Children's preoperative stress according to the parental presence evaluated by salivary cortisol and mYPAS: quasi-randomized trial / Estresse pré-operatório em crianças de acordo com a presença dos pais avaliada por cortisol salivar e mYPAS: ensaio quase-randomizado / Estrés preoperatorio en niños según la presencia de los padres evaluado mediante cortisol salival y mYPAS: ensayo cuasi-aleatorio

ABSTRACT Objective: The main objective of this study was to compare stress and anxiety levels in children undergoing surgical procedures with or without parental presence at induction of anesthesia by measuring salivary cortisol levels and applying the mYPAS. Method: Quasi-randomized trial with children aged 5-12 year, with ASA physical status I, II, or III, undergoing elective surgery. According to parents' willingness, the pair were defined as accompanied or unaccompanied group. Chi-square, Fisher's exact tests, Student's t test, Mann-Whitney, Hodges-Lehman and Spearman's tests were used for statistical analyzes. Results: We included 46 children; 63% were preschool children mostly accompanied by their mothers (80%). The median mYPAS score was 37.5 (quartile range, 23.4-51.6) in unaccompanied children, and 55.0 (quartile range, 27.9-65.0) in accompanied children, with an estimated median difference of +11.8 (95% CI of 0 to 23.4; p = 0.044). There were no significant differences in the mean salivary cortisol levels. Conclusion: The level of anxiety was higher in accompanied children. There were no differences in salivary cortisol levels between both groups. Brazilian Registry of Clinical Trials (ReBEC):RBR-9wj4qvy.

RESUMO Objetivo: O principal objetivo deste estudo foi comparar os níveis de estresse e ansiedade em crianças submetidas a procedimentos cirúrgicos com ou sem presença dos pais na indução da anestesia, medindo os níveis de cortisol salivar e aplicando o mYPAS. Método: Ensaio quaserandomizado com crianças de 5 a 12 anos, com estado físico ASA I, II ou III, submetidas a cirurgia eletiva. De acordo com a disposição dos pais, o par foi definido como grupo acompanhado ou não acompanhado. Foram utilizados testes de qui-quadrado, exato de Fisher, t de Student, Mann-Whitney, Hodges-Lehman e Spearman para as análises estatísticas. Resultados: Foram incluídas 46 crianças; 63% delas em idade préescolar, principalmente acompanhadas por suas mães (80%). A pontuação mYPAS mediana foi de 37,5 (intervalo interquartil, 23,4-51,6) em crianças não acompanhadas e de 55,0 (intervalo interquartil, 27,9-65,0) em crianças acompanhadas, com uma diferença mediana estimada de +11,8 (IC de 95% de 0 a 23,4; p = 0,044). Não houve diferenças significativas nos níveis médios de cortisol salivar. Conclusão: O nível de ansiedade foi maior em crianças acompanhadas. Não houve diferenças nos níveis de cortisol salivar entre os dois grupos. Registro Brasileiro de Ensaios Clínicos (ReBEC):RBR-9wj4qvy.

RESUMEN Objetivo: El objetivo principal de este estudio fue comparar los niveles de estrés y ansiedad en niños sometidos a procedimientos quirúrgicos con o sin presencia de los padres en la inducción de la anestesia mediante la medición de los niveles de cortisol salival y la aplicación del mYPAS. Método: Ensayo cuasi-aleatorio con niños de 5 a 12 años, con estado físico ASA I, II o III, sometidos a cirugía electiva. Según la disposición de los padres, se definieron como grupo acompañado o no acompañado. Se utilizaron pruebas de chi-cuadrado, exacta de Fisher, t de Student, Mann-Whitney, Hodges-Lehman y Spearman para los análisis estadísticos. Resultados: Se incluyeron 46 niños; el 63% eran niños en edad preescolar, en su mayoría acompañados por sus madres (80%). La puntuación mYPAS mediana fue de 37,5 (rango intercuartílico, 23,4-51,6) en niños no acompañados y de 55,0 (rango intercuartílico, 27,9-65,0) en niños acompañados, con una diferencia mediana estimada de +11,8 (IC del 95% de 0 a 23,4; p = 0,044). No hubo diferencias significativas en los niveles medios de cortisol salival. Conclusión: El nivel de ansiedad fue mayor en los niños acompañados. No hubo diferencias en los niveles de cortisol salival entre ambos grupos. Registro Brasileño de Ensayos Clínicos (ReBEC):RBR-9wj4qvy.

Normal ambulatory blood pressure in young adults with 21-hydroxylase enzyme deficiency undergoing glucocorticoid replacement therapy

ABSTRACT Objective: Herein, we compared ambulatory blood pressure (ABP) between young adults with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase enzyme (21OHase) deficiency and a control group. Additionally, we analyzed correlations between the glucocorticoid dose and androgen levels and ABP parameters. Subjects and methods: This case-control study included 18 patients (6 males and 12 females) and 19 controls (8 males and 11 females) matched by age (18-31 years). ABP monitoring was used to estimate blood pressure (BP) over a 24-h period. Results: No difference was noted between patients and controls in terms of systolic BP (males, 115.5 ± 5.6 vs. 117.0 ± 9.3, P = 0.733; and females, 106.4 ± 7.9 vs. 108.4 ± 7.6, P = 0.556, respectively) and diastolic BP during 24 h (males, 62.8 ± 7.5 vs. 66.2 ± 5.6, P = 0.349; and females, 62.7 ± 4.9 vs. 62.3 ± 4.9, P = 0.818, respectively). Systolic and diastolic BP and pulse pressure during daytime and nocturnal periods were similar between patients and controls. Furthermore, no differences were detected in the percentage of load and impaired nocturnal dipping of systolic and diastolic BP between patients and controls during the 24-h period. Additionally, the glucocorticoid dose (varying between r = −0.24 to 0.13, P > 0.05) and androgens levels (varying between r = 0.01 to 0.14, P > 0.05) were not associated with ABP parameters. Conclusion: No signs of an elevated risk for hypertension were observed based on ABP monitoring in young adults with CAH attributed to 21OHase deficiency undergoing glucocorticoid replacement therapy.

