Mean Serum Cortisol Levels Research Articles

Effect of Academic Activities on Plasma Cortisol, Glucose Levels and Body Mass Index in Students of College of Health Sciences, Nnamdi Azikiwe Uiversity, Nnewi Campus, Anambra State, Nigeria

Academic activities have been described as a naturalistic stressor capable of affecting human health. This study investigated the effect of academic activities on plasma cortisol, glucose levels and body mass index in students of College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria. A total number of 60 male subjects were recruited for this study. They were grouped into 2 stages (3 and 8 weeks) of intensive academic stress respectively. Thereafter, 5mls of blood sample was collected from the subjects into fluoride oxalate and lithium heparin containers respectively and used for analysis of biochemical parameters. Serum cortisol was assayed using ELISA method, whereas plasma glucose level was assayed using enzymatic method. Anthropometric parameters of the subjects were obtained using a well-structured questionnaire. Result showed that the mean plasma glucose level in 8 weeks was significantly higher (4.64±0.23) compared with 3 weeks (4.06±0.20) of academic stress (P<0.05). Again, the mean serum cortisol level was significantly higher in 8weeks (415.00±16.54) compared with 3 weeks (398.00±10.51) of subjects exposure to academic stress (P<0.05). Meanwhile, there was a significant decrease in the mean BMI of the subjects in 8weeks of examination (23.50±3.25) when compared to 3 weeks (24.51±4.10) (P<0.05). This study also revealed a significant positive correlation between Plasma glucose and serum cortisol levels (r= 0.184; P=0.002), BMI and cortisol level (r= 0.253; P=0.004) of the participants after 3weeks of academic stress. More so, at 8 weeks of academic stress, there was a significant positive correlation between mean plasma glucose and serum cortisol levels (r= 0.240; P=0.001) and between BMI and cortisol level (r= 0.151; P=0.000). This study showed that the mean levels of serum cortisol and plasma glucose increases with increasing duration of academic activities, whereas, BMI decreases with increase in the duration of academic stress.

Adrenocortical Suppression in Children with Nephrotic Syndrome Treated with Low-Dose Alternate Day Corticosteroids.

Corticosteroids form the mainstay of therapy for all forms of nephrotic syndrome. The long-term use of this medication is associated with serious side effects including adrenocortical suppression. The primary objective of this study was to identify adrenocortical suppression (assessed by single morning serum cortisol levels) in children with nephrotic syndrome on treatment with low-dose alternate day steroids. This cross-sectional study was conducted in the Department of Pediatrics in a tertiary care hospital from January 2014 to January 2015. Seventy children (1–18 years) with nephrotic syndrome (steroid sensitive and resistant) who were in remission and on low-dose alternate day steroids for at least 8 weeks or had received steroids of 2 mg/kg/d for at least 2 weeks in the last 1 year (infrequent relapsers) were enrolled. Relevant history was taken, clinical examination was done and blood samples were drawn for serum cortisol, lipid profile, kidney function tests, fasting blood sugar, glycated hemoglobin (HbA1c), and serum albumin. Forty percent (28/70) children had adrenocortical suppression as assessed by low morning serum cortisol levels. The mean serum cortisol levels were 188 nmol/L and were significantly lower in frequently relapsing individuals (85.9 nmol/L) as compared to other types of nephrotic syndrome (P = 0.05). The prevalence of adrenocortical suppression was higher in steroid-resistant patients (57%) as compared to 28% in frequently relapsing and 11% in steroid-dependent patients. Fifty-seven percent of patients with adrenocortical suppression had short stature while 50% had obesity. All individuals had normal serum HbA1c levels. The cumulative steroid doses and total duration of corticosteroid therapy were significantly higher in patients with adrenocortical suppression. Children with nephrotic syndrome treated with low-dose alternate day steroids have a high prevalence of adrenocortical suppression on screening with single morning cortisol sample. Those with frequently relapsing or steroid-resistant diseases are at a higher risk of suppression.

Serum Amyloid P and Endocrine Markers in a Cohort of Obese Children.

