RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BENGALURU PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE
CANDIDATE AND ADDRESS

Dr. Arun Kumar M, #98, 2nd cross, MEI colony, Laggere, Bangalore-560058 M.S. RAMAIAH MEDICAL COLLEGE, BANGALORE-560054

2. NAME OF THE
INSTITUTION

3. COURSE OF STUDY
& SUBJECT M.D. Physiology

4. DATE OF
ADMISSION

20th June 2009

5. TITLE OF THE
TOPIC

A COMPARATIVE STUDY OF SERUM CORTISOL LEVEL IN YOUNG ADULTS WITH AND WITHOUT APHTHOUS ULCERS.

6. BRIEF RESUME OF THE INTENDED WORK:

6.1 INTRODUCTION & NEED FOR THE STUDY

Aphthous ulcers or recurrent aphthous stomatitis is the most common and painful disorder in young adults who are under emotional, physical, and psychological stress. Various hypotheses on the etiology of aphthous ulcers like stress, trauma, immunodeficiency conditions, hematinic deficiency (iron, vitamin B 12, and folate) have been put forth but none are conclusive. Aphthous ulcers are very common and easy to recognize. Their cause remains uncertain. They are found on non-keratinized mucosa (eg, 1

buccal and labial mucosa and not attached gingiva or palate), they may be single or multiple, are usually recurrent, and appear as painful small (usually 12 mm, but sometimes 12 cm) round ulcerations with yellow-gray fibrinoid centers surrounded by red halos. The painful stage lasts 710 days; healing is completed in 13 weeks1. Almost any type of stress, whether physical or neurogenic, causes an immediate and marked increase in ACTH secretion by the anterior pituitary gland, followed within minutes by greatly increased adrenocortical secretion of cortisol2. Cortisol is called stress hormone and it is released during fight and flight reaction. While cortisol is an important and helpful part of the bodys response to stress, it mediates immune function and inflammatory response. Higher and more prolonged levels of cortisol in the bloodstream (like those associated with chronic stress) have been shown to have negative effects, such as impaired cognitive performance, suppressed thyroid function, decrease in muscle tissue, higher blood pressure, lowered immunity and inflammatory responses in the body, slowed wound healing, and other health consequences. Herein the purpose of the study is to analyze the possibility of stress (both physical and psychological) as the etiology of the aphthous ulcers.
6.2 REVIEW OF LITERATURE

Camillo De Barros et al 2009 in their study concluded that psychological stress may play a role in the manifestation of recurrent aphthous stomatitis (RAS); it may serve as a trigger or a modifying factor rather than being a cause of the disease 3. According to study of Kirschbaum et al 1995, cortisol levels were significantly elevated in healthy men who were subjected to prolonged psychological stress 4. Increased levels of plasma cortisol are observed and gives evidence of an intensified and sustained stress response 5. Eleni Albandou Farmakis et al 2008, found increased level of serum and salivary cortisol in the patients with recurrent aphthous ulcers6.

6.3 OBJECTIVES OF THE STUDY

1. 2.

To measure the serum cortisol in young adults with aphthous ulcers and controls. To assess the stress level in both cases and controls by using questionnaire namely STAI (State Trait Anxiety Inventory).

7. MATERIALS AND METHODS:

7.1 CASES AND CONTROLS.

35 patients aged between 16 to 30 years with aphthous ulcers who come to the MS Ramaiah College and Hospitals will be selected as study group. Controls comprise normal people of the same age group without ulcers. Informed consent is taken from all the subjects. Study will be done from January 2010 to January 2011.
7.2a INCLUSION CRITERIA:

Males and females aged 16 to 30 years. Recurrent aphthous ulcers with minimum of 2 years of history. Non-Smokers.

7.2b EXCLUSION CRITERIA:

Known HIV patient. Known history of inflammatory bowel disease. Multiple aphthous ulcers with genital ulcers and arthritis. Diabetes mellitus. Chronic hypertension. Known recent infectious disease or history of infectious disease. Drug history (corticosteroids).

7.3 INVESTIGATIONS AND INTERVENTIONS:

STAI (State Trait Anxiety Inventory) is given to the study and control groups to assess their stress level7. The test procedure is explained and about 5 ml of blood is

collected from both cases and controls with aseptic precautions. The serum is separated and the cortisol level is measured using Radioimmunoassay (RIA) technique under standard laboratory conditions. Then the values are compared between cases and controls.
STATISTICAL METHODS

Independent t test would be employed to compare the serum cortisol level, STAI score between cases and controls.

7.4 ETHICAL CLEARANCE:

YES, Certificate enclosed. 8 REFERENCES 1. Stephen J McPhee, Maxine A. Papadakis. Current Medical Diagnosis and Treatment, 48th edition, McGraw Hill Lange, 2009; Chapter 8, 204. 2. Arthur C Guyton, John Hall. Text book of medical physiology, 11th edition. Elsevier Saunders, 2006; Chapter 77, 950-951. 3. Camila de Barros Gallo, Maria Angela Martins Mimura, Norberto Nobuo Sugaya. Psychological stress and recurrent aphthous stomatitis. Clinics. 2009; 64(7):645648. 4. Clemens Kirschbaum, Jens Prussner, Arthur A Stone et al. Persistent high cortisol responses to repeated psychological stress in a subpopulation of healthy men. Psychosomatic Medicine. 1995; 57 (5), 468-474. 5. Boudarene M, Legros JJ, Timsit-Berthier M. Study of the stress response: role of anxiety, cortisol and DHEAs. Encephale. 2002; 28(2):139-46. 6. Eleni Albanidou Farmakis, Athanasios poulopoulos, Apostolos Epivatianos et al. Increased Anxiety Level and High Salivary and Serum Cortisol Concentrations in Patients with Recurrent Aphthous Stomatitis. Tohoku J. Exp. med. 2008; 214(4), 291-296.

7.

Spielberger CD, Gorsuch RL and Lushene RE. In: STAI Manual for the StateTrait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1970.

9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE: Aphthous ulcers are one of the commonest disorders seen in young people. The exact etiology and treatment has not yet been concluded. The present study will help to throw light on the etiology and the role of stress in the causation of aphthous ulcers. 11. NAME AND DESIGNATION OF: 11.1 GUIDE:
SIGNATURE:

Dr. G.JAISRI. MD

11.2 CO-GUIDE: SIGNATURE:

Dr. VASANTHI ANANTHAKRISHNAN. MD

11.3 HEAD OF THE DEPARTMENT:

SIGNATURE:

Dr. G.JAISRI. MD

12.1 REMARKS OF CHAIRMAN AND PRINCIPAL:

SIGNATURE: