Alterations in acetylcholinesterase and butyrylcholinesterase activities in chronic obstructive pulmonary disease: relationships with oxidative and inflammatory markers.

This work focused on finding a relationship between acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activities and the development and severity of COPD. The possible link of these enzymes to oxidative and inflammatory processes was also investigated. The study included 229 healthy controls and 153 COPD patients. Erythrocyte AChE and plasma BChE activities were determined using spectrophotometric methods. Markers related to the oxidative status including thiobarbituric acid-reactive substances (TBARS), total protein carbonyls (PCs), advanced oxidation protein products (AOPP), reduced glutathione, nitric oxide, and peroxynitrite were measured. We also evaluated the activity of glutathione peroxidase, catalase, and superoxide dismutase in the plasma and erythrocytes. Serum levels of IL-6 and TNF-α were measured by the enzyme-linked immunosorbent assay. COPD patients showed increased AChE and BChE activities in comparison to healthy controls. Interestingly, AChE activity was higher in COPD smokers than in nonsmokers, while no difference was revealed for BChE. In addition, our results showed an inverse correlation between AChE activity and the levels of IL-6 in COPD smokers. Positive correlations were found, in COPD smokers, between plasma BChE activity and the levels of several biomarkers of protein oxidative damage including AOPP and PC. Our findings suggest that the alterations in AChE and BChE activities may be related to the oxidative and inflammatory processes in COPD patients rendering these enzymes as markers of COPD disease.

Concomitant elevations of MMP-9, NGAL, proMMP-9/NGAL and neutrophil elastase in serum of smokers with chronic obstructive pulmonary disease.

A growing body of evidence points towards smoking-related phenotypic differences in chronic obstructive pulmonary disease (COPD). As COPD is associated with systemic inflammation, we determined whether smoking status is related to serum levels of matrix metalloproteinase-9 (pro- and active MMP-9), neutrophil gelatinase-associated lipocalin (NGAL) and the proMMP-9/NGAL complex in patients with COPD. Serum samples were collected in 100 stable-phase COPD patients (82 smokers, 18 never-smokers) and 28 healthy adults (21 smokers, 7 never-smokers). Serum levels of studied factors were measured in ELISA. Our data provide the first evidence of simultaneously elevated serum levels of MMP-9, NGAL and proMMP-9/NGAL in COPD smokers. While the triad discriminated between smokers and non-smokers in the COPD group, MMP-9 and proMMP-9/NGAL (but not NGAL) discriminated between smokers with and without COPD. Adjustment for age and smoking pack-years did not alter the findings. Serum MMP-9, NGAL and proMMP-9/NGAL levels were not correlated with the GOLD stage or FEV1 decline. Furthermore, serum levels of neutrophil elastase (NE) and MMP-3 (but not of IL-6 and MMP-12) were also higher in COPD smokers than in healthy smokers before and after adjustment for age and pack-years. Among COPD smokers, levels of MMP-9, NGAL and proMMP-9/NGAL were positively correlated with NE (P < 0.0001) but not with the remaining factors. Gelatin zymography detected proMMP-9 in serum samples of healthy and COPD smoking groups. Our results suggest that associated serum levels of proMMP-9, NGAL, proMMP-9/NGAL and NE may reflect the state of systemic inflammation in COPD related to cigarette smoking.

The -786 T/C polymorphism of NOS3 gene is a susceptibility marker of COPD among Tunisians that correlates with nitric oxide levels and airflow obstruction.