Objectives:Obesity in children can lead to morbidity and mortality due to metabolic and inflammatory comorbidities.Aims:The objective of the study was to investigate the alterations in acute inflammatory markers, serum amyloid P (SAP) and cortisol, and endocrine markers, leptin and insulin, in obese children.Materials and Methods:Serum leptin, insulin, cortisol, and amyloid P concentrations were measured in obese (BMI percentile >85, n = 17) and nonobese (BMI percentile < 75, n = 20) children using ELISA and Bio-Plex Bead-based assay.Statistical Analysis Used:Serum concentrations of analytes were compared between normal and obese groups using 2-tailed student's t-test.Results:Mean leptin, insulin, and SAP serum concentrations were significantly higher in obese children as compared to the controls (97.19 vs. 4.06, P < 0.05; 21.31 vs 3.56, P < 0.05; 46.77 vs. 17.89, P < 0.05; respectively). No difference was found in mean serum cortisol levels of the two groups. However, cortisol values were higher in obese subjects compared to the control group (7.89 vs 6.30, P = 0.15). Leptin corelated with insulin (r = 0.42, P = 0.043) and cortisol (r = 0.48, P = 0.025) levels in the obese group. Furthermore, leptin, insulin, and SAP levels were corelated with BMI (r = 0.80, P < 0.000; r = 0.67, P = 0.015, respectively) and body weight (r = 0.52, P = 0.01; r = 0.52, P = 0.002; r = 0.54, P = 0.01, respectively) in the obese group but did not demonstrate a significant relationship in the nonobese group.Conclusion:Elevated SAP levels and increase in leptin and insulin indicated a preeminent disposition of morbidly obese children to the development of low-grade inflammation and metabolic syndrome.

Dynamics of postoperative serum cortisol after transsphenoidal surgery for Cushing's disease: implications for immediate reoperation and remission.

OBJECTIVESuccessful transsphenoidal surgery for adrenocorticotropin hormone (ACTH)-producing pituitary tumors is associated with subnormal postoperative serum cortisol levels, which may guide decisions regarding immediate reoperation. However, little is known about the detailed temporal course of changes in serum cortisol in the immediate postoperative period, and the relationship of postoperative cortisol dynamics to remission and late recurrence.METHODSA single-center retrospective cohort analysis was performed for all patients undergoing pituitary surgery from 2007 through 2015. Standardized diagnostic and treatment algorithms were applied to all patients with potential Cushing's disease (CD), including microsurgical transsphenoidal adenomectomy (TSA) by a single surgeon. All patients had serum cortisol levels drawn at 6-hour intervals for 72 hours after surgery, and were offered reoperation within 3 days for normal or supranormal postoperative cortisol levels. Primary outcomes were 6-month remission and late recurrence; secondary outcomes were persistent postoperative hypocortisolism and surgical morbidity. Discriminatory levels of postoperative serum cortisol for predicting remission were calculated at various intervals after surgery using receiver operating characteristic (ROC) curves.RESULTSAmong 89 patients diagnosed with CD, 81 underwent initial TSA for a potentially curable lesion; 23 patients (25.8%) underwent an immediate second TSA. For the entire cohort, 6-month remission was achieved in 77.8% and late recurrences occurred in 9.5%, at a mean of 43.5 months. Compared with patients with a single surgery, those with an immediate second TSA had similar rates of remission (78.3% vs 77.6%) and late recurrence (5.6% vs 11.1%). The rate of hypocortisolism for patients with 2 surgeries (12/23, 52.2%) was significantly greater than that for patients with single surgeries (13/58, 22.4%; p < 0.001). There was no difference in the incidence of CSF leaks between the first and second operations. Remission was achieved in 58 (92.1%) of 64 patients who completed the 2-surgery protocol. The temporal course of postoperative serum cortisol levels among patients varied considerably, with subnormal nadir levels < 2 μg/dl occurring between 12 hours and 66 hours. Patients achieving remission had significantly lower mean serum cortisol levels at every time point after surgery (p < 0.01). By ROC curve analysis, nadir cortisol levels < 2.1 μg/dl were predictive of 6-month remission for the entire cohort over 3 days (positive predictive value [PPV] = 94%); discriminating cortisol levels for predicting remission on postoperative day (POD) 2 were < 5.4 μg/dl (PPV = 97%), although patients with remission after postoperative cortisol levels of 2-5 μg/dl had a significantly higher rate of late recurrence.CONCLUSIONSThere is substantial variation in the temporal course of serum cortisol levels over the first 72 hours after TSA for CD, with nadir levels predictive for remission occurring as late as POD 3. Although a cortisol level of 2.1 μg/dl at any point was an accurate predictor of 6-month remission, levels less than 5.4 μg/dl on POD 2 were reasonably accurate. These data may enable decisions regarding the efficacy of an immediate second surgical procedure performed during the same hospitalization; immediate reoperation is associated with excellent remission rates and low recurrence rates in patients otherwise unlikely to achieve remission, but carries a higher risk of permanent hypocortisolism.

