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Mohsen S, El-Gilany AH, Essam N. Effect of Ramadan fasting on changes in smoking and vaping behaviors and withdrawal symptoms severity: a cross-sectional study. J Addict Dis 2024:1-11. [PMID: 38790079 DOI: 10.1080/10550887.2024.2354565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Ramadan fasting, an obligatory duty for adult Muslims, entails refraining from eating, drinking, smoking, and vaping from dawn until sunset. Throughout Ramadan, people accept major changes to daily routines. Consequently, Ramadan is associated with abstinence symptoms and changes in smoking or vaping behavior. AIM The study aims to assess the presence of withdrawal symptoms and its severity, as well as smoking or vaping behavior change and its determinants during Ramadan fasting. METHODS A cross-sectional study was conducted during Ramadan in 2023. Data were collected online using a Google form, including questionnaires assessing socio-demographic data, nicotine dependence using Fagerstrom Test for Nicotine Dependence, vaping and shisha smoking, presence and severity of physiological and psychological withdrawal symptoms and its coping strategies. Smoking and vaping behavioral change during Ramadan and its contributing factors were also evaluated. RESULTS A total of 251 participants (96% males), mean age ± standard deviation (33 ± 12.1) were surveyed. Withdrawal symptoms were reported among 70.5%, however, their severity was generally low both physiologically and psychologically. Education, nationality, smoking duration, nicotine dependence, and the amount of consumed E-liquid per day were the independent predictors of withdrawal symptoms presence. Attempts to quit smoking and vaping were reported by 54.6% of the participants; young age and higher educational levels were the factors associated with more quitting attempts. CONCLUSIONS The withdrawal symptoms severity linked to Ramadan fasting is minimal. Many smokers and vapers made attempts to quit during Ramadan. Ramadan presents a chance for smoking and vaping cessation with some behavioral support.
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Affiliation(s)
- Shorouk Mohsen
- Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - Abdel-Hady El-Gilany
- Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - Noha Essam
- Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Mansoura City, Egypt
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Hillier KAW, Longworth ZL, Vatanparast H. Healthcare professionals knowledge, attitude, practices, and perspectives providing care to Muslims in Western countries who fast during Ramadan: a scoping review. Appl Physiol Nutr Metab 2024; 49:415-427. [PMID: 38128071 DOI: 10.1139/apnm-2023-0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The practice of fasting during the month of Ramadan is an obligation for healthy Muslims and involves abstaining from food and drinks from dawn to dusk for 29-30 consecutive days annually. With changes in dietary and lifestyle patterns, healthcare professionals (HCPs) play a significant role in supporting Muslims health during Ramadan. In this scoping review, we employed a systematic approach to map existing literature on HCPs' knowledge, attitude, practices, and perspectives working with Muslims who fast during Ramadan in Western countries. Our aim was to identify research gaps and opportunities for improving healthcare services for Muslims during Ramadan. Literature searches were generated through multiple scientific literature databases, including Web of Science, Ovid MEDLINE, CINAHL, and Embase and reviewed following The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidelines. From the eight sources included in this review, it was found that HCPs' knowledge of Ramadan fasting practices vary, with many lacking adequate knowledge. While HCPs recognize potential health complications, adjustments to medications for fasting patients, especially those with diabetes, are often neglected. Challenges in care included language barriers, limited cultural training, and resource awareness. Strategies identified to address barriers include reducing language barriers, providing resources in relevant languages, and enhancing cultural competence training. Further research is required on HCPs' knowledge providing care to Muslims during Ramadan, cultural competency training impact, and diverse healthcare interventions for fasting Muslims. Addressing these gaps may enhance culturally safe care and improve patient outcomes.
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Affiliation(s)
- Katherine A W Hillier
- University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, SK, Canada
| | - Zoe L Longworth
- University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, SK, Canada
| | - Hassan Vatanparast
- University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, SK, Canada
- University of Saskatchewan, School of Public Health, Saskatoon, SK, Canada
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Irfan B, Ankouni G, Reader J, Seraji-Bozorgzad N, Giordani B, Bakulski K, Bhaumik A, Hampstead BM, Rahman-Filipiak A. Alzheimer's Disease and Related Dementias in Muslim Women: Recommendations for Culturally Sensitive Care. J Alzheimers Dis 2024; 99:857-867. [PMID: 38759011 PMCID: PMC11191545 DOI: 10.3233/jad-240064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/19/2024]
Abstract
Alzheimer's disease and related dementias (ADRD) present significant challenges including cognitive and functional loss, behavioral disruption, emotional distress, and significant financial burden. These stressors are amplified in minority groups, who experience higher rates of ADRD but less frequent and later diagnosis. There is therefore a critical need to identify tangible approaches to culturally informed dementia assessment and care for patients from diverse communities. Muslim patients and particularly Muslim women are among the populations most understudied in the ADRD space. Muslim patients may hold unique religious, spiritual, and cultural beliefs and practices that can impact care-seeking for dementia symptoms, diagnostic accuracy, and treatment uptake. This paper outlines culturally informed approaches to assessing and treating Muslim women and families at each stage of ADRD care, though many recommendations extend to the broader Muslim community and others of diverse racial-ethnic backgrounds. We provide concrete suggestions for building rapport within and leveraging common family structures, respecting principles of modesty and privacy for all women including those who observe hijab or niqab, and communicating dementia diagnosis and care in the context of spiritual and ethical beliefs. While not intended as a comprehensive and prescriptive guide, this review provides important points of consideration and discussion with patients of Muslim backgrounds.
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Affiliation(s)
- Bilal Irfan
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ghadeer Ankouni
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jonathan Reader
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Navid Seraji-Bozorgzad
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Bruno Giordani
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kelly Bakulski
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Arijit Bhaumik
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Benjamin M. Hampstead
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- Research Program on Cognition & Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Mental Health Service, Veterans Affairs Ann Arbor Health Systems, Ann Arbor, MI, USA
| | - Annalise Rahman-Filipiak
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- Research Program on Cognition & Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Bhuiyan MN, Saadiq RA, Mueller MR, Abdalrhim AD, Overgaard J. Patient Care During Ramadan: A Narrative Review. Health Serv Res Manag Epidemiol 2024; 11:23333928241266041. [PMID: 39050928 PMCID: PMC11268016 DOI: 10.1177/23333928241266041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/05/2024] [Accepted: 06/15/2024] [Indexed: 07/27/2024] Open
Abstract
Ramadan is the Islamic holy month when Muslims around the world fast from dawn to sunset. This 30-day pattern of intermittent diurnal fasting can have a significant physiologic impact on the body. Importantly, oral intake is forbidden during this time, and many patients do not wish to take medications. From a clinical perspective, this potentially impacts healthcare delivery and chronic disease states. Despite these important changes, awareness of individual patient practices remains limited among healthcare providers in North America, which may worsen health disparities in Muslim patients. A fundamental understanding of the cultural and physiological implications of fasting during Ramadan can improve cultural competence and patient outcomes. In this paper, we review the physiologic changes during fasting, medical exemptions to fasting, and special considerations for the care of Muslim patients with chronic conditions who may fast during Ramadan.
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Affiliation(s)
- M. Nadir Bhuiyan
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rayya A. Saadiq
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael R. Mueller
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ahmed D. Abdalrhim
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joshua Overgaard
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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King JK, Kieu A, El-Deyarbi M, Aljneibi N, Al-Shamsi S, Hashim MJ, Östlundh L, King KE, King RH, AB Khan M, Govender RD. Towards a better understanding between non-Muslim primary care clinicians and Muslim patients: A literature review intended to reduce health care inequities in Muslim patients. HEALTH POLICY OPEN 2023; 4:100092. [PMID: 37383881 PMCID: PMC10297732 DOI: 10.1016/j.hpopen.2023.100092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
Although Muslims are a growing population within many non-Muslim countries, there are insufficient Muslim clinicians to care for them. Studies have shown that non-Muslim clinicians have limited knowledge and understanding of Islamic practices affecting health, which may lead to disparities in the quality of healthcare delivery and outcomes when caring for Muslim patients. Muslims come from many different cultures and ethnicities and have variations in their beliefs and practices. This literature review provides some insights which may strengthen therapeutic bonds between non-Muslim clinicians and their Muslim patients resulting in improved holistic, patient-centered care in the areas of cancer screening, mental health, nutrition, and pharmacotherapy. Additionally, this review informs clinicians about the Islamic perspective on childbirth, end of life issues, travel for Islamic pilgrimage, and fasting during the month of Ramadan. Literature was sourced by a comprehensive search in PubMed, Scopus, and CINAHL along with hand screening of citations. Title and abstract screening followed by full-text screening excluded studies including less than 30% Muslim participants, protocols, or reporting results deemed irrelevant to primary care. 115 papers were selected for inclusion in the literature review. These were grouped into the themes of general spirituality, which were discussed in the Introduction, and Islam and health, Social etiquette, Cancer screening, Diet, Medications and their alternatives, Ramadan, Hajj, Mental health, Organ donation and transplants, and End of life. Summarizing the findings of the review, we conclude that health inequities affecting Muslim patients can be addressed at least in part by improved cultural competency in non-Muslim clinicians, as well as further research into this area.
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Affiliation(s)
- Jeffrey K King
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Home Based Primary Care, Division of Extended Care and Geriatrics, Department of Veterans Affairs, Greater Los Angeles area, CA, USA
| | - Alexander Kieu
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Kanad Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Marwan El-Deyarbi
- Ambulatory Health Services, Abu Dhabi, United Arab Emirates
- Department of Pharmacology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Noof Aljneibi
- Emirates Center for Happiness Research, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Saif Al-Shamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Muhammad Jawad Hashim
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | | | | | - Renee Houjintang King
- Academic Family Medical Center, Ventura County Family Medicine Residency Program, 300 Hillmont Ave, Building 340, Suite 201, Ventura, CA, USA
| | - Moien AB Khan
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Primary Care, NHS North West London, London TW3 3EB, United Kingdom
| | - Romona Devi Govender
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
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Castillo-Aleman YM, Martinez MA, Ventura-Carmenate Y, Villegas-Valverde CA, Bencomo-Hernandez AA, Rivero Jimenez RA, Al-Kaabi FM. Effects of Ramadan Fasting on Extracorporeal Photopheresis Outcomes. Cureus 2023; 15:e47612. [PMID: 37886650 PMCID: PMC10598324 DOI: 10.7759/cureus.47612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 10/28/2023] Open
Abstract
Although there are many studies on the impact of Ramadan fasting on health in the medical literature, the effects have not been explored in Muslim patients undergoing extracorporeal photopheresis (ECP). This report aimed to describe the potential effects of Ramadan fasting on ECP treatment outcomes. Patients undergoing ECP were prospectively evaluated before and during the month of Ramadan 1443 AH (2022 AD) at the Abu Dhabi Stem Cells Center (ADSCC), United Arab Emirates. The following ECP outcomes were assessed: treatment completion, adverse events reported, body mass index (BMI), and laboratory test results, including complete blood count (CBC), C-reactive protein (CRP), and other systemic immune-inflammatory biomarkers (SIIBs). No statistically significant differences were found in most of the variables analyzed in the three patients who underwent ECP before and during the holy month. Two non-fasting patients were not able to complete the Ramadan ECP schedule, and one fasting patient experienced a vascular access event during his first procedure in Ramadan. These findings suggest that fasting during Ramadan could add further risk factors and develop serious complications related to the ECP treatment. Therefore, we suggest that fasting should be avoided during photopheresis treatment, and we provided recommendations to achieve the best possible clinical outcomes.
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Ochani RK, Shaikh A, Batra S, Pikale G, Surani S. Diabetes among Muslims during Ramadan: A narrative review. World J Clin Cases 2023; 11:6031-6039. [PMID: 37731557 PMCID: PMC10507567 DOI: 10.12998/wjcc.v11.i26.6031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Fasting during the month of Ramadan is one of the five fundamental principles of Islam, and it is obligatory for healthy Muslim adults and adolescents. During the fasting month, Muslims usually have two meals a day, suhur (before dawn) and iftar (after dusk). However, diabetic patients may face difficulties when fasting, so it is important for medical staff to educate them on safe fasting practices. Prolonged strict fasting can increase the risk of hypoglycemia and diabetic ketoacidosis, but with proper knowledge, careful planning, and medication adjustment, diabetic Muslim patients can fast during Ramadan. For this review, a literature search was conducted using PubMed and Google Scholar until May 2023. Articles other than the English language were excluded. Current strategies for managing blood sugar levels during Ramadan include a combination of patient education on nutrition, regular monitoring of blood glucose, medications, and insulin therapy. Insulin therapy can be continued during fasting if properly titrated to the patients' needs, and finger prick blood sugar levels should be assessed regularly. If certain symptoms such as hypoglycemia, hyperglycemia, dehydration, or acute illness occur, or blood glucose levels become too high (> 300 mg/dL) or too low (< 70 mg/dL), the fast should be broken. New insulin formulations such as pegylated insulin and medications like tirzepatide, a dual agonist of gastric-inhibitory peptideand glucagonlike-peptide 1 receptors, have shown promise in managing blood sugar levels during Ramadan. Non-insulin-dependent medications like sodium-glucose-cotransporter-2 inhibitors, including the Food and Drug Administration-approved ertugliflozin, are also being used to provide additional cardiovascular benefits in patients with type 2 diabetes.
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Affiliation(s)
- Rohan Kumar Ochani
- Internal Medicine, SUNY Upstate Medical University Hospital, Syracuse, NY 13210, United States
| | - Asim Shaikh
- Medicine, Aga Khan University, Sindh, Karachi 74500, Pakistan
| | - Simran Batra
- Internal Medicine, Dow University of Health Sciences, Sindh, Karachi 74200, Pakistan
| | - Gauri Pikale
- Internal Medicine, Chicago Medical School at Rosalind Franklin University, Chicago, IL 60064, United States
| | - Salim Surani
- Medicine and Pharmacology, Texas A and M University, College Station, TX 77843, United States
- Medicine, Aga Khan University, Nairobi 00100, Kenya
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Oqal M, Hijazi B, Al Momany E, Alqudah A, Almomani BA, Alrosan AZ, Alshweiat A, Istaiteyeh R, Alnajjar R, Bani Younes Y, Al-karra'ein R. Perspective of biopharmaceutics knowledge and practice of pharmacy personnel toward the effect of medication route and medical procedure on nullifying fasting. Saudi Pharm J 2023; 31:101747. [PMID: 37638218 PMCID: PMC10448202 DOI: 10.1016/j.jsps.2023.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023] Open
Abstract
Background In Ramadan, most of the dosing schedules for the patients are changed, and to ensure patient compliance to medications and to healthy life among patients, appropriate guidelines and educations are needed. This can be achieved by pharmacy personnel in all clinical settings who are recognized as biopharmaceutical experts and integral educators of medications. Aims This study aimed to identify the perspective knowledge of pharmacy personnel about effect of medication route and medical procedure on nullifying fasting in Ramadan and to determine the predictors of this knowledge. Methods A cross-sectional study was conducted in Jordan during March-April 2022. An internet-based self-administrated questionnaire on knowledge, and views was distributed using social media groups to the pharmacy personnel among different geographical areas in Jordan. A descriptive and univariate analysis were performed. Binary logistic regression was conducted to determine the predictors of knowledge including all variables with p < 0.20 on univariate analysis. Results A total of 1003 responses to the study questionnaire were collected and included in the analysis. The most common source that pharmacy personnel used to get information on medication intake and medical procedures during fasting in Ramadan was Fatwa (57.8%) followed by Islamic materials "books and brochures" (47.1%). The majority of respondents were knowledgeable about the effect of administration route of medication and medical procedures on nullifying fasting in Ramadan (greater than70%). The univariate analysis showed that more than half of respondents (56.1%) were considered knowledgeable, and the binary logistic regression analysis identified that both professional degree type and confidence of respondents to modify the patient's medication schedule as predictors for knowledge (OR = 1.791, 95% CI = 1.035-3.098, p = 0.037), (OR = 1.375, 95% CI = 1.04-1.817, p = 0.025), respectively. Conclusions Most of pharmacy personnel in Jordan are knowledgeable in biopharmaceutics principles and practice toward effect of medication route and medical procedure on nullifying fasting, and the identified predictors for this knowledge, can provide an opportunity to improve safe and effective use of medications and medical procedures during the holy month of Ramadan.
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Affiliation(s)
- Muna Oqal
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of pharmaceutical sciences, The Hashemite University, P.O box 330127, Zarqa 13133, Jordan
| | - Bushra Hijazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Enaam Al Momany
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of pharmaceutical sciences, The Hashemite University, P.O box 330127, Zarqa 13133, Jordan
| | - Abdelrahim Alqudah
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of pharmaceutical sciences, The Hashemite University, P.O box 330127, Zarqa 13133, Jordan
| | - Basima A. Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Amjad Z. Alrosan
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of pharmaceutical sciences, The Hashemite University, P.O box 330127, Zarqa 13133, Jordan
| | - Areen Alshweiat
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of pharmaceutical sciences, The Hashemite University, P.O box 330127, Zarqa 13133, Jordan
| | - Rasha Istaiteyeh
- Department of Economics, Faculty of Economics and Administrative Sciences, The Hashemite University, P.O box 330127, Zarqa 13133, Jordan
| | - Roaa Alnajjar
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of pharmaceutical sciences, The Hashemite University, P.O box 330127, Zarqa 13133, Jordan
| | - Yazeed Bani Younes
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of pharmaceutical sciences, The Hashemite University, P.O box 330127, Zarqa 13133, Jordan
| | - Ro'ya Al-karra'ein
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of pharmaceutical sciences, The Hashemite University, P.O box 330127, Zarqa 13133, Jordan
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Tibi S, Ahmed S, Nizam Y, Aldoghmi M, Moosa A, Bourenane K, Yakub M, Mohsin H. Implications of Ramadan Fasting in the Setting of Gastrointestinal Disorders. Cureus 2023; 15:e36972. [PMID: 37139278 PMCID: PMC10151003 DOI: 10.7759/cureus.36972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
Intermittent fasting is an increasingly popular dieting technique with many well-studied benefits, such as permitting weight loss in obese patients, lowering low-density lipoprotein cholesterol (LDL-C) levels and triglyceride levels, and optimizing circadian rhythms. A special type of intermittent fasting occurs during Ramadan, when Muslims worldwide fast daily from dawn to sunset for a month. Ramadan fasting has demonstrated several health benefits, including improving the gut microbiome, modifying gut hormone levels, and lowering proinflammatory markers such as cytokines and blood lipids. Although fasting has many health benefits, fasting during Ramadan may aggravate chronic medical conditions. We aim to review the literature devoted to Ramadan fasting and its effects on Muslim patients with gastrointestinal (GI) disorders, such as Inflammatory bowel disease (IBD), peptic ulcer disease (PUD), upper GI bleeding (UGIB), gastroesophageal reflux disease (GERD), and liver conditions. We will discuss recommendations for diet and medication compliance during Ramadan in the recommended pre-Ramadan counseling sessions. In this study, we used PubMed to research journals using the key terms "Ramadan," "intermittent fasting," and "gastrointestinal diseases." The current literature studying the impact of Ramadan on gastrointestinal disorders shows that patients with IBD have a minimal risk of disease exacerbation, although older men with ulcerative colitis (UC) were more prone to exacerbation during fasting. Patients with duodenal ulcers were at a higher risk of hemorrhage after Ramadan fasting. Although with mixed results, studies show patients with liver disease demonstrated improvements in liver enzymes, cholesterol, and bilirubin after Ramadan. Physicians should offer pre-Ramadan counseling to educate patients on the risks of fasting and encourage shared decision-making. To facilitate more definitive discussions between the physician and a Muslim patient, clinicians should seek a deeper understanding of how Ramadan fasting affects certain health conditions and offer accommodations, such as diet and medication adjustments.
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Taye K, Tolesa N, Tadewos A, Ketema W. Patterns of Childhood Tuberculosis Diagnosis in Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama Regional State, Ethiopia. Pediatric Health Med Ther 2022; 13:349-359. [PMID: 36386042 PMCID: PMC9657258 DOI: 10.2147/phmt.s380092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Because of the pauci bacillary nature of childhood tuberculosis and the difficulties in obtaining proper sputum samples from young children, diagnosing childhood tuberculosis (TB) is difficult. Childhood TB needs early identification and care since it advances swiftly to more advanced stages. This study was aimed to determine the patterns of all forms of childhood tuberculosis diagnosis at Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia. Methods A retrospective cross-sectional study was conducted from February 1, 2017 to January 30, 2021 among 175 children diagnosed and treated for tuberculosis in the pediatric ward. Children medical charts and pediatrics ward logbook were used to extract pertinent data by structured checklists. SPSS version 23.0 was used for data entry and statistical analysis. Results Of 175 children, fever was the leading clinical symptoms and diagnosed in 166 (94.9%) children followed by weight loss (154, 88%), and cough (136, 77.7%). In twenty seven out of 88 (30.6%) children, gastric aspirate was positive for TB infection by Xpert MTB/Rif, while 3/40 (7.5%) were positive for TB using fine needle aspiration cytology (FNAC), 19/66 (28.8%) had suggestive TB by cerebrospinal fluid analysis (CSF), 10/29 (34.5%) were smear positive for TB and 70/162 (43.2%) were suspected for TB by chest X-ray. Conclusion Despite recent breakthroughs in quick microbiological detection, such as Xpert MTB/Rif, this study revealed that more than half of the children, 89/175 (51%), were treated for TB diseases solely based on clinical criteria. This will significantly underestimate the true nature of the illness or disease and make them vulnerable to mistreatment. As a result, in order to appropriately treat the disease and manage patients in our settings, getting a microbiological diagnosis of childhood tuberculosis requires improvement, and we call for expanded availability and use of a more sensitive and specific diagnostic technique to circumvent these concerns.
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Affiliation(s)
- Kefyalew Taye
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Nagasa Tolesa
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Dembi Dollo University, Dembi Dollo, Ethiopia
| | - Agete Tadewos
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Worku Ketema
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Correspondence: Worku Ketema, Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia, Email
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11
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Naz H, Haider R, Rashid H, Ul Haq Z, Malik J, Zaidi SMJ, Ishaq U, Trevisan R. Islamic fasting: cardiovascular disease perspective. Expert Rev Cardiovasc Ther 2022; 20:795-805. [PMID: 36260858 DOI: 10.1080/14779072.2022.2138344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Ramadan is a month of obligatory fasting observed by the majority of 2 billion Muslims living around the globe. The guidelines for 'risk-free' fasting exist for chronic diseases, including diabetes mellitus, but recommendations for cardiovascular disease (CVD) patients are deficient due to the paucity of literature. AREAS COVERED Databases were screened to find relevant studies for an evidence-based consensus regarding the risk stratification and management of CVD. Using practical guidelines of the European Society of Cardiology (ESC), we categorized patients into low-, moderate-, and high-risk categories and proposed a pre-Ramadan checklist for the assessment of cardiac patients before fasting. Regular moderate-intensity exercise is recommended for most cardiac patients, which has been demonstrated to provide an anti-inflammatory and antioxidant effect that improves immune function. EXPERT OPINION In Ramadan, many physiological changes occur during fasting, which brings about a balanced metabolic homeostasis of the body. In addition, Ramadan fasting is a nonpharmacologic means of decreasing CV risk factors. As Islam exempts Muslims from fasting if they are unwell; therefore, patients with the acute coronary syndrome (ACS), advanced heart failure (HF), recent percutaneous coronary intervention (PCI), or cardiac surgery should avoid fasting.
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Affiliation(s)
- Hifza Naz
- Medical Student, School of Medicine and Surgery, University of Milan Bicocca, Bergamo, Italy
| | - Rakhshan Haider
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Haroon Rashid
- Department of Intensive care, Wythenshawe Hospital, Manchester, UK
| | | | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Uzma Ishaq
- Department of Hematology, Healthways Laboratories, Rawalpindi, Pakistan
| | - Roberto Trevisan
- Department of Endocrinology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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12
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Ahmed I, Raja UY, Wahab MU, Rehman T, Ishtiaq O, Aamir AH, Ghaffar T, Raza A, Kumar S, Sherin A, Masood F, Randhawa FA, Asghar A, Khan S. Efficacy and safety of combination of empagliflozin and metformin with combination of sitagliptin and metformin during Ramadan: an observational study. BMC Endocr Disord 2022; 22:247. [PMID: 36224542 PMCID: PMC9560019 DOI: 10.1186/s12902-022-01168-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Management of diabetes during fasting is a clinical challenge. Sodium glucose co-transporter -2 inhibitors (SGLT2i) are considered safe with a low risk of hypoglycemia. However, studies on SGLT2i are scarce. This study was designed to compare the efficacy, safety, and tolerability of empagliflozin with metformin during Ramadan in comparison with sitagliptin and metformin. METHODS It was a prospective, observational study, conducted at 11 different sites all across Pakistan on an outpatient basis during Ramadan (May 2021-June 2021). including 132 patients, 88 who received metformin and sitagliptin, and 44 patients who received metformin and empagliflozin. RESULTS Patients of the SGLT-2i group experienced similar symptomatic hypoglycemic episodes (15.9%) as the sitagliptin group. There was an improvement in blood sugar levels after the use of SGLT-2i (RBS 181 ± 64 before Ramadan vs 162 ± 53 after Ramadan). HbA1c also improved after the use of SGLT-2i before and after Ramadan (7.2 ± 0.8 vs 6.9 ± 0.9 for Metformin + Empagliflozin and 7.8 ± 1.5 vs 7.6 ± 1.6 for Metformin and sitagliptin). Weight and BMI improved after the use of SGLT-2i (BMI 36.5 ± 4.8 before Ramadan and 33.7 ± 2.4 after Ramadan). There were no reported cases of urinary tract infection in the empagliflozin group. CONCLUSION SGLT-2 inhibitors combined with metformin for patients with diabetes during Ramadan fasting is as effective, safe and well tolerated as DPP4 combined with metformin.
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Affiliation(s)
- Ibrar Ahmed
- Lady Reading Hospital, Soekarno Rd, PTCL Colony, Peshawar, House No 6A, Street 2, Akbar Town Danishabad, Near Academy Hostel, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Umar Yousaf Raja
- Shifa International, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Muhammad Umar Wahab
- Umer Diabetes and Foot Clinic, Malak shafait plaza, Mauza Mahal kot, Hathial, Main Murree Rd, Bhara Kahu, Islamabad, Pakistan
| | - Tejhmal Rehman
- Shifa International, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - Osama Ishtiaq
- Shifa International, Pitras Bukhari Road, Sector H-8/4, Islamabad, Pakistan
| | - A. H. Aamir
- Hayatabad Medical Complex, Phase-4 Phase 4 Hayatabad, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Tahir Ghaffar
- Hayatabad Medical Complex, Phase-4 Phase 4 Hayatabad, Peshawar, Khyber Pakhtunkhwa Pakistan
| | - Abbas Raza
- Shaukat Khanum Hospital, 153-E, Shah Noor Park (adjacent Clinix Pharmacy Head Office), Main Multan Road, Lahore, Pakistan
| | - Suresh Kumar
- Bolan Medical, Brewery Rd, Quetta, Balochistan Pakistan
| | - Akhtar Sherin
- KMU Institute of Medical Sciences, KIMS, Phase 2, KDA, Khyber Pakhtoonkhwa, Phase 2 Kohat Development Authority (KDA), Kohat Development Authority, KohatKohat, Khyber Pakhtunkhwa Pakistan
| | - Faisal Masood
- Alkhaliq Hospital, Nishtar Rd، Al Rahim Colony, Multan, Punjab Pakistan
| | | | - Ali Asghar
- Liaquat National Hospital, National Stadium Rd, Liaquat National Hospital, Karachi, Karachi City, Sindh Pakistan
| | - Sehrish Khan
- Liaquat National Hospital, National Stadium Rd, Liaquat National Hospital, Karachi, Karachi City, Sindh Pakistan
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13
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Obaideen K, Abu Shihab KH, Madkour MI, Faris ME. Seven decades of Ramadan intermittent fasting research: Bibliometrics analysis, global trends, and future directions. Diabetes Metab Syndr 2022; 16:102566. [PMID: 35872466 DOI: 10.1016/j.dsx.2022.102566] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/28/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS There is a large body of research focused on various aspects related to Ramadan intermittent fasting (RIF) and human health and disease. This study aimed to quantify the bibliometric data of RIF medical research over the past seven decades and explore these variables qualitatively via text mining analysis. METHODS We used the Scopus search engine to identify published articles related to RIF from inception to December 31, 2021. All types of research articles were included. Scientometric and bibliometric measures were determined using Excel, Biblioshiny, and VOSviewer. This study proposed a bibliometric and text mining method to qualitatively and quantitatively recognize the RIF research trend. RESULTS The Scopus search returned 1915 relevant articles. Most citations pertained to publications from the last two decades, and most publications were original research articles. These publications had received around 27,000 citations, and the 20 most prolific publishing journals had an average h-index of 112.25. More than one-third of all medical publications were in open-access journals. There was a 13-fold increase in medical research on RIF over the past few decades. We identified the 10 most prolific publishing countries, institutes, journals, and authors. We also identified five scientific hotspots of RIF scientific literature, which were: diabetes, metabolic health, public health, physiology, and maternity. CONCLUSION This is the first comprehensive bibliometric analysis of medical research related to RIF. The research gaps identified will shape future research directions and foster collaborative research activities toward enhanced medical nutrition research revolving around RIF.
