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CC BY-NC-ND 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences 2023; 15(01): 005-019
DOI: 10.1055/s-0043-1764355
Review Article

Burden and Patterns of Medical Emergencies during Ramadan Fasting: A Narrative Review

Anas S. Beshyah 
1   Department of Gastroenterology, Wythenshawe Hospital, Manchester, United Kingdom
,
Jamila S. Elamouri
2   Nephrology Unit, Department of Internal Medicine, Tripoli Central Hospital, Tripoli, Libya
,
Ihab Almagdub 
3   Department of Medicine, Sheikh Khalifa Medical City, SEHA, Abu Dhabi, United Arab Emirates
,
Husen Abdulrahman
3   Department of Medicine, Sheikh Khalifa Medical City, SEHA, Abu Dhabi, United Arab Emirates
,
Khadija Hafidh 
4   Department of Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
5   Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates
,
Salem A. Beshyah 
5   Department of Medicine, Dubai Medical College for Girls, Dubai, United Arab Emirates
6   Department of Medicine, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
7   Department of Medicine, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates
› Author Affiliations Funding and Sponsorship None.
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Abstract

Introduction Acute medical problems may occur more frequently during Ramadan fasting (RF). We aimed to provide a narrative overview of the global literature on medical emergencies during RF.

Methods This is a nonsystematic review of the international literature from one major medical online database (PubMed, National Institutes of Health, United States). The relevant literature was narrated in a concise thematic account.

Results There is a variable impact in the burden and time distribution of emergency services and hospitalization during RF that may require readjustment of resource allocation. Studies of the risk of accidents and injuries may be increased overall or at specified times, around Iftar time. A classical impact of emergencies has been the risk of worsening peptic ulcer disease. RF impacts diabetic emergencies such as severe hypoglycemia, hyperglycemia, and diabetic ketoacidosis, particularly in type 1 diabetes and poorly controlled patients. Glucocorticoid replacement therapy may represent a challenge to patients and physicians that require education and dose adjustment. Acute neurological conditions of interest include the “first day of Ramadan headache,” epilepsy, and strokes. Several studies evaluated the risk of the acute coronary syndrome and heart failure with inconsistent findings. RF may impact the renal and urological systems through stone disease, renal colic, and acute kidney. The impact on hematological conditions was mostly focused on the safety of anticoagulant therapy during Ramadan.

Conclusion The review addresses the emergency medical encounters of the fasting patient during Ramadan to allow a holistic and ethnically sensitive approach to medical care under circumstances where decisions have to be taken with no delay.

Keywords

Ramadan fasting - emergency services - accidents and injuries - peptic ulcer disease - diabetic emergencies - glucocorticoid replacement - acute neurological conditions

Author Contributions

The authors contributed equally to the manuscript's conception, drafting, and revision. All authors reviewed and approved the final version.


Compliance with Ethical Principles

Ethical approval is not required for review types of studies.




