Background: The major changes in the timing of meals during Ramadan may be challenging for hypothyroid patients on levothyroxine. We aimed to study the effect of Ramadan fasting on thyroid functions in hypothyroid patients taking levothyroxine. Methods: We did a comprehensive search of 8 databases for Randomized controlled studies (RCTs) and observational studies investigating the effect of Ramadan fasting on thyroid functions in hypothyroid individuals taking levothyroxine. Relevant data was extracted and analyzed. Mean difference (MD) and standard deviation (SD) were used to evaluate the continuous data. Risk ratios (RR) with a 95% confidence interval were used for outcomes constituting dichotomous data. National Institutes of Health (NIH) tools were used to assess the risk of bias. Results: Fourteen studies met our inclusion criteria, 3 RCTs, and 11 observational studies, all designed as pre-post studies. Ramadan fasting was associated with a statistically significant increase in TSH in patients who were euthyroid before Ramadan (MD = -0.76 [95% CI; -1.27, -0.25]). However, free thyroxine (FT4) was found to be stable (MD = 0.01, [95% CI; -0.03, 0.06]). All timing points were associated with a significant increase in TSH levels after Ramadan, pre-iftar (MD = -0.69 [95% CI; -1.03, -0.36]), post-iftar (MD = -0.76 [95% CI; -1.12, -0.39]), and pre-suhoor (MD = -1.19 [95% CI; -2.18, -0.19]). Conclusion: TSH increases significantly after Ramadan. No timing point has superiority in maintaining thyroid control. However, choosing the timing should be individualized according to the patient’s preference to guarantee the most possible compliance.

Background: Chronic ulcers cause persistent pain and impaired healing, often showing resistance to standard therapies. Topical sevoflurane has emerged as a potential agent for both pain relief and wound healing; however, current evidence remains limited. This review assesses the safety and efficacy of topical sevoflurane in managing painful chronic ulcers and promoting a reduction in ulcer size. Objective: To assess the safety and efficacy of topical sevoflurane as a promising drug compared with standard care. Methods: We searched PubMed, Web of Science, Cochrane Library, and Scopus up to March 2025 for studies on topical sevoflurane in chronic ulcers. Meta-analysis was based on the Cochrane Handbook for Systematic Reviews of Intervention. Results: Our meta-analysis showed that three studies (n = 127) demonstrated a significant reduction in pain with topical sevoflurane treatment, with a pooled Standardized Mean Difference (SMD) of −1.88 (95% CI: −2.31 to −1.44, P < .0001), and low heterogeneity (I² = 18.9%). Ulcer size reduction was also statistically significant in two studies (n = 79), with a pooled mean difference of −4.77 cm² (95% CI: −7.30 to −2.23, P = .0002), and moderate heterogeneity (I² = 30.0%). Effects were more pronounced at earlier assessment time points. Conclusion: Topical sevoflurane shows promise for pain management in chronic ulcers, with potential benefits for healing and reducing opioid use. However, stronger evidence from high-quality studies is needed to support a definitive recommendation.

Type 1 diabetes mellitus (T1DM) can lead to a severe and life-threatening complication called diabetic ketoacidosis (DKA). It is the leading cause of death in children with T1DM [1,2]. It is implic...

Background: Topical timolol appears to provide a curative effect in managing chronic ulcers. However, the pooled evidence of its effect hasn’t been established yet. This is the first Meta-analysis to evaluate and assess the efficacy of topical timolol in accelerating wound healing in patients with chronic refractory ulcers. Methods: We comprehensively searched different electronic databases; PubMed, Scopus, Web of Science, Cochrane library and ClinicalTrials.gov from their inception to November 2024. The search was conducted without imposing any restrictions on publication date or study design. The ROB-II tool was used to assess the quality of included RCTs. NIH tools were used to evaluate the quality of included cohort and single arm studies. Risk ratios (RR) and mean differences (MD), with 95% confidence intervals (CIs), were used as effect estimates. Results: Six studies were included in this systematic review, comprising two single-arm studies and four double-arm studies (3 RCTs and 1 cohort study). Data from the four double-arm studies on venous ulcers were pooled for meta-analysis. The results showed that topical timolol significantly reduced ulcer area compared to control at 2 weeks (−23.63%; 95% CI: −29.26 to −18.00; p < 0.00001), 4 weeks (−41.40%; 95% CI: −49.57 to −33.23; p < 0.00001), and 12 weeks (−23.38%; 95% CI: −39.43 to −7.33; p = 0.004). Complete ulcer healing was observed at 4 weeks (RR: 12.00; 95% CI: 1.68 to 85.84; p = 0.01) and 12 weeks (RR: 3.79; 95% CI: 0.44 to 32.54; p = 0.22). Conclusion: Topical timolol has the potential to promote healing in chronic unhealed ulcers. This meta-analysis, focusing on chronic venous ulcers, consistently showed favorable results across different time points. However, the small sample sizes, lack of blinding, and inclusion of only four studies limit the generalizability of the findings.