Steroid Consumption Research Articles

Hepatic Peliosis and Hemorrhage after Anabolic Steroid Abuse

AbstractAnabolic steroid abuse has become prevalent in modern society, with many athletes and bodybuilders using these substances for their performance-enhancing effects. A significant concern related to anabolic steroid abuse is the potential development of androgen-associated liver tumors such as hepatocellular carcinoma and adenomas. Anabolic steroid abuse has also been associated with hepatic vascular abnormalities like hepatic peliosis, a rare condition characterized by blood-filled cavities within the liver parenchyma. Hepatic peliosis can present with nonspecific symptoms or remain asymptomatic, making it difficult to diagnose without appropriate imaging studies. In this case report, the authors describe the imaging findings and management of two patients with intrahepatic bleeding associated with anabolic steroid consumption.

Influencing factors and implications of anabolic steroid consumption

RESUMO Os esteroides anabolizantes devem ser consumidos nos casos em que se atenta à alimentação e ao treino e desde que prescritos por profissionais qualificados. O presente estudo objetivou apontar os fatores influenciadores do consumo de esteroides anabolizantes e analisar a perceção acerca dos benefícios e malefícios do seu consumo. O grupo de estudo compreendeu 22 clientes de um Health Club da cidade de Viseu. Recorreu-se a entrevistas individuais semiestruturadas para a recolha de dados e, posteriormente, à análise de conteúdo. Os participantes consomem por auto prescrição, destacando a melhoria da performance no treino, assim como o aumento da força e densidade musculares, o alívio de dores articulares e recuperações mais rápidas no pós-treino como principais causas de consumo.

Anabolic steroid consumption among gym-goers in Amman: knowledge, attitudes, and behaviors.

The use of Anabolic-androgenic steroids (AAS) among gym members has become a significant concern due to their impact on physical training and performance. Research worldwide indicates a notable prevalence of AAS use among athletes and gym attendees, often involving substances that are neither safe nor legal. This study aims to determine the prevalence of AAS use among gym attendees in Amman, Jordan, and to explore the knowledge, attitudes, and behaviors associated with AAS use. The study involved 399 participants from 35 randomly selected gyms in the metropolitan area of Amman, Jordan. A cluster sampling technique was used to select a diverse and representative sample of gym attendees. Data was collected using a self-administered questionnaire that assessed AAS use, knowledge, attitudes, and behavioral factors. Statistical analyses were conducted using chi-square tests to explore the relationships between AAS use and categorical variables, while logistic regression was employed to identify predictors of AAS use. The analysis revealed significant associations between AAS use and various factors, including knowledge, attitudes, behavioral factors, and demographic variables such as gender, age, exercise frequency, reasons for exercise, and total exercise duration. The study identified key predictors of AAS use among gym attendees in Amman, highlighting the importance of demographic and behavioral factors. The findings underscore the need for targeted interventions to address misconceptions and promote safer practices among gym-goers in Amman. The study provides critical insights that can guide the development of strategies, policy adjustments, and educational initiatives aimed at reducing AAS misuse and fostering a healthier gym culture in the region.

Molecular mechanisms of steroid-resistant asthma

Steroid-resistant asthma (SRA) is clinically significant, approximately 10–15% of individuals with asthma do not exhibit a positive response to standard treatments. While this subset represents a relatively small proportion of asthma patients, severe refractory asthma places a substantial burden on healthcare resources and contributes significantly to illness and death. Additionally, the quality of life of patients is greatly affected by the adverse effects of excessive steroid consumption, there is a need to identify individuals who do not react well to steroid medication and the ongoing difficulties of these asthma patients in controlling their diseases, which have a large socio-economic impact. The current short article reviews the common molecular mechanisms responsible for steroid resistance in asthma patients.

Getting big but not hard: A retrospective case-study of a male powerlifter's experience of steroid-induced erectile dysfunction

This article aims to excavate the lived experience of suffering with steroid-induced erectile dysfunction. By drawing upon original qualitative data, we chart the subjective journey to recovery of a male powerlifter and draw attention to the potential dangers of a self-help approach to treatment. Erectile dysfunction is a common symptom of anabolic-androgenic steroid-induced hypogonadism, a condition not commonly reported or discussed and is therefore a poorly studied health issue. Often considered a taboo subject, detailed accounts of men's experience of erectile dysfunction are relatively sparce, and so this paper makes an important contribution to bolstering what is a limited literature base. Links between contemporary conceptions of masculinity, muscularity, and sexual prowess are explored and form the basis of a critical analysis of popular treatment and prevention strategies. Among the central findings, this article suggests that steroids are not consumed despite the well-known risks, but precisely because the risks are well-known and ostensibly mitigated through engagement with ‘bro-science’. We conclude that there is a concerning misalignment in current treatment and prevention strategies that needs to be addressed if the issue of non-prescribed steroid use is to be effectively tackled. This research therefore raises serious questions for the healthcare profession and its approach towards treating and preventing steroid consumption.

