Mahmoud Nassar - Academia.edu (original) (raw)
Papers by Mahmoud Nassar
Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and... more Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses. Traditional prognostic models, while useful, often fall short of accurately predicting clinical outcomes for these patients. This article discusses the development and implications of a novel prognostic tool, the GATIS score, which aims to enhance predictive accuracy and guide treatment strategies more effectively than current methods. Utilizing data from a large cohort and employing sophisticated statistical models, the GATIS score integrates clinical and pathological markers to provide a nuanced assessment of prognosis. We evaluate the potential of this score to transform clinical decision-making processes, its integration into current medical practices, and future directions for its development. The integration of genetic markers and other biomarkers could further refine its predictive power, highlighting the ongoing need for innovation in the management of rectal neuroendocrine neoplasms.
Nassar M, Baraka B, Talal AH. Innovative approaches in predicting outcomes for rectal neuroendocrine tumors. World J Gastroenterol 2025; 31(6): 100517 [DOI: 10.3748/wjg.v31.i6.100517]
ASIDE Internal Medicine, 2025
Introduction: Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disea... more Introduction: Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disease (CVD) risk, but the extent to which obesity and IIH-specific factors contribute to this risk is not well understood. WE aim to separate the effects of obesity from IIH-specific factors on the risk of stroke and CVD, building on previous findings that indicate a two-fold increase in cardiovascular events in women with IIH compared to BMI-matched controls.
Methods: An obesity-adjusted risk analysis was conducted using Indirect Standardization based on data from a cohort study by Adderley et al., which included 2,760 women with IIH and 27,125 matched healthy controls from The Health Improvement Network (THIN). Advanced statistical models were employed to adjust for confounding effects of obesity and determine the risk contributions of IIH to ischemic stroke and CVD, independent of obesity. Four distinct models explored the interactions between IIH, obesity, and CVD risk.
Results: The analysis showed that IIH independently contributes to increased cardiovascular risk beyond obesity alone. Risk ratios for cardiovascular outcomes were significantly higher in IIH patients compared to controls within similar obesity categories. Notably, a synergistic effect was observed in obese IIH patients, with a composite CVD risk ratio of 6.19 (95% CI: 4.58-8.36, p<0.001) compared to non-obese controls.
Conclusions: This study underscores a significant, independent cardiovascular risk from IIH beyond obesity. The findings advocate for a shift in managing IIH to include comprehensive cardiovascular risk assessment and mitigation. Further research is required to understand the mechanisms and develop specific interventions for this group.
ASIDE Internal Medicine , Dec 28, 2024
Introduction: Managing idiopathic intracranial hypertension (IIH) is challenging due to limited t... more Introduction: Managing idiopathic intracranial hypertension (IIH) is challenging due to limited treatment options. This study evaluates metformin as a potential therapy for IIH, examining its impact on disease outcomes and safety.
Methods: We performed a retrospective cohort study using the TriNetX database, covering data from 2009 to August 2024. The study included IIH patients, excluding those with other causes of raised intracranial pressure or pre-existing diabetes. Propensity score matching adjusted for age, sex, race, ethnicity, Hemoglobin A1C, and baseline BMI at metformin initiation. We assessed outcomes up to 24 months.
Results: Initially, 1,268 patients received metformin and 49,262 served as controls, showing disparities in various parameters. After matching, both groups consisted of 1,267 patients each. Metformin users had significantly lower risks of papilledema, headache, and refractory IIH at all follow-ups (p<0.0001). They also had fewer spinal punctures and reduced acetazolamide use. BMI reductions were more significant in the metformin group from 6 months onward (p<0.0001), with benefits persisting regardless of BMI changes. Metformin’s safety profile was comparable to the control group.
Conclusions: The study indicates metformin’s potential as a disease-modifying treatment in IIH, with improvements across multiple outcomes independent of weight loss. This suggests complex mechanisms at play, supporting further research through prospective clinical trials to confirm metformin’s role in IIH management and its mechanisms of action.
ASIDE Internal Medicine, 2024
Introduction: Despite technological advances in Type 1 Diabetes Mellitus (T1D) management, racial... more Introduction: Despite technological advances in Type 1 Diabetes Mellitus (T1D) management, racial disparities in insulin pump utilization persist. We investigated patterns of insulin pump adoption across different racial groups using a large-scale, multi-institutional database to quantify these disparities and identify potential intervention points.
Methods: We conducted a retrospective cohort study using the TriNetX research network, analyzing data from 978,665 T1D patients across 66 healthcare organizations. Propensity score matching was employed to balance cohorts, with a focused sub-analysis of Buffalo, NY (n=6,080) to examine regional variations in comparison to the United States nationwide present data.
Results: Nationwide data revealed significant racial disparities in insulin pump utilization, with White patients showing the highest adoption rate (11.74%) compared to Black or African American (AA) patients (4.056%). Buffalo cohort demonstrated higher overall adoption rates but maintained similar disparity patterns (White: 30.18%, Black or AA: 13.75%). Post-matching analysis confirmed these disparities persisted independent of demographic factors.
Conclusions: Our findings reveal significant racial disparities in insulin pump adoption, with regional variations suggesting the influence of institutional factors. These results highlight the need for targeted interventions to promote equitable access to diabetes technology and prevent the widening of health disparities in T1D care.
ASIDE Internal Medicine, 2024
Introduction: Gastrointestinal neuroendocrine carcinomas (GI-NECs) are a diverse group of aggress... more Introduction: Gastrointestinal neuroendocrine carcinomas (GI-NECs) are a diverse group of aggressive tumors with variable clinical outcomes. Although progress has been made in classifying and treating these cancers, detailed real-world data on their anatomical distribution and survival rates are scant. This study utilizes a large database to explore the epidemiological and anatomical distribution patterns and to assess the survival outcomes of GI-NECs.
Methods: We accessed the TriNetX global health research network, comprising about 197 million patient records from 160 healthcare organizations, to perform a retrospective analysis of GI-NEC cases through November 2024. Patients were identified via the ICD-O-3 morphology code 8246/3. We analyzed TNM staging and survival rates across various GI locations.
Results: We identified 4,515 cases of NECs with a nearly equal gender distribution (47.27% male, 47.35% female) and an average age of 71 years. Unknown primary sites were the most common (n=692) followed by Small intestinal NECs (n=682) and others. The least common were liver and intrahepatic biliary NECs (n=71). Survival varied significantly by site, from a high of 37.5% in small intestinal NECs to just 11.4% in hepatic/biliary NECs, highlighting notable differences even within the same organ, such as between appendiceal and cecal NECs (44.8% vs. 26.4%).
Conclusions: This study highlights the necessity for site-specific treatment and improved diagnostic strategies, especially for the worst-prognosis NECs found in hepatic and biliary locations. Our findings are vital for developing targeted therapies and refining prognostic tools based on anatomical sites.
ASIDE Internal Medicine, 2024
Abstract Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health b... more Abstract
Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United States (US).
Methods: We performed a retrospective analysis using the TriNetX US Collaborative Network database (1990-2024). We investigated demographic characteristics, time-based trends, geographic distribution, treatment pathways patterns, comorbidity profiles and associated risks with IIH. We used multivariate regression, Cox proportional hazards modeling, and standardized morbidity ratios to assess various outcomes and associations.
Results: Among 51,526 patients, we found a significant increase in adult IIH incidence from 16.0 to 127.0 per 100,000 (adjusted RR: 6.94, 95% CI: 6.71-7.17). Female predominance increased over time (female-to-male ratio: 3.29, 95% CI: 3.18-3.40). Southern regions showed the highest prevalence (43.0%, n=21,417). Initial medical management success rates varied between acetazolamide (42.3%) and topiramate (28.7%). Advanced interventional procedures showed 82.5% success rates in refractory cases. Cox modeling revealed significant associations between IIH and metabolic syndrome (HR: 2.14, 95% CI: 1.89-2.39) and cardiovascular complications (HR: 1.76, 95% CI: 1.58-1.94), independent of BMI.
Conclusions: Our findings highlight IIH as a systemic disorder with significant metabolic implications beyond its neurological manifestations. The marked regional disparities and rising incidence rates, especially among adults, suggest the need for targeted healthcare strategies. Early intervention success strongly predicts favorable outcomes, supporting prompt diagnosis and treatment initiation. These results advocate for an integrated approach combining traditional IIH management with broad metabolic screening care.