Relative Adrenal Insufficiency in Alcoholic Hepatitis

Background and Aim: Alcoholic hepatitis (AH) is an acute hepatic inflammation associated with high morbidity and mortality. The pathogenesis of alcoholic hepatitis is complex and involve oxidative stress, gut dysbiosis, and dysregulation of the innate and adaptive immune system similar to sepsis. It has been reported that adrenal insufficiency is common in sepsis. Further treatment with steroids decreases mortality in such patients. We hypothesize that adrenal insufficiency is associated with severe alcoholic hepatitis and affects prognosis. Methods: 50 patients of alcoholic hepatitis were included in study. As per ACTH stimulation protocol the criteria to diagnose relative adrenal insufficiency rise of serum cortisol less than 7 after 1 h of inj ACTH. After a baseline 8 AM cortisol sample, inj ACTH 25 IU was injected intramuscularly and blood sample was collected after 1 h for estimation of serum cortisol. Results: In our study it was observed that out of 50 patients of alcoholic hepatitis; 7 patients (14%) had DF < 32 and 43 patients (86%) had DF > 32. Patients with DF < 32 had baseline mean serum cortisol level 9.02 μm/dl and post ACTH mean serum cortisol level was 24.12 μm/dl. Patients with DF > 32 had baseline mean serum cortisol level of 18.9 μm/dl and post-ACTH mean serum cortisol levels was 22.6 μm/dl. None of the patients with DF < 32 had evidence of relative adrenal insufficiency while 24 patients (55.8%) out of 43 patients with DF > 32; had <7 rise in serum cortisol level suggestive of relative adrenal insufficiency. Conclusion: Relative adrenal insufficiency was observed in patients with alcoholic hepatitis and it correlated with severity of AH. The cause of relative adrenal insufficiency is still not known and it may be multifactorial in etiology and may have therapeutic and prognostic implications. The authors have none to declare.

Assessment of anxiety, depression, and serum cortisol level in oral submucous fibrosis patients: A controlled clinical trial.

Objective:The aim of this study was to assess the anxiety, depression, and serum cortisol level in OSMF patients.Materials and Methods:This cross-sectional study was conducted in the Outpatient Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India. Age- and gender-matched 105 patients were divided into three equal groups as follows: Group 1 – those with areca nut chewing habits and OSMF, Group 2 – those with areca nut chewing habits but no OSMF, and Group 3– those without areca nut chewing habits and without OSMF. Anxiety and depression were assessed by the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale, respectively. Serum cortisol level was also measured simultaneously.Statistical Analysis:Paired t-test, Chi-square test, and analysis of variance were used.Results:Fifty (47.62%) patients were observed to be in the age group of 25–32 years. Ninety-six (91.4%) patients were males and 9 (8.6%) were females. The mean serum cortisol level was observed to be higher among patients with OSMF-C followed by those with OSMF-D.Conclusion:We conclude that there is a significant association between OSMF, depression, and serum cortisol level.

Light and electron microscopic study on the effect of immobilization stress on adrenal cortex of adult rats and possible ameliorative role of vitamin E.

Background: Modern society is full of stress. Immobilization stress is a model used in animals to study its effects. Vitamin E is an antioxidant that protects biological membranes from oxidative stress. Objectives: This study aimed to investigate the effects of immobilization stress on the adrenal cortex of rats and the ameliorative effect of vitamin E.Materials and Methods: Forty adult male rats were used in this study and were divided equally into 4 groups. Group I:were divided equally into negative and positive controls. Group II: rats received vitamin E at a dose of 40 I.U/kg by gastric tube for 30 days. Group III: rats subjected to immobilization stress 2 hours /day for 30 days. Group IV: rats subjected to immobilization stress 2 hours /day and received 40 I.U/kg of vitamin E for 30 days. Adrenal sections were histologically prepared and examined. Results: Group II was comparable to group IA. Group III revealed zona glomerulosa (ZG) with loss of normal architecture, zona fasciculata (ZF) with multiple cells containing cytoplasmic vacuolations and darkly stained nuclei. By EM ZG cells appeared with accumulations of lipid droplets and lysosomes, irregular nuclear envelopes and chromatin condensation. ZF cells showed numerous lipid droplets and irregular nuclear envelopes. There were significant increases in the mean area of collagen fibers and mean serum cortisol level. Group IV revealed regression of these changes and increase in the mean count of CD44 +ve cells.Conclusions: Immobilization stress exerted deleterious suprarenal cortical changes and vitamin E had an ameliorative effect.

Evaluation of Evidence of Adrenal Insufficiency in Trials of Normocortisolemic Patients Treated With Mifepristone.

