Procedimientos fisioterapéuticos aplicados en la mejora de la calidad de vida de los pacientes con sida / Physical therapy procedures can be beneficial to improve the quality of life of AIDS patients

El virus de inmunodeficiencia humana (VIH) es causante del síndrome de inmunodeficiencia adquirida, o sida, una afección del sistema inmunológico que, por ahora, aún no siendo mortal, es crónica y afecta a la calidad de vida de los pacientes. Sin duda el tratamiento fisioterapéutico es una manera de mejorar la calidad de vida de los pacientes. En este sentido y dado que uno de los factores importantes en el seguimiento de la evolución de la enfermedad es la fatiga, todos aquellos mecanismos que podamos establecer como fisioterapeutas para disminuir esta sintomatología ayudarán al bienestar del paciente. Para minimizar y prevenir los efectos de la fatiga en el organismo, se vienen empleando distintos agentes físicos y procedimientos fisioterapéuticos: crioterapia, electroestimulación, masoterapia e incluso otras técnicas llamadas “alternativas”. Se ha sugerido que el ejercicio físico (aeróbico y de resistencia muscular) puede ser beneficioso y mejorar la calidad de vida de sujetos con sida, pero es necesario llevar a cabo más investigaciones para determinar los parámetros óptimos de trabajo; así, en función del estado vital del paciente, se podrán establecer los protocolos de ejercicio físico adecuados, dirigidos por profesionales de la fisioterapia

The human immunodeficiency virus (HIV) is a causal factor of the acquired immunodeficiency syndrome (AIDS), an immune system disease that is presently not mortal but is a chronic disease that affects that patient’s quality of life. Undoubtedly, physical therapy can improve the patient’s quality of life. In this regards and given that one of the important factors in the follow-up of the disease course is fatigue, all those mechanisms that we can establish such as physical therapy to diminish this symptom, will help to improve the patient. In order to minimize and to prevent the effects of fatigue on the body, different physical agents and physical therapy procedures have been used: cryotherapy, electrical nerve stimulation, massage, and even other so-called “alternative” techniques. It has been suggested that physical exercise (aerobic and muscular resistance) can be beneficial and improve the AID patient’s quality of life. However, more research is needed to determine the ideal work parameters. Thus, based on the vital state of the patient, the best exercise protocols, directed by physical therapy professionals, is to establish adequate physical exercise protocols (AU)

Los glucocorticoides y el rendimiento deportivo / Glucocorticoids and sport's performance

Además de los glucocorticoides endógenos tenemos los sintéticos, cuyas propiedades hormonales derivan de la hidrocortisona. Los efectos fisiológicos y farmacológicos de los glucocorticoides son fundamentalmente antiinflamatorios e inmunosupresores. Como cualquier medicamento no están exentos de efectos secundarios; sin embargo, cuando la prescripción es correcta, y bajo la supervisión médica, éstos se minimizan. Aunque en los corticoides se han descrito efectos antiinflamatorios, antiálgicos, ansiolíticos, antiasténicos, todos estos efectos se han visto en pacientes en reposo y no existe ningún estudio concerniente al comportamiento de los mismos con el ejercicio. Aquellos trabajos tendentes a analizar los efectos de los corticoides sobre el rendimiento deportivo no han constatado ninguna mejoría (AU)

There are endogen and exogenous glucocorticoids whose hormonal properties are derived from hydrocortisone. The physiological and pharmacological effects of the glucocorticoids are antiinflammatory and immunosupressor, basically. As other drugs, they have secondary effects, which are minimum when the prescription is correct and controlled by a medical doctor. Although antiinflammatory, antialgic, anxiolytic, and antiasthenic effects have been described in corticosteriods, all these effects have been seen at patients at rest and there is no study to confirm these effects in subjects that do exercise. These studies that tend to analyze the effects of corticosteroids on sport's performance have concluded that there is not any improvement of performance (AU)

[Glucocorticoids and sport's performance]. / Los glucocorticoides y el rendimiento deportivo.

There are endogenous and exogenous glucocorticoids whose hormonal properties are derived from hydrocortisone. The physiological and pharmacological effects of the glucocorticoids are antiinflammatory and immunosuppressor, basically. As other drugs, they have secondary effects, which are minimum when the prescription is correct and controlled by a medical doctor. Although antiinflammatory, antialgic, anxiolytic, and antiasthenic effects have been described in corticosteroids, all these effects have been seen at patients at rest and there is no study to confirm these effects in subjects that do exercise. These studies that tend to analyze the effects of corticosteroids on sport's performance have concluded that there is not any improvement of performance.

