Der septische Schock geht bis heute mit einer hohen Mortalität einher und stellt für die Intensivmedizin ein schwer beherrschbares Krankheitsbild dar. Er ist die häufigste Todesursache auf nicht kardiologischen Intensivstationen und es wird davon ausgegangen, dass der Anteil septischer Patienten relativ wie absolut zunehmen wird. Das Ziel der vorliegenden Arbeit war, den Einfluss von Hydrokortison auf die Schockdauer und die Wirkung von Hydrokortison in Abhängigkeit der Nebennierenrindenfunktion sowie den Einfluss auf die Morbidität, gemessen am SOFA-Score zu untersuchen. Es wurden 41 Patienten mit frühem septischem Schock in eine doppelblinde, placebokontrollierte, randomisierte Studie eingeschlossen. Zur Beurteilung der Nebennierenfunktion wurde vor Beginn der Studie ein ACTH-Test durchgeführt und je nach Anstieg wurden die Patienten in „Non-Responder“ und „Responder“ unterteilt. Es zeigte sich, dass Hydrokortison zu einer signifikanten Verkürzung der Schockdauer führte. Die Frage nach dem unterschiedlichen Effekt von Hydrokortison bei „Respondern“ und „Non-Respondern“ konnte nicht abschließend geklärt werden; es zeigte sich bei den „Respondern“ und „Non-Respondern“, die Hydrokortison erhalten hatten, ein Trend zu einer kürzeren Schockdauer, der aber keine statistische Signifikanz erreichte, vermutlich weil die Gruppengröße durch die Aufteilung zu klein wurde. Die vorliegenden Ergebnisse sind insofern mit anderen Studien kongruent, bedürfen aber noch der weiteren Abklärung in Studien mit größeren Patientenkollektiven. Der SOFA-Score war unter Hydrokortison in den ersten 48 Stunden signifikant reduziert. In anderen Studien war dies mit einer geringeren Mortalität assoziiert. Die Behandlung mit Hydrokortison reduziert also die Schockdauer und stellt eine wichtige Therapierationale zur Vorbeugung des sepsis-induzierten Organversagens dar. / Up to the present day septic shock is often accompanied with high mortality. For the medical intensive care field it is a hardly controllable disease pattern. Septic shock is the most frequent cause of death at non-cardiological intensive care units. It is believed that the number of septic patients will increase relatively as well as absolutely. The aim of this paper was to examine the influence of hydrocortisone on shock duration, the effect of hydrocortisone dependent on the adrenal function and the influence on morbidity, measured with SOFA score. 41 patients with early septic shock participated in a double-blind, placebo-controlled, randomised study. In the beginning of the study an ACTH-test was conducted in order to assess the adrenal function. Dependent on the increase of ACTH, the patients were classified into "non-responder" and "responder". It became apparent that hydrocortisone leads to a significant reduction of shock duration. The question about the different effect of hydrocortisone on “responder“ and “non-responder“ could not cleared up conclusively. “Responder“ and „non-responder“ who received hydrocortisone showed a trend towards shorter shock duration. There was, however, no statistic significance, probably because the groups became too small because of the division. The present results are insofar congruent with other studies, but they need further clarification through studies with bigger patient groups. For those using hydrocortisone the SOFA score was significantly reduced during the first 48 hours. In other studies this fact was associated with less mortality. The treatment with hydrocortisone therefore reduces the shock duration and is an important therapy rationale for the prevention of septic induced multi-organ failure.