Cerebrospinal fluid levels of hypothalamic-pituitary-adrenal axis hormones in MCI and dementia due to Alzheimer's disease: a systematic review / Níveis dos hormônios do eixo hipotálamo-pituitária-adrenal no líquido cefalorraquidiano de pacientes com CCL e demência devido à doença de Alzheimer: uma revisão sistemática

ABSTRACT Underlying the neuropsychological manifestations of Alzheimer's disease (AD), hypothalamic-pituitary-adrenal (HPA) axis dysregulation and subsequent hypercortisolemia have been proposed as major mechanisms driving AD progression from mild cognitive impairment (MCI) to the onset of dementia. Nonetheless, changes in cerebrospinal fluid (CSF) levels of HPA axis hormones remain controversial despite their potential in AD diagnosis and prognosis testing. Objective: This study aimed to review the evidence of the variation in CSF levels of CRH, ACTH, and cortisol in subjects with mild cognitive impairment (MCI) and AD compared with subjects without cognitive disorders. Methods: A systematic review was conducted in MEDLINE, EMBASE, and Web of Science databases on July 5, 2022. Results: Seventeen observational studies were included. The results from the compiled investigations showed that individuals with AD exhibit a significant elevation of CSF cortisol levels which appear to correlate with the presence of the ApoE-ε4 allele, being higher in those homozygous for this allele. The variation of CSF CRH and ACTH levels in AD, on the other hand, is still inconclusive. Moreover, most studies found no significant difference in CSF cortisol levels in individuals with MCI compared to healthy subjects and patients with AD. Conclusion: The findings gathered in this review disclose a significant elevation of CSF cortisol levels in AD. Future investigations are warranted to elucidate the potential use of CSF cortisol as a biomarker in AD-associated dementia.

RESUMO Subjacentes às manifestações neuropsicológicas da doença de Alzheimer (DA), a desregulação do eixo hipotálamo-pituitária-adrenal (HPA) e a subsequente hipercortisolemia foram propostas como mecanismos principais que conduzem a progressão da DA desde o comprometimento cognitivo leve (CCL) até o início da demência. No entanto, as alterações nos níveis do líquido cefalorraquidiano (LCR) dos hormônios do eixo HPA permanecem controversas, apesar de seu potencial no diagnóstico da DA e nos testes de prognóstico. Objetivo: Este estudo teve como objetivo revisar as evidências da variação nos níveis de CRH, ACTH e cortisol em indivíduos com comprometimento cognitivo leve (CCL) e DA em comparação com indivíduos sem distúrbios cognitivos. Métodos: Uma revisão sistemática foi realizada nas bases de dados MEDLINE, EMBASE e Web of Science em 5 de julho de 2022. Resultados: Dezessete estudos observacionais foram incluídos. Os resultados compilados mostraram que os indivíduos com DA apresentam uma elevação significativa dos níveis de cortisol no LCR que parecem correlacionar-se com a presença do alelo ApoE-ε4, sendo maior nos homozigotos para este alelo. A variação dos níveis de CRH e ACTH no LCR na DA, por outro lado, ainda é inconclusiva. Além disso, a maioria dos estudos não encontrou diferença significativa nos níveis de cortisol no LCR em indivíduos com CCL em comparação com indivíduos saudáveis e pacientes com DA. Conclusão: Os resultados reunidos nesta revisão revelaram uma elevação significativa dos níveis de cortisol no LCR na DA. Investigações futuras são necessárias para elucidar o uso potencial do cortisol no LCR como biomarcador na demência associada à DA.

Crisis adrenal neonatal secundaria a hipoplasia hipofisaria / Neonatal Adrenal Crisis Secondary to Pituitary Hypoplasia

Introducción: La insuficiencia adrenal hipotálamo hipofisaria usualmente se manifiesta secundaria a tumores y, cuando resulta congénita se asocia, con frecuencia, con otras deficiencias hormonales. La crisis adrenal suele presentarse en su debut y puede resultar potencialmente mortal. Objetivo: Examinar el caso de una paciente con insuficiencia adrenal central que debutó con una crisis adrenal congénita. Presentación del caso: Recién nacida a término, padres no consanguíneos, hospitalizada a los 9 días de vida por clínica de una semana con múltiples episodios eméticos y apnea. Ingresó con deshidratación severa, hipotensa y estuporosa. Además, se encontró acidosis metabólica severa, hipoglucemia persistente, hiponatremia e insuficiencia prerrenal. Ante la no mejoría de su estado hemodinámico, a pesar del uso de cristaloides y vasopresores, finalmente mejoró con la administración de dosis altas de hidrocortisona. El diagnóstico de deficiencia de cortisol de origen central se realizó con un test dinámico de insulina y la resonancia magnética nuclear hipofisaria. Conclusiones: La crisis adrenal se debe tener presente como diagnóstico diferencial en episodios agudos con inestabilidad hemodinámica persistente e hipoglucemia de difícil manejo. Adicionalmente, hay que considerar que existen otras causas menos comunes de insuficiencia adrenal en neonatos como la hipoplasia hipofisaria(AU)

