Ramadan fasting is one of the five Pillars of Islam. While there are several exemptions from fasting, many Muslims with medical conditions still choose to fast. This may adversely affect their health if not addressed properly. Recently, there has been an increased interest in the health implications of Ramadan fasting. The authors performed a narrative, nonsystematic review of the literature including case reports, case series, and review articles indexed in PubMed and Google Scholar in a full calendar year. All records were reviewed by two coauthors at least. Studies were reviewed, summarized, and represented to provide a readily comprehensible concise account of the contributions made to research and clinical practice in 1 year (January–December 2017). The publications spanned physiological and clinical aspects and crossed conventional disciplinary lines in various languages, locations, and systems of journal access. A total of 92 and 82 were found in the PubMed and Google Scholar databases, respectively. Diabetes, hypoglycemia, insulin, and body composition were among the most relevant issues addressed this year. Discipline wise, diabetes, physiology, gastrointestinal, cardiovascular, eyes, respiratory, nephrology, neuropsychiatry, and endocrinology were most prominent. Other articles have considered professional competence, education, ethics, culture, and organization of care. Many of the research groups are based in emerging countries with Muslim-majority, but the publications are still widely distributed in internationally recognized journals. Several workers seem to have Ramadan fast at the center of their academic interest inferred from the number of publications to which they have contributed. The authors hope this review will help direct further research and should inform clinical practice guidance.

Background: Breast cancer is the most common cancer in women in the Eastern Mediterranean region and the leading cause of cancer mortality worldwide. Objectives: The study aimed to ascertain the level of awareness about the breast self-examination (BSE) and early detection of breast cancer and risks of breast cancer in the women of Benghazi, the second capital city of Libya. Subjects and Methods: A community-based survey was carried out in Benghazi to assess the knowledge, attitude, and practice of women at Benghazi about BSE and risk and protective factors of breast cancer. Cluster sampling technique was used. 30 clusters were selected during the year 2013. Results: Three thousand women were targeted; 2601 women were interviewed. Their mean age was 36.4 ± 10.9 years; more than half of them were married. The respondents' knowledge about BSE was poor with less than half of them (48.1%) having ever heard about BSE. Less than one-fifth of them (16.9%) knew what is BSE and less than one-quarter (25.7%) had satisfactory knowledge about the recommended frequency of BSE. About 39.0% of the respondents knew how to perform BSE, less than one-quarter of them (22.5%) knew when to start it. However, about three quarters (74.4%) of women considered BSE practice very important based on information from television programs as their source of knowledge (23.8). Less than half (43%) thought that high-fat diet and 42% stated that that physical inactivity are recognized risk factors for developing breast cancer. Conclusions: There is a poor knowledge about BSE and about risk and protective factors of breast cancer even among educated women in Benghazi. Primary prevention and early detection awareness should be the first step for prevention of breast cancer in Benghazi, Libya.

Background: Noise induces free radicals release and can damage the cochlear epithelium. The outer hair cell motor protein prestin is necessary for sharp frequency tuning and cochlear function. Otolin-1 is a glycoprotein; its mRNA expression is restricted to the inner ear. Genes involved in repairing the oxidative damage as human 8-oxoG DNA glycosylase 1 (hOGG1) can affect the cochlea susceptibility to noise. Prestin upregulation may represent a response to compensate for noise-induced hearing loss (NIHL). Objectives: We investigated the association between exposure to noise, the blood perstin and otolin-1level, hOGG1 polymorphisms, and oxidative DNA damage as indicated by serum 8-hydroxy-2'-deoxyguanosine (8-OHdG) concentrations. Materials and Methods: In 300 patients with NIHL and 200 controls with normal hearing, blood prestin, otolin-1, and 8-OHdG levels were studied by ELISA; the hOGG1 polymorphism was genotyped by polymerase chain reaction amplification followed by digestion with restriction endonucleases. Results: The prestin, otolin-1, and 8-OHdG levels were significantly elevated in patients compared to controls (P < 0.05). Regression analysis showed that hOGG1 Cys/Cys genotype showed a significantly increased risk of hearing loss compared with the other genotypes exposed to the same environmental factors (95% confidence interval = 1.1–2.3, adjusted odds ratio = 1.5). This was associated with increased prestin, otolin-1, and 8-OHdG levels and the duration of noise exposure in months. Conclusion: These findings are consistent with the notion that prestin increases in an attempt to compensate for missing outer hair cells. Otolin-1 could be a circulatory biomarker for otoconia damage caused by noise, and the hOGG1 Cys/Cys genotype could be a susceptibility marker for NIHL. The hOGG1 Cys/Cys gene variant was more frequent in patients compared to controls exposed to the same environmental factors and more frequent in severe cases confirmed by elevated prestin, otolin-1, and 8-OHdG l levels.

Bronchogenic cysts may be asymptomatic or may present with symptoms of tracheal or esophageal compression. Several complications of bronchogenic cysts may occur. Intrabronchial rupture is an infrequent complication. A case of spontaneous intrabronchial rupture of a bronchogenic cyst with basal lobar pneumonia.

Metformin and sitagliptin are widely used in the management of type 2 diabetes mellitus. We present a case who reported ingestion of an overdose of metformin and sitagliptin in a suicidal attempt. The patient presented with severe lactic acidosis, hypotension, and hyperglycemic acute kidney injury, successfully treated medically with intravenous infusion of fluids and sodium bicarbonate, and prompt convection hemodialysis.