone profiles in above three cases demonstrated a decrease in 17-OH pregnenolone, 17-OH progesterone, and 11-deoxycorticosterone after switching the steroidogenesis inhibitors. Discussion and Conclusion: It has been noted that osilodrostat lowers serum cortisol in a shorter period of time compared to metyrapone and may also decrease the number of antihypertensive medications used. Under metyrapone administration, hypertrichosis, hypertension, and hypokalemia are often observed with increased mineralocorticoid precursors, but osilodrostat may have a different clinical effect as a result of its different pattern of steroid hormone synthase inhibition. Presentation: 6/2/2024

6426 Pregnancy-induced ACTH-independent Cushing Syndrome: A Rare Phenomenon Secondary To Aberrant Receptors On Adrenal Glands

Abstract Disclosure: K. Manglani: None. S.T. Sharma: None. Pregnancy-induced hypercortisolism is a rare phenomenon with very few cases reported in the literature. The pathogenesis is thought to be secondary to the expression of aberrant LH/hCG receptors on the adrenal gland that stimulate cortisol production in pregnancy. We present a case of a 31-year-old female with no past comorbidities until her first pregnancy in 2017 when she gained around 50lbs, developed violaceous striae, acne, hirsutism, depression with suicidal ideation for which she was hospitalized twice, and underwent emergent C-section at 34 weeks’ gestation due to pre-eclampsia. She was referred to the Endocrinology clinic post-delivery, and screening for Cushing syndrome was negative at that time: 24-hour urinary free cortisol (UFC), late-night salivary cortisol (LNSC) and 1-mg dexamethasone (dex) suppression test (DST) were normal. She presented again in 2020 during her second pregnancy at 14 weeks gestation, with 20lb weight gain in the first trimester, acne, hirsutism, and easy bruising. Labs showed cortisol of 22.4 mcg/dL (6.2-19.4), ACTH &amp;lt;1.5 pg/mL, total testosterone 168 ng/dL (8-48), androstenedione 751 ng/dL (41-262), DHEAS 91.2 mcg/dL (84.8-378), 24-hour UFC 277 mcg/day (6-42), LNSC 0.671 mcg/dL, 1mg DST with post-dex cortisol 24 mcg/dL (dex level 58 ng/dL), and 8-mg DST with post-dex cortisol level of 28.2 mcg/dL (dex level 457 ng/dL). Testing was consistent with ACTH-independent Cushing syndrome. Ultrasound and MRI of the abdomen/pelvis showed normal adrenal glands with no hyperplasia or mass. Given worsening hypercortisolism and her course during a prior pregnancy, medical treatment with metyrapone was initiated. We started at a dose of 500 mg daily and gradually increased to 1500 mg with close monitoring of her blood pressure and cortisol levels. She underwent vaginal delivery at 38 weeks’ gestation, and the baby required a brief stay in the NICU for respiratory distress but was otherwise doing well. The patient developed secondary adrenal insufficiency post-delivery requiring hydrocortisone, with recovery of her HPA axis in around 10 weeks. Since then, she has been off hydrocortisone with normal UFC, ACTH, and cortisol levels. This case enables discussion regarding the underlying etiology, diagnostic difficulties, and management of this rare condition. Although the exact etiology is unknown, the postulated mechanism is aberrant LH/hCG receptor expression given the patient’s presentation during each pregnancy, normal cortisol levels between both pregnancies, and a brief period of adrenal insufficiency post-delivery. Management of hypercortisolism during pregnancy remains challenging. Metyrapone, a steroidogenesis inhibitor, can be considered for control of hypercortisolemia during pregnancy (off-label) in select cases to prevent maternal and fetal complications. Presentation: 6/1/2024

N-Pep-Zn Improves Cognitive Functions and Acute Stress Response Affected by Chronic Social Isolation in Aged Spontaneously Hypertensive Rats (SHRs).