Introduction: Hypothalamic-pituitary adrenal insufficiency usually manifests secondary to tumors and, when congenital, is often associated with other hormonal deficiencies. Adrenal crisis usually occurs at its onset and can be life threatening. Objective: To review the case of a patient with central adrenal insufficiency who had an onset with a congenital adrenal crisis. Case presentation: Term newborn, non-consanguineous parents, hospitalized at 9 days of life for a week-long clinical presentation with multiple emetic episodes and apnea. She was admitted with severe dehydration, hypotensive and stuporous. In addition, severe metabolic acidosis, persistent hypoglycemia, hyponatremia and prerenal failure were found. Given the lack of improvement of her hemodynamic status, despite the use of crystalloids and vasopressors, she finally improved with the administration of high doses of hydrocortisone. The diagnosis of cortisol deficiency of central origin was made with a dynamic insulin test and pituitary nuclear magnetic resonance imaging. Conclusions: Adrenal crisis should be kept in mind as a differential diagnosis in acute episodes with persistent hemodynamic instability and difficult-to-manage hypoglycemia. Additionally, other less common causes of adrenal insufficiency in neonates, such as pituitary hypoplasia, should be considered(AU)

Effect of maternal cortisol levels on fetal heart rate patterns in primiparous pregnant women in the third trimester

SUMMARY OBJECTIVE: This study aimed to determine whether maternal cortisol levels affect fetal heart rate patterns in primiparous pregnant women in the third trimester. METHODS: This cross-sectional descriptive study included 400 primiparous pregnant women with uncomplicated pregnancies between November and December 2022. The study included primiparous pregnant women over 18 years old in the third trimester who had not exercised for at least 2 h before the fetal heart rate monitoring and had a healthy pregnancy without consuming any food or drink. Fetuses with decelerating heartbeats and pregnant women who showed uterine contraction and cervical dilation during the fetal heart rate monitoring were excluded from the study. Research data were collected with the data collection form. The fetal heart rate data were collected using a cardiotocograph. At least two accelerations during the 20-min nonstress test period were the basis for diagnosing a reactive nonstress test. About 5 mL of maternal saliva for cortisol measurements was collected before fetal heart rate monitoring. Research data were analyzed with IBM SPSS Statistics for Macintosh, Version 28.0. A p-value of <0.05 was considered significant. RESULTS: There were no significant differences in the comparison of the groups in terms of education and income status, family type, fetal gender, pregnancy planning status, BMI and age averages, or gestational week averages (p>0.05). The number of at least two accelerations required for the diagnosis of reactive NST was also higher in Group 1 (maternal salivary cortisol level ≤24.20). A moderately positive relationship between fetal heart rate and maternal salivary cortisol was observed (r=0.448, p=0.000). In total, 11.9% of the total change in fetal heart rate level is explained by maternal cortisol (R2=0.119). Maternal cortisol increases fetal heart rate level (ß=0.349). CONCLUSION: These findings suggest that stress in primiparous pregnant women with high cortisol levels may influence fetal heart rate patterns. It was revealed that the increase in cortisol level, considered a stress hormone, may be a harbinger of fetal tachycardia.

Tipos de partos y niveles de oxitocina, cortisol y hormonas tiroideas en plasma del cordón umbilical / Types of deliveries and levels of oxytocin, cortisol and thyroid hormones in umbilical cord plasma

Introducción: La placenta sintetiza y secreta varias hormonas que permiten la regulación del embarazo, el trabajo de parto y la adaptación metabólica materno-fetal. Su comportamiento asociado al tipo de parto puede dar información relevante sobre efectos epigenéticos. Objetivo: Describir el tipo de parto con los niveles de oxitocina, cortisol y hormonas tiroideas en plasma de cordón umbilical al nacer. Método: A 50 mujeres con embarazos principalmente normales se les cuantificaron los niveles neurohormonales en plasma de cordón umbilical, obtenido inmediatamente tras el periodo expulsivo. Los resultados se incorporaron a la base de datos clínicos de cada participante y se analizaron con Stata v.14.0. El protocolo fue aprobado por el comité de ética. Resultados: Hubo 33 partos vaginales (12 espontáneos, 13 acelerados y 8 inducidos) y 17 cesáreas (7 electivas y 10 de urgencia). Se observaron mayores niveles de cortisol en los partos vaginales acelerados; las cesáreas tuvieron menores niveles de cortisol y hormona estimulante de la tiroides. Las intervenciones clínicas, con altos o bajos niveles hormonales, están en directa relación con el tipo de parto. Conclusiones: El cortisol y la hormona estimulante de la tiroides medidos en plasma de cordón umbilical variaron según el tipo de parto. Esto es una primera cuantificación de hormonas en plasma de cordón umbilical y su posible regulación placentaria a propósito del tipo de parto.

Introduction: The placenta synthesizes and secretes several hormones allowing the regulation of pregnancy, labor and maternal-fetal metabolic adaptation. Their behavior associated with the type of delivery, may provide relevant information on epigenetic effects. Objective: To describe the type of delivery with the levels of oxytocin, cortisol and thyroid hormones in umbilical cord plasma at birth. Method: Neurohormonal levels from umbilical cord plasma obtained immediately post expulsion, were quantified in 50 women with mainly normal pregnancies. Results incorporated into the clinical database of each participant, statistically analyzed in Stata v.14.0. Protocol approved by ethics committee. Results: 33 were vaginal deliveries (12 spontaneous, 13 accelerated, 8 induced) and 17 cesarean sections (7 elective and 10 emergency). Higher cortisol levels were observed in accelerated vaginal deliveries, cesarean sections had lower cortisol and thyroid stimulating hormone levels. While clinical interventions, with high or low hormone levels, were related to the type of delivery. Conclusions: Cortisol and thyroid stimulating hormone measured in umbilical cord plasma varied according to the type of delivery. This is a first quantification of hormones in umbilical cord plasma and their possible placental regulation in relation to the type of delivery.

Advances in Hormone Replacement Therapy for Adult Adrenal Insufficiency / 罕见病研究

Adrenal insufficiency is a disease characterized by insufficient secretion of adrenocortical hormones, usually treated with glucocorticoid replacement therapy. The routine drugs have two forms-short-acting and long-acting. The shorter one should be taken 2-3 times a day resulting hormone level of patients fluctuating greatly within a day. Although long-acting drugs reduce the frequency of administration, it is easy to lead to excessive replacement, resulting in adverse effects on metabolism. New alternative treatments for adult patients have emerged, including modified-release hydrocortisone and hydrocortisone subcutaneous infusion pumps. In this review, we briefly introduce these new therapies, emphasizing the pharmacodynamics and pharmacokinetics of the replacement, the effects on metabolism and drug safety, aiming at contributing to the future clinical practice.

Evaluation of effect of horticultural therapy on improving mental health in university students / 中国学校卫生

Objective@#To investigate the effectiveness of horticultural therapy on improving university students mental health problems and to provide evidence to support the application of horticultural therapy in the prevention and treatment of university students mental health.@*Methods@#From March to May 2022,a before-and after paired design was used with a blank control group, mental health screening abnormalities were recruited from a comprehensive university in Hebei Province, including 57 in the intervention group and 21 in the control group, and the Symptom Checklist-90(SCL-90) score and hair cortisol were included as outcome indicators, which was measured by enzyme linked immunoassay Elisa double antibody sandwich method.@*Results@#The total SCL-90 scores of the intervention group decreased ( t=4.28, P <0.01) and were significantly lower compared with the control group( t=-2.66, P <0.01), while no significant difference was observed in the control group( t=0.29, P >0.05), and the difference between the pre and post measures on each dimension of the SCL-90 was significantly lower in the intervention group (all P <0.01); the difference between the pre and post measures of hair cortisol contentration in the intervention group was statistically significant( Z= -2.75, P <0.05), and the hair cortiso contentration in pre measure group was lower than that of control group( Z=-3.48, P < 0.01 ). In contrast, the difference between pre and post measurements of hair cortisol in the control group was not significant( Z= -0.75 , P >0.05).@*Conclusion@#Horticultural therapy can improve the psychological symptoms of university students is suitable for psychological interventions in the university population and is beneficial to the health and well being of university students.

Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants：a meta-analysis / 中国药房

OBJECTIVE To systematically evaluate the efficacy and safety of prophylactic use of low-dose hydrocortisone （HC） for the prevention and treatment of bronchopulmonary dysplasia （BPD）， and to provide evidence-based reference for clinical treatment. METHODS PubMed， Embase， Web of Science， Cochrane Library， CJFD， VIP and Wanfang databases were searched by computer； randomized controlled trials （RCT） about prophylactic use of low-dose HC （trial group） versus placebo or dopamine （control group） in very premature infants were collected from the establishment of the database to Jun. 2022. The quality of the included literature was evaluated by using bias risk assessment tool recommended by Cochrane system evaluator’s manual （version 6.2） after screening the literature and extracting the data. Meta-analysis， sensitivity analysis and publication bias analysis were carried out with RevMan 5.3 statistical software. RESULTS A total of 1 437 very premature infants were included in 9 RCTs. Meta- analysis showed that the incidence of BPD [OR＝0.75， 95%CI（0.58，0.95）， P＝0.02] and fatality [OR＝0.72， 95%CI （0.54， 0.97）， P＝0.03] in trial group were significantly lower than control group； the survival rate without BPD [OR＝1.36， 95%CI （1.06，1.74）， P＝0.02]， the incidences of gastrointestinal perforation [OR＝2.23， 95%CI （1.31，3.78）， P＝0.003] and sepsis [OR＝ 1.27， 95%CI （1.01，1.60）， P＝0.04] in trial group were all significantly higher than control group. There was no significant difference in the incidence of necrotizing enterocolitis， paraventricular leukomalacia， intraventricular hemorrhage， patent ductus arteriosus， hyperglycemia， pneumothorax， retinopathy of premature infants between the two groups （P＞0.05）. Results of sensitivity analysis showed that study results were robust. Results of publication bias analysis showed that there was little possibility of publication bias in this study. CONCLUSIONS The early prophylactic use of low-dose HC can reduce BPD in very premature infants， reduce fatality， and improve the survival rate without BPD， but we should pay attention to gastrointestinal perforation and sepsis.