OBJECTIVE: The goal of this study was to examine the role of G894T (rs1799983), -786T/C (rs3918161) and a 27 bp variable number of tandem repeats (VNTR) 4B/4A of NOS3 gene on the risk and severity of COPD. METHODS: The study included 194 controls and 138 COPD patients. NOS3 G894T, -786T/C and 4B/4A variants were determined by PCR analysis based on the banding pattern on gel electrophoresis. Pulmonary function was evaluated using body plethysmography. The levels of nitric oxide, peroxynitrite and lipid peroxides (T-BARS) were determined using spectrophotometric methods. Levels of serum IL-6, TNF-α and TGFß were determined by ELISA. RESULTS: In case-control studies, both G894T and -786T/C variants were associated with COPD risk. A significantly increased risk of COPD was found with the NOS3894T and -786C alleles (OR:1.93, P=0.001; OR:2.05, P=0.001, respectively). No significant impact of the G894T and 4B/4A SNPs was found on COPD severity, while a significant correlation was retrieved between the NOS3 -786T/C variation and advanced stages (OR: 1.89, P=0.009). In addition, COPD patients with the -786CC genotype exhibited lower FEV1% values in comparison to -786TT carriers (48±3.28 vs. 58.06±2.3, P=0.01, respectively). Patients having the -786CC genotype presented lower plasma levels of nitric oxide and higher T-BARS in comparison to -786TT individuals (173.22±13.4 vs. 228.93±16.8, P=0.01; 1.8±0.15 vs. 1.22±0.15, P=0.01, respectively). CONCLUSION: This study provides the first evidence for the association of G894T, -786T/C variants with COPD risk among Tunisians. The -786T/C variation correlates with enhanced airflow limitation. This finding could be related to altered levels of nitric oxide and enhanced lipid peroxides among patients carrying the -786CC genotype.

Alteration in systemic markers of oxidative and antioxidative status in Tunisian patients with asthma: relationships with clinical severity and airflow limitation.

OBJECTIVE: This study aims to determine the systemic oxidant-antioxidant status in Tunisian patients with asthma. METHODS: We evaluated the levels of malondialdehyde (MDA) as thiobarbituric acid complexes, total protein carbonyls (PCs) and advanced oxidation protein products (AOPP). The levels of total thiols, protein sulfhydryls, glutathione (GSH), together with hydrogen peroxide, ascorbic acid, iron and total antioxidant status (TAS) were colorimetrically estimated. Glutathione peroxidase (GSH-Px), catalase (CAT) and superoxide dismutase (SOD) activities were assessed in plasma and erythrocytes by spectrophotometry. We also determined the levels of nitric oxide (NO) and peroxynitrite in plasma from asthmatic patients and healthy controls. The volume of fractionated exhaled NO (FeNO) was evaluated by the Medisoft HypAir method. Estimation of DNA damage was determined using the comet assay. RESULTS: Asthmatic patients showed increased levels of MDA in comparison to healthy controls (p < 0.001), while no significant difference was found in protein carbonyls (p = 0.79) and AOPP (p = 0.98). Patients with asthma also had significantly lower levels of total thiols (355.9 ± 15.72 versus 667.9 ± 22.65, p < 0.001), protein sulfhydryls (333.99 ± 16.41 versus 591.95 ± 24.28, p < 0.001) and glutathione (p < 0.001). They also showed decreased GSH-Px activity (p < 0.001), whereas no significant differences in measurements of catalase and SOD enzyme activities were observed between the two groups (respectively, p = 0.06 and p = 0.55). In addition, ascorbic acid and nitric oxide levels were decreased in asthmatics in comparison to controls (p < 0.01). CONCLUSIONS: Our findings highlight that oxidative stress and defective anti-oxidative status are major alterations in Tunisian patients with asthma.

Adherence to treatment with continuous positive airway pressure in the obstructive sleep apnea syndrome.

INTRODUCTION: Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnea (OSA). Adequate compliance with the use of CPAP is cardinal to achieve cardiovascular, metabolic and neuropsychological benefits of treatment. AIM: Assess the factors affecting compliance to the CPAP treatment and analyze the long term acceptance. METHODS: Retrospective study on 130 patients treated by CPAP for OSA in the department of pulmonology between 2005 and 2014.  Long term acceptance was analysis using the method of survival analysis. RESULTS: These patients are characterized by a mean age of 55.4± 10.2 years; main comorbidities were found hypertension (47%), diabetes (25.5%) and COPD (11%). Median baseline apnea-hypopnea index was (AHI), 56 ± 19,5/h. One hundred thirty patients were enrolled with a mean follow up of 75 ± 34 months, 42 patients stopped their treatment, 21% of them in the first 6 months.  In compliant patients, the median value of daily CPAP use was 5, 5 ± 2 hours. Kaplan Meier analysis showed that 96% of patients were still using CPAP at 12 months, 69,4% at 5 years and 64,1% at 10 years. Chronic Obstructive Pulmonary Disease was identified as a predictor factor of long term CPAP use. Non observing patients had a higher probability to stop the use of CPAP compared to adherent patients Conclusion: the treatment of OSA with CPAP is generally well accepted in the long term. Treatment dropouts are more common among non-adherent patients justify regular monitoring in the first months of treatment.

