Estanozolol como anabólico: una causa de hepatotoxicidad / Estanozol as anabolic: a cause of hepatotoxicity / Estanozolol Como Anabólico: Uma Causa De Hepatotoxicidade

Los antibióticos y analgésicos han sido descritos frecuentemente como las principales causas de toxicidad hepática. Los esteroides anabólicos se han relacionado también con alteraciones en sistemas como el cardiovascular o el hepático; en este último causan colestasis, carcinoma hepatocelular, hiperplasia regenerativa nodular y sangrado de varices, secundario a hipertensión portal. Es importante entonces considerar los esteroides anabólicos como factores de riesgo para hepatotoxicidad. Se presenta el primer caso en Colombia y uno de los pocos en Latinoamérica, de colestasis asociada únicamente al uso de estanozolol. Se trata de un paciente de 21 años, en tratamiento con el medicamento para incrementar la masa muscular, que presentó compromiso hepático de tipo colestásico. Se descartaron otras posibles causas de ictericia, mediante la escala CIOMS/RUCAM se llegó a establecer causalidad entre el consumo de estanozolol y la colestasis. El objetivo de este reporte es hacer una descripción no reportada en la literatura colombiana y poco común en la literatura mundial.

Antibiotics and pain relievers have been frequently described as the main causes of liver toxicity. Anabolic steroids have also been linked to alterations in systems such as cardio-vascular or liver. In the latter, they seem to cause cholestasis, hepatocellular carcinoma, nodular regenerative hyperplasia and variceal bleeding secondary to portal hypertension. It is important to consider them as factors associated with hepatotoxicity. The first case in Colombia and one of the few in Latin America of cholestasis associated only to the use of Stanozolol is presented in a 21-year-old patient under treatment with the drug to increase muscle mass. The patient presented with cholestatic liver involvement. Other possible causes of jaundice were ruled out. From the CIOMS / RUCAM scale, causality was established between the consumption of Stanozolol and cholestasis. The objective of this case is to report a case not found in Colombian literature and little reported in world literature.

Antibióticos e analgésicos têm sido frequentemente descritos como as principais causas de toxicidade hepática. Os esteroides anabolizantes também têm sido relacionados a alterações em sistemas como cardiovasculares ou hepáticos; neste último, causam colestase, carcinoma hepatocelular, hiperplasia nodular regenerativa e sangramento varicoso, secundário à hipertensão portal. Portanto, é importante considerar os este-roides anabolizantes como fatores de risco para hepatotoxicidade. O primeiro caso é apresentado na Colômbia e um dos poucos na América Latina, de colestase associada apenas ao uso de estanozolol. Paciente de 21 anos, em tratamento com fármaco para aumento de massa muscular, apresentou acometimento hepático colestático. Outras possíveis causas de icterícia foram descartadas, a escala CIOMS / RUCAM estabeleceu causalidade entre o consumo de estanozolol e colestase. O objetivo deste relatório é fazer uma descrição não relatada na literatura colombiana e rara na literatura mundial

Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice / Esteroides anabolizantes e seus efeitos na densidade neuronal em áreas corticais e no hipocampo de camundongos

Abstract Anabolic substances have been increasingly used by bodybuilders and athletes with the goal of improving performance and aesthetics. However, this practice has caused some concern to physicians and researchers because of unknowledge of consequences that the indiscriminate and illicit use of these substances can cause. Thus, this study analyzed the effects of two commercially available anabolic steroids (AS), Winstrol Depot® (Stanozolol) and Deposteron® (Testosterone Cypionate), in the neuronal density of limbic, motor and sensory regions on the cerebral cortex and in CA1, CA2, CA3 regions of the hippocampus. A total of 60 Swiss mice were used (30 males and 30 females), separated into three groups: control and two experimental groups, which received the AAS. From each brain, homotypic and semi-serial samples were taken in frontal sections from areas established for the study. The results showed that females treated with testosterone cypionate presented a reduction in all regions tested and the ones treated with Stanozolol showed a decrease in some hippocampal areas. Regarding male animals, stanozolol led to a decrease in neuron number in one hippocampal region. These data allow us to conclude that supra-physiological doses of steroids used in this study, can cause considerable damage to nervous tissue with ultrastructural and consequently behavioral impairment. These changes could interfere with the loss of physical yield and performance of athletes and non-athletes and may cause irreparable damage to individuals making irresponsible use of anabolic steroids.

Resumo As substancias anabólicas tem sido cada vez mais utilizadas por fisiculturistas e atletas com o objetivo de melhorar o desempenho e a estética. No entanto, essa prática tem causado algumas preocupações aos médicos e pesquisadores, devido ao desconhecimento das consequencias que o uso indiscriminado e ilícito dessas substâncias podem causar. Diante disso, este estudo analisou os efeitos de dois esteroides anabolizantes (EA) comercialmente disponíveis, Winstrol Depot® (Stanozolol) e Deposteron® (cipionato de testosterona), na densidade neuronal das regiões corticais límbica, motora e sensitive bem como das áreas CA1, CA2, CA3 do hipocampo. Foram utilizados 60 camundongos Swiss (30 machos e 30 fêmeas), separados em três grupos: controle e dois grupos experimentais, que receberam o EA. De cada cérebro, foram coletadas amostras homotípicas e semi-seriadas em cortes frontais das áreas estabelecidas para o estudo. Os resultados mostraram que as fêmeas tratadas com cipionato de testosterona apresentaram uma redução em todas as regiões analisadas já as fêmeas tratadas com Stanozolol mostraram uma diminuição em algumas áreas do hipocampo. Em relação aos animais machos, o stanozolol levou a uma diminuição na densidade neuronal em uma região do hipocampo. Estes dados nos permitem concluir que doses supra fisiológicas de esteroides utilizadas neste estudo podem causar danos consideráveis ao tecido nervoso com comprometimento ultraestrutural e consequentemente comportamental. Essas alterações podem interferir na perda de rendimento físico e no desempenho de atletas e não atletas e podem causar danos irreparáveis a indivíduos que fazem uso irresponsável destes EA.

