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Evaluation of Forensic Deaths During the Month of Ramadan in Konya, Turkey, Between 2000 and 2009

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Ramadan is a holy month for Muslim people and includes long fasting periods. During Ramadan, practicing Muslims not only fast, but they also abstain from any kind of medication, smoking, sexual intercourse, and alcohol from sunrise to sunset. In the 10-year period between 2000 and 2009, it was determined that a total of 4881 death examinations and autopsies were performed at the Konya Branch of the Forensic Medicine Council (Turkey). All of the reports were retrospectively evaluated for demographic features of the cases and the manner of death. In the studied time period, a total of 491 deaths (10.1%) occurred in Ramadan. The manner of death was accident in 369 (75.2%) of the cases in Ramadan, 3107 (70.8%) of the other cases; suicide in 27 (5.5%) of the cases in Ramadan, 367 (8.4%) of the other cases; and homicide in 28 (5.7%) of the cases in Ramadan, 375 (8.5%) of the other cases. There was a significant statistical difference in terms of the manner of death between the deaths in Ramadan and in the remaining part of the year (P < 0.05). Our study suggested that there was an increase in accidental and natural deaths and a decrease in suicide and homicides in Ramadan.
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Evaluation of Forensic Deaths During the Month of
Ramadan in Konya, Turkey, Between 2000 and 2009
Serafettin Demirci, MD,* Kamil Hakan Dogan, MD, PhD,Þand Sermet Koc, MDþ
Abstract: Ramadan is a holy month for Muslim people and includes
long fasting periods. During Ramadan, practicing Muslims not only fast,
but they also abstain from any kind of medication, smoking, sexual
intercourse, and alcohol from sunrise to sunset. In the 10-year period
between 2000 and 2009, it was determined that a total of 4881 death
examinations and autopsies were performed at the Konya Branch of the
Forensic Medicine Council (Turkey). All of the reports were retro-
spectively evaluated for demographic features of the cases and the
manner of death. In the studied time period, a total of 491 deaths
(10.1%) occurred in Ramadan. The manner of death was accident in
369 (75.2%) of the cases in Ramadan, 3107 (70.8%) of the other cases;
suicide in 27 (5.5%) of the cases in Ramadan, 367 (8.4%) of the other
cases; and homicide in 28 (5.7%) of the cases in Ramadan, 375 (8.5%)
of the other cases. There was a significant statistical difference in terms
of the manner of death between the deaths in Ramadan and in the re-
maining partof the year (PG0.05). Our study suggested that there was an
increase in accidental and natural deaths and a decrease in suicide and
homicides in Ramadan.
Key Words: forensic, fasting, death, Ramadan
(Am J Forensic Med Pathol 2013;34: 267Y270)
One of the 5 fundamental rituals of Islam, the religion pro-
fessed by more than 1 billion people, is fasting during the
month of Ramadan. Muslims neither eat nor drink anything
from dawn until sunset.
1
Ramadan is the ninth month of the
Islamic lunar calendar. This calendar is based on 12 lunar
months in a year of 354 or 355 days, used to date events in many
Muslim countries (concurrently with the Gregorian calendar),
and used by Muslims everywhere to determine the proper day
on which to celebrate Islamic holy days and festivals.
During Ramadan, practicing Muslims not only fast, but
they also abstain from any kind of medication, smoking, sexual
intercourse, and alcohol from sunrise to sunset.
2
These dietary
and lifestyle changes may affect forensic deaths.
It is important to note that Ramadan is a lunar month, and
each year it occurs 11 to 12 days earlier. Each 9 years, Ramadan
occurs in a different season; the length and temperature of
fasting days also change.
3
The period in which the person fasts
may vary depending on the geographic location of the country
and the season of the year and can be as long as 20 hours per
day. Following fasting, at sunset people usually eat a great meal
and worship for a long time, which requires some effort. Before
dawn, men get a meal (sahoor) and perform the morning wor-
ship.
4
The first 3 days of the next month is spent in celebrations
and is observed as the ‘‘Festival of Breaking Fast.
To the best of our knowledge, there is not any study on
forensic deaths in Ramadan in the literature. This study aimed
to investigate forensic deaths in Ramadan.
MATERIALS AND METHODS
Konya is the fourth largest city in Turkey, which the study
was carried out in. It is located in the Middle Anatolia Region,
and according to the census data for 2011, the total population
is 2,038,555, of which 1,009,855 are male and 1,028,700 are
female.
5
This study retrospectively investigated 4881 death exam-
inations and autopsies that were performed at the Konya
Branch of the Forensic Medicine Council (Turkey) between
2000 and 2009. Since the lunar (Muhammadan) calendar is 11
to 12 days shorter than the solar year, time periods corre-
sponding to the month of Ramadan in the Gregorian calendar
were established,
6
and the deaths that occurred in these dates
were classified as Ramadan deaths (Table 1).
All of the reports were retrospectively evaluated for de-
mographic features of the cases, manner of death, and cause
of death. The forensic deaths that occurred in Ramadan were
compared with the forensic deaths that occurred in the remaining
part of the year. Statistical analysis was performed using SPSS
(Statistical Package for Social Sciences, SPSS Inc, Chicago, Ill)
version 16.0, and W
2
test was used for the evaluation of parameters.
RESULTS
In the studied time period, of the 4881 total forensic deaths
491 (10.1%) of them occurred in Ramadan. Most of the Ram-
adan deaths were in 2003 (n = 69), and most of the non-
Ramadan deaths were in 2007 (n = 639). The distribution of
TABLE 1. Exact Dates of Ramadan According to the Gregorian
Calendar Between 2000 and 2009
Common
Era
Ramadan
Starting Date End Date Lunar Year
2000 27 November 26 December 1421
2001 16 November 15 December 1422
2002 5 November 4 December 1423
2003 26 October 24 November 1424
2004 14 October 12 November 1425
2005 4 October 2 November 1426
2006 23 September 22 October 1427
2007 12 September 11 October 1428
2008 1 September 30 September 1429
2009 21 August 19 September 1430
ORIGINAL ARTICLE
Am J Forensic Med Pathol &Volume 34, Number 3, September 2013 www.amjforensicmedicine.com 267
Manuscript received December 17, 2012; accepted February 22, 2013.
From the *Department of Forensic Medicine, Meram Medical School,
Necmettin Erbakan University; and Department of Forensic Medicine,
Faculty of Medicine, Selcuk University, Konya; and Department of
Forensic Medicine, Cerrahpasa Medical School, Istanbul University,
Istanbul, Turkey.
The authors report no conflicts of interest.
Reprints: Kamil Hakan Dogan, MD, PhD, Department of Forensic Medicine,
Faculty of Medicine, Selcuk University, Aleaddin Keykubat Campus,
42075 Selcuklu, Konya, Turkey. E-mail: drhakan2000@gmail.com.
Copyright *2013 by Lippincott Williams & Wilkins
ISSN: 0195-7910/13/3403Y0267
DOI: 10.1097/PAF.0b013e3182a0a430
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Ramadan and non-Ramadan deaths according to years is shown
in Figure 1.
As the Ramadan is a month of the lunar calendar, between
the years 2000 and 2009, Ramadan months were overlapping
with the months August, September, October, November, and
December of the Gregorian calendar. Most of the Ramadan
deaths occurred in November (n = 172), and most of the non-
Ramadan deaths occurred in August (n = 502) in the time pe-
riod studied (Fig. 2).
Mean forensic deaths per year were 49.1 for Ramadan
and 43.9 for the other months. Mean ages of the victims were
38.4 T21.7 years for Ramadan and 37.5 T22.1 years for the
remaining period. Seventy-four percent (n = 363) of the vic-
tims were male in Ramadan, and 73% (n = 3206) were male
for the remaining period (Fig. 3).