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Affiliation(s)
- Khaled Obaideen
- Sustainable Energy & Power Systems Research Centre, RISE, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Katia H Abu Shihab
- Department of Clinical Nutrition and Dietetics, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed I Madkour
- Department of Medical Laboratory Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - MoezAlIslam E Faris
- Department of Clinical Nutrition and Dietetics, University of Sharjah, Sharjah, United Arab Emirates.
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14
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Ben Saad H. Comments on "Anthropometric, Psychosocial, Physiological, and Postural Observances During Ramadan in Men With Chronic Obstructive Pulmonary Disease". Am J Mens Health 2022; 16:15579883221099427. [PMID: 35567283 PMCID: PMC9257979 DOI: 10.1177/15579883221099427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Helmi Ben Saad
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Farhat HACHED Hospital, Heart Failure (LR12SP09) Research Laboratory, Sousse, Tunisia
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15
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Besbes A, Khemiss M, Bragazzi N, Ben Saad H. The Impacts of Ramadan Intermittent Fasting on Saliva Flow-Rate and Metabolic Data: A Systematic Review. Front Nutr 2022; 9:873502. [PMID: 35464020 PMCID: PMC9019589 DOI: 10.3389/fnut.2022.873502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
The aim of this systematic review was to report the impacts of Ramadan intermittent fasting (RIF) on salivary flow-rate (SFR) and metabolic parameters. A thorough literature search was carried out using the databases PubMed and Scopus from their inception up to 15 July 2021. The Boolean connectors used in PubMed were (Saliva [Mesh] AND Fasting [Mesh]). The same keywords were used in Scopus. Inclusion criteria were defined using PICOS. The research included all original studies involving “healthy” adults and published in English. Methodological quality assessment was performed utilizing the Joanna Briggs Institute Critical Appraisal Tool, which allows attributing scores from 1 to 11 to the selected studies. Two authors carried out the literature search, study selection, and data extraction. Differences on issues were resolved by a third author if necessary. The systematic review protocol was registered within the “Open Science Framework” (Doi: 10.17605/OSF.IO/DE7BH). Six articles met the inclusion criteria. All studies were heterogeneous and had a high score of bias and several methodological differences. The following parameters were collected: SFR, melatonin, cortisol, glucose, immunoglobulin A (IgA), uric-acid, alkaline phosphatase (ALP), and aspartate aminotransferase (AST). The SFR decreased by 10% during Ramadan in fasting subjects. The circadian pattern of melatonin remained unchanged during Ramadan, but melatonin levels dropped significantly from baseline. The salivary cortisol levels were unchanged or increased during Ramadan. The salivary glucose levels were decreased. ALP increased significantly, whilst uric-acid and AST decreased significantly. Salivary IgA decreased during the last week of Ramadan. To conclude, there is a trend toward a decrease in SFR and the content of the majority of the biomarkers investigated, with the exception of ALP and uric-acid. These changes cannot be easily attributed to any single factor (hydration status, dietary habits, physical activity, or hygiene habits). Systematic Review Registration: [https://osf.io/de7bh/], identifier [Doi: 10.17605/OSF.IO/DE7B].
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Affiliation(s)
- Amira Besbes
- Laboratory Research of Medical and Molecular Parasitology and Mycology, LR12ES08, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
- Unit of Microbiology, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Mehdi Khemiss
- Department of Dental Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Nicola Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Department of Health Sciences, Postgraduate School of Public Health, University of Genoa, Genoa, Italy
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom
- *Correspondence: Nicola Bragazzi,
| | - Helmi Ben Saad
- Research Laboratory “Heart Failure, LR12SP09”, Faculty of Medicine, Hospital Farhat Hached, University of Sousse, Sousse, Tunisia
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16
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Tatta J, Nijs J, Elma Ö, Malfliet A, Magnusson D. The Critical Role of Nutrition Care to Improve Pain Management: A Global Call to Action for Physical Therapist Practice. Phys Ther 2022; 102:6492043. [PMID: 35023558 DOI: 10.1093/ptj/pzab296] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/06/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023]
Abstract
UNLABELLED Physical therapists have unique education in the comprehensive biopsychosocial assessment and treatment of chronic pain and its mechanisms. Recently, physical therapists have raised awareness regarding the impact of nutrition on promoting health and managing noncommunicable diseases. Robust evidence supports the implementation of nutrition in physical therapist education and practice. Of particular interest for the physical therapist are investigations that use dietary interventions for the treatment of chronic pain. Yet physical therapists have received little guidance regarding their role in nutrition care for pain management and may pass on opportunities to counsel their patients on the connection between nutrition and pain. Therefore, a clinical paradigm shift and unified voice within the profession is called on to encourage physical therapists to develop tailored multimodal lifestyle interventions that include nutrition care for the management of chronic pain. This Perspective describes evidence supporting the implementation of nutrition care in physical therapist practice, supports the role of nutritional pain management for physical therapists, and encourages the use of nutrition care for primary, secondary, tertiary, prevention, health promotion, and wellness related to chronic pain. To achieve these aims, this Perspective offers suggestions for how physical therapists can (1) enhance clinical decision making; (2) expand professional, jurisdictional, and personal scope of practice; (3) evolve entry-level education; and (4) stimulate new investigations in nutrition care and pain science research. In doing so, physical therapists can assert their role throughout the pain management continuum, champion innovative research initiatives, and enhance public health by reducing the impact of chronic pain. IMPACT The nutrition care process for pain management is defined as the basic duty to provide adequate and appropriate nutrition education and counseling to people living with pain. Including the nutrition care process as part of a multimodal approach to pain management provides an opportunity for physical therapists to assert their role throughout the pain management continuum. This includes championing innovative research initiatives and enhancing public health by reducing the impact of chronic pain for over 50 million Americans.
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Affiliation(s)
- Joe Tatta
- Integrative Pain Science Institute, New York, New York, USA
| | - Jo Nijs
- Integrative Pain Science Institute, New York, New York, USA.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Sweden. University of Gothenburg Center for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ömer Elma
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Dawn Magnusson
- Department of Physical Medicine and Rehabilitation-Physical Therapy Program, University of Colorado, USA
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Selmouni F, Amrani L, Sauvaget C, Bakkar M, El Khannoussi B, Souadka A, Benkabbou A, Majbar MA, Belekhel L, Lucas E, Muwonge R, Chami Khazraji Y, Mohsine R, Bennani M, Sankaranarayanan R, Bekkali R, Basu P. Delivering colorectal cancer screening integrated with primary health care services in Morocco: Lessons learned from a demonstration project. Cancer 2022; 128:1219-1229. [PMID: 34985785 DOI: 10.1002/cncr.34061] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/31/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence and mortality rates are increasing rapidly in many low-income and middle-income countries. A demonstration project was implemented in Morocco in collaboration with the Ministry of Health to assess the feasibility, acceptability, and challenges of implementing CRC screening through routine primary care facilities. METHODS The objective of the project was to screen 10,000 men and women aged 50 to 75 years through 10 primary health centers (PHCs) in 2 provinces. All eligible men and women attending the selected PHCs were offered the fecal immunochemical test (FIT). Stool specimens brought to the PHCs were tested immediately by trained nurses. FIT-positive individuals were referred to the National Oncology Institute for colonoscopy. RESULTS In total, 9763 eligible men and women were screened by FIT between June 2017 and May 2019; most (73.3%) were women. The test was positive in 460 participants (4.7%). Among the individuals who had positive FIT results, 62.6% underwent colonoscopy. The main reasons for noncompliance to colonoscopy were competing life priorities (15.4%), other health problems (13%), and fear of getting a cancer diagnosis (12.3%). As the number of referrals to colonoscopy increased, the waiting time for the procedure increased, resulting in a drop in compliance. The detection rates of advanced adenomas and CRC were 4.0 in 1000 and 0.5 in 1000 individuals screened, respectively. CONCLUSIONS An effective strategy to reach the target populations (especially men), a pragmatic assessment of the health system's capacity to deal with large numbers of referrals, and a formal cost-effectiveness analysis are essential before making any decision to introduce CRC screening in Morocco.
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Affiliation(s)
- Farida Selmouni
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Laila Amrani
- Gastroenterology Unit, Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Catherine Sauvaget
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Meryem Bakkar
- Gastroenterology Unit, Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Basma El Khannoussi
- Department of Pathology, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Latifa Belekhel
- Noncommunicable Diseases Unit, Epidemiology and Disease Control Department, Ministry of Health, Rabat, Morocco
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Richard Muwonge
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat Mohammed V University, Rabat, Morocco
| | - Maria Bennani
- Lalla Salma Foundation, Prevention and Treatment of Cancers, Rabat, Morocco
| | | | - Rachid Bekkali
- Lalla Salma Foundation, Prevention and Treatment of Cancers, Rabat, Morocco
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
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18
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Al-Marhabi A, Hashem A, Zuberi BF, Onyekwere C, Lodhi I, Mounir M, Alkhowaiter S, Al Awadhi S, Naidoo VG, Hamada Y. The views of African and Middle Eastern Gastroenterologists on the management of mild-to-moderate, non-erosive gastro-esophageal reflux disease (GERD). Expert Rev Gastroenterol Hepatol 2022; 16:217-233. [PMID: 35184616 DOI: 10.1080/17474124.2022.2043744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Gastro-esophageal reflux disease (GERD) is a common gastrointestinal disorder that occurs when backflow of the gastric contents into the esophagus results in troublesome symptoms. Though GERD has been extensively studied in Western populations, literature on the management of GERD in patients in Africa and Middle East (AME) is scarce. AREAS COVERED In this review, we provide an overview of the management of mild-to-moderate GERD in AME. Here we focus on the efficacy and safety of currently available treatments for GERD to help physicians and community pharmacists appropriately manage patients with mild-to-moderate GERD in the primary healthcare setting, detailing specific situations and patient scenarios that are relevant to the region, including management of GERD during Ramadan and post-bariatric surgery. EXPERT OPINION Under-appreciation of the burden of GERD in the region has resulted in a lack of consensus on management. Barriers that currently prevent the adoption of treatment guidelines in the primary healthcare setting may include lack of availability of local guidelines and referral systems, a paucity of region-specific research, and dogmatic adherence to traditional practice. By increasing awareness, strengthening knowledge, and by more effective utilization of resources, physicians and pharmacists could optimize GERD management strategies to better support patients.
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Affiliation(s)
- Ahmed Al-Marhabi
- Department of Internal Medicine, College of Medicine, Imam AbdulRahman Bin Faisal University, Khobar, Kingdom of Saudi Arabia
| | - Ahmed Hashem
- Endemic Medicine Department, Cairo University, Egypt.,Department of Medicine & Gastroenterology, Saudi German Hospital Jeddah, Jeddah, Kingdom of Saudi Arabia
| | - Bader Faiyaz Zuberi
- Department of Medicine & Gastroenterology, Dow University of Health Sciences, Karachi, Pakistan
| | - Charles Onyekwere
- Department of Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | - Imran Lodhi
- Global Medical Sciences, Reckitt Healthcare, London, UK
| | - Mohamed Mounir
- Regional Medical Affairs, Reckitt Benckiser (Arabia) FZE, Dubai, United Arab Emirates
| | - Saad Alkhowaiter
- Gastroenterology, King Saud University, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Sameer Al Awadhi
- Digestive Diseases Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Vasudevan G Naidoo
- Department of Gastroenterology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Gastroenterology, University of KwaZulu-Natal, Durban, South Africa
| | - Yasser Hamada
- Endemic Medicine Department, Cairo University, Egypt
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19
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Rabea EM, Abbas KS, Awad DM, Elgoweini NH, El-Sakka AA, Mahmoud NH, Abdelazeem B. Does ramadan fasting affect the therapeutic and clinical outcomes of warfarin? a systematic review and meta-analysis. Eur J Clin Pharmacol 2022; 78:755-763. [PMID: 35179616 DOI: 10.1007/s00228-022-03281-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Warfarin's therapeutic effect is affected by many factors, including diet modifications. The impact of Ramadan fasting on warfarin is controversial. The aim of this systematic review and meta-analysis was to investigate the effect of Ramadan fasting on patients taking warfarin. METHODS A literature search was done in PubMed, WOS, Scopus, and Embase from inception to May 24, 2021. All relevant studies measuring the international normalized ratio (INR), time in therapeutic range (TTR), or the number of patients within therapeutic range before, during, and after Ramadan were assessed by full-text screening for achieving all of the inclusion criteria. We used the Newcastle-Ottawa Scale for quality assessment and RevMan 5.4 software for meta-analysis. RESULTS A total of five studies with 446 patients were included in the meta-analysis. The patients served as their own control. Our pooled analyses showed no significant difference during Ramadan compared to pre-Ramadan (MD: 0.08; 95% CI: - 0.00, 0.15; P = 0.06) and post-Ramadan (MD: - 0.00; 95% CI: - 0.14, 0.14; P = 1.00, respectively). There was only a significant increase in the risk ratio of supratherapeutic INR when comparing post-Ramadan vs. pre-Ramadan (RR: 1.69; 95% CI: 1.22, 2.33; P = 0.001). However, there was no significant risk for supratherapeutic INR during Ramadan compared to pre-Ramadan or post-Ramadan; the number of patients within the therapeutic range of INR during Ramadan compared to pre-Ramadan; and TTR during Ramadan, pre-Ramadan, and post-Ramadan. CONCLUSION Ramadan fasting did not affect INR level, TTR, or the number of patients within the therapeutic range before, during, and after Ramadan. However, there was a possibility of achieving a supratherapeutic INR post-Ramadan compared to pre-Ramadan. Therefore, INR monitoring and warfarin dose adjustments accordingly are recommended after Ramadan.
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Affiliation(s)
| | | | - Dina M Awad
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Nada H Mahmoud
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Basel Abdelazeem
- McLaren Health Care, Flint, MI, USA. .,Michigan State University, East Lansing, MI, USA.
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20
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Kumar S, Diamond T. Ramadan Fasting and Maternal and Fetal Outcomes in Pregnant Women with Diabetes Mellitus: Literature Review. Front Endocrinol (Lausanne) 2022; 13:900153. [PMID: 35813638 PMCID: PMC9263982 DOI: 10.3389/fendo.2022.900153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
There is an emerging Muslim and diabetic population in the United States and other Western countries and majority of pregnant women and patients with diabetes mellitus choose to fast during Ramadan. Fasting during Ramadan in pregnant women with diabetes may represent a 'perfect storm' of metabolic disturbances including hyperglycemia, hypoglycemia and ketosis. Recent continuous and flash glucose monitoring data suggests increased glycemic variability (fasting hypo- and post-Iftar hyperglycemia) in non-pregnant patients with diabetes during Ramadan. Only five small-scale studies, predominantly focused on women with gestational diabetes mellitus in Muslim-majority nations have explored maternal glycemic outcomes during Ramadan which is associated with lower mean blood glucose levels and higher frequency of fasting hypoglycemia. Data is limited however on important clinical outcomes such as symptomatic and serious hypoglycemia requiring hospitalization. Results have been conflicting regarding maternal Ramadan fasting and association with fetal outcomes in women without diabetes. Only one recently published study reported on perinatal outcomes in pregnant women with gestational diabetes which found no effect of Ramadan exposure on mean birthweight or macrosomia frequency but lower neonatal hypoglycemia prevalence, however a significant limitation was lack of documentation of maternal fasting status. At this stage, due to paucity of data, the current medical recommendation is against Ramadan fasting for pregnant Muslim women with diabetes. Large-scale population-based studies are warranted regarding maternal and fetal outcomes in pregnant fasting women with diabetes and such studies should characterize maternal fasting status and have meaningful and consistent clinical outcomes. High-quality data derived from these studies can assist clinicians in providing more evidence-based advice to safely navigate both mother and fetus through a potentially challenging pregnancy.
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Alwan IA, Alsalamah S, Albaiahy A, Almazyad L, Karim R, Alenazi A, Alzayer J, Alhudaif A, Sheshah E, Badri M, Babiker A, Babiker A. Parents' perceptions of quality of life of their children and adolescents with type 1 diabetes during Ramadan fasting in Riyadh. Sudan J Paediatr 2022; 22:138-146. [PMID: 36875945 PMCID: PMC9983772 DOI: 10.24911/sjp.106-1670347614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023]
Abstract
This study aimed to assess parents' perceptions of the quality of life (QoL) of their children with type 1 diabetes (T1D) during Ramadan fasting (RF). In this cross-sectional study, an Arabic-translated version of the standard diabetes-specific QoL questionnaire (PedsQL™ version 3.0) was used to compare perceptions of QoL during Ramadan month (Rm) versus non-Rm (NRm) of parents of children/adolescents with T1D from two tertiary hospitals in Riyadh. We used regression analysis to compare proxies (parents' reports) of their perceptions on their children/adolescents' QoL during Rm compared to NRm. A sample of 61 proxies (parents') of two age groups T1D offspring: 8-12 years (41%) and 13-18 years (59%) who reported their perceptions of their children/adolescents QoL during Rm were matched by children/adolescents' age and gender of 61 proxies in NRm. QoL scores of all domains were significantly lower in Rm compared to NRm; p < 0.0001, however, worries domain showed no statistical differences p = 0.052 in a regression analysis. The total aggregate median (IQR) in Rm was 850 (612-1,062) compared to 1,750 (1,475-2,062) in NRm, p < 0.001. The highest differences in NRm and Rm median scores were observed in communications (OR = 3.64; 95% CI 2.7-5.57) and treatment adherence (OR = 3.09; 95% CI 2.48-3.84) domains especially in the age of 13-18 years. Parents of adolescent boys, who are usually risk-takers and more exposed to outdoor activities, perceived lower QoL for them. Parents of adolescents with T1D perceived a lower QoL for their children during RF, especially in the treatment adherence and communication domains.