Swim training reverses some effects of nandrolone decanoate in wistar rats / El entrenamiento en natación revierte algunos efectos del decanoato de nandrolona en los ratones wistar / Treinamento de natação reverte alguns efeitos do decanoato de nandrolona em ratos wistar

ABSTRACT Introduction: The indiscriminate use of androgenic steroids may have deleterious effects on human tissue. Objectives: Evaluate the effects of chronic administration of the steroid nandrolone decanoate (DECA) on autonomic cardiovascular modulation, kidney morphometry and the association between these variables in Wistar rats subjected to physical training with swimming. Methods: Thirty-two male Wistar rats aged 20 weeks were distributed among four experimental groups according to the training received: sedentary control (SC), sedentary treated with DECA (SD), trained control (TC) and trained treated with DECA (TD). The hemodynamic parameters, including blood pressure and variations in systolic blood pressure (SBPV) and diastolic blood pressure (DBPV), and kidney morphometry were evaluated. The level of significance adopted was 5%. Results: The SD group had higher baseline SBP and DBP values when compared to the SC, TC and TD groups, which were similar to each other. The rats in the SD group had higher systolic blood pressure (SBPV) and diastolic blood pressure (DBPV) variation values and higher absolute and normalized values in the LF band of the DBPV when compared to the animals in the SC, TC and TD groups. The animals in the SD group had a significantly higher rate of kidney fibrosis compared to the SC, TC and TD groups. There were no significant differences between the sympathetic modulation of SBPV through the LF component and kidney fibrosis. Conclusions: Physical training with swimming was effective in preventing the increase in blood pressure levels and lowering the occurrence of kidney fibrosis in animals treated with anabolic steroids. Level of Evidence IV; Series of cases .

RESUMEN Introducción: El uso indiscriminado de esteroides androgénicos puede tener consecuencias nocivas para el organismo. Objetivo: Evaluar los efectos de la administración crónica del esteroide decanoato de nandrolona (DECA) en ratones Wistar sometidos a entrenamiento físico con natación, sobre la modulación autonómica cardiovascular, morfometría renal y asociación entre esas variables. Métodos: Fueron utilizados 32 ratones Wistar machos con edad de 20 semanas, distribuidos en 4 grupos experimentales de acuerdo con el tratamiento recibido: sedentarios controles (SC), sedentarios que recibieron el DECA (SD), entrenados controles (EC) y entrenados que recibieron el DECA (ED). Se evaluaron parámetros hemodinámicos, como presión arterial y variación de la presión arterial sistólica (VPAS) y diastólica (VPAD) y morfometría renal. El nivel de significancia adoptado fue de 5%. Resultados: El grupo SD presentó valores basales mayores de PAS y PAD cuando comparados a los grupos SC, EC y ED, los cuales fueron semejantes entre sí. Los animales del grupo SD tuvieron valores mayores de la variancia de VPAS y VPAD y valores absolutos mayores y normalizados de la banda LF de la VPAD, en comparación con los animales de los grupos SC, EC y ED. El grupo SD tuvo tasa significativamente mayor de fibrosis renal en comparación con los animales de los grupos SC, EC y ED. No se evidenciaron diferencias considerables entre la modulación simpática de la VPAS a través del componente LF y fibrosis renal. Conclusiones: El entrenamiento físico con natación fue efectivo en prevenir el aumento de niveles presóricos y disminuir la ocurrencia de fibrosis renal en animales tratados con esteroide anabolizante. Nivel de Evidencia IV; Serie de casos .

RESUMO Introdução: O uso indiscriminado de esteroides androgênicos pode ter consequências deletérias no organismo. Objetivo: Avaliar os efeitos da administração crônica do esteroide decanoato de nandrolona (DECA) em ratos Wistar submetidos a treinamento físico com natação sobre a modulação autônoma cardiovascular, morfometria renal e associação entre essas variáveis. Métodos: Foram utilizados 32 ratos Wistar machos com idade de 20 semanas, distribuídos em 4 grupos experimentais de acordo com o tratamento recebido: sedentários controles (SC), sedentários que receberam o DECA (SD), treinados controles (TC) e treinados que receberam o DECA (TD). Avaliaram-se parâmetros hemodinâmicos, como pressão arterial e variação da pressão arterial sistólica (VPAS) e diastólica (VPAD) e morfometria renal. O nível de significância adotado foi de 5%. Resultados: O grupo SD apresentou valores basais maiores de PAS e PAD quando comparado aos grupos SC, TC e TD, os quais foram semelhantes entre si. Os animais do grupo SD tiveram valores maiores da variância da VPAS e VPAD e valores absolutos maiores e normalizados da banda LF da VPAD, em comparação com os animais dos grupos SC, TC e TD. O grupo SD teve taxa significativamente maior de fibrose renal em comparação com os animais dos grupos SC, TC e TD. Não se evidenciaram diferenças consideráveis entre a modulação simpática da VPAS através do componente LF e fibrose renal. Conclusões: O treinamento físico com natação foi efetivo em prevenir o aumento de níveis pressóricos e diminuir a ocorrência de fibrose renal em animais tratados com esteroide anabolizante. Nível de Evidência IV; Série de casos .

