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.

Polycythemia: a mystery solved by history

Testosterone is responsible for increased muscle mass. Leaner body mass helps control weight and increases energy. High levels of testosterone help build muscles and also stimulate growth in strength. Androgenic-anabolic steroids (AAS) are drugs that are structurally related to the cyclic steroid rings system and have similar effects to testosterone in the body. Athletes who abuse steroids do so for muscle growth and quick recovery. Testosterone - whether it's injected, applied via a patch or cream, or taken orally - allows athletes to rapidly increase muscle mass beyond their usual capacity, and also reduces their recovery time which allows them to train continuously with little need to rest their bodies in between workouts. Physiologically, erythrocytosis is defined by an erythrocyte mass that exceeds 125% of that predicted for sex and body mass. Much of the concern with the use of testosterone involves increase in blood viscosity, resulting from increased red blood cell mass causing a potential increased risk for venous thromboembolism (VTE), myocardial infarction (MI), and cerebrovascular accidents (CVA). We report a case of secondary polycythemia related to testosterone therapy.

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)

Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery

There is often inherent conflict in the overlapping fields of male fertility and andrology. While the goal of all male fertility specialists is to facilitate and preserve biologic paternity, many practitioners also care for a significant number of patients suffering from hypogonadism. Exogenous testosterone administration, the gold standard for the management of these patients, almost universally impairs spermatogenesis and can even completely eradicate it in some men. With steady increases in both the incidence of hypogonadism and average paternal age, practitioners are now encountering hypogonadal men who desire future fertility or men suffering the effects of earlier androgenic anabolic steroid use with increasing frequency. In this manuscript, we review management strategies for these complex patients and explore novel medications that may be of use in this population.

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.

Uso de Esteroides Anabólicos en Jóvenes de Asunción / Anabolic Steroid Use in Young People of Asuncion

Los esteroides anabólicos típicamente usados por jóvenes, atletas y culturistas para incrementar el musculo y la fuerza son peligrosos, están accesibles, y se prescriben de manera errónea como eficaces, pero con riesgo bajo. No solo los atletas consumen esteroides anabólicos. Algunos jóvenes los toman para lucir más musculosos o para quemar grasa. El objetivo del estudio fue identificar los factores asociados al uso de anabólicos esteroides en jóvenes de 16 a 25 años que asisten al Gimnasio Fitness Family Caff de Asunción, conocer los datos socio-demográficos, caracterizar los conocimientos y el uso de esteroides anabólicos en el gimnasio y determinar el factor de consumo de esteroides anabólicos de acuerdo a la práctica en el gimnasio. Estudio tipo observacional descriptivo de corte transversal que contó con la participación de 41 jóvenes provenientes en su mayoría de Asunción. En cuanto a los factores se determinó que su uso está motivado por mejorar el aspecto físico, es decir, por un factor estético al igual que por la participación en competencias fitness

Anabolic steroids, typically used by young people, athletes and bodybuilders to increase muscle and strength, are dangerous, accessible and are prescribed incorrectly as effective, but with low risk. Not only athletes consume anabolic steroids. Some young people take them to look more muscular or for fat burning. The study had the following objectives: To identify factors associated with the use of anabolic steroids in 16 to 25 years young people who attend the Family Fitness Caff Gym in Asuncion, to know the socio-demographic data, characterize the knowledge and use of anabolic steroids in the gym, and determine the consumption factor of anabolic steroids according to the practice in the gym. This was an observational descriptive cross-sectional study. The study had the participation of 41 young people, mostly from Asuncion. In relation to the factors, it was determined that their use was motivated to improve their physical appearance; this is to say, for an aesthetic factor as well as for the participation in fitness competitions.

Anabolic steroids and their effects of on neuronal density in cortical areas and hippocampus of mice

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.

Progress of Chemical Derivatization in Analysis of Endogenous Anabolic Steroids in Bio-matrices / 医药导报

The content of endogenous anabolic steroids is extremely low in biological matrices.Its chemical structure contains polar functional groups such as hydroxyl and carbonyl, which limits their applicability in GC-MS.The lack of ionized groups in the chemical structure leads to poor sensitivity in LC-MS, which plays a significant role in various physiological activities analysis.It is an effective way to enhance the response of mass spectrometer by modifying the chemical structure of endogenous anabolic steroids through derivatization technology.This review summarizes various derivatization reagents and corresponding derivatization processes of endogenous anabolic steroids analysis in the methods based on different testing instruments and methodologies.The advantage and disadvantage of all kinds of derivatiaztion methods and the prospect of the endogenous anabolic steroids derivatiaztion techniques are also discussed.

Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use / 亚洲男科学杂志(英文版)

The use of testosterone replacement therapy (TRT) for hypogonadism continues to rise, particularly in younger men who may wish to remain fertile. Concurrently, awareness of a more pervasive use of anabolic-androgenic steroids (AAS) within the general population has been appreciated. Both TRT and AAS can suppress the hypothalamic-pituitary-gonadal (HPG) axis resulting in diminution of spermatogenesis. Therefore, it is important that clinicians recognize previous TRT or AAS use in patients presenting for infertility treatment. Cessation of TRT or AAS use may result in spontaneous recovery of normal spermatogenesis in a reasonable number of patients if allowed sufficient time for recovery. However, some patients may not recover normal spermatogenesis or tolerate waiting for spontaneous recovery. In such cases, clinicians must be aware of the pathophysiologic derangements of the HPG axis related to TRT or AAS use and the pharmacologic agents available to reverse them. The available agents include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their off-label use is poorly described in the literature, potentially creating a knowledge gap for the clinician. Reviewing their use clinically for the treatment of hypogonadotropic hypogonadism and other HPG axis abnormalities can familiarize the clinician with the manner in which they can be used to recover spermatogenesis after TRT or AAS use.

Ginecomastia: aspectos clínicos y etiológicos. Estudio retrospectivo y multicéntrico / Gynecomastia: Clinical and Ethiological Aspects. Retrospective, Multicenter Study

La ginecomastia es el agrandamiento benigno del tejido mamario en el varón. Es una causa frecuente de consulta que produce ansiedad e incomodidad y puede ser la expresión clínica de una enfermedad relevante. Objetivos: 1) Evaluar las características de presentación de la ginecomastia y el perfil bioquímico; 2) Evaluar la etiología de la ginecomastia en la población estudiada. Material y Métodos: Estudio retrospectivo, multicéntrico. Se evaluaron las historias clínicas de 220 varones (18-85 años) con diagnóstico clínico y por imágenes de ginecomastia, con evaluación bioquímica completa. Resultados: Se observó mayor prevalencia entre 21-30 años de edad (n = 66; 30 %). La mayoría consultó en forma espontánea (77,7 %); el resto fue derivado por otras especialidades. Principales motivos de consulta: razones estéticas (70,4 %) y dolor (27,3 %). El 23,2 % tenía antecedente de ginecomastia puberal. El tiempo de evolución previo a la consulta fue muy variable: 1 mes a 40 años. Examen físico: 122 pacientes (55,4 %) presentaron ginecomastia bilateral y 98 (44,6 %) unilateral (54,1 % izquierda y 45,9 % derecha). El 44,8 % presentó sobrepeso y 22,4 % obesidad. En 29,1 % se constató dolor mamario al examen. Un paciente (con macroprolactinoma) presentó secreción mamaria espontánea y 3 pacientes secreción mamaria provocada. Etiología: la ginecomastia idiopática fue la más frecuente (49,1 %) y de las causas secundarias, el consumo de anabólicos. Se constató un 10 % de pacientes con hipoandrogenismo, 16,4 % con hiperprolactinemia y 10,5 % con hiperestrogenemia. En 6 casos coexistieron 2 causas (total 226 causas). No se hallaron marcadores oncológicos elevados. En los < 40 años las causas más frecuentes fueron uso de anabólicos y ginecomastia puberal persistente; y en los > 40 años fueron hipogonadismo y consumo de fármacos. Los pacientes con ginecomastia bilateral tuvieron mayor tiempo de evolución, mayor IMC y menores niveles de TT versus ginecomastia ...

