Postharvest melatonin and chitosan treatments retain quality of 'Williams' bananas during ripening.

The effect of postharvest dipping treatments with 0.5 mM melatonin (MT) and 1% chitosan (CT) either alone or in combination on quality of pre-climacteric 'Williams' bananas during ripening at ambient conditions were investigated. MT or CT treatments delayed ripening by retaining greener peel, higher firmness, titratable acidity (TA), but lower total soluble solids (TSS) and TSS/TA, weight loss, browning and electrolyte leakage than the control. Total phenol (TPC) and flavonoid contents (TFC) in both peel and pulp increased up to 6 days and then decreased and was higher in treated fruit than the control. Vitamin C content decreased up to 3 days, then increased and was higher in treated fruit than control. MT and CT combination exhibited the highest TPC, TFC and vitamin C contents compared to other treatments. Radical scavenging capacity (RSC) of peel and pulp increased up to 6 days, then decreased and was higher in treated fruit than the control. The treated fruit exhibited lower polyphenoloxidase (PPO) and hydrolytic enzymes but higher peroxidase (POD) activities in both peel and pulp than the control. Postharvest treatments with 0.5 mM MT and 1% CT alone or in combination could be used to retain quality of 'Williams' bananas during ripening.

Effects of Spirulina platensis and/or Allium sativum on Antioxidant Status, Immune Response, Gut Morphology, and Intestinal Lactobacilli and Coliforms of Heat-Stressed Broiler Chicken.

This study aims to evaluate the effectiveness of the dietary addition of Spirulina platensis (SP) and/or garlic powder (GP) on heat-stressed broiler chickens. For this purpose, 600 Ross-308 broiler chicks were allocated at 22 days of age into five groups (G1-G5), each comprising six groups of 20 birds each. Chickens kept in G1 (negative control) were fed a basal diet and raised at 26 ± 1 °C. Chickens kept in G2 to G5 were exposed to periodic heat stress (35 ± 1 °C for 9 h/day) from 22 to 35 days old. Chickens in G2 (positive control) were provided a basal diet, while G3, G4, and G5 were fed a basal diet enriched with SP (1 g/kg diet), GP (200 mg/kg diet), or SP/GP (1 g SP/kg + 200 mg GP/kg diet), respectively. The assessment parameters included the chickens' performance, malondialdehyde and total antioxidant capacity, blood biochemistry, intestinal morphology, and modulation of lactobacilli and total coliforms in the intestinal microbiota. Our findings demonstrated that supplementing heat-stressed chickens with SP and/or GP significantly mitigated the negative effects on the European production efficiency index (EPEF), survival rate, cholesterol profile, and oxidative stress markers. Chickens supplemented with GP and/or SP exhibited significantly better EPEF and survivability rates. Heat stress had a significant impact on both the gut structure and gut microbiota. However, SP and/or GP supplementation improved the gut morphology, significantly increased the intestinal lactobacilli, and reduced the coliform contents. It was also found that the simultaneous feeding of SP and GP led to even higher recovery levels with improved lipid metabolites, immunity, and oxidative status. Overall, supplementing chickens with SP and/or GP can alleviate the negative effects of heat stress.

Heat detoxification of Jatropha cucas meal and its effect on productive and reproductive performance of quail.

