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Women are more at risk to stress in pregnancy than during the puerperium. One method of coping with stress is through physical exercise. Maryam Exercise can be used as an alternative to the development of pregnancy exercises in Indonesia because it covers the holistic aspects and easy to do. It is a combination of basic pregnancy exercises, Islamic prayer (Salat) movements and dhikr. The purpose of this study was to examine the impact of Maryam exercise on the stress levels and cortisol serum levels among primiparous pregnant women. This study used a quasi-experimental study design, pre-test and post-test with non-equivalent control group. In the third trimester of 40 primiparous women were randomly assigned into two groups such the experimental group (n=20) and the control group (n=20). The experimental group received the Maryam exercise while the control group received the standard antenatal exercise. There was a significant difference in stress levels between the intervention group and the control group before and after receiving the intervention (p

Background: The number of people with mental health problems is still high in the world, especially depression. This incident is triggered by the stress of each individual on an ongoing basis and failure to adapt. Stress regulation is a preventive measure to prevent depression in individuals. Currently, there are many developing uses of essential oils as antistress relaxation therapy. Vetiver essential oil is believed to reduce stress levels. Purpose: This study aimed to determine the effect of using vetiver essential oil with different concentrations and administration periods on changes in cortisol levels. Methods: This study used Rattus norvegicus experimental animals with the Forced Swim Test (FST) as a stressor. Vetiver essential oil concentrations of 10% and 30% were administered with the essential oil preparation given after giving stressor. Stress level in experimental animals was measured from the hormone cortisol in the blood. The method of measuring cortisol in experimental animals was carried out using the Enzyme-Linked Immuno Sorbent Assay (ELISA) method. Results: This study obtained significant results from the Kruskal Wallis statistical test on decreasing cortisol levels in experimental animals by administering vetiver essential oil with 10% concentration. Changes in the cortisol hormone in experimental animals and cortisol levels were not affected by the length of time of administration.

Background: The increasing prevalence of polycystic ovary syndrome (PCOS) in Indonesia reaches 8-10%. Patients with polycystic ovary syndrome are at risk of experiencing complex psychological disorders and decreased well-being. Psychological disorders in polycystic ovary syndrome are at risk of developing physical symptoms and increasing insulin resistance. The Holistic Program consists of a combination of diet yoga and remembrance therapy as an integrated holistic therapy. There is no non-pharmacological therapy that is holistically integrated to reduce serum cortisol levels in polycystic ovary syndrome. This study aimed to examine the effect of holistic programs on cortisol serum levels in polycistic ovarium syndrome. Subjects and Method: This was a randomized controlled trials conducted in Yogyakarta . A sample of 30 women patients with PCOS aged 19-40 years old was selected for this study. The sample was divided into 2 groups. The intervention group received holistic program for 14 days. The dependent variable was cortisol serum. The independent variable was holistic program. Cortisol serum and insulin levels were measure by ELISA method at the Integrated Research and Testing Laboratory, Universitas Gadjah Mada, Yogyakarta. Insulin resistance was calculated using the HOMA IR method. The data were analyzed by independent t-test and different test Paired t-test Results: Serum cortisol levels in the intervention group were lower than the control group. Serum cortisol levels decrease after the implementation of a holistic program. Conclusion: The holistic program that was carried out for 14 days in polycystic ovary syndrome is effective to reduce serum cortisol levels. Keywords: holistic program, cortisol serum, polycystic ovary syndrome Correspondence: Erna Yovi Kurniawati. Masters Program in Applied Midwifery, School of Health Polytechnics, Ministry of Health Semarang. Jl. Tirto Agung, Pedalangan, Banyumanik, Semarang 50239, Central Java. Mobile: +6287739122352. Email: yovi.raharjanto@gmail.com Indonesian Journal of Medicine (2019), 4(4): 376-382 https://doi.org/10.26911/theijmed.2019.04.04.11