Impaired cardiac structure and systolic function in athletes using supra-physiological doses of anabolic androgenic steroids

ObjectivesAthletes are increasingly using supra-physiological doses of anabolic androgenic steroids without weighing health side effects. This study aims to conjointly evaluate the effect of supraphysiological doses of anabolic androgenic steroids on global cardiovascular structure and functional capacity. DesignCross-sectional study. Methods92 males enrolled in the study, including 18 sedentary subjects, 26 anabolic androgenic steroid non-user athletes, and 48 anabolic androgenic steroid-user athletes. Two-dimensional echocardiography was done to evaluate the cardiovascular structure and function. ResultsAnabolic androgenic steroid-users presented increased cardiac remodeling of the left ventricle and left atrium compared to control groups (p < 0.001). Anabolic androgenic steroid-users showed increased left ventricular mass/body surface area versus control groups (p < 0.001), with 28 steroid-users (58.3 %) having cardiac remodeling, which is more than control groups (p < 0.001). Anabolic androgenic steroid-users presented lower diastolic function (E and E/A) compared to non-users (p = 0.003 and <0.001, respectively). Ejection fraction was decreased among anabolic androgenic steroid-users versus the sedentary group only (p = 0.020), while anabolic androgenic steroid-users presented reduced global longitudinal strain of 15.43 % compared to both control groups (p < 0.001). Moreover, anabolic androgenic steroid-users experienced more tricuspid valve regurgitation (p = 0.001). ConclusionsAnabolic androgenic steroid consumption is associated with global cardiac remodeling with increased dimensions of the left ventricle, and atrium. Anabolic androgenic steroid-users present left ventricular hypertrophy with reduced subclinical systolic function. Moreover, anabolic androgenic steroid consumption is correlated with valve regurgitation and dilation of the sino-tubular junction.

The Burden of Anabolic Androgenic Steroid-Induced Gynecomastia.

Introduction Gynecomastia is benign proliferation of male breast tissue that can be idiopathic or secondary to hormonal imbalance. Consumption of steroids plays a major role in the development of gynecomastia. The increased consumption of anabolic androgenic steroid (AAS) in youngsters to boost the physical strength and improve appearance is associated with increased prevalence of gynecomastia. True estimation of AAS-associated gynecomastia is difficult to calculate and prone to underestimation because of low social acceptance. Accurate estimation is required to assess future healthcare, for prevention and to give appropriate treatment. Aims and Objectives The aim of this study was to calculate the steroid consumption in gynecomastia patients accurately so that appropriate treatment can be given and their response to treatment could be analysed. Methods This is a prospective study done in a tertiary care hospital from June 2019 to June 2022. All the gynecomastia patients treated during this period in Burns & Plastic Surgery Department of PGIMS Rohtak were included in the study. Patient's detailed history was recorded and also after 3 months of surgery patients were again enquired about their history to record any change. Results Real prevalence of AAS-associated gynecomastia (39.19%) was much higher than that recorded in preoperative period (4.05%). Also, AAS users were having higher body mass index and a greater proportion of patients were bodybuilders. Conclusion Patients with high body mass index, athletic body, and history of recent weight gain should raise the suspicion of anabolic steroid intake. Surgery is not always indicated in AAS-associated gynecomastia. If gynecomastia persisted, surgery necessitates and it involves meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve low complication rates.