Jatropha is a large, multipurpose, drought-tolerant plant with many traits and great potential as a biofuel crop. It originates from Central America but is now distributed throughout the tropics, including Africa and Asia. The study determines whether the dietary inclusion of raw Jatropha cucas meal (RJM, 3.5%) had negative impacts on the reproductive and productive performances of male Japanese quail as well as whether these impacts could be mitigated by heating the jatropha meal at 100°C for 24 or 48 h (JH24 or JH48 respectively). One hundred twenty healthy mature male quails at the age of 12 wk were assigned randomly to 4 treatments. Every treatment had 6 replicates, with 5 birds per replicate. The RJM caused a considerable decline in fertility and a high mortality rate in quail, whereas heat-treated jatropha meal (JH24 or JH48) decreased these unwanted effects. The RJM significantly increased triglycerides, aspartate aminotransferase (AST), and alanine aminotransferase (ALT), while reducing total protein and albumin. These values returned to normal in the JH24 and JH48 groups. The RJM significantly reduced the testosterone and increased estradiol and hepatic content of vitellogenin (Vtg) and estrogen receptor alpha (ERα) while they were normal in JH48 group. Superoxide dismutase (SOD) and catalase (CAT) activities, and the reduced glutathione (GSH) content in testicular tissues were significantly reduced in the RJM group when compared to control. Protein carbonyl (PC), malondialdehyde (MDA), and 8-hydroxy 2 deoxyguanosine (8-OHdG) levels were significantly increased in the RJM group when compared to control. Heating of JM for 48 h reduced the 8-OHdG and MDA levels toward the control level better than JH24 and restored PC to normal. Based on the obtained results, The toxic components in JM could be eliminated through heat treatment, and extending the treatment duration to 48 h is recommended for transforming the potentially harmful jatropha meal into an alternative protein source for livestock nutrition.

Efficacy of 24-epibrassinolide-chitosan composite coating on the quality of 'Williams' bananas during ripening.

BACKGROUND: Banana fruit undergo rapid metabolic changes following the induction of ripening. They result in excessive softening, chlorophyll degradation, browning, and senescence during postharvest life. As part of a continuous effort to extend fruit shelf life and maintain the best possible quality, this study examined the effect of a 24-epibrassinolide (EBR) and chitosan (CT) composite coating on 'Williams' bananas ripening in ambient conditions. Fruit were soaked in 20 µM EBR, 10 g L-1 CT (w/v), and 20 µM EBR + 10 g L-1 CT solutions for 15 min and were kept at 23 ± 1 °C and 85-90% (RH) for 9 days. RESULTS: The combined treatment (20 µM EBR + 10 g L-1 CT) clearly delayed fruit ripening; bananas treated with this showed less peel yellowing, weight loss, and total soluble solids, and greater firmness, titratable acidity, membrane stability index, and ascorbic acid content than the untreated control. After the treatment, the fruit also presented higher radical scavenging capacity, and higher total phenol and flavonoid content. The activity of polyphenoloxidase and hydrolytic enzymes was lower, and that of peroxidase was higher in both the peel and pulp of all the treated fruit than in the control. CONCLUSION: The combined treatment (20 µM EBR + 10 g L-1 CT) is suggested as an effective composite edible coat to retain the quality of 'Williams' bananas during ripening. © 2023 Society of Chemical Industry.

Global calibration for non-targeted fraud detection in quinoa flour using portable hyperspectral imaging and chemometrics.

Quinoa is one of the highest nutritious grains, and global consumption of quinoa flour has increased as people pay more attention to health. Due to its high value, quinoa flour is susceptible to adulteration. Cross-contamination between quinoa flour and other flour can be easily neglected due to their highly similar appearance. Therefore, detecting adulteration in quinoa flour is important to consumers, industries, and regulatory agencies. In this study, portable hyperspectral imaging in the visible near-infrared (VNIR) spectral range (400-1000 nm) was applied as a rapid tool to detect adulteration in quinoa flour. Quinoa flour was adulterated with wheat, rice, soybean, and corn in the range of 0-98% with 2% increments. Partial least squares regression (PLSR) models were developed, and the best model for detecting the % authentic flour (quinoa) was obtained by the raw spectral data with R2p of 0.99, RMSEP of 3.08%, RPD of 8.77, and RER of 25.32. The model was improved, by selecting only 13 wavelengths using bootstrapping soft shrinkage (BOSS), to R2p of 0.99, RMSEP of 2.93%, RPD of 9.18, and RER of 26.60. A visualization map was also generated to predict the level of quinoa in the adulterated samples. The results of this study demonstrate the ability of VNIR hyperspectral imaging for adulteration detection in quinoa flour as an alternative to the complicated traditional method.

Opposite Effects of CRABP1 and CRABP2 Homologs on Proliferation of Breast Cancer Cells and Their Sensitivity to Retinoic Acid.

Resistance of tumor cells to retinoic acid (RA), a promising therapeutic agent, is the major factor limiting the use of RA in clinical practice. The mechanisms of resistance to RA are still poorly understood. Cellular Retinoic Acid Binding Proteins, CRABP1 and CRABP2, are essential mediators of RA signaling, but role of the two CRABP homologs in regulating cellular sensitivity to RA has not been well studied. In addition, the effects of CRABP1 and CRABP2 on cell proliferation have not been compared. Here, using a broad panel of breast cancer cell lines with different levels of RA sensitivity/resistance, we show for the first time that in the RA-sensitive cells, CRABP1 expression is restricted by methylation, and protein levels are highly variable. In the moderately-RA-resistant cell lines, high level of CRABP1 is observed both at the mRNA and protein levels, unchanged by inhibition of DNA methylation. The cell lines with maximum resistance to RA are characterized by complete repression of CRABP1 expression realized at transcriptional and posttranscriptional levels, and exogenous expression of each of the CRABP homologs has no effect on the studied characteristics. CRABP1 and CRABP2 proteins have opposing effects on proliferation and sensitivity to RA. In particular, CRABP1 stimulates and CRABP2 reduces proliferation and resistance to RA in the initially RA-sensitive cells, while in the more resistant cells the role of each homolog in both of these parameters is reversed. Overall, we have shown for the first time that CRABP proteins exert different effects on the growth and sensitivity to RA of breast cancer cells (stimulation, suppression, or no effect) depending on the baseline level of RA-sensitivity, with the effects of CRABP1 and CRABP2 homologs on the studied properties always being opposite.

Comparison of Methods for MicroRNA Isolation from Extracellular Vesicles Obtained from Ascitic Fluids.

Secreted extracellular vesicles (EVs) contain active biomolecules, including miRNAs, composition of which reflects epigenetic changes occurring in cells during pathological processes, in particular, malignant transformation. The accumulated pool of data on the role of EVs in carcinogenesis has stimulated investigations of the EV-derived cancer markers. The most important factor limiting development of this scientific direction is lack of "gold standards" both for methods of EV isolation from biological fluids and for analyzing their molecular content, including composition of miRNAs. Here we first examined efficacy of various methods for small RNA isolation from EVs contained in ascitic fluid for subsequent miRNA analysis. Comparison of different commercial kits showed advantages of the methods based on phenol-chloroform extraction: Total Exosome RNA & Protein Isolation Kit and miRNeasy Serum/Plasma Kit. Analysis of the small RNA transcriptome showed presence of various classes of molecules in the EVs, among which proportion of miRNAs averaged 6% and reaching 10% with the Total Exosome RNA & Protein Isolation Kit. The PureLink miRNA Isolation Kit demonstrated the lowest efficiency. The miRNeasy Advanced Serum/Plasma Kit showed the highest concentration of the small RNA fraction, miRNA proportion of which, however, did not exceed that obtained with the miRNeasy Serum/Plasma Kit and Total Exosome RNA & Protein Isolation Kit. Moreover, RT-PCR analysis of the individual molecules showed lower levels of each of investigated miRNAs (miR-1246, miR-200b-5p, miR-200c-3p, and miR-23a-3p) when using the miRNeasy Advanced Serum/Plasma Kit. In conclusion, Total Exosome RNA & Protein Isolation Kit and miRNeasy Serum/Plasma Kit can be considered as optimal kits in terms of performance based on combination of the studied characteristics, including small RNA concentration, percentage of microRNA according to bioanalyzer and sequencing results, and levels of individual miRNAs detected by RT-PCR.

Investigation of Potential In Vitro Anticancer and Antimicrobial Activities of Balanites aegyptiaca (L.) Delile Fruit Extract and Its Phytochemical Components.

The therapeutic importance of Balanites aegyptiaca in folk medicine for the treatment of several common human diseases has led researchers to conduct phytochemical and pharmacological studies on extracts from various parts of the plant. In the current study, the phytochemical composition of the B. aegyptiaca methanolic fruit extract was characterized, and its antimicrobial activity was evaluated together with the cytotoxic activity against MCF-7, PC-3, and Caco-2, compared with normal Vero cells. Further, its effects on cell cycle arrest, apoptosis induction and expression of apoptosis-related genes were assessed. The phytochemical screening revealed the presence of fatty acids and their esters in addition to phytosterols, steroid derivatives, and bioflavonoid glycosides with oleic and palmitic acids being the prevalent components (24.12 and 21.56%, respectively). The results showed considerable cytotoxic activity of the extract against the three cancer cell lines (MCF-7, PC-3, and Caco-2) with a selectivity index ranging from 5.07 to 6.52. This effect was further confirmed with the accompanied increased total apoptosis of treated PC-3 cells (19.22% of the total number of cells) compared to the control cells (0.64% of the total number of cells) with cell cycle arrest at G1 phase and the increased transcription of pro-apoptotic genes including P53 (3.69) and BAX (3.33) expressed as fold change (2^ ΔΔCT). The calculated minimum inhibitory concentration (MIC) was similar (62.5 µg/mL) against the three tested bacterial strains (Acinetobacter johnsonii, Serratia marcescens and Agrobacterium tumefaciens), while it was higher than 1000 µg/mL for the fungal species (Rhizoctonia solani, Penicillium italicum, and Fusarium oxysporium). Our findings suggest a promising anticancer activity for B. aegyptiaca, which paves the way for more detailed future studies.

The impact of COVID-19 on the sustainability of the environment, animal health and food security, and safety.

COVID-19 pandemic influenced the environment, animal health, and food security. Due to reduced human mobility, the air and water quality increased. Other environmental consequences were the personal protective types of equipment and their haphazard disposal. Atmospheric pollution could be a cofactor leading to an increased COVID-19 mortality rate. Lockdown, however, caused a reduction in air and water pollution. Noise pollution affects the health of individuals and communities in terms of cardiovascular disorders and sleeping problems. Meanwhile, the COVID-19 lockdown controls human activities that reduce noise pollution. Municipal waste affects the environment. Recycling has been reduced in some countries but not in Saudi Arabia. COVID-19 had a drastic effect on livestock production on national, regional, and global levels, affecting countries' capacities to prevent and control diseases of animals and increasing global poverty, becoming a threat to the sustainability of global food security and safety. Many lessons have been learned from the COVID-19 pandemic, so it is wise to study and analyze the previous lessons and shed some light on past pandemics such as the Spanish flu to understand the readings and earn experiences. This paper is focused on the interaction between the pandemic and environmental health from the public health concern rather than other health classifications.

Isolation and Characterization of Extracellular Vesicles from Gastric Juice.

EVs are involved in local and distant intercellular communication and play a vital role in cancer development. Since EVs have been found in almost all body fluids, there are currently active attempts for their application in liquid diagnostics. Blood is the most commonly used source of EVs for the screening of cancer markers, although the percentage of tumor-derived EVs in the blood is extremely low. In contrast, GJ, as a local biofluid, is expected to be enriched with GC-associated EVs. However, EVs from GJ have never been applied for the screening and are underinvestigated overall. Here we show that EVs can be isolated from GJ by ultracentrifugation. TEM analysis showed high heterogeneity of GJ-derived EVs, including those with exosome-like size and morphology. In addition to morphological diversity, EVs from individual GJ samples differed in the composition of exosomal markers. We also show the presence of stomatin within GJ-derived EVs for the first time. The first conducted comparison of miRNA content in EVs from GC patients and healthy donors performed using a pilot sampling revealed the significant differences in several miRNAs (-135b-3p, -199a-3p, -451a). These results demonstrate the feasibility of the application of GJ-derived EVs for screening for miRNA GC markers.