Context:Adrenal insufficiency (AI) is an important medical concern for clinicians when normocortisolemia is achieved during treatment of endogenous Cushing syndrome (CS).Objective:To examine symptoms of potential AI in a large population of normocortisolemic patients without CS treated with mifepristone, a glucocorticoid receptor antagonist indicated for the treatment of patients with CS.Methods:We conducted a pooled safety analysis of five phase 3, placebo-controlled clinical trials of normocortisolemic adults without CS but diagnosed with psychotic depression (n = 1460). Patients were treated with once-daily mifepristone 300 mg (n = 110), 600 mg (n = 471), or 1200 mg (n = 252), or placebo (n = 627) administered for 7 consecutive days. All study investigators were trained and instructed to assess for the development of AI and to report all adverse events (AEs) at each clinic visit. The incidence of (1) AI or similar terminologies and that of (2) ≥3 concurrent symptoms that could be associated with AI was evaluated.Results:Mean serum cortisol and adrenocorticotropic hormone levels increased dose dependently with mifepristone treatment. There were no reports of AI and no significant differences between the mifepristone-treated and placebo groups in the incidence of patients having ≥3 AEs that could be associated with AI.Conclusions:This large pooled analysis of normocortisolemic patients without CS found no cases of AI and no differences between mifepristone therapy and placebo in the incidence of symptom combinations mimicking AI, even at the highest (1200 mg) dose. These findings further add clinically important insights to the safety and tolerability profile of mifepristone therapy.

Prognostic Value of Cortisol in Patients with Acute Ischemic Stroke

Background: Activation of the hypothalamo-pituitary-adrenal axis has been shown in acute ischemic stroke. Some recent studies suggest that serum cortisol level may have prognostic value in patients with ischemic stroke. The aim of this study was to evaluate the prognostic value of cortisol in patients with acute ischemic stroke. Methods: In this prospective observational study, 51 patients with acute ischemic stroke were evaluated. Cardioembolic and lacunar strokes were excluded. In the first 24 hours of admission, serum cortisol level, national institutes of health stroke scale (NIHSS), diabetes and hypertension were assessed to determine their value to predict mortality within 90 days. The results were analyzed using descriptive statistics, t-test, chi-square test and logistic regression. Results: In this study, 26 patients (51%) were female and the rest were male. Serum cortisol level was normal in 37 patients (72.5%). 14 patients died (27.5%) during the follow-up period. The mean serum cortisol level of dead patients were 33.48 ± 15.14 μg/dL and for alive patients was 35.10 ± 19.74. This difference was not statistically significant. After statistical analysis using logistic regression, no significant correlation between serum cortisol level and mortality was seen. Conclusions: Although ischemic stroke is associated with change in serum cortisol level but this change has no prognostic value.

The effect of local injection of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis among patients with greater trochanteric pain syndrome.

Greater trochanteric pain syndrome (GTPS) is a common clinical entity for which the most effective treatment is local corticosteroid injection (LCI). There are no studies on the effect of LCI among patients with GTPS on the hypothalamic-pituitary-adrenal axis. The present study recruited nonselected patients diagnosed with GTPS. After consenting, participants received low dose (1μg) of adrenocorticotropin hormone (ACTH) stimulation test at 09:00. Immediately following the test, participants received a LCI of 80mg of methylprednisolone acetate at the greater trochanteric region. The ACTH stimulation test was repeated 1, 2, 4, and 6weeks following the LCI. Cortisol samples were obtained at just prior to (basal) and 30min (post-stimulation) following every ACTH stimulation test. Serum cortisol levels of <500μmol/l obtained 30min following the ACTH stimulation test were considered evidence of secondary adrenal insufficiency. The study enrolled 22 patients, 21 of whom completed participation. There were 19 female participants (~90%), and mean age of all the participants was 55.2±8.6years. Four participants showed evidence of secondary adrenal insufficiency, which was observed only at weeks 1 and 2 following the LCI. Mean serum cortisol level among these four participants 30min following the ACTH stimulation test was 354μmol/l, with a range of 268-430μmol/l. LCI of 80mg of methylprednisolone acetate in the greater trochanteric area among patients with GTPS was associated with transient secondary adrenal insufficiency in ~20% of the patients, mainly 1week following the injection.

Pharmacodynamics and pharmacokinetics of fluticasone furoate/vilanterol in healthy Chinese subjects.