Uso de corticosteroides no tratamento da lesão hepática aguda grave decorrente de anabolizante estanazolol / Use of corticosteroids in the treatment of stanazolol-induce severe acute liver injury

A busca pelo corpo perfeito pode gerar graves consequências para a população que faz uso indiscriminado de substâncias visando a resultados rápidos. O caso relatado se refere a um pa- ciente de 21 anos, do sexo masculino, na cidade de São Paulo (SP), que apresentou quadro de síndrome colestática 15 dias após uso do anabolizante estanazolol para fins estéticos na ativi- dade física, evoluindo com hepatite medicamentosa grave, com aumento de transaminases, hiperrubilinemia às custas de bilirrubina direta e fatores de coagulação, sem resposta satis- fatória ao tratamento de suporte convencional, com melhora significativa após introdução de corticoterapia.

Searching for the perfect body image can cause severe conse- quences to the population using substances indiscriminately to reach results fast. The case reported refers to a male patient, 21 years old, from the city of São Paulo (SP), who developed choles- tatic syndrome 15 days after the use of the steroid Stanazol for aesthetic purposes during physical activity, progressing with se- vere drug-induced hepatitis, transaminases, bilirubin, and coagu- lation factors increase with no satisfactory response to the con- ventional support treatment, and significant improvement after the introduction of corticotherapy.

Effects of nandrolone decanoate on femur morphology. Experimental study

ABSTRACT Purpose To evaluate the immediate and late effects of nandrolone on femur morphology of rats. Methods Twenty-eight animals with 20 weeks of age were divided into four groups: C28, control animals that were euthanized eight weeks after the experiment started; C40, control animals euthanized 20 weeks after the experiment started; T28, treated animals receiving nandrolone during eight weeks and euthanized immediately after the treatment period; and T40, animals treated during eight weeks and euthanized 12 weeks after the end of the treatment. Treated animals received nandrolone decanoate during eight weeks and control groups received peanut oil by intramuscular injection. After euthanasia, femurs were removed, dissected, weighted and measured by digital pachymeter. Results The T40 group presented an increase on distal epiphysis diameter when compared to C40 group. There was no difference between treated and control groups in relation to body and femur absolute weight, relative weight and length of femur. There was also no difference in relation to diameter of proximal epiphysis and diameter of diaphysis among the groups. Conclusions Nandrolone decanoate does not produce significant effect on femur, exception on its distal extremity at late period. The effects of such drug may depend on the time after administration.

Ação do estanozolol sobre a histologia renal e hepática em ratos treinados com natação / [Stanozolol action on renal and hepatic histology in swimming trained rats]

No presente estudo, foram analisados os efeitos do estanozolol, associado ou não à atividade física, sobre o hemograma, o peso ponderal, a ingestão líquida e sólida, a urinálise, a expressão do VEGF-A renal e o glicogênio hepático, além da histopatologia hepática e renal em ratos Wistar. Foram utilizados 32 ratos Wistar, machos, jovens, separados em quatro grupos: GC (grupo controle); GCE (grupo controle-exercício); GT (grupo tratamento-esteroide); GTE (grupo tratamento-esteroide-exercício). Os animais dos grupos GT e GTE (n=16) foram submetidos a injeções subcutâneas, cinco dias/semana, durante 30 dias, na concentração de 5mg/kg de estanozolol diluído em 1mL de óleo de gergelim, utilizado como veículo. A natação foi definida como exercício físico. Houve aumento no peso dos animais submetidos ao estanozolol e ao exercício a partir da terceira semana de uso e aumento da excreção urinária a partir da quinta semana; os demais parâmetros da urinálise foram semelhantes entre os grupos. O uso de estanozolol associado ou não à atividade física promoveu redução da expressão do VEGF-A nos rins e do glicogênio hepático, além de alterações histopatológicas nesses órgãos. Quanto à hematologia, houve uma diminuição dos leucócitos no GTE em relação aos grupos GT e GCE. Quanto aos linfócitos, houve um aumento no GT e uma diminuição no GTE, e, em relação ao número de plaquetas, houve diminuição no GTE quando comparado ao GT e ao GCE Assim, conclui-se que estanozolol na dose de 5,0mg/kg causa alterações renais e hepáticas em ratos Wistar, podendo levar à falência dos rins e do fígado.(AU)

The goal of this study was to determine the effect of stanozolol (ST) on kidney and liver of Wistar rats. Thirty-two male animals were divided into the following four groups: control group (CG); Control group-exercise (GCE); Group-steroid treatment (GT); Group treatment-steroid-exercise (GTE). Swimming was defined as exercise. The animals GT and GTE was submitted to subcutaneous injections, five days/week for 30 days, at a concentration of 5mg/kg ST diluted in 1mL/kg of sesame oil. The results showed an increase in weight gain in all animals submitted to ST and exercise from the 3rd week of use and increase in urinary excretion from the 5th week and the other urinalysis parameters were similar. The ST associated or not with physical activity reduced VEGF-A expression in the kidneys and hepatic glycogen, as well as histopathological changes in these organs. Regarding hematology, there was a decrease in leukocytes in the GTE. As for lymphocytes there was an increase in GT and a decrease in GTE, and in relation to the number of platelets, there was a decrease in GTE. In conclusion, the administration of stanozolol at 5.0mg/kg caused a structural change of kidney and liver in treated animals.(AU)