The manner of death was accident in 369 (75.2%) of the
cases in Ramadan, 3107 (70.8%) of the other cases; suicide in
27 (5.5%) of the cases in Ramadan, 367 (8.4%) of the other
cases; homicide in 28 (5.7%) of the cases in Ramadan, 375
(8.5%) of the other cases; and natural causes in 64 (13.0%) of
the cases in Ramadan, 523 (11.9%) of the other cases (Table 2).
It was determined that the difference of the ratio of manner of
death between Ramadan and non-Ramadan was statistically
significant (PG0.05).
DISCUSSION
Some studies indicate changes in specific mortality rates
during special festivals or holiday periods.
7Y11
Several series
also have evaluated Ramadan’s effect on general health in Muslim
populations.
4,12Y19
However, any studies that evaluate the re-
lationship between Ramadan and forensic deaths could not be
found in the literature review.
Turkey is a secular Islamic country, and more than 99% of
the population is Muslim.
20
Although a significant proportion
of Muslims may not follow all the Islamic principles, Ramadan
fasting is the most popular ritual in the country, and at least 70%
of Muslims fast regularly during the month of Ramadan.
4,21
Ramadan fasting differs from other types of hunger as it
is also a self-discipline.
1
Muslims have a more sedentary life
both spiritually and physiologically during the month of Rama-
dan.
4
According to Muslim teaching, Ramadan is the month
during which the holy Koran was revealed. Fasting is thought
to endow the believer with the habit of self-control, helping
FIGURE 1.Distribution of the Ramadan and non-Ramadan deaths according to years.
FIGURE 2.Distribution of the Ramadan and non-Ramadan deaths according to months of the Gregorian calendar.
Demirci et al Am J Forensic Med Pathol &Volume 34, Number 3, September 2013
268 www.amjforensicmedicine.com *2013 Lippincott Williams & Wilkins
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
to avoid sin.
22
Most people also continue to abstain from al-
cohol intake after sunset until Ramadan month is over.
23
The physical fatigue associated with fasting lowers one’s
sense of well-being and results in impairment of cognitive
function, as shown by performance in flicker fusion tests.
24
Bener et al
25
reported that the number of people injured in
traffic accidents was slightly higher during Ramadan than at
other periods of the year. In another study from England, it was
stated that emergency department admission rates were higher
during Ramadan among the Muslim population, and both nonY
accident-related and accident-related attendances were high dur-
ing Ramadan than the periods before and after Ramadan.
22
The
higher rates of accidents as the manner of death in Ramadan than
the remaining part of the year may be related with the impairment
of cognitive function due to physical fatigue, and this finding is
consistent with the literature.
In fact, Ramadan fasting has some probable negative
effects on patients with coronary heart disease; the obligation
that the daily calorie intake has to be taken in 1 or 2 meals,
instead of 3 to 5, is an effort. The obligation that a heavy
physical worship is performed after a heavy meal and after
sahoor, which is before dawn in relatively cold weather, walk-
ing toward the mosque seem to be unwise for patients with
coronary heart diseases The other negative effects are that
during fasting patients cannot take any drugs, such as coronary
dilatator, antihypertensive drugs, antiaggregant drugs, or fast-
reacting nitrites. The regimen of patients with diabetes is also
negatively affected by unfamiliar diet and restrictions on drug
use during fasting and so on.
4,26,27
‘Natural causes’’ as the man-
ner of death were found slightly higher in Ramadan in this study.
Under Islam, birth and death are considered divine decrees,
and therefore, suicide is considered a crime, and even thinking
about suicide is prohibited, because this would be a reflection
of one’s lack of commitment and degree of despair. Suicide
is killing oneself who was created by God, andVas in other
monotheistic religionsVsuicide is one of the greatest sins
in Islam. Thus, this specific commandment plays a great role
in the prevention of suicides among Muslim communities.
