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Al-Ghumlas AK. Ramadan intermittent fasting is associated with improved anticoagulant activity among healthy people: a case-control study. Sci Rep 2024; 14:13855. [PMID: 38879576 PMCID: PMC11180170 DOI: 10.1038/s41598-024-64582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/11/2024] [Indexed: 06/19/2024] Open
Abstract
Data on the pathophysiological mechanisms of hemostatic alterations in the thrombotic events that occur during Ramadan intermittent fasting (RIF), particularly in the natural coagulation inhibitors, are very limited. Thus, our objective was to evaluate the effect of RIF on the natural anticoagulants level, antithrombin, protein C, and total and free protein S (PS) in healthy participants. Participants were divided into two groups. Group I consisted of 29 healthy fasting participants whose blood samples were taken after 20 days of fasting. Group II included 40 healthy non-fasting participants whose blood samples were taken 2-4 weeks before the month of Ramadan. Coagulation screening tests including prothrombin time (PT), activated partial thromboplastin time (APTT) and plasma fibrinogen level, natural anticoagulants; antithrombin, protein C, free and total PS and C4 binding protein (C4BP) levels were evaluated in the two groups. High levels of total and free PS without change in antithrombin, protein C, and C4BP levels were noted in the fasting group as compared with non-fasting ones (p < 0.05). PT and APTT showed no difference between the two groups. However, the fibrinogen level was higher in the fasting group. In conclusion, RIF was found to be associated with improved anticoagulant activity in healthy participants, which may provide temporal physiological protection against the development of thrombosis in healthy fasting people.
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Affiliation(s)
- Abeer Khalid Al-Ghumlas
- The Coagulation Research Laboratory, Physiology Department, College of Medicine and King Saud University Medical City, King Saud University, 11461, Riyadh, Saudi Arabia.
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2
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Beshyah AS, Elamouri JS, Almagdub I, Abdulrahman H, Hafidh K, Beshyah SA. Burden and Patterns of Medical Emergencies during Ramadan Fasting: A Narrative Review. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2023. [DOI: 10.1055/s-0043-1764355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Abstract
Introduction Acute medical problems may occur more frequently during Ramadan fasting (RF). We aimed to provide a narrative overview of the global literature on medical emergencies during RF.
Methods This is a nonsystematic review of the international literature from one major medical online database (PubMed, National Institutes of Health, United States). The relevant literature was narrated in a concise thematic account.
Results There is a variable impact in the burden and time distribution of emergency services and hospitalization during RF that may require readjustment of resource allocation. Studies of the risk of accidents and injuries may be increased overall or at specified times, around Iftar time. A classical impact of emergencies has been the risk of worsening peptic ulcer disease. RF impacts diabetic emergencies such as severe hypoglycemia, hyperglycemia, and diabetic ketoacidosis, particularly in type 1 diabetes and poorly controlled patients. Glucocorticoid replacement therapy may represent a challenge to patients and physicians that require education and dose adjustment. Acute neurological conditions of interest include the “first day of Ramadan headache,” epilepsy, and strokes. Several studies evaluated the risk of the acute coronary syndrome and heart failure with inconsistent findings. RF may impact the renal and urological systems through stone disease, renal colic, and acute kidney. The impact on hematological conditions was mostly focused on the safety of anticoagulant therapy during Ramadan.
Conclusion The review addresses the emergency medical encounters of the fasting patient during Ramadan to allow a holistic and ethnically sensitive approach to medical care under circumstances where decisions have to be taken with no delay.
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Affiliation(s)
- Anas S. Beshyah
- Department of Gastroenterology, Wythenshawe Hospital, Manchester, United Kingdom
| | - Jamila S. Elamouri
- Nephrology Unit, Department of Internal Medicine, Tripoli Central Hospital, Tripoli, Libya
| | - Ihab Almagdub
- Department of Medicine, Sheikh Khalifa Medical City, SEHA, Abu Dhabi, United Arab Emirates
| | - Husen Abdulrahman
- Department of Medicine, Sheikh Khalifa Medical City, SEHA, Abu Dhabi, United Arab Emirates
| | - Khadija Hafidh
- Department of Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
- Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Salem A. Beshyah
- Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates
- Department of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Medicine, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates
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El-Taravi Y, Baimukhambetova DV, Gorlenko CL, Kiseljow HY, Kokhanovskaia II, Burotina AI, Rassadina ES, Martirosian NS, Petunina NA. Management of diabetes during Ramadan: an update for Russian-speaking doctors. DIABETES MELLITUS 2023. [DOI: 10.14341/dm12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Fasting during the Islamic Ramadan month is one of the five obligatory pillars for each adult, healthy, and sane Muslim. People with severe illnesses, including type 1 and type 2 diabetes mellitus are exempt from fasting. However, many Muslims often insist on Ramadan participating despite any medical advises. It’s known that Muslims are the second largest religious group in Russia; thus, its crucial to have as much modern recommendation for management patients with type 1 and type 2 diabetes mellitus as possible. The aim of this narrative review is to evaluate physiological and pathophysiological metabolism changing during holy Ramadan month, to clarify the management of patients with type 1 and type 2 diabetes mellitus during Ramadan, to determine the frequency of glucose measuring during the day, and to understand when its time to interrupt the fasting. Moreover, we discuss specific recommendations in glucose-lowering therapy changing, nutrition, physical activities and education.
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Affiliation(s)
- Y.A. El-Taravi
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - C. L. Gorlenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - H. Yu. Kiseljow
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - A. I. Burotina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. S. Rassadina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. S. Martirosian
- I.M. Sechenov First Moscow State Medical University (Sechenov University); L.A. Vorokhobov City Clinical Hospital No. 67
| | - N. A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University); L.A. Vorokhobov City Clinical Hospital No. 67
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Alotaibi N, Aldriweesh MA, Alhasson MA, Albdah BA, Aldbas AA, Alluhidan WA, Alsaif SA, Almutairi FM, Alskaini MA, Al Khathaami AM. Clinical characteristics and outcomes of ischemic stroke patients during Ramadan vs. non-Ramadan months: Is there a difference? Front Neurol 2022; 13:925764. [PMID: 35937074 PMCID: PMC9353707 DOI: 10.3389/fneur.2022.925764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To study the clinical characteristics and outcomes of patients experiencing an ischemic stroke during Ramadan vs. non-Ramadan months in a tertiary academic center in an Islamic country. Methods We retrospectively reviewed all patients with ischemic stroke (IS) in Ramadan and non-Ramadan months for four consecutive years (February 2016–June 2019). All demographics, vascular risk factors, laboratory results, modified Rankin Scale (mRS) at admission and discharge, National Institute Stroke Scale (NIHSS), and in-hospital complication data were collected for all patients. Results One thousand and 58 patients were included (non-Ramadan, n = 960; during Ramadan, n = 98). The mean age during Ramadan was 59 ± 13 years. Most non-Ramadan IS patients during Ramadan were male (68.5%; 57.1%, respectively). There was no statistical difference in vascular risk factors and medical history between the two groups. However, Ramadan patients had higher median NIHSS scores at discharge (p = 0.0045). In addition, more ICU admissions were noted among Ramadan patients (p = 0.009). In the gender-specific analysis for Ramadan patients, we found a statistically significant difference in smoking and urinary tract infection (p = 0.006, p = 0.005, respectively). Conclusion Based on our results, there was no difference, in general, between patients with IS during Ramadan and non-Ramadan months. However, IS patients had higher NIHSS scores at discharge and more ICU admissions during Ramadan. Last, we suggest future studies with larger sample sizes, longer duration, and including all types of strokes.
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Affiliation(s)
- Naser Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed A. Aldriweesh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Muath A. Alhasson
- Unaizah College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Bayan A. Albdah
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz A. Aldbas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Waleed A. Alluhidan
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | - Faisal M. Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed A. Alskaini
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali M. Al Khathaami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
- *Correspondence: Ali M. Al Khathaami ;
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Roky R, Aadil N, Krami AM, Benaji B, Errabih I, Abdelrahim DN, Faris ME. Sex as a Biological Factor in the Changes in Disease Patients During Ramadan Intermittent Fasting: A Systematic Review. Front Nutr 2022; 9:908674. [PMID: 35845800 PMCID: PMC9284209 DOI: 10.3389/fnut.2022.908674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background During Ramadan, many patients with diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy choose to fast even against their doctor's advice. The impact of this intermittent fasting on health and disease could be different in men and women. The aim of this study was to determine the effect of sex as a factor in diseases outcomes of patients who opt to fast during Ramadan. Main Body The articles included in this study reported data on six diseases: diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy. A systematic search was performed on PubMed and Scopus for observational and clinical studies mentioning Ramadan, diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy in both men and women. Data was extracted by two independent reviewers using a standardized data-collection form. From 381 original articles, 38 studies were selected, including 25,023 patients of which 44.4% were women. Sex-based differences were reported by 18 studies for several variables such as body mass index, blood glucose, the frequency of hypoglycemia, renal colic, mortality, thrombosis, and gastrointestinal diseases in patients fasting during Ramadan. Most of the differences between men and women were reported both in the baseline period before Ramadan and during Ramadan. Indeed, during the period outside Ramadan, the frequency of renal colic, cardiovascular, gastrointestinal diseases, were higher in men; while body mass index, Thrombosis, and headache were higher in women. In the remaining 21 studies, it was reported that the sex factor was not associated with the effect of Ramadan fasting in the frequency and other outcomes of these diseases. Conclusion Currently, small attention is paid to sex as a determinant factor in patients while fasting during Ramadan. There appeared to be differences in the frequency and incidence of diseases in men and women during Ramadan. Closer attention to sex differences regarding the frequency and the progression of the diseases during fasting may help to improve patient care, especially to benefit those patients willing to fast during Ramadan.
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Affiliation(s)
- Rachida Roky
- Department of Biology, Laboratory of Physiopathology, Molecular Genetics & Biotechnology, Faculty of Sciences Ain Chock, Health and Biotechnology Research Centre, Hassan II University of Casablanca, Casablanca, Morocco
| | - Nadia Aadil
- Department of Biology, Laboratory of Microbiology, Pharmacology, Toxicology, Biotechnology and Environment Faculty of Sciences Ain Chock, Hassan II University of Casablanca, Casablanca, Morocco
| | - Al Mehdi Krami
- Department of Biology, Laboratory of Physiopathology, Molecular Genetics & Biotechnology, Faculty of Sciences Ain Chock, Health and Biotechnology Research Centre, Hassan II University of Casablanca, Casablanca, Morocco
| | - Brahim Benaji
- Health Technologies Engineering Department, Research Group in Biomedical Engineering and Pharmaceutical Sciences, ENSAM, Mohammed V University, Agdal, Morocco
| | - Ikram Errabih
- Gastroenterology Department, Ibn Sina Hospital, Mohammed V University, Agdal, Morocco
| | - Dana N. Abdelrahim
- Department of Clinical Nutrition and Dietetics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - MoezAlIslam Ezzat Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
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Ahmed SH, Chowdhury TA, Hussain S, Syed A, Karamat A, Helmy A, Waqar S, Ali S, Dabhad A, Seal ST, Hodgkinson A, Azmi S, Ghouri N. Ramadan and Diabetes: A Narrative Review and Practice Update. Diabetes Ther 2020; 11:1-44. [PMID: 32922560 PMCID: PMC7480213 DOI: 10.1007/s13300-020-00886-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
Fasting in the Islamic month of Ramadan is obligatory for all sane, healthy adult Muslims. The length of the day varies significantly in temperate regions-typically lasting ≥ 18 h during peak summer in the UK. The synodic nature of the Islamic calendar means that Ramadan migrates across all four seasons over an approximately 33-year cycle. Despite valid exemptions, there is an intense desire to fast during this month, even among those who are considered to be at high risk, including many individuals with diabetes mellitus. In this review we explore the current scientific and clinical evidence on fasting in patients with diabetes mellitus, focussing on type 2 diabetes mellitus and type 1 diabetes mellitus, with brief reviews on pregnancy, pancreatic diabetes, bariatric surgery, the elderly population and current practice guidelines. We also make recommendations on the management of diabetes patients during the month of Ramadan. Many patients admit to a do-it-yourself approach to diabetes mellitus management during Ramadan, largely due to an under-appreciation of the risks and implications of the rigors of fasting on their health. Part of the issue may also lie with a healthcare professional's perceived inability to grasp the religious sensitivities of Muslims in relation to disease management. Thus, the pre-Ramadan assessment is crucial to ensure a safe Ramadan experience. Diabetes patients can be risk-stratified from low, medium to high or very high risk during the pre-Ramadan assessment and counselled accordingly. Those who are assessed to be at high to very high risk are advised not to fast. The current COVID-19 pandemic upgrades those in the high-risk category to very high risk; hence a significant number of diabetes patients may fall under the penumbra of the 'not to fast' advisory. We recognize that fasting is a personal choice and if a person chooses to fast despite advice to the contrary, he/she should be adequately supported and monitored closely during Ramadan and for a brief period thereafter. Current advancements in insulin delivery and glucose monitoring technologies are useful adjuncts to strategies for supporting type 1 diabetes patients considered to be high risk as well as 'high-risk' type 2 patients manage their diabetes during Ramadan. Although there is a lack of formal trial data, there is sufficient evidence across the different classes of therapeutic hypoglycaemic agents in terms of safety and efficacy to enable informed decision-making and provide a breadth of therapeutic options for the patient and the healthcare professional, even if the professional advice is to abstain. Thus, Ramadan provides an excellent opportunity for patient engagement to discuss important aspects of management, to improve control in the short term during Ramadan and to help the observants understand that the metabolic gains achieved during Ramadan are also sustainable in the other months of the year by maintaining a dietary and behavioural discipline. The application of this understanding can potentially prevent long-term complications. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (10.1007/s13300-020-00886-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Syed H. Ahmed
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, UK
| | - Ateeq Syed
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ali Karamat
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ahmed Helmy
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Salman Waqar
- Nuffield Department of Primary Care Health Sciences, University Oxford, Oxford, UK
| | - Samina Ali
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Susan T. Seal
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Anna Hodgkinson
- Department of Diabetes and Endocrinology, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- NHS South East London Clinical Commissioning Group, London, UK
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nazim Ghouri
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK
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Zloto O, Lubetsky A, Ben-Bassat Mizrachi I, Kesler A, Quiros PA, Huna-Baron R. Prognostic value of JAK2V617F mutation in pseudotumor cerebri associated with cerebral venous sinus thrombosis. Acta Neurol Scand 2019; 139:166-171. [PMID: 30251405 DOI: 10.1111/ane.13032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/26/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the clinical characteristics and prognosis of cerebral venous sinus thrombosis (CVST) that presented as pseudotumor cerebri (PTC) patients with JAK2V617F mutation. METHODS Medical records of all consecutive patients that presented with PTC and a JAK2V617F mutation who were treated were retrospectively reviewed. Data regarding demographics and ocular presenting symptoms and signs, neurological signs, hematological factors treatment, and prognosis were collected. RESULTS The most common presenting symptoms were headache (5 patients, 83.3%) and visual obscurations (5 patients, 83.3%). CVST of the sagittal sinus and sigmoid sinus were the most common site of thrombus. Platelet count and hemoglobin count were higher than normal during follow-up. There was significant change in the disk edema degree as well as decline in retinal nerve fiber layer (RNFL) thickness (P < 0.001, P < 0.001, Matched pairs). There was no significant change in visual acuity (VA) or mean deviation (MD) during follow-up (P = 0.95, 0.64, respectively, Matched pairs). CONCLUSIONS Pseudotumor cerebri resulting from CSVT in our patients with JAK2V617F mutation was frequent in young patients and needed medical and surgical treatment, without improvement in visual functions and in third caused poor visual outcome. Therefore, we believe that a screening test for JAK2V617F mutation should be considered for patients with CVST without known risk factor presenting with PTC, especially when sagittal sinus or sigmoid sinus involvement or thrombocytosis or high hemoglobin are found upon presentation. This might lead to more aggressive management which may improve the visual prognosis of those young patients.
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Affiliation(s)
- Ofira Zloto
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Neuro-Ophthalmology Unit; Sheba Medical Center; Tel Hashomer Israel
| | - Aharon Lubetsky
- Thrombosis & Hemostasis Unit; Sheba Medical Center; Tel Hashomer Israel
| | | | - Anat Kesler
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Peter A. Quiros
- Stein Eye Institute; University of California; Los Angeles California
| | - Ruth Huna-Baron
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Neuro-Ophthalmology Unit; Sheba Medical Center; Tel Hashomer Israel
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Ali S, Davies MJ, Brady EM, Gray LJ, Khunti K, Beshyah SA, Hanif W. Guidelines for managing diabetes in Ramadan. Diabet Med 2016; 33:1315-29. [PMID: 26802436 DOI: 10.1111/dme.13080] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/03/2015] [Accepted: 01/19/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Globally there are approximately 90 million Muslims with diabetes of which approximately 400 000 reside within the UK. The holy month of Ramadan is a fundamental practice of this religion of which fasting from sun-rise to sun-set is an integral part. This poses many potential risks for those with diabetes who wish to observe Ramadan. METHODS The evidence base for best clinical management of Type 1 and Type 2 diabetes during Ramadan was reviewed. We reviewed current and previous recommendations for safe fasting during Ramadan. RESULTS The risks associated with fasting in those with diabetes and preparing your patient for Ramadan are discussed. We have reviewed the evidence around diet-controlled diabetes and therapies including; metformin, acarbose, metglitinides, sulfonylureas, thiazolidinidiones, dipeptidyl peptidase-4 inhibitor (DPP-4), sodium glucose co-transporter -2 (SGLT-2) inhibitors, glucagon-like peptide -1 (GLP-1) receptor agonists and insulin. CONCLUSION Up to date guidelines for the management of treatment regimes are set-out for those with Type 1 and Type 2 diabetes who wish to fast during Ramadan.
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Affiliation(s)
- S Ali
- Department of Diabetes & Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester
| | - E M Brady
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester
| | - L J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester
| | - S A Beshyah
- Center for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - W Hanif
- Department of Diabetes & Endocrinology, University Hospital Birmingham, NHS Trust, Birmingham, UK.
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9
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Salehi G, Sarraf P, Fatehi F. Cerebral Venous Sinus Thrombosis May Follow a Seasonal Pattern. J Stroke Cerebrovasc Dis 2016; 25:2838-2843. [PMID: 27562710 DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/02/2016] [Accepted: 07/30/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Several studies have demonstrated seasonal and temporal variations in the incidence of arterial stroke; however, for cerebral venous sinus thrombosis (CVST), such study seems lacking. The main aim of this study was to investigate whether there is any seasonal variation for CVST, and association between CVST occurrence and temperature. METHODS This retrospective study was conducted from January 2004 to July 2015 in 2 referral centers for the patients with cerebrovascular disorders. One hundred and sixty-six consecutive patients with a hospital admission or discharge diagnosis of definite CVST were included. The incidence of CVST was compared between high-temperature and low-temperature months. RESULTS The mean age of patients was 36.71 ± 12.44 and 130 (78.31%) subjects were female. The highest frequency of CVST was seen in 3 months of July to September (1.69/month per year); and the lowest frequency of CVST was seen from December to April (.83/month per year). Additionally, there was a significant correlation between the mean average of temperature in each month and the frequency of CVST occurrence (r = .60, P = .03). Moreover, we found a cluster of patients, mostly females, in whom CVST occurred in cold months and accompanied visible cerebral infarct with higher occurrence of seizure, focal neurological deficit, and loss of consciousness. CONCLUSIONS It seems that the incidence of CVST increases in high-temperature months of the year and dehydration and ensuing consequences may play an important role in such augmentation; however, the visible cerebral infarct is again more observed in low-temperature months.
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Affiliation(s)
- Golshan Salehi
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Sarraf
- Iranian Center of Neurological Research, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Iranian Center of Neurological Research, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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10
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Turin TC, Ahmed S, Shommu NS, Afzal AR, Al Mamun M, Qasqas M, Rumana N, Vaska M, Berka N. Ramadan fasting is not usually associated with the risk of cardiovascular events: A systematic review and meta-analysis. J Family Community Med 2016; 23:73-81. [PMID: 27186152 PMCID: PMC4859102 DOI: 10.4103/2230-8229.181006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Over one billion Muslims worldwide fast during the month of Ramadan. Ramadan fasting brings about some changes in the daily lives of practicing Muslims, especially in their diet and sleep patterns, which are associated with the risk of cardiovascular diseases. Over the years, many original studies have made the effort to identify the possible impact of the Ramadan fast on cardiovascular diseases. This systematic review and meta-analysis is an attempt to present the summary of key findings from those articles and an appraisal of selected literature. A systematic search using keywords of “;Ramadan fasting” and “;cardiovascular diseases” was conducted in primary research article and gray-literature repositories, in combination with hand searching and snow balling. Fifteen studies were finally selected for data extraction on the outcomes of stroke, myocardial infarction, and congestive heart failure. The analysis revealed that the incidence of cardiovascular events during the Ramadan fast was similar to the nonfasting period. Ramadan fast is not associated with any change in incidence of acute cardiovascular disease.
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Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Foothills Medical Center, Calgary, Alberta, Canada; Department of Community Health Sciences, Foothills Medical Center, Calgary, Alberta, Canada
| | - Salim Ahmed
- Department of Family Medicine, Foothills Medical Center, Calgary, Alberta, Canada
| | - Nusrat S Shommu
- Department of Family Medicine, Foothills Medical Center, Calgary, Alberta, Canada
| | - Arfan R Afzal
- Department of Family Medicine, Foothills Medical Center, Calgary, Alberta, Canada
| | - Mohammad Al Mamun
- Department of Public Health, General Directorate of Health Affairs in Tabuk Region, Ministry of Health, Kingdom of Saudi Arabia
| | - Mahdi Qasqas
- Department of Faculty of Social Work, Foothills Medical Center, Calgary, Alberta, Canada
| | - Nahid Rumana
- Department of Sleep Center, Foothills Medical Center, Calgary, Alberta, Canada
| | - Marcus Vaska
- Knowledge Resource Service, Alberta Health Services, Calgary, Alberta, Canada
| | - Noureddine Berka
- Calgary Laboratory Services, University of Calgary, Calgary, Alberta, Canada
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Almalki MH, Alshahrani F. Options for Controlling Type 2 Diabetes during Ramadan. Front Endocrinol (Lausanne) 2016; 7:32. [PMID: 27148163 PMCID: PMC4834520 DOI: 10.3389/fendo.2016.00032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 04/04/2016] [Indexed: 11/13/2022] Open
Abstract
The Muslim population is about 1.5 billion worldwide. Based on a global diabetes prevalence of 4.6%, it is estimated that there are about 50 million Muslims with diabetes around the world who observe fasting during the month of Ramadan each year. Ramadan, one of the five pillars of Islam, and which takes place during the ninth month of the Islamic calendar, involves fasting from sunrise to sunset. During the fast, Muslims are required to refrain from eating food, drinking, using medications, and smoking from dawn until after sunset, with no restrictions on food or fluid intake between sunset and dawn. Islam exempts people from the duty of fasting if they are sick, or if fasting may affect their health, as fasting for patients with diabetes carries a risk of an assortment of complications, including hypoglycemia, postprandial hyperglycemia, and metabolic complications, associated with dehydration. Nevertheless, a large number of people with diabetes who still choose to fast during Ramadan despite the advice of their doctor, and the permission received from religious authorities thus create medical challenges for themselves and their health-care providers. It is thus important for patients with diabetes who wish to fast during Ramadan to make the necessary preparations to engage in fasting as safely as possible. This review presents a guide to the care of diabetic patients during Ramadan to help them fast safely if they wish to do so.
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Affiliation(s)
- Mussa H. Almalki
- Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
- King Fahad Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- *Correspondence: Mussa H. Almalki,
| | - Fahad Alshahrani
- King Abdulaziz Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
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Borhani Haghighi A, Ashjazadeh N, Safari A, Cruz-Flores S. Cerebral venous sinus thrombosis in iran: cumulative data, shortcomings and future directions. IRANIAN RED CRESCENT MEDICAL JOURNAL 2012; 14:805-10. [PMID: 23483618 PMCID: PMC3587871 DOI: 10.5812/ircmj.3728] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 07/19/2012] [Accepted: 07/25/2012] [Indexed: 02/02/2023]
Abstract
Background Cerebral venous sinus thrombosis (CVST) is a frequent cause of cerebrovascular disease in Iran. Objectives In this study, we report cumulative data of published Iranian studies in a systematic manner with critically appraisal and presenting future directions. Materials and Methods The authors systematically searched the ISI web of knowledge, Pubmed, Scopus, EBESCO and iranmedex for keywords attributed to cerebral venous sinus thrombosis. The methodological and demographic characteristics, etiology, site of involvement and clinical manifestations of the patients with CVST were investigated. Results Seven eligible series with 465 patients were found. Age of the patients were between 29.5-43.8 in these series. The ratio of Female to male was 2.79. The Mortality rate was 11.4%. Oral contraceptive pills the single most common risk factor in the all series(40-71% of female patients). Headache(80-97%), sensori/motor deficits(39-64%) and seizure(20-62%) were the most common clinical presentations. Hemorrhagic transformation was seen in 11-58% of the patients. All included studies have substantial shortcomings. Majority of the studies were retrospective and only one study was population based. Despite the ethnic heterogeneity in Iran, none of these studies reported ethnic information. Detailed methodology was missing in all studies. The extent of investigation for hematologicalor neoplastic disorders was not clear methods. Only one study reported a subgroup with multifactorialetiology. Neither Barthel index nor modified Rankin scale were reported in any studies. The mortality was reported only in the three studies. The analysis of prognostic factors was not done in any study. Conclusions To overcome theses hortcomings, more well-structured epidemiologic studies should be conducted in Iran as a CVST-raising country.
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Affiliation(s)
- Afshin Borhani Haghighi
- Research Center for Stem Cell and Transgenic Technology, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Department of Neurology, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Afshin Borhani Haghighi, Neurology Department, Namazi Hospital, Shiraz, IR Iran. Tel.: +98-7116121065, Fax: +98-7116121065, E-mail:
| | - Nahid Ashjazadeh
- Department of Neurology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Anahid Safari
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Alkandari JR, Maughan RJ, Roky R, Aziz AR, Karli U. The implications of Ramadan fasting for human health and well-being. J Sports Sci 2012; 30 Suppl 1:S9-19. [PMID: 22742901 DOI: 10.1080/02640414.2012.698298] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
UNLABELLED Islamic Ramadan is a 29-30 day fast in which food, fluids, medications, drugs and smoking are prohibited during the daylight hours which can be extended between 13 and 18 h · day(-1) depending on the geographical location and season. The majority of health-specific findings related to Ramadan fasting are mixed. The likely causes for these heterogeneous findings lie in the amount of daily time of fasting, number of subjects who smoke, take oral medications, and/or receive intravenous fluids, in the type of food and eating habits and in changes in lifestyle. During Ramadan fasting, glucose homeostasis is maintained by meals taken during night time before dawn and by liver glycogen stores. Changes in serum lipids are variable and depend on the quality and quantity of food intake, physical activity and exercise, and changes in body weight. Compliant, well-controlled type II diabetics may observe Ramadan fasting, but fasting is not recommended for type I, noncompliant, poorly controlled and pregnant diabetics. There are no adverse effects of Ramadan fasting on respiratory and cardiovascular systems, haematologic profile, endocrine, and neuropsychiatric functions. CONCLUSIONS Although Ramadan fasting is safe for all healthy individuals, those with various diseases should consult their physicians and follow medical and scientific recommendations.
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Affiliation(s)
- Jasem Ramadan Alkandari
- Physical Activity & Exercise Physiology Unit, Department of Physiology, Faculty of Medicine, The Health Sciences Center, Kuwait University, Kuwait.
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