Impact of FDA-Approved Novel Agents for Steroid-Refractory Chronic Graft-Vs. Host Disease on Treatment Patterns and Outcomes - a Single Center Longitudinal Cohort Analysis

Background - Chronic graft vs host disease (cGVHD), explicitly steroid-refractory disease, is associated with substantial morbidity and mortality in patients undergoing allogeneic hematopoietic cell transplantation (HCT). Since 2018, access to novel immunosuppressive therapies (IST) for steroid-refractory GVHD have become available via clinical studies, early-access programs and private insurances. We aimed to analyze changes in treatment pattern and thus outcomes during the last decade in this population. Methods - We included all patients above the age of 18 years who developed cGVHD after first allogeneic transplantation performed between 2012 and 2020 in the Tel Aviv Sourasky Medical Center. We divided the patient cohort into 3 treatment periods according to clinical trials available/FDA approved drugs - 2012-2014 (group 1), 2015-2017 (group 2), and 2018-2020 (group 3). The NIH 2004 criteria was used to define chronic GVHD. All patients were managed by the same medical team with a well-established long-term survival program. Data was extracted on July, 2022. Results - between 2012 and 2020, 301 patients underwent HCT, of them 222 survived more than 3 months and 91 (41%) developed chronic GVHD and fulfilled the inclusion criteria. Median follow-up was 51 (range, 13-97) months. There was no statistically significant differences in patient characteristics between the 3 groups, except of older age and greater employment of reduced intensity conditioning in patients included in group 3, Table 1a. All patients, except 1, received GCSF-moblized peripheral blood stem cells and all patients receiving matched-unrelated donor allografts, were given anti-thymocyte globulin. 92% of patients were managed with steroids as first line treatment for cGVHD. Patients in the second and third group, compared to the first, received lower mean cumulative dose of steroids/kg/day (p=.008) and fewer mean number of treatment days for cGVHD (p=.042). However, there was no difference between the groups in the proportion of number of steroids treatment days/total days of treatment of cGVHD (p=0.72), Table 1b. The median IST-free survival was 79 (95% CI 54-94) months, with a higher percentage of patients in group 3 able to discontinue IST at 3 years from GVHD onset, though this did not reach statistical significance (p=0.1). Regarding long-term complications, patients in cohort 2/3 had better diabetes control (p<0.001), a trend for lower cardiovascular complications, and a higher bone density (p=0.06). A significantly higher proportion of patients returned to work in cohort 2 and 3 (56% and 43%, respectively) compared to cohort 1 (20%) in a shorter period of time from HCT (p=0.05 and p=0.01). There was no difference in the incidence of depression/anxiety. There was no difference in 3-year relapse incidence (p=0.54), non-relapse mortality (p=0.69) and overall survival (0.68). Cox regression analysis identified lower platelets at the onset of cGVHD and the employment of reduced intensity regimen, as being associated with shorter survival (P=.005, HR-1.1 and p=.049, HR-3.5, respectively), while patient's group, sex, age and eosinophil count ,did not impact survival. Conclusions - this real-world data clearly show that incorporation of FDA-approved novel agents for the management of cGVHD is associated with reduced overall steroid consumption and a better control of metabolic long-term complications. While these effects significantly improve some aspects of quality of life, these modifications in therapy are yet to be translated to survival advantage. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Severe anemia on the treatment of a Lepra patient with a history of long-term steroid consumption suspect of Cushing syndrome

ABSTRACT Anemia is a clinical symptom caused by the disruption of erythrocyte formation, bleeding, and premature blood hemolysis. Severe anemia can occur in patients taking dapsone for the treatment of leprosy. Long-term use of steroids is also a predisposing factor for the occurrence of hematological changes and raises the suspicion of Cushing's syndrome. Reportedly a 20-year-old woman with the main complaint of sudden shortness of breath, accompanied by a cough with phlegm. The patient has had a history of multibacillary type leprosy since a month ago. There was a history of steroid consumption for about two years and only stopped a couple of months ago. Physical examination showed the oxygen saturation was 93%, conjunctival anemia, hyperpigmented plaques, tenderness in the abdominal, meteorism, and pitting edema in the upper and lower extremities. Laboratory examination revealed hemoglobin (Hb) level 2.4 mg/dl, erythrocytes 0.8x106/ul, and albumin 3.2g/dl. Peripheral blood smear results suggest refractory anemia and myelodysplasia syndrome. After being treated for seven days, the patient was re-evaluated and controlled at the Internal Medicine outpatient clinic, Syekh Yusuf Hospital. Complex symptoms and limited investigations make it difficult to establish the exact cause. Immediate blood transfusion and management of the underlying disease causing anemia, such as discontinuation of dapsone, are the primary management of this case. Keywords : severe anemia, leprosy, steroid, Cushing syndrome.Correspondence : gedepadmawijaya@yahoo.com

Trends in Medical Management of Moderately to Severely Active Ulcerative Colitis: A Nationwide Retrospective Analysis.