Objetivo: Analisar a existência de correlações entre carga horária de trabalho com níveis de estresse ocupacional, reações fisiológicas do estresse e níveis de cortisol salivar, entre enfermeiros atuantes em unidade de emergência hospitalar. Metodos: Estudo descritivo, correlacional, transversal, de abordagem quantitativa, realizado na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, sendo a coleta de dados realizada no segundo semestre de 2011 e no primeiro de 2012, por meio de um questionário para caracterização amostral, Inventário de Estresse em Enfermeiros, Inventário das Reações Fisiológicas do Estresse e dispositivo Sallivette?. Houve aprovação de um Comitê de Ética em Pesquisa e compuseram a amostra 95 enfermeiros atuantes no período matutino. Utilizaram-se os Testes de Correlação de Spearmann e Pearson e o nível de significância considerado foi ?= 0,05. Para verificar a associação entre variáveis categorizadas, utilizou-se o Teste Exato de Fisher; a quantificação desta associação foi mensurada por meio de modelos de regressão logística em que se calculou odds ratio bruto com seus respectivos intervalos de confiança de 95%. Valores de p menores que 0,05 foram considerados significativos. Resultados: A maioria dos sujeitos eram mulheres, com faixa etária entre 23 e 61 anos, solteiras (44,2%) e casadas (43,2%). Com relação aos vínculos empregatícios, constatou-se que 80% dos enfermeiros tinham apenas um e 51,6% trabalhavam de 37 a 57 horas semanais. Quanto ao contrato na instituição, 68,4% foram contratados por meio de concurso público e tinham vínculo com o Estado, 55,8% não trabalhavam no período noturno e 80% desenvolviam suas atividades laborais em finais de semana e feriados. No tocante ao tempo de atuação na profissão, 51,6% referiram exercê-la de 0,1 a 10 anos e 56% atuavam no hospital em estudo pelo mesmo período. Quanto ao nível de estresse, 15,8% dos enfermeiros apresentaram níveis baixos, 69,5% moderados e 14,7% altos. As reações fisiológicas mais presentes foram dores lombares, fadiga/exaustão, rigidez no pescoço e acidez estomacal; tais reações apresentaram- se baixas em 46,3% dos sujeitos e moderadas em 42,1%. Com relação aos níveis de cortisol salivar, constatou-se que não houve resultados acima do valor de referência para a normalidade, sendo que 73,7% dos enfermeiros obtiveram valores dentro desta normalidade e 26,3% valores abaixo dela. A amplitude variou de 0,06 a 1,29 nm/ml. Não foi constatada correlação entre carga horária de trabalho e níveis de estresse ocupacional, reações fisiológicas do estresse e níveis de cortisol salivar. Conclusão: Embora a maioria dos enfermeiros trabalhasse por mais de 36 horas/semana, estes apresentaram níveis moderados de estresse ocupacional, fisiologicamente não estavam com reações elevadas de estresse e os níveis de cortisol não se mostraram aumentados; estes fatos podem ser explicados pela utilização de mecanismos de enfrentamento, levando em consideração suas histórias de vida, traços de personalidade, apoio social, clima organizacional, entre outros. Mesmo que a carga horária não se tenha correlacionado com o estresse, ela pode provocar fadiga e influenciar na ocorrência de erros interferindo na qualidade da assistência aos pacientes; portanto, a carga horária apresenta relevância no contexto da saúde do trabalhador / Objective: To analyze the correlations between workload and levels of occupational stress, physiological responses to stress and salivary cortisol levels among nurses working in an emergency unit. Methods: A descriptive, correlational and cross-sectional study with quantitative approach, performed in the Emergency Unit of the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School; data collection was carried out in the second half of 2011 and in first half of 2012 through a questionnaire for sample characterization, Stress Inventory for Nurses, Physiological Responses to Stress Inventory and device Salivette?. The study was approved by the Research Ethics Committee and the sample was consisted of 95 nurses working in the morning. The Spearman correlation tests and Pearson were used and the level of significance was ? = 0,05. To investigate the association between categorized variables, the Fisher\'s exact test was used; and the quantifying of this association was measured by means of logistic regression models in which the crude odds ratio was calculated with their respective confidence intervals of 95%. P values less than 0,05 were considered significant. Results: Most subjects were women, aged between 23 and 61 years old, single (44,2%) and married (43,2%). With respect to employment relationships, it was found that 80% of nurses had just one job and 51,6% worked from 37 to 57 hours a week. As for the contract in the institution, 68.4% were hired through civil service exam and were linked with the state, 55,8% did not work at night and 80% developed their work activities on weekends and holidays regarding the period of time in the profession, 51,6% reported practicing it from 0,1 to 10 years and 56% worked in the hospital for the same period. Related to the stress level, 15.8% of nurses had low levels, 69,5% moderate and 14,7% high. The physiological responses more common were back pain, fatigue/exhaustion, stiff neck and stomach acidity; such responses presented themselves low in 46,3% of subjects and moderate in 42,1%. With regard to salivary cortisol levels, it was observed that there were no results above the reference value for normality, and 73,7% of nurses had values within this normality and 26,3% values below it. The amplitude ranged from 0,06 to 1,29 nm/ml. There was no correlation between workload and levels of occupational stress, physiological responses to stress and salivary cortisol levels. Conclusion: Although the majority of nurses worked for more than 36 hours/week, they showed moderate levels of occupational stress, physiologically showed no elevated responses to stress and cortisol levels had not increased; these facts can be explained by the use of coping mechanisms, taking into account their life histories, personality traits, social support, organizational climate, among others. Even though the workload has not been correlated with stress, it can cause fatigue and influence the occurrence of errors, which interferes with quality of patient care; thus the workload has relevance in the context of occupational health