Extracellular Vesicles from Uterine Aspirates Represent a Promising Source for Screening Markers of Gynecologic Cancers.

Extracellular vesicles (EVs), including exosomes, are key factors of intercellular communication, performing both local and distant transfers of bioactive molecules. The increasingly obvious role of EVs in carcinogenesis, similarity of molecular signatures with parental cells, precise selection and high stability of cargo molecules make exosomes a promising source of liquid biopsy markers for cancer diagnosis. The uterine cavity fluid, unlike blood, urine and other body fluids commonly used to study EVs, is of local origin and therefore enriched in EVs secreted by cells of the female reproductive tract. Here, we show that EVs, including those corresponding to exosomes, could be isolated from individual samples of uterine aspirates (UA) obtained from epithelial ovarian cancer (EOC) patients and healthy donors using the ultracentrifugation technique. First, the conducted profiling of small RNAs (small RNA-seq) from UA-derived EVs demonstrated the presence of non-coding RNA molecules belonging to various classes. The analysis of the miRNA content in EVs from UA performed on a pilot sample revealed significant differences in the expression levels of a number of miRNAs in EVs obtained from EOC patients compared to healthy individuals. The results open up prospects for using UA-derived EVs as a source of markers for the diagnostics of gynecological cancers, including EOC.

COVID-19 and the adaptive evolution of genetic counseling.

Emerging diseases such as the Coronavirus Disease (COVID-19) have exposed severe weaknesses in the United States and global health. Healthcare systems have struggled and are still severely challenged and strained by this pandemic. It is clear that additional resources are needed to support healthcare providers in managing this and future pandemics. Genetic counselors can play an important supporting role in this fragile ecosystem because their comprehensive and broad training makes them uniquely qualified to meet many of the challenges that arise when healthcare workers and patients are faced with novel diseases. This paper describes the recent involvement of a telegenetic counseling company (Metis Genetics) in communicating and explaining COVID-19 serum antibody results to patients and physicians. This experience demonstrates how genetic counselors may be called upon to play a vital supporting role in the management of infectious disease pandemics. From May 2020 to July 2020, our genetic counseling telegenetics team was asked to provide support to more than 1,580 patients who underwent serum COVID-19 antibody testing and to educate their healthcare providers on the performance properties of this new test. The genetic counselors were able to utilize their expertise to convey test results, information on Center for Disease Control and Prevention (CDC) recommendations, COVID-19 fact-based evidence, to provide psychological support and reassurance to patients, and to respond to providers questions about the test. This experience suggests that the genetic counselors' skillset that has allowed the profession to continuously evolve can also be used in the management of pandemics by communicating directly with the public, supporting other healthcare workers, and assisting individual patients and families navigate the many medical and psychological issues caused by such events.

Bovine serum albumin functionalized blue emitting Ti3 C2 MXene quantum dots as a sensitive fluorescence probe for Fe3+ ion detection and its toxicity analysis.

In the present work, an improved class of protein functionalized fluorescent 2D Ti3 C2 MXene quantum dots (MXene QDs) was prepared using a hydrothermal method. Exfoliated 2D Ti3 C2 sheets were used as the starting precursor and transport protein bovine serum albumin (BSA) was used to functionalize the MXene QDs. BSA-functionalized MXene QDs exhibited excellent photophysical property and stability at various physiological parameters. High-resolution transmission electron microscopy analysis showed that the BSA@MXene QDs were quasispherical in shape with a size of ~2 nm. The fluorescence intensity of BSA@MXene QDs was selectively quenched in the presence of Fe3+ ions. The mechanism of fluorescence quenching was further substantiated using time-resolved fluorescence and Stern-Volmer analysis. The sensing assay showed a linear response within the concentration range 0-150 µM of Fe3+ ions with excellent limit of detection. BSA@MXene QDs probe showed good selectivity toward ferric ions even in the presence of other potential interferences. The practical applicability of BSA@MXene QDs was further tested in real samples for Fe3+ ion quantification and the sensor had good recovery rates. The cytotoxicity studies of the BSA@MXene QDs toward the human glioblastoma cells revealed that BSA@MXene QDs are biocompatible at lower doses and showed significant cytotoxicity at higher dosages.