With an increasing number of therapeutic options available for the management of ulcerative colitis (UC), the variability in treatment and prescribing patterns is not well known. While recent guidelines have provided updates on how these therapeutic options should be used, patterns of long-term use of these drugs over the past 2 decades remain unclear. We analyzed a retrospective, nationwide cohort of more than 1.7 million prescriptions for trends in prescribing behaviors and to evaluate practices suggested in guidelines relating to ordering biologics, step-up therapy, and combination therapy. The primary outcome was 30-day steroid-free remission and secondary outcomes included hospitalization, cost, and additional steroid usage. A pipeline was created to identify cohorts of patients under active UC medical management grouped by prescribing strategies to evaluate comparative outcomes between strategies. Cox proportional hazards and multivariate regression models were utilized to assess postexposure outcomes and adjust for confounders. Among 6 major drug categories, we noted major baseline differences in patient characteristics at first exposure corresponding to disease activity. We noted earlier use of biologics in patient trajectories (762 days earlier relative to UC diagnosis, 2018 vs 2008; P < .001) and greater overall use of biologics over time (2.53× more in 2018 vs 2008; P < .00001) . Among biologic-naive patients, adalimumab was associated with slightly lower rates of remission compared with infliximab or vedolizumab (odds ratio, 0.92; P < .005). Comparisons of patients with early biologic initiation to patients who transitioned to biologics from 5-aminosalicylic acid suggest lower steroid consumption for early biologic initiation (-761 mg prednisone; P < .001). Combination thiopurine-biologic therapy was associated with higher odds of remission compared with biologic monotherapy (odds ratio, 1.36; P = .01). As biologic drugs have become increasingly available for UC management, they have increasingly been used at earlier stages of disease management. Large-scale analyses of prescribing behaviors provide evidence supporting early use of biologics compared with step-up therapy and use of thiopurine and biologic combination therapy.

Mucor Mycosis Associated with COVID-19: A Case Series at a Tertiary Care Center in India

Background: COVID-19 patients across the globe have been reporting several post-COVID health conditions such as respiratory, vascular, cardiac and renal complications and opportunistic infections; the most common of which has been fungal infections. Objective: The objective of our study was to identify socio-demographic characteristics, risk factors, clinical parameters, site of involvement and outcome of patients with COVID-19 associated Mucor Mycosis (CAM) at a tertiary care centre in Rewa (Madhya Pradesh, India), Materials and Methods: This was a prospective observational study, conducted between 1st May to 30th June 2021; including 40 patients who had Mucor Mycosis with recent or active COVID-19. The data was collected using a structured data collection form by trained interviewers who were already working in Mucor Mycosis Ward. Results: The overall mean and median age of the patients was 50.8 years and 52.5 years respectively, with majority of the males (72.5%). Of total, 47.5% patients had active COVID-19, whereas 50% had recent COVID-19 infection. Twenty-two patients (55%) had co-morbidities, among whom the majority had underlying diabetes mellitus (50%). History of Oxygen supplementation and use of steroids was found in 75% and 45% of the patients respectively. History of self-consumption of decoction (Kadha) and self-administration of inhalation drugs was found among 22 (80%) and 8 (20%) patients respectively. Twnty-one patients (52.5%) had gone through operative procedure/ intervention and 11 (27.5%) patients received conservative treatment. In terms of outcome, 20 patients (50%) had been successfully discharged, followed by 14 deaths (35%), 3 referrals (7.5%) to the higher centres and 3 readmissions (7.5%). Conclusion: Addictions and Indian traditional therapies might have played crucial role in occurrence of CAM. In addition, although Oxygen supplementation and steroid consumption have been life-saving against COVID-19, yet might be responsible for acute surge in CAM cases.

Invasive fungal infection management in patients with hematological malignancies

Invasive fungal infections are frequently observed in patients with hematological malignancies. Thus, monitoring the immunosuppressive factors in each patient, such as neutropenia, mucosal injury, steroid consumption, cellular and humoral immunodeficiencies, etc., is important to establish an appropriate antifungal strategy. Additionally, prophylactic approaches should be planned considering the risk of fungal infection, and early clinical tests should be required in patients with persistent fever or other clinical manifestations for the timely diagnosis of invasive fungal infection. Antifungal profile, adverse effects, and clinical purposes, such as prophylaxis, empiric, preemptive, and target therapies, should be considered in antifungal agent selection.

Mucormycosis During Second Wave Of COVID-19 in India: Exploratory Analysis From Tertiary Care Centre Of Uttar Pradesh

Background: In April and May 2021, India faced massive second wave of COVID-19 pandemic and then became the hotspots of mucormycosis across globe. Hence, we planned the first analysis of mucormycosis in Uttar Pradesh. Aim and Objectives: coThe objectives were to explore the epidemiology, vaccination status, clinical features, microbiological findings, treatment of mucormycosis and outcome. Material and Methods: This was an observational study of mucormycosis at tertiary care centre of Agra, Uttar Pradesh, India from 20 May 2021 to 15 July 2021. Results: 98 patients’ data with mucormycosis was analyzed. Patients had median age of 55 years. COVID-19 infection was present in 69.4% of participants and diabetes mellitus was present as underlying co-morbid condition in more than 85% of patients. 91.8 % of cases were unvaccinated with steroid consumption in almost 60% of patients. R. arrhizus was among the most common agent while we found less commonly reported fungi like R.homothallicus, Apophysomyces, Cunninghamella. 41.8% of cases were successfully treated and 16.3% of cases expired. Conclusion: Diabetes mellitus was labeled as major predisposing factor and most patients were unvaccinated. Awareness about fungal infections, rigorous monitoring of chronic diseases, judicious use of drugs, early diagnosis and prompt treatment is decisive for better outcome.

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.

Forensic investigations in a case of aggressive behavior of three dogs: Identification of dietary supplements contamination by metandienone and confirmation by hair tests

• Anabolic steroid consumption by dogs can increase their aggressive behavior. • Development of a specific analytical method for the quantification of metandienone in the hair of three dogs by UPLC-MS/MS. • Analysis of the dietary supplements of three dogs. • Analyses of the hair of the dogs and their dietary supplements enabled to make an association with the aggressive behavior. After observing a modification in behavior of his three dogs, an owner consulted a laboratory to determine if a drug could be involved. Hair strands of each animal were collected from the neck area and sent to the laboratory for anabolic steroid screening. Initial screening by liquid chromatography coupled to high-resolution mass spectrometry identified the presence of metandienone, an anabolic androgenic steroid, in all three samples. In order to quantify metandienone in hair, a specific method was developed using a liquid chromatography to tandem mass spectrometry system. In addition, sixteen animal pharmaceutical products and food supplements that the dogs had received were tested for a possible source of contamination. The hair specimens of the dogs tested positive for metandienone at 42, 13 and 32 pg/mg. Final interpretation of these concentrations was difficult as there is no data about metandienone detection in hair collected from dogs. Analysis of the animal pharmaceutical and food supplements demonstrated the presence of metandienone in two supplements, with amounts at 25 and 452 ng/g. Simultaneous analyses of the hair of the dogs and their supplements enabled to make an association with the observed aggressive behavior in the dogs. Testing for anabolic steroids in the hair of the dog in case of aggressiveness can be useful to help to understand an unexpected behavior in dogs.

Risk factors and pathogenesis of steroid-induced osteonecrosis of femoral head - A scoping review

Steroid induced osteonecrosis of the femoral head is commonly seen in clinical practice, but yet not fully understood. It is intriguing why only some cases develop and others escape from it. We did an extensive and up to date literature review on it, with the aim to identify its incidence, associated risk factor and pathogenesis. We found that the incidence ranged from 03 to 40%, and was more with associated risk factors. Several risk factors were identified, which included higher dose and prolonged duration of steroid consumption, and underlying disease for which the steroids were given. Pathogenesis of this disease is complex and not yet fully understood. Awareness about this condition and associated risk factors should help the clinicians in identifying the cases who are prone to develop osteonecrosis with the use of steroids.