[Women smoking in the Tunisian center: socio demographic characteristics and effects on functional respiratory parameters]. / La tabagisme au feminin au centre Tunisien : Caractéristiques sociodémographiques et retentissement fonctionnel respiratoire.

UNLABELLED: Objectives of this study were to describe sociodemographic characteristics of Tunisian woman smoker and to study her respiratory functional profile. METHODS: all women answered for a questionnaire and benefited of a total physical plethysmography and of a carbon monoxide lung transfer measure (TLCO). RESULTS: 101 smoking women were selected. These women consumed cigarettes (74 %), the snuff "neffa "(10 %) and the water pipe (15 %). A chronic bronchitis was present at 22 women. A proximal bronchial obstruction was found at 11 women who were consumer of the "neffa" and cigarettes. A lower airway obstruction was found in all women consumer of water pipe. The TLCO was low at "neffa" group of women. CONCLUSION: woman smoking has a negative influence on pulmonary function which depends on sociocultural characteristics and on the history of smoking.

[Early detection of COPD in smoking cessation outpatients]. / Détection précoce de la BPCO dans les consultations d'aide au sevrage tabagique.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of chronic morbidity and mortality throughout the world. Potentially, COPD can be prevented by the early detection of COPD, which generally entails spirometry. Physicians in smoking cessation outpatient are in an ideal position to detect early-stage of COPD by the simple examination of the patient. They can also perform spirometry to confirm the diagnosis of COPD. The main objective of this study was to assess the frequency of COPD among smokers in smoking cessation outpatient. Secondary objectives were to Compare two methods for COPD screening, the questionnaire (clinical score) and the mini-electronic spirometer (Neo-6) and to assess the degree of motivation to stop smoking by the announcement of lung age to smokers. METHODS: a prospective cross-sectional study was carried out in four consultations for smoking cessation. Inclusion criteria were male patients aged over 35 years and seen in smoking cessation outpatient. A clinical score was then calculated to detect COPD. This score is based on age, BMI, the quantity of tobacco smoking and the respiratory clinical signs. By establishing this score, we could classify our smokers on consultants with likely COPD if the clinical score>16. Secondly, a measure of the breath with a portable minispirometre "neo6" was performed with quantification of the first second forced expiratory volume (FEV1), forced expiratory volume in 6 seconds (FEV6) and their ratio (FEV1/FEV6). A ratio FEV1/FEV6 less than 0.8 was in favor of an obstructive ventilator defect (DVO). In this case a total body plethysmography was indicated. RESULTS: The sample of the study consisted of 115 male smokers with a mean age of 48±12 years old. A low socio-economic level and a low level of education were found respectively in 50.4% and 58% of smokers. Cigarette smoking is the most consumed form of tobacco. A significant clinical score predicting COPD, was found in 54 patients. The measurement of the breath through the Neo-6 found that 23 (20%) smokers had FEV1/FEV6 less than or equal to 0.7 predicting bronchial obstruction and 26 had a ratio between 0.7 and 0.8. plethysmography confirmed the diagnosis of COPD for 27 patients. So the prevalence of COPD in our sample was of 23.48%. The clinical score had a sensibility of 81.48% and a specificity of 63.64 with a negative predictive value of 91.8%. The sensitivity of the Neo 6 (70.37%) is smaller than the clinical score but the specificity is better than 95.94 % of the clinical score. Its negative predictive value was 91.3%. So when VEMS/VEM6 ratio is greater than 0.7, the probability of COPD remains very low. The announcement of the pulmonary patient age is an important parameter for the motivation to stop smoking. CONCLUSION: The combination of a standardized questionnaire to the measure of breath by Neo6 can further optimize COPD screening.

Prognostic value of Quality of life (QoL) assessment among Tunisian lung cancer patients.

OBJECTIF: Etudier la valeur pronostique de l'évaluation de la qualité de vie (QDV) pour la survie chez les patients Tunisiens atteints du CDP. Méthodes: Une étude prospective de cohorte a été réalisée entre Janvier 2018 et Juin 2019. Le Performance status (PS), QoL questionnairecore30 (QLQ-C30), QoL questionnaire-Lung Cancer 13 (QLQ-LC13) et European QoL-5 dimensions-3level version questionnaire (EQ-5D-3L) ont été utilisés pour l'évaluation de la QDV. Les patients ont été divisés en 2 groupes selon le score global QLQ-C30, un Déficit Cliniquement Significatif (DCS) a été considéré si le score était ≤50. Les modèles de régression de Cox et Stepwise ont été réalisée pour évaluer la signification pronostique de la QDV. La survie globale (SG) a été calculée à l'aide de la méthode de Kaplan-Meier. Le test du log-rank a été utilisé pour comparer les courbes de survie. Le seuil de valeur de p pour la signification statistique était de 0,05. Résultats: Cent patients ont été inclus. La médiane de SG des patients avec DCS en qualité de vie était significativement inférieure à celle des patients sans déficit : respectivement 365 jours versus 467 jours, (test du log-rank, p = 0,036). De même pour la médiane de survie sans progression : 122 jours versus 326 jours pour ceux qui n'ont pas signalé de différence significative en QDV (test du log-rank, p = 0,05). L'analyse de régression multivariée stepwise a montré que le score global de QDV (QLQ-C30) était un facteur prédictif significatif de SG (coefficient estimate (CE)= 0.336, p=0.005), ainsi que le stade IV (CE=-0.193, p=0.033) et la progression tumorale (CE =-0.238, p=0.047). CONCLUSION: La QDV était un facteur prédictif de survie dans notre cohorte de patients atteints de CDP. Cela devrait recommander une intervention active en soins palliatifs précoces pour les patients présentant un déficit significatif en QDV.

Anti-Saccharomyces cerevisiae antibodies in patients with COVID-19.

BACKGROUND AND STUDY AIM: Anti-Saccharomyces cerevisiae antibodies (ASCA) have been described in many autoimmune diseases (AIDs). Coronavirus disease 2019 (COVID-19) could trigger AIDs. This study aimed to determine the frequency of ASCA in patients with COVID-19. PATIENTS AND METHODS: This study included 88 adult patients with severe COVID-19, 51 mild COVID-19, and 160 healthy blood donors. ASCA of isotype immunoglobulin (Ig)G and IgA were detected by enzyme-linked immunosorbent assay. RESULTS: The frequency of ASCA (IgG or IgA) was significantly higher in patients with severe COVID-19 (21.6 % vs 3.7 %, p < 10-3) and in patients with mild COVID-19 than in the healthy controls (13.7 % vs 3.7 %, p = 0.03). ASCA-IgA was significantly more frequent in patients with severe COVID-19 than in healthy controls (15.9 % vs 0.6 %, p < 10-3). ASCA-IgG was significantly more frequent in patients with mild COVID-19 than in healthy controls (13.7 % vs 3.1 %, p = 0.02). ASCA (IgG or IgA) were more frequent in severe than in mild COVID-19, but the difference was not statistically significant (21.6 % vs 13.7 %). ASCA-IgA was significantly more frequent in patients with severe than those with mild COVID-19 (15.9 % vs 0 %, p = 0.003). The mean ASCA-IgG and ASCA-IgA levels were significantly higher in patients with severe COVID-19 than in healthy controls (5.8 U/mL ± 11.8 vs 2.3 U/mL ± 2.8, p < 10-3 and 9.2 U/mL ± 21.5 vs 3.4 U/mL ± 1.7, respectively, p < 10-3). The mean ASCA-IgG levels were significantly higher in patients with mild COVID-19 than in healthy controls (6.2 U/mL ± 12.9 vs 2.3 U/mL ± 2.8, p < 10-3). The mean ASCA-IgA levels were significantly higher in patients with severe than in those with mild COVID-19 (9.2 U/mL ± 21.5 vs 2.6 U/mL ± 1.2, p = 0.03). CONCLUSION: ASCA was more frequent in patients with COVID-19 than in healthy controls.