Journal of Endocrinological Investigation , 2024
Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used to manage t... more Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used to manage type 2 diabetes (T2D) and obesity. Despite their recognized benefits in glycemic control and weight management, their impact on broader systemic has been less explored. Objective This study aimed to evaluate the impact of GLP-1RAs on a variety of systemic diseases in people with T2D or obesity. Methods We conducted a retrospective cohort study using data from the Global Collaborative Network, accessed through the TriNetX analytics platform. The study comprised two primary groups: individuals with T2D and those with obesity. Each group was further divided into subgroups based on whether they received GLP-1RA treatment or not. Data were analyzed over more than a 5-year follow-up period, comparing incidences of systemic diseases; systemic lupus erythematosus (SLE), systemic sclerosis (SS), rheumatoid arthritis (RA), ulcerative colitis (UC), crohn's disease (CD), alzheimer's disease (AD), parkinson's disease (PD), dementia, bronchial asthma (BA), osteoporosis, and several cancers. Results In the T2D cohorts, GLP-1RA treatment was associated with significantly lower incidences of several systemic and metabolic conditions as compared to those without GLP-1RA, specifically, dementia (Risk Difference (RD):-0.010, p < 0.001), AD (RD:-0.003, p < 0.001), PD (RD:-0.002, p < 0.001), and pancreatic cancer (RD:-0.003, p < 0.001). SLE and SS also saw statistically significant reductions, though the differences were minor in magnitude (RD:-0.001 and − 0.000 respectively, p < 0.001 for both). Conversely, BA a showed a slight increase in risk (RD: 0.002, p < 0.001). Conclusions GLP-1RAs demonstrate potential benefits in reducing the risk of several systemic conditions in people with T2D or obesity. Further prospective studies are needed to confirm these effects fully and understand the mechanisms. Highlights • 1. GLP-1 RAs decrease the risk of SLE, SS, dementia, AD, PD, CD, UC, and osteoporosis in patients with T2D or obesity. • 2. Further, GLP-1 RAs decrease the risk of pancreatic cancer, liver cell carcinoma, thyroid cancer, or colon cancer in patients with T2D or obesity alone. • 3. GLP-1RAs influenced BA and RA risk variably across T2D or obesity alone cohorts.
International Journal of Diabetes in Developing Countries, 2024
Background & Aims: Diabetes and related metabolic syndromes represent a significant global health... more Background & Aims: Diabetes and related metabolic syndromes represent a significant global health challenge, with the global burden of diabetes increasing considerably since 1990. In this article, we examined the trend of publications in Endocrinology, Diabetes and Metabolism between 1996 and 2021, focusing on Asian countries.
Methods: We obtained and used the data from the Scopus database from the SCImago website (https://www.scimagojr.com/), on 1 April 2023, related to the subspecialty of Endocrinology, Diabetes and Metabolism for country rankings between 1996 and 2021. We did not include any data related to other medical specialties or other fields.
Results: There has been a steady rise in global publications on these subspecialties over the past decade, with the number of publications from Asian countries increasing significantly. Western Europe recorded the highest number of publications, followed by North America and Asia. The COVID-19 pandemic also contributed to a surge in publications in this field. In Asian countries, China and India have notably increased their global contribution to publications, with China emerging as the top Asian nation in 2021.
Conclusion: Our findings provide valuable insights into the research output from various countries and the productivity trends in Diabetes, Endocrinology and Metabolism-related research.
medrxiv, 2024
Introduction: Idiopathic intracranial hypertension (IIH) remains a challenging condition to manag... more Introduction: Idiopathic intracranial hypertension (IIH) remains a challenging condition to manage, with limited therapeutic options. This study investigated the potential of metformin as a novel treatment for IIH, exploring its effects on disease outcomes and safety profile. Methods: We conducted a retrospective cohort study using the TriNetX database, analyzing data from 2009 to August 2024. Patients diagnosed with IIH were included, with exclusions for other causes of elevated intracranial pressure and pre-existing diabetes. Propensity score matching was employed to balance cohorts according to age, sex, race, ethnicity, Hemoglobin A1C, and baseline body mass index (BMI) at the time of metformin initiation. Outcomes were assessed at various follow-up points up to 24 months. Results: The study initially comprised 1,268 patients in the metformin group and 49,262 in the control group, with notable disparities in several parameters. Post-matching, both cohorts were refined to 1,267 patients each after matching with metformin group. Metformin-treated patients showed significantly lower risks of papilledema, headache, and refractory IIH status at all follow-up points (p<0.0001). The metformin group also had reduced rates of therapeutic spinal punctures and acetazolamide continuation. BMI reductions were more pronounced in the metformin group, with significant differences observed from 6 months onward (p<0.0001). Notably, metformin's beneficial effects persisted independently of BMI changes. The safety profile of metformin was favorable, with no significant differences in adverse events compared to the control group which did not receive metformin during the study timeframe. Conclusions: This study provides evidence for metformin's potential as a disease-modifying therapeutic approach in IIH, demonstrating improvements across multiple outcomes. The benefits appear to extend beyond weight loss, suggesting complex mechanisms of action. These findings warrant further investigation through prospective clinical trials to establish metformin's role in IIH management and explore its underlying therapeutic mechanisms.
Baylor University Medical Center Proceedings, 2024
Hepatitis C virus (HCV) is a major global health concern, particularly in Egypt, due to historic ... more Hepatitis C virus (HCV) is a major global health concern, particularly in Egypt, due to historic schistosomiasis control efforts that inadvertently led to widespread HCV transmission. This study aimed to evaluate the efficacy of Egypt’s national strategies in controlling and reducing the prevalence of HCV, including introducing sofosbuvir and implementing the “100 Million Healthy Lives” campaign. The approach includes a review of epidemiological data, an analysis of the national HCV control strategies implemented, and an assessment of their outcomes, focusing on the period from 2006 to 2022. Significant milestones were achieved, including a drastic reduction in new HCV infections from 300 per 100,000 in 2014 to 9 per 100,000 in 2022 and successful treatment of over 4 million people. Egypt has become the first country in the world to achieve the “gold tier” status based on World Health Organization criteria on the path to eradication of HCV. Egypt’s comprehensive approach can serve as a model for similar endemic regions. Other nations with high HCV prevalence might benefit from adopting similar multidimensional strategies, emphasizing prevention and treatment.
cureus, 2024
Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening hematologic disorder charac... more Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening hematologic disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ dysfunction. This report highlights a rare case of small bowel ischemia and ischemic colitis caused by TTP in a 35-year-old woman with systemic lupus erythematosus (SLE), hypertension, and end-stage renal disease on hemodialysis. She presented with severe abdominal pain, diarrhea, vomiting, and bloody bowel movements. Diagnosed through CT, EGD, and colonoscopy and confirmed by ADAMTS13 levels, she was treated with plasma exchange, steroids, and rituximab. After standard therapies failed, resection anastomosis surgery led to clinical improvement. This case underscores the importance of early recognition and treatment of TTP in SLE patients to improve prognosis and reduce morbidity and mortality.
cureus, 2024
Abosheaishaa et al. This is an open access article distributed under the terms of the Creative Co... more Abosheaishaa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The Barw Medical Journal, 2024
Introduction Clinical case reports enrich medical literature by presenting rare medical issues.... more Introduction
Clinical case reports enrich medical literature by presenting rare medical issues. However, case reports that do not adhere to a standard template often lack rigor and limit their usefulness in clinical guidance. Several guidelines for reporting case reports have been structured, while further improvements are still required. The current guideline (CaReL) aims to enhance the comprehensiveness of case reports by integrating a detailed literature review.
Methods
In total, 56 researchers were selected based on specific publication criteria for structuring the guidelines. The guideline development was based on a two-step consensus process, including a literature review and survey distribution. Responses underwent scrutiny to ensure reliability and validity. Content validity was assessed, with revisions made to achieve a content validity index exceeding 0.78. The guideline's feasibility and effectiveness were evaluated by pilot testing, with feedback incorporated for finalization, ensuring the robustness and practicality of the guideline.
Results
The CaReL guidelines can improve the quality of case reports through a comprehensive checklist with an increased emphasis on literature review. In addition to traditional sections with their subsections discussed in previous guidelines, the checklist also focuses on literature review in the abstract and discussion.
Conclusion
The CaReL guidelines offer a comprehensive structure for documenting case reports. They highlight the importance of incorporating a literature review to better introduce medical issues to readers and scholars and embedding reported cases into the current scientific state of the art. Implementing these guidelines can promote knowledge sharing and improve patient care
BMC Endocrine Disorders, 2024
Background Persistent symptoms in hypothyroid patients despite normalized TSH levels suggest the ... more Background
Persistent symptoms in hypothyroid patients despite normalized TSH levels suggest the need for alternative treatments. This study aims to evaluate the effectiveness of combined T4 and T3 therapy or desiccated thyroid (DTE) compared to T4 monotherapy, with a focus on thyroid profile, lipid profile, and quality of life metrics.
Methods
We conducted a systematic review in Embase, Medline/PubMed, and Web of Science up to 11/23/2023. We used the following keywords: “Armour Thyroid,” OR “Thyroid extract,” OR “Natural desiccated thyroid,” OR “Nature-Throid,” “desiccated thyroid,” OR “np thyroid,” OR “Synthroid,” OR “levothyroxine,” OR “Liothyronine,” “Cytomel,” OR “Thyroid USP,” OR “Unithroid.” AND “hypothyroidism. “ We only included RCTs and excluded non-RCT, case–control studies, and non-English articles.
Results
From 6,394 identified records, 16 studies qualified after screening and eligibility checks. We included two studies on desiccated thyroid and 15 studies on combined therapy. In this meta-analysis, combination therapy with T4 + T3 revealed significantly lower Free T4 levels (mean difference (MD): -0.34; 95% CI: -0.47, -0.20), Total T4 levels (mean difference: -2.20; 95% CI: -3.03, -1.37), and GHQ-28 scores (MD: -2.89; 95% CI: -3.16, -2.63), compared to T4 monotherapy. Total T3 levels were significantly higher in combined therapy (MD: 29.82; 95% CI: 22.40, 37.25). The analyses demonstrated moderate to high heterogeneity. There was no significant difference in Heart Rate, SHBG, TSH, Lipid profile, TSQ-36, and BDI Score.
Subjects on DTE had significantly higher serum Total T3 levels (MD: 50.90; 95% CI: 42.39, 59.42) and significantly lower serum Total T4 (MD: -3.11; 95% CI: -3.64, -2.58) and Free T4 levels (MD: -0.50; 95% CI: -0.57, -0.43) compared to T4 monotherapy. Moreover, DTE treatment showed modestly higher TSH levels (MD: 0.49; 95% CI: 0.17, 0.80). The analyses indicated low heterogeneity. There was no significant difference in Heart Rate, SHBG, Lipid profile, TSQ-36, GHQ-28, and BDI Score.
Conclusions
Our study revealed that combined therapy and DTE lead to higher T3 and lower T4 levels, compared to T4 monotherapy in hypothyroidism. However, no significant effects on heart rate, lipid profile, or quality of life were noted. Given the heterogeneity of results, personalized treatment approaches are recommended.
Gastroenterology, 2024
Introduction: Helicobacter pylori (H. pylori) infection is associated with the development of pep... more Introduction: Helicobacter pylori (H. pylori) infection is associated with the development of peptic ulcer disease, chronic gastritis, primary gastric lymphoma, and gastric cancer. Treatment with bismuth-based quadruple therapy is the first line of treatment but can be challenging due to increased pill burden and adverse effects, leading to non-adherence to therapy. Recent studies have shown that Vonoprazan can be used in combination with amoxicillin as a potential treatment option. We conducted a systematic review and meta-analysis to assess the efficacy and tolerability of Vonoprazan-based dual therapy as compared to bismuthbased quadruple therapy. Methodology: We conducted a comprehensive search of multiple electronic databases including PubMed, EMBASE, and Cochrane Library to identify studies assessing Vonoprazan and amoxicillin (VA) in comparison to bismuth-based quadrable therapy (BQT) for H. pylori treatment in adults > 18 years of age. Studies with pediatric population, written in languages other than English, or without control groups were excluded. Results: Out of 1491 citations, 3 studies including 380 patients in each group were included in the final analysis. There were 169 and 171 males in the VA and the BQT groups, respectively. The mean age ranged from 39.9- 42.7 years in the VA group and from 41.1 - 43.3 in the BQT group. VA group had a similar eradication rate as compared to the BQT group (OR: 1.38, 95% CI:0.76-2.51; p=0.29). VA treatment regimen had a lower incidence of total adverse events than the BQT group (OR: 0.34, 95% CI: 0.24-0.48, p=0.00001), including a reduced occurrence of nausea and vomiting (OR: 0.43, 95% CI: 0.21-0.88, p= 0.02). Both groups had similar adherence rates to the treatment (OR: 1.16, 95% CI: 0.50- 2.72; p= 0.73). Conclusion: Our study shows a similar eradication rate of H. pylori but a significantly lower incidence of adverse events in the VA treatment regimen as compared to the BQT group. Our analysis suggests that a VA-based regimen is an acceptable treatment option for H. Pylori patients who cannot tolerate BQT
Gastroenterology, 2024
Elhanafi Introduction: Chronic pancreatitis encompasses various risk factors such as alcohol con... more Elhanafi Introduction: Chronic pancreatitis encompasses various risk factors such as alcohol consumption, smoking, autoimmune conditions, and other causes. However, there's limited understanding regarding the difference in disease progression and outcomes among its different subtypes. Our study is a population-based study that aims to evaluate the outcomes between alcohol-related chronic pancreatitis and non-alcohol-related chronic pancreatitis. Methods: TriNetX is the global federated health research network providing access to electronic medical records across large healthcare organizations (HCOs). The analysis utilized the TriNetX Diamond Network; a network that includes 92 HCO(s) and more than 200 million patients in the US. This analysis compared the baseline characteristics and the clinical outcomes of alcohol-related chronic pancreatitis (Alcohol cohort) and non-alcohol-related chronic pancreatitis (Non-alcohol cohort). ICD10 codes were used to identify both cohorts. Any patient with a history of alcohol intake was excluded from the non-alcohol cohort. The primary outcome was mortality. Secondary outcomes were exocrine pancreatic insufficiency, pseudocyst formation, diabetes mellitus, and pancreatic cancer. This analysis included outcomes that occurred in the time window that started 1 day after the first occurrence of the index event (diagnosis of chronic pancreatitis). Patients with outcomes that occurred before the index event were excluded. Results: The study included 17,912 patients in the alcohol cohort and 407,618 patients in the non-alcohol cohort. The mean age (+/- SD) was 52.9 +/- 13.7 in the alcohol cohort and 60.3 +/- 16.9 in the non-alcohol cohort. The proportion of females was 27.5% in the alcohol cohort and 43.8% in the non-alcohol cohort. Propensity score matching was performed on all baseline characteristics that can be potential confounders, including age, sex, smoking status, diabetes, hypertension, ischemic heart disease, and pancreatic congenital malformations. The baseline characteristics of the cohorts before and after matching are summarized in table 1. Outcome analysis after propensity score matching showed lower rates of mortality, exocrine pancreatic insufficiency, pseudocyst, and pancreatic cancer in alcohol-related chronic pancreatitis cohort compared to the other cohort (Table 2). There were lower rates of ERCP and celiac plexus injection utilization in the alcohol cohort. (Table 2) Conclusion: This population-based study revealed more favorable outcomes in alcoholrelated chronic pancreatitis including mortality compared to cases attributed to other etiologies. Further research is imperative to comprehend the variances in pathophysiology and disease patterns between these categories, including investigating potential differences in genomic interactions within both types
Endocrine Practice, 2024
Objective Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are used in managing type 2 diabet... more Objective
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are used in managing type 2 diabetes mellitus (T2DM) and weight loss. However, their use is associated with various gastrointestinal adverse effects, notably gastroparesis, attributed to their role in delaying gastric emptying and enhancing satiety. Case studies and recent retrospective analyses in non-diabetic, obese populations have indicated a heightened incidence of gastroparesis linked to GLP-1 RA usage. Despite these findings, there is a notable gap in the literature regarding the incidence of gastroparesis among patients with T2DM treated with GLP-1 RA, especially when compared to other treatment modalities such as dipeptidyl peptidase-4 (DPP-4) inhibitors, which are not traditionally associated with an increased risk of gastroparesis. This study seeks to ascertain whether semaglutide, a GLP-1 RA, is associated with a significant rise in gastroparesis incidence compared to sitagliptin, a DPP-4 inhibitor, in patients with pre-existing T2DM, focusing on the initial six months following treatment commencement.
Methods
In this retrospective cohort study, we utilized data sourced from the TriNetX electronic health records global collaborative network, which included 131,466,594 patients. The target population of this investigation was patients with T2DM who had no prior ICD-10 code for gastroparesis or usage of GLP-1 RA or DPP-4 inhibitors in the five years preceding their initial semaglutide treatment. A comparative group meeting the same inclusion criteria was identified among patients who commenced treatment with sitagliptin. Before matching, the patient population consisted of 54,951 in the semaglutide cohort and 118,123 in the sitagliptin cohort. To mitigate potential confounding factors such as age, sex, alcohol consumption, smoking habits, and obesity, a propensity score match was executed, resulting in two well-balanced cohorts (n=53,989 each).
Results
Within the 6 months following initiation of semaglutide or sitagliptin, the incidence of gastroparesis was slightly higher in the semaglutide group (154 events) compared to the sitagliptin group (137 events), but this difference was not statistically significant (p = 0.3183). The relative risk associated with semaglutide was 1.124 (95% CI: 0.893-1.415), indicating no significant increase in risk compared to sitagliptin. Similarly, no significant differences were observed within 1 year of starting semaglutide as compared to sitaglitptin.
Discussion/Conclusion
Our data show that semaglutide is not associated with a significant increase in gastroparesis within six months of initiation compared to sitagliptin in patients with T2DM and that overall incidence is low. Prospective studies are required to elucidate if there is an increased risk of gastroparesis with GLP-1 RA as compared to other hypoglycemic therapies, given that this patient population is already at a higher baseline risk.
