As the holy month of Ramadan approaches, it is essential to prepare various aspects for this blessed month for all Muslims worldwide. One of the preparations is ensuring good health. Maintaining bodily health is crucial, especially during Ramadan, so the body remains strong to perform various daily activities while fasting. One way to assess an individual's health condition is through regular health check-ups (medical check-ups).

Several health check-ups (medical check-ups) that can be done before the fasting month include:

1. Anamnesis and Physical Examination

Anamnesis or patient complaints are medical interviews conducted by doctors with their patients to obtain information about the condition the patient is experiencing, so the doctor can conclude the diagnosis of the patient's disease. The purpose of anamnesis is to obtain comprehensive information about the patient's health and maintain good communication between the doctor and the patient professionally. Anamnesis data is grouped into six essential parts: patient identity, current illness history (preceded by the main complaint), past illness history, system anamnesis, family health history, and personal history related to social, economic, and cultural aspects.

Physical examination is one of the procedures commonly performed by doctors to diagnose diseases. The results of this examination are then used to plan further treatment. Physical examinations are usually carried out systematically, from head to toe (head to toe), performed in four ways: inspection, palpation, auscultation, and percussion. The scope of physical examination includes:

- Anthropometry: height and weight (body mass index), body circumference. This examination aims to determine the patient's nutritional status, which is divided into underweight, normal, overweight, or obese.

- Vital signs examination, such as temperature, pulse, respiratory rate, and blood pressure (tension). This examination aims to assess hemodynamics and the general condition of the patient. In a fasting state, low blood pressure (hypotension) is prone to occur, so tension examination is needed to detect this abnormality.

- Head-to-toe physical examination or examination of the body's persistent system.

  - Eye examination. To assess whether there are signs of anemia (anemia signs) or sunken eyes (dehydration signs).

  - Dental and oral examination. To assess whether there are carries teeth/hollows that are risk factors for bad breath or whether there are signs of dry lips, irritation/inflammation in the oral cavity and throat area due to dry mouth conditions due to the effects of fasting.

  - Examination of the head, ENT, neck, chest, abdomen, extremities, and skin. Skin examination is related to assessing dehydration signs. Patients with mild dehydration usually still have good skin turgor, while patients with moderate and severe dehydration can be found to have decreased skin turgor.

  - Balance examination. To assess whether there are signs of dizziness/vertigo.

2. Laboratory Examination

a) Complete Hematology

It is a panel examination consisting of Hemoglobin, Hematocrit, Leukocytes, Count Type, Platelets, ESR, Erythrocytes, and MC values. Hematology examination is a basic examination widely used as an initial screening examination. This examination can determine infectious diseases/signs of inflammation, blood disorders such as anemia, dehydration signs (hematocrit), degenerative diseases, and others. Hematocrit levels usually increase in dehydrated patients.

b) Complete Urine

Urine tests are conducted to examine the patient's urine sample so the doctor can detect signs of dehydration experienced and what causes it.

c) Electrolyte Panel (Na, K, Cl)

The Electrolyte Panel (Na, K, Cl) is a package examination that measures the levels of Sodium, Potassium, and Chloride, which are the main electrolytes in the blood. The main function of electrolytes is to regulate body fluids, transmit electrical signals in nerves, regulate muscle contractions, and maintain heart function. Electrolyte imbalance is one of the complications or effects of dehydration.

d) Kidney Function Test (urea and serum creatinine)

The kidney function test is a procedure conducted to determine how well the kidneys are working. This procedure will also detect any disorders in the organ. In dehydrated patients, urea and creatinine levels can increase due to renal hypoperfusion.

e) Liver Function Test (SGOT and SGPT)

The liver function test is a blood test used to assess the health condition of the liver organ, which can be done routinely or when there is a disease in the liver. This test is conducted by measuring the levels of SGOT and SGPT in the blood. If the measurement results of SGOT and SGPT show abnormal levels, there is a high possibility of liver disease or liver damage.

