Hypnotherapy influence on maternal psychological, breastfeeding, mRNA-OXTR expression, and OXTR protein.

Hypnotherapy has emerged as a potential alternative to improve exclusive breastfeeding rates, particularly in countries like Indonesia where they are below optimal levels. This study aims to evaluate the impact of audio hypnotherapy on the psychological, exclusive breastfeeding behavior, the OXTR protein and mRNA expression gene OXTR in mothers of infants aged 0-6 months. This study employed a Pragmatic Randomized Controlled Trial design, conducted from November 2022 to May 2023 in 11 primary health centers. The study population included breastfeeding mothers with infants aged 0-6 months, with a total sample size of 70 respondents who were randomly divided into intervention (received audio hypnotherapy) and control groups (received standard care). The psychological condition was measured using the Depression Anxiety Stress Scale. Exclusive breastfeeding behavior was assessed based on both quality and quantity. Genetic factors were evaluated through mRNA OXTR expression using real-time PCR and protein OXTR levels using ELISA. Analyzing data using linear and logistic regression models. Both bivariate and multivariate analyses revealed significant differences in psychological condition (p < .0001). There were big differences in the exclusive breastfeeding behavior (p < .0001), as well as in the amounts of protein OXTR and mRNA expression of the OXTR gene (p < .0001). We recommend the implementation of audio hypnotherapy as an effective complementary therapeutic approach to manage the psychological well-being, exclusive breastfeeding behavior, the mRNA expression of the OXTR gene and levels of OXTR protein in mothers of infants aged 0-6 months.

The Effects of 10,000 IU Vitamin D Supplementation on Improvement of Clinical Outcomes, Inflammatory and Coagulation Markers in Moderate COVID-19 Patients: A Randomized-Controlled Trial / Los efectos de la suplementación con 10 000 UI de vitamina D en la mejora de los resultados clínicos, los marcadores inflamatorios y de coagulación en pacientes con COVID-19 moderado: un ensayo controlado aleatorizado

Background & aims: Vitamin D supplementation as animmunomodulator has been identified as a potential strategy to prevent and treat Coronavirus disease 2019 (COVID-19). We aimed to analyze the effect of 10,000 IU vitamin D3supplementation on 25(OH)D levels on primary clinical outcomes (conversion length), inflammatory markers (TotalLymphocyte Count (TLC), Neutrophil-to-Lymphocyte Ratio(NLR), Platelet-to-Lymphocyte Ratio (PLR)) and coagulationmarker (D-Dimer) in moderate COVID-19 patients atWahidin Sudirohusodo Hospital, Makassar, Indonesia.Methods: We conducted a singleblind randomized-controlled trial on the confirmed moderate COVID-19 patientsabove 18 years old and low vitamin D status. Each of inter-vention and control groups were supplemented of 10,000 IUand 1000 IU cholecalciferol that taken daily for 2 weeks.Levels of 25(OH)D were analyzed for the primary endpoint(conversion length), then correlated to secondary endpoints(Length of Stay (LOS)), clinical manifestations improvement,and markers TLC, NLR, PLR, and D-Dimer serum, handgripstrength (HGS) as functional capacity measurement, after ad-justed to age, sex, nutritional status based on body mass in-dex (BMI) and Subjective Global Assessment (SGA) tool, co-morbidities, and anticoagulant administration. Medical nutri-tional therapy was given and presented as energy, protein,carbohydrate, and fat achievement, and vitamin D intake wasalso calculated.Results: A significant effects was found in 60 samples withpre-intervention vitamin D deficiency (61.7%) and insuffi-ciency (38.3%) status, and 10,000 IU of vitamin D3 supplementation could increase 25(OH)D levels within 2 weeks toreach sufficiency status (16.7%). The Vitamin D3 supplementation of 10,000 IU and 1000 IU could significantly increase25(OH)D levels compared to the control group of 1000 IU(4.61±5.43 vs. -0.29±2.72; P <0.0001) and it was correlatedto primary clinical outcome, which is length of conversion...(AU)

Use of technology for monitoring the development of nutritional status 1000 hpk in stunting prevention in Indonesia.

OBJECTIVE: This study is reviewed about the use of technology to monitor the nutritional status of the first thousand days of life (1000 HPK), a program in Indonesia to prevent stunting. METHOD: In this study, which is looking for journals used in the literature review, journals used in literature review obtained through the database of international journal providers such as Google scholar, PubMed, and Proquest. Researchers wrote the appropriate keywords, namely nutritional status of 1000 HPK, stunting, and application. The year limit used is ten years from 2010 to 2020. RESULTS: Nutritional status in the first thousand days of life (1000 HPK), which is 270 days during pregnancy and 730 days in the baby's first life, is critical because the consequences are permanent and irreparable. Pregnant women and toddlers who are less attentive about their food intake will impact nutritional problems or nutritional status that will then affect their development in the future. The level of optimal nutritional status will be achieved if nutritional needs are met, but on the contrary unbalanced nutrition can cause several diseases, including stunting. Monitoring the development of toddlers is very important to know the existence of growth disorders early on, by taking weight measurement as the best way to assess the nutritional status of pregnant women and toddlers every month so that the child's growth will be monitored. One tool for measuring nutritional status is to use applications, and technological advances have now undergone rapid development. Application is a multifunctional product with all its sophistication which can help humans in various ways. CONCLUSION: From some journals can be concluded that the use of applications in monitoring the nutritional status of 1000 HPK facilitates parents, midwives, and other health workers in working to monitor the nutritional development of pregnant women and the growth of infants and toddlers for stunting prevention.

Anchovy fish biscuits improve adolescents nutritional status.

AIM: This study determines how giving fish anchovy biscuits (Stolephorus sp) improves nutritional status in Adolescent Girls at Vocational High School 01 Rangas, Mamuju Regency. RESEARCH METHODS: It was a quantitative research Quasi Experiment by Nonequaivalent Control Group design where there are 2 test groups, namely the control group and the intervention group. The intervention group was given fish anchovy biscuits, while the control group was given Placebo biscuits. The dose given is four pieces of biscuits in a day for 12 weeks. The study population was all female teenagers in class XII Vocational High School 01 Rangas, Mamuju Regency. This research was conducted from January to April 2020. The sampling technique uses purposive sampling by considering inclusion and exclusion criteria to obtain a sample of 60 people. Nutritional status measurements were carried out twice before and after the intervention using a digital weighing instrument and height measurement. Data were analyzed using the Wilcoxon test and the Mann-Whitney test. RESULTS: This study shows that the statistical test results obtained values (p=0.001, p<0.05), which means that there is an influence of fish anchovy biscuits on improving the nutritional status of Adolescent Girls at Vocational High school 01 Rangas Mamuju Regency. CONCLUSION: The results of data analysis and evaluation results on the Fish anchovy Biscuit intervention show a difference in improving the nutritional status after being given the fish anchovy Biscuit intervention on Young Women in Vocational High School 01 Rangas, Mamuju Regency.

Effects of synbiotic supplement on body weight and fasting blood glucose levels in obesity: A randomized placebo-controlled trial.

BACKGROUND: Obesity and diabetes are related. The role of gut microbiota disruption in obesity has been reported as a cause of several metabolic diseases including diabetes. OBJECTIVES: Evaluate the effects of synbiotic supplementation (a combination of probiotic and prebiotic) on body weight (BW), Body Mass Index (BMI), and Fasting Blood Glucose (FBG) in obese subjects. METHODS: This study was a randomized, double-blind placebo-controlled. Participants were allocated with randomization into 2 groups: the obese group with synbiotic supplementation and the obese group with placebo; each group consists of 8 participants. BW, BMI, and FBG level were measured at baseline, 8 weeks after supplementation, and 4 weeks after terminating the supplementation. RESULTS: There were no significant change of body weight and BMI after 8 weeks synbiotics supplementation and 4 weeks after supplement discontinuation, but there were significant increases in body weight by 3.38 kg and BMI by 1.37 kg/m2 in the control group. Fasting blood glucose levels were significantly decreased by 6.125 mg/dL after synbiotic supplementation. FBG did not resume 4 weeks after terminating the supplementation. In contrast, there was a significant increase of FBG in control group on week 8 and was further increased 4 weeks after placebo was discontinued. CONCLUSIONS: Synbiotic supplementation may prevent increase of body weight and BMI in obesity and this may be related with lower fasting blood glucose levels.

Comparison of 2% deoxyarbutin and 4% hydroquinone as a depigmenting agent in healthy individuals: A double-blind randomized controlled clinical trial.

