Vol 4, No 2 (2019)
Research paper
Published online: 2019-08-06

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Analysis of Patients Who Present to Emergency Departments During Ramadan

Togay Evrin1, İlker Akbaş2, Abdullah Osman Koçak3, Sibel Güçlü Utlu4, Burak Katipoğlu1, Lukas Szarpak5, Meryem Betos Koçak6, Zeynep Çakır3
Disaster Emerg Med J 2019;4(2):33-41.


INTRODUCTION: Fasting is one of the five basic obligations of Islam. Muslims fast during the month of Ramadan according to the lunar calendar. Fasting during Ramadan involves abstinence from food and drinks from sunrise to sunset. The present study investigated the effect of fasting during Ramadan in patients who presented to emergency departments. Results of this study may guide healthcare authorities in countries that provide health services to Muslim communities because of increased migration.

MATERIAL AND METHODS: This is the first prospective multicentre study to examine emergency department applications for Ramadan. The study was performed between 05.26.2017 and 06.24.2017. Patients were classified according to cardiopulmonary complaints, trauma-associated complaints, neurological complaints, gastrointestinal complaints, headache, renal colic, upper respiratory tract complaints, and malaise. Vital signs, age, gender, presentation type, complaint type, hospital stay duration, requested laboratory examination, radiological examination, treatment outcomes, application time, smoking status, and fasting status of the study patients were recorded by using a questionnaire.

RESULTS: Fasting and non-fasting patients showed a significant difference with respect to presentation type, gastrointestinal complaints, upper respiratory tract complaints, hospitalization status, requested radiological and biochemical examinations, hospitalization duration, and application time (p < 0.05).

CONCLUSIONS: To the authors’ knowledge, the present study is the first to compare the complaints of fasting and non-fasting patients during Ramadan. The authors feel that this study is superior to several previous studies because it has been performed using a different perspective and provides more accurate and objective data than those reported in previous studies.

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  1. Assaad RAl, Bachir R, Sayed MEl. Impact of Ramadan on emergency department visits and on medical emergencies. Eur J Emerg Med. 2017: 1.
  2. Butt T, Khan HU, Ahmed I, et al. Emergency department attendance patterns during Ramadan. Ann Saudi Med. 2016; 36(4): 258–264.
  3. Beano AM, Zmaili MA, Gheith ZH, et al. Predetermined Anti-Diabetic Drug Regimen Adjustments during Ramadan Fasting: An Observational Study of Safety. Endocrinol Metab (Seoul). 2017; 32(2): 265–273.
  4. 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(1): 39–45.
  5. Mehmood A, Khan IQ, Mir MU, et al. Vulnerable road users are at greater risk during Ramadan — results from road traffic surveillance data. J Pak Med Assoc. 2015; 65(3): 287–291.
  6. Pekdemir M, Ersel M, Yilmaz S, et al. No significant alteration in admissions to emergency departments during Ramadan. J Emerg Med. 2010; 38(2): 253–256.
  7. 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(8): 900–905.
  8. Lugo L, Cooperman A, Bell J, et al. The ’s Muslims: Unity an rld’s Muslims: Unity and Diversity. World. 2012.
  9. Miller T. Mapping the global Muslim population: a report on the size and distribution of the world’s Muslim population. Washington, DC: Pew Research Center. 2009.
  10. Halasa W. Effect of Ramadan fasting on emergency walk-in-clinics in Jordan. Br J Gen Pract. 2014; 64(625): 388.
  11. Husain R, Duncan MT, Cheah SH, et al. Effects of fasting in Ramadan on tropical Asiatic Moslems. Br J Nutr. 1987; 58(1): 41–48.
  12. Göçmen E, Koç M, Tez M, et al. Effect of Ramadan on surgical emergencies. Ann Emerg Med. 2004; 44(3): 283–285.
  13. Temizhan A, Dönderici O, Ouz D, et al. Is there any effect of Ramadan fasting on acute coronary heart disease events? Int J Cardiol. 1999; 70(2): 149–153.
  14. Mustafa K, Mahmoud N, Gumno K, et al. The effect of fasting in Ramadan: serum uric acid lipid concentration. Br J Nutr. 1978; 40: 573–581.
  15. Al Suwaidi J, Zubaid M, Al-Mahmeed WA, et al. Impact of fasting in Ramadan in patients with cardiac disease. Saudi Med J. 2005; 26(10): 1579–1583.
  16. 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(1): 30–33.
  17. 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.
  18. Göçmen E, Koç M, Tez M, et al. Effect of Ramadan on surgical emergencies. Ann Emerg Med. 2004; 44(3): 283–285.
  19. Bener A, Absood GH, Achan NV, et al. Road traffic injuries in Al-Ain City, United Arab Emirates. J R Soc Health. 1992; 112(6): 273–276.
  20. Langford EJ, Ishaque MA, Fothergill J, et al. The effect of the fast of Ramadan on accident and emergency attendances. J R Soc Med. 1994; 87(9): 517–518.
  21. Bener A, Hamad A, Fares A, et al. Is there any effect of Ramadan fasting on stroke incidence? Singapore Med J. 2006; 47(5): 404–408.
  22. Akhan G, Kutluhan S, Koyuncuoglu HR. Is there any change of stroke incidence during Ramadan? Acta Neurol Scand. 2000; 101(4): 259–261.
  23. Ozkan S, Durukan P, Akdur O, et al. Does Ramadan fasting increase acute upper gastrointestinal haemorrhage? J Int Med Res. 2009; 37(6): 1988–1993.
  24. Iraki L, Abkari A, Vallot T, et al. Effect of Ramadan fasting on intragastric pH recorded during 24 hours in healthy subjects. Gastroenterol Clin Biol. 1997; 21(11): 813–819.
  25. Hakkou F, Tazi A, Iraqui L, et al. The observance of Ramadan and its repercussion on gastric secretion. Gastroenterol Clin Biol. 1994; 18(3): 190–194.
  26. Dönderici O, Temizhan A, Küçükbaş T, et al. Effect of Ramadan on peptic ulcer complications. Scand J Gastroenterol. 1994; 29(7): 603–606.
  27. Hosseini SV, Torabijahromi M, Mosallaei M, et al. The effect of season and Ramadan fasting on the onset of acute cholecystitis. Saudi Med J. 2006; 27(4): 503–506.
  28. Drescher M, Wimpfheimer Z, Khalef SA, et al. 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: The Journal of Head and Face Pain. 2011; 52(4): 573–581.
  29. Mosek A, Korczyn AD. Fasting headache, weight loss, and dehydration. Headache. 1999; 39(3): 225–227.
  30. Torelli P, Evangelista A, Bini A, et al. Fasting headache: a review of the literature and new hypotheses. Headache. 2009; 49(5): 744–752.
  31. 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(6): 1199–1202.
  32. Cevik Y, Corbacioglu SK, Cikrikci G, et al. The effects of Ramadan fasting on the number of renal colic visits to the emergency department. Pak J Med Sci. 2016; 32(1): 18–21.
  33. al-Hadramy MS. Seasonal variations of urinary stone colic in Arabia. J Pak Med Assoc. 1997; 47(11): 281–284.
  34. Basiri A, Moghaddam SM, Khoddam R, et al. Monthly variations of urinary stone colic in Iran and its relationship to the fasting month of Ramadan. J Pak Med Assoc. 2004; 54(1): 6–8.
  35. Miladipour AH, Shakhssalim N, Parvin M, et al. Effect of Ramadan fasting on urinary risk factors for calculus formation. Iran J Kidney Dis. 2012; 6(1): 33–38.

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