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The coronavirus disease 2019 (COVID-19) pandemic placed an extraordinary demand on health systems and healthcare providers all over the world. The pandemic presented a number of unprecedented challenging ethical issues. Across the globe, hospitals are being challenged by a large number of patients presenting to the emergency room for treatment, creating scarcities of critical care resources, and uncovering the need for formal crisis standards of care. Difficult life and death decisions, which may create severe moral distress to the physicians, have to be made in emergency rooms and intensive care units. Other ethical issues, such as that related to conducting clinical trials during the pandemic, and the increase in domestic violence during the quarantine period, will be also discussed.

Critical congenital heart disease (CCHD) is a heart lesion for which neonates require early surgical intervention to survive. Without intervention, the rates of mortality and survival with significant disability are extremely high. Early diagnosis can potentially improve health outcomes in newborns with CCHD. Until recent years, no routine screening protocol existed. In the last few years, pulse oximetry screening for CCHD in newborns has been added to the list of recommended uniform screening panels and advocated by several health-care authorities. A positive screening test result warrants an echocardiogram to evaluate for CCHD. Newborn screens do not usually require parental consent. However, most of the states mandates in the United States include a statement allowing exemption from the screen on the basis of parental religious or personal beliefs.

During the month of Ramadan, all healthy, adult Muslims are required to fast from dawn to sunset. Fasting during Ramadan involves abstaining from food, water, beverages, smoking, oral drugs, and sexual intercourse. Although the Quran exempts chronically ill from fasting, many Muslims with diabetes still fast during Ramadan. Patients with diabetes who fast during the month of Ramadan can have acute complications. The risk of complications in fasting individuals with diabetes increases with longer periods of fasting. All patients with diabetes who wish to fast during Ramadan should be prepared by undergoing a medical assessment and engaging in a structured education program to undertake the fast as safely as possible. Although some guidelines do exist, there is an overwhelming need for better designed clinical trials which could provide us with evidence-based information and guidance in the management of patients with diabetes fasting Ramadan.

Introduction: Over one billion Muslims elect to fast during the month of Ramadan worldwide. The data available regarding the effect of Islamic fasting in patients with heart failure and reduced ejection fraction (HFrEF) are insufficient. Methodology: We prospectively studied 249 outpatients with HFrEF who plan to fast Ramadan in three Cardiac centers in Saudi Arabia. A detailed clinical assessment, diagnostic data, emergency department visit, and hospitalization during Ramadan and the preceding month were obtained. Results: A total of 249 patients were enrolled, 227 (91%) patients fast for the full lunar month. During Ramadan 209 (92%) patients remained stable while 18 (8%) patients became unstable. With fasting, the mean New York Heart Association (NYHA) functional class was significantly lower in the stable when compared to the unstable group (1.46 ± 0.7 vs. 3.22 ± 0.55. P

Ibn Sina, known in the West as Avicenna, was the most famous and influential of all the Islamic philosopher-scientists. His most important medical works are the Canon of Medicine medical encyclopedia and a treatise on cardiac drugs. His Canon of Medicine remained the standard text in both the East and West until the 16 th century. Avicenna′s description of cardiac diseases was logically presented perhaps for the first time in the history of medicine. Avicenna was the first to describe carotid sinus hypersensitivity, which presents with vasovagal syncope. He was a pioneer in pulsology and the first correct explanation of pulsation was given by Avicenna, after he refined Galen′s theory of the pulse. Besides, he discussed the action of available drugs on the heart in details and mentioned their indications and contraindications. In conclusion, Avicenna made important contributions to cardiology. This article describes some of his contributions in this field.

There is a wide gap between organ supply and demand, which results in a very long waiting time for kidney transplantation and an increasing number of deaths of the patients while on the waiting list. These events have raised many ethical, moral and societal issues regarding organ donation, allocation and use of living donors through exploitation of the poor for the benefit of the wealthy. Success in the implementation of kidney transplantation programs in a country depends on various factors including the economic situation, religious approval, public views, medical expertise and existing legislation. The public attitude toward donation is pivotal in all transplantation programs; increasing the awareness of the leaders of religion is vital in this regard.