Dietary supplements in fitness centers: body management and health risks / Suplementos alimentares em academias de ginástica: gerenciamentos do corpo e riscos à saúde

ABSTRACT The purpose of this study was to explore the meanings of supplement use among those who engage in physical activity in fitness centers. A qualitative study was carried out based on 67 questionnaires answered on the internet by practitioners of physical training. There was also an observation of the groups in the Facebook, the dynamic and other aspects such as discussions, messages, profiles and images. It was detected that physical activity practitioners care more about the quantity of substances ingested than any other factor that may lead them to suffer certain health risks. They believe that so-called "excesses" may cause diseases to the internal organs. Although the participants believe that their own consumption of supplements does not compromise their health, a biomedical authority is crucial for them to recognize whether or not they are at risk. The consumption of supplements can vary depending on what is understood to be excessive and which risks may compromise the body. There are many motivations for managing these substances. Health risks should not be analyzed solely from a biomedical perspective, but also addressed by the socio-cultural logic of the perceptions and meanings attributed by the subjects to the body and the management thereof.

RESUMO O objetivo deste estudo foi explorar os significados do uso de suplementos entre aqueles que praticam atividade física em academias de ginástica. Um estudo qualitativo foi realizado com base em 67 questionários respondidos na internet por praticantes de atividade física. Houve também uma observação dos grupos na Facebook, a dinâmica e outros aspectos como discussões, mensagens, perfis e imagens. Foi detectado que os praticantes de atividade física se importam mais com a quantidade de substâncias ingeridas do que com qualquer outro fator que possa levá-los a sofrer certos riscos à saúde. Eles acreditam que os chamados "excessos" podem causar doenças aos órgãos internos. Embora os participantes acreditem que seu próprio consumo de suplementos não compromete a saúde, a autoridade biomédica é crucial para que eles reconheçam se estão ou não em risco. O consumo de suplementos pode variar dependendo do que se entende ser excessivo e quais os riscos que podem comprometer o corpo. Existem muitas motivações para gerenciar essas substâncias. Os riscos para a saúde não devem ser analisados apenas a partir de uma perspectiva biomédica, mas também abordados pela lógica sociocultural das percepções e significados atribuídos pelos sujeitos ao corpo e ao seu gerenciamento.

Anabolizantes na graduação em educação física: um dilema ético-sanitário entre estudantes que praticam fisiculturismo / Anabolics steroids in a physical education undergraduate program: an ethical-sanitary dilemma among bodybuilder students

RESUMO Este artigo trata do dilema enfrentado por estudantes-fisiculturistas de Educação Física que se dedicam a aprender, por conta própria, sobre o uso de anabolizantes para fins não terapêuticos em um curso de graduação vinculado à área da saúde. A noção de dilema ético-sanitário é desenvolvida a partir da articulação entre os conceitos de expertise, de Nikolas Rose, e o de risco em saúde, de Deborah Lupton. Entrevistas episódicas com seis alunos da graduação dos cursos de licenciatura e bacharelado em Educação Física de uma universidade brasileira foi a opção metodológica adotada. Como resultado, identificamos dois perfis de estudantes praticantes de fisiculturismo: um composto pelos que ingressaram no curso com o objetivo de aprender a usar anabolizantes; e outro que julgava já saber sobre e tinha por objetivo buscar uma certificação profissional universitária. Concluímos que o dilema ético-sanitário observado em ambos os perfis deveria ser tratado em aula nos cursos de graduação em Educação Física, pois o "silêncio curricular" sobre o processo de hipertrofia muscular pela via medicamentosa, associado à atmosfera de clandestinidade, pode favorecer a circulação de mais desinformação e ainda mais riscos ao público alvo deste estudo.

ABSTRACT This article deals with the dilemma faced by physical education student-bodybuilders who are dedicated to learning on their own about the uses of anabolic steroids for non-therapeutic purposes. The concept of the ethical-sanitary dilemma is developed from the articulation between Nikolas Rose's concept of expertise and Deborah Lupton's concept of risk. Episodic interviews with six undergraduate students of Physical Education from a Brazilian university were applied in this study as the principal method. As a result, we identified two profiles of student-bodybuilders: one composed of those who joined the program in order to learn how to use anabolic steroids, and another one composed of those who presumed to know about the uses and whose purpose was to earn an undergraduate diploma. We conclude that the ethical-sanitary dilemma observed in both profiles should be addressed in the Physical Education undergraduate courses since the "curricular silence" on the process of muscular hypertrophy via steroid anabolics, associated with the clandestine atmosphere, may add more misinformation and even more risks to the target audience of this study.