Publication History

Article published online:
17 March 2023

© 2023. The Libyan Biotechnology Research Center. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Beshyah WS, Beshyah SA. Bibliometric analysis of the literature on Ramadan fasting and diabetes in the past three decades (1989-2018). Diabetes Res Clin Pract 2019; 151: 313-322
    CrossrefPubMedSearch in Google Scholar
  • 2 Beshyah SA, Fathalla W, Saleh A. et al. Ramadan fasting and the medical patient: an overview for clinicians. Ibnosina J Med Biomed Sci. 2010; 2 (05) 240-257
    Thieme ConnectSearch in Google Scholar
  • 3 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 (08) 102566
    CrossrefPubMedSearch in Google Scholar
  • 4 Leca A, Fortesa L. Greater incidence of perforated peptic ulcers in the Ramadan period [in French]. Afr Fr Chir 1954; 12 (06) 577-578
    PubMedSearch in Google Scholar
  • 5 Lahbabi H. [Significance of the frequency of perforated ulcer during the Ramadan]. Maroc Med 1957; 36 (384) 449-450
    PubMedSearch in Google Scholar
  • 6 Vach B. Perforation of gastroduodenal ulcer among the population of Tunis. Effect of the Ramadan on the frequency of perforations [in Czech]. Rozhl Chir 1966; 45 (05) 300-304
    PubMedSearch in Google Scholar
  • 7 Langford EJ, Ishaque MA, Fothergill J, Touquet R. The effect of the fast of Ramadan on accident and emergency attendances. J R Soc Med 1994; 87 (09) 517-518
    CrossrefPubMedSearch in Google Scholar
  • 8 Parrilla Ruiz F, Cárdenas Cruz DP, Vargas Ortega DA, Cárdenas Cruz A. El ayuno del Ramadán y una unidad de urgencias. [The Ramadan fast and an emergency unit] Aten Primaria 2003; 32 (01) 61-63
    CrossrefPubMedSearch in Google Scholar
  • 9 Topacoglu H, Karcioglu O, Yuruktumen A. et al. Impact of Ramadan on demographics and frequencies of disease-related visits in the emergency department. Int J Clin Pract 2005; 59 (08) 900-905
    CrossrefPubMedSearch in Google Scholar
  • 10 Pekdemir M, Ersel M, Yilmaz S, Uygun M. No significant alteration in admissions to emergency departments during Ramadan. J Emerg Med 2010; 38 (02) 253-256
    CrossrefPubMedSearch in Google Scholar
  • 11 Halasa W. Effect of Ramadan fasting on emergency walk-in-clinics in Jordan. Br J Gen Pract 2014; 64 (625) 388
    CrossrefPubMedSearch in Google Scholar
  • 12 Al Assaad RG, Bachir R, El Sayed MJ. Impact of Ramadan on emergency department visits and on medical emergencies. Eur J Emerg Med 2018; 25 (06) 440-444
    CrossrefPubMedSearch in Google Scholar
  • 13 Balhara KS, Levin S, Cole G. et al. Emergency department resource utilization during Ramadan: distinct and reproducible patterns over a 4-year period in Abu Dhabi. Eur J Emerg Med 2018; 25 (01) 39-45
    CrossrefPubMedSearch in Google Scholar
  • 14 Thomas SA, Bashir K, Jenkins DW, Pathan SA, Thomas SH. Ramadan-associated circadian census variation in a busy Middle Eastern emergency department. J Ayub Med Coll Abbottabad 2019; 31 (04) 586-592
    PubMedSearch in Google Scholar
  • 15 Saleh R, Makki M, Tamim H, Hitti E. The impact of Ramadan on patient attendance patterns in an emergency department at a tertiary care center in Beirut, Lebanon. J Emerg Med 2020; 59 (05) 720-725
    CrossrefPubMedSearch in Google Scholar
  • 16 Faruqi I, Mazrouei LA, Buhumaid R. Impact of Ramadan on emergency department patients flow; a cross-sectional study in UAE. Adv J Emerg Med 2020; 4 (02) e22
    PubMedSearch in Google Scholar
  • 17 Butt T, Khan HU, Ahmed I, Eldali A. Emergency department attendance patterns during Ramadan. Ann Saudi Med 2016; 36 (04) 258-264
