Ajustes endocrino-metabólicos durante el ayuno de Ramadán en jóvenes deportistas / Endocrine-metabolic adjustments during Ramadan fasting in young athletes

El precepto islámico del Ramadán (R), implica importantes modificaciones fisiológicas debido a las restricciones hídricas y dietéticas a lo largo del día y durante un mes, lo que tiene una especial repercusión física e intelectual de los musulmanes, particularmente en sociedades occidentales, en las que no se producen reajustes horarios para las actividades cotidianas. Entre las modificaciones impuestas por el R, el ayuno intermitente día/noche, desencadena mecanismos de adaptación para rentabilizar el consumo energético. El objetivo del presente estudio ha sido valorar algunos cambios endocrinometabólicos que acontecen a lo largo de la jornada, durante el mes de ayuno, en jóvenes que tienen que continuar con su actividad y entrenamiento deportivo habitual. Diez jóvenes musulmanes, varones, sanos, sometidos a entrenamiento deportivo, con edades entre 18 y 25 años que realizaron el R. Se analizaron parámetros bioquímicos y hormonales en plasma, una semana previa al R, primera y cuarta del periodo de ayuno (mañana y tarde) y semana posterior. Durante el R, se observa un descenso de los parámetros bioquímicos a lo largo del día, especialmente de la glucemia, siendo estos cambios más evidentes en la primera semana. La concentración de cortisol se encuentran significativamente elevada durante todo el mes, como consecuencia del cambio de ritmo circadiano de secreción. El R obliga al organismo a un ajuste endocrino-metabólico con el fin de preservar la eficiencia energética durante la jornada. Este control se vuelve más eficaz conforme avanza el mes de ayuno y la consecuente adaptación fisiológica.

The Islamic precept of R implies important physiological modifications due to the hydric and dietetic restrictions along a whole month plus a day, all of which have a crucial repercussion over the physical and intellectual performance of Muslims, particularly in occidental societies, in which there is no hour readjustments for daily activities. Among the imposed modifications by Ramadan in daily habits, intermittent fasting along day and night causes adaptation mechanisms to optimize the energy consumption. The objective of this study was to analyze the metabolic-endocrine changes that happen during daily working hours, along the month of fasting in young subjects who have to continue their usual activities and sport training. Ten young muslim subjects, male, healthy, set to sport training, ages in between 18 and 25 who completed Ramadan. Plasma biochemical and hormonal parameters were analyzed in plasma, a week before Ramadan, in the first and fourth of the fasting month and a week after conclusion. During Ramadan, have been observed a drop of biochemical parameters along daytime, especially those related to glycemia, being these changes stronger in the first week. The concentration of cortisol found to be significantly high during the whole month as a consequence of adaptation to the change of circadian secretion rhythms. Ramadan obliges subject´s organisms to readjust their endocrine and metabolic system in order to preserve the energetic efficiency during daytime. This auto control becomes more efficient as long as the month advances due to physiological adaptations.

[The impact of therapy with TNF-blockers on health-related quality of life in rheumatoid arthritis patients. A pilot study]. / Calidad de vida relacionada con la salud tras terapia anti-factor de necrosis tumoral alfa en pacientes con artritis reumatoide. Un estudio piloto.

INTRODUCTION: The aim of this pilot study was to evaluate the initial response to 16 weeks of treatment with infliximab and etanercept of disease activity and quality of life in a cohort of 37 patients with established rheumatoid arthritis. PATIENTS AND METHOD: Patients were selected from the Unit of Rheumatology in Hospital Clínico San Cecilio from Granada, refractory to conventional treatment with disease modifying antirheumatic drugs. To assess the disease activity, Disease activity score (DAS28) was used and the measurement of quality of life was evaluated with the Spanish version of the SF-36 Health Survey (SF-36) and the RA-specific questionnaire QoL Scale (Quality of Life in Rheumatoid Arthritis). RESULTS: Preliminary results show a significant decrease in inflammatory activity of the disease and consequently in HRQL scores. The comparison with the general reference population shows a deviation well below average, especially in the "physical function" dimension with a rising response pattern in all dimensions. The correlation between specific scores (QoL-RA scale) and generic ones (SF-36) for HQ-treatment also showed significance, especially with the physical aggregate. DISCUSSION: An important limitation of the present study is the number of patients and the duration of the treatment; despite this, improvements in functional parameters and quality of life are evident and remain roughly stable since the first weeks of treatment. This allow us to continue the study and increase the number of patients. CONCLUSIONS: The preliminary results obtained with TNF-blockers after 16 weeks of treatment in RA objectively show the effectiveness of these drugs and also the perception by the patients of the effect on their quality of life.

[Functional level and quality of life in ankylosing spondylitis, pilot study after 16 weeks TNF blocker treatment]. / Nivel funcional y calidad de vida en espondilitis anquilosante. Estudio piloto tras 16 semanas de tratamiento anti-TNF.

BACKGROUND AND OBJECTIVES: The aim of the present study is to assess the impact of infliximab and etanercept, TNF-alpha (tumour necrosis factor-alpha blockers) on functional disability and quality of life in thirteen patients over 65 years-old with ankylosing spondylitis (AS). PATIENTS AND METHODS: We consecutively included patients over 65 years-old, attending our clinic from Rheumatology Service in Hospital Clínico de Granada. These patients were all refractory to conventional therapy with disease-modifying anti-rheumatic drugs (DMARD). Disease activity was assessed using BASDAI index (bath ankylosing spondylitis disease activity index). Functional disability was assessed using BASFI (bath ankylosing spondylitis functional index) and ASQol index (ankylosing spondylitis quality of life index). RESULTS: We present a pilot study with 13 patients over 65 years-old treated with TNF blockers for 16 weeks. A significant decrease in disease activity was observed. Mean values of VAS (visual analogue scale) pain scores and disease decreases significantly after treatment (from 6.72 to 3.67 and 6.15 to 2.79 respectively), less than 4, which is considered an acceptable BASDAI response. Functional ability (BASFI) and health related quality of life (HRQOL) improved significantly from 6.15 to 2.79 and 13.85 to 4.22. CONCLUSIONS: Our results are consistent with the data available in the literature about TNF blockers decreasing clinical signs of the disease. Disease activity had significantly decreased 16 weeks after the onset of TNF blocker therapy. Functionality and quality of life have been also improved in elderly people with AS.