BACKGROUND: Hydroquinone, which is considered the gold standard skin depigmenting agent, has been associated with multiple side effects. Lately, deoxyarbutin has been suggested to be an alternative of hydroquinone with better safety profile. OBJECTIVE: To compare the depigmenting effect of 2% deoxyarbutin and 4% hydroquinone sera. METHODS: This double-blind randomized controlled study was done on the right and left arms of healthy participants. Subjects were instructed to apply either 2% deoxyarbutin or 4% hydroquinone serum on each arm, which were randomly labeled as group A and B, every day for 12 weeks. Chromameter and mexameter analysis were done every 2 weeks to assess the color change. Paired and independent t-tests were used to assess the color change within and between both groups, respectively. RESULTS: A total of 59 females participated in this study. Both groups showed significant improvement in skin depigmentation as shown by the chromameter (increase in L* value) and mexameter (decrease in melanin index) analysis at the end of the study (p < 0.05). No significant difference in both parameters was observed between both groups (p > 0.05). No side effects were reported in either groups. CONCLUSION: 2% deoxyarbutin and 4% hydroquinone sera showed comparable depigmenting efficacy.

Use of technology for monitoring the development of nutritional status 1000 hpk in stunting prevention in Indonesia

Objective: This study is reviewed about the use of technology to monitor the nutritional status of the first thousand days of life (1000 HPK), a program in Indonesia to prevent stunting. Method: In this study, which is looking for journals used in the literature review, journals used in literature review obtained through the database of international journal providers such as Google scholar, PubMed, and Proquest. Researchers wrote the appropriate keywords, namely nutritional status of 1000 HPK, stunting, and application. The year limit used is ten years from 2010 to 2020. Results: Nutritional status in the first thousand days of life (1000 HPK), which is 270 days during pregnancy and 730 days in the baby's first life, is critical because the consequences are permanent and irreparable. Pregnant women and toddlers who are less attentive about their food intake will impact nutritional problems or nutritional status that will then affect their development in the future. The level of optimal nutritional status will be achieved if nutritional needs are met, but on the contrary unbalanced nutrition can cause several diseases, including stunting. Monitoring the development of toddlers is very important to know the existence of growth disorders early on, by taking weight measurement as the best way to assess the nutritional status of pregnant women and toddlers every month so that the child's growth will be monitored. One tool for measuring nutritional status is to use applications, and technological advances have now undergone rapid development. Application is a multifunctional product with all its sophistication which can help humans in various ways. Conclusion: From some journals can be concluded that the use of applications in monitoring the nutritional status of 1000 HPK facilitates parents, midwives, and other health workers in working to monitor the nutritional development of pregnant women and the growth of infants and toddlers for stunting prevention. (AU)

Anchovy fish biscuits improve adolescents nutritional status

Aim: This study determines how giving fish anchovy biscuits (Stolephorus sp) improves nutritional status in Adolescent Girls at Vocational High School 01 Rangas, Mamuju Regency. Research methods: It was a quantitative research Quasi Experiment by Nonequaivalent Control Group design where there are 2 test groups, namely the control group and the intervention group. The intervention group was given fish anchovy biscuits, while the control group was given Placebo biscuits. The dose given is four pieces of biscuits in a day for 12 weeks. The study population was all female teenagers in class XII Vocational High School 01 Rangas, Mamuju Regency. This research was conducted from January to April 2020. The sampling technique uses purposive sampling by considering inclusion and exclusion criteria to obtain a sample of 60 people. Nutritional status measurements were carried out twice before and after the intervention using a digital weighing instrument and height measurement. Data were analyzed using the Wilcoxon test and the Mann–Whitney test. Results: This study shows that the statistical test results obtained values (p = 0.001, p < 0.05), which means that there is an influence of fish anchovy biscuits on improving the nutritional status of Adolescent Girls at Vocational High school 01 Rangas Mamuju Regency. Conclusion: The results of data analysis and evaluation results on the Fish anchovy Biscuit intervention show a difference in improving the nutritional status after being given the fish anchovy Biscuit intervention on Young Women in Vocational High School 01 Rangas, Mamuju Regency. (AU)

Comparison of Different Early Enteral Feeding Formulas on Critically Ill Patients.