    CrossrefPubMedSearch in Google Scholar
  • 18 Ben Saida I, Kallel H, Chaouch S, Toumi R, Zarrougui W, Boussarsar M. Impacts of Ramadan on intensive care unit admission patterns and outcomes. Tunis Med 2019; 97 (10) 1153-1159
    PubMedSearch in Google Scholar
  • 19 Kayipmaz AE, Celikel E, Kavalci C, Ozbay S, Coskun A. The duration of fasting in Ramadan affects the admissions to emergency department. Eurasian J Emerg Med 2018; 17 (04) 178-181
    CrossrefSearch in Google Scholar
  • 20 Sawaya RD, Wakil C, Shayya S. et al. Pediatric emergency department utilisation during Ramadan: a retrospective cross-sectional study. Arch Dis Child 2021; 106 (03) 272-275
    CrossrefPubMedSearch in Google Scholar
  • 21 Bener A, Absood GH, Achan NV, Sankaran-Kutty M. Road traffic injuries in Al-Ain City, United Arab Emirates. J R Soc Health 1992; 112 (06) 273-276
    CrossrefPubMedSearch in Google Scholar
  • 22 Mehmood A, Khan IQ, Mir MU, Moin A, Jooma R. Vulnerable road users are at greater risk during Ramadan – results from road traffic surveillance data. J Pak Med Assoc 2015; 65 (03) 287-291
    PubMedSearch in Google Scholar
  • 23 Tahir MN, Macassa G, Akbar AH, Naseer R, Zia A, Khan S. Road traffic crashes in Ramadan: an observational study. East Mediterr Health J 2014; 19 (Suppl. 03) S147-S151
    PubMedSearch in Google Scholar
  • 24 Akman C, Kuru T. Analysis of emergency department presentations due to injuries from motor vehicle crashes and pedestrian strikes. Cureus 2020; 12 (07) e9468
    PubMedSearch in Google Scholar
  • 25 Ghumman U, Horney J. Characterizing the impact of extreme heat on mortality, Karachi, Pakistan, June 2015. Prehosp Disaster Med 2016; 31 (03) 263-266
    CrossrefPubMedSearch in Google Scholar
  • 26 Khammash MR, Al-Shouha TF. Do road traffic accidents increase during the fasting month of Ramadan. Neurosciences (Riyadh) 2006; 11 (01) 21-23
    Search in Google Scholar
  • 27 Göçmen E, Koç M, Tez M, Yoldaş O, Bilgin A, Keşkek M. Effect of Ramadan on surgical emergencies. Ann Emerg Med 2004; 44 (03) 283-285
    CrossrefPubMedSearch in Google Scholar
  • 28 Husseiny AM, El-Sayed MA, Eshra A, Al-Meshaan M. The effect of Ramadan fasting on surgical emergency attendants. Kuwait Med J 2008; 40 (02) 124-126
    Search in Google Scholar
  • 29 AlZahrani AM, Zawawi MM, Almutairi NA, Alansari AY, Bargawi AA. The impact of Ramadan on visits related to diabetes emergencies at a tertiary care center. BMC Emerg Med 2021; 21 (01) 162
    CrossrefPubMedSearch in Google Scholar
  • 30 Tong CV, Yow HY, Mohd Noor N, Hussein Z. DEARS (Diabetes Emergencies Around Ramadan Study) study group. Diabetes emergencies around Ramadan study (DEARS) - A multi-center study of diabetes emergencies admitted before, during and after Ramadan in Malaysia. Diabetes Res Clin Pract 2021; 175: 108854
    CrossrefPubMedSearch in Google Scholar
  • 31 Elbarsha A, Elhemri M, Lawgaly SA, Rajab A, Almoghrabi B, Elmehdawia RR. Outcomes and hospital admission patterns in patients with diabetes during Ramadan versus a non-fasting period. Ann Saudi Med 2018; 38 (05) 344-351
    CrossrefPubMedSearch in Google Scholar
  • 32 Salti I, Bénard E, Detournay B. et al; EPIDIAR study group. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care 2004; 27 (10) 2306-2311
    CrossrefPubMedSearch in Google Scholar
  • 33 Beshyah SA, Hassanein M, Ahmedani MY. et al. Diabetic hypoglycaemia during Ramadan fasting: a trans-national observational real-world study. Diabetes Res Clin Pract 2019; 150: 315-321
    CrossrefPubMedSearch in Google Scholar
  • 34 Al Sifri S, Basiounny A, Echtay A. et al; 2010 Ramadan Study Group. The incidence of hypoglycaemia in Muslim patients with type 2 diabetes treated with sitagliptin or a sulphonylurea during Ramadan: a randomised trial. Int J Clin Pract 2011; 65 (11) 1132-1140
    CrossrefPubMedSearch in Google Scholar
  • 35 Mohamed K, Al-Abdulrazzaq D, Fayed A. et al. Fasting during the holy month of Ramadan among older children and adolescents with type 1 diabetes in Kuwait. J Pediatr Endocrinol Metab 2019; 32 (08) 843-849
    CrossrefPubMedSearch in Google Scholar
  • 36 Beshyah AS, Beshyah SA. The incidence of diabetic ketoacidosis during Ramadan fasting: a 10-year single-centre retrospective study. Diabetes Res Clin Pract 2019; 150: 296-300
    CrossrefPubMedSearch in Google Scholar
  • 37 Alshahrani M, Alraddadi A. Incidence of diabetic ketoacidosis during Ramadan compared with non-fasting months in King Saud Medical City, Riyadh, Saudi Arabia. J Family Med Prim Care 2022; 11 (07) 3905-3908
    CrossrefPubMedSearch in Google Scholar
  • 38 Beshyah SA, Chowdhury TA, Ghouri N, Lakhdar AA. Risk of diabetic ketoacidosis during Ramadan fasting: a critical reappraisal. Diabetes Res Clin Pract 2019; 151: 290-298
    CrossrefPubMedSearch in Google Scholar
  • 39 Elamari S, Elaziz S, Chadli A, Farouqi A. Management of diabetes during Ramadan fasting: applications of international recommendations in clinical practice [in French]. Pan Afr Med J 2020; 36: 316
    PubMedSearch in Google Scholar
  • 40 Loh HH, Lim LL, Loh HS, Yee A. Safety of Ramadan fasting in young patients with type 1 diabetes: a systematic review and meta-analysis. J Diabetes Investig 2019; 10 (06) 1490-1501
    CrossrefPubMedSearch in Google Scholar
  • 41 Beshyah SA, Fiad TM, Saadi HF. Management of common endocrine conditions other than diabetes mellitus during Ramadan fasting. Ibnosina J Med BS 2012; 4 (04) 137-146
    Thieme ConnectSearch in Google Scholar
  • 42 Chihaoui M, Chaker F, Yazidi M. et al. Ramadan fasting in patients with adrenal insufficiency. Endocrine 2017; 55 (01) 289-295
    CrossrefPubMedSearch in Google Scholar
  • 43 Hussain S, Hussain S, Mohammed R, Meeran K, Ghouri N. Fasting with adrenal insufficiency: practical guidance for healthcare professionals managing patients on steroids during Ramadan. Clin Endocrinol (Oxf) 2020; 93 (02) 87-96
    CrossrefPubMedSearch in Google Scholar
  • 44 Chihaoui M, Yazidi M, Oueslati I, Khessairi N, Chaker F. Intermittent fasting in adrenal insufficiency patients: a review and guidelines for practice. Endocrine 2021; 74 (01) 11-19
    CrossrefPubMedSearch in Google Scholar
  • 45 Betesh-Abay B, Shiyovich A, Davidian S, Gilutz H, Shalata W, Plakht Y. The Association between acute myocardial infarction-related outcomes and the Ramadan period: a retrospective population-based study. J Clin Med 2022; 11 (17) 5145
    CrossrefPubMedSearch in Google Scholar
  • 46 Sriha Belguith A, Baccouche H, Grissa MH. et al. The risk of acute coronary syndrome in Ramadan. Tunis Med 2016; 94 (8-9): 599-603
    PubMedSearch in Google Scholar
  • 47 Temizhan A, Dönderici O, Ouz D, Demirbas B. Is there any effect of Ramadan fasting on acute coronary heart disease events?. Int J Cardiol 1999; 70 (02) 149-153
    CrossrefPubMedSearch in Google Scholar
  • 48 Raffee LA, Alawneh KZ, Al Suleiman MK, Ibdah RK, Rawashdeh SI, Al-Mistarehi AW. An observational study of the occurrence of acute coronary syndrome (ACS) among Jordanian patients: identifying the influence of Ramadan fasting. Ann Med Surg (Lond) 2020; 59: 171-175
    CrossrefPubMedSearch in Google Scholar