Aging and chronic stress are regarded as the most important risk factors of cognitive decline. Aged spontaneously hypertensive rats (SHRs) represent a suitable model of age-related vascular brain diseases. The aim of this study was to explore the effects of chronic isolation stress in aging SHRs on their cognitive functions and response to acute stress, as well as the influence of the chronic oral intake of N-Pep-Zn, the Zn derivative of N-PEP-12. Nine-month-old SHRs were subjected to social isolation for 3 months (SHRiso group), and one group received N-pep-Zn orally (SHRisoP, 1.5 mg/100 g BW). SHRs housed in groups served as the control (SHRsoc). The behavioral study included the following tests: sucrose preference, open field, elevated plus maze, three-chamber sociability and social novelty and spatial learning and memory in a Barnes maze. Levels of corticosterone, glucose and proinflammatory cytokines in blood plasma as well as salivary amylase activity were measured. Restraint (60 min) was used to test acute stress response. Isolation negatively affected the SHRs learning and memory in the Barnes maze, while the treatment of isolated rats with N-Pep-Zn improved their long-term memory and working memory impairments, making the SHRisoP comparable to the SHRsoc group. Acute stress induced a decrease in the relative thymus weight in the SHRiso group (but not SHRsoc), whereas treatment with N-Pep-Zn prevented thymus involution. N-pep-Zn mitigated the increment in blood cortisol and glucose levels induced by acute stress. N-pep-Zn enhanced the adaptive capabilities towards chronic (isolation) and acute (immobilization) stress in aged SHRs and prevented cognitive disturbances induced by chronic isolation, probably affecting the hypothalamo-pituitary-adrenal, sympathetic, and immune systems.

Allostatic Load as a Mediator and Perceived Chronic Stress as a Moderator in the Association between Maternal Mental Health and Preterm Birth: A Prospective Cohort Study of Pregnant Women in Pakistan

Introduction: The complex biopsychosocial pathways linking maternal mental health with preterm birth (PTB) are not well understood. This study aimed to explore allostatic load (AL) as a mediator and perceived chronic stress as a moderator in the pathway linking maternal mental health and PTB. Methods: A cohort study of pregnant women (n = 1,567) recruited at clinic visits within 10–19 weeks of gestation was assessed for maternal mental health (i.e., pregnancy-related anxiety, state anxiety, depressive symptoms) and perceived chronic stress. Blood pressure and levels of cortisol, total cholesterol, C-reactive protein, and glycosylated hemoglobin were used to create a composite measure of AL. Results: AL had the most significant effect on PTB (odds ratio (OR) = 1.84, 95% CI = 1.26–12.67, p = 0.001), while systolic blood pressure emerged as the only significant individual marker using variable selection (OR = 22%, 95% CI = 1.06–1.40, p < 0.001) in multiple logistic regression analysis. A mediation analysis revealed that maternal mental health did not have a significant direct effect on PTB (p = 0.824), but its indirect effect mediated by AL was significant (z = 2.33, p < 0.020). Low and high levels of perceived chronic stress, relative to the mean, moderated this indirect effect (z = 3.66, p < 0.001). Conclusions: AL has a significant direct influence on PTB and mediates the effect of maternal mental health on PTB; however, the indirect effect of AL is indistinguishable between women with higher or lower levels of perceived chronic stress than normal.

Lesser Weeks of Gestation Correlated with Levels of Cortisol in Ghanaian Women with Preeclampsia, Case-control Study

Following the different kinds of treatment of Preeclampsia (PE) that have challenged clinical regimens, it seems expedient to find ways of preventing PE. Cortisol might be the best factor and marker to provide the baseline information, hence the focus. The aim was to determine cortisol levels in preeclampsia. STROBE consensus checklist was utilized for this case-control study. Clinical information on 125 subjects (50 controls, 30 PE, 50 pregnant normotensive; with 5 lost by attrition) was obtained after ethical consideration (MS-Et/M.3 – P.3.2/2013 – 2014) and informed consent. Full blood count, lipid profile, and cortisol levels were analyzed after venipuncture and blood processing from subjects. SPSS version 20 was used to analyze data. The mean cortisol level in PE was 149.37ng/mL and this was statistically significant when compared with non-pregnant normotensive (controls) only (p = 0.004); and likewise, with both pregnant normotensive and controls (p = 0.008). During cortisol stratification, the odds ratio between PE and controls was 0.0927 (p = 0.0001) while the odds between pregnant normotensives and controls was 0.0374 (p &lt; 0.0001). A significant finding was seen between cortisol levels and lesser gestational weeks. The fewer the weeks of gestation, the higher the cortisol level of the preeclamptic patient.

Methylation alterations of imprinted genes in different placental diseases

BackgroundImprinted genes play important functions in placentation and pregnancy; however, research on their roles in different placental diseases is limited. It is believed that epigenetic alterations, such as DNA methylation, of placental imprinting genes may contribute to the different pathological features of severe placental diseases, such as pre-eclampsia (PE) and placenta accreta spectrum disorders (PAS).ResultsIn this study, we conducted a comparative analysis of the methylation and expression of placental imprinted genes between PE and PAS using bisulfite sequencing polymerase chain reaction (PCR) and quantitative PCR, respectively. Additionally, we assessed oxidative damage of placental DNA by determining 8-hydroxy-2′-deoxyguanosine levels and fetal growth by determining insulin-like growth factor 2 (IGF2) and cortisol levels in the umbilical cord blood using enzyme-linked immunosorbent assay. Our results indicated that methylation and expression of potassium voltage-gated channel subfamily Q member 1, GNAS complex locus, mesoderm specific transcript, and IGF2 were significantly altered in both PE and PAS placentas. Additionally, our results revealed that the maternal imprinted genes were significantly over-expressed in PE and significantly under-expressed in PAS compared with a normal pregnancy. Moreover, DNA oxidative damage was elevated and positively correlated with IGF2 DNA methylation in both PE and PAS placentas, and cortisol and IGF2 levels were significantly decreased in PE and PAS.ConclusionsThis study suggested that DNA methylation and expression of imprinted genes are aberrant in both PE and PAS placentas and that PE and PAS have different methylation profiles, which may be linked to their unique pathogenesis.

Effects of Maltodextrin-Fructose Supplementation on Inflammatory Biomarkers and Lipidomic Profile Following Endurance Running: A Randomized Placebo-Controlled Cross-Over Trial.

Managing metabolism for optimal training, performance, and recovery in medium-to-high-level endurance runners involves enhancing energy systems through strategic nutrient intake. Optimal carbohydrate intake before, during, and after endurance running can enhance glycogen stores and maintain optimal blood glucose levels, influencing various physiological responses and adaptations, including transitory post-endurance inflammation. This randomized trial investigates the impact of a high-dose 2:1 maltodextrin-fructose supplementation to medium-to-high-level endurance runners immediately before, during, and after a 15 km run at 90% VO2max intensity on post-exercise inflammatory stress. We evaluated inflammatory biomarkers and lipidomic profiles before the endurance tests and up to 24 h after. We focused on the effects of high-dose 2:1 maltodextrin-fructose supplementation on white blood cell count, neutrophil number, IL-6, cortisol, and CRP levels, as well as polyunsaturated fatty acids, ω-3 index, and AA/EPA ratio. This supplementation significantly reduced inflammatory markers and metabolic stress. Additionally, it may enhance the post-activity increase in blood ω-3 fatty acid levels and reduce the increase in ω-6 levels, resulting in a lower trend of AA/EPA ratio at 24 h in the treated arm. Adequate carbohydrate supplementation may acutely mitigate inflammation during a one-hour endurance activity of moderate-to-high intensity. These effects could be beneficial for athletes engaging in frequent, high-intensity activities.