28Y31
It was found that suicide rate was slightly lower in Ramadan in
this study. This may be due to the fact that most of the people’s
religious feelings are higher in Ramadan than in the other
months of the year.
Daily routines are markedly changed during Ramadan.
Although people fast during the daytime, they supply their bodies’
needs between sunset and sunrise. Thus, the obligation to eat
and smoke only during the night has been shown to change the
rhythm of life, including sleep and eating schedules and alter-
nation of working and resting times. As a result of withdrawal
during the daytime and massive intake after sunset, people
have been shown to have more irritability and anxiety during
Ramadan.
32
However, broad-based market research conducted
throughout Turkey during Ramadan has shown that alcohol
sales and consumption decrease noticeably during Ramadan.
Consequently, decreased alcohol consumption results in a de-
creased ratio of fights, loss of self-control, and violence, all of
which result in a decreased ratio of violence-induced pene-
trating injuries such as stab wounds and gunshot wounds.
23
We
found a slight decrease in homicide rates in Ramadan in this
study. As penetrating injuries are the most used methods of
homicides, our finding is consistent with the literature.
According to the findings of this study, it may be con-
cluded that physiologic and behavioral changes during Rama-
dan in the Muslim community may affect forensic death cases’
profiles, but there is need for multicentric international studies
to better identify the differences of forensic deaths between
Ramadan and the other months.
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Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
... The Islamic lunar calendar month of Ramadan is considered the holiest month in Islam, and one of the five fundamental pillars of Islam is fasting during this month (Demirci et al., 2013;Ongsara et al., 2017). In addition to the restriction of eating and drinking, Ramadan fasting also includes the restriction of sexual intercourse, smoking and intake of alcohol and all kinds of medicine (Benaji et al., 2006). ...
... Finally, some changes have also been observed in forensic medical parameters. There has been shown to be a significant decrease in suicides (Taktak et al., 2016), an increase in the number of forensic autopsies (Canturk et al., 2013) and changes in the manner of death during Ramadan (Canturk et al., 2013;Demirci et al., 2013). ...
... One of the reasons for these contradictory findings may be methodological errors. For example, due to the difference between the Lunar year and the Gregorian year, the month of Ramadan coincides with different seasons in different years (Demirci et al., 2013), which may result in studies giving conflicting results due to seasonal variability. ...
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... Demirci et al. have studied the forensic death cases in Ramadan, and reported a significantly less number of death cases due to murder and suicide in Ramadan compared to that in non-Ramadan period [9]. In our study, we have found a significantly less number of suicides and acts of violence in Ramadan compared to that in non-Ramadan period. ...
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... Attending religious services as a protection against SI and SB is also supported by a Turkish study that examined deaths between 2000 and 2009 during the month of Ramadan. They found that during this holy month of fasting from sunrise to sunset and an increased involvement in religious activities, Muslim deaths by suicide decreased (Demirci, Dogan, Koc [25]). This decrease in deaths by suicide may be due to the higher spirituality, increase social interaction and increase engagement in religious activities such as congregational prayers that are held daily during that month. ...
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... This protective effect appears to be particularly prominent at times of heightened religious significance, such as times of religious worship, celebration, and fasting. For example, the period preceding Christmas is associated with reduced self-harm rates in Christians (Plöderl et al. 2015), as is the period of Ramadan amongst Muslims (Demirci et al. 2013). No such data exist for Lent, which comprises the 40 days immediately preceding Easter, the Christian celebration of the resurrection of Jesus Christ. ...
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... In other words, Ramadan alternates moments of fasting with moments of re-feeding, being a time-restricted fasting or intermittent or circadian fasting [9][10][11]. In European settings, particularly in the Mediterranean area, Ramadan fasting may therefore coincide not only with the hottest weeks of the summer season, but also with a longer daytime [12,13]. Evidence suggests that the disruption of the internal biological clock due to the altered circadian rhythm, together with the fasting and the reduced water intake (potentially leading to dehydration), has the potential to severely impair the worker cognitively and/or physically, eventually increasing the risk of making mistakes, leading to accidents and injuries [14][15][16][17][18][19][20], especially among those subjects who would otherwise spend little time outdoors, such as part-time or seasonal workers [14][15][16][17][18][19][20][21]. ...