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Affiliation(s)
- Ibrahim Al Alwan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Shmokh Alsalamah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Arwa Albaiahy
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lujain Almazyad
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ragad Karim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Areej Alenazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jumana Alzayer
- Diabetes Centre, King Salman Hospital, Riyadh, Saudi Arabia
| | | | - Eman Sheshah
- Diabetes Centre, King Salman Hospital, Riyadh, Saudi Arabia
| | - Motasim Badri
- Department of Epidemiology & Biostatistics, College of Public Health & Heath Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amir Babiker
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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22
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Malik S, Hamer R, Shabir S, Youssouf S, Morsy M, Rashid R, Waqar S, Ghouri N. Effects of fasting on solid organ transplant recipients during Ramadan - a practical guide for healthcare professionals. Clin Med (Lond) 2021; 21:e492-e498. [PMID: 38594852 DOI: 10.7861/clinmed.2021-0250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fasting in the month of Ramadan is an obligatory act for healthy adult Muslims. It requires abstinence from food and drink from dawn to sunset. Although there are exemptions from fasting, many patients are keen to fulfil what they see as a religious obligation, even if this may be against medical advice in some cases. Solid organ transplant (SOT) recipients often ask healthcare professionals for advice on fasting. Studies on the effect of fasting in transplant patients have all been done in the Middle East and North Africa where the average fasting duration is between 12 and 14 hours. In comparison, in temperate regions in the summer, fasting duration can be as long as 20 hours. Fasting when patients have to take immunosuppression 12 hours apart with little time variation poses unique challenges. In this review, current literature is reviewed, and a decision-making tool has been developed to assist clinicians in discussing the risks of fasting in transplant recipients, with consideration also given to circumstances such as the COVID-19 pandemic. Our review highlights that SOT recipients wishing to fast should undergo a thorough risk assessment, ideally 3 months before Ramadan. They may require medication changes and a plan for regular monitoring of graft function and electrolytes in order to fast safely. Recommendations have been based on risk tiers (very high risk, high risk and low/moderate risk) established by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. Patients in the 'very high risk' and 'high risk' categories should be encouraged to explore alternative options to fasting such as winter fasting or Fidyah. Those in the 'low/moderate' category may be able to cautiously fast with guidance from their clinician. Prior to the commencement of Ramadan, all patients must receive up-to-date education on sick-day rules, instructions on when to terminate their fast or abstain from fasting.
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Affiliation(s)
- Shafi Malik
- University Hospitals Coventry and Warwickshire NHS Trust, UK, and honorary clinical lecturer, University of Leicester, Leicester, UK.
| | - Rizwan Hamer
- University Hospitals Coventry and Warwickshire NHS Trust, UK
| | | | | | - Mohamed Morsy
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Nazim Ghouri
- University of Glasgow, Glasgow, UK, and consultant physician in diabetes, endocrinology and general medicine, Queen Elizabeth University Hospital, Glasgow, UK
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Jahrami H, BaHammam AS, Haji EA, Bragazzi NL, Rakha I, Alsabbagh A, Nugraha B, Pasiakos SM. Ramadan Fasting Improves Body Composition without Exacerbating Depression in Males with Diagnosed Major Depressive Disorders. Nutrients 2021; 13:nu13082718. [PMID: 34444878 PMCID: PMC8398343 DOI: 10.3390/nu13082718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Ramadan fasting (RF) is a form of intermittent fasting that generally improves body composition and related metabolic profiles. Whether RF exacerbates depressive symptomatology in individuals diagnosed with major depressive disorder (MDD) is undetermined. Methods: 100 men, who lived in Bahrain and were between the ages of 18 and 64 years with an established diagnosis of MDD, participated in this 4-week study. Based on preference, participants were assigned to a fasting group (FG, n = 50) and a non-fasting group (NFG, n = 50). The FG engaged in fasting from 03:40 to 18:10 (dawn and dusk timings). Changes in depressive symptoms, body mass, body composition, and components of metabolic syndrome were measured. Results: There were no significant changes in depressive symptoms within the FG vs. NFG after controlling for baseline covariates: mean difference 0.49 (SE = 0.63), p = 0.43. No adverse effects were reported in either group. The FG experienced significant reductions in body mass, 1.87 kg, p = 0.001; body mass index, 0.69 kg/m2, p = 0.001; body fat, 0.87%, p = 0.001; body surface area, 0.03 m2, p = 0.001; and lean mass, 0.77 kg, p = 0.001. Conclusions: RF did not negatively affect depressive symptoms and improved body composition, suggesting short-term intermittent fasting may be a safe dietary practice for adult males with MDD.
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Affiliation(s)
- Haitham Jahrami
- Ministry of Health, Manama 410, Bahrain; (E.A.H.); (I.R.); (A.A.)
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
- Correspondence: (H.J.); (N.L.B.)
| | - Ahmed S. BaHammam
- University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, P.O. Box 225503, Riyadh 11324, Saudi Arabia;
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh 11324, Saudi Arabia
| | - Eman Ahmed Haji
- Ministry of Health, Manama 410, Bahrain; (E.A.H.); (I.R.); (A.A.)
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
| | - Nicola L. Bragazzi
- Laboratory for Industrial and Applied Mathematics, Departments and Statistics, York University, Toronto, ON M3J 1P3, Canada
- Correspondence: (H.J.); (N.L.B.)
| | - Ihab Rakha
- Ministry of Health, Manama 410, Bahrain; (E.A.H.); (I.R.); (A.A.)
| | - Amani Alsabbagh
- Ministry of Health, Manama 410, Bahrain; (E.A.H.); (I.R.); (A.A.)
| | - Boya Nugraha
- Department of Rehabilitation Medicine, Hannover Medical School, 30625 Hannover, Germany;
| | - Stefan M. Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA;
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24
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Amin MEK, Abdelmageed A, Farhat MJ. Communicating with Clinicians on Fasting during Ramadan: The Patients' Perspective. JOURNAL OF RELIGION AND HEALTH 2021; 60:922-940. [PMID: 31485879 DOI: 10.1007/s10943-019-00910-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Caring for millions of Muslim patients who decide to fast during Ramadan can be challenging for clinicians. Using a theory-guided approach, this study explores Muslim patients' perspectives on factors influencing communication with clinicians in relation to fasting during Ramadan. Semi-structured interviews were conducted with a sample of patients in Egypt (9) and the USA (8). Participants were purposefully sampled to assure variance in age, gender, education, decision to fast and ethnicity. Data emerging from narratives were mapped to constructs within the Linguistic Model of Patient Participation in Care (LMOPPC). Using framework analysis, iterative sampling and analysis continued until saturation. Drawing on LMOPPC, participants' narratives were mapped and clustered into patient participation and quality of care; predisposing factors (perceptions about fasting and its significance including sense of spiritual benefit when fasting and sense of guilt when not fasting, prior experiences including prior conversations with clinicians on fasting and experience of fasting while sick, patients' personality and locus of control, belief in the legitimacy of participation, motivations and perception of need to communicate with clinicians about fasting, provider verbal and nonverbal responses, and provider-patient rapport); and enabling factors (knowledge about the topic and repertoire of communicative skills, presence of companions during appointment, and timing of appointments). The LMOPPC framework provided insight into patients' perspectives on barriers and facilitators for communication with clinicians about fasting during Ramadan. It is important for stakeholders to consider those issues when implementing interventions aiming to adopt a concordant approach in providing care for this group of patients.
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Affiliation(s)
| | - Ahmed Abdelmageed
- College of Pharmacy, Natural and Health Sciences, Manchester University, 10627 Diebold Rd., Fort Wayne, IN, 46845, USA
| | - Marwa J Farhat
- College of Pharmacy, Natural and Health Sciences, Manchester University, 10627 Diebold Rd., Fort Wayne, IN, 46845, USA
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25
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Ramadan Fasting Increases Socialization in Patients Who Underwent Sleeve Gastrectomy: An Observational Study. Obes Surg 2021; 31:2576-2582. [PMID: 33555450 DOI: 10.1007/s11695-021-05270-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The prevalence of obesity is increasing along with the number of sleeve gastrectomies. Patients' mental health and social life, along with their physical health, should be considered. Their cultural and religious values are an important part of treatment. Fasting is an important act of worship in all religions. Ramadan fasting is one of the five pillars of Islam. In this study, we aimed to investigate the effect of Ramadan fasting on quality of life in patients who underwent sleeve gastrectomy. MATERIALS AND METHODS Data regarding the demographic characteristics, weight, the time elapsed after surgery, and the amount of liquid and solid food consumed during fasting were collected with two surveys, one of which was carried out at the beginning and the other at the end of Ramadan. In addition, the SF-36 health survey questionnaire was administered to evaluate the impact of Ramadan fasting on patients' quality of life. RESULTS Fifty-one people participated in the first survey, but the second survey included 19 of them. While the median weight of the patients was 86.52 ± 17.78 kg before fasting, the median weight after 25 days of fasting was 83.31 ± 17.06 kg. A significant decrease was observed in weight after 25 days of fasting (p < 0.001). A comparison of the SF-36 scores for quality of life revealed a significant increase in the social functioning (p = 0.032). CONCLUSION Ramadan fasting caused significant weight loss in patients who underwent sleeve gastrectomy. Besides, it did not adversely affect the quality of life, but rather increased social functioning.