Facet joint steroid injections are used to treat chronic low back pain. However, little is known about the systemic absorption and serum levels of steroids following intra-articular facet joint injections. The primary objective of this preliminary study was to investigate the pharmacokinetics of triamcinolone acetonide following fluoroscopically guided intra-articular lumbar facet joint injections in a cohort of patients with chronic low back pain. A secondary aim was to investigate the effects of triamcinolone on serum cortisol levels following lumbar facet joint injections.The study cohort included 5 patients undergoing fluoroscopically guided intra-articular lumbar facet joint injections at a pain medicine specialty clinic. Blood was collected prior to the injections and on days 1, 2, 4, 6, 8, 14, 21, 28, 35, and 42 following the injections.The terminal elimination half-life of triamcinolone in a noncompartmental analysis was 213 hours. The peak median triamcinolone concentration of 3.6 ng/mL was detected within 24 hours after the injections. Serum cortisol levels were30 ng/mL for an average of 4.4 days. The maximum effect of triamcinolone on cortisol suppression was observed with triamcinolone serum levels of1.9 ng/mL.The peak serum concentration of triamcinolone following intra-articular facet joint injections occurred within 24 hours. The median terminal elimination half-life was 213 hours, but baseline cortisol levels were suppressed for an average of 4.4 days. Clinically, the prolonged half-life and endocrine effects of triamcinolone could increase the risk for serious drug-drug interactions in patients taking medications that inhibit corticosteroid metabolism.

Background: Prematurity is one of the leading causes of death in children. In Mexico there is a frequency of 12% of preterm birth and this leads to significant maternal-fetal complications comprising 31.5% of neonatal morbidity and mortality. The patient who receives obstetric care in the gynecology service at the naval medical center requires prevention, diagnosis and treatment of threat of preterm birth to reduce perinatal and neonatal complications. Serum cortisol levels was determined as a prognostic factor for the threat of preterm birth in patients with obstetric care at the Naval Medical Center, it is a relatively easy parameter to obtain and would support a timely treatment.Methods: We used a quantitative, non-experimental, retrospective descriptive study of 30 patients with risk factors to develop preterm birth threats in gynecology service of the naval medical center from January to December 2018, which were taken 3 milliliters of peripheral blood to measure serum cortisol concentrations for later analysis. For statistical analysis of the present study, it was used Shapiro Wilk test. Likewise, Pearson's test was performed to measure the degree of association between the dependent and independent variable. Student's t-test was implemented to compare cortisol levels of pregnant women.Results: A total of 30 patients of these were analyzed, the mean age was 30.4 years (SD±5.184). The gestation weeks the average value was 30.63 weeks (SD±4.781). A student t test was performed where the cortisol values of pregnant women were compared with an average value of 2,586 (95% CI 0.45-472) and a t value=2,476 and a p=0.019 lower value of the significance value of 0.05 rejecting the null hypothesis. Which indicates that cortisol levels can be used as a predictive marker of the threat of preterm birth, considering it as an independent factor for this situation to occur in pregnant patients. The variables of the cortisol level and the weeks of gestation Pearson=-0.061 and a significance of p=0.747 were correlated (there being no strong enough relationship between the study variables). Regarding the triggers, it is observed that the highest factor was for urinary tract infection 40% n=12, abnormal uterine activity 20% n=6, followed by premature membrane rupture 16.7% n=5.Conclusions: The risk factors associated with the threat of preterm birth can be multiple, encompassing them in three important areas such as socioeconomic, psycho-emotional and clinicopathological, of the latter, nine of which are most frequent in our population are urinary infection, abnormal uterine activity and premature rupture of membranes. Regarding the association of cortisol levels as a prognostic factor for the threat of preterm birth taking it into account as an independent factor, it can be concluded that it is not statistically significant, however, according to what is reported in the literature, It should be considered as one of the multiple risk factors, considering this timely premise to boost the development of new research in the field.

BACKGROUND Cosyntropin stimulation testing (CST) is used to screen patients for adrenal insufficiency (AI). Traditionally, CST includes baseline cortisol concentration, the administration of cosyntropin, and cortisol concentration at 30 and 60 minutes poststimulation. There is debate surrounding the utility of testing and cut-off points for concentrations at each time point. OBJECTIVE To determine if a single cortisol measurement at 30 or 60 minutes could replace the traditional approach. DESIGN looked retrospectively at inpatients who underwent standard, high-dose CST (n = 702) and evaluated the number of patients who would screen positive for AI by using a single time point (30 or 60 minutes) compared with the traditional CST. SETTING A tertiary-care, academic medical center. PATIENTS Hospital inpatients present between January 2012 and September 2013. RESULTS Of tests, 84.3% were normal, which was defined as at least 1 cortisol concentration of 18 mcg/dL or higher at any time after stimulation. The average 60-minute concentration was higher than the average 30-minute concentration (P < .001). A single 60-minute concentration is 100% concordant with the full CST in the intensive care unit (ICU) subgroup and 99.6% concordant in floor patients. A single 30-minute concentration is significantly less concordant, 91.9% and 86.9%, in the ICU and floor subgroups, respectively. CONCLUSIONS Overall, a single 60-minute cortisol concentration to screen for AI was 99.7% concordant with the traditional CST, and the positive percent agreement was 98%. Fewer false-positive screens would occur with a single 60-minute cortisol concentration compared with a single 30-minute concentration (P < .001). High-dose CST screening may safely be interpreted with single 60-minute poststimulation cortisol serum concentrations.

Background There is a reduction in the GH-IGF1 axis activity with increasing age, but there is evidence that the pool of GH available for release is not diminished in elderly subjects. We investigated whether there are differences among healthy young-middle aged and old aged subjects in the 24 hour secretory profiles of GH and IGF1. Methods The study was carried out on 15 healthy young-middle aged subjects (age range 36–55 years) and 15 healthy old aged subjects (age range 67–79 years). GH, IGF1, melatonin and cortisol serum levels were measured on blood samples collected every four hours for 24 hours. The fractional variation between single time point GH and IGF1 serum levels, mean photoperiod (06:00h–10:00h–14:00 h) and scotoperiod (18:00h–22:00h–02:00 h) values and the presence of circadian rhythmicity were evaluated. Results A normal circadian rhythmicity was recognizable for GH, melatonin and cortisol secretion in young-middle aged and old aged subjects, MESOR of cortisol was higher in the elderly ( P = 0.002 ) and the acrophase of cortisol was advanced in the group of old aged subjects ( P = 0.03 ), whereas the amplitude of IGF1 was higher in the group of young-middle-aged subjects ( P 0.01 ). Old aged subjects presented higher mean GH levels in the photoperiod ( P = 0.01 ), but lack of variability of GH and IGF1 fractional variations, whereas young-middle aged subjects presented significant variability of GH and IGF1 factional variations ( P = 0.05 and P = 0.003, respectively) and increased fractional variation of nocturnal GH and IGF1 serum levels in respect to older subjects ( P = 0.03 and P = 0.05, respectively). There was no statistically significant difference between mean melatonin serum levels in the photoperiod ( P = 0.937) and in the scotoperiod (P = 0.494) . There was no statistically significant difference between mean cortisol serum levels in the photoperiod (P = 0.235) , whereas mean cortisol serum levels were higher in old aged subjects in the scotoperiod (P = 0.04) . Linear regression evidenced a statistically significant negative trend between age and the 24 h mean of GH (P 0.01) and a statistically significant positive trend between age and the 24 h mean of cortisol (P 0.001). Conclusions Aging is associated with an altered pattern of GH secretion and IGF1 production.

Epidemiological studies have implicated maternal protein-calorie deficiency as an important public health problem in developing countries. Over the last decades, a remarkable diffusion of electricity and an increased level of the electromagnetic field (EMF) in the environment have characterized modern societies. Therefore, researchers are concerned with the biological effects of 50-60 Hz, EMF. The aim of this paper is to show the effects of EMF of 60 Hz, 3 μT, exposure for two hours per day in the regulation of the hormonal and metabolic concentrations in pregnant rats, which were fed by Regional Basic Diet (RBD) during their pregnancy as compared with pregnant rats fed a standard diet. Pregnant rats exposed to EMF of 60 Hz, 3 μT, over the pregnancy and fed with RBD presented an increase in glucose release when compared with the Group subjected only to the RBD ration. Rats fed RBD presented a decrease in their insulin and cortisol serum levels when compared with the Group fed with casein. The T3 and T4 concentrations presented the greatest variation among the Groups. The relation T4:T3 was much exaggerated in the Group subjected to RDB and exposed to EMF when compared to the others. In conclusion, the group subjected to the association of EMF and undernutrition suffered a decrease in its serum concentration of T4 and T3 when compared to the well-nourished group and the relationship T4:T3 in the former group was almost eighteen-fold the later one.

