Ramadan Fasting in Individuals with Metabolic Dysfunction-Associated Steatotic Liver Disease, Liver Transplant, and Bariatric Surgery: A Narrative Review.

Metabolic dysfunction-associated steatotic liver disease is a growing worldwide pandemic. A limited number of studies have investigated the potential effect of Ramadan fasting on metabolic dysfunction-associated steatotic liver disease (MASLD). There is no single medication for the treatment of MASLD. There is a growing interest in dietary intervention as potential treatment for metabolic diseases including MASLD. The aim of this study was to discuss the epidemiology, pathogenesis, and risk factors of MASLD and the potential effects of Ramadan fasting on MASLD, liver transplant, and bariatric surgery. We searched PubMed and SCOPUS databases using different search terms. The literature search was based on research studies published in English from the year 2000 to the 2024. Thirty-two studies were included in this review. Ramadan fasting reduced body weight and improved lipid profile, anthropometric indices, fasting plasma glucose, plasma insulin, and inflammatory cytokines. Ramadan fasting improved risk factors of nonalcoholic fatty liver disease and might improve MASLD through weight reduction. However, further studies are needed to assess the safety and effectiveness of Ramadan fasting in liver transplant recipients and bariatric surgery.

Thiamine deficiency in diabetes, obesity and bariatric surgery: Recipes for diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) is a life-threatening condition affecting individuals with diabetes characterised by hyperglycaemia, metabolic acidosis and ketonemia. The incidence and financial burden of DKA is still high. Thiamine deficiency is well documented in patients with DKA and could be associated with cardiac dysfunction in those patients. Thiamine deficiency leads to cardiac dysfunction, neuronal death and worsens the prognosis of DKA. There is an existing metabolic relationship between thiamine deficiency in diabetes, obesity and bariatric surgery. Careful monitoring of thiamine, along with other vitamins, is essential for diabetic patients, obese individuals and postbariatric surgery. Further research and clinical studies are urgently needed to assess the following: (1) Whether diabetes, obesity and bariatric surgery make individuals more prone to have DKA related to thiamine deficiency and (2) Whether supplementation of thiamine can protect diabetic patients, obese subjects and individuals undergoing bariatric surgery from DKA. This review summarises the biochemistry of thiamine and the existing metabolic relationships between thiamine deficiency in DKA, diabetes, obesity and bariatric surgery. Primary and family physicians have an important role in ensuring adequate replacement of thiamine in individuals with diabetes, obesity and bariatric surgery.

Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population.

INTRODUCTION: Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. METHODS: Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. RESULTS: Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. CONCLUSION: The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.

Hypokalaemia associated with excessive cola-flavoured drinks consumption.

We present a case involving a male patient in his 30s who was admitted to hospital due to recurrent episodes of hypokalaemia over the past 5 years. His medical history revealed hypertension, attention deficit hyperactivity disorder (ADHD), autism, and paranoia. He was taking citalopram, ramipril, amlodipine, and pramipexole. Tests indicated normal levels of aldosterone/renin ratio and plasma metanephrines. On reviewing his dietary history, it was noted that he consumed 3 to 3.5 L of cola-flavoured drinks on a daily basis. Normal potassium levels were achieved after a significant reduction in cola-flavoured drinks intake and potassium replacement. Subsequent outpatient clinic follow-up revealed that normal potassium levels were maintained even after the patient ceased taking potassium replacement tablets. Given the rarity of hypokalaemia associated with fizzy drinks, the underlying mechanism for this association remains unclear. In this case report, we attempt to provide a possible explanation for the involved mechanisms.

Hip Dysplasia in a Patient in Late Adolescence With Charcot-Marie-Tooth and Multiple Acyl-CoA Dehydrogenase Deficiency.

This case report explores a unique presentation of hip dysplasia in a female patient aged 21 years old diagnosed with Charcot-Marie-Tooth disease (CMT) type 1A and multiple acyl-CoA dehydrogenase deficiency (MADD). The coexistence of these neuromuscular and metabolic disorders in a patient with hip dysplasia provides an opportunity to investigate their potential interactions and impact on diagnosis, treatment, and prognosis. The patient underwent labral repair with shelf osteotomy and later a total hip replacement. This case highlights the need for further research to better understand the relationships between CMT, MADD, neuromuscular dysplasia, and hip dysplasia. A deeper understanding of these interactions may lead to improved diagnostic techniques, earlier intervention, and personalized treatment approaches for patients with co-morbid conditions, ultimately improving patient outcomes and reducing complications later in life.