Medicine , 2024
There are multiple mechanisms by which The Coronavirus-19 (COVID-19) infection can cause electrol... more There are multiple mechanisms by which The Coronavirus-19 (COVID-19) infection can cause electrolyte abnormalities, which may not be the case for bacterial causes of pneumonia. This study aimed to assess the differences in electrolyte levels between patients suffering from COVID-19 and bacterial pneumonia. This is an original, retrospective study. Two cohorts of hospitalized patients were included, 1 suffering from COVID-19 and the other from bacterial pneumonia. Their day 1 and day 3 levels of sodium, potassium, magnesium, and phosphorus, as well as their outcomes, were extracted from the charts. Statistical analysis was subsequently performed. Mean admission levels of sodium, potassium, phosphorus, and magnesium were 135.64 ± 6.13, 4.38 ± 0.69, 3.53 ± 0.69, and 2.03 ± 0.51, respectively. The mean day 3 levels of these electrolytes were 138.3 ± 5.06, 4.18 ± 0.59, 3.578 ± 0.59, and 2.11 ± 0.64, respectively. Patients suffering from bacterial pneumonia were significantly older (N = 219, mean = 64.88 ± 15.99) than patients with COVID-19 pneumonia (N = 240, mean = 57.63 ± 17.87). Bacterial pneumonia group had significantly higher serum potassium (N = 211, mean = 4.51 ± 0.76), and magnesium (N = 115, mean = 2.12 ± 0.60) levels compared to COVID-19 group (N = 227, mean = 4.254 ± 0.60 for potassium and N = 118, mean = 1.933 ± 0.38 for magnesium). Only magnesium was significantly higher among day 3 electrolytes in the bacterial pneumonia group. No significant association between electrolyte levels and outcomes was seen. We found that COVID-19 patients had lower potassium and magnesium levels on admission, possibly due to the effect of COVID-19 on the renin-angiotensin-aldosterone system as well as patient characteristics and management. We did not find enough evidence to recommend using electrolyte levels as a determinator of prognosis, but more research is needed. Abbreviations: ACE-2 = angiotensin-converting enzyme-2, AKI = acute kidney injury, BMP = basic metabolic panel, CI = confidence interval, CKD = chronic kidney disease, CMP = complete metabolic panel, COVID-19 = coronavirus disease 2019, GI = gastrointestinal, K-S = Kolmogorov-Smirnov, PCR = polymerase chain reaction, RAAS = renin-angiotensin-aldosterone system, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, SD = standard deviation, SIADH = syndrome of inappropriate antidiuretic hormone secretion, SPSS = Statistical Package for the Social Sciences, VBG = venous blood gas.
Dentistry Review, 2024
Objective To assess the correlation between patients with type 1 diabetes mellitus (T1DM) and den... more Objective
To assess the correlation between patients with type 1 diabetes mellitus (T1DM) and dental caries outcomes, including missing teeth, missing surface, filling teeth, filling surface, plaque index, gingival index, and calculus index.
Methods
A comprehensive search was performed across EMBASE, Medline/Pubmed, and Web of Science databases from inception until February 20, 2023. Observational and interventional studies reporting dental caries outcomes in patients with T1DM were included. A random effects meta-analysis was performed to estimate the pooled effect sizes and 95 % confidence intervals.
Results
Thirty-three studies met the criteria for inclusion in the meta-analysis, which revealed that patients with T1DM had a reduced risk of missing teeth in comparison to those without diabetes (control group), with a mean difference (MD) of -0.03, CI 95 % [-0.03, -0.03]. No significant differences were found in missing surface, filling teeth, filling surface, or calculus index between T1DM and non-diabetic groups. However, patients with T1DM had a significantly higher plaque index (MD: 0.47, CI 95 % [0.06, 0.89]) than the non-diabetic group. The overall MD in DFMT between the DM and non-DM groups was 0.47 (95 % CI: 0.13, 0.82). The gingival index showed no significant difference between the groups.
Conclusion
This meta-analysis suggests that patients with T1DM have a higher plaque index than the non-diabetic group, whereas no significant differences were observed in other dental caries outcomes. Because of the considerable variability identified in certain analyses, additional research employing more extensive sample sizes and rigorous methodologies is required to validate these results.
Journal of Diabetes, 2024
Objective To assess the association between glucagon-like peptide-1 receptor agonists (GLP-1RA) t... more Objective
To assess the association between glucagon-like peptide-1 receptor agonists (GLP-1RA) treatment and the risk of suicide attempts in people with type 2 diabetes (T2D), with a focus on subgroups with and without a history of depression or suicide attempts.
Methods
This retrospective cohort study utilized TriNetX, a federated network of real-world data. Using the Global Collaborative Network data, we collected electronic medical records from 113 health care organizations with 135 million patient records with 8 million with T2D, 83% from the United States. The four cohorts were identified based on age, medication, diagnosis, and presence of depression or suicide attempts. Analytic methods included measures of association and number of Instances, with propensity score matching employed to mitigate potential confounders. The primary outcome was the incidence of suicide attempts among people with T2D with GLP-1RA treatment in comparison with dipeptidyl peptidase-4 inhibitor (DPP-4i) treatment.
Results
People with T2D treated with GLP-1RA consistently exhibited a lower risk of suicide attempts compared to those treated with DPP-4i. This was particularly significant in people with a history of depression or suicide attempts. The risk and odds ratios were significantly lower in the GLP-1RA-treated cohorts than in DPP-4i across all analyses.
Conclusion
As compared with DPP-4i, our analysis shows a protective effect associated with GLP-1RA treatment on the risk of suicide attempts among people with T2D. However, further research, particularly prospective and randomized studies, is necessary to confirm these observations and understand the underlying mechanisms.
Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and... more Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses. Traditional prognostic models, while useful, often fall short of accurately predicting clinical outcomes for these patients. This article discusses the development and implications of a novel prognostic tool, the GATIS score, which aims to enhance predictive accuracy and guide treatment strategies more effectively than current methods. Utilizing data from a large cohort and employing sophisticated statistical models, the GATIS score integrates clinical and pathological markers to provide a nuanced assessment of prognosis. We evaluate the potential of this score to transform clinical decision-making processes, its integration into current medical practices, and future directions for its development. The integration of genetic markers and other biomarkers could further refine its predictive power, highlighting the ongoing need for innovation in the management of rectal neuroendocrine neoplasms.
Nassar M, Baraka B, Talal AH. Innovative approaches in predicting outcomes for rectal neuroendocrine tumors. World J Gastroenterol 2025; 31(6): 100517 [DOI: 10.3748/wjg.v31.i6.100517]
ASIDE Internal Medicine, 2025
Introduction: Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disea... more Introduction: Idiopathic intracranial hypertension (IIH) is known to elevate cardiovascular disease (CVD) risk, but the extent to which obesity and IIH-specific factors contribute to this risk is not well understood. WE aim to separate the effects of obesity from IIH-specific factors on the risk of stroke and CVD, building on previous findings that indicate a two-fold increase in cardiovascular events in women with IIH compared to BMI-matched controls.
Methods: An obesity-adjusted risk analysis was conducted using Indirect Standardization based on data from a cohort study by Adderley et al., which included 2,760 women with IIH and 27,125 matched healthy controls from The Health Improvement Network (THIN). Advanced statistical models were employed to adjust for confounding effects of obesity and determine the risk contributions of IIH to ischemic stroke and CVD, independent of obesity. Four distinct models explored the interactions between IIH, obesity, and CVD risk.
Results: The analysis showed that IIH independently contributes to increased cardiovascular risk beyond obesity alone. Risk ratios for cardiovascular outcomes were significantly higher in IIH patients compared to controls within similar obesity categories. Notably, a synergistic effect was observed in obese IIH patients, with a composite CVD risk ratio of 6.19 (95% CI: 4.58-8.36, p<0.001) compared to non-obese controls.
Conclusions: This study underscores a significant, independent cardiovascular risk from IIH beyond obesity. The findings advocate for a shift in managing IIH to include comprehensive cardiovascular risk assessment and mitigation. Further research is required to understand the mechanisms and develop specific interventions for this group.
ASIDE Internal Medicine , Dec 28, 2024
Introduction: Managing idiopathic intracranial hypertension (IIH) is challenging due to limited t... more Introduction: Managing idiopathic intracranial hypertension (IIH) is challenging due to limited treatment options. This study evaluates metformin as a potential therapy for IIH, examining its impact on disease outcomes and safety.
Methods: We performed a retrospective cohort study using the TriNetX database, covering data from 2009 to August 2024. The study included IIH patients, excluding those with other causes of raised intracranial pressure or pre-existing diabetes. Propensity score matching adjusted for age, sex, race, ethnicity, Hemoglobin A1C, and baseline BMI at metformin initiation. We assessed outcomes up to 24 months.
Results: Initially, 1,268 patients received metformin and 49,262 served as controls, showing disparities in various parameters. After matching, both groups consisted of 1,267 patients each. Metformin users had significantly lower risks of papilledema, headache, and refractory IIH at all follow-ups (p<0.0001). They also had fewer spinal punctures and reduced acetazolamide use. BMI reductions were more significant in the metformin group from 6 months onward (p<0.0001), with benefits persisting regardless of BMI changes. Metformin’s safety profile was comparable to the control group.
Conclusions: The study indicates metformin’s potential as a disease-modifying treatment in IIH, with improvements across multiple outcomes independent of weight loss. This suggests complex mechanisms at play, supporting further research through prospective clinical trials to confirm metformin’s role in IIH management and its mechanisms of action.
ASIDE Internal Medicine, 2024
Introduction: Despite technological advances in Type 1 Diabetes Mellitus (T1D) management, racial... more Introduction: Despite technological advances in Type 1 Diabetes Mellitus (T1D) management, racial disparities in insulin pump utilization persist. We investigated patterns of insulin pump adoption across different racial groups using a large-scale, multi-institutional database to quantify these disparities and identify potential intervention points.
Methods: We conducted a retrospective cohort study using the TriNetX research network, analyzing data from 978,665 T1D patients across 66 healthcare organizations. Propensity score matching was employed to balance cohorts, with a focused sub-analysis of Buffalo, NY (n=6,080) to examine regional variations in comparison to the United States nationwide present data.
Results: Nationwide data revealed significant racial disparities in insulin pump utilization, with White patients showing the highest adoption rate (11.74%) compared to Black or African American (AA) patients (4.056%). Buffalo cohort demonstrated higher overall adoption rates but maintained similar disparity patterns (White: 30.18%, Black or AA: 13.75%). Post-matching analysis confirmed these disparities persisted independent of demographic factors.
Conclusions: Our findings reveal significant racial disparities in insulin pump adoption, with regional variations suggesting the influence of institutional factors. These results highlight the need for targeted interventions to promote equitable access to diabetes technology and prevent the widening of health disparities in T1D care.
ASIDE Internal Medicine, 2024
Introduction: Gastrointestinal neuroendocrine carcinomas (GI-NECs) are a diverse group of aggress... more Introduction: Gastrointestinal neuroendocrine carcinomas (GI-NECs) are a diverse group of aggressive tumors with variable clinical outcomes. Although progress has been made in classifying and treating these cancers, detailed real-world data on their anatomical distribution and survival rates are scant. This study utilizes a large database to explore the epidemiological and anatomical distribution patterns and to assess the survival outcomes of GI-NECs.
Methods: We accessed the TriNetX global health research network, comprising about 197 million patient records from 160 healthcare organizations, to perform a retrospective analysis of GI-NEC cases through November 2024. Patients were identified via the ICD-O-3 morphology code 8246/3. We analyzed TNM staging and survival rates across various GI locations.
Results: We identified 4,515 cases of NECs with a nearly equal gender distribution (47.27% male, 47.35% female) and an average age of 71 years. Unknown primary sites were the most common (n=692) followed by Small intestinal NECs (n=682) and others. The least common were liver and intrahepatic biliary NECs (n=71). Survival varied significantly by site, from a high of 37.5% in small intestinal NECs to just 11.4% in hepatic/biliary NECs, highlighting notable differences even within the same organ, such as between appendiceal and cecal NECs (44.8% vs. 26.4%).
Conclusions: This study highlights the necessity for site-specific treatment and improved diagnostic strategies, especially for the worst-prognosis NECs found in hepatic and biliary locations. Our findings are vital for developing targeted therapies and refining prognostic tools based on anatomical sites.
ASIDE Internal Medicine, 2024
Abstract Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health b... more Abstract
Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United States (US).
Methods: We performed a retrospective analysis using the TriNetX US Collaborative Network database (1990-2024). We investigated demographic characteristics, time-based trends, geographic distribution, treatment pathways patterns, comorbidity profiles and associated risks with IIH. We used multivariate regression, Cox proportional hazards modeling, and standardized morbidity ratios to assess various outcomes and associations.
Results: Among 51,526 patients, we found a significant increase in adult IIH incidence from 16.0 to 127.0 per 100,000 (adjusted RR: 6.94, 95% CI: 6.71-7.17). Female predominance increased over time (female-to-male ratio: 3.29, 95% CI: 3.18-3.40). Southern regions showed the highest prevalence (43.0%, n=21,417). Initial medical management success rates varied between acetazolamide (42.3%) and topiramate (28.7%). Advanced interventional procedures showed 82.5% success rates in refractory cases. Cox modeling revealed significant associations between IIH and metabolic syndrome (HR: 2.14, 95% CI: 1.89-2.39) and cardiovascular complications (HR: 1.76, 95% CI: 1.58-1.94), independent of BMI.
Conclusions: Our findings highlight IIH as a systemic disorder with significant metabolic implications beyond its neurological manifestations. The marked regional disparities and rising incidence rates, especially among adults, suggest the need for targeted healthcare strategies. Early intervention success strongly predicts favorable outcomes, supporting prompt diagnosis and treatment initiation. These results advocate for an integrated approach combining traditional IIH management with broad metabolic screening care.
Journal of Endocrinological Investigation , 2024
Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used to manage t... more Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used to manage type 2 diabetes (T2D) and obesity. Despite their recognized benefits in glycemic control and weight management, their impact on broader systemic has been less explored. Objective This study aimed to evaluate the impact of GLP-1RAs on a variety of systemic diseases in people with T2D or obesity. Methods We conducted a retrospective cohort study using data from the Global Collaborative Network, accessed through the TriNetX analytics platform. The study comprised two primary groups: individuals with T2D and those with obesity. Each group was further divided into subgroups based on whether they received GLP-1RA treatment or not. Data were analyzed over more than a 5-year follow-up period, comparing incidences of systemic diseases; systemic lupus erythematosus (SLE), systemic sclerosis (SS), rheumatoid arthritis (RA), ulcerative colitis (UC), crohn's disease (CD), alzheimer's disease (AD), parkinson's disease (PD), dementia, bronchial asthma (BA), osteoporosis, and several cancers. Results In the T2D cohorts, GLP-1RA treatment was associated with significantly lower incidences of several systemic and metabolic conditions as compared to those without GLP-1RA, specifically, dementia (Risk Difference (RD):-0.010, p < 0.001), AD (RD:-0.003, p < 0.001), PD (RD:-0.002, p < 0.001), and pancreatic cancer (RD:-0.003, p < 0.001). SLE and SS also saw statistically significant reductions, though the differences were minor in magnitude (RD:-0.001 and − 0.000 respectively, p < 0.001 for both). Conversely, BA a showed a slight increase in risk (RD: 0.002, p < 0.001). Conclusions GLP-1RAs demonstrate potential benefits in reducing the risk of several systemic conditions in people with T2D or obesity. Further prospective studies are needed to confirm these effects fully and understand the mechanisms. Highlights • 1. GLP-1 RAs decrease the risk of SLE, SS, dementia, AD, PD, CD, UC, and osteoporosis in patients with T2D or obesity. • 2. Further, GLP-1 RAs decrease the risk of pancreatic cancer, liver cell carcinoma, thyroid cancer, or colon cancer in patients with T2D or obesity alone. • 3. GLP-1RAs influenced BA and RA risk variably across T2D or obesity alone cohorts.
International Journal of Diabetes in Developing Countries, 2024
Background & Aims: Diabetes and related metabolic syndromes represent a significant global health... more Background & Aims: Diabetes and related metabolic syndromes represent a significant global health challenge, with the global burden of diabetes increasing considerably since 1990. In this article, we examined the trend of publications in Endocrinology, Diabetes and Metabolism between 1996 and 2021, focusing on Asian countries.
Methods: We obtained and used the data from the Scopus database from the SCImago website (https://www.scimagojr.com/), on 1 April 2023, related to the subspecialty of Endocrinology, Diabetes and Metabolism for country rankings between 1996 and 2021. We did not include any data related to other medical specialties or other fields.
Results: There has been a steady rise in global publications on these subspecialties over the past decade, with the number of publications from Asian countries increasing significantly. Western Europe recorded the highest number of publications, followed by North America and Asia. The COVID-19 pandemic also contributed to a surge in publications in this field. In Asian countries, China and India have notably increased their global contribution to publications, with China emerging as the top Asian nation in 2021.
