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   2010| September-October  | Volume 2 | Issue 5  
    Online since July 18, 2017

 
 
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SPECIAL COMMUNICATION
Mini-symposium: Ramadan fasting and the medical patient: An overview for clinicians
Salem A Beshyah, Waseem Fathalla, Abdulkarim Saleh, Abdulrazzak Al Kaddour, Mohamed Noshi, Husni Al Hateethi, Nameer Al-Saadawi, Hussein Elsiesi, Numan Amir, Mohamed Almarzouqi, Ali Khalil, Mahmoud Benbarka, Urooj Ahmed, Huda Ezzeddin Mustafa, Wael Al-Mahmeed
September-October 2010, 2(5):240-257
DOI:10.4103/1947-489X.211004  
The daytime fasting of Ramadan is observed annually by millions of adult Muslims all over the world. Some may have mild, moderate or severe medical conditions. They may seek advice on feasibility and safety of fasting and/or their management. Physicians ought to have a working knowledge about the religious rules of Ramadan fast and their medical implications. In this article we present a concise summary of the proceedings of a series of symposia. Their objectives were to review the effects of Ramadan fasting on the health of Muslim patients with various chronic medical conditions and to propose practical management strategies. An initial introductory Islamic perspective on fasting to set the scene for the following presentations. The religious rulings excluding patients with acute and chronic medical conditions from fasting were highlighted. The roles of the medical professional in guiding patients on best ways to make informed decisions to fast and feast safely were stressed. Available evidence from published literature and clinical practice was reviewed and practical guidance covering the major body systems was given. Generally speaking, fasting in Ramadan is possible for most stable chronically ill patients under medical supervision. The effect of fasting on health issues should be explained to patients well ahead of starting the holy month. Counseling patients about their use of medications as well as their suitability to undertake the fast is a major step in health care for Muslim patients. Available observations cover a spectrum of chronic medical conditions affecting various body systems. These include renal, hematological cardiac, neurological, rheumatologic, gastroenterological, endocrine conditions and drug therapy during Ramadan. Changes in the parameters of clinical functions in healthy people and in non-renal patients were minimal, insignificant and remained within the normal range. Patients on hemodialysis could fast safely on nondialysis days. Stable renal transplant recipients do not seem to sustain any risk from fasting after the first year. No evidence of increased risk of renal stones and colic was found during Ramadan. No consistent rise in cardiac events was observed during Ramadan. Hypertension needs special treatment manipulations. Headache and risk of seizures are two neurological conditions with relevance to fasting. These can be managed by simple medical measures. Peptic acid disease complications may increase by the long fasting, however treatment with peptic disease medications reduces the risks. Hematological conditions influenced by dehydration such as sickle disease are better managed by adequate hydration particularly under stressful circumstances. Rheumatological conditions can be managed by usual therapies during Ramadan. Diabetes received most attention from the medical profession for obvious reasons. Several expert statements were published. Where the risk of hypoglycemia or hyperglycemia is increased many would advise against fasting. Patients controlled by simple regimens with low risk of hypoglycemia may be able to fast safely. Changes in medication aim at adjusting the amount and timing of the drug administration to match calorie intake thus preventing hypoglycemia in the daytime and hyperglycemia after sunset. In conclusion, management of the medical patients during Ramadan represents a special challenge to patients alike. Taking on this challenge is an opportunity to test the cultural-competence of health services.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,938 230 10
REVIEW
Cardiac biomarkers: The troponins and CK- MB
Jagannadha Rao Peela, Abdalla M Jarari, Abdul Hai, Avinaash K Rawal, Shoba Devi Kolla, Shakila Sreekumar, Lokesh Khurana, Narsinga Rao Sidhanathi
September-October 2010, 2(5):190-197
DOI:10.4103/1947-489X.210998  