Adherence of North-African Pulmonologists to the 2017-Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND: No previous study has investigated the adherence rate of North-African pulmonologists to the 2017-GOLD PTGs. AIMS: To investigate the adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs and to identify the barriers to their adherence. METHODS: This was a cohort study involving clinically stable COPD patients who presented to a pulmonology outpatient consultation. The patients were classified as having been appropriately and inappropriately (over- or undertreatment) treated for the GOLD group. Logistic regression was performed to determine the adherence barriers to the 2017-GOLD PTGs. RESULTS: A total of 296 patients were included (88.1% males, mean age: 68 ± 10 years; GOLD A (7.1%), B (36.1%), C (4.1%), and D (52.7%)). The pulmonologists' adherence rate to the 2017-GOLD PTGs was 29.7%. There was a significant statistical difference between the adherence rates among the four GOLD groups (A: 19.0%, B: 20.6%, C: 8.3%, and D: 39.1%; p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (. CONCLUSION: The adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs is low. It seems that the patients' age, socioeconomic level, national health insurance coverage, and GOLD groups influenced their adherence.

A rare cause of cough: Agenesis of the right pulmonary artery.

Unilateral pulmonary artery agenesis is a rare malformation. It can lead to several complications.The diagnosis is usually set at adolescence, however it can remain asymptomatic and late diagnosis is possible. Diagnosis is based on thoracic angioscanner. Treatment is essentially symptomatic. A 20-year-old male patient presented to our clinic with a history of cough and dyspnea with an abnormal chest X-ray. Physical examination was normal. Chest X-ray, CT-Scan and Pulmonary ventilation-perfusion scintigraphy led to the diagnosis of right pulmonary artery agenesis. Unilateral agenesis of the pulmonary artery with pulmonary hypoplasia is a rare malformation whose prognosis can be fatal. Once the diagnosis has been established medical follow up is mandatory.

Influence of Weather Conditions on the Onset of Spontaneous Pneumothorax in the Region of Sousse (Tunisia): Analysis of Time Series.

INTRODUCTION: Weather conditions were implicated in the onset of spontaneous pneumothorax (SP). AIM: Investigate the influence of weather conditions on the onset of SP. METHODS: A total of 200 patients with SP in Sousse (Tunisia) were enrolled in the study between January 2010 and December 2014. An analysis of two time series (meteorological data and pneumothorax cases) was performed. Data on weather conditions were collected daily throughout the 5-year period. RESULTS: A comparison of the mean temperature between days with and without SP showed significantly higher temperatures during the days with SP. A decrease of 1% in the relative humidity one day lag (D-1) was associated with an increase in the risk of SP by 1.6% (p=0,02). The occurrence of clusters was associated significantly with higher temperature averages on the same days. This same observation was made regarding the mean duration of sunshine two days before the cluster onset (p = 0.05). The occurrence of storms two days before clusters was also significantly associated with a risk multiplied by 1.96. CONCLUSION: There was a correlation between clusters of spontaneous pneumothorax and weather conditions in the region of Sousse-Tunisia.

Lung Adenocarcinoma with Gingival Metastasis.

Gingival metastasis of lung cancer is uncommon. We report the case of an 82-year-old male smoker admitted to the pulmonology department with right pleural effusion. A chest computed tomography (CT) scan showed an invasive right hilar tumour, adherent to the superior vena cava, pulmonary artery, main right bronchus, mediastinal pleura and pericardium with lymphangitic carcinomatosis of the right lung. Pleural biopsy revealed pleural metastasis of pulmonary adenocarcinoma, its primary lung origin being confirmed by immunohistochemistry. One month later, the patient developed an ulcerated polypoid gingival mass. Biopsy of this lesion showed a poorly differentiated carcinoma compatible with metastasis from the lung adenocarcinoma. The patient underwent irradiation of the gingival mass at a dose of 30 Gray, but his condition worsened rapidly and he was not fit for chemotherapy. He received palliative treatment and died 2 months after diagnosis of his metastatic lung cancer. LEARNING POINTS: Lung cancers mostly metastasize to the bones, liver, lymph nodes, brain, lung and adrenal glands, with adenocarcinoma being the most common histological type.Distant metastasis to the oral region is very uncommon but can be the first manifestation of a primary tumour.Oral metastasis can be mistaken for a benign lesion, so a biopsy should be taken for further analysis.

The Effects of Ramadan Intermittent Fasting (RIF) on Spirometric Data of Stable COPD Patients: A Pilot Study.