Critically ill patients are physiologically unstable, often have complex hypermetabolic responses to trauma. These patients are facing a high risk of death, multi-organ failure, and prolonged ventilator use. Nutrition is one of therapy for critical illness, however, patients often experience malnutrition caused by disease severity, delays in feeding, and miscalculation of calorie needs. The study aims to evaluate clinical improvement in critically ill participants that were given 3 kinds of early enteral feeding formulas, which were control (5% Dextrose), high-protein polymeric, or oligomeric formulas. A total of 55 critically ill participants admitted to the intensive care unit (ICU) between October 2017-March 2018 and assigned in this controlled trial. Early enteral feeding was initiated within 24-48 h after ICU admission. Each enteral feeding group were categorized to traumatic brain injury (TBI) or non-TBI. The primary endpoints were changes in white blood cell count, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and Nutrition Risk in the Critically Ill (NUTRIC) score from baseline to day 3. Baseline characteristics were similar between control (n=22), high-protein polymeric (n=19) and oligomeric (n=14) groups. There were significant decreases for white blood cell count (13,262.5±6,963.51 to 11,687.5±7,420.92; p=0.041), APACHE II score (17.33±3.31 to 13.83±1.95; p=0.007), and NUTRIC scores changes (3.08±1.44 to 1.92±1.00; p=0.022) in non-TBI participants receiving highprotein polymeric compared those in control or oligomeric participants. But there is no significant clinical improvement in TBI patients. In conclusion, non-TBI patients benefit from early enteral feeding with high-protein polymeric formula.

Nutrition Therapy in Critically Ill Overweight Elderly Patient with Heart Failure, Myocardial Infarction, Pneumonia, and Chronic Kidney Disease.

Overweight or obesity will increase the risk of morbidity and mortality from cardiovascular disease. In older people, the risk is higher, but also paradoxically associated with lower mortality rates. Overweight patients vary in body composition and when it coupled with limited reliable sources to make caloric requirements estimation will make nutrition therapy extremely challenging. This case study reveals the nutrition therapy support in critically ill overweight elderly patient with heart failure, myocardial infarction, pneumonia, and chronic kidney disease. An 80-year old moderate malnourished male patient (body mass index 24.6 kg/m2) with acute lung edema, cardiogenic shock, myocardial infarction, pneumonia, and chronic kidney disease was admitted in the cardiovascular intensive-care unit. The patient was treated with diuretics, vasopressor support, and antibiotics. Oral intake was reduced due to shortness of breath and loss of appetite. The physical examination revealed basal lung rales, wheezing, muscle wasting, edema. Blood tests showed hyperkalemia, leucocytosis, depletion of the immune system, hyperuricemia, hypoalbuminemia, and dyslipidemia. The patient was on stage 5 renal failure (GFR 6.2 mL/min) but refused hemodialysis treatment. Nutritional therapy was given gradually with calorie target 1900 kcal and protein 0.6-1.2 g/ideal body weight/d using normal foods, oral nutrition supplement, and amino acids parenteral nutrition. After 13 d of nutritional treatment, the patient was discharged from the hospital with no shortness of breath, adequate nutrition intake, increased renal function (GFR 22.4 mL/min), and improvement of the blood test results (immune status, uric acid, albumin, and lipid profile). Critically ill overweight elderly patients are hypercatabolic and have increased nutrient demands. Nutritional support in these patients is required to provide necessary nutrient substrates and to alter the course and outcome of the disease.

Effect of Ajwa Dates Consumption to Inhibit the Progression of Preeclampsia Threats on Mean Arterial Pressure and Roll-Over Test.

BACKGROUND: Preeclampsia is the major problem and the main leading cause of fetal and maternal mortality worldwide. The early prediction of preeclampsia in pregnant women is required to prevent the occurrence of preeclampsia. The mean arterial pressure (MAP) and roll-over test (ROT) are the combination of measurement which can be used to predict preeclampsia. On the contrary, Ajwa dates were reported to have an enormous activity which contributes to its role in improving health conditions. In this study, we aimed to evaluate the effect of daily consumption of seven Ajwa dates on prevention of preeclampsia, through MAP and ROT changes. METHODS: Forty pregnant women (n = 40) were randomly assigned into the control group (n = 10) and the intervention group which received a daily intake of Ajwa dates (n = 30). The MAP and ROT were assessed before and after the 8-week intervention period. RESULTS: The intervention group showed the significant reduction in MAP and ROT following the 8-week intervention period (p < 0.05). CONCLUSION: Daily consumption of seven Ajwa dates has a remarkable potential to decrease the MAP and ROT in pregnant women at risk of developing preeclampsia, and thus, it can contribute to prevent the development of preeclampsia.