COVID-19 pandemic: impacts on bees, beekeeping, and potential role of bee products as antiviral agents and immune enhancers.

COVID-19 pandemic has passed to the front all the contradictions of the beekeeping sector: the valuable role of bee products as immune enhancers and antiviral agents and the impact that unsustainability of human activities has on bees' health and survival. The COVID-19 emergency led several countries to adopt severe restriction measures to contrast the infection. The lowering of industrial and commercial activities, transports, and the general lockdown had immediate consequences on the air quality, significantly improving environmental conditions. This had a positive impact on honeybees' life's quality. On the other hand, the bee and beehive transportation limitations threaten to hit food production by affecting the pollinator service, and this is particularly true in large, food-exporting countries like the USA and China where due to the few numbers of local bees, beekeepers import them by other countries and convey by truck hives for thousands of kilometers to pollinate crops. Furthermore, honeybee products, focusing on their natural pharmacological properties, can play an essential role as a potential natural contrast to the virus by enhancing the immunity defenses of both humans and animals, and their demand by consumers is expected to increase. Several researchers in the last months focused their attention on bee products to evaluate their effect in the cure of COVID-19 patients to ameliorate the symptoms or to contrast the coronavirus directly. This review reports these preliminary results.

An overview of recent advances and applications of FT-IR spectroscopy for quality, authenticity, and adulteration detection in edible oils.

Authenticity and adulteration detection are primary concerns of various stakeholders, such as researchers, consumers, manufacturers, traders, and regulatory agencies. Traditional approaches for authenticity and adulteration detection in edible oils are time-consuming, complicated, laborious, and expensive; they require technical skills when interpreting the data. Over the last several years, much effort has been spent in academia and industry on developing vibrational spectroscopic techniques for quality, authenticity, and adulteration detection in edible oils. Among them, Fourier transforms infrared (FT-IR) spectroscopy has gained enormous attention as a green analytical technique for the rapid monitoring quality of edible oils at all stages of production and for detecting and quantifying adulteration and authenticity in edible oils. The technique has several benefits such as rapid, precise, inexpensive, and multi-analytical; hence, several parameters can be predicted simultaneously from the same spectrum. Associated with chemometrics, the technique has been successfully implemented for the rapid detection of adulteration and authenticity in edible oils. After presenting the fundamentals, the latest research outcomes in the last 10 years on quality, authenticity, and adulteration detection in edible oils using FT-IR spectroscopy will be highlighted and described in this review. Additionally, opportunities, challenges, and future trends of FT-IR spectroscopy will also be discussed.

CRABP1 and CRABP2 Protein Levels Correlate with Each Other but Do Not Correlate with Sensitivity of Breast Cancer Cells to Retinoic Acid.

Retinoic acid (RA) binding proteins, CRABP1 and CRABP2, are molecular chaperones that mediate intracellular activity of RA, the key promoter of cell differentiation with tumor suppressor activity. One of the main functions of CRABP2 is delivery and transfer of RA to the nuclear receptors RAR/RXR, which leads to activation of the transcription of a wide range of retinoid-responsive genes. The functions of CRABP1 are less studied but are apparently associated with sequestration of RA in cytoplasm and limitation of its transcriptional activity, suggesting involvement of this protein in the development of RA resistance. The mechanisms regulating activity of CRABP1 are also poorly understood. Comparison of the CRABP1 level in tumor cell lines of various origins, performed for the first time here, showed absence of the CRABP1 protein in the cell lines of tumors considered to be RA-resistant, and pronounced production of this protein in the RA-sensitive cells. However, analysis carried out with a panel of breast cancer cell lines with different levels of RA-sensitivity showed that there was no correlation between the production of CRABP1 protein and the sensitivity of the cells to RA. At the same time, we found strong correlation between the expression of CRABP1 and CRABP2 proteins in all studied cell types, regardless of their origin and RA-sensitivity/resistance. Moreover, suppression of the CRABP1 level in both RA-sensitive and RA-resistant cells was shown in the cells with cells with knockdown of CRABP2 gene. The revealed CRABP2-dependent regulation of CRABP1 production is a new mechanism of the intracellular retinoic signaling system.