Gynecomastia is a benign enlargement of breast tissue in men. It occurs physiologically in three stages of life: newborns, pubescent boys and older adults. It is a frequent reason for consulting and -though generally benign- it produces anxiety and discomfort. It is important to differentiate between the asymptomatic presence of palpable breast tissue, which is of little clinical relevance, and a recent onset breast enlargement usually associated with pain and swelling, which can be a sign of illness or pharmacological impact. Aims: To evaluate the presenting features (symptoms, duration, laterality, etc.) and biochemical profile of gynecomastia; to assess the etiology of gynecomastia in the study population. Methods: Retrospective, multicenter study. We evaluated the medical records of 220 men aged 18-85 years (average age 33 years: median 39.5 ± 19.6 years) with imaging and clinical diagnosis of gynecomastia who had undergone biochemical assessment. The consultation period was from May 2002 to June 2013. The following data was assessed: breast pain, duration of gynecomastia, sexual function, galactorrhea, weight change, habits (alcohol, drug addiction, anabolic steroids), history of pubertal gynecomastia, use of medication and family history of gynecomastia. Physical examination: weight, height, body mass index (BMI), breast and gonadal examination. Laboratory: total testosterone (TT), bioavailable testosterone (Bio-T), estradiol (E2), luteinizing hormone, follicle stimulating hormone, prolactin, thyrotropin, alpha fetoprotein, β subunit of human chorionic gonadotropin and carcinoembryonic antigen. For hormonal abnormalities, each site’s reference values were considered. In all patients, gynecomastia was confirmed by ultrasound and / or mammography. Results: A higher prevalence of gynecomastia is observed in the age range between 21 and 30 years (n = 66; 30 %). Most patients presented spontaneously (77.7 %); the rest were referred from other specialties. The most frequent reasons for consultation were aesthetic reasons (70.4 %) and breast pain (27.3 %). Twenty-three point two percent of subjects had a history of pubertal gynecomastia. Evolution time prior to consultation was highly variable (1 month to 40 years). On physical examination, 122 patients (55.4 %) had bilateral and 98 patients (44.6 %) had unilateral gynecomastia (54.1 % left and 45.9 % right); 44.8 % were overweight and 22.4 % were obese. BMI: 27.2 ± 4.3 kg/m2. In 29.1 % of patients breast pain was identified on medical examination. One patient (with macroprolactinoma) had spontaneous galactorrhea and in 3 patients mammary secretion was found on physical examination. Gonadal examination was performed in 147 patients, 126 had normal testicular volume, 10 had bilateral hypotrophy, 7 had unilateral hypotrophy and 4 unilateral absence of the testis. Idiopathic gynecomastia was the most common etiology (47.8 %). The most relevant secondary cause of gynecomastia was anabolic steroids consumption (14.1 %). In 6 cases two causes coexisted (total: 226 causes). Elevated cancer markers were not found in any of the cases. If we divide the population into patients younger and older than 40, in the former the most common second­ary causes were the use of anabolic steroids and persistent pubertal gynecomastia, while in patients older than 40, they were hypogonadism and medical drug use. Patients with bilateral gynecomastia had a longer history of gynecomastia: 3.4 ± 5.7 versus 1.4 ± 1.9 years (p = 0.0004); higher BMI: 28.4 ± 4.4 versus 25.5 ± 3.5 kg/m2 (p < 0.0001) and lower TT levels: 4.7 ± 2.0 versus 5.4 ± 1.9 ng/ml (p=0.019) than patients with unilateral gynecomastia, respectively. A negative correlation between BMI and TT was found (r= -0.38, p< 0.0001). No correlation between BMI and E2 and between BMI and bio-T was found. Ultrasound was used in 83.2 % of patients and mammography in 43.6 % (both 28.2 %). Conclusions: Patients with gynecomastia consulted more often for aesthetic reasons and secondarily for breast pain. Detection of galactorrhea was rare. Gonadal examination was normal in most patients and 66.7 % were overweight or obese. Just over half of the patients presented with bilateral gynecomastia and compared with cases of unilateral gynecomastia, they had a longer history of disease, higher BMI and lower TT levels. The most common cause of gynecomastia was idiopathic in all age groups. Persistent pubertal gynecomastia and anabolic steroids consumption were frequent in patients younger than 40 years, and medical drug use and hypogonadism in patients over 40. The presence of gynecomastia may be the expression of an underlying and clinically relevant disease. This highlights the need for an adequate and complete clinical, biochemical and imaging assessment in these patients. Rev Argent Endocrinol Metab 52:22-28, 2015 No financial conflicts of interest exist.

Consumo e nível de conhecimento sobre recursos ergogênicos nutricionais em atletas / Consumption and level of knowledge about nutritional ergogenic resources in athletes

A busca por melhora da performance e por alterações na composição corporal têm motivado a ingestão de recursos ergogênicos nutricionais (REN) entre atletas, promovendo o consumo indiscriminado destas substancias sem adequada prescrição. O objetivo do presente estudo foi averiguar a prevalência do uso, o nível de conhecimento, e as fontes informações sobre REN e esteróide anabolizantes (EA) em uma amostra de 351 atletas, maiores de 18 anos, da cidade de Viçosa- MG, através de questionário semi-estruturado e auto-aplicável. O uso de REN foi relatado por 74% da amostra, sendo os atletas masculinos (80%) fazem mais uso destes suplementos, comparados às mulheres (71%). Os suplementos mais utilizados foram creatina (43,5%), maltodextrina (40%), Whey protein (39,5), bebidade carboidratada (39%) e albumina (45%), desta forma é observado um alto consumo suplemento protéico. Por outro lado, este alto consumo de REN não é orientado por profissional habilitado, uma vez que a maioria dos atletas consomem estes suplementos sem prescrição de nutricionista ou médico, colocando em risco a saúde. Apesar da amostra apresentar elevado nível de escolaridade, as informações que estes possuem sobre REN são questionáveis, pois as principais fontes de informação são a internet e os amigos. Embora estes atletas apresentem conhecimento sobre os efeitos deletérios dos esteróides anabolizantes, foi observada uma prevalência de 45% no uso destas substâncias. Conclui-se que o consumo de REN entre atletas da cidade de Viçosa- MG é rotineiro, sem a devida prescrição profissional, e que o nível de conhecimento destes sobre os REN é baixo.

The demand for improved performance and body composition changes have motivated the intake of nutritional ergogenic resources (REN) in athletes, promoting the indiscriminate use of these substances without a proper prescription. The aim of this study was to determine the prevalence of use, the level of knowledge and information sources on anabolic steroid (EA) and REN in a sample of 351 athletes, over 18 years, the city of Viçosa-MG, by semi-structured self-administered. The use of REN was reported by 74% of the sample being male athletes (80%) make more use of these supplements, compared to women (71%). Commonly used supplements were creatine (43.5%), maltodextrin (40%), whey protein (39.5), bebidade carbohydrate (39%) and albumin (45%), thus it is observed a high consumption of protein supplements. Moreover, this high intake of REN is not guided by a qualified professional, as most athletes consume these supplements without a prescription by a dietitian or doctor, putting health at risk. Although the sample has high education level, the information they possess on REN is questionable, since the main sources of information are the internet and friends. While these athletes have knowledge about the harmful effects of anabolic steroids, there was a prevalence of 45% in substance use. It was concluded that consumption of REN among athletes of Viçosa, MG is routine without a proper prescription professional, and that the level of knowledge about these REN is low.

Use of the anabolic steroid nandrolone decanoate associated to strength training in Wistar rats / Uso do esteróide anabólico decanoato de nandrolona associado ao treinamento de força em ratos Wistar

Anabolic steroids have been constantly used among athletes and physically active individuals. Adverse effects of such use are reported in the literature. However, little is known about the effects of anabolic steroid use associated with strength training. Thus, this research aimed to identify possible morphophysiological alterations in Wistar rats treated with the anabolic steroid nandrolone decanoate and submitted to strength training. Twenty Wistar rats were divided in four groups: sedentary control (SC), sedentary hormone (SH), trained control (TC) and trained hormone (TH). After the experimental protocol period, animals were killed and body weight, adiposity, renal and hepatic injury markers, plasmatic lipid profile, glycemia, and insulinemia were determined. The experimental conditions strength training and nandrolone decanoate (isolated or associated) were positively correlated to a reduction on visceral and subcutaneous adipose tissue. The association of strength training with nandrolone decanoate was the most effective condition to increase muscle mass. Heart and kidneys weights, aspartate aminotransferase (AST) and high density lipoprotein (HDL) concentration were also negatively modified. The data demonstrated effects of anabolic steroids in body composition, with better results when associated with strength training, but collateral effects were observed.

Os esteróides anabólicos são usados indiscriminadamente entre atletas e praticantes de atividades físicas sendo que os efeitos adversos desse uso constam na literatura. Contudo, pouco se sabe dos efeitos do uso de esteróides anabólicos associados ao treinamento de força. Assim, este estudo objetivou identificar possíveis alterações morfofisiológicas em ratos Wistar tratados com decanoato de nandrolona e submetidos ao treinamento de força. Para atingir tal propósito, vinte ratos Wistar foram divididos em quatro grupos: sedentário controle (SC), sedentário hormônio (SH), treinado controle (TC) e treinado hormônio (TH). Após o período experimental, foram analisados o peso corporal, a adiposidade, marcadores de lesões hepáticas e renais, o perfil lipídico, a glicemia e a insulinemia. Foram observados efeitos do treinamento de força e do uso de decanoato de nandrolona (isolados ou associados) nos tecidos adiposos viscerais e subcutâneo. A associação de treinamento de força e uso de decanoato de nandrolona foi mais efetiva para aumentar a massa muscular. Os pesos dos rins e coração, e concentrações de aspartato aminotransferase (AST) e lipoproteína de alta densidade (HDL) foram negativamente modificados. Os dados demonstram efeitos do esteróide anabólico sobre a composição corporal, com melhores resultados obtidos com a associação ao treinamento de força, contudo efeitos colaterais foram observados.

Onde os fracos não têm vez: discursos sobre anabolizantes, corpo e masculinidades em uma revista especializada / Where the weak have no place: discourses on steroids, body and masculinities in a specialized magazine

O objetivo deste estudo é analisar as matérias sobre esteróides anabolizantes androgênicos (EAA) e doping, publicadas em uma revista especializada em artes marciais, a Tatame, entre os anos 1996 e 2010. Utilizou-se metodologia qualitativa, a partir do referencial fornecido pelas Ciências Sociais e suas interfaces com o campo da Saúde Coletiva. A análise e discussão dos discursos acerca do uso de EAA e doping foram organizados em quatro etapas: na primeira, ocorreu uma leitura abrangente do material jornalístico; na segunda etapa, foram examinadas as matérias, focalizando os títulos, subtítulos e conteúdos. Na terceira, verificou-se o meio circundante dos boxes, capas, contracapas e espaços publicitários da revista. A quarta etapa privilegiou a perspectiva dos lutadores sobre a utilização de EAA e/ou doping, veiculadas tanto nas matérias em que estes usos são o foco central, quanto em reportagens em que estes não são a temática principal. Os resultados indicam um descompasso entre os conteúdos veiculados na imprensa, que, de um lado, condenam o uso de EAA e doping, e de outro, divulgam uma série de estímulos para o desenvolvimento da musculosidade. Desta forma, os conteúdos acabam por corroborar a ideia de uma estreita associação entre musculosidade e um tipo de masculinidade tradicional ancorado na positivação da força e na invencibilidade.

This study aims to analyze the materials on anabolic androgenic steroids (AAS) and doping, published in a magazine specializing in martial arts, Tatame, between the years 1996 and 2010. We used qualitative methodology, from the benchmark provided by the Social Sciences and its interfaces with Public Health. The analysis and discussion of the discourses about the use of AAS and doping were organized into four phases: first, there was a comprehensive reading of journalistic material; in the second, the subjects were examined, focusing on titles, subtitles and content. In the third, it was the surroundings of boxes, covers, back covers and magazine advertising space. The fourth stage favored the perspective of fighters on the use of EAA and / or doping, conveyed both in matters where these uses are the central focus, as in stories in which they are not the main theme. The results indicate a mismatch between the content conveyed in the press, which, on one hand, condemns the use of AAS and doping, and the other, discloses a series of stimuli for the development of muscularity. Thus, the contents eventually support the idea of close association between muscularity and a kind of traditional masculinity positivization anchored in the strength and invincibility.

Decanoato de nandrolona aumenta a parede ventricular esquerda, mas atenua o aumento da cavidade provocado pelo treinamento de natação em ratos / Nandrolone decanoate increases the left ventricular wall but attenuates the cavity increase caused by swimming training in rats

Os esteroides anabólicos androgênicos (EAAs) são drogas sintetizadas a partir da testosterona. Sua ação anabólica deve-se principalmente ao aumento da síntese e redução na degradação das proteínas musculares. Este trabalho investiga os efeitos do treinamento de natação associado ao tratamento com decanoato de nandrolona sobre a pressão arterial, as dimensões cardíacas e reatividade vascular. Quarenta ratos Wistar machos, com idade de 60 dias, foram divididos em quatro grupos (n = 10): sedentário (SN), sedentário tratado (ST), treinados (TN) e treinados tratados (TT). Animais TN e TT realizaram um treinamento de natação durante 12 semanas, enquanto os animais ST e TT receberam decanoato de nandrolona semanalmente (15mg/kg). O coração e os testículos foram removidos e pesados. O diâmetro da cavidade do ventrículo esquerdo (DcVE) e a espessura da parede ventricular (EspVE) foram medidos com um paquímetro eletrônico. A pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD) foram medidas semanalmente; ainda, foi estudada a reatividade vascular das artérias mesentéricas em resposta à noradrenalina. Em nosso trabalho não houve alterações no peso do coração; no entanto, verificamos aumento no DcVE (p < 0,05) em ratos TN, enquanto a EspVE aumentou (p < 0,05) nos ratos ST e TT, ambos em relação ao SN. O peso do testículo diminuiu (p < 0,05) em ST e TT em relação a SN. Tanto a pressão arterial quanto a reatividade vascular não foram alteradas. Concluímos que o treinamento de natação aumentou o diâmetro da cavidade ventricular esquerda, enquanto o tratamento com decanoato de nandrolona aumentou a espessura da parede ventricular esquerda, sugerindo uma hipertrofia concêntrica.

Anabolic androgenic steroids (AASs) are drugs synthesized from testosterone. Their anabolic action is mainly due to increased synthesis and reduced degradation of muscle proteins. The purpose of this study was to investigate the effects of swimming training associated to nandrolone decanoate treatment on the blood pressure, the myocardial dimensions, vascular reactivity. Forty Wistar male rats, aged 60 days, were divided into 4 groups (n = 10): sedentary (SN), sedentary treated (ST), trained (TN) and trained treated (TT). TN and TT animals performed a swimming training during 12 weeks and ST and TT animals received weekly nandrolone decanoate (15mg/ kg). The heart and teste were removed and weighted. The left ventricular diameter (LVD) and left ventricular wall thickness (LVWT) had been measured with an electronic pachymeter. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) was weekly measured, while the mesenteric arteries vascular reactivity was studied for its response to noradrenaline. There were no alterations in the heart weight, but the LVD increased (p < 0,05) in TN rats, while the LVWT increased (p < 0,05) in ST and TT rats, both in relation to SN. Testicle weight decreased (p < 0,05) in the ST and TT animals in relation to SN. There was no alteration in blood pressure, neither vascular reactivity. It was concluded that swimming training increased the left ventricular diameter, while nandrolone decanoate treatment increased mainly the left ventricular wall thickness, suggesting concentric hypertrophy.

Resistance training and androgenic anabolic steroids on aged skeletal muscles: a review about methodological approaches

One of the most frequent effects of aging is the involuntary loss of muscle mass, strength and function, termed sarcopenia. Longitudinal data suggest that muscle strength is a robust predictor of functional decline that occur during aging. Since strength capacity appears to also be indicative of disability, resistance training may serve as an effective mode of physical activity to directly improve functional capacity. There is also a growing evidence to indicate that age-related decline in production and activity of hormones plays an important role in aging muscle. Testosterone deficiency has been associated with a marked decrease in measures of whole body protein anabolism and decrease strength. The purpose of the present study was to explore the characteristics of the methodological approaches used in the studies related to the role of resistance training and androgenic anabolic steroids in the aged skeletal muscle that have been published in the last ten years. A literature review was conducted in April 2011 using the following databases: PubMed; Medline; Lilacs; and Scielo. We found sixty two articles analyzing the influence of resistance training on skeletal muscle of aged samples, seven articles which proposed to verify the chronic influence of androgenic anabolic steroids and only one article mixing both interventions. The great variety of analysis methods is notable. Morphological analysis was done in only few articles.

Anabolic steroids induced acute myocardial infarction

Androgenic anabolic steroids are commonly abused by athletes and body-builders to help develope lean body mass and muscular strength to enhance their performance. However, at doses which are much higher than recommended therapeutic dosage, abuse of these drugs is commonly associated with cardiovascular side-effects that can lead to acute myocardial infarction and sudden death. We report here three cases of acute myocardial infarction in local young bodybuilders who were using Stanazolol, an androgenic anabolic steroid, and discuss the pathophysiological mechanisms behind the observed cardiovascular side effects.

Effects of administering testosterone undecanoate in rats subjected to physical exercise: effects on the estrous cycle, motor behavior and morphology of the liver and kidney / Efeitos da administração de undecanoato de testosterona em ratos submetidos a exercício físico: efeitos sobre o ciclo estral, o comportamento motor e a morfologia do fígado e do rim

The aim of the work was evaluate the effects of testosterone undecanoate (TU) treatment combined with moderate physical training on: the estrous cycle, body weight (BW), motor behavior (MB), and the morphohistology of the reproductive system, the liver and kidney in rats. Female Wistar rats (180 g - 250 g) were divided as follows: sedentary + TU (S + TU), trained + TU (T + TU), sedentary + vehicle (S + V), trained + vehicle (T + V). The rats swam 50 min/Day, strapped with a 5 percent BW load, for 4 weeks. During this training, (BW) was monitored daily as well as the estrous cycle (EC) by vaginal smear. The TU (15 mg/kg s.c) was administered 3 times/week for 4 weeks. At the end of the study, data on MB, BW and morphohistopathological changes in viscera were compiled. The (T + TU) group had on average, a higher (BW) in the fourth week compared to the first week, and (BW) higher than (S + V) and (S + TU) groups. We noted an interruption in the EC and a decrease in weight of ovaries in animals treated with TU. In addition, there was an increase in the relative weight of the heart in groups (T + V) and (T+ TU), and kidneys in group (T + TU). Histopathological analysis showed periportal congestion and isolated foci of hepatic necrosis in rats with TU. Thus, TU combined with training abolished the EC, promoted ovarian atrophy, liver necrosis, cardiac hypertrophy and a decrease in motor activity.

