ANABOLIC STEROID ABUSE AND CARDIOVASCULAR TOXICITY: CASE REPORT

Despite the development of tests for the detection of doping, Anabolic steroids, are still used to increase sports performance. Unfortunately, studies have clearly shown that overdose of anabolic steroids can induce serious cardiovascular complications that can be life-threatening. This implies the determining role of health professionals in informing the general population and athletes in particular about the lethal effect of these substances. We report the case of a young high-level athlete who consults for palpitations and in whom cardiac imaging reveals abnormalities related to chronic consumption of anabolic steroids.

Anabolic-androgenic steroid use among bodybuilders in Erbil city

Background and objective: Anabolic-androgenic steroids are synthetic testosterone derivatives with a longer duration of action than physiological androgens. They are abused by bodybuilders because of their potential to enhance muscle strength. Serious medical and psychological complications may be associated with their non-medical use. This study aimed to determine the prevalence of anabolic androgenic steroids among bodybuilders and their awareness of health-related risks. Methods: A cross-sectional study was carried out from the 1st of January 2019 to the end of July 2019 in 18 randomly selected gym centers in Erbil city, Iraq using stratified random sampling. A self-administered questionnaire was distributed to 400 bodybuilders to assess the prevalence and knowledge of using Anabolic-androgenic steroids. Results: The study showed a high prevalence of Anabolic-androgenic steroid consumption (26.3%) among gym users in Erbil city. Anabolic-androgenic steroid use was significantly higher among participants with a longer duration of bodybuilding practice ≥4 years (P = 0.001). Anabolic-androgenic steroid abuse was significantly associated with drinking alcohol, smoking cigarettes, and using growth hormones. Trainers were the commonest source of recommendation. Conclusion: The prevalence of anabolic androgenic steroids abuse is high among bodybuilders in Erbil city. Public health awareness is essential and may help avoid the propagation of the problem. Keywords: Anabolic steroids; Gym users; Bodybuilders; Knowledge, Erbil.

Clinico-epidemiological study and microbiological correlation of tinea incognito at a tertiary care hospital

Tinea incognito also known as steroid-modified tinea are dermatophytic infections modified by the use of topical or systemic corticosteroids. Dermatophytic infection being very common and very simple to diagnose, is a diagnostic dilemma due to steroid abuse. Hence making a simple curable infection into a chronic persistent dermatological condition. As a treating doctor it’s important to recognize and educate the patients regarding the tinea infections and steroid abuse. To study the various morphological presentations, epidemiology and etiological agent of tinea incognito. An observational study was performed with 100 cases from 2017 to 2019 in the department of Dermatology & Venerology, SS Institute of Medical Sciences and Research, Davangere, Karnataka, India. The baseline data, thorough general physical, local, and systemic examination were done with reference to clinical features of tinea incognito. Skin scraping were collected and subjected to potassium hydroxide (KOH) preparation. The part of the sample was inoculated into Sabouraud’s Dextrose Agar (SDA) media for fungal culture. Later the fungus was identified by standard techniques. The mean age of study population was 32.83 years. The males outnumbered females in our study. Almost 29% cases remain asymptomatic followed by 34% itching and 37% burning sensation. The source of drug responsible for tinea incognito were highly suggested by friends (29%) with the combination use of drugs account for 35% of study population. 77% cases showed erythema followed by 48% of hypopigmentation. The scraping of lesion showed positive KOH mount in 71% and T.mentagrophytes were the most common dermatophyte grown in SDA medium. Misuse of steroid formulations in dermatophytic infections may lead to adverse effect as well as chronicity. Awareness of this problem is needed for prevention of steroid modified dermatophytosis, which is a rising menace.

Severe Cardiac and Metabolic Pathology Induced by Steroid Abuse in a Young Individual

Androgenic-Anabolic Steroids (AAS) abuse is known to play an important role in causing the systemic inflammatory response and multiple-organ dysfunction in healthy individuals. Although many of the undesirable effects of steroid abuse have been reported, at present, little is known about the effect of anabolic supplements and the correlation between cardiac and metabolic pathology. This paper presents a case of a 25 year old patient with a complex medical history after 6 months of steroid administration. Myocardial infraction, dyslipidemia, obesity, hyperuricemia, secondary diabetes, and chronic renal disease were identified after clinical and para-clinical examinations. The particularities of this case were interpreted in the context of a literature review, highlighting the effect of multi-organ damage as a result of the uncontrolled use of anabolic steroid supplements.