‘No one’s going to buy steroids for a home workout’: the impact of the national lockdown on hardcore gym users, anabolic steroid consumption and the image and performance enhancing drugs market

2020 has proven to be an unprecedented year for all of us, as the ‘new normal’ of lockdown, the challenges of home schooling and the realities of living through a global pandemic have raised fundamental questions about the structure of our society and made us evaluate how we live. But how has the COVID-19 pandemic, and the subsequent restrictions upon public life, affected those of the population whose lives are contoured around the gym and bodywork? Utilising data precured through semi-structured interviews with image and performance enhancing drug-using bodybuilders as part of the author’s PhD research, this article sets out to provide a glimpse into the realities of life in the hardcore fitness community in 2020. First, the impact of lockdown on the men’s training will be explored, and their flouting of the restrictions will be described. Following this, the sample’s IPED consumption during this period will be examined, noting an overall reduction in use and a homogenisation of their favoured substances. Finally, the impacts of the COVID-19 pandemic on the IPED market itself will be explored, wherein the sample’s accounts of panic-buying, supply chain issues and declining demand will be presented. Ultimately, whilst not entirely generalisable given the modest sample size, it is hoped that this article will serve to paint a picture of life under lockdown for the most committed gym users in the population, and follow the community’s challenges during the ‘longest year’.

Steroid use among male sports students in Germany

A large number of studies have already dealt with steroid consumption in leisure and popular sports. The aim of this explorative study was to give an insight into the anabolic steroid use among male sports students in Germany. Semi-structured face-to-face interviews with n = 5 participants, all steroid-users and fellow students recruited by the third author, were conducted. Through the interviews we explored data on individual perceptions of active users with academic background and access to expertise. The interview guide is based on international findings concerning doping/steroid abuse within the framework of social differentiation theory (Alexander & Colomy, 1990; Stichweh, 2012). The study's results indicate that it is primarily the health factor that influences the planning, execution and control of steroid consumption among male sports students. Physical appearance forms a constant reason for substitution, besides the subjectively perceived pressure of physical performance inside and outside high-performance sports. However, explorative data reveal that universities’ performance requirements do not lead to steroid use.

INDICAÇÃO DE USO INDISCRIMINADO DE SILDENAFILA E TADALAFILA POR JOVENS

Erectile dysfunction (DE) is known as a man's difficulty in obtaining or maintaining an erection, may have as causes some diseases and conditions such as: depression, diabetes, arterial hypertension, high cholesterol, obesity, coronary disease, disease of Parkinson's, prostate cancer treatment, anabolic steroid consumption, spinal cord injuries, drug addiction, alcoholism, and even stress and anxiety. An accidental discovery of one of the most famous pharmaceuticals in the pharmaceutical industry began at the end of the 80, when the American laboratory Pfizer, who had invested heavily in research and testing to find a drug for hypertension Pulmonary and angina pectoris. So, these studies were terminated in 1992, because the first results suggested that the drug had a small effect on angina. However, it was noted some properties in the Sildenafil citrate that could be a new light on the treatment of erectile dysfunctions. In the 30-day period, in the region's drugstores, approximately 800 individuals aged between 17 and 85 years were treated, where it can be verified that not only people with erectile dysfunction make use of sildenafil and tadalafila. Where 51% of these individuals aged between 17 and 30 years make use of these regular medications, in most cases if they are for recreational use, without a medical indication only for personal reasons such as: increase libido and improve sexual performance.

Risk factors for a second nonsimultaneous hip fracture in a prospective cohort study.

The risk factors for a second nonsimultaneous hip fracture are unclear, and in general, it is empirically assumed that they are similar to those associated with the first hip fracture. We aimed to determine the incidence of a second hip fracture and define the characteristics of the patients sustaining the event in a prospective cohort study in a Spanish population. We conducted a multicentric, prospective cohort study in a representative sample of 45 hospitals from 15 autonomic regions in Spain. In total, the study included 994 patients. One hundred and one patients presented a nonsimultaneous contralateral hip fracture, constituting the intervention group. The remaining 893 patients presenting with a hip fracture formed the control group. The main outcome measures of this study were sociodemographic characteristics of the patient, comorbid conditions, and baseline and postfracture clinical outcomes (inpatient complications and acute mortality). The key fracture risk factors were a history of fragility fractures, the need for assistance when walking outdoors and a history of falls. There were no associations between the groups in any of the common fragility risk factors, including rheumatoid arthritis, secondary osteoporosis, or steroid consumption. The results showed that patients suffering a nonsimultaneous hip fracture had an increased risk of mortality after discharge compared with the control group. A nonsimultaneous second hip fracture leads to a near-significant increase in four-month mortality. In our study, this fracture was associated with a history of falls, prior fragility fractures, and the need for a walking aid.