With the prevalence of ischemic heart disease, early diagnosis and management of myocardial infarction is important, and necessitates the need for cardiac biomarkers. Since several markers have evolved over time, it becomes important to understand which markers are best in different clinical situations. After a review of the literature, we have summarized the most frequent markers used. Though the search for an ideal cardiac biomarker remains, troponins seem to have evolved as the most advantageous. Features of troponins include high specificity, sensitivity, a wide diagnostic window allowing prompt, early diagnosis, as well as enhancing detection of myocardial injury in patients presenting late. Enabling risk stratification, estimation of infarct size, detecting reperfusion, usefulness in predicting prognostic outcomes, and offering therapeutic guidance also are among the advantageous features of troponins. Troponins also aid in detecting perioperative myocardial injuries and cardiac injury in renal failure patients. CK myocardial band (CK-MB), however, seems to be more advantageous in detecting reinfarction, though it has limitations in terms of early diagnosis. Troponins are being increasingly used, compared to other cardiac biomarkers, in the detection of acute coronary events and myocardial damage, though CK-MB is still preferred in selective situations.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,361 195 3
ARTICLES
Hand grip strength: An assessment criteria of upper extremity musculoskeletal disorders in Indian collegiate computer users
Shyamal Koley, Jasmine Kaur Chawla, Jaspal Singh Sandhu
September-October 2010, 2(5):198-204
DOI:10.4103/1947-489X.210999  
The purpose of this study was two-fold: first, to evaluate the anthropometric profile of Indian computer students and, second, to search the correlation of hand grip strength with other anthropometric characteristics studied. Methods: Fourteen anthropometric characteristics; viz. height, sitting height, weight, BMI, knee height, thigh height, leg length, bi-trochantric diameter, waist and hip circumferences, percent body fat, percent lean body mass, hand grip strength (right dominant) and back strength were measured on purposively selected 208 Indian computer students (108 males,100 females) ages 18–25 years (mean 21.67 years, ± 1.61) collected from Guru Nanak Dev University, Amritsar, Punjab, India. An adequate number of non-computer users (n = 208, 108 males,100 females, mean age 21.72 years, ± 1.69) were also collected as controls from the same location for comparison. Results: One way ANOVA showed significant differences among the groups (p ≤ .001 - .000) in the variables studied, except the hip circumference, in computer students and controls. In Indian computer students, significant positive correlations (p≤ .05 - .01) were found in hand grip strength and height, sitting height, leg length, back strength (in both sexes), knee height (females only), weight, BMI, bi-trochantric diameter, waist circumference, hip circumference, % body fat and % lean body mass (males only). Conclusion: Despite the higher BMI status, Indian computer students had both lower handgrip strength and back strength than their control counterparts, possibly linked to their poor physical activity in work stations.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,126 100 1
COMMENTARY
Ramadan fasting and the medical patient: Consensus is welcome but more evidence is needed
Ibrahim H Sherif, Abdulfattah A Lakhdar
September-October 2010, 2(5):237-239
DOI:10.4103/1947-489X.211003  
Full text not available  [PDF] [CITATIONS]
  819 240 8
ARTICLES
Chronic musculoskeletal pain in females as a manifestation of vitamin D deficiency in Saudi Arabia
Aisha M Siddiqui
September-October 2010, 2(5):205-209
DOI:10.4103/1947-489X.211000  
Objective: To determine the prevalence of vitamin D deficiency among females presenting with chronic musculoskeletal pain. Methods: One hundred female patients with chronic pain were screened between January 2007 and November 2008 in the medical out-patient clinics in King Abdulaziz University Hospital, Jeddah. Serum (25- hydroxycholecalciferol) and bone chemistry levels were done. Vitamin D deficient patients were identified, treated with supplements, and followed for improvement of symptoms. Results: 84% were vitamin D deficient. Of that group, 67% were of childbearing age, and 50% were noted to have a severe deficiency. Only 14% were hypocalcaemic, 8% had hypophosphatemia, while 13% had high alkaline phosphatase levels. All responded after vitamin D and calcium supplement therapy was initiated, and symptoms improved. Conclusions: Consideration of vitamin D deficiency during consultations for chronic musculoskeletal pain is warranted. Screening of such patients should be standard practice in clinical care. Diagnosis is missed or delayed if 25- hydroxycholecalciferol levels are not evaluated. Treatment is beneficial and improvement is rapid.
[ABSTRACT]   Full text not available  [PDF]
  903 91 -
VIEW POINT
Children's environmental health
Iain Blair
September-October 2010, 2(5):187-189
DOI:10.4103/1947-489X.210997  
Full text not available  [PDF]
  753 113 -
QUIZ
The EKG quiz: “Good or Bad”
Fathi I Ali
September-October 2010, 2(5):210-211
DOI:10.4103/1947-489X.211001  
Full text not available  [PDF]
  720 104 -
ABSTRACTS BOOK
Abstracts of the eighth libyan diabetes and endocrinology conference July 23-25, 2010 Benghazi, Libya
Amna A Salhin, Salem A Eltabal, Abdelhadi M Habeb, Salem A Beshyah
September-October 2010, 2(5):212-236
DOI:10.4103/1947-489X.211002  
Full text not available  [PDF]
  707 100 -