The effect of intermittent fasting on the clinical and hematological parameters of patients with sickle cell disease: A preliminary study

Introduction

Sickle cell disease is a genetic disorder that frequently presents with vaso-occlusive crisis (VOC). Most patients with sickle cell disease in Qatar are Muslims; hence, they practice intermittent fasting during the holy month of Ramadan. However, there is a paucity of literature describing the effect of intermittent fasting on the occurrence of severe VOC. As a result, there is a lack of guidelines or standardized protocols that can help physicians advise patients with sickle cell disease who wish to practice intermittent fasting. Therefore, this study's aim was to investigate the effect of intermittent fasting on the clinical and hematological parameters of individuals with sickle cell disease.

Methods

We conducted a retrospective study for 52 Muslim patients with sickle cell disease in Qatar aged ≥18 years who were confirmed to be fasting during the holy month of Ramadan during any of the years 2019-2021. The difference in the occurrence of severe VOC, hemolytic crisis, and other clinical, hematological, and metabolic parameters were studied one month before, during, and one month after the intermittent fasting of Ramadan using the patient's medical records. Mean (sd), median (IQR), and frequency (%) described the data. One-way with repeated measures ANOVA with a Greenhouse-Geisser correction and Friedman tests (^*) were used at alpha level 0.05.

Results

The study participants' (mean±sd) age was (31.1±9.2) years, 51.9% were males, and 48.1% were females. Roughly seventy percent of the participants were of Arab ethnicity, while the rest were either African or Asian. Most of the patients were homozygotes (SS) (90.4%). The median number of severe VOC (P = 0.7) and hemolytic crisis (P = 0.5) was not found to be significantly different before, during, or after Ramadan. Significant differences, however, were found in platelet count (P = 0.003), reticulocyte count (P < 0.001), and creatinine level (P = 0.038) with intermittent fasting.

Discussion

In this preliminary study, intermittent fasting does not seem to influence the rate of occurrence of severe vaso-occlusive crisis or hemolytic crisis in patients with sickle cell disease; however, it was found to be associated with differences in platelet count, reticulocytes count, and creatinine level. The statistical and clinical significance of these findings needs to be confirmed in studies with a larger sample size.

The mercury burden in waste water released from dental clinics

The aim of this study was to estimate mercury burden in waste water samples collected during one working day in 27 dental clinics. The samples were subjected to authorized analysis using the technique of QS-IE Enhanced Cold Vapour Mercury Analyzer to estimate the amount of mercury discharged. The mean value of mercury discharged was 2.49 parts per billion (ppb) for the clinics equipped with amalgam separators and 94.75 ppb for the clinics without amalgam separators. Some of the small amalgam particles released when new fillings are placed or during removal of old restorations form a sediment in tubes and drains. The remaining particles are carried with the waste water stream to the local purifying plant. If threshold values for heavy metal content including mercury are exceeded, the sludge is not allowed to be recycled as fertiliser. Installation of an approved amalgam-separating apparatus in dental clinics is recommended so as to reduce considerably the discharge of mercury into waste water.