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Background Time trends are one of the most studied phenomena in suicide research; however, evidence for time trends in the Dutch population remains understudied. Insight into time trends can contribute to the development of effective suicide prevention strategies. Methods Time trends in national daily and monthly data of 33,224 suicide events that occurred in the Netherlands from 1995 to 2015 were examined, as well as the influence of age, gender, and province, in a longitudinal population-based design with Poisson regression analyses and Bayesian change point analyses. Results Suicide incidence among Dutch residents increased from 2007 until 2015 by 38%. Suicide rates peak in spring, up to 8% higher than in summer (p < 0.001). Suicide incidence was 42% lower at Christmas, compared to the December-average (IRR = 0.580, p < 0.001). After Christmas, a substantial increase occurred on January 1, which remained high during the first weeks of the new year. Suicide occurred more than twice as often in men than in women. For both genders, the results indicated a spring time peak in suicide incidence and a trough at Christmas. Suicide rates were highest in the elderly (age group, 80+), and no evidence was found of a differential effect by season in the age groups with regard to suicide incidence. No interaction effect was found with regard to province of residence for both season and Christmas, indicating that no evidence was found that these time trends had differential effects in the Dutch provinces in terms of suicide incidence. Conclusion Evidence was found for time trends in suicide incidence in the Netherlands. It is recommended to plan (mental) health care services to be available especially at high-risk moments, at spring time, and in the beginning of January. Further research is needed to explore the protective effect of Christmas in suicide incidence.
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Background: Suicide risk fluctuates during the Christmas holidays, suggesting a role for social integration in suicide prevention. In Taiwan, the Lunar New Year is the longest and most culturally significant family holiday. This study examines gender-specific suicide risks during the Lunar New Year and Western New Year holidays. Methods: Daily suicide data between 2012 and 2022 were obtained from national cause-of-death data. A Poisson regression model compared the suicide risk seven days before and after the Lunar and Western New Year's Day with that of the remainder of the year, stratified by gender and marital status. A moderation analysis by gender was conducted. Results: Suicide risks in married and divorced men decreased before Lunar New Year's Day, but the risk was elevated in divorced men a few days after both the Lunar and Western New Year's Days. Compared to men, divorced women had a higher suicide risk on Lunar New Year's Day. Divorced women had a lower suicide risk after the Lunar New Year holiday, whereas married women had a higher suicide risk. Conclusion: The differential suicide risk by marital status and gender offers important implications for suicide prevention, particularly concerning temporal landmarks, social integration, and caregiving burdens during holidays.
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Background Intermittent fasting may increase longevity and lower cardiometabolic risk. This study evaluated whether fasting modifies clinical risk scores for mortality [i.e., Intermountain Mortality Risk Score (IMRS)] or chronic diseases [e.g., Pooled Cohort Risk Equations (PCRE), Intermountain Chronic Disease score (ICHRON)]. Methods and results Subjects (N = 71) completing the WONDERFUL trial were aged 21–70 years, had ≥1 metabolic syndrome criteria, elevated cholesterol, and no anti-diabetes medications, statins, or chronic diseases. The intermittent fasting arm underwent 24-h water-only fasting twice-per-week for 4 weeks and once-per-week for 22 weeks (26 weeks total). Analyses examined the IMRS change score at 26 weeks vs. baseline between intermittent fasting (n = 38) and ad libitum controls (n = 33), and change scores for PCRE, ICHRON, HOMA-IR, and a metabolic syndrome score (MSS). Age averaged 49 years; 65% were female. Intermittent fasting increased IMRS (0.78 ± 2.14 vs. controls: −0.61 ± 2.56; p = 0.010) but interacted with baseline IMRS (p-interaction = 0.010) to reduce HOMA-IR (but not MSS) more in subjects with higher baseline IMRS (median HOMA-IR change: fasters, −0.95; controls, +0.05) vs. lower baseline IMRS (−0.29 vs. −0.32, respectively). Intermittent fasting reduced ICHRON (−0.92 ± 2.96 vs. 0.58 ± 3.07; p = 0.035) and tended to reduce PCRE (−0.20 ± 0.22 vs. −0.14 ± 0.21; p = 0.054). Conclusions Intermittent fasting increased 1-year IMRS mortality risk, but decreased 10-year chronic disease risk (PCRE and ICHRON). It also reduced HOMA-IR more in subjects with higher baseline IMRS. Increased IMRS suggests fasting may elevate short-term mortality risk as a central trigger for myriad physiological responses that elicit long-term health improvements. Increased IMRS may also reveal short-term fasting-induced safety concerns.