Conclusion: Our findings provide valuable insights into the research output from various countries and the productivity trends in Diabetes, Endocrinology and Metabolism-related research.
medrxiv, 2024
Introduction: Idiopathic intracranial hypertension (IIH) remains a challenging condition to manag... more Introduction: Idiopathic intracranial hypertension (IIH) remains a challenging condition to manage, with limited therapeutic options. This study investigated the potential of metformin as a novel treatment for IIH, exploring its effects on disease outcomes and safety profile. Methods: We conducted a retrospective cohort study using the TriNetX database, analyzing data from 2009 to August 2024. Patients diagnosed with IIH were included, with exclusions for other causes of elevated intracranial pressure and pre-existing diabetes. Propensity score matching was employed to balance cohorts according to age, sex, race, ethnicity, Hemoglobin A1C, and baseline body mass index (BMI) at the time of metformin initiation. Outcomes were assessed at various follow-up points up to 24 months. Results: The study initially comprised 1,268 patients in the metformin group and 49,262 in the control group, with notable disparities in several parameters. Post-matching, both cohorts were refined to 1,267 patients each after matching with metformin group. Metformin-treated patients showed significantly lower risks of papilledema, headache, and refractory IIH status at all follow-up points (p<0.0001). The metformin group also had reduced rates of therapeutic spinal punctures and acetazolamide continuation. BMI reductions were more pronounced in the metformin group, with significant differences observed from 6 months onward (p<0.0001). Notably, metformin's beneficial effects persisted independently of BMI changes. The safety profile of metformin was favorable, with no significant differences in adverse events compared to the control group which did not receive metformin during the study timeframe. Conclusions: This study provides evidence for metformin's potential as a disease-modifying therapeutic approach in IIH, demonstrating improvements across multiple outcomes. The benefits appear to extend beyond weight loss, suggesting complex mechanisms of action. These findings warrant further investigation through prospective clinical trials to establish metformin's role in IIH management and explore its underlying therapeutic mechanisms.
Baylor University Medical Center Proceedings, 2024
Hepatitis C virus (HCV) is a major global health concern, particularly in Egypt, due to historic ... more Hepatitis C virus (HCV) is a major global health concern, particularly in Egypt, due to historic schistosomiasis control efforts that inadvertently led to widespread HCV transmission. This study aimed to evaluate the efficacy of Egypt’s national strategies in controlling and reducing the prevalence of HCV, including introducing sofosbuvir and implementing the “100 Million Healthy Lives” campaign. The approach includes a review of epidemiological data, an analysis of the national HCV control strategies implemented, and an assessment of their outcomes, focusing on the period from 2006 to 2022. Significant milestones were achieved, including a drastic reduction in new HCV infections from 300 per 100,000 in 2014 to 9 per 100,000 in 2022 and successful treatment of over 4 million people. Egypt has become the first country in the world to achieve the “gold tier” status based on World Health Organization criteria on the path to eradication of HCV. Egypt’s comprehensive approach can serve as a model for similar endemic regions. Other nations with high HCV prevalence might benefit from adopting similar multidimensional strategies, emphasizing prevention and treatment.
cureus, 2024
Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening hematologic disorder charac... more Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening hematologic disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ dysfunction. This report highlights a rare case of small bowel ischemia and ischemic colitis caused by TTP in a 35-year-old woman with systemic lupus erythematosus (SLE), hypertension, and end-stage renal disease on hemodialysis. She presented with severe abdominal pain, diarrhea, vomiting, and bloody bowel movements. Diagnosed through CT, EGD, and colonoscopy and confirmed by ADAMTS13 levels, she was treated with plasma exchange, steroids, and rituximab. After standard therapies failed, resection anastomosis surgery led to clinical improvement. This case underscores the importance of early recognition and treatment of TTP in SLE patients to improve prognosis and reduce morbidity and mortality.
cureus, 2024
Abosheaishaa et al. This is an open access article distributed under the terms of the Creative Co... more Abosheaishaa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The Barw Medical Journal, 2024
Introduction Clinical case reports enrich medical literature by presenting rare medical issues.... more Introduction
Clinical case reports enrich medical literature by presenting rare medical issues. However, case reports that do not adhere to a standard template often lack rigor and limit their usefulness in clinical guidance. Several guidelines for reporting case reports have been structured, while further improvements are still required. The current guideline (CaReL) aims to enhance the comprehensiveness of case reports by integrating a detailed literature review.
Methods
In total, 56 researchers were selected based on specific publication criteria for structuring the guidelines. The guideline development was based on a two-step consensus process, including a literature review and survey distribution. Responses underwent scrutiny to ensure reliability and validity. Content validity was assessed, with revisions made to achieve a content validity index exceeding 0.78. The guideline's feasibility and effectiveness were evaluated by pilot testing, with feedback incorporated for finalization, ensuring the robustness and practicality of the guideline.
Results
The CaReL guidelines can improve the quality of case reports through a comprehensive checklist with an increased emphasis on literature review. In addition to traditional sections with their subsections discussed in previous guidelines, the checklist also focuses on literature review in the abstract and discussion.
Conclusion
The CaReL guidelines offer a comprehensive structure for documenting case reports. They highlight the importance of incorporating a literature review to better introduce medical issues to readers and scholars and embedding reported cases into the current scientific state of the art. Implementing these guidelines can promote knowledge sharing and improve patient care
BMC Endocrine Disorders, 2024
Background Persistent symptoms in hypothyroid patients despite normalized TSH levels suggest the ... more Background
Persistent symptoms in hypothyroid patients despite normalized TSH levels suggest the need for alternative treatments. This study aims to evaluate the effectiveness of combined T4 and T3 therapy or desiccated thyroid (DTE) compared to T4 monotherapy, with a focus on thyroid profile, lipid profile, and quality of life metrics.
Methods
We conducted a systematic review in Embase, Medline/PubMed, and Web of Science up to 11/23/2023. We used the following keywords: “Armour Thyroid,” OR “Thyroid extract,” OR “Natural desiccated thyroid,” OR “Nature-Throid,” “desiccated thyroid,” OR “np thyroid,” OR “Synthroid,” OR “levothyroxine,” OR “Liothyronine,” “Cytomel,” OR “Thyroid USP,” OR “Unithroid.” AND “hypothyroidism. “ We only included RCTs and excluded non-RCT, case–control studies, and non-English articles.
Results
From 6,394 identified records, 16 studies qualified after screening and eligibility checks. We included two studies on desiccated thyroid and 15 studies on combined therapy. In this meta-analysis, combination therapy with T4 + T3 revealed significantly lower Free T4 levels (mean difference (MD): -0.34; 95% CI: -0.47, -0.20), Total T4 levels (mean difference: -2.20; 95% CI: -3.03, -1.37), and GHQ-28 scores (MD: -2.89; 95% CI: -3.16, -2.63), compared to T4 monotherapy. Total T3 levels were significantly higher in combined therapy (MD: 29.82; 95% CI: 22.40, 37.25). The analyses demonstrated moderate to high heterogeneity. There was no significant difference in Heart Rate, SHBG, TSH, Lipid profile, TSQ-36, and BDI Score.
Subjects on DTE had significantly higher serum Total T3 levels (MD: 50.90; 95% CI: 42.39, 59.42) and significantly lower serum Total T4 (MD: -3.11; 95% CI: -3.64, -2.58) and Free T4 levels (MD: -0.50; 95% CI: -0.57, -0.43) compared to T4 monotherapy. Moreover, DTE treatment showed modestly higher TSH levels (MD: 0.49; 95% CI: 0.17, 0.80). The analyses indicated low heterogeneity. There was no significant difference in Heart Rate, SHBG, Lipid profile, TSQ-36, GHQ-28, and BDI Score.
Conclusions
Our study revealed that combined therapy and DTE lead to higher T3 and lower T4 levels, compared to T4 monotherapy in hypothyroidism. However, no significant effects on heart rate, lipid profile, or quality of life were noted. Given the heterogeneity of results, personalized treatment approaches are recommended.
Gastroenterology, 2024
Introduction: Helicobacter pylori (H. pylori) infection is associated with the development of pep... more Introduction: Helicobacter pylori (H. pylori) infection is associated with the development of peptic ulcer disease, chronic gastritis, primary gastric lymphoma, and gastric cancer. Treatment with bismuth-based quadruple therapy is the first line of treatment but can be challenging due to increased pill burden and adverse effects, leading to non-adherence to therapy. Recent studies have shown that Vonoprazan can be used in combination with amoxicillin as a potential treatment option. We conducted a systematic review and meta-analysis to assess the efficacy and tolerability of Vonoprazan-based dual therapy as compared to bismuthbased quadruple therapy. Methodology: We conducted a comprehensive search of multiple electronic databases including PubMed, EMBASE, and Cochrane Library to identify studies assessing Vonoprazan and amoxicillin (VA) in comparison to bismuth-based quadrable therapy (BQT) for H. pylori treatment in adults > 18 years of age. Studies with pediatric population, written in languages other than English, or without control groups were excluded. Results: Out of 1491 citations, 3 studies including 380 patients in each group were included in the final analysis. There were 169 and 171 males in the VA and the BQT groups, respectively. The mean age ranged from 39.9- 42.7 years in the VA group and from 41.1 - 43.3 in the BQT group. VA group had a similar eradication rate as compared to the BQT group (OR: 1.38, 95% CI:0.76-2.51; p=0.29). VA treatment regimen had a lower incidence of total adverse events than the BQT group (OR: 0.34, 95% CI: 0.24-0.48, p=0.00001), including a reduced occurrence of nausea and vomiting (OR: 0.43, 95% CI: 0.21-0.88, p= 0.02). Both groups had similar adherence rates to the treatment (OR: 1.16, 95% CI: 0.50- 2.72; p= 0.73). Conclusion: Our study shows a similar eradication rate of H. pylori but a significantly lower incidence of adverse events in the VA treatment regimen as compared to the BQT group. Our analysis suggests that a VA-based regimen is an acceptable treatment option for H. Pylori patients who cannot tolerate BQT
Gastroenterology, 2024
Elhanafi Introduction: Chronic pancreatitis encompasses various risk factors such as alcohol con... more Elhanafi Introduction: Chronic pancreatitis encompasses various risk factors such as alcohol consumption, smoking, autoimmune conditions, and other causes. However, there's limited understanding regarding the difference in disease progression and outcomes among its different subtypes. Our study is a population-based study that aims to evaluate the outcomes between alcohol-related chronic pancreatitis and non-alcohol-related chronic pancreatitis. Methods: TriNetX is the global federated health research network providing access to electronic medical records across large healthcare organizations (HCOs). The analysis utilized the TriNetX Diamond Network; a network that includes 92 HCO(s) and more than 200 million patients in the US. This analysis compared the baseline characteristics and the clinical outcomes of alcohol-related chronic pancreatitis (Alcohol cohort) and non-alcohol-related chronic pancreatitis (Non-alcohol cohort). ICD10 codes were used to identify both cohorts. Any patient with a history of alcohol intake was excluded from the non-alcohol cohort. The primary outcome was mortality. Secondary outcomes were exocrine pancreatic insufficiency, pseudocyst formation, diabetes mellitus, and pancreatic cancer. This analysis included outcomes that occurred in the time window that started 1 day after the first occurrence of the index event (diagnosis of chronic pancreatitis). Patients with outcomes that occurred before the index event were excluded. Results: The study included 17,912 patients in the alcohol cohort and 407,618 patients in the non-alcohol cohort. The mean age (+/- SD) was 52.9 +/- 13.7 in the alcohol cohort and 60.3 +/- 16.9 in the non-alcohol cohort. The proportion of females was 27.5% in the alcohol cohort and 43.8% in the non-alcohol cohort. Propensity score matching was performed on all baseline characteristics that can be potential confounders, including age, sex, smoking status, diabetes, hypertension, ischemic heart disease, and pancreatic congenital malformations. The baseline characteristics of the cohorts before and after matching are summarized in table 1. Outcome analysis after propensity score matching showed lower rates of mortality, exocrine pancreatic insufficiency, pseudocyst, and pancreatic cancer in alcohol-related chronic pancreatitis cohort compared to the other cohort (Table 2). There were lower rates of ERCP and celiac plexus injection utilization in the alcohol cohort. (Table 2) Conclusion: This population-based study revealed more favorable outcomes in alcoholrelated chronic pancreatitis including mortality compared to cases attributed to other etiologies. Further research is imperative to comprehend the variances in pathophysiology and disease patterns between these categories, including investigating potential differences in genomic interactions within both types
Endocrine Practice, 2024
Objective Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are used in managing type 2 diabet... more Objective
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are used in managing type 2 diabetes mellitus (T2DM) and weight loss. However, their use is associated with various gastrointestinal adverse effects, notably gastroparesis, attributed to their role in delaying gastric emptying and enhancing satiety. Case studies and recent retrospective analyses in non-diabetic, obese populations have indicated a heightened incidence of gastroparesis linked to GLP-1 RA usage. Despite these findings, there is a notable gap in the literature regarding the incidence of gastroparesis among patients with T2DM treated with GLP-1 RA, especially when compared to other treatment modalities such as dipeptidyl peptidase-4 (DPP-4) inhibitors, which are not traditionally associated with an increased risk of gastroparesis. This study seeks to ascertain whether semaglutide, a GLP-1 RA, is associated with a significant rise in gastroparesis incidence compared to sitagliptin, a DPP-4 inhibitor, in patients with pre-existing T2DM, focusing on the initial six months following treatment commencement.
Methods
In this retrospective cohort study, we utilized data sourced from the TriNetX electronic health records global collaborative network, which included 131,466,594 patients. The target population of this investigation was patients with T2DM who had no prior ICD-10 code for gastroparesis or usage of GLP-1 RA or DPP-4 inhibitors in the five years preceding their initial semaglutide treatment. A comparative group meeting the same inclusion criteria was identified among patients who commenced treatment with sitagliptin. Before matching, the patient population consisted of 54,951 in the semaglutide cohort and 118,123 in the sitagliptin cohort. To mitigate potential confounding factors such as age, sex, alcohol consumption, smoking habits, and obesity, a propensity score match was executed, resulting in two well-balanced cohorts (n=53,989 each).
Results
Within the 6 months following initiation of semaglutide or sitagliptin, the incidence of gastroparesis was slightly higher in the semaglutide group (154 events) compared to the sitagliptin group (137 events), but this difference was not statistically significant (p = 0.3183). The relative risk associated with semaglutide was 1.124 (95% CI: 0.893-1.415), indicating no significant increase in risk compared to sitagliptin. Similarly, no significant differences were observed within 1 year of starting semaglutide as compared to sitaglitptin.
Discussion/Conclusion
Our data show that semaglutide is not associated with a significant increase in gastroparesis within six months of initiation compared to sitagliptin in patients with T2DM and that overall incidence is low. Prospective studies are required to elucidate if there is an increased risk of gastroparesis with GLP-1 RA as compared to other hypoglycemic therapies, given that this patient population is already at a higher baseline risk.
Medicine , 2024
There are multiple mechanisms by which The Coronavirus-19 (COVID-19) infection can cause electrol... more There are multiple mechanisms by which The Coronavirus-19 (COVID-19) infection can cause electrolyte abnormalities, which may not be the case for bacterial causes of pneumonia. This study aimed to assess the differences in electrolyte levels between patients suffering from COVID-19 and bacterial pneumonia. This is an original, retrospective study. Two cohorts of hospitalized patients were included, 1 suffering from COVID-19 and the other from bacterial pneumonia. Their day 1 and day 3 levels of sodium, potassium, magnesium, and phosphorus, as well as their outcomes, were extracted from the charts. Statistical analysis was subsequently performed. Mean admission levels of sodium, potassium, phosphorus, and magnesium were 135.64 ± 6.13, 4.38 ± 0.69, 3.53 ± 0.69, and 2.03 ± 0.51, respectively. The mean day 3 levels of these electrolytes were 138.3 ± 5.06, 4.18 ± 0.59, 3.578 ± 0.59, and 2.11 ± 0.64, respectively. Patients suffering from bacterial pneumonia were significantly older (N = 219, mean = 64.88 ± 15.99) than patients with COVID-19 pneumonia (N = 240, mean = 57.63 ± 17.87). Bacterial pneumonia group had significantly higher serum potassium (N = 211, mean = 4.51 ± 0.76), and magnesium (N = 115, mean = 2.12 ± 0.60) levels compared to COVID-19 group (N = 227, mean = 4.254 ± 0.60 for potassium and N = 118, mean = 1.933 ± 0.38 for magnesium). Only magnesium was significantly higher among day 3 electrolytes in the bacterial pneumonia group. No significant association between electrolyte levels and outcomes was seen. We found that COVID-19 patients had lower potassium and magnesium levels on admission, possibly due to the effect of COVID-19 on the renin-angiotensin-aldosterone system as well as patient characteristics and management. We did not find enough evidence to recommend using electrolyte levels as a determinator of prognosis, but more research is needed. Abbreviations: ACE-2 = angiotensin-converting enzyme-2, AKI = acute kidney injury, BMP = basic metabolic panel, CI = confidence interval, CKD = chronic kidney disease, CMP = complete metabolic panel, COVID-19 = coronavirus disease 2019, GI = gastrointestinal, K-S = Kolmogorov-Smirnov, PCR = polymerase chain reaction, RAAS = renin-angiotensin-aldosterone system, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, SD = standard deviation, SIADH = syndrome of inappropriate antidiuretic hormone secretion, SPSS = Statistical Package for the Social Sciences, VBG = venous blood gas.
Dentistry Review, 2024
Objective To assess the correlation between patients with type 1 diabetes mellitus (T1DM) and den... more Objective
To assess the correlation between patients with type 1 diabetes mellitus (T1DM) and dental caries outcomes, including missing teeth, missing surface, filling teeth, filling surface, plaque index, gingival index, and calculus index.
Methods
A comprehensive search was performed across EMBASE, Medline/Pubmed, and Web of Science databases from inception until February 20, 2023. Observational and interventional studies reporting dental caries outcomes in patients with T1DM were included. A random effects meta-analysis was performed to estimate the pooled effect sizes and 95 % confidence intervals.
Results
Thirty-three studies met the criteria for inclusion in the meta-analysis, which revealed that patients with T1DM had a reduced risk of missing teeth in comparison to those without diabetes (control group), with a mean difference (MD) of -0.03, CI 95 % [-0.03, -0.03]. No significant differences were found in missing surface, filling teeth, filling surface, or calculus index between T1DM and non-diabetic groups. However, patients with T1DM had a significantly higher plaque index (MD: 0.47, CI 95 % [0.06, 0.89]) than the non-diabetic group. The overall MD in DFMT between the DM and non-DM groups was 0.47 (95 % CI: 0.13, 0.82). The gingival index showed no significant difference between the groups.
Conclusion
This meta-analysis suggests that patients with T1DM have a higher plaque index than the non-diabetic group, whereas no significant differences were observed in other dental caries outcomes. Because of the considerable variability identified in certain analyses, additional research employing more extensive sample sizes and rigorous methodologies is required to validate these results.
Journal of Diabetes, 2024
Objective To assess the association between glucagon-like peptide-1 receptor agonists (GLP-1RA) t... more Objective
To assess the association between glucagon-like peptide-1 receptor agonists (GLP-1RA) treatment and the risk of suicide attempts in people with type 2 diabetes (T2D), with a focus on subgroups with and without a history of depression or suicide attempts.
Methods
This retrospective cohort study utilized TriNetX, a federated network of real-world data. Using the Global Collaborative Network data, we collected electronic medical records from 113 health care organizations with 135 million patient records with 8 million with T2D, 83% from the United States. The four cohorts were identified based on age, medication, diagnosis, and presence of depression or suicide attempts. Analytic methods included measures of association and number of Instances, with propensity score matching employed to mitigate potential confounders. The primary outcome was the incidence of suicide attempts among people with T2D with GLP-1RA treatment in comparison with dipeptidyl peptidase-4 inhibitor (DPP-4i) treatment.
Results
People with T2D treated with GLP-1RA consistently exhibited a lower risk of suicide attempts compared to those treated with DPP-4i. This was particularly significant in people with a history of depression or suicide attempts. The risk and odds ratios were significantly lower in the GLP-1RA-treated cohorts than in DPP-4i across all analyses.
Conclusion
As compared with DPP-4i, our analysis shows a protective effect associated with GLP-1RA treatment on the risk of suicide attempts among people with T2D. However, further research, particularly prospective and randomized studies, is necessary to confirm these observations and understand the underlying mechanisms.
Endocrine Practice, 2024
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are used in managing type 2 diabetes mellitu... more Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are used in managing type 2 diabetes mellitus (T2DM) and weight loss. However, their use is associated with various gastrointestinal adverse effects, notably gastroparesis, attributed to their role in delaying gastric emptying and enhancing satiety. Case studies and recent retrospective analyses in non-diabetic, obese populations have indicated a heightened incidence of gastroparesis linked to GLP-1 RA usage. Despite these findings, there is a notable gap in the literature regarding the incidence of gastroparesis among patients with T2DM treated with GLP-1 RA, especially when compared to other treatment modalities such as dipeptidyl peptidase-4 (DPP-4) inhibitors, which are not traditionally associated with an increased risk of gastroparesis. This study seeks to ascertain whether semaglutide, a GLP-1 RA, is associated with a significant rise in gastroparesis incidence compared to sitagliptin, a DPP-4 inhibitor, in patients with pre-existing T2DM, focusing on the initial six months following treatment commencement.
Methods
In this retrospective cohort study, we utilized data sourced from the TriNetX electronic health records global collaborative network, which included 131,466,594 patients. The target population of this investigation was patients with T2DM who had no prior ICD-10 code for gastroparesis or usage of GLP-1 RA or DPP-4 inhibitors in the five years preceding their initial semaglutide treatment. A comparative group meeting the same inclusion criteria was identified among patients who commenced treatment with sitagliptin. Before matching, the patient population consisted of 54,951 in the semaglutide cohort and 118,123 in the sitagliptin cohort. To mitigate potential confounding factors such as age, sex, alcohol consumption, smoking habits, and obesity, a propensity score match was executed, resulting in two well-balanced cohorts (n=53,989 each).
Results
Within the 6 months following initiation of semaglutide or sitagliptin, the incidence of gastroparesis was slightly higher in the semaglutide group (154 events) compared to the sitagliptin group (137 events), but this difference was not statistically significant (p = 0.3183). The relative risk associated with semaglutide was 1.124 (95% CI: 0.893-1.415), indicating no significant increase in risk compared to sitagliptin. Similarly, no significant differences were observed within 1 year of starting semaglutide as compared to sitaglitptin.
Discussion/Conclusion
Our data show that semaglutide is not associated with a significant increase in gastroparesis within six months of initiation compared to sitagliptin in patients with T2DM and that overall incidence is low. Prospective studies are required to elucidate if there is an increased risk of gastroparesis with GLP-1 RA as compared to other hypoglycemic therapies, given that this patient population is already at a higher baseline risk.
American Thoracic Society 2023 International Conference, 2023
Persistent air leaks (PALs) are related to lengthy hospital stays, contamination of the pleural s... more Persistent air leaks (PALs) are related to lengthy hospital stays, contamination of the pleural space, consideration for re-operative surgery, patient dissatisfaction, and substantial morbidity. There is no consensus on treatment for PALs. Autologous blood patching (ABP) is a simple and inexpensive treatment that reaches success rates from 59% to 100% in the published literature. Herein we present a systematic review and meta-analysis of the safety and efficacy of ABP for PALs. METHODS: The search was conducted from Databases from inception to 8/27/2022 using the keywords "Blood patch" OR "Autologous blood patch" AND "pleurodesis" in Embase, Medline/PubMed, and Web of Science. A total of 101 articles were identified, of which 30 were duplicates. A total of 71 papers were screened by title and abstract. A total of 30 articles were excluded at this stage. A total of 41 articles were screened by full text. Only 9 articles were included in the review. The inclusion criteria are randomized control trials, age 18 or above, and reported outcomes. The exclusion criteria are age less than 18 years old, abstracts only, non-English articles, retrospective studies, review articles, case reports and series. The following outcomes were examined; the number of days required to seal an air leak, the average length of hospital stay, the infection rate and pain. RESULTS: Compared to the conservative management group, a mean difference of-3.73 (95% CI-5.61,-1.86, p<0.001) was found between both groups, with significant considerable heterogeneity (I² = 84%, P=0.002). However, the average length of stay was insignificantly shorter in the ABP group with a mean difference of-2.09 (95% CI-4.72, 0.54, p=0.12) with considerable heterogeneity (I² = 93%, P<0.001). The risk of infection was found to be lower in the ABP group, but the data was insignificant (OR 0.97, 95% CI 0.35, 2.63, p-0.15). Similarly, compared to conservative management, pain was insignificantly lower than the conservative group OR 0.07 (95% CI 0.00, 1.32, p=0.08), with significant considerable heterogeneity (I² = 91%, P<0.001). CONCLUSION: Autologous blood patching was found to be effective in decreasing the average duration of days to seal an air leak. However, the data on average length of hospital stay and side effects such as infection and pain were insignificant. We need more randomized clinical trials to assess the impact of ABP in PALs better.
Circulation, 2022
Introduction: Obstructive sleep apnea (OSA) is a common and underestimated chronic condition reco... more Introduction: Obstructive sleep apnea (OSA) is a common and underestimated chronic condition recognized as a risk factor for cardiovascular diseases. OSA and acute coronary syndrome (ACS) have been reported in several cases. This study aims to assess the prevalence of the OSA among patients with ACS.
Hypothesis: We hypothesize that there is a correlation between OSA and ACS.
Methods: This study is a cross-sectional, descriptive study that included 110 patients with ACS at the Cairo University Hospitals in Egypt between December 2018 and July 2019. We included patients diagnosed with ACS over the age of 40. We excluded patients who had disturbed consciousness levels, were intubated/mechanically ventilated, were on psychiatric medications, or used drugs. Furthermore, we excluded individuals with CKD or liver disease. We collected patients’ demographic characteristics, and chronic medical conditions, and performed a sleep assessment. Every patient had a detailed workup for ACS. We assessed OSA based on the STOP-BANG score. The significance of baseline and clinical characteristics, laboratory and imaging findings, and the severity of ACS and its outcome were studied.
Results: The mean age of the patients was 58.2±9.6. The majority of patients were male (74.5%). 70.9% of the patients had metabolic syndrome. The mean body mass index was 28.6±4.8; the majority of patients presented with STEMI (60.9%), while only 26.4% and 12.7% presented with NSTEMI and unstable angina respectively. The prevalence of OSA among ACS patients was 63.6%, and of them, 55.7% presented with STEMI, while only 32.9% and 11.4% presented with NSTEMI and unstable angina respectively. Also, the study revealed a statistically significant relationship between OSA and NSTEMI patients (OR: 2.77 [95% CI 1.02-7.55], p=0.041), while there was no statistically significant relationship between OSA and unstable angina patients (OR: 0.73 [95% CI 0.2-2.3], p=0.579) and between OSA and STEMI patients (OR: 0.54 [95% CI 0.2-1.2], p=0.14).
Conclusion: To the best of our knowledge, this is the first study to study the prevalence of OSA in ACS patients in the region of Africa. The study indicated a high prevalence of OSA among ACS patients, with a more significant correlation between OSA and NSTEMI patients.