BACKGROUNDFasting during Ramadan is a challenge for Muslim patients with diabetes and for their healthcare providers. However, data on the effects of Ramadan fasting on hospital admissions and outcomes in patients with diabetes are scarce.OBJECTIVESEvaluate the characteristics of patients with diabetes admitted during the fasting month of Ramadan compared with the non-fasting month of Dhu al-Qidah.DESIGNA retrospective cohort study medical record review.SETTINGA university teaching hospital.PATIENTS AND METHODSWe reviewed the records of all patients with diabetes admitted to the medical department at Benghazi Medical Center, including medical ward, intensive care unit and coronary care unit, during the months of Ramadan and Dhu al-Qidah, 2016. We compared differences in reasons for admission, length of stay and in-hospital mortality between patients admitted during Ramadan and Dhu al-Qidah and between patients who were fasting at time of admission during Ramadan and those who were not.MAIN OUTCOME MEASURESMain reason for admission, length of stay and in-hospital mortality rate.SAMPLE SIZE402 patients with diabetes.RESULTSDuring Ramadan, 186 patients were admitted compared with 216 during Dhul al-Qidah. There was no statistically significant difference in reasons for admission, length of hospital stay, or in-hospital mortality (borderline for mortality, P=.078), between patients with diabetes admitted during Ramadan and Dhu al-Qidah. Of those admitted in Ramadan, 59.1% were fasting on admission. Fasting patients admitted during Ramadan had a significantly higher proportion of the diseases of the circulatory system when compared with non-fasting patients (39.4% vs. 23.6%, P=.028) while in-hospital mortality was higher in non-fasting patients (29.2% vs. 8.7%, P<.001). There was no significant difference in length of stay between fasting and non-fasting patients.CONCLUSIONSThe frequency of admissions for most medical conditions were not changed during Ramadan but the frequency of acute coronary syndrome was higher in those who were fasting on admission. Patients with diabetes who were not fasting on admission had more high-risk features that prevented them from fasting and therefore are at increased risk of in-hospital mortality.LIMITATIONSSingle center and retrospective.

Original Article introduCtionGraves' hyperthyroidism is the most common cause of hyperthyroidism. [1] Treatment options include antithyroid drugs (ATDs), radioactive iodine, or surgical resection, although none of these options target the mechanism of the disease, and there is no single treatment that can target both hyperthyroidism and the main extrathyroidal manifestation (orbitopathy). [2] ATDs act by inhibiting thyroid hormone synthesis, but they have some immunosuppressive action. In Europe and Japan, ATDs are still the first-line treatment, [1] but in North America, radioactive-iodine is much preferred. [3,4] Endocrinologists in the Middle East and North Africa (MENA) seemed to practice in a hybrid fashion between these two groups depending on previous training and current affiliations. [5] Background: Choice of the treatment for patients with Graves' hyperthyroidism depends on local preference, the higher recurrence risk, comorbidities, and the patient's preferences. About half of the patients relapse after a course of a standard antithyroid drug (ATD) therapy for Graves' disease. Objectives: The objective of this study was to determine the clinical and biochemical features of Graves' hyperthyroidism that can predict the relapse of the disease after a standard course of ATD therapy. Patients and Methods: We conducted a retrospective 6-month study of 79 patients with Graves' hyperthyroidism who were treated with ATD (carbimazole) therapy for 12-18 months and went into remission for at least 1 year after ATD withdrawal. Results: The relapse rate in Graves' hyperthyroidism after 1 year in remission was 40.5%; patients with younger age (<40 years) and with severe biochemical disease correlated significantly with relapse. Gender, presence of a palpable goiter, orbitopathy, and smoking habits were not significant predictors of relapse, perhaps because of the small sample size. Conclusions: Forty percent of Graves' hyperthyroidism relapsed after 1 year of remission. Younger age and severe biochemical disease at diagnosis predicted relapse.

Background: Neonatal morbidity and mortality are major global public health challenges with approximately 3.1 million babies worldwide dying each year in the first month of life. The vast majority of neonatal death occurs in developing countries.                                      Aims: This study was undertaken to assess the magnitude of neonatal mortality and identify the main causes and associated factors of neonatal mortality.               Methodology: A retrospective study of 5791 neonates was conducted in Benghazi children hospital from 1st January 2013 up to December 2014.              Results: During the two years of the study there were 5791 neonates admitted to neonatal unit of Benghazi hospital, out of them 389 died (6.7% of total neonatal admissions) accounting for 59.6% of the total Paediatric deaths within the same period, moreover approximately one neonate died every 48 hours throughout the study period. There was a slight predominance of male deaths 225 (57.5%) over females 164 (42.5%). The majority of neonates were Libyan 365 (94%), 212 of them were born in Benghazi, while the remaining 177 from other cities. Preterm neonate accounted for 35% (138) of deceased neonates. The most common causes were lung diseases of prematurity (29%), sepsis (25%), Congenital Heart Diseases (12.5%), post-operative intestinal obstruction (7%), multiple congenital anomalies (7%), intractable convulsions (6.5%). Conclusion: This study indicated that neonatal mortality represented the highest portion of all deaths reported at Benghazi children hospital during the study period. Lung diseases of prematurity was found to be the top leading cause followed by sepsis then congenital heart diseases. Male showed marginal predominance over female in this study. More than one third of deceased neonates were preterm.

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