We examined the effect of daily stress, age, and emotional stability/neuroticism on stress reactivity, using cortisol diurnal rhythms. We used data from the Normative Aging Study (Spiro & Bosse, 2001). The 72 men in this study ranged from 67-93 (M =79.29, SD =4.88). Multilevel modeling showed that higher daily stress predicted flatter cortisol diurnal rhythms, B = .09, p < .001, as did age, B = .01, p < .001, while those higher in neuroticism on the emotional stability/neuroticism measure showed steeper slopes for cortisol diurnal rhythms, B = -.04, p < .001. These results indicate that age and emotional stability/neuroticism levels explain some of the variance in individual differences in stress reactivity and provide a basis for future research focused on the effects of psychosocial variables on physiological outcomes. / Graduation date: 2013

Objectives: Dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis has frequently been reported in multiple sclerosis (MS). So far, HPA axis function in MS has predominantly been studied under pharmacological stimulation which is associated with a series of methodological caveats. Knowledge of circadian cortisol patterns and cortisol awakening response (CAR) is still limited. Methods: A total of 77 MS patients (55 relapsing-remitting MS (RRMS)/22 secondary-progressive MS (SPMS)) as well as 34 healthy control (HC) subjects were enrolled. Diurnal cortisol release was assessed by repeated salivary cortisol sampling. Neurological disability was rated by the Kurtzke’s Expanded Disability Status Scale (EDSS). Depressive symptoms and perceived stress were assessed by self-report measures. Results: RRMS but not SPMS patients differed in circadian cortisol release from HC subjects. Differences in cortisol release were restricted to CAR. Treated and treatment naïve RRMS patients did not differ in CAR. In a RRMS follow-up cohort (nine months follow-up), RRMS patients with EDSS progression (≥0.5) expressed a significantly greater CAR compared to HC subjects. RRMS patients with a stable EDSS did not differ from HC subjects. Neither depressive symptoms nor perceived stress ratings were associated with CAR in RRMS patients. In a step-wise regression analysis, EDSS at baseline and CAR were predictive of EDSS at follow-up (R2 = 67%) for RRMS patients. Conclusions: Circadian cortisol release, in particular CAR, shows a course specific pattern with most pronounced release in RRMS. There is also some evidence for greater CAR in RRMS patients with EDSS progression. As a consequence, CAR might be of predictive value in terms of neurological disability in RRMS patients. The possible role of neuroendocrine-immune interactions in MS pathogenesis is further discussed.

In a three year study, the applicability of the cortisol response to capture as a biomarker of the health of fish from areas chronically exposed to pollution was assessed. Northern pike (Esox lucius) and yellow perch (Perca flavescens) captured from an area contaminated by bleached kraft pulp mill effluent (BKME) were initially found to be incapable of elevating their blood cortisol concentration to reference levels. Following a reduction of the amount of absorbable organochlorines (AOX) in the BKME, fish downstream of the mill regained their normal cortisol response to capture. The time frame for this recovery was from between 6 to 18 months. Fewer young fish downstream of the effluent provided evidence for the impact of long-term exposure to BKME at the population level. / The impairment of the cortisol response to capture, and its subsequent recovery after effluent reduction provide the foundation for developing cortisol as a biomarker of contaminant exposure. Further work should determine the relationship between cortisol and the effect at higher levels of biological organization (e.g., population and community).