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Background Major holidays such as Christmas and New Year’s Eve are regular occasions for get-togethers in families and other social groups. Socially, these days are often loaded with memories and expectations but also involve the potential for interpersonal tension and conflicts and disappointments. In addition, loneliness might also be most intense during these days. All these factors might lead to the expectation of increased mental distress and subsequently increased help-seeking in psychiatric contexts resulting in emergency psychiatric contacts, psychiatric hospitalizations, and even suicidal behavior. But is there evidence for increased psychiatric emergencies and hospitalizations around the days of Christmas? Methods The existing evidence is systematically reviewed here (studies in PubMed in English investigating annual and Christmas-related variations in suicide (attempts), psychiatric emergencies and hospitalizations, last search date (13.07.2022) and complemented by an analysis of acute admissions at the University Psychiatry Clinics Basel, Switzerland, around Christmas and Easter holidays compared to the other days of the year. Easter was chosen as a comparison holiday. Results In 25 reviewed studies, Christmas holidays were not associated with increased utilization of emergency psychiatric services. In contrast, hospitalizations were lower on Christmas and other holidays than the rest of the year. Analyzing the annual variation of 26,088 hospitalizations in our center between 2012 and 2021 revealed the same pattern. Conclusion The assumption of increased utilization of psychiatric emergency services on Christmas and other major holidays is not confirmed by multiple studies around the globe in various socio-cultural and medical settings. The study is registered in the international prospective register for systematic reviews (PROSPERO; 351057). Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier 351057.
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The number of migrants to Sweden from the Middle East and the Horn of Africa has increased strongly over the last decades. Many of these migrants come as refugees from regions of conflict, with limited social and financial resources, and many of the migrants face discrimination on labour market. Most newly arrived migrants find their homes in poor suburbs in the outskirts of the metropolitan regions in Sweden. In this paper, the mortality rates for all immigrants from predominately Islamic countries that officially resided in Sweden at any time between 1991 and 2010 are analysed using Cox proportional hazard regressions. The research questions in this paper focus on finding the associations between mortality rate and socio-economic situations as well as the relationship between seasonal variations in religious activity and mortality. This large-scale longitudinal study reveals that for men, especially men between 16 and 55 years of age, mortality rates are significantly lowered during Ramadan. Other factors affecting mortality rates include being a recent immigrant, civil, employment, and educational status as well as residing in immigrant dense areas.
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The manner in which people manage their grief and mourning for loved ones who have died is a window into a culture and people. The beliefs and practices of Muslim citizens in Israel stem from a cultural-religious world-view that organizes the public and private experience of loss and bereave-ment. Prolonged public expression of grief and ritualized mourning are discouraged in Islamic practice which places great value on the acceptance of God's or Allah's will with restraint and understanding. The distinction between the return to functioning following loss and the management of memories and attachments to the deceased are fundamental to the Two Track Model of Bereavement (Rubin, 1999). The distinction is also relevant to the analysis of Israeli Muslims' responses to loss. Following an introduc-tion to Islamic attitudes to death and loss, a number of basic elements of response to loss are considered. The Islamic emphasis on acceptance and a return to functioning is clear cut. The myriad ways in which the memory of the deceased and the relationship to him or her is bound up with the life lived following death is an area that leaves significant room for individual variation.