Impact of psychological correlates, Social isolation and loneliness on the management and self care behaviors of Cardio-vascular Disease after COVID- 19 Pandemic

The present research paper examines the impact of psychological correlates (stress, anxiety and depression), social isolation and loneliness in the management and self care behaviors of cardiovascular disease after Covid 19 pandemics. According to World Heart Federation 2023 report shows that more than half a billion people around the world continue to be affected by cardiovascular diseases, which accounted for 20.5 million deaths in 2021 – close to a third of all deaths globally and an overall increase on the estimated 121 million CVD deaths. Over three quarters of Cardiovascular disease deaths take place in low- and middle-income countries. Out of the 17 million premature deaths (under the age of 70) due to non-communicable diseases in 2019 (World Health Organization), 38% were caused by cardiovascular diseases. Most cardiovascular diseases can be prevented by addressing psychologically, socially, behavioral and environmental risk factors such as anxiety, anger, stress, depression, social isolation, loneliness, tobacco use, unhealthy diet and obesity, physical inactivity, harmful use of alcohol and air pollution. Anxiety is associated with a variety of physical and psychological symptoms that can negatively impact the health outcome. Anxiety can lead to increased blood pressure, heart rate, and cortisol levels, which can contribute to the development and progression of Cardio vascular disease. Psychological interventions can help individuals with Cardio vascular disease better cope with the disease, improve their quality of life, and reduce the risk of adverse health outcomes. It is important to detect cardiovascular disease as early as possible for the management and prevention of it. Research involves 300 participants with cardiovascular disease during 2021 to 2024. The data was collected by the participant of Chhattisgarh and Madhya Pradesh visited to the private clinics and hospital for their routine checkups. Using standardized questionnaire following information was gathered i.e. Demographic, biomedical information, anxiety, depression, stress, as well as feelings of social isolation and loneliness, self health care inventory for cardio vascular disease and their lifestyle related information for preventing from the diseases. The data was analyzed using descriptive statistics, and one way ANOVA. The results revealed a significant relationship with psychological correlates, social isolation and loneliness in the management and care of cardiovascular diseases participants after Covid 19 pandemic. The results of the study are fruitful for Health Care Professionals and Health Care Providers for the management of cardiovascular diseases; also it’s useful for Ministry of Health to make a policy related to the control the death rate which is caused due to cardiovascular diseases. Hence it is important to "Identifying sustainable ways to work with communities to take action to prevent and control modifiable risk factors for heart disease is essential for reducing the global burden of heart disease," said George A. Mensah, MD, FACC, director of the Center for Translation Research and Implementation Science at the NHLBI.

Lack of Acute Agomelatine Effect in a Model of Social Anxiety in Healthy Volunteers: A Double-Blind, Placebo-Controlled Trial.

Agomelatine is an antidepressant drug that acts as an agonist of melatoninergic MT1/2 receptors and an antagonist of serotonergic 5-HT2C receptors. Studies suggest that agomelatine has anxiolytic properties in social anxiety, but there are no studies that assessed the effects of this compound in human experimental anxiety induced by a public speaking test. The objective of our investigation was to assess the effects of agomelatine on human experimental anxiety using the Simulation Public Speaking Test (SPST). Agomelatine (25 mg, n = 14), citalopram (20 mg, n = 14), venlafaxine (75 mg, n = 14), or placebo (n = 14) were administered in single doses to healthy volunteers in a double-blind study. Subjective anxiety was assessed with the Visual Analogue Mood Scale. Arterial blood pressure, heart rate, and blood levels of prolactin and cortisol were also recorded, as well as plasma levels of the 3 drugs. The SPST induced significant subjective, physiological, and hormonal effects in all groups. The SPST also increased the anxiety and decreased mental sedation Visual Analogue Mood Scale factors during the anticipatory and performance phases of the test. Citalopram increased anxiety during the test in females, whereas agomelatine and venlafaxine were not different from placebo. Confirming previous results, a serotonin selective reuptake inhibitor, citalopram, caused an anxiogenic effect in the SPST only in females. Acute administration of a low dose of agomelatine failed to modify the behavioral and physiological changes caused by this test. Future studies using higher doses and repeated administration should investigate if agomelatine behavioral and physiological effects could be detected in human experimental anxiety models.