  • 49 Al Suwaidi J, Bener A, Gehani AA. et al. Does the circadian pattern for acute cardiac events presentation vary with fasting?. J Postgrad Med 2006; 52 (01) 30-33 , discussion 33–34
    PubMedSearch in Google Scholar
  • 50 Al Suwaidi J, Bener A, Hajar HA, Numan MT. Does hospitalization for congestive heart failure occur more frequently in Ramadan: a population-based study (1991-2001). Int J Cardiol 2004; 96 (02) 217-221
    CrossrefPubMedSearch in Google Scholar
  • 51 Salam AM, Sulaiman K, Alsheikh-Ali AA. et al. Acute heart failure presentations and outcomes during the fasting month of Ramadan: an observational report from seven Middle Eastern countries. Curr Med Res Opin 2018; 34 (02) 237-245
    CrossrefPubMedSearch in Google Scholar
  • 52 Abazid RM, Khalaf HH, Sakr HI. et al. Effects of Ramadan fasting on the symptoms of chronic heart failure. Saudi Med J 2018; 39 (04) 395-400
    CrossrefPubMedSearch in Google Scholar
  • 53 Abdolreza N, Omalbanin A, Mahdieh TS. et al. Comparison of the number of patients admitted with renal colic during various stages of peri-Ramadan month. Saudi J Kidney Dis Transpl 2011; 22 (06) 1199-1202
    PubMedSearch in Google Scholar
  • 54 al-Hadramy MS. Seasonal variations of urinary stone colic in Arabia. J Pak Med Assoc 1997; 47 (11) 281-284
    PubMedSearch in Google Scholar
  • 55 Sagy I, Zeldetz V, Halperin D, Abu Tailakh M, Novack V. The effect of Ramadan fast on the incidence of renal colic emergency department visits. QJM 2017; 110 (09) 571-576
    CrossrefPubMedSearch in Google Scholar
  • 56 Hill FJ, Sayer JA. Re: Sagy I, Zeldetz V, Halerin D, Abu Tailakh M, Novack V. The effect of Ramadan fast on the incidence of renal colic emergency department visits. QJM 2018; 111 (05) 353-354
    CrossrefPubMedSearch in Google Scholar
  • 57 Al Mahayni AO, Alkhateeb SS, Abusaq IH, Al Mufarrih AA, Jaafari MI, Bawazir AA. Does fasting in Ramadan increase the risk of developing urinary stones?. Saudi Med J 2018; 39 (05) 481-486
    CrossrefPubMedSearch in Google Scholar
  • 58 Cevik Y, Corbacioglu SK, Cikrikci G, Oncul V, Emektar E. The effects of Ramadan fasting on the number of renal colic visits to the emergency department. Pak J Med Sci 2016; 32 (01) 18-21
    PubMedSearch in Google Scholar
  • 59 Al Wakeel JS. Kidney function and metabolic profile of chronic kidney disease and hemodialysis patients during Ramadan fasting. Iran J Kidney Dis 2014; 8 (04) 321-328
    PubMedSearch in Google Scholar
  • 60 AlAbdan NA, Almohammed OA, Altukhaim MS. et al. Fasting during Ramadan and acute kidney injury (AKI): a retrospective, propensity matched cohort study. BMC Nephrol 2022; 23 (01) 54
    CrossrefPubMedSearch in Google Scholar
  • 61 Wan Md Adnan WA, Zaharan NL, Wong MH, Lim SK. The effects of intermittent fasting during the month of Ramadan in chronic haemodialysis patients in a tropical climate country. PLoS One 2014; 9 (12) e114262
    CrossrefPubMedSearch in Google Scholar
  • 62 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 (01) 48
    CrossrefPubMedSearch in Google Scholar
  • 63 Al-Kaabi S, Bener A, Butt MT. et al. Effect of Ramadan fasting on peptic ulcer disease. Indian J Gastroenterol 2004; 23 (01) 35
    PubMedSearch in Google Scholar
  • 64 Kucuk HF, Censur Z, Kurt N. et al. The effect of Ramadan fasting on duodenal ulcer perforation: a retrospective analysis. Indian J Surg 2005; 67 (04) 195-198
    Search in Google Scholar
  • 65 Bener A, Derbala MF, Al-Kaabi S. et al. Frequency of peptic ulcer disease during and after Ramadan in a United Arab Emirates hospital. East Mediterr Health J 2006; 12 (1-2): 105-111