Investigação na formação de profissionais de Educação Física e Psicologia revela déficit no conhecimento sobre esteroides anabólico androgênicos / Research on the formation of physical education and psychology professionals reveals deficits in knowledge aboutanabolic androgenic steroids / Investigación en la formación de los profesionales de la edu-cación física y psicología revela déficit en el conocimiento acerca de los esteroides anabólicos androgénicos

Praticantes de exercícios físicos e atletas têmabusado de esteroides anabólico androgênicos(EAA's),sujeitando-se a um elevado risco de surgimento de reações adversas à saúde física e psíquica. Profissionais de saúde têm o dever de informar a população sobre os riscos da utili-zação de EAA's. Este estudo investigou a formação de estudantes dos cursos de Psicologia e Educação Física da cidade de Belo Horizontesobre esse tema analisando-seum questionário respondido por 414 voluntários. Os resultados revelaram que, na formação desses estudantes, pouca atenção tem sido dada quanto ao uso de EAA's. Conclui-se que os estudantes de ambos os cursos não obtiveram conhecimento satisfatório acerca dos EAA's e suas aplicações.

Physical exercise practitioners and athletes have abused of anabolic androgenic steroids (EAA's) subject themselves to the occurrence of harmful reactions to physical and mental health. Healthcare professionals should inform people about issues arising from the use of AAS. The present study investigated the professional formation of students of Psychology and Physical Education of the city of Belo Horizonte regarding this topic. Four hundred and fourteen volunteers answered a questionnaire. The results reveal that minor attention has been given to this matter in the formation of these students, resulting in a trivial understanding about the EAA's. It was concluded that these students of EF and PSI did not obtain satisfacto-ry knowledge about the AAS and its applications.

Los practicantes de ejercicio físico y atletas han abusado de los esteroides anabólicos andro-génicos (EAA's), sujetándose a un alto riesgo de surgimiento de reacciones adversas a la sa-lud física y psíquica. Los profesionales de la salud deben informar a la población sobre los riesgos de la utilización de EAA's. Este estudio investigó la formación de los estudiantes de Psicología y Educación Física de la ciudad de Belo Horizonte, con respecto a este tema. El instrumento investigativo fue el análisis de un cuestionario respondido por 414 voluntarios. Los resultados revelaron que poca atención acerca de los EAA's y de sus aplicaciones se ha dado en la formación de estos estudiantes. Se concluyó que los estudiantes de ambos cursos no obtuvieron conocimiento satisfactorio.

Stanozolol promotes osteogenic gene expression and apposition of bone mineral in vitro

Abstract Stanozolol (ST) is a synthetic androgen with high anabolic potential. Although it is known that androgens play a positive role in bone metabolism, ST action on bone cells has not been sufficiently tested to support its clinical use for bone augmentation procedures. Objective: This study aimed to assess the effects of ST on osteogenic activity and gene expression in SaOS-2 cells. Material and Methods: SaOS-2 deposition of mineralizing matrix in response to increasing doses of ST (0-1000 nM) was evaluated through Alizarin Red S and Calcein Green staining techniques at 6, 12 and 24 days. Gene expression of runt-related transcription factor 2 (RUNX2), vitamin D receptor (VDR), osteopontin (SPP1) and osteonectin (ON) was analyzed by RT-PCR. Results: ST significantly influenced SaOS-2 osteogenic activity: stainings showed the presence of rounded calcified nodules, which increased both in number and in size over time and depending on ST dose. RT-PCR highlighted ST modulation of genes related to osteogenic differentiation. Conclusions: This study provided encouraging results, showing ST promoted the osteogenic commitment of SaOS-2 cells. Further studies are required to validate these data in primary osteoblasts and to investigate ST molecular pathway of action.

Rotura simultanea bilateral de tendon cuadricipital asociada a anabolizantes esteroideos / Bilateral simultaneous rupture of quadriceps tendon associated to anabolic steroids administration

La rotura bilateral y simultánea del tendón cuadricipital es una lesión rara con pocos reportes en la literatura, que suele ocurrir en mayores de 50 años con enfermedades sistémicas crónicas subyacentes. Presentamos el caso de un paciente masculino sano de 32 años con rotura bilateral de tendón cuadricipital durante la práctica de musculación asociada a la administración de anabolizantes esteroideos y el tratamiento realizado

Bilateral and simultaneous rupture of the quadriceps tendon is a rare injury with a few reports in record that usually occurs in people older than 50 years with underlying chronic systemic diseases. We present the case of a healthy 32-year-old male patient with bilateral quadriceps tendon rupture during weight training practice associated to anabolic steroids administration and the treatment provided

Hepatotoxicidad por esteroides anabólicos androgénicos, reporte de 2 casos en Uruguay / Hepatotoxicity induced by anabolic-androgenic steroids, 2 cases report in Uruguay / Hepatotoxicidade por anabolizantes esteróides androgênicos, relato de 2 casos no Uruguai

El consumo ilícito de esteroides anabólicos androgénicos con fines estéticos ha aumentado en los últimos años y, aunque raro, es causa de hepatotoxicidad. Los casos con daño hepatocelular son más frecuentes, pero los colestásicos son más graves y pueden asociarse a falla renal. Salvo por la suspensión del fármaco, la hepatotoxicidad por anabólicos no tiene tratamiento específico. Se describe y discuten las historias clínicas de dos hombres jóvenes, deportistas aficionados que consultaron por ictericia y presentaron colestasis e insuficiencia renal. El reporte de casos, en patologías poco frecuentes, resulta fundamental para difundir y ampliar la información que ayude al clínico a considerar con firmeza este diagnóstico, incluso ante la falta de reconocimiento inicial del consumo por parte del paciente.

