Can I start fasting based on the moon sighting of another country?
You must follow the moon sighting of the country you are in.
Should missed Sunnah prayer be made up?
Making up missed voluntary acts of worship is from Sunnah.
What is the ruling on performing istinja' before every ablution?
Istinja' is not from the conditions for the validity of ablution. It is only obligatory for prayer when there is impurity from urine or stool on the private part, or if there is fear of the impurity spreading to the body or clothing. And Allah the Almighty knows best.
Does using a gargling medicine break the fast?
If the medicine reaches the body cavity (jauf), the fast is invalidated. However, if it does not enter the body cavity, the fast remains valid.
Therefore, it is advisable to avoid using it during the day in Ramadan.