Anabolic–Androgenic Steroid Abuse among Gym Users, Eastern Province, Saudi Arabia

Background and Objectives: The main aim of the present study was to assess the use of androgenic–anabolic steroids (AAS) and to investigate its potentially unfavorable effects among gym members attending gym fitness facilities in Eastern Province, Saudi Arabia. Materials and Methods: A cross-sectional questionnaire-based study was carried out during the summer of 2017. Male gym users in the Eastern Province region of Saudi Arabia were the respondents. Information on socio-demographics, use of AAS, knowledge, and awareness about its side effects were collected using a self-administered questionnaire. Results: The prevalence of AAS consumption among trainees in Eastern Province was 21.3%. The percentage was highest among those 26–30 years of age (31.9%), followed by the 21–25 (27.4%) (p = 0.003) age group. Participants in the study were not aware of the potential adverse effects of AAS use. Adverse effects experienced by 77% of AAS users include psychiatric problems (47%), acne (32.7%), hair loss (14.2%), and sexual dysfunction (10.7%). Moreover, it appears that trainers and friends are major sources (75.20%) for obtaining AAS. Conclusion: AAS abuse is a real problem among gym members, along with a lack of knowledge regarding its adverse effects. Health education and awareness programs are needed not only for trainees, but also for trainers and gym owners as they are reportedly some of the primary sources of AAS.

Evaluation of Adverse Drug Reactions caused by Topical Steroids in Patients Presenting in Dermatology Department of Teaching Institute of Tertiary Health Care Centre of Central India

Introduction : Topical steroids are most commonly being used today. Mostly these are being misused due to lack of awareness of their adverse effects. Malpractice and easy availability of these agents also responsible for their abuse. Aim : To Evaluate Topical Steroid abuse in various parameters according to CDSCO ADR forms. Objectives : This study was conducted to know the extent of abuse of topical steroid ,along with clinical profile and mode of accessibility in dermatology department of a teaching institute of tertiary health care centre of central India. Material and Method: First 200 patients of adverse drug reaction attending dermatology department were screened according to ICSR form of CDSCO in a period of December 2015 to November 2016 and 181 patients of them who gave history of topical steroid application were further analyzed. Result: Most commonly affected people belong to age of 21 to 30 years (41.98%),Tinea incognito (58%) was the commonest manifestation of steroid abuse, Tinea (58%)was the most common indication of steroid application, self medication (46.40%) was most common mode of steroid accessibility, betamethasone (61.87%) was most commonly applied topical steroid. Conclusion :Self medication and over the counter drug use were most common mode of steroid accessibility both can be controlled by making strict health regulatory policies . Simultaneously health education program must be targeted to young population who are more vulnerable to steroid abuse to make them aware regarding harmful effects of unguided or misguided use of topical steroid.

TOPICAL STEROIDS ABUSE AND IT'S HIGH PREVALENCE WITH TEANIA INFECTIONS IN COVID-19 CRISIS TIME -A CLNICO EPIDEMIOLOGICAL STUDY

Introduction: Topical corticosteroids are today among the most commonly prescribed medications indermatology clinics. Due to easy availability of steroid creams as over-the-counter drugs Steroid abuse has become a common problem .This study was conducted to see the magnitude of this problem of it and the clinical profile of these patients in our population in one part of south India. Material And Methods: All patients with a history of topical use of steroids on different skin problems mainly teania infected areas for a period greater than few months were enrolled in this study after taking an informed consent. A detailed history about the type of steroid used, duration of application, source of prescription of the drug (doctor/chemist/self/acquaintances) and indications were recorded. A detailed clinical examination of these patients was carried out and results were recorded. Results: This study was conducted over a period of 1 year and 380 patients who fulfilled the inclusion criteria were enrolled in this study. There were247 males and 133 female patients. The range of age of these patients varied from 5 years to 60 years.Teania cruris was the most common indication for steroid use.Severity of problem was got neglected mainly because of covid crisis time situation and other misguidance by ignorance,friends and Chemists.Chemists were the most common source of prescribing steroids.COVID economic crisis may be an another leading factor of using the easy avilable medicine at counter for mild to moderate severity of skin problems especially fungal tinea corporis/cruris. Atrophic changes of the skin were the most common adverse effects seen. Conclusion:Topical steroids are very commonly abused drugs.This problem is more common in youngsters,especially males.Over the counter availability of these drugs in our part of world is a major cause of their abuse