Illicit consumption of anabolic-androgenic steroids for aesthetic purposes has increased in recent years. Hepatocellular damage is more frequent, but cholestasis is more dangerous and may be associated with renal failure. The clinical records of two young men, amateur athletes who consulted for jaundice in the last year and denied its consumption at the beginning, are described. Except for the drug interruption, hepatotoxicity by anabolics has no specific treatment. Usually presented as cholestatic liver disease and renal failure, case reports are fundamental to characterize its clinical-evolutionary presentation. This may also allow clinicians to firmly consider diagnosis even when the patient denies consumption.

O uso ilícito de esteróides androgênicos anabólicos para fins estéticos tem aumentado nos últimos anos e, apesar de raro, é causa de hepatotoxicidade. Casos com dano hepatocelular são mais freqüentes, mas colestesia é mais grave e pode estar associada à insuficiência renal. Com exceção da suspensão do medicamento, a hepatotoxicidade anabólica não possui tratamento específico. As histórias clínicas de dois homens jovens, atletas amadores que consultaram para icterícia e apresentaram colestase e insuficiência renal, são descritos e discutidos. O relato de casos, em patologias pouco freqüentes, é fundamental para disseminar e ampliar as informações que auxiliam o clínico a considerar com firmeza esse diagnóstico antes mesmo do não reconhecimento inicial do consumo pelo paciente.

Estudio comparativo de la absorción neta de calcio de dos formulaciones distintas de carbonato de calcio en mujeres posmenopáusicas / Comparative study of net calcium absorption of two different pharma¬ceutical formulations of calcium carbonate in posmenopausal women

La suplementación con calcio reduciría, sola o asociada a otra medicación para osteoporosis, la pérdida de masa ósea y el riesgo de fracturas. Sin embargo, su tasa de adherencia es baja debido a la poca tolerancia. Objetivo: comparar la tasa de absorción neta de calcio entre dos formulaciones distintas de carbonato de calcio (500 mg): comprimidos vs. mousse. Material y métodos: 11 pruebas fueron realizadas en mujeres posmenopáusicas de 58,9±3 años. El diseño fue exploratorio abierto, aleatorizado, prospectivo cruzado de fase 4. Intervención: las participantes fueron aleatorizadas en dos grupos para recibir las dos formulaciones previa suplementación con vitamina D3. La tasa de absorción neta de calcio fue estudiada por la prueba de inhibición de hormona paratiroidea (PTH). Se obtuvieron muestras de sangre: basal y en la 1a, 2a y 3a hora posadministración del calcio asignado, y de orina de 2 horas basal y al final de la prueba. Determinaciones bioquímicas: calcio, fósforo, albúmina, 25-hidroxivitamina D y hormona paratiroidea intacta y calciuria. Análisis estadístico: método de los trapecios para calcular el área bajo la curva (AUC) de la concentración de calcio en el tiempo (R Development Core Team (2008). http://www.Rp-project.org) y Anova con dos términos de error para evaluar el efecto secuencia, período y formulación. Resultados: la mayor inhibición de PTH se observó a dos horas de la toma de ambas formulaciones (comprimidos -39,2% vs. mousse -38,0%; p=ns), con similar AUC0-3 h (comprimidos 3,35; IC 95%: 3,32; 3,37 vs. mousse 3,36; IC 95%: 3,33; 3,38). Cuando analizamos tolerancia y preferencias no se observaron diferencias estadísticamente significativas entre ambas formulaciones. Conclusión: el carbonato de calcio en mousse mostró similar tasa de absorción intestinal, preferencia y tolerancia gastrointestinal que en comprimido. (AU)

Calcium supplementation, administered alone or in combination with a specific medication for osteoporosis, would reduce bone mass loss and fracture risk in postmenopausal women. However, the adherence rate to calcium supplements is low, mainly due to low tolerance. Objective: comparisson of net calcium absorption rate between two different pharmaceutical formulations of calcium carbonate (PFCa) in postmenopausal women. Materials and Methods: 11 tests were performed in postmenopausal women aged 58.9±3 yrs. Design: Comparative, randomized, prospective, open-label exploratory crossover study of calcium mousse versus calcium pills. Intervention: Participants were randomized in 2 groups to receive the 2 different PFCa (500mg): pills vs. mousse, with previous vitamin D3 supplementation. The parathyroid hormone (PTH) inhibition test and the area-under-thecurve (AUC) of calcium were analyzed. Blood samples were taken at baseline and 1, 2 and 3 hrs after intake of the assigned PFCa. Urine samples (2hs) were obtained at -baseline, after 2hs of PFCa intake and at the end of the test. Biochemical Determinations: Serum: calcium, phosphorus, albumin, 25-hydroxyvitamin D, and intact PTH. In urine: calcium. Statistical Analysis: The trapezoid rule was applied to assess AUC in time (R Development Core Team (2008). http://www.Rp-project.org). An ANOVA model with 2 error terms was used to assess the effect of sequence, period, and formulation. Results: The highest inhibition PTH rates were observed after 2 hrs of PFCa (pills -39.2% vs. mousse -38.0%; p=ns). The AUC0-3hrs for both PFCa was similar (pills 3.35; 95%CI: 3.32; 3.37 vs. mousse 3.36; 95%CI: 3.33; 3.38). No statistically significant differences were observed when we analyze tolerance and predilection. Conclusion: The calcium carbonate in mousse showed an adequate rate of intestinal absorption, similarly predilection and gastrointestinal tolerance than the pill presentation. (AU)