    PubMedSearch in Google Scholar
  • 66 Emami MH, Rahimi H. Effects of Ramadan fasting on acute upper gastrointestinal bleeding due to peptic ulcer. J Res Med Sci 2006; 11 (03) 170-175
    Search in Google Scholar
  • 67 Ozkan S, Durukan P, Akdur O, Vardar A, Torun E, Ikizceli I. Does Ramadan fasting increase acute upper gastrointestinal haemorrhage?. J Int Med Res 2009; 37 (06) 1988-1993
    CrossrefPubMedSearch in Google Scholar
  • 68 Drozdinsky G, Agabaria A, Zuker-Herman R, J Drescher M, Bleetman T, Shiber S. High rate of acute pancreatitis during the Ramadan fast. Eur J Gastroenterol Hepatol 2018; 30 (06) 608-611
    CrossrefPubMedSearch in Google Scholar
  • 69 Tabrizi N, Karimi N. Clinical epidemiologic study of admissions due to neurologic diseases during and after Ramadan fasting, Sari, Iran, 2015. J Mazandaran Univ Med Sci 2019; 29 (179) 117-125
    Search in Google Scholar
  • 70 Drescher MJ, Wimpfheimer Z, Abu Khalef S, Gammaitoni A, Shehadeh N, Torgovicky R. Prophylactic etoricoxib is effective in preventing “first of Ramadan” headache: a placebo-controlled double-blind and randomized trial of prophylactic etoricoxib for ritual fasting headache. Headache 2012; 52 (04) 573-581
    CrossrefPubMedSearch in Google Scholar
  • 71 Bener A, Hamad A, Fares A, Al-Sayed HM, Al-Suwaidi J. Is there any effect of Ramadan fasting on stroke incidence?. Singapore Med J 2006; 47 (05) 404-408
    PubMedSearch in Google Scholar
  • 72 Assy MH, Awd M, Elshabrawy AM, Gharieb M. Effect of Ramadan fasting on incidence of cerebrovascular stroke in Egyptian patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2019; 151: 299-304
    CrossrefPubMedSearch in Google Scholar
  • 73 Saadatnia M, Zare M, Fatehi F, Ahmadi A. The effect of fasting on cerebral venous and dural sinus thrombosis. Neurol Res 2009; 31 (08) 794-798
    CrossrefPubMedSearch in Google Scholar
  • 74 El-Mitwalli A, Zaher AA, Mohamed MAE, Elmenshawi E. The effect of Ramadan fasting on cerebral stroke: a prospective hospital-based study. Egypt J Neurol Psychiat Neurosurg 2009; 46 (01) 51-56
    Search in Google Scholar
  • 75 Salama HH, Belal T. Is there any consequence of Ramadan fasting on acute cerebral stroke?. Egypt J Neurol Psychiat Neurosurg 2014; 51 (03) 333-336
    Search in Google Scholar
  • 76 Magdy R, Kishk NA, Abokrysha NT, Ramzy GM, Rizk HI, Hussein M. Fasting and post fasting effect of Ramadan on different seizure types in patients with active epilepsy. Nutr Neurosci 2022; 25 (05) 1100-1104
    CrossrefPubMedSearch in Google Scholar
  • 77 Mzoughi K, Zairi I, Fennira S. et al. Effect of Ramadan fasting on acenocoumarol-induced anticoagulant effect. Ann Biol Clin (Paris) 2017; 75 (05) 513-518
    PubMedSearch in Google Scholar
  • 78 Lai YF, Cheen MH, Lim SH. et al. The effects of fasting in Muslim patients taking warfarin. J Thromb Haemost 2014; 12 (03) 349-354
    CrossrefPubMedSearch in Google Scholar
  • 79 Alwhaibi A, Alenazi M, Alwagh F. et al. Does Ramadan fasting disrupt international normalised ratio control in warfarin-treated medically stable patients?. Int J Clin Pract 2021; 75 (11) e14796
    CrossrefPubMedSearch in Google Scholar
  • 80 Leo A, La Tegola D, Logroscino G, Carabellese F. Approach to the patient hospitalized during the Muslim Ramadan: bioethical and clinical considerations. Riv Psichiatr 2016; 51 (05) 172-176
    PubMedSearch in Google Scholar
  • 81 Erbay H, Alan S, Kadıoğlu S. A case study from the perspective of medical ethics: refusal of treatment in an ambulance. J Med Ethics 2010; 36 (11) 652-655
    CrossrefPubMedSearch in Google Scholar