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Malik S, Bhanji A, Abuleiss H, Hamer R, Shah SH, Rashad R, Junglee N, Waqar S, Ghouri N. Effects of fasting on patients with chronic kidney disease during Ramadan and practical guidance for healthcare professionals. Clin Kidney J 2021; 14:1524-1534. [PMID: 34079617 PMCID: PMC7929006 DOI: 10.1093/ckj/sfab032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 12/30/2022] Open
Abstract
There are an estimated 1.8 billion Muslims worldwide, with the majority of them choosing to fast during the month of Ramadan. Fasting, which requires abstinence from food and drink from dawn to sunset can be up to 20 h per day during the summer months in temperate regions. Fasting can be especially challenging in patients on haemodialysis and peritoneal dialysis. Moreover, there is concern that those with chronic kidney disease (CKD) can experience electrolyte imbalance and worsening of renal function. In this article, current literature is reviewed and a decision-making management tool has been developed to assist clinicians in discussing the risks of fasting in patients with CKD, with consideration also given to circumstances such as the coronavirus disease 2019 pandemic. Our review highlights that patients with CKD wishing to fast should undergo a thorough risk assessment ideally within a month before Ramadan, as they may require medication changes and a plan for regular monitoring of renal function and electrolytes in order to fast safely. Recommendations have been based on risk tiers (very high risk, high risk and low-moderate risk) established by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. Patients in the very high risk and high risk categories should be encouraged to explore alternative options to fasting, while those in the low-moderate category may be able to fast safely with guidance from their clinician. Prior to the commencement of Ramadan, all patients must receive up-to-date education on sick-day rules and instructions on when to terminate their fast or abstain from fasting.
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Affiliation(s)
- Shafi Malik
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK.,University of Leicester, Leicester, UK
| | - Amir Bhanji
- Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Rizwan Hamer
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Naushad Junglee
- University Hospital Llandough, Cardiff and Vale, University Health Board, Cardiff, Wales
| | - Salman Waqar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nazim Ghouri
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, Scotland.,Department of Diabetes and Endocrinology, Queen, Elizabeth University Hospital, Glasgow, Scotland
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27
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Adanan NIH, Adnan WAHWM, Khosla P, Karupaiah T, Daud ZAM. Exploring the experiences and perceptions of haemodialysis patients observing Ramadan fasting: a qualitative study. BMC Nephrol 2021; 22:48. [PMID: 33530941 PMCID: PMC7851908 DOI: 10.1186/s12882-021-02255-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/08/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The festival of Ramadan is a month of spiritual reflection for Muslims worldwide. During Ramadan, Muslims are required to refrain from eating and drinking during daylight hours. Although exempted from fasting, many patients undergoing maintenance haemodialysis (HD) opt to participate in this religious practice. Many studies have explored the effects of Ramadan on health outcomes, however, the exploration from patients' own point of view pertaining to this religious practice is lacking. Thus, we aimed to explore the experiences and perceptions of Muslim HD patients observing Ramadan fasting from three HD centres in Klang Valley, Malaysia. METHOD An exploratory phenomenology qualitative study was conducted whereby subjects were purposively selected based on previous experience in observing Ramadan fasting. Face-to-face in-depth interviews were conducted, and study data were analyzed thematically and iteratively coded using a constant comparison method. RESULTS Four major themes emerged from the data, namely: (i) "fasting experiences", (ii) "perceived side effects of fasting", (iii) "health-seeking behavior" and, (iv) "education and awareness needs". Patients expressed the significance of Ramadan fasting as well as the perceived impact of fasting on their health. Additionally, there is lack of health-seeking behaviour observed among patients thus, raising needs for awareness and education related to Ramadan fasting. CONCLUSIONS Findings of this study shed light on patients' experiences and perceptions regarding Ramadan fasting which warrants the needs for an effective communication between patients and health care practitioners through a structured-Ramadan specific education program.
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Affiliation(s)
- Nurul Iman Hafizah Adanan
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
| | | | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA
| | | | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.
- Research Center of Excellent Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
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28
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Hamodat H, Syed S, Ali M, Sardiwalla Y, Imran F, Jarrar A, Rafiq F, Zimmo K, Eissa M, Haroon B. Primary Care Physicians' Knowledge, Perceptions, and Comfort Level in Managing Patients Fasting in Ramadan. J Prim Care Community Health 2020; 11:2150132720933796. [PMID: 32590924 PMCID: PMC7328480 DOI: 10.1177/2150132720933796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Once a year, Muslims fast from dawn to sunset during the month of Ramadan. While fasting has many positive health implications, it may pose risks to individuals with underlying health issues. Despite the exemption from fasting for those who are ill, many Muslims with chronic conditions choose to fast. It is unclear how many Muslim patients receive counseling on fasting. As such, the purpose of this pilot project was to assess the knowledge, perception, and comfort level of primary care physicians (PCPs) at Dalhousie University’s Department of Family Medicine in managing patients choosing to fast during Ramadan. Methods: A 16-item anonymous, self-administered, structured online survey was distributed to PCPs with an academic affiliation with the Department of Family Medicine at Dalhousie University. Participants rated their level of comfort, objective knowledge, and perceptions of managing patients fasting in Ramadan. Results: Many PCPs perceived the importance of understanding Ramadan fasting and its relevance to their patients’ health, however, they did not have adequate knowledge about the matter. The majority of PCPs felt they received inadequate training in this area and did not feel comfortable counseling and managing the health of these patients. Conclusions: The findings of this study have outlined a knowledge gap that exists within our PCP community and will help inform and prioritize educational needs and direct efforts to ensure safe patient management during Ramadan.
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Affiliation(s)
- Hayam Hamodat
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | - Saif Syed
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | - Malik Ali
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | | | - Fatima Imran
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | - Ameer Jarrar
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | - Farina Rafiq
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | - Khader Zimmo
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | - Mohamed Eissa
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
| | - Babar Haroon
- Dalhousie Medical School, Halifax, Nova Scotia, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada
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29
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Hanif W, Patel V, Ali SN, Karamat A, Saeed M, Hassanein M, Syed A, Chowdhury TA, Farooqi A, Khunti K. The South Asian Health Foundation (UK) guidelines for managing diabetes during Ramadan. Diabetes Res Clin Pract 2020; 164:108145. [PMID: 32335096 DOI: 10.1016/j.diabres.2020.108145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fasting in the holy month of Ramadan is among the five pillars of Islam and is considered as a religious obligation by the Muslim population. People with diabetes observing the practice of fasts are at a higher risk of complications such as hypoglycaemia, hyperglycaemia and ketoacidosis due to changes in eating patterns and circadian rhythms. With the objective of mitigating these complications, the South Asian Health Foundation (UK) has developed the present guidelines based on robust evidence derived from epidemiological studies and clinical trials. METHODS We have highlighted the role of pre-Ramadan risk stratification and counselling by healthcare professionals with emphasis on the need for advice on adequate dietary and fluid intake, blood glucose monitoring and awareness of when to break the fast. RESULTS We reviewed the current literature and have given clinically-relevant recommendations on lifestyle modifications and glucose-lowering therapies such as metformin, sulphonylureas, dipeptidyl peptidase-4 inhibitors, sodium glucose co-transporter-2 inhibitors, thiazolidinediones, glucagon-like peptide-1 receptor agonists and insulin. CONCLUSIONS An individualised patient-centric treatment plan is essential to not only achieve optimal glycaemic outcomes but also enable people with diabetes to observe a risk-free month of fasting during Ramadan.
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Affiliation(s)
- W Hanif
- University Hospital Birmingham. UK.
| | | | - S N Ali
- Department of Diabetes & Endocrinology, Royal Free Hospital, London, UK
| | | | - M Saeed
- University Hospital Birmingham, UK
| | - M Hassanein
- Department of Diabetes and Endocrinology, Dubai Hospital, Dubai, United Arab Emirates
| | - A Syed
- Heartlands Hospital Birmingham, UK
| | | | | | - K Khunti
- Diabetes Research Centre, University of Leicester, UK
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30
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Ulhaque MS, Bin Zafar A, Ahmed F, Ahmedani MY. Role of 24-hour Helpline Service in the Management of Diabetes During the Holy Month of Ramadan. Cureus 2020; 12:e7320. [PMID: 32313761 PMCID: PMC7164709 DOI: 10.7759/cureus.7320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To assess the role of the 24-hour helpline service in the management of diabetes during the holy month of Ramadan. Methodology This prospective study was conducted at the Baqai Institute of Diabetology & Endocrinology, Baqai Medical University, Karachi, Pakistan, between December 2017 and August 2018. Patients with type 1 and type 2 diabetes who were willing to observe the fast in Ramadan 2018 were included. Pre-Ramadan education on a one-to-one basis was given and the 24-hour helpline number was provided to each patient. Details of baseline characteristics, anthropometric measurements, and biochemical parameters (lipid profile, serum creatinine, urine D/R (protein), and glycated hemoglobin A1c pre- and post-Ramadan) were noted. Self-monitoring blood glucose (SMBG) recording books were provided to each patient to record blood sugar levels during Ramadan. Results A total of 102 patients, 41 (40.2%) with type 1 diabetes and 61 (59.8%) with type 2 diabetes were included. The mean age of patients with type 1 diabetes was 17.02±5.22 years and that of patients with type 2 diabetes was 49.48±9.68 years. Most of the patients were male in both groups. By using the 24-hour helpline service, 912 calls were made to patients, 502 calls for type 1, and 410 calls for type 2 diabetes. Mean HbA1c (%) level before and after Ramadan was 8.94±1.72 and 8.70±2.03 in patients with type 1 diabetes and 8.59±1.73 and 7.71±1.27 in patients with type 2 diabetes, respectively. In the last 10 days of Ramadan, the decreasing trends of mean self-monitoring of blood glucose (SMBG) in patients with type 1 diabetes was observed for pre-dawn meal (suhoor), pre-sunset meal (iftar), and before sleeping while this trend in type 2 diabetes was found in the pre-dawn meal (suhoor)and two hours after iftar. Conclusion Pre-Ramadan diabetes education and treatment adjustment by using a station-based, 24-hour helpline service during the holy month of Ramadan have a significant role in controlling blood sugar levels, thus minimizing the complications of diabetes, facilitating timely adjustments in treatment, and reducing unnecessary hospital visits and admissions.
