Exploring the New Moon during the Time of Prophet Muhammad Using Digistar 6 Planetarium

ISPAD Clinical Practice Consensus Guidelines 2022: Ramadan and other religious fasting by young people with diabetes.

Fasting, the voluntary abstinence from food intake for a certain period of time is a well-known practice in relation with spiritual purposes (Trepanowski, JF, 2010). Ramadan fasting (RF) is an obligation of Muslim across the world during the entire holy month of Ramadan. In this specified period, Muslim every day from dawn to dusk are prohibited to eat, drink, and sexual relation, by which Muslim seek an enhanced level of closeness to God (Alloh). This testament is referenced in the verse of Al Baqoroh 183 of Holy Qur’an: “ O you who believe! Fasting is prescribed for you, as it was prescribed for those before you, that you may become righteous” . In addition to closeness, RF in the Islamic perspective also believed capable of improving human health as prophet of Mohammad (peace be upon him) said that “fasting makes you healthier” . However, to the benefit of RF during the entire month of Ramadan on health remain circumstantial. There is germane question regarding RF, whether or not RF can elicit benefits or otherwise will compromise health status and physical activity performances in fasted people, considering total calorie and fluid intake were reduced (Aziz AR, et al. 2012; Bouhlel E, et al. 2006). Accordingly, in the last two decades, the health effects of RF have recently been the subject of scientific research, not only in health outcome (Trepanowski, JF, 2010; Moro T, et al. 2016), but also in exercise performance (Aziz AR, et al. 2012).

Background: Ramadan fasting is an obligation for many Muslims around the world who abstain from eating and drinking for one month, which has different medical and physiological effects, such as reducing blood pressure, lipid profile, blood glucose, and body weight. It has also been hypothesized that Ramadan fasting may induce some changes in the hematologic parameters. Thus, we aimed to investigate the effect of Ramadan fasting on blood cell count (CBC), and erythrocyte sedimentation rate (ESR). Methods: In the present study, 59 adult healthy individuals, who had completed one month of Ramadan fasting were included. Fasting blood samples were analyzed for ESR, hemoglobin (Hb), hematocrit (Hct), white blood cell (WBC), platelet count (PLT), mean corpuscular Volume (MCV) and mean platelet volume (MPV), one day before, on the second and last week of Ramadan and one month after Ramadan (phase I , II, III, and IV, respectively). Results: 34 men and 25 women with an age range of 15 to 24 years participated in the study. Mean ESR increased significantly (except phase IV, in comparison phase III). Mean Hb and Hct levels were significantly greater in phase III than phase I (P<0.001). Also mean MCV decreased significantly (P<0.001). Although MPV decreased in phase II, it returned to baseline in phase IV (P=0.028). Mean WBC count decreased during all phases of the study significantly (P=0.003). Mean platelet count mildly increased during Ramadan fasting (P<0.001). Conclusion: Ramadan fasting has statistically significant effects on hematological parameters, which were within normal range.

Effect of Ramadan Fasting on Clinical and Biochemical Parameters in Healthy Adults

Intermittent fasting (IF) is an intervention that involves not only dietary modifications but also behavioral changes with the main core being a period of fasting alternating with a period of controlled feeding. The duration of fasting differs from one regimen to another. Ramadan fasting (RF) is a religious fasting for Muslims, it lasts for only one month every one lunar year. In this model of fasting, observers abstain from food and water for a period that extends from dawn to sunset. The period of daily fasting is variable (12-18 hours) as Ramadan rotates in all seasons of the year. Consequently, longer duration of daily fasting is observed during the summer. In fact, RF is a peculiar type of IF. It is a dry IF as no water is allowed during the fasting hours, also there are no calorie restrictions during feeding hours, and the mealtime is exclusively nighttime. These three variables of the RF model are believed to have a variable impact on different liver diseases. RF was evaluated by different observational and interventional studies among patients with non-alcoholic fatty liver disease and it was associated with improvements in anthropometric measures, metabolic profile, and liver biochemistry regardless of the calorie restriction among lean and obese patients. The situation is rather different for patients with liver cirrhosis. RF was associated with adverse events among patients with liver cirrhosis irrespective of the underlying etiology of cirrhosis. Cirrhotic patients developed new ascites, ascites were increased, had higher serum bilirubin levels after Ramadan, and frequently developed hepatic encephalopathy and acute upper gastrointestinal bleeding. These complications were higher among patients with Child class B and C cirrhosis, and some fatalities occurred due to fasting. Liver transplant recipients as a special group of patients, are vulnerable to dehydration, fluctuation in blood immunosuppressive levels, likelihood of deterioration and hence observing RF without special precautions could represent a real danger for them. Patients with Gilbert syndrome can safely observe RF despite the minor elevations in serum bilirubin reported during the early days of fasting.

Introduction: The aim of present study was to assess the correlation between glucose and lipid biomarkers variations with biometric characteristics and intraocular pressure changes following Ramadan fasting. Methods: A total of 100 healthy fasting volunteers were enrolled in the study. Of them, 89 subjects completed the study with respect to inclusion and exclusion criteria. Right eye ocular axial length and anterior chamber depth were determined using the IOLMaster, (Carl Zeiss Meditec, Jena, Germany). Following that, intraocular pressure of right eye was measured using a non-contact tonometer (Topcon, Computerized Tonometer CT-1/CT-1P, Tokyo, Japan). Blood samples were taken from all the participants and concentrations of the biomarkers, including Fast blood sugar, Triglyceride, Cholesterol, High-density lipoprotein and Low-density lipoprotein were measured using the Hitachi 717 analyzer (Hitachi, Tokyo, Japan). All assessments were obtained one week before and after Ramadan. Results: Of 89 healthy Muslims who complete the study, 51 were men (mean age: 35.51±8.94 years) and 38 were women mean age: 34.26±9.41 years).The results indicated no significant relationship between the axial length with glucose and lipid biomarkers variations in the fasting individuals. The assessment of result showed only a slight correlation between anterior chamber depth and High-density lipoprotein changes during Ramadan, however, this was not statistically significant. Also, findings revealed only a slight correlation between intraocular pressure and cholesterol changes in healthy fasting individuals, however, this was not statistically significant. Conclusion: Our study revealed that ocular parameters changes during Ramadan fasting is probably independent to variation levels of glucose and lipid biomarkers.

The study aimed to examine the effects of diurnal Ramadan fasting (RF) on substrate oxidation, energy production, blood lipids and glucose as well as body composition. Nine healthy Muslim men (fasting (FAST) group) and eight healthy non-practicing men (control (CNT) group) were assessed pre- and post-RF. FAST were additionally assessed at days 10, 20 and 30 of RF in the morning and evening. Body composition was determined by hydrodensitometry, substrate oxidation and energy production by indirect calorimetry, blood metabolic profile by biochemical analyses and energy balance by activity tracker recordings and food log analyses. A significant group×time interaction revealed that chronic RF reduced body mass and adiposity in FAST, without changing lean mass, whereas CNT subjects remained unchanged. In parallel to these findings, a significant main diurnal effect (morning v. evening) of RF on substrate oxidation (a shift towards lipid oxidation) and blood metabolic profile (a decrease in glucose and an increase in total cholesterol and TAG levels, respectively) was observed, which did not vary over the course of the Ramadan. In conclusion, although RF induces diurnal metabolic adjustments (morning v. evening), no carryover effect was observed throughout RF despite the extended daily fasting period (18·0 (sd 0·3) h) and changes in body composition.

BACKGROUND Kidney function profile is one of the important parameters in determining the health of the elderly. In Indonesia, no study has been conducted on kidney function profile during Ramadan fasting to determine the safety of Ramadan fasting in the elderly. This study aimed to determine the kidney function profile in the elderly who fasted during Ramadan.&#x0D; METHODS This study used a prospective cohort design. The inclusion criteria were elderly aged &gt;60 years undergoing Ramadan fasting in Jatinegara, Jakarta from April to July 2019. Patients with end-stage renal failure who had an acute infection, hypertension crisis, or refused to participate in the study were excluded. Patients who did not fast for 3 consecutive days were dropped out. The kidney function profile was calculated by the estimated glomerular filtration rate (eGFR) using the CKD-EPI formula 1 week before the first day of Ramadan, 3 weeks after the first day of fasting, and 2 weeks after the last day of fasting. Decreased eGFR was defined as having a minimum of 20% eGFR decline during or after the fasting period. Bivariate analysis was performed using McNemar or Cochran tests.&#x0D; RESULTS 2 patients had eGFR decline during fasting, and 7 patients had eGFR decline after fasting. The median eGFR before, during, and after fasting were 81.5, 88.7, and 76.8 ml/min/1.73 m², respectively. A total of 1.4% of subjects had decreased eGFR during Ramadan, while 9.1% had decreased eGFR after Ramadan. However, the changes were not statistically significant.&#x0D; CONCLUSIONS Although most elderly had lower eGFR following Ramadan fasting compared to before and during Ramadan, only individuals with several comorbidities had significant changes of kidney function.

Introduction: Although sick and pre-pubertal children are exempted from fasting, many patients with T1D choose to fast. Objectives: To explore feelings &amp; perceptions towards Fasting Ramadan of children &amp;adolescents with uncontrolled type 1 diabetes (T1D) who insisted on fasting Ramadan against medical advice. Methods: Before Ramadan, children and adolescents under 18 years with uncontrolled T1D received advice by their healthcare providers to not fast Ramadan to avoid the severity of acute complications. Shortly after the end of the month of Ramadan, the patients who fast against medical advice were invited to attend a focus group to discuss emotions towards fasting Ramadan. Data from the focus group was analyzed using thematic analysis. Results: Forty-four patients with T1D duration 5.25 ± 4.32 y (age 12.7 ± 3.78 y); HbA1c 7.96% ± 1.34% (before Ramadan) participated in prior Ramadan education. 34% fasted against medical advice; 70.2% intend to fast again in the following years. The 4 main themes emerged from the focus group: 1- Proud to meet a religious obligation of Islam, 2-feeling happy sharing their fasting experience with the community and avoiding social stigma, 3-feeling "normal" as all their peers, 4- readiness to follow strict instructions to control diabetes to be able to fast again. Conclusion: Although of the current Fasting Ramadan guidelines clearly highlight the risk of fasting Ramadan for T1D, especially in uncontrolled patients, still, many T1D individuals insist on fasting due to social stigma and misconceptions of religious rules, regardless of the risk they may face. Therefore, we need to develop a new protocol and guidelines to closely follow up with those individuals during fasting days. Adding to that the importance of Muslim Clerics' role in clarifying the opinion of religion in fasting Ramadan for people with chronic diseases to help them in improving acceptance and adherence to medical advice regarding fasting. Disclosure Z. Rahme: None. N. Mesbah: None. N. Taha: None. D. Alroudhan: None.

SLE is a common autoimmune disease with considerable morbidity. Ramadan fasting is a religious custom Muslims regularly practice. We aimed to evaluate the effect of Ramadan fasting on SLE patients' disease activity, health quality of life and lipid profile. We conducted this case control study as a pilot study in 40 quiescent SLE patients, 21 cases who decided to fast and 19 controls who decided not to have Ramadan fasting between August and November 2009 in lupus unit of Rheumatology Research Center in Tehran University of Medical Sciences, Iran. They were assessed for SLE Disease Activity Index, lipid profile and quality of life with Short-Form 36 (SF-36) Health Survey, 1day before Ramadan, the day after and 3months after Ramadan fasting. After 24.1±5.4 (mean±SD) days of fasting, anti-ds DNA increased for 0.34±0.41mmol/dL in cases versus 0.07±0.31 in controls (P=0.026). Likewise C3 increased more dramatically in cases (16.8±17.5 vs. 2.3±13.2mg/dL, P=0.006). Three months after fasting, anti-ds DNA was still increased 0.28±0.46mmol/dL in cases while a 0.02±0.43mmol/dL drop in controls was detected (P=0.04). On the contrary, C3 returned to baseline. These changes were not accompanied with significant changes in disease activity and health quality of life. Ramadan fasting had no effect on lipid profile except for delayed total cholesterol decrease in cases in comparison with controls (16.4±29.4 decrease vs. 4.6±23.9mg/dL decrease, P=0.018). Ramadan fasting probably has no detrimental effect on SLE patients' disease activity and their quality of life in the quiescent phase of disease.

In the current study, we aimed at evaluating the effect of a culturally-based pre-Ramadan education program (PREP) on glycemic control, weight, adherence to post-sunset physical activity, perception of hypoglycemia, and anti-diabetic medication dose adjustment during Ramadan fasting in type 2 diabetics. A total of 1008 type 2 Diabetes patients were offered a culturally-based PREP in addition to the standard of care, two months before Ramadan. A retrospective interview one month after Ramadan compared the fasting experience of PREP attendees (470 patients) with those who merely received standard of care (538 patients) (Non-PREP). Ramadan fasting improved glycemic control with a correlation between HbA1c percent reduction and the number of fasting days (r = -0.290, p = 0.007). More HbA1c and weight percent reduction were observed in PREP attendees compared to the Non-PREP group (-14.8% ± 9.3 vs. -5.4% ± 5.4; p < 0.001; and - 1.96% ± 5.4 vs. -0.39% ± 2.8; p < 0.001, respectively). More commitment to night prayers in the PREP attendees compared to the Non-PREP group, (85.5% prayed >20 nights vs 28.4%; p < 0.001) with more HbA1c and weight percent reduction in the those who performed the prayers more than 20 nights compared to those who performed no prayers (-11.69% ± 8.8 vs -6.28% ± 6.4, p < 0.001; and - 2.76% ±5.1 vs 1.35% ±1.8, p < 0.001, respectively). More perception of true hypoglycemia was associated with PREP attendance (p0.046), insulin treatment (p0.000), and reduction of antidiabetic medication dosage (p0.004). Repeated lowering of antidiabetic medications doses with sequential downsizing of meals' portions, and appetite was reported. Ramadan fasting was beneficial for people with type 2 diabetes with reduction of HbA1c in correlation with the number of fasting days. Contrasting PREP with Non-PREP participants discovered better HbA1c and weight reduction in the former group even with equal number of fasting days. PREP participants performed more Taraweeh night prayers. The more the prayer nights the more decline of HbA1c and weight was observed. PREP improved perception and response to hypoglycemia with low-dosing of antidiabetic medications, especially insulin.

The risk for hypoglycemia during Ramadan fasting in patients with adrenal insufficiency.

Fasting in Ramadan of Muslim patients with diabetes Mellitus, and knowledge and practice in relation to diabetes control in Brunei

To our knowledge, no reports are available indicating the effects of Ramadan fasting on metabolic parameters, inflammatory factors and oxidative stress in polycystic ovary syndrome (PCOS). The current study was designed to evaluate the effects of Ramadan fasting on metabolic status among women with PCOS. This cross-sectional study was conducted on twenty seven PCOS patients who had fasted for a mean period of 16.5 hours a day during the 29 days of the month of Ramadan in Kashan, Iran. Fasting blood samples were collected at the beginning of the study and after 29 days of the study to quantify related variables. To identify within-group differences (before and after Ramadan), paired-samples t-tests were used. Plasma nitric oxide (NO) levels in PCOS women after Ramadan fasting were significantly higher compared to the baseline values (70.63 ± 15.78 vs. 59.94 ± 13.87 μmol/L, P = 0.003). Post-Ramadan levels of plasma glutathione (GSH) increased significantly in comparison with pre-Ramadan (974.95 ± 414.20 vs. 746.96 ± 205.93 μmol/L, P = 0.011). In addition, a trend toward a significant effect of Ramadan fasting on reducing serum high sensitivity C-reactive protein (hs-CRP) concentrations (2001.07 ± 1686.08 vs. 2962.72 ± 2845.21 ng/mL, P = 0.072) was seen. We did not observe any significant effect of Ramadan fasting on glucose hemostasis parameters, lipid profiles or total antioxidant capacity (TAC). In conclusion, Ramadan fasting in women with PCOS for 4 weeks had beneficial effects on NO and GSH levels, but did not affect glucose hemostasis parameters, lipid profiles or TAC.

Background: Dyspepsia is a symptoms collection of discomfort at the upper abdomen. Ramadan Fasting is a worship that must be run by all Moslems that do not eat and drink for ± 12 hours. Proton pump inhibitors are drugs commonly given to patients with dyspepsia with mechanism controlling gastric acid secretion. The aim of this study is to find the effect of omeprazole to the patient with dyspepsia and undergo Ramadan fasting. Method: Using analytic study design, conducted in outpatient in Koja Hospital Jakarta from June - July 2013, for patients with dyspepsia who will undergo Ramadan fasting. Subjects are divided into 2 groups; one group was given omeprazole while others were given a placebo. Before and after 2 weeks of fasting, dyspepsia symptoms severity index scores (DSSI) was taken which assessed changes in both groups and compared using student T-test. Results: DSSI scores on average before the intervention of both groups (n = 30) was not significant (p = 0.9). In the placebo group obtained increasing of DSSI score from 27.7 ± 14 to 36 ± 14.8 (p = 0.001), whereas in the omeprazole group obtained increasing of score only from 27.2 ± 9.4 to 30 ± 9.9 (p = 0.08). In the placebo group score worsened by 8.3 ± 7.2 but in the omeprazole group with only 2.7 ± 5.7 (p = 0.02). Conclusion: There was a significant decrease of DSSI scores in fasting patient with omeprazole. Therapy with omeprazole 20 mg twice daily during the month of fasting can reduce the abdominal complain in patient with dyspepsia. Keywords: dyspepsia, DSSI, fasting, Ramadan