[Relationship between acute phase reactant proteins (APRP) and fatigue during post-operative convalescence]. / Relación entre proteínas séricas reactantes de fase aguda (PRFA) y la fatiga durante la convalecencia postquirúrgica.

Surgery originates an inflammatory state which triggers an acute phase response (APR). In this study, variations in the acute phase reactant proteins (APRP) and their relationship with fatigue were assessed. A total of 58 candidate patients for elective abdominal surgery participated in this study. In the preoperative period (PRE) and in the post-operative period (9 days [9-P], 27 days [27-P] and 45 days [45-P]), variations in serum APRP and fatigue were analyzed. In the post-operative period (9-P), a significant decrease in PT, ALB, PAB, TRF, and an increase in CER were observed. In 27-P, significant decreases were observed in PAB and PBR, with increased PT and CER, and without significant variations in ALB ad TRF. In the 45-P day, a concomitant increase in PT and CER was observed. Dynamometric parameters also decreased significantly in the post-operative period (9-P). In conclusion, our results demonstrate the existence of changes in serum proteins and in APRP after an elective abdominal surgical intervention, which are associated with fatigue, evaluated both by subjective and objective (dynamometry) means and the use of a mathematical model that considers weight, proteins and APRP.

Relación entre proteínas séricas reactantes de fase aguda (PRFA) y la fatiga durante la convalecencia postquirúrgica / Relationship between acute phase reactant proteins (APRP) and fatigue during post-operative convalescence

La intervención quirúrgica provoca un estado inflamatorio que desencadena una respuesta de fase aguda (RFA). En este estudio evaluamos las variaciones de las proteínas reactantes de fase aguda (PRFA) y su relación con el estado de fatiga.Participaron 58 pacientes programados para cirugía abdominal. En el preoperatorio (PRE), y postoperatorio (9 días [9-P], 27 días [27-P] y 45 días [45-P]) analizamos las variaciones séricas de PRFA y la fatiga. En el postoperatorio (9-P) observamos un descenso significativo de proteínas totales, albúmina, prealbúmina, transferrina y aumento de ceruloplasmina. En el día 27-P observamos descensos significativos de prealbúmina y PBR, con incremento de proteínas totales y ceruloplasmina, sin variaciones significativas de la albúmina y la transferrina. En el día 45-P se observó un aumento de proteínas totales concomitante con un incremento de la ceruloplasmina. Las variables dinamométricas también disminuyeron significativamente en el postoperatorio (9-P).En conclusión, nuestros resultados muestran que tras la intervención quirúrgica abdominal electiva se producen alteraciones de las proteínas séricas y de las PRFA, acompañadas de un estado de fatiga valorado tanto por métodos subjetivos, objetivos (dinamometría) y mediante la utilización de un modelo matemático que tiene en cuenta el peso, las proteínas y las PRFA (AU)

Intensidad del ejercicio y orografía en ciclistas profesionales / Exercise intenstity and orography in professional cyclists

El propósito del estudio fue analizar la intensidad del esfuerzo realizado por ciclistas profesional en los diferentes puertos de montaña ascendidos en la Vuelta España de 1999 y 2000.El estudio constó de 2 fases, en la primera se realizó a todos los ciclistas del estudio una prueba de esfuerzo antes de comenzar las Vueltas a España, detenninándose los umbrales ventilatorios, aeróbico y anaeróbico. En la segunda fase se monitorizó la respuesta de la frecuencia cardiaca (FC) de los ciclistas cuando ascendían a los puertos de montaña, de categoría Especial (PME), de 1ª categoría (PM1), 2ª categoría (PM2) y 3ª categoría (PM3). Se establecieron tres zonas de trabajo en función de los umbrales determinados en el laboratorio, una por encima del umbral anaeróbico (Z3), otra por debajo del umbral aeróbico (Z1) y una última entre los dos umbrales (Z2).Se obtuvieron frecuencias cardiacas máximas (FC.,) (174ñ0.84 ppm) y frecuencias cardiacas medias (FC.) (160ñ0.99 ppm) significativamente mayores en los PM 1ª con respecto a PME, PM2 y PM3 (155ñ1.06, 156ñ0.82, 153ñ0.99 ppm, respectivamente). La media de tiempo que permanecieron en Z3 fue de 4.04ñ1.21, 10.72ñ1.42, 4.28ñ0.60 y 2.19ñ0.24min.; en Z2 se estuvo 43.14ñ1.46, 44.26ñ3.14, 21.60:E1.06 y 1 1.89ñ1.07min.; y en ZI, 5.57ñ0.81, 4.80ñ0.58, 3.3 1-@-0.30 y 4.40ñ0.3 1 min. en PME, PMI, PM2 y PM3 respectivamente. Finalmente los porcentajes de trabajo en Z3, Z2 y Z 1 fueron, respectivamente, 8.08ñ2.49, 81.55ñ2.59 y 10.18ñ1.40 por ciento para PME; 21.16ñ2.90, 70.58ñ2.69 y 24ñ1.03 por ciento en los PM 1; 15ñ1.83, 71.99ñ1.80 y 12.99ñ1.24 por ciento en PM2 y 17.31ñ1.98, 59.47ñ1.96 y 23.31ñ1.65 por ciento en PM3. En conclusión la ascensiones a los puertos de montaña es una actividad de esfuerzo intenso y así lo refleja el porcentaje y el tiempo que los ciclistas permanecieron por este umbral aeróbico-anaeróbico y por encima de este. Si comparamos unos puertos con otros la intensidad del esfuerzo decrece en el siguiente orden: PMI, PME, PM2 y PM3 (AU)

Influencia de la postura y la utilización del casco en la resistencia aerodinámico del ciclista / The influence of posture and use of aerohelmet in cyclist's aerodinamic resistance

La resistencia más importante que impide el avance de un ciclista en una contrarreloj individual (CRI) es la fuerza aerodinámico de arrastre ó FA (un 90 por ciento a 5OKm/h) que puede minimizarse (2-15 por ciento) con la utilización de diferentes implementos permitidos por la U.C.I. (manillares, cascos, cte.). La única técnica directa para medir FA es el túnel de viento, siendo escasos los estudios referenciados, y siempre analizando a un solo corredor. En este trabajo se pretende estudiar la resistencia aerodinámico de tres ciclistas profesionales en el túnel de viento e introducir una serie de modificaciones en la postura y en el uso de materiales que permitan aumentar el rendimiento en competiciones CRI. Participaron 3 ciclistas del equipo Kelme-Costa Blanca competidores en el Tour-2001 y Vuelta-2001. Se utilizó un túnel de viento subsónico de circuito cerrado (ITER, Tenerife).Estudiaron 4 posiciones sobre la bicicleta de CRI (I-Estática 2- Dinámica a ritmo competición durante 1Omin, 3-ldem, con modifiaciones en el apoyo de antebrazos, 4-ldem, sin casco) y 1 sobre la de carretera (5-Agarrados de las manetas sin casco), calculándose FA y las medidas derivadas (FA/Kg, SCx y SCx/Kg).Se minimizó F. al modificar el apoyo de antebrazos, pero no todos los ciclistas se vieron favorecidos por el uso del casco. FA fue mayor en las posiciones de pedaleo (2-3-4) que en la posición estática (1). Los valores de SCx para CRI (1 -4) oscilaron entre 0.2368-0.365 SM2 y para bicicleta de carretera entre 0.4284-0.5209 m2 existiendo una serie de factores que dificultan su comparación con los obtenidos en otros estudios. En conclusión, las modificaciones en la posición posiblemente hallan incrementado su rendimiento en competiciones CRI, no así la utilización del casco. Para comparar valores de resistencia aerodinámico de diferentes ciclistas es necesario considerar algunas fuentes de error (técnica de medición, valores de F, Y Scx relativizados, valoración estática o dináinica, cte.). El túnel de viento es la única técnica útil en la valoración de la resisten- cia aerodinámico para el incremento del rendimiento ciclista en competiciones CRI (AU)

The role of ATP as a mediator in the action of iron complexes on cellular calcium homeostasis.

The effects of the interaction between low molecular weight iron complexes (citrate, lactate, and ATP complexes) with ATP and proteins, on the modification of Ehrlich carcinoma cell calcium homeostasis have been studied. In that modification the ferric-ATP complex shows much higher activity than the others. Sodium ATP, by iron translocation from citrate and lactate, increases their activity. This phenomenon implicates ATP as a mediator on the cellular activity of the complexes. Proteins, particularly ferritin, appear to moderately reduce their activity, whereas glutathione and ascorbic acid, acting as lipid peroxidation-inhibitors, show only a slight reduction of the iron complex's effects on cellular calcium uptake.

Effects of albumin and adenosine phosphates on iron transfer from ferric lactate.

Ferric lactate is known to modify Ca2+ uptake by the cells. To enlighten the role of protein and ATP in this phenomenon, iron transfer from ferric lactate to albumin and adenosine polyphosphates was determined by electrophoresis. The order of iron affinity was ATP > ADP > AMP for the polyphosphates, and albumin does not compete for iron binding with the polyphosphates. The iron transfer to ATP was also observed in vivo by adsorption chromatography of the adenosine polyphosphates fraction from blood plasma of mice injected with ferric lactate plus ATP. In vitro iron and calcium uptake by Ehrlich ascites tumor cells showed that albumin and ATP decreased iron uptake, whereas calcium incorporation is diminished by albumin but augmented by ATP. This difference might be explained by albumin binding of ferric lactate that is inhibited from reaching cell structures, whereas ATP, known to be an inhibitor of iron polymerization, facilitates it.

Liver calcium homeostasis modification by iron: a probable factor in its carcinogenesis.

Low molecular weight iron complexes, ferric lactate and ferric-ATP complex, induce an important increase of Ca(2+)-uptake by liver. The activity of ferric lactate increased by the presence of sodium ATP, and the steady high effect of ferric-ATP complex appear to indicate that ATP might play an important role in the in vivo formation of low molecular weight iron complexes that can induce the modification of the hepatocytes calcium homeostasis, the event that might be one of the factors triggering the malignant transformation.

On the mechanism of soft tissue calcification induced by complexed iron.

The interaction of ferric lactate with Ehrlich carcinoma ascites cells induces a modification of Ca(2+)-uptake which is in direct relationship with the iron mass bound to the cells. Competitive binding of iron by deferoxamine indicates that only a part of the bound iron penetrates the cell, and that to trigger a Ca(2+)-influx this intracellular iron must be over a threshold concentration. The experimental finding that ferric lactate transfers its iron to albumin and to ATP suggests that in the Ca(2+)-uptake modification it works through its iron transfer which provokes the inhibition of the cell calcium homeostasis regulatory systems (Ca(2+)-channels, intracellular Ca(2+)-binding sites and Ca(2+)-pump ATPase). The involvement of ATP in the action of ferric lactate seems related to a higher stability of the complex, and to a larger availability of active iron able to perform the inhibitory process.

Iron, transferrin, and haptoglobin levels after a single bout of exercise in men.

Twelve, healthy male university student volunteers, between the ages of 20 and 23, were studied. All subjects were considered normal after cardiopulmonary and electrocardiographic examination. The maximal aerobic capacity (Vo2 max) of each subject was determined. The exercise programmes were performed on a mechanically braked Monark cycle ergometer. The subjects were required to perform the three tests, one per week. Each subject had a catheter inserted in an antecubital vein and blood samples were drawn at rest and at the end of exercise. Before and immediately after each exercise session total proteins (TP), hematocrit (Hct), hemoglobin (Hb), and other hematological parameters were measured. Serum iron (Fe), transferrin (TRF), and haptoglobin (HPT) were also determined. Immediately after the end of the exercise (TPT, RST, and IET), TP, Hb, Hct, and RBC increased significantly. TRF and HPT concentrations remained unchanged and iron decreased significantly after maximum sustained test (RST).

Changes in serum trace elements after surgery: value of copper and zinc in predicting post-operative fatigue.

Triceps skin fold, arm muscular performance and fatigue were quantified, haematocrit measured and haemoglobin, serum total protein, albumin, transferrin, zinc and copper concentrations determined in 60 patients (36 women, 24 men) before and 3-45 days after surgery. On days 3 and 9 after surgery, there was a significant (P less than 0.05) decrease in serum zinc concentrations but by 45 days concentrations had return to pre-operative values. In contrast, serum copper concentrations were significantly (P less than 0.05) elevated until day 45. Haematocrit and haemoglobin and albumin concentrations were decreased significantly (P less than 0.05) 3 and 9 days after surgery, whereas serum total protein concentrations remained significantly (P less than 0.05) lower for 45 days compared with concentrations prior to surgery.

The role of the interaction between Fe(III) and cell surface in the accumulation of 67Ga by tumor cells.

The study of the interaction between complexed iron and tumor cells in the presence of 67Ga-citrate indicates that a phenomenon of iron-binding related to the thermodynamic constant of stability of the iron complex, and a hydrolysis (or anion penetration) of the interaction product determine the uptake of 67Ga. The effects of various parameters such as ionic composition of the medium, nature of the iron complex, time of incubation and number of cells are discussed.

In vivo behaviour of low molecular weight iron complexes.

The in vivo distribution in mice of ferric citrate, ferric beta-glycerophosphate and ferric lactate complexes has been studied. There is a relationship between the 59Fe uptake by various tissues and the physicochemical characteristics of the complexes. Ferric lactate seems a useful preparation for iron deficiency therapy.