The Impact of Clinical Pharmacist Diabetes Education on Medication Adherence in Patients with Type 2 Diabetes Mellitus: An Interventional Study from Khartoum, Sudan.

BACKGROUND: Continuous therapeutic care with good medication adherence is the cornerstone of management of all chronic diseases including diabetes. This study aimed to evaluate the impact of clinical pharmacist intervention on the medication adherence in individuals with type 2 diabetes (T2DM). METHODS: This was a randomized, double-blind, controlled trial conducted at a diabetes clinic located at Omdurman Military Hospital, Sudan. Individuals with T2DM attending the diabetes clinic within 1 year were selected. The sample size was 364 participants (182 control and 182 interventional group). We used a pre-structured standardized questionnaire and checklist to collect the data. Data were analyzed by using the Statistical Package for the Social Sciences (SPSS) (version 28). RESULTS: Majority, 76.4% (n = 278) were females, and they consisted of 80.8% (n = 147) of the interventional group and 72% of the controls. The mean age of the interventional group was 54.5 (±10) years; 31.9% (n = 58) of the interventional group had diabetes for 6-10 years, compared with 26.4% (n = 48) of the control group. Among the control group, the mean adherence score was 6.8 (±1.7) at baseline and it was 6.7 (±1.6) at the end of the study (p < 0.001), while in the interventional group, the mean adherence score was 6.8 (±1.7) at baseline and it was 7.4 (±1.5) at the end of the study (p < 0.001). CONCLUSION: Adherence score among the intervention group was increased significantly from baseline to the end of the study when compared to the control group.

Integrating PET chemical recycling with pyrolysis of mixed plastic waste via pressureless alkaline depolymerization in a hydrocarbon solvent.

This study presents a proof of concept for a technology train that integrates polyethylene terephthalate (PET) recovery from mixed plastic waste and plastic pyrolysis. PET is depolymerized into terephthalic acid (TPA) by hydrolysis using a low volatility oil as medium, which enables (i) low-pressure operation, and (ii) a selective separation and recovery of TPA from the product mix by a simple process of filtration, washing, and precipitation. Full PET conversion and high TPA recovery (>98 %) were achieved at 260 °C. This technology train is demonstrated to be effective for processing mixed waste streams, leading to higher yield and quality of liquid product from thermal pyrolysis when compared with feedstock that has not been pre-treated. Further, the technology could be readily integrated with a plastics pyrolysis process, whereby a by-product from the pyrolysis could be used as the low-volatility oil.

Gemini ionic liquid-based surfactants: efficient synthesis, surface activity, and use as inducers for the fabrication of Cu2O nanoparticles.

Discovery of green and novel synthetic routes for nanoparticles (NPs) has drawn a lot of interest due to the distinct nano size and unusual features as well as applications of such particles. Ionic liquid-based surfactants (ILBSs) and gemini ionic liquid-based surfactants (GILBSs) have become some of the best choices to be used as inducers or dispersing agents for the fabrication of nanoparticles. This work involves the synthesis, spectroscopic characterization, and surface property evaluation of three novel GILBSs (4a-c), which incorporate the imidazolium cation as the polar head with an ethylene spacer. The simple synthetic route includes, first, alkylating imidazole-N1 with the as-prepared fatty alkyl chloroacetates followed by quaternization of two equivalents of imidazole-N2 with ethylene dibromide. Investigations into the compounds' surface characteristics and thermodynamic parameters were carried out. The prepared GILBSs, 4a-c, were then used as inducers at various concentrations for the preparation of cuprous oxide nanoparticles. The size and shape of the produced NPs were examined by X-ray diffraction (XRD) and transmission electron microscopy (TEM) analysis in each case to study the effect of concentration on the NP morphology and to determine the best concentration for the NPs fabrication. The XRD patterns of the produced Cu2O NPs contain distinguishable peaks, which refer to crystalline Cu2O. Also, TEM images show that the obtained Cu2O is present in form of well dispersed nanorod particles with sizes about 55 and 23 nm at concentrations of 60 and 200 ppm, respectively.

Does dietary linseed or canola oil affect lipid metabolism, immunity, and n-3 polyunsaturated fatty acids content in quail eggs?

One of the most intriguing areas of research and innovation in the animal production and food sector recently has been designed-enriched products. These items are regarded as functional foods because they feature components that have advantageous physiological impacts on human health. In the production of poultry, designed eggs constitute a significant category of functional foods. The present study hypothesized that adding different kinds of oils to quail diets will help produce designer eggs rich in omega-3 and 6 fatty acids in addition to enhancing productive performance. So, this study examined how linseed (flaxseed) and canola oils with various levels can affect lipid metabolism, immune function, and the amount of n-3 polyunsaturated fatty acids (n-3 PUFA) in Japanese quail eggs. This work was conducted using 3 different vegetable oils (sunflower, linseed, and canola oils) and 3 different antioxidant supplements (0, 250 mg vitamin E/kg feed, and 1,000 mg ginger/kg feed) in a 3 × 3 factorial experiment. When linseed or canola oil was added to the diet, the number of fatty acids in the egg yolks of Japanese quail layers fell by (12.7 and 18.9%) and (41.4 and 24.6%), respectively. The amounts of saturated and monounsaturated fatty acids in total eggs fell by 21.9 and 14.6% and 24.5 and 15.8%, respectively, at 20 wk of age. However, when linseed and canola oil were added to the diet, the sum n-3 PUFA content in the egg yolk of Japanese quail-laying hens was noticeably raised at 15 and 20 wk of age. At 15 and 20 wk of age, the same groups' total n-6 PUFA content considerably increased compared to the group that did not receive flaxseed. In conclusion, during the laying period of Japanese quail, linseed oil, canola oil, vitamin E, or ginger positively affected productivity, blood hematology, constituents, resistance, lipid digestion system, and antioxidative properties in serum and egg yolk.

HIV and an Ageing Population-What Are the Medical, Psychosocial, and Palliative Care Challenges in Healthcare Provisions.

The continuing increase in patient numbers and improvement in healthcare provisions of HIV services in the UK, alongside the effectiveness of combined antiretroviral therapy (cART), has resulted in increasing numbers of the ageing population among people living with HIV (PLWH). It is expected that geriatricians will need to deal with many older people living with HIV (OPLWH) as life expectancy increases. Therefore, geriatric syndromes in OPLWH will be similar to the normal population, such as falls, cognitive decline, frailty, dementia, hypertension, diabetes and polypharmacy. The increase in the long-term use of cART, diabetes, dyslipidaemia and hypertension may lead to high prevalence of cardiovascular disease (CVD). The treatment of such conditions may lead to polypharmacy and may increase the risk of cART drug-drug interactions. In addition, the risk of developing infection and cancer is high. OPLWH may develop an early onset of low bone mineral density (BMD), osteoporosis and fractures. In this review, we have also provided potential psychosocial aspects of an ageing population with HIV, addressing issues such as depression, stigma, isolation and the need for comprehensive medical and psychosocial care through an interdisciplinary team in a hospital or community setting. OPLWH have a relatively high burden of physical, psychological, and spiritual needs and social difficulties, which require palliative care. The holistic type of palliative care that will improve physical, emotional and psychological wellbeing is discussed in this review.

Prevalence of obesity related hypertension among overweight or obese adults in River Nile State in Northern Sudan: a community based cross-sectional study.

Background: Reducing excess body weight is important for control and management of high blood pressure (BP) in adults. Previous studies showed high prevalence of hypertension in River Nile State-north of Sudan, hence this study to establish whether obesity can be among the main risk factors and to study the prevalence of obesity related hypertension among Sudanese adults in River Nile State. Methods: This was a cross sectional community-based study conducted in River Nile State, Northern Sudan from January to June 2021. Obese and overweight, aged 18 years and above and accepted to participate in the study were included in the study. Convenience sampling method was used to select the participants. Data was collected through structured questionnaire filled by the patients after taking informed consent. Anthropometric measurements were taken. Two measurements of BP were obtained. Data was analyzed using SPSS version 23.0 (IBM, Chicago, USA). Chi-square test was used to determine the associations between categorical variables while logistic regression test was used to predict the presence of hypertension among studied population. Results: A total of 1,295 participants were enrolled in this study. Obesity was reported in 1,118 (86.3%) of the participants. The prevalence of hypertension among the participants was 1,027 (79.3%). Central obesity was reported in 951 (92.6%) among hypertensive patients (P<0.001). Moreover, among hypertensive patients 470 (45.8%) were obese class I, 334 (32.5%) overweight, 139 (13.5%) obese class II and 84 (8.2%) obese class III (P<0.001). Obesity, BMI are risk factor of hypertension (P<0.001). Other risk factors were age above 40 years (P<0.001), unemployment (P<0.001), low education level (P<0.001) and being married (P<0.001). Logistic regression analysis showed that increasing age [P<0.001; odds ratio (OR) =1.055; 95% confidence interval (CI): 1.041-1.068], central obesity (P<0.001; OR =5.16; 95% CI: 3.4-7.8) and high body mass index (BMI) (P<0.001; OR =3.7; 95% CI: 1.7-7.9) were associated with uncontrolled hypertension. Conclusions: The study showed that the prevalence of obesity related hypertension was high. Common risk factors were age above 40 years, unemployment, and marriage. Importantly, central obesity, gross obesity and increasing age can be associated with uncontrolled BP management.