The relation between Islam and medicine has been described as intimate. Muslims are expected to be moderate and balanced in all matters, including health. Islamic law is based on a complete system of morality that can provide a moral context in medicine from a legal perspective. Islamic teaching is also very flexible and adaptable to many new and novel situations. Islamic Ethics also upholds "the four principles" of biomedical ethics proposed by Beauchamp and Childress. Several authors claim that the roots of these principles are clearly identifiable in Islamic teachings. However, there are some differences in the applications of these principles. This article shed light on the roots of the four principles in Islamic teachings and elaborates on the differences between Islamic and contemporary western bioethics.

A 40-year-old woman presented with a 1 month history of shortness of breath and easy fatigability. Two-dimensional echocardiography and real-time three-dimensional echocardiography (RT3DE) showed a large right atrial mass protruding into the right ventricle and an atrial septal defect (ASD). Successful excision of the mass, which proved to be a myxoma, and closure of the ASD completely relieved her symptoms. To our knowledge, this is the first report of RT3DE in a patient with right atrial myxoma associated with an ASD. [ABSTRACT FROM AUTHOR]

The nocebo effect, the inverse of the placebo effect, is a well-established phenomenon, yet under-appreciated. It refers to nonpharmacological, harmful, or undesirable effects occurring after active or inactive therapy. The frequency of adverse events can dramatically increase by informing patients about the possible side effects of the treatment, and by negative expectations on the part of the patient. Patients who were told that they might experience sexual side effects after treatment with β-blocker drugs reported these symptoms between three and four times more often than patients in a control group who were not informed about these symptoms. Nocebo effect has been reported in several neurological diseases such as migraine, epilepsy, multiple sclerosis, Parkinson's disease and neuropathic pain, and in patients with depression. The investigation of the biological and theoretical underpinning of the nocebo phenomenon is at an early stage, and more research is required. Physicians need to be aware of the influence of nocebo phenomenon and be able to recognize it and minimize its effects.

Muslim patients and families are often reluctant to discuss and accept fatal diagnoses and prognoses. In many instances, aggressive therapy is requested by a patient's family, prolonging the life of the patient at all costs. Islamic law permits the withdrawal of futile treatment, including life support, from terminally ill patients allowing death to take its natural course. “Do not resuscitate” is permitted in Islamic law in certain situations. Debate continues about the certainty of brain death criteria within Islamic scholars. Although brain death is accepted as true death by the majority of Muslim scholars and medical organizations, the consensus in the Muslim world is not unanimous, and some scholars still accept death only by cardiopulmonary criteria. Organ transplantation has been accepted in Islamic countries (with some resistance from some jurists). Many fatwas (decrees) of Islamic Jurisprudence Councils have been issued and allowed organs to be donated from living competent adult donor; and from deceased (cadavers), provided that they have agreed to donate or their families have agreed to donate after their death (usually these are brain-dead cases). A clear and well-defined policy from the ministry of health regarding do not resuscitate, brain death, and other end-of-life issues is urgently needed for all hospitals and health providers in most (if not all) Muslim and Arab countries.

Ramadan is one of the five fundamental pillars of Islam. During this month, the majority of the 1.6 billion Muslims worldwide observe an absolute fast from dawn to sunset without any drink or food. Our review shows that the impact of fasting during Ramadan on patients with stable cardiac disease is minimal and does not lead to any increase in acute events. Most patients with the stable cardiac disease can fast safely. Most of the drug doses and their regimen are easily manageable during this month and may need not to be changed. Ramadan fasting is a healthy nonpharmacological means for improving cardiovascular risk factors. Most of the Muslims, who suffer from chronic diseases, insist on fasting Ramadan despite being exempted by religion. The Holy Quran specifically exempts the sick from fasting. This is particularly relevant if fasting worsens one's illness or delays recovery. Patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting.