Hepatitis B-associated Polyarteritis Nodosa and Hypertensive Encephalopathy

The case of a two-year old boy with hypertensive encephalopathy to Hepatitis B-associated polyarteritis nodosa is presented. Polyarteritis nodosa is a rare condition in children and its association with Hepatitis B viral infection is also rare

Knowledge, attitudes and practices of anabolic steroid usage among gym users in Trinidad

Self-administered questionnaires were completed by 1062 gym-users in 14 gyms in Trinidad from February 1997 to July 1997 to determine the knowledge, attitudes and practices regarding anabolic steroids (AS). Five hundred and sixty (52.7 percent) females and 502 (48.3 percent) males completed the questionnaire. Half of the total sample were individuals in the 20 to 29 year age group. From the 17 questions that tested knowledge about AS, the median number of correct responses was 7 with a mode of 8. Increased muscle mass was correctly identified as one of the effects of AS by 841 respondents (79.2 percent), while 249 (23.6 percent) of the total sample thought asthma was treated with AS. Most (872 or 82.1 percent) felt that their knowledge about AS was inadequate and 700 (66.0 percent) were of the opinion that AS should be banned from use in competitive sports. Similarly, 733 (70.0 percent) of the gym-users thought AS should only be available by prescription. Thirty respondents reported having used AS (2.9 percent CI 2.0-4.1). The prevalence of AS use was higher among males than females (p<0.001). Improvement of physical appearance and not competitive advantage in sport was the main reason cited for AS use. Anabolic steroid users knew more about the adverse effects of AS than non-AS users but the therapeutic uses of AS were comparatively less well-known. This study demonstrated a general lack of knowledge concerning AS use and that a small but significant proportion of persons using gyms admitted to abusing AS.

Dengue haemorrhagic fever/dengue shock syndrome: an unwelcome arrival in Trinidad

This is the first report of dengue haemorrhagic fever and dengue shock syndrome in Trinidad. Dengue infection was confirmed serologically or by viral isolation in five patients, aged 15 to 33 years, who presented with fever, thrombocytopenia and haemoconcentration. Three patients developed dengue shock syndrome, which was fatal; although there was no haemorrhagic tendency among these patients, bleeding occurred shortly before death in one of them. Two patients who had dengue haemorrhagic fever survived. The co-circulation of dengue virus serotypes 1, 2 and 4 in the Caribbean facilitates the development of dengue shock syndrome (DSS) or dengue haemorrhagic fever (DHF). Clinicans should therefore be aware of their clinical features, laboratory diagnosis and clinical management. Appropriate public health interventions and improved surveillance should be implemented to reduce the risk of DHS/DSS associated mortality in Trinidad and Tobago.

Cushing's syndrome from tropical glucocorticoids

A case of Cushing's syndrome is described in a woman who self-treated psoriasis with a variety of potent tropical glucocorticoids over 15 years. She was successfully weaned off corticosteroids and was treated with alternative anti-psoriatic drugs. The disappearance, nine months later, of most features of Cushing"s syndrome, and the normal supression of cortisol in response to dexamethasone, excluded endogenous hypercorticolism. The apparent widespread availability across the counter of potent corticosteriods is a cause of concern.