Relationship between Vitamin D Level and Serum TNF-α Concentration on the Severity of Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease and disturbed bacterial clearance. Vitamin D deficiency is sometimes observed in COPD patients and as significant roles in increasing inflammation of airway obstruction and systemic obstruction, increasing pro-inflammatory cytokine including TNF-α, reduction of bacterial clearance and increase exacerbation risk due to infection. Also, vitamin D plays significant roles in the metabolism of calcium and mineralisation of bones and regulation system of immune. TNF-α also has essential roles in pathogenesis and inflammation of COPD. Several studies that investigate the relationship between vitamin D level and serum TNF-α concentration in COPD patients are relatively uncommon, including in Indonesia. AIM: This study aimed to assess the relationship between vitamin D level and TNF-α concentration in patients on the severity of the chronic obstructive pulmonary disease. METHODS: This study was a hospital-based descriptive cross-sectional study. Total samples were 50 COPD patients with the average age of older than 60 years during their enrollments at the Department of Pulmonology and Respiratory Medicine of the Dr Wahidin Sudirohusodo General Hospital Makassar in September 2018-January 2019. All procedures of the present study were reviewed and approved by the Research Ethics Committee of Medicine Faculty of Hasanuddin University. The severity of COPD was assessed according to the combination of COPD assessment stages that referred to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guideline 2015 that consisted of the combination of scoring COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) questionnaire and results of the spirometry measurement. Assessment of airway obstruction levels referred to the GOLD spirometry criteria. Determination of thoracic photographs was conducted to verify the COPD diagnosis of the severity of COPD. Determination of serum TNF-α concentration and vitamin D3 [1,25(OH)2D3] level used the ELISA method. RESULTS: The majority of COPD patients were observed in the category of older than 60 years old accounted for 34 COPD patients (68%), and the majority of COPD patients were males accounted for 47 males with COPD (94%). The majority of COPD patients were observed in the group of D (38%). All the study subjects observed in this study were smokers, and 82% of them were in the category of heavy smokers. 21 study subjects had higher concentration of serum TNF-α (tertile 3 = 0.21-1.83 pg/dl), 20 study subjects and lower level of vitamin D (tertile 1 = 182.1-364.5 pg/dl). The majority of the study subjects (38%) were in the category of severe COPD (category D of the severity of COPD at the tertile 3) according to the GOLD Combine Assessment. Given the relationship between vitamin D level and serum TNF-α concentration on the airway obstruction, there were significant positive correlations between the increase of vitamin D levels and the increase of serum TNF-α concentrations on airway obstruction. Given the relationship between vitamin D level and serum TNF-α concentration on the severity of COPD, there were significant positive correlations between the increase of vitamin D levels (tertiles 1, 2 and 3) and the increase of serum TNF-α concentrations on the severity of COPD at p-value < 0.05. Overall, there were non-linear relationships between vitamin D level and serum TNF-α concentration on the severity of COPD. CONCLUSIONS: Serum TNF-α concentration was positively associated with airway obstruction level and severity of COPD. Low level of vitamin D was negatively associated with airway obstruction level and severity of COPD. Vitamin D3 level (1,25(OH)2D) was negatively associated with serum TNF-α concentration and airway obstruction level and severity of COPD.

Energy regulation in newly diagnosed TB with chronic energy deficiency: free fatty acids and RBP4.

BACKGROUND AND OBJECTIVES: Energy metabolism may be dysfunctionally integral between host and infective agent in active tuberculosis, mediated by adipocytokines and free fatty acids (FFA) as the products of triglyceride lipolysis in fat, blood or other tissues. Retinol Binding Protein 4 (RBP4) and asymmetric dimethylarginine (ADMA) are candidate adipocytokines. The possibility of a deleterious metabolic nexus in chronic energy deficiency (CED) (BMI <18.5 kg/m2) is explored. METHODS AND DESIGN: Newly diagnosed patients with tuberculosis (n=63) were selected using consecutive random sampling at a Centre for the Care and Treatment of Lung Diseases in Makassar, Indonesia. Diagnosis of pulmonary TB required microscopy with Ziehl-Neelsen stain. Anthropometric measurements were taken. Venesection allowed glomerular filtration rate, FFA, serum glutamic oxaloacetic transaminase and glutamate-pyruvate transaminase to be assessed. RESULTS: CED was evident in 60.3%. For the well and lesser nourished, medians were, respectively, FFA 0.30 and 0.37 mmol/mL (p=0.960); RBP4 199730 ng/mL and 11721 ng/mL (p=0.009); GFR 106 ml/min and 113 ml/min (p=0.673); and ADMA 0.52 ng/mL and 0.51 ng/mL (p=0.172). BMI and serum RBP4 were correlated (ρ=0.52, p<0.001), with odds ratios (OR) 5.8 (CI 1.68-20.3). RBP4 in CED was lower than in better nourished patients. Serum FFA is not evidently associated with BMI in patients with active TB. CONCLUSIONS: RBP4 is some 6-fold lower when active TB patients have CED than when BMI >25 kg/m2. However, FFA was not associated with CED in these active TB patients which may be a type 2 error or represent an energy impasse where infection and the host's metabolic needs are in competition.