Study ObjectiveTo investigate the pharmacodynamic and pharmacokinetic profiles of fluticasone furoate (FF)/vilanterol (VI) – a fixed‐dose combination of an inhaled corticosteroid (ICS) and a long‐acting β2‐agonist for the treatment of asthma and chronic obstructive pulmonary disease – after single and repeat administration in healthy Chinese subjects.DesignDouble‐blind, placebo‐controlled, single‐site, randomized, four‐way crossover study.SettingThe Clinical Pharmacological Research Centre at Peking Union Medical College Hospital [PUMCH]) in Beijing, China.SubjectsSixteen healthy, nonsmoking Chinese adults.InterventionSubjects were randomized to receive FF/VI 50/25, 100/25, or 200/25 μg, or placebo once/daily in the morning, delivered by the Ellipta dry powder inhaler, for 7 consecutive days. The subjects then received the other three treatments, with each treatment period separated by a 7‐day washout period.Measurements and Main ResultsThe co‐primary outcome measures reflected pharmacodynamic responses relating to recognized class effects of the two drug classes: reduced serum cortisol level (ICSs), and increased Fridericia's corrected QT interval (QTcF) and reduced serum potassium level (long‐acting β2‐agonists). Co‐primary pharmacodynamic endpoints were 0–24‐hour weighted mean serum cortisol level on day 7 (cortisol0–24 hr, Day 7), and 0–4‐hour weighted mean and maximum QTcF and weighted mean and minimum serum potassium level on days 1 and 7. Fluticasone furoate and VI plasma concentrations, derived pharmacokinetic parameters, and safety were also assessed. Of the 16 subjects randomized, 15 completed the study. Reductions in cortisol0–24 hour, Day 7 of 15% and 25% were observed with FF/VI 100/25 and 200/25 μg, respectively, versus placebo. Minor increases (< 10 msec) in maximum QTcF on day 7 were seen with FF/VI 50/25 and 100/25 μg but not with 200/25 μg. Slight decreases in serum potassium level were only observed in subjects receiving FF/VI 50/25 μg on day 1 and FF/VI 50/25 and 200/25 μg on day 7. Fluticasone furoate accumulation (day 7 vs day 1) for FF/VI 50/25–200/25 μg ranged from 38 to 54% for maximum observed concentration and 63–71% for area under the concentration‐time curve from 0 to 4 hours. Fluticasone furoate pharmacokinetics were less than dose proportional. The VI pharmacokinetic profiles were similar for all three FF/VI doses. Adverse events were all mild in intensity and were reported by 13 (81%) of the 16 subjects.ConclusionIn healthy Chinese subjects, minimal and non–clinically relevant β‐adrenergic pharmacodynamic effects were observed with FF/VI doses ranging from 50/25 to 200/25 μg. FF dose‐dependent reductions in serum cortisol levels of 15–25% were seen after administration of FF/VI 100/25 and 200/25 μg. FF/VI was safe and well tolerated in these subjects at doses ranging from 50/25 to 200/25 μg.

Serum and Salivary Cortisol Levels in Diabetics Attending University of Calabar Teaching Hospital, Calabar, Nigeria

Aims: To investigate if salivary cortisol can be used as an alternative to serum cortisol in the management of diabetes mellitus. Study Design: The design of the study was cross sectional. Place and Duration of Study: Diabetic Clinic of the Department of Internal Medicine and the Department of Chemical Pathology, University of Calabar Teaching Hospital between June 2009 and July 2010. Original Research Article Bassey et al.; BJMMR, 9(7): 1-7, 2015; Article no.BJMMR.19286 2 Methodology: Fifty five (55) type II diabetic patients and thirty three (33) non-diabetic controls (45 men, 43 women; age range 30 69 years) were recruited for this study. The levels of salivary cortisol, serum cortisol, fasting plasma glucose and glycated haemoglobin were determined. Serum and salivary cortisol was determined using enzyme immunoassay; fasting plasma glucose using colorimetric method and glycated haemoglobin using cation-exchange resin separation method. Results: The mean serum and salivary cortisol levels were significantly higher (p=0.000) in diabetics as compared to the controls. The salivary cortisol was about 70% lower than the serum cortisol in each group. There was no significant difference between the percentage difference between the serum and salivary cortisol levels in both the diabetics and controls. There was a significant positive correlation between serum cortisol and salivary cortisol in both the diabetic subjects (r = 0.362, p=0.007) and controls (r =0.406, p= 0.019). Conclusion: Cortisol levels in saliva reflected those in serum in both diabetics and controls therefore salivary cortisol may be used in place of serum cortisol in the management of diabetes.