The accurate measurement of steroid hormones is the fulcrum of modern endocrinology. Our aim was to develop a mass spectrometry coupled with a liquid chromatographic method for 17-hydroxyprogesterone, androstenedione, 11-desoxycortisol, 21-desoxycortisol and cortisol serum quantification simultaneously. The samples were submitted to isotopic internal standards addition, protein precipitation and two dimensional liquid chromatography consisting of trapping column and reverse-phase C18 analytical column following atmospheric pressure chemical ionization and mass spectrometry detection. For all compounds tested functional sensitivity was less than 0.5 ng/mL, precision was less than 15%, recovery ranged from 93% to 120%, linearity ranged from 89% to 111%, and accuracy was considered adequate. In conclusion, we developed a suitable, fast and reliable method for simultaneous routine measurement of 17-hydroxyprogesterone, androstenedione, 11-desoxycortisol, 21-desoxycortisol and cortisol in serum.

It is postulated that clinical benefit of low-dose hydrocortisone in septic shock is related to reversal of relative adrenal insufficiency [1]. This was proved in an animal model of sepsis.

UNLABELLED This work provides results of therapeutic efficacy testing and clonidine toleration in moderating of perioperative tachicardia and hypertension, as well as reducing the needs for anaestathic drugs, thus providing better patients' cardiovascular stability. MATERIAL AND METHODS The study involved 60 patients, that were subdued to elective non-cardiosurgical operations in general anaesthesia. One half of the patients was administred the Clonidine, 0.2 microg/kg/min in solution, while the other half served as a control group. RESULTS of the study it was evident that the Clonidine group had considerably less stress response, which was shown through variaton of cortisol levels during operation, glicemy levels and vital parameters. There was a statisticly significant difference (p < 0.001) in cortisol serum levels and glicemy beetwen these two groups. Complications during anesthesia were fewer in the Clonidine group, and the consumption of anesthetic drugs was also lower. CONCLUSION Clonidine effects were favourable during anaesthesia.

Backgrounds: Etomidate is one of anesthetic agent which has minimal effect on cardiovascular function. However, etomidate depress cortisol production. Vitamin C is one of the agent that hamper the effect of etomidate toward cortisol production. Objectives: To analyze the effect of pre-treatment with vitamin C 200 mg on cortisol serum concentration in elective surgery under general anesthesia. Method: This double blind, Randomized Controlled Trial with 30 subjects which divided into two groups (n=15), control group and treatment group which received etomidate 0,2 mg/kgBW and combination of etomidate and vitamin C 200 mg in pre-operation respectively. Each group was then examined for cortisol serum concentration pre-anesthesia, 2 hours post induction, and 8 hours post induction. Wilcoxon Signed Rank Test and Paired T Test was performed to compare cortisol serum concentration in each group. While Mann Whitney and Independent Sample T Test was used to compare between control and treatment group. Results: Cortisol serum concentration in control group between pre-anesthesia ;244,15 (181,39-382,75)] and 2 hours post induction [185,52 ± 35,88]; and between 2 hours and 8 hours post induction [349,81 ± 121,28] was significantly different with value 0,002 and 0,000 respectively. It showed that decrement of etomidate dosage mo 0,2 mg/kgBW still able to decrease cortisol serum production significantly. However, in treatment group cortisol serum concentration pre-anesthesia [258,49 1"5,45-369,09)] and 2 hours post induction [202,14 ± 45,3]; and between 2 hours and 8 hours post induction [251,39 ± 122,91] was non significant, with p value 0,256 and 0,691 respectively. It proved the negative effect of vitamin C on cortisol depression effect of etomidate. Cortisol serum concentration between control and treatment group was significantly different on 2 hours post induction, but non significant on 8 hours post induction. It showed that the negative effect of vitamin C in cortisol depression because of etomidate only significant during 8 hours post eduction Conclusions: The effect of Vitamin C 200 mg iv 30 minutes pre-operation can minimize Cortisol depression on administration of etomidate 0,2 mg/kgBW Keywords : Pretreatment, vit c 200 mg, cortisol serum, etomidate ABSTRAK Latar Belakang: Etomidat adalah salah satu agen anestesi yang berefek minimal terhadap kardiovaskular. Namun, etomidat mendepresi produksi kortisol. Salah satu agen yang dapat meminimalisir efek depresi tersebut adalah vitamin C. Tujuan: Tujuan penelitian ini adalah menganalisis pengaruh pretreatment vitamin C 200 mg pada operasi elektif dengan anestesi umum terhadap kadar kortisol serum. Metode: penelitian ini merupakan penelitian Randomized Contolled Trial dengan 30 subjek yang dibagi dalam dua kelompok sama besar (n=15), yaitu kelompok kontrol yang menerima etomidat 0,2 mg/kgBB dan kelompok perlakuan yang menerima etomidat dan vitamin C 200 mg iv preoperasi. Masing-masing kelompok tersebut selanjutnya diperiksa kadar kortisolnya pre anestesi, 2 jam pasca induksi, 8 jam pasca induksi. Uji statistik Wilcoxon Signed Rank Test dan Paired T Test digunakan untuk membandingkan kadar kortisol di masing-masing kelompok. Uji Mann Whitney dan Independent Sample T Test digunakan untuk membandingkan antar kelompok kontrol dan perlakuan. Hasil: Hasil penelitian menunjukkan pada kelompok kontrol, kadar kortisol preanestesi 244,15 dan 2 jam pasca induksi 185,52 + 35,88 berbeda bermakna (p=0,002). Begitu pula antara kadar 2 jam dengan 8 jam pasca induksi 349,81 + 121,28 (p=0,000). Sedangkan pada kelompok perlakuan, kadar kortisol antara pre anestesi 258,49 (175,45-369,09) dan 2 jam pasca induksi 202,14 + 45,3 tidak berbeda bermakna (p=0,256), begitu pula 2 jam pasca induksi dengan 8 jam pasca induksi 251,39 + 122,91 (p=0,691). Kesimpulan: Dari penelitian ini dapat disimpulkan bahwa pemberian vitamin C 200 mg intra vena 30 menit pre operasi dapat menurunkan efek depresi kortisol oleh pemberian etomidat 0,2 mg/kgBB. Kata kunci : pretreatment, vit c 200 mg, cortisol serum, etomidat

