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Ramadan is a lunar month when fasting Muslims are not allowed to eat, drink, or take their medications from dawn until sunset. Many of them have chronic medical illnesses such as ischemic heart disease, hypertension & diabetes mellitus. This study aims to investigate the association between fasting during Ramadan and the prevalence and risk of having coronary artery disease (CAD) in patients who underwent coronary catheterization. METHODS: Retrospectively, we recruited all adult patients who were admitted to King Abdullah University Hospital, Jordan, and underwent coronary catheterization. We compared the prevalence of CAD between Ramadan, one month before and month after. The study was conducted over two lunar years (1338-1339 AH). The finding of $70% coronary luminal narrowing confirmed the presence of CAD. RESULTS: A total of 258 patients underwent coronary catheterization: 77 during Ramadan, 108 before Ramadan, and 73 after Ramadan. The majority were men (85.3%) with a mean age of 54.9 years (range, 27-83). There were no significant differences in risk factors of CAD such as age, gender, diabetes mellitus, hypertension, smoking, and previous history of CAD between the threetime periods; during, before, and after Ramadan, P > 0.05. The presence of hyperlipidemia was more common in patients who were admitted before Ramadan (36.1%) when compared to those admitted during and after Ramadan (22.1%, and 19.2% respectively), p ¼ 0.021. During Ramadan, fewer patients (48, 62.3%) had CAD compared to the other two time periods, before Ramadan (89, 82.4%), and after Ramadan (53, 72.6%), p ¼ 0.009. After adjusting for age, gender, and CAD risk factors; the adjusted risk of having CAD was significantly lower during Ramadan compared to the period before Ramadan [odds ratio ¼ 0.317, 95% confidence interval (0.130-0.772), p ¼ 0.011]. CONCLUSIONS: Fasting during Ramadan, from dawn until sunset, is associated with a lower risk of coronary artery disease. More studies are needed to identify the underlying mechanism. CLINICAL IMPLICATIONS: Time-restricted fasting for 14-16 hours with an eating window every day could have a positive effect on decreasing the risk of coronary artery disease.

Background. This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to compare the safety and efficacy of supine vs. nonsupine positions during intubation. Methods. Based on the literature from inception to October 2020, 13 studies with nonemergent intubation in supine and nonsupine positions were chosen using PRISMA and MOOSE protocols. Pooled estimates were calculated using random-effects models with 95% confidence interval (CI). The primary outcome was a successful intubation, attempt, and duration of intubation. The secondary outcome was adverse events (trauma and hypoxia). Bias was evaluated qualitatively, by visual analysis, and quantitatively through the Egger test. Results. The final analysis included 13 clinical trials with 1,916 patients. The pooled success rates in the supine vs. lateral positions were 99.21% and 98.82%. The supine vs. semierect positions were 99.21% and 98.82%. The 1st attempt success rate in the supine vs. lateral position was 85.35% and 88.56% compared to 91.38% and 90.76% for the supine vs. semierect position. The rate of total adverse events in the supine position was 3.73% vs. 6.74% in the lateral position, and the rate of total adverse events in the supine position was 0.44% vs. 0.93% in semierect position. Low to substantial heterogeneity was noted in our analysis. Discussion. There is no significant difference between total successful intubations and success from 1st intubation attempt between supine and nonsupine positions. However, there are slightly higher rates of adverse events in nonsupine position. Addition of more recent studies on supine vs. nonsupine intubations would improve this study. Given these findings, it is important to develop more studies regarding different intubation positions and techniques with the aim of improving efficacy and decreasing adverse outcomes. Other. This review is not registered in a public database. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.