Salivary cortisol is becoming an effective method with which to quantify cortisol levels, including the ability to track diurnal patterns and acute stress fluctuations. The purpose of this study was to validate salivary cortisol for use in African elephants (Loxodonta Africana), establish baseline cortisol values in three African elephants at Zoo Atlanta and explore the relationship between cortisol and various behaviors and husbandry events. Elephant salivary cortisol was found to be a valid measure based on correlations with serum cortisol and serial dilution results. Salivary cortisol also decreased across the day, but no definitive patterns were revealed. Using baseline values, salivary cortisol was used to examine the effects of enrichment, maintenance and novel training, and a mild stressor. Maintenance training was found to lead to lower cortisol values than novel training. Salivary cortisol after enrichment did not differ from individual overall means. The mild stressor initiated a rise in salivary cortisol. The final focus of this study was to investigate the link between salivary cortisol and stereotypic behavior. Stereotypies are described as repetitive behaviors with little variance and no discernible function or goal. There is not a straightforward relationship between stereotypies and welfare. Analysis of salivary cortisol at various durations into swaying bouts established that swaying appears to decrease cortisol levels. Additionally, behavioral data were collected. Behavioral data confirmed anecdotal reports of circular dominance in these animals. Behavioral data also revealed that although these individuals spend the majority of their time consuming food, one individual in particular devotes a significant amount of her time to swaying, a percentage much higher than that found when Wilson, Bloomsmith, and Maple (2004) examined stereotypic swaying rates in these same animals. Results of this study have direct ramifications for the current management requirements for captive elephants around the world. It helps tap into aspects of psychological well being of captive elephants to elucidate factors influencing welfare and stereotypic behavior. Research of this nature is a critical endeavor if we are to appropriately manage these magnificent animals in captivity.

Diss. Linköping : Linköpings universitet, 2006.

Thesis (M.Sc.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science, Psychiatry. Title from pdf file main screen (viewed on August 13, 2009). Includes bibliographical references.