The predicting indices for the outcome of refractory septic shock in preterm infants / 中国新生儿科杂志

Objective:To study the predictive value of vasoactive-inotropic score (VIS), fluid overload (FO) and lactate level for the outcome of preterm infants with refractory septic shock.Methods:Preterm infants diagnosed with refractory septic shock and required hydrocortisone treatment in our Department from January 2016 to December 2021 were analyzed retrospectively. Preterm infants were assigned into three gestational age groups (<28 weeks, 28-31 weeks, 32-36 weeks). According to the outcome of the disease, the children were further divided into good prognosis group and poor prognosis group. The relationship between the maximum VIS, FO and the mean lactic acid before hydrocortisone and the outcome of refractory septic shock was analyzed by receiver operating characteristic (ROC) curve, the cut-off point of ROC curve was calculated to obtain the predictive efficacy of the three indicators for the outcome of refractory septic shock in preterm infants.Results:A total of 50 preterm infants with refractory septic shock and received hydrocortisone treatment were enrolled, including 20 in the good prognosis group and 30 in the poor prognosis group. There were no significant differences in the maximum VIS, FO and mean lactic acid before hydrocortisone treatment between the two groups of gestational age of <32 weeks ( P> 0.05). The maximum VIS, FO and mean lactic acid of gestational age of 32-36 weeks in the poor prognosis group were higher than those in the good prognosis group, VIS: 56.1±15.7 vs. 37.1±12.9, FO (%): 108.2 (78.6,137.7) vs. 55.5 (10.3, 100.7), and mean lactic acid (mmol/L): 8.3 (4.6, 12.0) vs. 4.8 (-0.8, 10.5), all P<0.05. The area under the ROC curve of the mean lactic acid was the largest, the cut-off value was 4.1 mmol/L, and the Youden index was 1.732. Conclusions:VIS, FO and lactate level are difficult to be used for determining the outcome of refractory septic shock in preterm infants of <32 weeks. While the mean lactic acid has the best predictive performance in preterm infants of 32-36 weeks.

No obvious symptoms in acute (eltroxin) thyroxine poisoning in euthyroid – A case report

Levothyroxine (T4) (Eltroxin) poisoning is a rare clinical entity which is usually asymptomatic. It can occur accidently, mostly in children, and can happen intentionally in adults with suicidal intention especially psychiatric patients. Thyrotoxicosis from an overdose of medicinal thyroid hormone is a condition that may be associated with a significant delay in onset of toxicity. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In this case report, we present a patient who ingested high doses of levothyroxine i.e., 90 tab. of Eltroxin 100 mcg, for suicidal intension and admitted to intensive care unit. She is an euthyroid person but took these tablets, which her mother was taking Eltroxin tablets for hypothyroidism. Gastric lavage was done with activated charcoal, Inj. Hydrocortisone, Tab Propranolol and Tab Neomercazole administered. Despite ingestion of high dose of levothyroxine, thyrotoxicosis symptoms like palpitations resolved with appropriate treatment and the patient was discharged after complete recovery.

Salivary Cortisol and Sustained Auditory Attention in Children with and without Cleft Lip and Palate

Abstract Introduction Cortisol is a hormone involved in the response to stress. Attention is a function that can change due to exposure to stress. Objectives To verify the correlation between the level of salivary cortisol and sustained auditory attention in children with cleft lip and palate, as well as to compare the results of the variables analyzed between female and male patients. Methods In total, 103 children aged 6 to 11 years, were divided into 2 groups: those with cleft lip and palate (experimental group, EG; n = 69) and the control group (CG; n = 34). The Sustained Auditory Attention Ability Test (SAAAT) and salivary cortisol levels, measured by an enzyme immunoassay kit (Salimetrics, Stage College, PA, US), were calculated and compared regarding the two groups. The statistical tests used were the Mann-Whitney test and the Spearman correlation. Results The median level of salivary cortisol was of 0.03615 μl/dL and 0.18000 μl/dL respectively for the EG and CG, with a significant difference between the groups (p =0.000). Absence of statistical significance (total error score = 0.656; vigilance decrement = 0.051) was observed the for SAAAT among the EG (median total error score = 12.00; 25th percentile [25%] = 7.00; 75th percentile [75%] = 21.00; and vigilance decrement = 1.00; 25% = 0.00; 75% = 2.50) and the CG (median total error score = 12.00; 25% = 6.00; 75% = 24.00; and vigilance decrement = 0.00; 25% = -1.00; 75% = 2.00). Conclusion All children had median levels of salivary cortisol and scores for sustained auditory attention within normal parameters. A significant correlation between the level of salivary cortisol and the ability to sustain auditory attention was observed in children without cleft lip and palate. There were no differences regarding the SAAAT and salivary cortisol between female and male patients.

Exercise-induced hormonal responses to hmb administration: a systematic review and meta-analysis / Respostas hormonais induzidas por exercícios à administração do hmb: uma revisão sistemática e meta-análise / Respuestas hormonales inducidas por el ejercicio a la administración de hmb: revisión sistemática y meta-análisis

ABSTRACT Introduction: The β-hydroxy β-methyl butyrate (HMB) is an amino acid leucine metabolite with several ergogenic benefits. It is known that it can benefit testosterone and cortisol concentration in athletes. However, no systematic review and meta-analysis has focused on the effects of HMB supplementation on testosterone and cortisol in trained athletes. Objectives: The meta-analysis evaluates the effect of HMB supplementation on testosterone and cortisol in trained athletes and verifies conflicting results between studies. Methods: A systemic review was performed in Scopus, Medline, and Google scholar databases of articles published until August 2021. The Cochrane Collaboration tool was used to assess the risk of bias and assess the quality of the studies. Random effects model, weighted mean difference (WMD), and 95% confidence interval (CI) were used to estimate the overall effect. Results: Although the meta-analysis showed that HMB consumption does not alter cortisol and testosterone concentration, subgroup analysis based on exercise type exhibited a significant decrease in cortisol concentration in resistance training exercises (P<0.05) and a significant increase in testosterone concentration in combined aerobic and anaerobic sports (P<0.05). Conclusion: The results indicate that HMB supplementation in athletes can reduce cortisol concentration in endurance exercise and increase testosterone concentration in combined aerobic and anaerobic exercise. Evidence Level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução: o β-hidroxi β-metilbutirato (HMB) é um metabólito de aminoácido leucina e tem vários benefícios ergogênicos. Sabe-se que ela pode beneficiar a concentração de testosterona e cortisol em atletas. Porém, nenhuma revisão sistemática e meta-análise focou-se nos efeitos que a suplementação de HMB provoca sobre testosterona e cortisol em atletas treinados. Objetivos: A meta-análise tem como objetivo avaliar o efeito de suplementação de HMB na testosterona e cortisol em atletas treinados, além de verificar resultados contraditórios entre estudos. Métodos: Foi feita uma revisão sistêmica nas bases Scopus, Medline e Google scholar dos artigos publicados até agosto de 2021. A ferramenta de colaboração Cochrane foi utilizada para avaliar o risco de viés e também para avaliar a qualidade dos estudos. Modelo de efeitos aleatórios, diferença média ponderada (ADM) e intervalo de confiança de 95% (IC) foram utilizados para estimar o efeito geral. Resultados: Embora a meta-análise tenha evidenciado que o consumo de HMB não altere a concentração de cortisol e testosterona, a análise do subgrupo com base no tipo de exercício exibiu uma diminuição significativa na concentração do cortisol nos exercícios de treinamento de resistência (P<0,05) e um aumento significativo na concentração de testosterona em esportes combinados aeróbicos e anaeróbicos (P<0,05). Conclusão: Os resultados indicam que a suplementação de HMB em atletas pode reduzir a concentração de cortisol em exercícios de resistência e aumentar a concentração de testosterona em exercícios aeróbicos e anaeróbicos combinados. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: El β-hidroxi-β-metilbutirato (HMB) es un metabolito del aminoácido leucina y tiene varios beneficios ergogénicos. Está comprobado que puede beneficiar la concentración de testosterona y cortisol en los deportistas. Sin embargo, ninguna revisión sistemática y meta-análisis se ha centrado en los efectos que la suplementación con HMB provoca en la testosterona y el cortisol en atletas entrenados. Objetivos: El meta-análisis tiene como objetivo evaluar el efecto de la suplementación con HMB sobre la testosterona y el cortisol en atletas entrenados, y verificar los resultados contradictorios entre los estudios. Métodos: Se realizó una revisión sistémica en las bases de datos Scopus, Medline y Google scholar de los artículos publicados hasta agosto de 2021. Se utilizó la herramienta de colaboración Cochrane para evaluar el riesgo de sesgo y también para evaluar la calidad de los estudios. Se utilizó un modelo de efectos aleatorios, una diferencia de medias ponderada (DMP) y un intervalo de confianza (IC) del 95% para estimar el efecto global. Resultados: Aunque el meta-análisis mostró que el consumo de HMB no altera la concentración de cortisol y testosterona, el análisis de subgrupos basado en el tipo de ejercicio mostró una disminución significativa de la concentración de cortisol en los ejercicios de entrenamiento de resistencia (P<0,05) y un aumento significativo de la concentración de testosterona en los deportes aeróbicos y anaeróbicos combinados (P<0,05). Conclusión: Los resultados indican que la suplementación con HMB en los atletas puede reducir la concentración de cortisol en el ejercicio de resistencia y aumentar la concentración de testosterona en el ejercicio aeróbico y anaeróbico combinado. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Anthropometric and Pubertal Outcomes in Girls With Classical Congenital Adrenal Hyperplasia

Objective: To evaluate the anthropometric and pubertal outcomes, over a spectrum of treatment regimens and compliance. Methods: We reviewed records of the patients with classical CAH seen at the endocrinology clinic of a tertiary care center between 1995 and 2016. Results: 25 females were included in the study, the majority (80%) with simple virilizing variant. All patients had genital ambiguity since birth, yet 40% (10/25) presented much later with menstrual complaints. All patients received hydrocortisone, but some switched to dexamethasone (n=7) or prednisolone (n=4). 7/9 (77.9%) girls who achieved target height, were on hydrocortisone. Menarche occurred with corticosteroid treatment in 60% (15/25) patients at a median (IQR) age of 16 (12-22) years. Conclusion: Hydrocortisone seems to have a beneficial effect on linear growth. Once target height is achieved, dexamethasone may be considered as an alternative.

Crisis suprarrenal: prevención, corticoterapia y elección del fármaco, revisión de la evidencia actual y recomendaciones / Adrenal crisis: prevention, corticotherapy and choice of the drug, review of current evidence and recommendations

INTRODUCCIÓN. La crisis suprarrenal se refiere a la insuficiencia suprarrenal aguda; la cual es un trastorno en el que la corteza adrenal no produce suficientes hormonas esteroides (en especial cortisol) para satisfacer las demandas del cuerpo, de acuerdo al mecanismo fisiopatológico se la puede clasificar como primaria, secundaria y terciaria, siendo más común en pacientes con insuficiencia suprarrenal primaria. Es una emergencia potencialmente mortal que requiere tratamiento inmediato. OBJETIVO. Establecer una estrategia de prevención y tratamiento de la crisis suprarrenal, así como la farmacoterapia ideal y sus alternativas válidas. MATERIAL Y MÉTODOS. Se realizó una revisión bibliográfica en varias revistas virtuales de alto carácter científico como Cochrane Library, Cochrane Systematic Reviews Database, MEDLINE a través de PubMed y ClinicalTrial.gov. Se seleccionaron revisiones sistemáticas con o sin metaanálisis, ensayos clínicos y recomendaciones de expertos relacionados con prevención y tratamiento de crisis suprarrenal en general. RESULTADOS. Se obtuvieron 1819 resultados, de los cuales se seleccionaron 20 artículos con mayor validez y replicabilidad en el medio para establecer un protocolo unificado de actuación. CONCLUSIÓN. El objetivo de la terapia es el tratamiento de la hipotensión y reversión de las anomalías electrolíticas y de la deficiencia de cortisol. Se deben infundir por vía intravenosa grandes volúmenes (1 a 3 litros) de solución salina al 0,9% o dextrosa al 5% en solución salina al 0,9% y la administración de hidrocortisona (bolo de 100 mg), seguido de 50 mg cada 6 horas (o 200 mg / 24 horas como infusión continua durante las primeras 24 horas). Si no se dispone de hidrocortisona, las alternativas incluyen prednisolona, prednisona y dexametasona.