Bioanalytical Detection of Steroid Abuse in Sports Based on the Androgenic Activity Measurement

The anabolic androgenic steroids (AAS) are the most frequently consumed performance enhancing drugs (PED) in sports. In the anti-doping field, the detection of AAS is carried out by the analysis of the athlete’s urine using methodologies based on liquid/gas chromatography-mass spectrometry. Unfortunately, the detection of unknown compounds is not possible. BDS’s AR CALUX® bio detection technology was studied as an indirect method to detect the administration of a single dose of testosterone (T). Twelve T and placebo single dose administered men volunteers underwent a triple-blind crossover clinical trial. The UGT2B17 deletion was present among the volunteers and evenly distributed in heterozygous (ins/del), wild-type homozygous (ins/ins), and mutated homozygous (del/del) groups. A significant statistical difference in terms of bioluminescence was observed after the testosterone (T) administration for the three types of polymorphic groups. The ratio of means between the pre- and post-T administration periods, depending on the type of polymorphism, was in group ins/ins 3.31 (CI. 95%: 2.07–5.29), group ins/del 4.15 (CI 95%: 3.05–5.67), and group del/del 2.89 (CI 95%: 2.42–3.46). The results of the study are very promising, as they may offer us the possibility of designing a detection approach that, based on intra-individual monitoring of androgenic values, in the UGT2B17 deletion type.

PATTERN OF ADDISONS DISEASE AND ADDISONION CRISIS IN PATIENTS PRESENTING TO TERTIARY HEALTH CARE HOSPITAL IN INDIA

BACKGROUND: Thomas Addison described a group of patients with diseased adrenal glands at autopsy, with similar signs and symptoms before death; a condition now known as primary adrenal insufciency i.e. Addison's disease. Secondary adrenal insufciency also causes similar symptoms and signs that are due to reduced ACTH secretion from the pituitary gland. Sometimes these symptoms and signs can be subtle and nonspecic. Patients may experience fatigue, weakness, weight loss, and gastrointestinal upset, hyperpigmentation of the skin and mucous membranes. These symptoms are gradual in progression and worsen over years, making early diagnosis difcult. The clinical presentation of adrenal insufciency in India may be underdiagnosed and not paid sufcient attention to. We, therefore, studied the clinical prole of adrenal insufciency. METHODS: We used a prospective study as a study design. We studied 26 patients with adrenal insufciency for their etiology, clinical features, and various laboratory prole including autoantibodies and cortisol levels. RESULTS: Drug-induced adrenal insufciency (steroid abuse) etiology was present in 46.15% of the patients. Tuberculosis was the cause in 26.92% of the patients. Septicemic shock with multiorgan dysfunction syndrome was the etiology in 23.07% of patients. Postural hypotension and salt craving and hyponatremia were noted in about 30.76% of patients with s/o mineralocorticoid deciency. CONCLUSION: Steroid abuse was the most common cause of adrenal insufciency followed by septicemic shock and tuberculosis. Thus, a high index of clinical suspicion is required for a diagnosis of adrenal insufciency in the early stages for diagnosis and prompt treatment.

Management of Ocular Surface Squamous Neoplasia in Association with Fungal Keratitis in a HIV Positive Individual

Ocular Surface Squamous Neoplasia (OSSN) co-existent with fungal keratitis in an immunodeficient individual has rarely been talked about in literature. Risk factors for fungal keratitis are trauma with vegetative matter, topical steroid abuse, poor ocular surface, corneal anaesthesia, systemic immunosuppression, etc., and for OSSN a major risk factor is immunodeficiency. In current report, patient had multiple risk factors. This report highlights the management of HIV positive 42-year-old male with OSSN and fungal keratitis. A comprehensive evaluation helps clinician decide on treatment priority and achieve good clinical outcome.