Surgical treatment of pectoralis major muscle rupture with adjustable cortical button / Tratamento cirúrgico da ruptura do tendão do músculo peitoral maior com botão cortical ajustável

ABSTRACT Objective: To assess the tendon reconstruction technique for total rupture of the pectoralis major muscle using an adjustable cortical button. Methods: Prospective study of 27 male patients with a mean age of 29.9 (SD = 5.3 years) and follow-up of 2.3 years. The procedure consisted of autologous grafts taken from the semitendinosus and gracilis tendons and an adjustable cortical button. Patients were evaluated functionally by the Bak criteria. Results: The surgical treatment of pectoralis major muscle tendon reconstruction was performed in the early stages (three weeks) in six patients (22.2%) and in 21 patients (77.8%), in the late stages. Patients operated with the adjustable cortical button technique obtained 96.3% excellent or good results, with only 3.7% having poor results (Bak criteria). Of the total, 85.2% were injured while performing bench press exercises and 14.8%, during the practice of Brazilian jiu-jitsu or wrestling. All weight-lifting athletes had history of anabolic steroid use. Conclusion: The early or delayed reconstruction of ruptured pectoralis major muscle tendons with considerable muscle retraction, using an adjustable cortical button and autologous knee flexor grafts, showed a high rate of good results.

RESUMO Objetivo: Avaliar a técnica de reconstrução do tendão do músculo peitoral maior com ruptura total com o uso do botão cortical ajustável. Métodos: Estudo prospectivo de 27 pacientes do sexo masculino com média de 29,9 anos (DP = 5,3 anos) e acompanhamento de 2,3 anos. A técnica cirúrgica usada representa o uso de enxerto autólogo do tendão semitendineo e grácil e botão cortical ajustável. Os pacientes foram avaliados funcionalmente pelo critério de Bak. Resultados: O tratamento cirúrgico de reconstrução do tendão do músculo peitoral maior foi feito na fase precoce (três semanas) em seis pacientes (22,2%) e na fase tardia em 21 (77,8%). Os pacientes operados com a técnica de botão cortical ajustável obtiveram 96,3% de excelentes ou bons resultados contra apenas 3,7% de resultados ruins (critério de Bak). Do total, 85,2% sofreram lesão no exercício do supino e 14,8% eram praticantes de jiu-jitsu ou luta. Todos os atletas de levantamento de peso tinham história de uso de esteroide anabolizante. Conclusão: A reconstrução do tendão do músculo peitoral maior rompido, com grande retração muscular (tardia ou precoce) com o uso do botão cortical com ajuste e enxerto autólogo de flexores do joelho representa uma boa opção de tratamento.

Resting spontaneous baroreflex sensitivity and cardiac autonomic control in anabolic androgenic steroid users

OBJECTIVES: Misuse of anabolic androgenic steroids in athletes is a strategy used to enhance strength and skeletal muscle hypertrophy. However, its abuse leads to an imbalance in muscle sympathetic nerve activity, increased vascular resistance, and increased blood pressure. However, the mechanisms underlying these alterations are still unknown. Therefore, we tested whether anabolic androgenic steroids could impair resting baroreflex sensitivity and cardiac sympathovagal control. In addition, we evaluate pulse wave velocity to ascertain the arterial stiffness of large vessels. METHODS: Fourteen male anabolic androgenic steroid users and 12 nonusers were studied. Heart rate, blood pressure, and respiratory rate were recorded. Baroreflex sensitivity was estimated by the sequence method, and cardiac autonomic control by analysis of the R-R interval. Pulse wave velocity was measured using a noninvasive automatic device. RESULTS: Mean spontaneous baroreflex sensitivity, baroreflex sensitivity to activation of the baroreceptors, and baroreflex sensitivity to deactivation of the baroreceptors were significantly lower in users than in nonusers. In the spectral analysis of heart rate variability, high frequency activity was lower, while low frequency activity was higher in users than in nonusers. Moreover, the sympathovagal balance was higher in users. Users showed higher pulse wave velocity than nonusers showing arterial stiffness of large vessels. Single linear regression analysis showed significant correlations between mean blood pressure and baroreflex sensitivity and pulse wave velocity. CONCLUSIONS: Our results provide evidence for lower baroreflex sensitivity and sympathovagal imbalance in anabolic androgenic steroid users. Moreover, anabolic androgenic steroid users showed arterial stiffness. Together, these alterations might be the mechanisms triggering the increased blood pressure in this population.

Behavioral cross-sensitization between testosterone and fenproporex in adolescent and adult rats

The abuse of psychoactive drugs is considered a global health problem. During the last years, a relevant number of studies have investigated the relationship between anabolic-androgenic steroids (AAS) and other psychoactive drugs. AAS, such as testosterone, can cause a dependence syndrome that shares many features with the classical dependence to psychoactive substances. Pre-clinical evidence shows that there are interactions between testosterone and psychoactive drugs, such as cocaine. However, few studies have been performed to investigate the effect of repeated testosterone treatment on behavioral effects of amphetamine derivatives, such as fenproporex. The purpose of the present study was to investigate the effects of repeated testosterone administration on fenproporex-induced locomotor activity in adolescent and adult rats. Adolescent male Wistar rats were injected with testosterone (10 mg/kg sc for 10 days). After 3 days, animals received an acute injection of fenproporex (3.0 mg/kg ip) and the locomotor activity was recorded during 40 min. Thirty days later, the same animals received the same treatment with testosterone followed by a fenproporex challenge injection as described above. Our results demonstrated that repeated testosterone induced behavioral sensitization to fenproporex in adolescent but not in adult rats. These findings suggest that repeated AAS treatment might increase the dependence vulnerability to amphetamine and its derivatives in adolescent rats.