Neurophysiological response to stress in younger individuals of the modern generation

Introduction: Stress and its response among young adults in the modern generation are not evaluated fully. There is a need to understand the normal physiological changes in the individual in response to a stressor. Serum cortisol and state-trait anxiety inventory (STAI) are most commonly used to assess the quality and quantity of stress in an individual. STAI measures the quantum of stress the person perceives. Serum cortisol measures the neurophysiological response to the stressor. Relationship between STAI and serum cortisol is studied in order assess the stress pattern and its response in the individuals. Materials and Methods: A total of 80 subjects in the age group of 18-24 were included in this study. STAI Questionnaire was administered. Serum cortisol assay was done. Subjects were divided into three groups based on the STAI score. The pattern of serum cortisol was studied in all the groups. Results: The mean age of the participants was 21.5 ± 2.07 years with a range of 18-24 years. The mean values of body mass index were 21.85 ± 4.05 kg/m 2 , serum cortisol was 130.07 ± 64.38 ng/dl, and STAI scores were 46.81 ± 6.15, respectively. The mean difference in serum cortisol level between the groups was found to be statistically significant ( P = 0.016). Negative correlation was seen between STAI scores and serum cortisol in the entire group (r = −0.235, P 50) had increased stress, but mean serum cortisol level was least when compared with other two groups. This indicates that group individuals had experienced more stress, but physiological adaptations in response to stress was insufficient. This is also true in Group 2 who showed similar findings. There is a need for understanding the type of stressor and their intensity in stimulating the appropriate defense mechanism. Accordingly the stress coping techniques has to be inculcated in the young adults of present generation.

Effects of two doses of tramadol on pain and some biochemical parameters in rabbits post-gastrotomy

This study was conducted to evaluate the effect of two doses of tramadol on pain and some biochemical parameters in rabbits post-gastrotomy. Fifteen 6-month-old male rabbits were used for the study. The animals were randomly assigned into three groups of five rabbits each. Physiological (heart rate [HR], respiratory rate [RR], body weight [bw], temperature, blood glucose and serum cortisol) and biochemical (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], blood urea nitrogen [BUN] and creatinine) parameters of all the animals were determined and recorded as the baseline values. Thirty minutes before gastrotomy, groups 1 and 2 were injected subcutaneously with 10 and 20 mg/kg body weight tramadol, respectively, while group 3 was similarly injected with sterile normal saline and served as the control. Anaesthesia was induced in the three groups by intravenous injection of diazepam and ketamine at the doses of 1 and 30 mg/kg, respectively. Gastrotomy was performed by a standard method. The HR, RR, rectal temperature, blood glucose and serum cortisol levels were re-assessed at 0.5, 2, 3, 4 and 5 h post-gastrotomy (hpg). The body weight was re-measured for 14 days post-surgery (dps). Tramadol was re-administered to groups 1 and 2 using the same doses and route as above, twice daily for 3 dpg. Penicillin and streptomycin at the doses of 0.5 and 1 mg/kg bw was given intramuscularly to all the groups, once daily for 5 dpg. Wound swabs were collected at 2 and 5 dpg. The swabs were cultured for isolation and identification of wound-contaminating bacteria following standard methods. The activities of ALT, AST and ALP and the levels of BUN and creatinine were re-assayed at 3 and 6 dpg. The mean blood glucose and serum cortisol levels of the groups increased above their baseline values from 0.5 to 5 hpg. Blood glucose level of groups 1 and 2 significantly (p 0.05) difference occurred when the mean rectal temperature of the groups were compared. At 6 dpg, the activities of ALT, AST and ALP significantly decreased (p 0.05) difference existed when the mean BUN and creatinine of the groups were compared. This study has shown that pre-surgical subcutaneous administration of tramadol at doses of 10 and 20 mg/kg bw can provide adequate analgesia in post-surgical period and has no adverse effect on some biochemical parameters in rabbits.

How does the quality of life and the underlying biochemical indicators correlate with the performance in academic examinations in a group of medical students of Sri Lanka?

BackgroundIndividual variation of examination performance depends on many modifiable and non-modifiable factors, including pre-examination anxiety. Medical students’ quality of life (QoL) and certain biochemical changes occurring while they are preparing for examinations has not been explored.PurposeWe hypothesize that these parameters would determine the examination performance among medical students.MethodsFourth-year medical students (n=78) from the University of Ruhuna, Sri Lanka, were invited. Their pre- and post-exam status of QoL, using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, and the level of biochemical marker levels (i.e., serum levels of thyroid profile including thyroglobulin, cortisol and ferritin) were assessed. Differences between the scores of QoL and serum parameters were compared with their performance at the examination.ResultsThe mean QoL score was significantly lower at pre-exam (56.19±8.1) when compared with post-exam (61.7±7.1) levels (p<0.001). The median serum TSH level prior to the exam (0.9 mIU/L; interquartile range 0.74–1.4 mIU/L) was significantly lower (p=0.001) when compared with the level after the exam (median of 2.7 mIU/L; IQR 1.90–3.60). The mean±SD fT4 level was significantly higher before the exam (19.48±0.4 pmol/L at study entry vs. 17.43±0.3 pmol/L after the exam; p<0.001). Median serum ferritin (SF) level prior to the exam (43.15 (23.5–63.3) µg/L) was significantly lower (p≤0.001) when compared with after-exam status (72.36 (49.9–94.9) µg/L). However, there was no difference in mean serum cortisol levels (16.51±0.7 at pre-exam and 15.88±0.7 at post-exam, respectively; p=0.41).ConclusionsStudents had higher fT4 and low ferritin levels on pre-exam biochemical assessment. It was evident that students who perform better at the examination had significantly higher QoL scores at each domain tested through the questionnaire (Physical health, Psychological, Social interaction and Environment). The higher the QoL scores, the better the grades were. It was also found that students who failed exhibited profound differences in the QoL score.