Orientador: Carlos Alberto Anaruma / Banca: Roberto Naves Domingos / Banca: Miriam Maria de Magalhães Oliveira / Resumo: Este trabalho apresenta uma série de resultados referentes à utilização da transmissão de fármacos tópicos através de ondas ultra-sônicas (fonoforese), em lesão cirúrgica produzida no músculo tibial anterior de ratos Wisttar. O fármaco utilizado foi a hidrocortisona gel manipulada a 10%. Foram utilizados 42 ratos Wisttar machos, com 60 dias de idade e peso médio de 300,0 g ( 50,0 g), que foram submetidos à lesão cirúrgica na pata direita no músculo tibial anterior. Após 24 horas a área da lesão foi tratada com ultra-som tendo como gel acoplante hidrocortisona a 10%. A freqüência utilizada foi de 1,0 MHz e intensidade de 0,4 W/cm2 por 1 minuto, durante 14 dias consecutivos. Depois da terapia aplicada os ratos foram sacrificados, o músculo criofixado e cortado em criostato. As lâminas obtidas foram coradas por H/E, Tricrômico de Masson e Tricrômico de Mallory para serem fotografadas em fotomicroscópio Zeiss. O tecido analisado proveniente dos animais lesados, tratados com ultra-som e hidrocortisona a 10% (fonoforese) apresentam: após 1 dia de tratamento, fibras musculares seccionadas pela incisão já fagocitada com predomínio de células mononucleadas. Nos animais sacrificados após 3 dias de tratamento notamos a presença de mioblastos, alguns miotubos e neovascularização. Quando analisamos os tecidos dos animais sacrificados após 7 dias de tratamento, observamos a presença de reorganização dos tecidos musculares. Nos animais sacrificados 14 dias após o tratamento, as fibras musculares mostram-se em avançado estado de regeneração. O aparecimento precoce de mioblastos e raras fibras necróticas, a partir do terceiro dia de aplicação, levam-nos a concluir que o fármaco tópico anti-inflamatório consegue atravessar a barreira de tecidos biológicos através da transmissão da energia ultra-sônica, e assim acelerar a reconstituição do tecido lesado. / Abstract: This work presents a series of referring results to the use of the transmission of topical pharmacs through ultrasonic waves (Phonophoresis) in a produced surgical injuries in previous in the tibialis anterior muscle of Wisttar rats. The used pharmac was hydrocortisone gel to 10%. We had been used, in these experiment 42 rats with 60 days years' old and 300,0 average weight of g ( 50,0 g). The animals had been submitted to the chirurgical injury in the right leg, in previous the tibiae muscle. After 24 hours the area of the injury was dealt with ultrasound with faceplate hydrocortisone gel to 10%. The used frequency was of 1,0 MHz and the intensity of 0,4 W/cm2, with a time of 1 minute of insomniac, during 14 days. After the therapeutically one applied the rats they had been sacrificed, the frost fixed and cut muscle in cryostat. The gotten blades had been stain by H/E, Gomori's Trichrome, Masson's Trichrome and Mallory's Trichrome to be photographed in Zeiss photomicroscope. The analyzed proceeding from the animals injured, treated with ultra-sound and hydrocortisone present: after 1 day of treatment, skeletal muscle staple fibers parted by the phagocyte incision already with predominance of mononuclear cells. After 3 days of treatment, in the sacrificed animals, it is noticed myoblasts, some multinucleated myofibers and new vessel. When one analyzes of the sacrificed animals after 7 days of treatment, observes it presence of reorganization of muscular. In the sacrificed animals 14 days after the treatment, visualizes muscular fibers in advanced state of regeneration. The precocious appearance of myoblasts and rare necrotic tissue as fibers to leaving of the third day of application of treatment lever to conclude that the topical pharmac obtained to cross the biological barrier through the transmission of the ultrasonic energy. Of this form the hydrocortisone is taken until the small farm of lesion. / Mestre

Made available in DSpace on 2015-07-22T20:49:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-06-27. Added 1 bitstream(s) on 2015-08-11T03:25:48Z : No. of bitstreams: 1 Publico-10871.pdf: 288428 bytes, checksum: 1c97fa2e91133c59ce89adf43ddcefed (MD5) / A sindrome de Cushing (SC) endogena e rara. Pacientes com SC subclinica (SCS) apresentam hipercortisolismo sem manifestacoes clinicas. SC ocorre em 2-3% de diabeticos mal controlados. Estudamos 103 pacientes adultos obesos ambulatoriais com diabetes mellitus tipo 2 para avaliar alteracoes do cortisol e SCS. Todos coletaram cortisol salivar as 23:00h e cortisol salivar e serico apos teste de supressao com 1mg de dexametasona (DST). Pacientes cujos resultados de qualquer teste estavam no quintil superior (253ng/dL, 47ng/dL e 1,8ƒÊg/dL, respectivamente para cortisol salivar 23:00h e salivar e serico pos-DST) foram reavaliados. Os valores medios desse grupo encontravam-se 2,5 vezes acima dos valores dos demais pacientes. Apos um teste confirmatorio com 2mgx2dias DST a investigacao da SC foi encerrada para 61 pacientes com todos os testes normais e 33 com apenas um teste (falso) positivo. Todos os 8 pacientes com dois testes alterados apresentaram cortisol urinario normal, mas 3 deles mostraram maior probabilidade diagnostica de SCS (hipercortisolismo e alteracoes em exames de imagem). Contudo, o diagnostico final nao pode ser confirmado por cirurgia ou patologia em nenhum deles. Embora nao confirmatorios, os resultados deste estudo sugerem que a prevalencia de SCS seja maior em populacoes de risco do que na populacao geral. / Endogenous Cushing’s syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00h and salivary and serum cortisol after a 1mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253ng/dL, 47ng/dL and 1.8ìg/dL, respectively for the 23:00h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5- fold higher than in the remaining patients. After a confirmatory 2mgx2day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population. / TEDE / BV UNIFESP: Teses e dissertações