In addition, several other parameters can be used to support the examination of liver function, such as Alkaline phosphatase (ALP), Gamma Glutamyl Transferase (GGT), direct/indirect Bilirubin, albumin,

 and globulin. These examinations are based on medical indications and doctor's considerations.

f) Blood Gas Analysis

Patients with severe dehydration can experience acidosis characterized by increased lactate levels and decreased bicarbonate levels.

g) Blood Glucose Examination

Blood glucose is divided into random blood glucose, fasting blood glucose, and blood glucose 2 hours after eating. When fasting for a long time, the body is prone to hypoglycemia. The diagnosis of hypoglycemia is established based on the examination of plasma glucose levels. A person can be said to have hypoglycemia if the plasma glucose level is below 70 mg/dl. In addition, there can also be an increase in blood sugar levels called hyperglycemia due to the lack of control of eating patterns during suhoor and iftar, especially in individuals who already have a history of diabetes. In hyperglycemia conditions, it is characterized by increased blood glucose levels, namely FPG >125 mg/dl, 2-hour PPG >140 mg/dl, or RBS >200 mg/dl.

h) IgM and IgG Helicobacter pylori

The IgM and IgG Helicobacter pylori examination is used to assist in diagnosing the cause of gastritis (stomach ulcers) from a possible infection by the H. Pylori bacteria. This bacterium can infect the stomach and cause gastritis or ulcers (wounds) in the stomach. The examination is conducted by detecting Immunoglobulin (antibodies) against H.Pylori. IgM antibodies are a sign of early infection from bacteria, while IgG antibodies will increase 2 months after infection and will remain for more than a year after treatment.

i) Helicobacter pylori stool Antigen

This test aims to determine the infection of H. pylori bacteria in the digestive tract, which is the cause of gastritis. This test aims to find the antigen of H. pylori bacteria in the feces. Antigen is a substance that triggers an immune response. The specimen for this examination is from the patient's feces collection. Preparation that can be done before undergoing the helicobacter stool antigen or feces test is to stop consuming some drugs that are routinely consumed for two weeks to a month before the examination.

3. Non-Laboratory Examination

a) Urea Breath Test

In cases of gastric ulcers caused by Helicobacter pylori, there are several examinations that can be done to establish a diagnosis. One of them is the Urea Breath Test. Helicobacter pylori bacteria have the ability to break down the urea enzyme into ammonia and carbon dioxide, so it is expected to be detected through this test. The patient will be asked to swallow urea, 30 minutes later the patient is asked to exhale into a special place that has a carbon trap. This examination is non-invasive, so it is more often chosen.

b) USG Upper and Lower Abdomen

The USG examination uses ultrasound waves to visually detect abnormalities in the body. USG examination is often done because it is effective, non-invasive, and has minimal side effects. USG examination of the abdomen consists of 2 parts, namely upper (upper part) and lower (lower part). The main organs in the USG upper abdomen examination include: Liver, gallbladder, pancreas, spleen, right and left kidneys, abdominal blood vessels (abdominal aorta), etc. While in the lower abdomen examination, among others: bladder, intestines, especially the appendix, prostate gland in men, ovaries and uterus in women. If you are planning for an abdominal USG examination, the doctor will recommend fasting for at least 6 hours because undigested food can interfere with the examination. In addition, it is recommended to drink water 2 hours before the examination and make sure the bladder is full during the examination.

c) Electrocardiogram

The electrocardiogram, also known as ECG or EKG, is an examination of heart rhythm and electrical activity at rest. This examination is used to investigate symptoms of possible heart problems, such as chest pain, palpitations or palpitations, dizziness, and shortness of breath. This ECG examination can also help rule out a diagnosis for heartburn complaints (chest feels hot/burning), which is also a similar symptom of GERD (gastritis complication).

Thus, examinations that can be done related to complaints during fasting and as screening in preparation for fasting. All these examinations are available at health services in all branches of PRAMITA Medical Laboratory and Clinic.

Keywords: Health Problems During Fasting, Dehydration During Fasting, Headache While Fasting, Increased Stomach Acid, Constipation During Fasting, Low Blood Pressure, Bad Breath While Fasting, Hypoglycemia During Fasting, Healthy Fasting Tips, Healthy Food During Suhoor, Preventing Dehydration, Overcoming Headache, How to Avoid Stomach Acid, Overcoming Constipation, High Fiber Food, Overcoming Low Blood Pressure, How to Overcome Bad Breath, Preventing Hypoglycemia, Healthy Suhoor, Tips for Breaking the Fast.

Keywords: Ramadan Preparation, Maintaining Health During Fasting, Medical Check-Up Before Ramadan, Routine Health Examination, Anamnesis and Physical Examination, Laboratory Examination During Fasting, Complete Hematology, Complete Urine, Electrolyte Panel, Kidney Function Test, Liver Function Test, Blood Gas Analysis, Blood Glucose, Helicobacter Pylori, Urea Breath Test, Abdominal Ultrasound, Electrocardiogram, Thyroid Health, Heart Health, Ramadan Health Screening

Author: Dr. Ninda Ariesta (Medical Service Doctor at PRAMITA Lab, Sultan Agung Branch, Yogyakarta)