Evaluation of Salivary Cortisol and Anxiety Levels in Myofascial Pain Dysfunction Syndrome

BackgroundMyofascial pain dysfunction syndrome (MPDS), otherwise called myofascial pain is one of the most common temporomandibular disorders, which in turn is the most common cause of orofacial pain of non-dental origin. Its etiology is multifactorial and still poorly understood. Psychological factors have been shown to play a role in the etiology. The aim of the study was to evaluate the association between anxiety and salivary cortisol levels in patients with myofascial pain.MethodsTwenty patients suffering from myofascial pain were recruited as the study group. The same number of age and sex matched healthy individuals were taken as the control group. The salivary samples collected between 9-9:15 am from both groups were analyzed for cortisol levels with the competitive enzyme-linked immunosorbent assay method. Anxiety levels of 40 patients were measured using Hamilton's anxiety scale.ResultsThe mean serum cortisol level of the MPDS group showed a highly significant difference (p < 0.001) from the controls. The mean anxiety scores of the MPDS group showed a highly significant difference (p < 0.001) from the controls. A positive correlation was found between anxiety and the salivary cortisol levels in MPDS patients.ConclusionsThese findings suggest that anxiety plays a vital role in the etio-pathogenesis of MPDS; thus, besides pharmacological treatment, psychological support is also needed.

Inhaled fluticasone furoate/vilanterol does not affect hypothalamic‐pituitary‐adrenal axis function in adolescent and adult asthma: randomised, double‐blind, placebo‐controlled study

IntroductionFluticasone furoate (FF) is a novel inhaled corticosteroid with 24-h activity. FF is in development as a once-daily treatment for asthma as monotherapy and in combination with vilanterol (VI), a long-acting β2 agonist. Corticosteroids can have systemic effects on hypothalamic-pituitary-adrenal (HPA) axis function, potentially resulting in cortisol suppression.ObjectivesTo assess the effect of FF/VI compared with placebo on the HPA axis by evaluating 24-h weighted mean serum cortisol levels in adolescent and adult patients with persistent asthma.MethodsOne hundred eighty-five patients with >12 weeks history of asthma were randomised in a 4:4:4:1 ratio to one of two once-daily FF/VI treatments (100/25 μg or 200/25 μg), placebo or an active control group that received inhaled placebo plus one prednisolone 10 mg capsule daily for the last 7 days of the study. Twenty-four-hour serum and urinary cortisol was measured at baseline and on day 42.ResultsNon-inferiority in 24-h weighted mean serum cortisol after 6 weeks of treatment with once-daily FF/VI at either strength was shown. Treatment ratios [95% confidence interval (CI)] to placebo for FF/VI 100/25 μg [0.99 (0.87–1.12)] or FF/VI 200/25 μg [0.97 (0.86–1.10)] indicated non-inferiority of both FF/VI doses to placebo as the lower limit of the 95% CI was greater than the predefined 0.8. Prednisolone substantially reduced 24-h weighted mean serum cortisol [treatment ratio to placebo 0.34 (0.28–0.41)]. FF/VI was well-tolerated, and no safety concerns were identified.ConclusionsFF/VI was found to be non-inferior to placebo on HPA axis function, with no indication of significant cortisol suppression after 42 days.

