Thyroxin can be taken half an hour before Sehri or at bed time if patient takes dinner early-Prof. Najmul Islam


 Ramadan & Health Conference at JSMU-III

Thyroxin can be taken half an hour before Sehri or at
bed time if patient takes dinner early-Prof. Najmul Islam

Per-Ramadan education will make fasting safe otherwise
diabetics will have several complications - Yakoob Ahmedani

KARACHI: Prof. Najmul Islam from Aga Khan University was the first speaker in the second session of Ramada & Health Conference jointly organized by Jinnah Sindh Medical University and SSIDE from September 9-10th 2017. This session was chaired by Prof. Noshed Sheikh Vice Chancellor of Liaquat University of Medical & Health Sciences along with Prof. Zaman Sheikh Director of SSIDE at Sir Syed Institute of Medical Sciences, Karachi. The topic of Prof. Najmul Islam’s presentation was management of Thyroid disorders. These patients he said, need some adjustments in treatment during Ramadan as there are changes in T3 and T4. There are changes in hormones levels as well during fasting. Thyroxin is to be taken orally on empty stomach. Medications affect its absorption. Taking thyroxin at bed time is another option, it has the same effect but we have to be careful as these studies were done in the West where people take dinner early. In Pakistan it may not be possible due to delayed dinner.

Almost 90% of hypothyroidism, he said, are due to grave’s disease. Thyroiditis treatment is with NSAIDs, steroids, beta blockers along with weight loss. Shortness of breath is seen in some patients. Methamezole is safe. Carbimazole is available in Pakistan. Anti-thyroid drugs take at least a week to show effects. Beta blockers are added for quick symptoms control. Thyroiditis, Prof. Najmul Islam opined is a self-limiting disease. Thyroxin can be taken half an hour before Sehri or at bed time if the patient takes dinner early.

Prof Tariq Rafi Vice Chancellor of JSMU presenting a memento to Sikandar Ali Mandhro Sindh Minister
Law at the inaugural session of Ramadan & Health Conference organized by JSMU and SSIDE
On right Mr. Mandhro is presenting memento to Prof. Mafauzy Mohammad from Malaysia.

Prof. Yakoob Ahmedani from BIDE, Baqai Medical University spoke on Lessons learnt during Pre-Ramadan Diabetes Education. He pointed out that educating the patients will make fasting safe otherwise they will have several problems and complications. During our practice and in this study we have learnt that education is necessary for patients with diabetes as well as doctors before Ramadan. He quoted various studies. Some doctors felt that use of insulin or blood glucose tests will break the fast which is not true. That is why we started this Ramadan specific education. Almost 33-48% of patients breakfast due to hypoglycemia after education which has been documented in various studies. Majority of the patients change their life style and they do not suffer from Diabetes Ketoacidosis and they also do not need any hospitalization. We have done patient to patient as well as group education besides educating the patients with diabetes through leaflets. We observed that acute complications in these patients with diabetes were much less after this Ramadan specific education.

Prof. Jamal Zafar from Islamabad talked about Diet in Diabetics during Ramadan. This holy month, he opined, provides a good opportunity to reduce weight and improve quality of life but actually what happens is that since we use lot of fats, fry items for Iftar, many patients end up increasing their weight. Ramadan also provides an opportunity to maintain glycaemia besides helping in having discipline in life. Adjustment in medications is necessary during Ramadan. The patients should be offered advice about managing various symptoms. Education of patients about medical nutrition helps avoiding the risks. These patients should be advised to have Sehar as late as possible and early Iftar. Avoid fry foods and change physical activity. During Ramadan sleep pattern also gets disturbed. Total calorie intake should be between 1200-2200 of which 50% should be carbohydrates. Sugary drinks should be avoided. It is important that diet plan for individuals should be prepared and while doing so dietary pattern of individuals and the society as a whole should be taken into account. He concluded his presentation by suggesting that patients with diabetes during Ramadan should have early Iftar and Sehri as late as possible.

Prof. Mohsin Naymati from Iran was the next speaker who talked about advances in practices and Guidelines for patients with diabetes specific to Ramadan. He pointed out that by the Year 2030 it is estimated that there will be 2.2 Billion Muslims in the world which will be 26% of the world population which will be Muslims. There is a faster population growth among Muslims. We have people with Type I and Type2 diabetes, some women are pregnant during Ramadan, some are lactating, there are patients with stroke, epilepsy, asthma, multiple sclerosis, Gastric Bypass Surgery, Fatty Liver, NASH and many other diseases. We need scientific evidence to show whether fasting is safe for these patients. Adjustments in dosage of certain drugs is needed. PubMed search showed that there were 877 papers on this subject til 2017 which shows that very little research was going on in this field. We have to do research because it is our and not problem of non-Muslim scientists overseas.

Prof. Noshad Shaikh along with Prof.Tariq Rafi and Prof. Zaman Sheikh presenting mementoes to
Dr. Mohsin Naymati from Iran and Prof. Yakoob Ahmedani from BIDE during the
Ramadan and Health
Conference organized by JSMU recently.

Many ISI or journals with Impact Factor do not encourage this type of research. There are very few sites and research centers in the Muslim world. We need guidelines. EPIDIAR was the first such study which looked at fasting during Ramadan. It was a mostly observational study. There are a very few RCTs on Ramadan and Health while we need much more. We need more papers, more books. We have recently launched the Fasting Journal in Mashad. His advice to the healthcare professionals was to at least keep a specific session on Ramadan and Health at every medical conference particularly conferences related to nutrition and diabetes, he added.

Prof. Noshad Shaikh Chairman of the Session in his concluding remarks suggested that we should have a specific website which should provide all such related information on Ramadan and Health and this website should be constantly updated adding any latest information.

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