O objetivo do trabalho foi avaliar o efeito do tratamento com undecanoato de testosterona (UT) combinado ao treinamento físico moderado sobre ciclo estral, peso corporal, estruturas do sistema reprodutor, comportamento motor e morfologia hepática e renal em ratas. Ratas Wistar (180 a 250 g) foram divididas em: sedentárias + UT (S+UT), treinadas + UT (T+UT), sedentárias + veículo (S+V), treinadas + veículo (T+V). As ratas nadaram 50 min/dia com sobrecarga de ~5 por cento do peso corporal por 4 semanas. Durante o período de treinamento foi realizado acompanhamento diário do peso corporal (PC) e do ciclo estral (CE) pelo esfregaço vaginal. O UT (15 mg/kg s.c.) foi administrado 3x/semana durante 4 semanas. Ao final foram avaliados comportamento motor, pesos e alterações histopatológicas de alguns órgãos. O grupo T+UT apresentou PC maior na quarta semana do que na primeira, com pesos corporais maiores que os grupos S+V e S+UT. Houve interrupção no CE e redução do peso dos ovários nos animais tratados com UT. Houve aumento do peso relativo do coração, nos grupos T+V e T+UT, e do peso relativo dos rins, no grupo T+UT. A análise histopatológica revelou congestão periportal e focos isolados de necrose hepática nas ratas com UT. O UT combinado com treinamento produziu supressão do ciclo estral, atrofia ovariana, necrose hepática, hipertrofia cardíaca e redução da atividade motora.

Uso crônico de decanoato de nandrolona como fator de risco para hipertensão arterial pulmonar em ratos Wistar / Chronic use of nandrolone decanoate as risk factor for pulmonary arterial hypertension in Wistar rats

INTRODUÇÃO: O uso indiscriminado de esteróides anabolizantes sintéticos, análogos à testosterona, implica aumento do risco cardiovascular e hipertrofia cardíaca. Assim, o aumento da massa ventricular direita corrigido pelo peso corporal (i.é., hipertrofia ventricular direita - HVD), poderia elevar o risco para o desenvolvimento de hipertensão arterial pulmonar (HAP). OBJETIVOS: Examinar os efeitos do tratamento em longo prazo com decanoato de nadrolona na HVD e sua relação com a HAP em ratos. MÉTODOS: 16 ratos Wistar com três meses de idade foram aleatoriamente divididos em dois grupos: 1) controle-sham (CONT, n = 8); 2) tratados com decanoato de nandrolona (DECA, n = 8). O tratamento consistiu na aplicação intramuscular de Deca-durabolin® 6.0mg.kg-1 de peso corporal durante quatro semanas. Após tratamento, os animais foram anestesiados com hidrato de cloral (4.0mL.kg-1, i.p.), submetidos à cateterização da artéria femoral para registro da pressão arterial media (PAM) e frequência cardíaca (FC). O coração, os rins e o fígado foram retirados, pesados e avaliados os índices de hipertrofia, os quais foram calculados pela razão da massa do órgão pelo peso corporal (mg.g-1). RESULTADOS: Os animais tratados com DECA apresentaram aumento (p < 0,01) do peso corporal (338 ± 6g) vs. CONT (315 ± 5g). Não houve alterações da PAM, embora houvesse (p < 0,01) bradicardia nos animais tratados com DECA (321 ± 13bpm) vs. CONT (368 ± 11bpm). Verificou-se significativa (p < 0,01) hipertrofia dos ventrículos e rins, mas não no fígado. A correlação entre a HVD e PAM no grupo DECA apresentou coeficiente de Pearson positivo e maior (r² = 0,4013) quando comparado com o controle (r² = 0,0003). CONCLUSÕES: Esses dados demonstram que o uso em longo prazo de decanoato de nandrolona induz importante bradicardia e HVD, o que sugere aumento do risco para HAP.

INTRODUCTION: The unsystematic use of anabolic steroids, synthetic analogs of testosterone, implies enhanced cardiovascular risk and cardiac hypertrophy. Thus, increased right ventricular mass corrected by the body weight (e.g.right ventricular hypertrophy -RVH) could raise the risk for development of pulmonary arterial hypertension (PAH). OBJECTIVES: to examine the effects of long-term chronic treatment with nandrolone decanoate on the RVH and its relationship with PAH in rats. METHODS: 16 three-month Wistar male rats were treated with nandrolone decanoate (6.0 mg/kg-1 body weight; DECA, n=8) or control vehicle (CONT, n=8). The drug and vehicle were administered by a single injection in the femoral muscle once a week for 4 weeks. After the treatment, rats were anesthetized with chloral hydrate (4.0mL/kg-1, ip), and catheterized in the femoral artery. Twenty-four hours later, mean arterial pressure (MAP) and heart ratio were measured. The heart, kidneys and liver were removed, weighed and the rates of hypertrophy (RH) were measured, which were calculated by the ratio of the weight of the organs by the body weight (mg.g-1). RESULTS: DECA treatment increased body weight (338 ± 6g; p <0.01) vs. CONT (315 ± 5g). This treatment had no effect on the MAP (CONT, 110±4mmHg, DECA, 113 ± 4mmHg). However, the bradycardia of animals treated with DECA (321 ± 13bpm, p<0.01) was significantly lower than that of CONT (368 ±11bpm). RH increased (p <0.01) the cardiac ventricles and the kidneys, but not in the liver. The correlation between the RVH and MAP in DECA showed positive and higher Pearson's coefficient (r² = 0.4013) vs CONT (r² = 0.0003). CONCLUSIONS: It was concluded that chronic nandrolone decanoate treatment induced bradycardia and RVH, which suggests increased risk for PAH.

Óleos de aplicação local intramuscular: epidemiologia do uso em praticantes de musculação / Oils of local application inside of the muscle: epidemiology of the use in bodybuilding

Há muito que se observa a utilização de substâncias que incrementam o desempenho na musculação quando não se conquista o músculo hipertrofiado, no tempo esperado, com o volume desejado. O objetivo do presente estudo foi descrever a utilização dos óleos de aplicação local intramuscular na prática da musculação na cidade de João Pessoa, Paraíba. As informações foram coletadas por questionário previamente validado, estruturado e fundamentado a partir de artigos científicos da literatura. Participaram do estudo 510 praticantes de musculação (masculino= 405 e feminino= 105), de 52 academias de ginástica, usuários ou não de óleos de aplicação local intramuscular, de 18 a 57 anos de idade (24,99 ± 6,29) da cidade de João Pessoa (PB), em 2008. Foi realizada análise univariada dos dados e o teste qui-quadrado com nível de significância de 5%. Entre os praticantes de musculação 11% administrava algum tipo de óleo de aplicação local, prevalecendo o ADE (85,7%; p<0,05) sobre o uso concomitante de ADE e óleo mineral (10,7%) e, apenas óleo mineral (3,6%). A média de idade dos usuários foi de 24,14 ± 4,91 anos, todos do sexo masculino, principalmente freqüentadores de academias da zona sul (55,4%; p=0,001), com renda familiar entre 1 e 3 salários mínimos (65,5%; p=0,0005). 53,6% dos usuários relataram efeitos colaterais, como dor local (60%); febre local (50%); nódulos, furúnculos e febre geral (16,7%); taquicardia, dormência no local da aplicação, queda de cabelo e diminuição da libido (6,7%); bem como cálculo renal e insuficiência respiratória (3,3%). Concluímos que estes achados identificam e contribuem para o entendimento de um grave problema que demanda medidas oficiais, além de postura adequada nas áreas da saúde, especialmente a Educação Física, especialidade à qual necessitam tanto a informação dos potenciais distúrbios decorrentes, quanto às medidas preventivas que possam ser implementadas.

It has long observed the use of substances that improve performance in resistance training when you do not conquer the muscle hypertrophy in the time expected, with the desired volume. The objective of this study was to describe the use of waste from local intramuscular application in bodybuilding in the city of João Pessoa, Paraíba. The Information was collected by questionnaire previously validated, structured and reasoned articles from scientific literature. The study included 510 bodybuilders (405 male and 105 female), in 52 gyms, users or non-oil local intramuscular application of 18 to 57 years of age (24.99 ± 6.29) of João Pessoa (PB), in 2008. Performed was univariate analysis of data and chi-square test with significance level of 5%. Among bodybuilders 11% ran some kind of oil, local application, whichever is ADE (85.7%, p <0.05) with concomitant use of ADE and mineral oil (10.7%), and only mineral oil (3.6%). The average age of users was 24.14 ± 4.91 years, all male, mostly gym-goers in the south zone (55.4%, p = 0.001), with family income between 1 and 3 minimum wages (65.5%, p = 0.0005). 53.6% of users reported side effects such as local pain (60%), local fever (50%), nodules, fever and boils general (16.7%), tachycardia, numbness at the application site, hair loss and decreased libido (6.7%), as well as kidney and respiratory failure (3.3%). We conclude that these findings identify and contribute to the understanding of a serious problem that requires official action, and proper posture in health, especially physical education, which require expertise so much information to potential disturbances related, for the preventive measures can be implemented.