Epidemiological, Clinical, and Histopathological Features of Salivary Gland Tumors among 150 Sudanese Patients: 10 Years' Experience.

Background and Objectives: Salivary gland tumors (SGTs) are serious challenges to pathologists. Herein, we aimed to assess epidemiological and histopathological characteristics of SGTs among Sudanese patients. Materials and Methods: This retrospective descriptive study was undertaken at The pathology department in Khartoum State between 2008 and 2018. Patient records, histopathological reports, and slides were retrieved; and re-examined by two histopathologists. Diagnoses were reclassified according to the 2017 WHO classification of SGTs. Results: Overall, 150 cases of Sudanese patients with SGT were included (90 [60%] males and 60 [40%] females). Among these, 105 were benign (70%) and 45 were malignant (30%). The parotid glands were the most common site for both benign and malignant tumors (77/150; 51%: 59 benign (76.6%) and 18 malignant [23.4%]). The next common site was the submandibular gland (54 [36%]: 38 benign [70.3%] and 16 malignant [29.7%]), followed by minor salivary glands (19 [12.7%]: 8 benign and 11 malignant [57.9%]). Benign gland entities included pleomorphic adenoma (88/105; 83.7%), oncocytoma (5/105; 4.8%), myoepithelioma (4/105; 3.8%), Whartin tumors (3/105; 2.9%), basal cell adenoma (3/105; 2.9%), and sialolipoma (2/105; 1.9%). Malignant gland entities included adenoid cystic carcinoma (12; 26.7%), mucoepidermoid carcinoma (10; 22,2%), acinic cell carcinoma (6; 13.3%), poorly differentiated carcinoma (4; 8.9%), adenocarcinoma NOS (not otherwise specified) (4; 8.9%), basal cell adenocarcinoma (3; 6.7%), carcinoma ex pleomorphic adenoma (3; 6.7%), polymorphous adenocarcinoma (2; 4.4%), salivary duct carcinoma (1; 2.2%), and epithelial-myoepithelial carcinoma (2.2%). Conclusions: SGTs shared several epidemiological and histopathological features, exhibiting high incidence in the parotid and submandibular glands, lower prevalence in minor glands, and greater male predominance.

Knowledge and attitudes toward COVID-19 vaccination in Sudan: A cross-sectional study.

Background: Vaccines are an essential part of public health interventions to mitigate the devastating health and non-health impacts of COVID-19 pandemic. Despite the fact that Sudan launched the COVID-19 vaccination program in March 2021, only 10% of the population received their two primary doses of vaccines by the end of May 2022. This delayed uptake of vaccines obviously warrants investigation. Therefore, we have conducted this study to evaluate the knowledge, attitude and acceptance of the general population in Sudan toward COVID-19 vaccines. Methodology: A descriptive cross-sectional community-based study. The data were collected using an electronic questionnaire from 403 individuals living in Khartoum, Sudan. The data were processed using the Statistical Package for Social Sciences (SPSS), and data analysis was performed using appropriate tests. Results: 51% of the participants were found to have sufficient knowledge about the COVID-19 vaccine, and the knowledge level is higher among those educated beyond the secondary school and those who were employed. Among those unvaccinated, only 47% of the participants expressed their intention to take the vaccine when offered to them. The major reason for not trusting the vaccine is safety concerns expressed by 65.5% of the unvaccinated. Conclusion: Higher education levels and employment were associated with an increase in sufficient knowledge about the vaccine in around half of the participants. However, most of participants had not taken the vaccine at the time of the study, and the trust in vaccines is not high. Effective interventions by the health authorities are needed to address these issues in order to accelerate the COVID-19 vaccination program in Sudan.

Fog computing-assisted path planning for smart shopping.