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To determine whether altered eating habits and periods, especially the pre-dawn meal, during Ramadan fasting have any significant effect on intraocular pressure (IOP), tear secretion, corneal and anterior chamber parameters. IOP, basal tear secretion (BTS), reflex tear secretion (RTS), and Pentacam measurements of 31 healthy volunteers were performed at 0800 and 1600 hours during Ramadan fasting and 1 month later during non-fasting period. Comparison of measurements between fasting and non-fasting periods at 0800 hours revealed significantly higher values for IOP (P=0.005), RTS (P=0.006), and BTS (P=0.014) during fasting. Conversely at 1600 hours, IOP was significantly lower during fasting (P=0.013) and no statistically significant difference was noted for RTS and BTS. IOP showed a diurnal variation of 2.45 mmHg (P<0.001) and BTS showed a 3.06 mm decrease (P=0.04) during the fasting period. No significant differences could be found in the corneal and anterior chamber parameters during fasting and non-fasting periods. Our results revealed that fluid loading at the pre-dawn meal during Ramadan fasting might increase the IOP and tear secretion in the early morning period and these values decrease remarkably at the end of 12 h of fasting due to dehydration.
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In the Islamic context, "fitrah" refers to humanity's innate disposition toward virtue and the ability to differentiate between right and wrong. A common quote regarding fitrah, from the Prophet is "The fitrah consists of 5 things: circumcision, trimming the moustache, cutting the nails, plucking the armpit hairs, and shaving the pubic hairs."In this study, our aim was to determine the status of axillary and pubic shaving in medicolegal death cases that took place in the Konya Province of Turkey and to evaluate the relationship with the origin of suicide. Of 2850 medicolegal death cases, 206 (7.2%) were of suicidal origin. It was observed that the average age in the cases of suicidal origin was 36.76 +/- 17.72 years, and 146 of 206 cases (70.9%) were men. As a method of suicide, hanging was the chosen method in 100 cases (48.5%), whereas firearm injuries occurred in 54 cases (26.2%), and intoxication was involved in 37 cases (18.0%). Daily axillary and pubic shaving was observed in 26 of 2644 (1.0%) death cases that occurred with nonsuicidal reasons, but in 65 of 206 were (31.6%) suicidal cases. Because suicidal notes were present in 25 (12.1%) of all of the suicidal cases, the ratio of daily axillary and pubic shaving was significantly higher than that of the suicidal notes.In investigating the cases of suicidal origin for medicolegal purposes, evidence showing that this action was committed by the victim, the presence of a suicide note at the death scene and, a history of a previous suicidal attempt, it was thought that the presence of daily axillary and pubic shaving on external examination of the victim's body, when of Muslim faith, could also be considered a feature of suicide.
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Islamic countries display lower suicide rates compared to the other countries of the world. Since most studies dealing with the relationships between Islam and suicide have focused on the extent of the problem and not the underlying mechanisms, the focus of this brief communication is to provide a rather more in-depth discussion regarding the mechanism of this relation. It also covers issues which may have an adverse effect on suicide within Islamic countries and consequently tries to sketch a path ahead in the area of suicide research within the Islamic countries.
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Ethnic background is a factor always to be considered in dealing with food habits. Here is a clear explanation of partial fasting as practiced by Muslims—three million of whom live in the United States and Canada
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The effects of fasting on humans have not been adequately investigated. Ramadan fasting is a great opportunity for scientific research due to its peculiar nature. With this in mind, we conducted research on the effects of Ramadan on stroke, which is one of the most common causes of death in adults. Patients hospitalized solely for ischemic stroke and intracerebral hemorrhage were evaluated retrospectively. The ratio of these cases to other patients hospitalized in the neurology department was determined. The in-hospital clinical course and mortality rates of the patients with stroke were evaluated. Within the entire cohort, the most frequently encountered type of stroke was ischemic (P < 0.05). The proportions of hemorrhagic and ischemic strokes had no statistically significant differences between the periods before Ramadan, during Ramadan, and after Ramadan (P > 0.05). The ratio of hemorrhagic stroke decreased in hypertensive patients during Ramadan (P < 0.05). In diabetic patients, the ratio of ischemic stroke increased in the month of Ramadan significantly (P < 0.05). Although Ramadan fasting had an adverse effect on diabetic patients with ischemic stroke, there was no negative effect on hypertensive patient with hemorrhagic stroke or stroke frequency. However, further prospective studies are needed to confirm our results. We think that to understand the effects of Ramadan fasting on stroke in humans evaluation in terms of risk factors such as diabetes and hypertension is required.
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BACKGROUND: Differences in baseline mortality, age structure, and influenza epidemics confound comparisons of cold-related increases in mortality between regions with different climates. The Eurowinter study aimed to assess whether increases in mortality per 1 degree C fall in temperature differ in various European regions and to relate any differences to usual winter climate and measures to protect against cold. METHODS: Percentage increases in deaths per day per 1 degree C fall in temperature below 18 degrees C (indices of cold-related mortality) were estimated by generalised linear modelling. We assessed protective factors by surveys and adjusted by regression to 7 degrees C outdoor temperature. Cause-specific data gathered from 1988 to 1992 were analysed by multiple regression for men and women aged 50-59 and 65-74 in north Finland, south Finland, Baden-Wurttemburg, the Netherlands, London, and north Italy (24 groups). We used a similar method to analyse 1992 data in Athens and Palermo. FINDINGS: The percentage increases in all-cause mortality per 1 degree C fall in temperature below 18 degrees C were greater in warmer regions than in colder regions (eg, Athens 2.15% [95% CI 1.20-3.10] vs south Finland 0.27% [0.15-0.40]). At an outdoor temperature of 7 degrees C, the mean living-room temperature was 19.2 degrees C in Athens and 21.7 degrees C in south Finland; 13% and 72% of people in these regions, respectively, wore hats when outdoors at 7 degrees C. Multiple regression analyses (with allowance for sex and age, in the six regions with full data) showed that high indices of cold-related mortality were associated with high mean winter temperatures, low living-room temperatures, limited bedroom heating, low proportions of people wearing hats, gloves, and anoraks, and inactivity and shivering when outdoors at 7 degrees C (p < 0.01 for all-cause mortality and respiratory mortality; p > 0.05 for mortality from ischaemic heart disease and cerebrovascular disease). INTERPRETATION: Mortality increased to a greater extent with given fall of temperature in regions with warm winters, in populations with cooler homes, and among people who wore fewer clothes and were less active outdoors.
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Dietary and lifestyle changes during Ramadan may affect the appearance rate of emergency health problems or increase emergency department (ED) use. This study's aim was to investigate Ramadan's effects on ED use. The study group consisted of patients admitted to the ED during Ramadan, and the control group consisted of patients admitted during the 30-day period immediately after Ramadan. The study compared the daily number, diagnosis, and demographic and clinical characteristics of the two groups. The study included 2079 patients. Of these, 1094 (52.6%) were admitted during Ramadan, and the remaining 985 (47.4%) formed the control group. The average number of patients admitted to the ED per day was 36.47 +/- 7.9 in the study group and 32.83 +/- 5.8 in the control group (p = 0.046). The two groups' demographic and clinical characteristics, such as age, sex, final diagnosis, admission times to ED, and diagnosis, were similar. Our results show that during Ramadan, the clinical features of patients admitted to the ED and the number of ED admissions for specific ailments did not change significantly.