Star anise extracts modulation of reproductive parameters, fertility potential and DNA fragmentation induced by growth promoter Equigan in rat testes

ABSTRACT Equigan is an anabolic steroid that has been developed for veterinary use and derived from endogenous sex hormone testosterone that plays a key role in the development of male reproductive tissue as well as in puberty and spermatogenesis. The current study is aimed to investigate the possible prophylactic effect of star anise extracts (SAE) on the toxicity of rat testes, sexual hormones alternations, sperm count, sperm abnormalities and testicular DNA damage by Equigan. Forty adult male rats were equally divided into four groups (1st Control group, 2nd SAE group, 3rd Equigan and 4th Equigan+SAE group). Food and fluid intakes, relative body weight, potassium, chloride, phosphorous, non-progressive and immotile sperms were significantly increased in Equigan group as compared to control group. In contrast; relative testes weight, sodium, magnesium, total calcium, testosterone, FSH, LH, PRL, sperm count, progressive motility, and viability showed a significant decrease in Equigan group as compared to control groups. The relative weight of epididymis, seminal vesicles, prostates and serum calcium ions didn't change significantly in different studied groups. Co-administration of SAE with Equigan improved the sexual toxicity, electrolyte alternations, sperm count, abnormalities and DNA damage induced by Equigan.

Nandrolone decanoate appears to increase bone callus formation in young adult rats after a complete femoral fracture

Abstract Purpose: To evaluate the influence of nandrolone decanoate on fracture healing and bone quality in normal rats. Methods: Male rats were assigned to four groups (n=28/group): Control group consisting of animals without any intervention, Nandrolone decanoate (DN) group consisting of animals that received intramuscular injection of nandrolone decanoate, Fracture group consisting of animals with a fracture at the mid-diaphysis of the femur, and Fracture and nandrolone decanoate group consisting of animals with a femur fracture and treatment with nandrolone decanoate. Fractures were created at the mid-diaphysis of the right femur by a blunt trauma and internally fixed using an intramedullary steel wire. The DN was injected intramuscularly twice per week (10 mg/kg of body mass). The femurs were measured and evaluated by densitometry and mechanical resistance after animal euthanasia. The newly formed bone and collagen type I levels were quantified in the callus. Results: The treated animals had longer femurs after 28 days. The quality of the intact bone was not significantly different between groups. The bone callus did show a larger mass in the treated rats. Conclusion: The administration of nandrolone decanoate did not affect the quality of the intact bone, but might have enhanced the bone callus formation.

Hepatite tóxica complicada com lesão renal aguda por hiperbilirrubinemia decorrente do uso excessivo de esteroides anabolizantes / Toxic hepatitis complicated with acute kidney injury due to hyperbilirubinemia from abuse of anabolic steroids

O uso de esteroides anabólicos androgênicos é comum entre jovens praticantes de musculação, devido ao seu efeito trófico no tecido muscula. No entanto, seu abuso pode levar a danos teciduais dose-dependentes graves e irreversíveis. Foi relatado o caso de intoxicação hepática por droga anabolizante complicando com lesão renal aguda por hiperbilirrubinemia. Foram realizadas revisão de prontuário do paciente e pesquisa bibliográfica do assunto, após a assinatura de Termo de Consentimento Livre e Esclarecido. Um homem de 28 anos foi admitido neste hospital por icterícia, perda ponderal, febre alta, náuseas e prurido, sintomas estes iniciados 2 meses antes. À anamnese, revelou uso de estanozolol, testosterona e oximetolona em altas doses durante os 4 anos pregressos. Seus exames iniciais revelaram lesão hepática grave e azotemia, sendo o paciente diagnosticado com insuficiência renal aguda por lesão tubular pela hiperbilirrubinemia, necessitando de hemodiálise. O abuso de substâncias anabolizantes pode levar a complicações com risco de vida. São necessárias informação e divulgação das consequências do uso não terapêutico destas drogas, de modo a desestimular seu uso indiscriminado e a otimizar a habilidade dos setores de saúde em lidar com estes pacientes.(AU)

The use of anabolic androgenic steroids is common among young bodybuilders, because of their trophic effects on muscle tissue; however, the abuse of these substances may lead to dosedependent, severe and irreversible tissue damage. A case of liver poisoning from anabolic drug, complicated by acute kidney injury due to hyperbilirubinemia was reported. The patient's medical report review, and bibliographical research on the subject were conducted after the signing of the Free Informed Consent. A 28-year-old man was admitted in this hospital because of jaundice, weight loss, high fever, nausea and itching, which began 2 months earlier. At history taking, he revealed the use of stanozolol, testosterone, and oxymetholone in higher doses than recommended for 4 years. His first laboratorial tests revealed acute liver damage and azotemia, and the patient was diagnosed with acute kidney injury by tubular lesion caused by hyperbilirubinemia, and the need for hemodyalisis. The abuse of anabolic substances may lead to life-threatening complications. It is necessary to inform and disclose the consequences of non-therapeutic use of these drugs, in order to discourage its indiscriminate use, and to optimize clinical management of these patients in healthcare centers.(AU)