A Smart City (SC) is a viable solution for green and sustainable living, especially with the current explosion in global population and rural-urban immigration. One of the fields that is not getting much attention in the Smart Economy (SE) is customer satisfaction. The SE is a component of SC that is concerned with using Information and Communication Technology (ICT) to improve stages of the traditional economy. In this paper, we propose a fog computing-based shopping recommendation system. Our simulations used Al-Madinah city as a case study. It aims to improve the customer shopping experience. Customers in shopping malls can connect to the system via Wi-Fi. Then the system recommends products to the shoppers according to their preferences. It optimizes shoppers' schedules using price, the distance between the shops, and the congestion. It also improves customers' savings by up to 30%. It also increases the shopping speed by up to 6.12% compared to the system proposed in the literature.

Fracture Neck of the Femur: A Case of Two Pathologies.

We report a case of a 65-year-old woman who sustained a left neck of femur (NOF) fracture following low-energy trauma. Computed tomography (CT) scan for the neck, chest, abdomen and pelvis was normal apart from enlargement of the right lobe of the thyroid. Interestingly, thyroid function was normal. While waiting for the result of thyroid cytology and bone histology, the patient recovered well from the operation and started to engage well with physiotherapy. The result of the investigation showed presence of diffuse large B-cell lymphoma in the left NOF and right lobe of the thyroid. As the presence of lymphoma only in these two organs is extremely rare, it is not yet clear what is underlying mechanism for such association. Therefore, such observations may raise many future research questions as detailed in the discussion of this case report. This case also illustrates the importance of a multidisciplinary approach in identifying, evaluating, and treating unique and complex presentations of NOF fracture, with a focus on the patient's history, clinical examination and applying diagnostic tools.

Risk factors associated with fasting during Ramadan among individuals with diabetes according to IDF-DAR risk score in Atbara city, Sudan: Cross-sectional hospital-based study.

BACKGROUND: Ramadan is a holy month for Muslims. The aim of this study was to assess risk associated with Ramadan fasting among Sudanese individuals with diabetes (high, moderate, and low risk) according to International Diabetes Federation in collaboration with Diabetes and Ramadan International alliance (IDF-DAR) Practical Guidelines 2021 risk score. METHODS: This was a cross-sectional hospital-based study recruited 300 individuals with diabetes (79% have type 2 diabetes) from diabetes centers in Atbara city, the River Nile state, Sudan. RESULTS: The risk score was distributed as low risk (13.7%), Moderate risk (24%), and High risk (62.3%). T-test showed a significant difference in mean risk score by gender, duration and type of diabetes (p values = 0.004, 0.000, & 0.000, respectively). One-way ANOVA revealed a statistically significant difference in the risk score by age groups (p = 0.000). Logistic regression revealed that the odds of being in the 41-60 years age group had lower probability to be categorized in the moderate risk group of fasting rather than low risk by 4.3 times than being in the age more than 60 years. (p = 0.008), the odds of being in the age group 41-60 years lower probability to be categorized in the high risk of fasting rather than low risk by 8 times than being in the age more than 60 years. (p = 0.000). CONCLUSION: The majority of patients in this study have a high risk for Ramadan fasting. IDF-DAR risk score is of great significance in assessing individuals with diabetes for Ramadan fasting.

Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies.

The developments in Human Immunodeficiency Virus (HIV) treatment and in the care of people living with HIV (PLWHIV) and Acquired Immunodeficiency Syndrome (AIDS) over the last three decades has led to a significant increase in life expectancy, on par with HIV-negative individuals. Aside from the fact that bone fractures tend to occur 10 years earlier than in HIV-negative individuals, HIV is, per se, an independent risk factor for bone fractures. A few available antiretroviral therapies (ARVs) are also linked with osteoporosis, particularly those involving tenofovir disoproxil fumarate (TDF). HIV and hepatitis C (HCV) coinfection is associated with a greater risk of osteoporosis and fracture than HIV monoinfection. Both the Fracture Risk Assessment Tool (FRAX) and measurement of bone mineral density (BMD) via a DEXA scan are routinely used in the assessment of fracture risk in individuals living with HIV, as bone loss is thought to start between the ages of 40 and 50 years old. The main treatment for established osteoporosis involves bisphosphonates. Supplementation with calcium and vitamin D is part of clinical practice of most HIV centers globally. Further research is needed to assess (i) the cut-off age for assessment of osteoporosis, (ii) the utility of anti-osteoporotic agents in PLWHIV and (iii) how concomitant viral infections and COVID-19 in PLWHIV can increase risk of osteoporosis.

Enhancing semen quality, antioxidant status and sex hormones of V-line rabbit bucks fed on supplemented diets with dried moringa leaves.

This study was conducted to evaluate the impact of dried moringa leaves (DML) on semen quality, immunoglobulin measurements, blood metabolic analysis, antioxidant status and sex hormones of V-line rabbit bucks. Twenty-four mature rabbit bucks of 7-8 months-old of proven fertility with an average weight (2.8 ± 0.4 kg) were classified into four treatments (basal diet with 0, 750, 1500 and 3000 mg DML/kg diet) and 6 bucks per treatment were used. Seminal plasma cholesterol (p = 0.013) and triglycerides (p = 0.0001) of all moringa supplemented rabbits were higher than the control. Moringa leaves enhanced (p < 0.05) serum testosterone, follicle stimulating hormone and luteinizing hormone. Total antioxidant capacity, superoxide oxidase, glutathione peroxidase and catalase in seminal plasma of moringa rabbits were higher (p < 0.05) than the control. Serum total lipid (p = 0.002), cholesterol (p = 0.008), triglycerides (p = 0.019) and blood urea (p < 0.05) were lower in DML rabbits. Moringa leaves improved total antioxidant capacity (p = 0.0001), glutathione peroxidase (p = 0.0001) and superoxide oxidase (p = 0.037) in rabbits versus control. Rabbits consuming DML had higher (p < 0.05) immunoglobulin IgG and IgM than control. Results suggest that DML improved rabbits' antioxidant, and immunological status, semen quality, and sex hormones, but DML (750 mg/kg diet) is recommended because it was more effective than the other two high doses.

Safety and effectiveness of newer antidiabetic medications during Ramadan fasting and safety of Ramadan fasting after bariatric surgery.

Background: Fasting during Ramadan is mandatory for all adult healthy Muslims. International studies found that most Muslims with diabetes mellitus fast during Ramadan. The main risk factors are hypoglycemia, Hyperglycemia, diabetic ketoacidosis, and dehydration during fasting. Therefore, stratification of the risks for severe acute diabetes complications needs to be considered for each individual and strategies personalized to advert these complications. The advent of new diabetes medications which are effective yet with a better safety profile and monitoring of blood glucose levels during the day are important to reduce the risk of untoward effects of hypoglycemia and hyperglycemia during Ramadan fasting. Here we review the safety and effectiveness of the newer diabetes medications for Ramadan fasting and whether it is safe to perform fasting after bariatric surgery. Methods: An extensive literature search using PubMed and Google Scholar was done using different search terms. The eligible studies were 48 randomized controlled trials, prospective observational studies, and reviews from January 2008 to June 2022 which were conducted in individuals living with diabetes. Results and Conclusions: The newer diabetes medications such as GLP-1 agonists, DPP-4 inhibitors, SGLT-2 inhibitors, and new Insulin therapy are thought to be safe and effective during fasting of Ramadan. These medications are associated with a reduction in HbA1c, body weight, systolic blood pressure and risk of hypoglycemia during Ramadan fasting. However, further studies with larger sample size are needed to confirm the efficacy and safety of these newer medications during Ramadan fasting. Individuals with Bariatric surgery should seek advice and approval to fast from the bariatric dietician, physician, and surgeon before the beginning of the month of Ramadan.

Reproductive performance and milk yield of rabbits fed diets supplemented with garden cress (Lepidium sativum) seed.

Recently, phytochemicals in plants have evoked interest as sources of naturally beneficial substances and as alternatives to antimicrobials. Based on these benefits, it was hypothesized that garden cress (GC; Lepidium sativum) supplementation could overcome the negative impacts of severe heat stress on the reproductive and lactation performance, physiological parameters, and antioxidant status of rabbits. Twenty-four mature V-line does (6 months old) with an average body weight of 3.65 ± 0.54 kg were randomly assigned into four homogenously equal groups (n = 6) according to the level of supplemented GC seeds. Rabbits in the control group were fed a basal diet without GC seeds (GC 0), the other three treatment groups (GC 3, GC 4.5, and GC 6) were fed a basal diet supplemented with GC seeds at levels 3, 4.5 and 6%, respectively. Investigations revealed that the inclusion of 3% GC enhanced the litter weight of heat-stressed rabbits on the 7th, 14th, and 21st days. Furthermore, treatment with 3% and 6% GC seeds increased the milk yield on the 28th day. the most of lipid profile parameters, such as cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), serum urea levels, and antioxidant status improved in rabbits supplemented with 6% GC. In conclusion, the dietary supplemention of GC seed at 6% increased milk yield at 28th day "weaning age", consequently, improved the blood lipid profile and antioxidant status. Further studies should be conducted to commercialize theusage of garden cress seeds as a supplement in rabbits.