INTRODUCTION. Adrenal crisis refers to acute adrenal insufficiency; which is a disorder in which the adrenal cortex does not produce enough steroid hormones (especially cortisol) to meet the body's demands, according to the pathophysiological mechanism it can be classified as primary, secondary and tertiary, being more common in patients with primary adrenal insufficiency. It is a life-threatening emergency that requires immediate treatment. OBJECTIVE. To establish a strategy for the prevention and treatment of adrenal crisis, as well as the ideal pharmacotherapy and its valid alternatives. MATERIAL AND METHODS. A literature review was performed in several highly scientific virtual journals such as Cochrane Library, Cochrane Systematic Reviews Database, MEDLINE through PubMed and ClinicalTrial.gov. Systematic reviews with or without meta-analysis, clinical trials and expert recommendations related to prevention and treatment of adrenal crisis in general were selected. RESULTS. A total of 1819 results were obtained, from which 20 articles with greater validity and replicability in the setting were selected to establish a unified protocol for action. CONCLUSIONS. The aim of therapy is the treatment of hypotension and reversal of electrolyte abnormalities and cortisol deficiency. Large volumes (1 to 3 liters) of 0.9% saline or 5% dextrose in 0.9% saline and administration of hydrocortisone (100 mg bolus), followed by 50 mg every 6 hours (or 200 mg / 24 hours as a continuous infusion for the first 24 hours) should be infused intravenously. If hydrocortisone is not available, alternatives include prednisolone, prednisone, and dexamethasone.

Calcium-based antimicrobial peptide compounds cooling gel for the treatment of atopic dermatitis: a randomized, double-blind controlled clinical study / 中华皮肤科杂志

Objective:To evaluate clinical efficacy and safety of calcium-based antimicrobial peptide compounds cooling gel (CAPCS cooling gel) in the treatment of atopic dermatitis (AD) .Methods:A randomized, double-blind, active-controlled clinical study was conducted. From July 2019 to May 2020, 80 adult patients with mild-to-moderate AD were enrolled from Beijing Friendship Hospital, Capital Medical University, and randomly and equally divided into 2 groups: test group topically treated with CAPCS cooling gel, control group topically treated with hydrocortisone cream, and the treatment was performed thrice a day for 4 consecutive weeks. Before, 1, 2 and 4 weeks after the start of treatment, efficacy was evaluated according to the Eczema Area and Severity Index (EASI), Visual Analog Scale (VAS), and Investigator′s Global Assessment (IGA) scores, and adverse events were recorded. Efficacy and safety were compared by using repeated measures analysis of variance and chi-square test.Results:Of the 80 patients with AD, 43 were males and 37 were females, and the age was 52.71 ± 16.71 years. Before the treatment, there was no significant difference in gender, age, EASI, VAS or IGA scores between the two groups (all P > 0.05). After 1- and 2-week treatment, there was no significant difference in the response rate between the test group (10.00% [4/40], 57.50% [23/40], respectively) and control group (15.00% [6/40], 52.50% [21/40] respectively, both P > 0.05). After 4-week treatment, the response rate was significantly higher in the test group (82.50%, 33/40) than in the control group (57.50%, 23/40, P < 0.05). Compared with the control group, the test group showed significantly decreased VAS scores after 1-, 2- and 4-week treatment ( U = 1253.00, 1121.00, 1091.50, respectively, all P < 0.05). No drug-related adverse events were observed in either of the groups. Conclusion:CAPCS cooling gel is safe and effective in the treatment of mild-to-moderate AD in adults, and can be applied in clinic.

Peer victimization on early onset of breast development:mediation effects of morning cortisol and body fat / 中国学校卫生

Objective@#To explore the relationship and potential mechanism between peer victimization and early onset of breast development in girls, and to provide new strategies for precocious puberty prevention.@*Methods@#A total of 950 girls aged (9.0±1.2) years participated in this survey in Ma anshan City in China. Revised Bully/Victim Questionnaire (BVQ) was used. Each girl was assessed on breast Tanner stage by one female pediatric endocrinologist. All the girls collected morning awakening saliva sample with Salivette at home. Body fat percentage (%BF) was derived from Bioelectrical Impedance Analyzer (BIA) measurements.The association between peer bullying and early breast development was analyzed by stepwise Logistic regression.The mediation coefficient was estimated using the Logistic regression.@*Results@#Totally 23.2% (220/950) of all the girls reported being victimized at school. More girls reported peer victimization had early breast onset (24.1%,53) compared with girls with no victimization experience ( 13.7 %,100). Logistic regression analyses indicated that peer victimization was associated with early onset of breast development ( OR=1.74, 95%CI =1.16-2.59) after body fat and awakening cortisol adjusted. Mediation analysis showed that high cortisol and high fat both had indirect effects in the association between peer victimization and early onset of breast development.Mediating analysis showed that both high cortisol level and high body fat rate had indirect effects between peer bullying and early breast development, and the mediating effect values were 0.37 and 0.45,respectively.@*Conclusion@#Peer victimization significantly correlated with early onset of breast development among girls, which might be mediated through HPA axis hyperactivity and high adiposity.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE

Abstract: There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

Análisis bibliométrico y mapeo de publicaciones internacionales sobre cortisol salival (1960-2019) / Bibliometric analysis and mapping of international publications about salivary cortisol (1960-2019)

El objetivo del presente estudio fue evaluar la actividad científica sobre el cortisol salival. Se aplicó un método bibliométrico utilizando MEDLINE y LILACS. El período estudiado fue de 1960 a 2019. Los datos fueron analizados por los programas VOSviewer y Publish or Perish. La búsqueda localizó 6063 documentos en MEDLINE y 47 en LILCAS. El crecimiento de las publicaciones mostró un aumento notorio en el período 2010-2019. En MEDLINE, Estados Unidos lideró la producción científica con el 21 por ciento de los documentos y en LILACS, Brasil, con el 70,2 por ciento. Los autores con índice de productividad igual o mayor que 1 (grandes productores) alcanzaron el 0,93 por ciento en MEDLINE y en LILACS, 0 por ciento. El número medio de autores por publicación fue de 5,12 en MEDLINE y 4,70 en LILACS. Hubo seis temas principales de investigación relacionada con cortisol salival: 1) estrés; 2) eje hipotalámico-pituitario-suprarrenal; 3) ritmo circadiano; 4) emociones, ansiedad, depresión; 5) vigilia-sueño; 6) factores determinantes. El número de estudios sobre cortisol salival va en aumento y la multiautoría, como expresión de la colaboración entre los autores, también. La investigación futura debe centrarse en las diferencias interindividuales y la variabilidad intraindividual de la concentración del cortisol salival(AU)

The purpose of the study was to evaluate the scientific activity about salivary cortisol. A bibliometric method was applied using MEDLINE and LILACS. The study period extended from 1960 to 2019. The data presented in the study were analyzed with the software VOSviewer and Publish or Perish. The search retrieved 6063 documents from MEDLINE and 47 from LILACS. Increase in the number of publications was notable in the period 2010-2019. The United States had the largest scientific production in MEDLINE with 21percent of the documents, whereas Brazil was at the top of the list in LILACS with 70.2percent. Authors with a productivity index equal to or greater than 1 (prolific producers) represented 0.93percent in MEDLINE and 0percent in LILACS. Mean number of authors per publication was 5.12 in MEDLINE and 4.70 in LILACS. Six main research topics were found to be related to salivary cortisol: 1) stress 2) hypothalamic-pituitary-adrenal axis; 3) circadian rhythm; 4) emotions, anxiety, depression; 5) sleep-wake; 6) determining factors. Research on salivary cortisol is on the increase, with gradual improvement in multiauthorship as an expression of collaboration between authors. Future research should focus on interindividual differences and intraindividual variability of salivary cortisol concentration(AU)

Crisis adrenal asociada al uso de modafinilo / Adrenal crisis associated with modafinil use

Resumen La crisis adrenal es la forma más extrema de presentación de la insuficiencia adrenal y representa una urgencia endocrinológica que llega a poner en riesgo la vida. Esta situación puede ser des encadenada por diferentes causas, entre las cuales se incluye el uso de fármacos inductores del CYP3A4, que aceleran la depuración de la hidrocortisona. Describimos el caso de una mujer de 85 años, con antecedentes de insuficiencia adrenal secundaria y enfermedad renal crónica, que presentó síntomas compatibles con crisis adrenal (astenia, adinamia, hiponatremia grave con síntomas neurológicos e hipotensión arterial) luego de nueve días del inicio de tratamiento con modafinilo. El cuadro clínico mejoró rápidamente con la suspensión del modafinilo y la administración de hidrocortisona endovenosa. Luego de descartar las posibles causas desencadenantes (infecciosas, isquémicas, tromboembolismo pulmonar y omisión en la toma de hidrocortisona), se interpretó que el modafinilo precipitó los síntomas de insuficiencia adrenal al aumentar la depuración del corticoide. El modafinilo tiene la capacidad de inducir la actividad del CYP3A4 y, en consecuencia, disminuir la biodisponibilidad de la hidrocortisona. Recalcamos la necesidad de ajustar la dosis de reemplazo de corticoides en sujetos que reciben fármacos inductores del metabolismo.

Abstract Adrenal crisis is the most extreme presentation form of adrenal insufficiency and represents a life-threatening endocrinological emergency. This situation can be triggered by different causes including the use of CYP3A4-inducing drugs, which accelerate hydrocortisone clearance. We describe the case of an 85-year-old woman with secondary adrenal insufficiency and chronic renal disease, who presented symptoms compatible with adrenal crisis (asthenia, adynamia, severe hyponatremia associated with neurological symptoms and hypotension) nine days after the start of modafinil treat ment. The clinical picture improved rapidly with the suspension of modafinil and the administration of intravenous hydrocortisone. After ruling out the possible triggering causes (infectious, ischemic, pulmonary thromboembo lism and failure to take hydrocortisone), it was interpreted that modafinil precipitated the symptoms of adrenal insufficiency by increasing the steroid clearance. Modafinil has the ability to induce the activity of CYP3A4 and consequently decrease the bioavailability of hydrocortisone. We emphasize the need to adjust steroid dose re placement in subjects receiving metabolism-inducing drugs.