COVID-19: pathogenesis, advances in treatment and vaccine development and environmental impact-an updated review.

Diseases negatively impact the environment, causing many health risks and the spread of pollution and hazards. A novel coronavirus, severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has led to a recent respiratory syndrome epidemic in humans. In December 2019, the sudden emergence of this new coronavirus and the subsequent severe disease it causes created a serious global health threat and hazards. This is in contrast to the two aforementioned coronaviruses, SARS-CoV-2 (in 2002) and middle east respiratory syndrome coronavirus MERS-CoV (in 2012), which were much more easily contained. The World Health Organization (WHO) dubbed this contagious respiratory disease an "epidemic outbreak" in March 2020. More than 80 companies and research institutions worldwide are working together, in cooperation with many governmental agencies, to develop an effective vaccine. To date, six authorized vaccines have been registered. Up till now, no approved drugs and drug scientists are racing from development to clinical trials to find new drugs for COVID-19. Wild animals, such as snakes, bats, and pangolins are the main sources of coronaviruses, as determined by the sequence homology between MERS-CoV and viruses in these animals. Human infection is caused by inhalation of respiratory droplets. To date, the only available treatment protocol for COVID-19 is based on the prevalent clinical signs. This review aims to summarize the current information regarding the origin, evolution, genomic organization, epidemiology, and molecular and cellular characteristics of SARS-CoV-2 as well as the diagnostic and treatment approaches for COVID-19 and its impact on global health, environment, and economy.

Self-Monitoring of Blood Glucose and Hypoglycemia Association During Fasting in Ramadan Among Patients with Diabetes.

PURPOSE: The study aims to assess current practices of patients with diabetes to control blood glucose levels during Ramadan. PATIENTS AND METHODS: A cross-sectional approach has been used for collecting data through a structured and interview-based questionnaire to assess the association between self-monitoring of blood glucose (SMBG) and hypoglycemia. The questionnaire has recorded information about demographics, duration of diabetes, and treatment of diabetes, and hypoglycemia complications faced during Ramadan. The primary outcomes of this study include frequency of SMBG during fasting in Ramadan and association of SMBG and hypoglycemia and break of fasting. However, the secondary outcomes include medications, glycemic control, and other influencing factors. The data was analyzed using Statistical Package of Social Sciences (SPSS) version 20. RESULTS: The findings have shown that the majority of the patients used a combination of metformin+sulphonylurea (23.02%) following metformin+insulin (20.86%), insulin (12.94%), and metformin (8.63%). Whereas diet control, high or low blood sugar, insulin dose adjustment in fasting conditions were the most influential factors during Ramadan when the blood sugar levels were tested. Majority of the patients monitored their blood glucose level during pre-iftar (56.8%) following to hypoglycemia (30.2%), post-iftar (29.4%), and rarely monitored in afternoon (3.5%) despite that only 10.1% monitored their blood glucose on a daily basis. Patients who had symptoms of hypoglycemia and had to break their fasting at least once were 41% and 27.2%, respectively. There is a significant association between age and gender with symptoms of low blood sugar level. Additionally, a significant association between blood sugar monitoring and high blood sugar level has been shown (p=0.041), indicating that lack in daily blood sugar monitoring can increase the blood sugar level of a patient during Ramadan. CONCLUSION: The present study has helped in providing better understanding about the self-monitoring of blood glucose level and hypoglycemia. Furthermore, it also emphasizes the pre-Ramadan education about when to break their fasting along with frequency and timing of SMBG.