Cortisol dynamics are associated with electrocardiographic abnormalities following the aneurysmal subarachnoid hemorrhage.

CONTEXT: Electrocardiographic (ECG) abnormalities are common following subarachnoid hemorrhage (SAH). It probably represents cardiovascular stress after SAH. AIMS: The purpose of this study was to assess cortisol dynamics in relation to the ECG abnormality and disease course of SAH. SETTINGS AND DESIGN: The study follows a consecutive cohort of aneurysmal SAH patients, who underwent surgery within 72 hours of onset, and they were followed up for 10 days. MATERIALS AND METHODS: Serum cortisols, cortisol-binding globulin (CGB), adenocorticotropic hormone were measured (between 08.00-09.00 hours) preoperatively and then on postoperative days (PODs) 2, 4, 7, and 10. Electrocardiographs (ECG) were recorded on initial assessment and after surgery on daily basis in ICU. ECG abnormalities will be followed up by measurement of cardiac troponin T to quantify the myocyte necrosis. STATISTICAL ANALYSIS USED: Logistic regression analysis using commercial available software STATA 9. RESULTS: A total of 44 patients (20 M and 24 F) were eligible for the cohort analysis. Average patient age is 52.02 years (52.02 ± 11.23), and 86% (6/44) arrived with World Federation of Neurosurgical Society Scale grade 3 or better. The ECG abnormality was found in 10 cases (22.7%), but the abnormal TnT (>1 µg/l) were found in eight cases, and two cases contribute to the mortality. The ECG abnormalities are significantly associated with total cortisol on day 4 (P < 0.05) and free cortisol on day 2 (P = 0.0065). CONCLUSIONS: Elevated levels of morning cortisol within the first four days after surgery are associated with the ECG abnormality.

The association between cortisol dynamics and the course of aneurysmal subarachnoid hemorrhage.

CONTEXT: One of aneurysmal subarachnoid hemorrhage complication is delayed ischemic neurological deficits (DIND). It is postulated that cortisol dynamics might be associated with the severity of this complication. AIMS: The goal of the study is to investigate whether the peak of morning serum cortisol levels are associated with the severity of its complication during the course of the disease. SETTINGS AND DESIGN: This is a prospective cohort study conducted from January 2009 to June 2011, at our institution. MATERIALS AND METHODS: The study follows a consecutive cohort of patients for 14 days after the aneurysmal subarachnoid hemorrhage. Serum cortisols, cortisol binding globulin, adenocorticotrophic hormone (ACTH) were measured pre operatively and then on post operative days (POD) 2, 4, 7, and 10. Blood was drawn to coincide with peak cortisol levels between 08.00-09.00 hours. Neurological examinations were conducted at least twice daily and patient outcome were graded according to modified Ranklin Scale. DIND was defined by a decrease in the Glasgow Coma Scale of two or more points compared to the status on POD 1. STATISTICAL ANALYSIS: All the results were analyzed using statistical software, Statistical Package for Social Sciences (SPSS v61; SPSS, Inc., Chicago, IL). Logistic regression analysis was used to compare the relationship between the variables. RESULTS: Thirty six consecutive patients are collected, but only 28 patients (12 M and 16 F) were eligible for the cohort analysis. Average patient age is 50.75 years old (50.75±12.27), and more than 50% (15/28) arrived with World Federation of Neurologic Surgeons grade 3 or better. Elevated total cortisol levels of more than 24 mg/dl on day 2, 4, and 10 were associated with DIND, and the most significant being on day 4 (P=0.011). These patients also had a higher grade on the modified Ranklin scale of disability. CONCLUSIONS: This study shows that the elevated levels of morning total cortisol in the serum are associated with the onset of DIND during the disease course, and it's also associated with bad outcomes.