Background: Epilepsy affects over 50 million people globally, with a substantial number residing in Muslim-majority countries where Ramadan fasting is widely observed. Ramadan fasting involves prolonged daily abstinence from food, drink, and oral medications, potentially impacting seizure control in patients with epilepsy due to changes in medication adherence, sleep patterns, and metabolic status.

Aim: This systematic review synthesizes clinical evidence regarding the effects of Ramadan fasting on seizure frequency and control.

Methods: A systematic search of PubMed, Scopus, Web of Science, Embase, and the Cochrane Library was conducted on May 10, 2025, identifying prospective observational studies assessing seizure control during Ramadan fasting. Five studies encompassing 672 patients were included. Quality was appraised using the Newcastle-Ottawa Scale. Due to heterogeneity, findings were narratively synthesized.

Results: The evidence reveals mixed effects of Ramadan fasting on seizure control. Some studies report a significant reduction in focal and myoclonic seizures during and after Ramadan, potentially linked to favorable metabolic adaptations and improved medication adherence. Conversely, other studies observed increased seizure frequency associated with altered antiepileptic drug regimens and sleep disturbances. Medication adherence was variable but critical to seizure outcomes. Quality of life measures showed limited improvement during fasting, reflecting psychosocial stress and physiological challenges.

Conclusion: Ramadan fasting can be safe for well-controlled epilepsy patients with stable medication regimens, but individualized management and close monitoring are essential. Metabolic changes, medication scheduling, and sleep hygiene must be carefully managed to minimize seizure risk. Further large-scale prospective studies are needed to optimize clinical guidelines balancing religious observance with patient safety.

Background: Although Lugol’s iodine is routinely used in hyperthyroid patients before thyroidectomy to reduce gland vascularity, its role in euthyroid patients remains controversial.

Aim: This study aims to evaluate the effectiveness of Lugol’s iodine in reducing intraoperative blood loss in euthyroid patients undergoing thyroidectomy.

Methods: A systematic search of PubMed, Embase, Web of Science, and Scopus was performed up to May 2025. Randomized controlled trials (RCTs) comparing preoperative Lugol’s iodine to placebo or no intervention in euthyroid patients were included. The primary outcome was intraoperative blood loss. Meta-analysis was conducted using a random-effects model, with mean difference (MD) and 95% confidence intervals (CI).

Results: Out of 487 screened records, 3 RCTs with 250 euthyroid patients (125 Lugol’s, 125 control) were included. Lugol’s iodine significantly reduced intraoperative blood loss compared to control (MD: –18.22 mL, 95% CI: –21.53 to –14.92; p < 0.00001). Moderate heterogeneity was observed (I² = 85%). All included studies had moderate-to-high methodological quality. No consistent data on adverse effects were reported.

Conclusion: Preoperative Lugol’s iodine significantly reduces intraoperative blood loss in euthyroid patients undergoing thyroidectomy. While findings support its use as a blood-conserving adjunct, further large-scale trials with standardized protocols are warranted to confirm efficacy and assess safety.

Hypertension is a common condition frequently managed in primary care. However, secondary causes such as Cushing’s syndrome may be overlooked, leading to delays in diagnosis and treatment. We present the case of a 50-year-old female with a 5-year history of hypertension who presented for routine medication adjustment. A systematic clinical assessment revealed features suggestive of hypercortisolism. Subsequent biochemical testing confirmed Cushing’s disease, and MRI imaging revealed a pituitary adenoma with associated visual field defects, previously unnoticed by the patient. This case highlights the importance of comprehensive evaluation in hypertensive patients to identify secondary causes and prevent complications.