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Affiliation(s)
- Muhammad Saif Ulhaque
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Awn Bin Zafar
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Farrukh Ahmed
- Diet and Education, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
| | - Muhammad Yakoob Ahmedani
- Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK
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31
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Catic T, Jusufovic R. Physician Practice and Knowledge on Diabetes Management During Ramadan in Bosnia and Herzegovina. Mater Sociomed 2020; 32:57-61. [PMID: 32410893 PMCID: PMC7219712 DOI: 10.5455/msm.2020.32.57-61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Ramadan is the holy month of Muslims including fasting sometimes more than 20 hours. Even diabetes patients can be exempted from fasting it has been shown that almost 80% of diabetes type 2 patients intend and do fasting. To avoid acute complications during fasting, different recommendations on diabetes management are available. Considering the fact that there are more than 226 thousand diabetics in Bosnia and Herzegovina, it is important to provide structured support and healthcare service to those who are practicing fast during Ramadan. Aim: To evaluate knowledge, practice and attitudes of physicians treating diabetes (diabetologists and endocrinologists) in Bosnia and Herzegovina regarding management of diabetes in fasting patients during Ramadan. Methods: A 32 questions survey has been developed, validated and disseminated to the 27 specialists treating diabetes in Bosnia and Herzegovina through online form examining demographic characteristics, current practices and attitudes and knowledge on diabetes management during Ramadan. Results: All surveyed physicians deal with patients who are fasting during Ramadan. The majority of surveyed physicians 23 (85,2%) proactively initiate a discussion about planned fasting. More than 63,0% are following their experience and only 18,5% ADA/EASD guidelines on diabetes management during Ramadan. There are no significant differences between gender of the physicians, place of work and specialization when it comes to specific knowledge related to treatment guidelines, but some differences are observed. Conclusion: Although overall physicians` knowledge of diabetes management during Ramadan is satisfying there is opportunity in additional specialized education and measures introduction into the practice in order to improve treatment outcomes and standards of care.
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Affiliation(s)
- Tarik Catic
- University Sarajevo School of Science and Technology - Medical School, Sarajevo, Bosnia and Herzegovina
| | - Rasim Jusufovic
- University Sarajevo School of Science and Technology - Medical School, Sarajevo, Bosnia and Herzegovina
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Petrovski G, Al Khalaf F, Campbell J, Hussain K, Fisher H, Umer F. Glucose control during Ramadan fasting in a teenager with type 1 diabetes on MiniMed 670G hybrid closed-loop system. Acta Diabetol 2020; 57:105-107. [PMID: 31473833 PMCID: PMC6971130 DOI: 10.1007/s00592-019-01414-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/22/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Goran Petrovski
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, PO Box 26999, Doha, Qatar.
| | - Fawziya Al Khalaf
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, PO Box 26999, Doha, Qatar
| | - Judith Campbell
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, PO Box 26999, Doha, Qatar
| | - Khalid Hussain
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, PO Box 26999, Doha, Qatar
| | - Hannah Fisher
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, PO Box 26999, Doha, Qatar
| | - Fareeda Umer
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, PO Box 26999, Doha, Qatar
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Mrad S, Rejeb H, Ben Abdallah J, Graiet H, Ben Khelifa M, Abed A, Ferchichi S, Limem K, Ben Saad H. The Impacts of Ramadan Intermittent Fasting on Oxidant/Antioxidant Stress Biomarkers of Stable Chronic Obstructive Pulmonary Disease Male Patients. Am J Mens Health 2019; 13:1557988319848281. [PMID: 31046536 PMCID: PMC6501488 DOI: 10.1177/1557988319848281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
No prior study has evaluated the impacts of Ramadan intermittent fasting (RIF) on oxidant/antioxidant stress (OS/AOS) biomarkers in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the impacts of RIF on some OS/AOS biomarkers measured in male patients with stable COPD. Fifteen COPD patients (mean age: 71 ± 6 years) fasting Ramadan in 2017 volunteered to take part in the study. Three sessions (before Ramadan [BR], end Ramadan [ER], after Ramadan [AR]) were selected. Blood samples of OS (homocysteine [μmol/L], thiobarbituric acid reactive substances [TBARS, μmol/L]) and AOS (catalase [U/ml], ceruloplasmin [g/L], superoxide dismutase [SOD, ng/ml], zinc [µmol/L], albumin [g/L]) biomarkers were consistently taken 4.5 to 2.5 hr before the iftar. Findings were analyzed by applying Friedman or Kruskal-Wallis ANOVA. Comparisons of the number of patients with high OS [high homocysteine and/or TBARS] and low AOS (low catalase and/or ceruloplasmin and/or SOD and/or zinc and/or albumin) blood values between the three sessions were performed using the Cochran test. The median ± interquartile of homocysteine (BR: 21.48 [18.98-24.49], ER: 23.15 [21.77-26.45], AR: 24.87 [21.91-37.12]), ceruloplasmin (BR: 0.27 [0.24-0.30], ER: 0.28 [0.26-0.33], AR: 0.28 [0.25-0.32]), SOD (BR: 288.00 [112.00-400.00], ER: 182.00 [152.00-386.00], AR: 234.00 [190.00-420.00]) and the mean ± SD of TBARS (BR: 5.66 ± 1.26, ER: 4.59 ± 0.78, AR: 5.29 ± 1.69), catalase (BR: 120.97 ± 54.62, ER: 106.73 ± 50.92, AR: 137.39 ± 40.88), zinc (BR: 11.85 ± 2.01, ER: 12.47 ± 2.34, AR: 12.21 ± 2.58) and albumin (BR: 39.78 ± 3.19, ER: 40.74 ± 2.26, AR: 40.56 ± 2.38) were not significantly affected by RIF. The number of patients with high OS (BR [ n = 13], ER [ n = 15], AR [ n = 14]) or low AOS (BR [ n = 12], ER [ n = 13], AR [ n = 13]) statuses were not significantly influenced by RIF. In conclusion, RIF did not induce any significant statistical or clinical changes in OS/AOS biomarkers or statuses in COPD patients.
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Affiliation(s)
- Sawssan Mrad
- Laboratory of Biochemistry, Farhat Hached Hospital, Sousse, Tunisia
| | - Hadhemi Rejeb
- Pulmonary Department, Farhat Hached Hospital, Sousse, Tunisia
| | | | - Hajer Graiet
- Research Unit of Clinical and Molecular Biology (UR17ES29), University of Monastir, Tunisia
| | | | - Amel Abed
- Laboratory of Biochemistry, Farhat Hached Hospital, Sousse, Tunisia
| | - Salima Ferchichi
- Research Unit of Clinical and Molecular Biology (UR17ES29), University of Monastir, Tunisia
| | - Khelifa Limem
- Laboratory of Biochemistry, Farhat Hached Hospital, Sousse, Tunisia
| | - Helmi Ben Saad
- Laboratory of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia,Heart Failure (LR12SP09) Research Laboratory, Farhat Hached Hospital, Sousse, Tunisia,Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Tunisia,Helmi Ben Saad, Laboratory of Physiology, Faculty of Medicine of Sousse, Rue Mohamed Karoui, Sousse 4002, Tunisia.
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Gad H, Al-Muhannadi H, Mussleman P, Malik RA. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with Type 1 diabetes mellitus who fast during Ramadan: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 151:265-274. [PMID: 30825561 DOI: 10.1016/j.diabres.2019.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The benefits and risks of continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) in patients with Type 1 diabetes mellitus (T1DM) who fast during Ramadan are not known. METHODS Systematic review and meta-analysis of observational studies conducted in PubMed, Embase (Ovid), and the Cochrane Library. Quality of included studies was assessed using the ROBINS-I tool for risk of bias assessment and analyses were performed using RevMan version 5.1. RESULTS From 709 records, 306 full text studies were assessed. After exclusions, the final analysis included a total of 9 studies. Heterogeneity for outcomes was I2 = 0%. There was no significant difference for the change in glycemic control (HbA1c) between CSII and MDI (P > 0.05). There was no change in weight or the lipid profile in patients with T1DM on MDI during Ramadan. There were insufficient data to assess the impact on glucose profiles and the incidence of hypoglycemia or diabetic ketoacidosis (DKA) in patients on CSII or MDI during Ramadan. CONCLUSIONS Studies assessing the effect of CSII or MDI in patients with T1DM who fast during Ramadan are limited to observational studies and show no difference in the change in HbA1c, weight or lipids during Ramadan.
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Affiliation(s)
- Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Paul Mussleman
- Library Services, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar; University of Manchester, Institute of Cardiovascular Medicine, Manchester, United Kingdom.
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Farooqi B, Modi A, Hussaini MO, Markham MJ, Duff JM. Principles for the Oncologist in Caring for Muslim Patients. J Oncol Pract 2018; 14:521-524. [DOI: 10.1200/jop.18.00116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Bilal Farooqi
- University of Florida College of Medicine; Gainesville; and H Lee Moffitt Cancer Center, Tampa, FL
| | - Aadil Modi
- University of Florida College of Medicine; Gainesville; and H Lee Moffitt Cancer Center, Tampa, FL
| | - Mohammad Omar Hussaini
- University of Florida College of Medicine; Gainesville; and H Lee Moffitt Cancer Center, Tampa, FL
| | - Merry Jennifer Markham
- University of Florida College of Medicine; Gainesville; and H Lee Moffitt Cancer Center, Tampa, FL
| | - Jennifer M. Duff
- University of Florida College of Medicine; Gainesville; and H Lee Moffitt Cancer Center, Tampa, FL
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