No previous study has raised the effects of RIF on lung function data of chronic obstructive pulmonary disease (COPD) patients. The objective of the present study was to assess the effects of RIF on spirometric data measured in male patients with a stable COPD. Sixteen patients with stable COPD (mean ± SD of age: 64 ± 7 years) who fasted during Ramadan volunteered to the study. Three sessions (Before-R, End-R, and After-R) were selected for spirometry tests that were consistently performed 2.5-4.5 hr before fasting break. Assessment sessions comprised: forced vital capacity (FVC), 1st s forced expiratory volume (FEV1), FEV1/FVC, peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and forced expiratory flow rate at the x% of FVC to be exhaled (FEFx%). A reversibility test was performed only during the Before-Ramadan session. Spirometric data were expressed in percentages of local reference values. Findings were analyzed by applying repeated measures analysis of variance. The mean ± SD of the postbronchodilator FEV1/FVC ratio and the FEV1 were, respectively, 0.52 ± 0.14 and 48 ± 19%. The mean ± SD of FEV1 (Before-R: 47 ± 19, End-R: 45 ± 18, After-R: 44 ± 19%), FVC (Before-R: 73 ± 18, End-R: 71 ± 16, After-R: 69 ± 17%), FEV1/FVC (Before-R: 67 ± 16, End-R: 66 ± 16, After-R: 65 ± 16%), PEF (Before-R: 46 ± 19, End-R: 47 ± 22, After-R: 45 ± 21%), MMEF (Before-R: 19 ± 10, End-R: 18 ± 8, After-R: 18 ± 9%), FEF25% (Before-R: 16 ± 6, End-R: 16 ± 5, After-R: 15 ± 5%), FEF50% (Before-R: 21 ± 14, End-R: 20 ± 12, After-R: 20 ± 12%) and FEF75% (Before-R: 27 ± 19, End-R: 27 ± 19, After-R: 27 ± 19%) were not significantly influenced by RIF. RIF did not bring about any significant changes in the spirometric data of stable COPD male patients fasting the 2016 holy month of Ramadan.

The Effects of Ramadan-Fasting (RF) on Inflammatory and Hematological Indices of Stable Chronic Obstructive Pulmonary Disease (COPD) Male Patients: A Pilot Study.

No previous study has evaluated the effects of RF on inflammatory and hematological indices of COPD patients. The main objective of the present pilot study was to assess the effects of RF on some inflammatory and hematological indices measured in male patients with stable COPD. Fifteen COPD patients (mean ± SD of age: 71 ± 6 years) who fasted during Ramadan 2017 volunteered for the study. Three sessions (Before-Ramadan, End-Ramadan and After-Ramadan) were selected. Spirometry tests and blood samples were consistently performed 2.5-4.5 hr before the interruption of the fasting. Assessment sessions comprised: spirometry, inflammatory [erythrocyte sedimentation rate (ESR); C-reactive protein (CRP)] and hematological [red and white blood cells (RBC, WBC); hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; platelets] indices. Findings were analyzed by applying Friedman ANOVA. The median (lower-upper quartiles) of ESR (Before-Ramadan: 3 (2-9), End-Ramadan: 7 (0-13), After-Ramadan: 9 (5-15) mm/h) and CRP (Before-Ramadan: 20 (11-38), End-Ramadan: 15 (9-34), After-Ramadan: 20 (12-46) mg/L) were not significantly affected by RF. Among all the hematological indices, RF influenced only hemoglobin (Before-Ramadan: 14.4 ± 2.2, End-Ramadan: 13.4 ± 1.3, After-Ramadan: 12.2 ± 0.9 g/dL), hematocrit (Before-Ramadan: 45 ± 7, End-Ramadan: 40 ± 4, After-Ramadan: 39 ± 4%), RBC (Before-Ramadan: 5.1 ± 1.0, End-Ramadan: 4.6 ± 0.7, After-Ramadan: 4.4 ± 0.5 106/mm3) and WBC (Before-Ramadan: 8,673 ± 1,911, End-Ramadan: 7,840 ± 1,526, After-Ramadan: 9,507 ± 2,190/mm3). Compared to the Before-Ramadan session, the End-Ramadan session values for hemoglobin, hematocrit, RBC and WBC were lower. Compared to the After-Ramadan session, the End-Ramadan session values for hemoglobin and WBC were higher and lower, respectively. In conclusion, RF caused significant reduction in hemoglobin, hematocrit, RBC and WBC. However, it did not induce any significant changes in the CRP and ESR indices.