Cortisol is responsible for positive and negative effects in the ovarian maturation induced by the exposure to acute stressors in Nile tilapia, Oreochromis niloticus

The aim of the present study was to evaluate the effect of acute stress and cortisol injection on oocyte final maturation process in female Nile tilapia (Oreochromis niloticus). Handling followed by a prophylactic treatment (0.3 mL L(-1) H(2)O(2), 5 g L(-1) NaCl solution during 30 min) and an environmental change (transfer from a 2 m(3) fibreglass square tank to 50 L aquaria) were used as acute stressors and compared to a single cortisol injection (0.5 or 5 mg kg(-1) body weight). For both acute stress and cortisol injection (0.5 mg kg(-1) body weight), serum cortisol level was significantly increased from 2.3 to 134.1 ng mL(-1) 1 h post-stress/injection and returned to a resting basal value 24 h after the stress/injection. In fish injected with 5 mg kg(-1) body weight cortisol, mean serum cortisol level reached a peak up to 2500 ng mL(-1) 1 h after injection. 63 % of the females (mean body weight: 242 ± 4 g) submitted to the acute stress ovulated within 72 h after the stress. In the same way, cortisol injection (5 mg kg(-1) body weight) at the 10th day of the maturation cycle led to a twofold reduction of the time before ovulation compared to vehicle injected control fish. Relative and total fecundity were significantly decreased in females submitted to an acute stress or cortisol injected at 5 mg kg(-1) body weight, but not fertilization or hatching rates. In conclusion, acute stress and cortisol induction exert both positive and negative effects on the final reproductive process in O. niloticus, and cortisol is the endocrine mediator causing these changes.

Adrenal Insufficiency in Hemodynamically Unstable Neonatesafter Open-Heart Surgery

To investigate if the low dose (1 µg) ACTH stimulation test appropriately assesses adrenal responsiveness in neonates undergoing open-heart surgery requiring cardio-pulmonary bypass. In this retrospective study, adrenal axis response was assessed on the first post-operative day with the low-dose (1 µg) ACTH stimulation test. Age, gender, weight, RACHS category, inotrope score, and baseline and post-stimulation cortisol levels were collected. The association between basal serum cortisol levels and degree of response to the ACTH stimulation test was also investigated. Tertiary care referral center. Twenty-one neonates who underwent neonatal cardiac surgery on cardiopulmonary bypass and underwent an ACTH stimulation test. Interventions. Hydrocortisone 50 mg/m(2) bolus in four divided doses daily. Response to the low dose (1 µg) ACTH stimulation was assessed. All neonates with hemodynamic instability in the immediate post-operative period had low basal serum cortisol levels. The basal mean serum cortisol level for the 21 patients who underwent the low dose ACTH stimulation test was 7.3 µg/dL (median 2.2, range 0.7-42). The mean serum cortisol level increased after the ACTH stimulation test in the 21 patients to 39.6 µg/dL (median 38, range 79-17). The mean inotrope score in the first 24 hours after surgery was 24 (median 17.5, range 7-76.5) and decreased to 17 (median 14, range 5-52.3) 24-48 hours after surgery. At 48 hours post-surgery the mean arterial pressure in the groups with a serum cortisol increase after ACTH stimulation (<30 µg/dL vs. >50 µg/dL) was significantly different (P value 0.026). The low dose (1 µg) ACTH stimulation test is a valid test to assess adrenal responsiveness among neonates after open heart surgery requiring CPB. Traditionally used basal serum cortisol level cutoff of <20 µg/dL used to define relative adrenal insufficiency may not be applicable in neonates undergoing open heart surgery on CPB thus indicating the need for re-defining adrenal insufficiency in this patient population.

Higher cortisol content in hair among long-term unemployed individuals compared to controls

Unemployment and financial strain are chronic stressors that have been shown to be associated with an increase in mean salivary and serum cortisol levels. Hair analysis for cortisol content is a new promising tool by which hair segmental analysis may provide a retrospective calendar of cumulative cortisol exposure over time rather than momentary assessments. Participants of this study were 31 unemployed and 28 employed individuals (46 women). Hair segmental analysis was conducted using 3-cm long segments starting with the scalp-near segment. Due to differing hair length, 52 individuals had values for the second segment and n=33 individuals had values for the third segment. Univariate analysis of variance indicated that unemployed individuals had higher cortisol content in the first (p<0.05, eta(2)=0.071) and second (p<0.05, eta(2)=0.085) hair segment (a total of 6 cm long hair representing the preceding 6 months of collection). Consistent with other data from our laboratory, there was a wash-out effect for the third segment (p<0.05 for segment 3 vs. segment 1 and 2). Unemployed individuals indicated increased levels of perceived stress and impairments in subjective well-being compared to employed individuals. These subjective measures of perceived stress and well-being were unrelated to cortisol content in hair. We conclude that hair analysis for cortisol content may be a valid method to detect differences in cumulative cortisol exposure between chronically stressed individuals and healthy controls. Due to a wash-out effect, retrospective ascertainment of cortisol exposure may be limited to the preceding 6 months of specimen collection.