To determine the influence of age, gestational age, gender and methodological protocol on serum 17OHP and cortisol concentrations. 17OHP in non-extracted (NE) and extracted (E) sera was measured by RIA in 319 full-term (FT) (1 d-5 yr) infants, 38 pre-term (PT) and in 19 neonates with classical CAH at diagnosis. 17OHP (NE- and E-) decreased with age in normal children. The extraction procedure significantly reduced 17OHP by eliminating interfering steroids in children < 1 year. Sexual dimorphism was only observed in NE-17OHP. 17OHP in PT was always higher than in FT up to 2 months of age (p < 0.001). Neither NE- nor E-17OHP in CAH overlapped with those of FT or PT (p < 0.001) allowing to omit the extraction procedure to confirm CAH diagnosis. Cortisol levels were within normal range in neonates with CAH, thus not adding useful information about adrenal function. Chronological and gestational age, gender, and extraction for 17OHP measurement are important factors to know when assessing adrenal function during the first year of life.

Psychologically stressful events have been reported to elevate nerve growth factor (NGF) serum concentrations. NGF and cortisol serum concentrations were measured in 20 healthy male volunteers before (3 p.m.) and after (5 p.m.) an academic oral presentation and on a control day. Cortisol showed a significant overall change (p=0.001), i.e. cortisol serum concentrations were increased on the lecture day at 3 p.m. (p=0.007; 155%) and at 5 p.m. (p=0.001; 175%) as compared with the control day. In contrast to cortisol no significant differences among the four serum NGF measurements was detected (Chi-quadrat 2.94, df=3, p=0.401), i.e. the NGF serum concentrations remained unchanged on the lecture day at 3 p.m. (p=0.279) and at 5 p.m. (p=0.627) as compared with the control day. We conclude that NGF serum levels do not change during acute stress, at least after this type of stressor.

Leukocyte subsets, serum cortisol and immunoglobulin production were investigated in a group of 12 migraine without aura patients, 12 chronic tension-type headache patients and compared with findings in 12 healthy controls. Chronic tension-type headache patients had statistically significant increased levels of B-lymphocytes (CD19 + cells) ( p < 0.05), while migraine sufferers had a similarly significant decrease in CD8 + T-lymphocytes ( p < 0.05). Migraine patients also had an increased percentage of B-lymphocytes although this failed to reach statistical significance. Immunoglobulin production and cortisol serum levels did not differ in the two headache groups. We conclude that the observed abnormalities in tension-type headache and migraine are unlikely to be a consequence of pain or of hypothalamic-pituitary-adrenal axis dysfunction.

– A double-blind cross-over study on the neuroendocrine and behavioural effects of naloxone, 10 mg/day, was performed in 12 male, acute and chronic schizophrenic patients, currently treated with neuroleptic drugs. The opiate antagonist was ineffective on prolactin, but increased β-endorphin and cortisol serum levels. Treatment over 5 days did not change psychotic behaviour in any of the patients.