Omnia Azmy Nabeh

Aim Tirzepatide, a dual agonist of the glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1R) receptors, has demonstrated efficacy in glycemic control and weight loss in patients with Type 2 diabetes mellitus (T2DM). Its role as adjunctive therapy in individuals with Type 1 diabetes mellitus (T1DM), particularly those who are overweight or obese, remains underexplored. This review aims to evaluate the efficacy of tirzepatide as an adjunct to insulin therapy in adults with Type 1 diabetes mellitus (T1DM) and overweight or obesity, focusing on changes in glycemic control, body weight, body mass index (BMI), and insulin dose requirements. Methods A systematic review and meta-analysis, registered in PROSPERO (CRD42025633998), were conducted in accordance with PRISMA guidelines. Databases searched included PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov. Risk of bias was assessed using ROBINS-I, and certainty of evidence was rated using GRADE. A random-effects model was applied. Results Six observational studies, comprising 248 adults with Type 1 diabetes mellitus (T1DM) and overweight or obesity, were included. Tirzepatide adjunct therapy resulted in significant improvements across all major outcomes. HbA1c decreased by 0.61% [95% CI: − 0.69, − 0.52], body weight by 9.9 kg [95% CI: − 10.46, − 9.35], and BMI by 8.3 kg/m² [95% CI: − 9.92, − 7.31] at 6 months. Total daily insulin requirements declined by 23.73 IU/day [95% CI: − 25.36, − 22.11], with basal and bolus doses reduced by 8.71 IU/day [95% CI: − 9.09, − 8.33] and 15.02 IU/day [95% CI: − 15.59, − 14.46], respectively. The most common adverse effects were gastrointestinal symptoms (nausea, vomiting, loss of appetite). Conclusions Tirzepatide adjunct therapy demonstrates meaningful improvements in glycemic control, weight, and insulin requirements among adults with T1DM and obesity, without major safety concerns. Despite promising findings, the evidence is limited by the observational design and overlapping patient cohorts. Larger randomized controlled trials are warranted to confirm these results and define optimal dosing and long-term safety.

Background: Dyslipidemia constitutes one of the foremost metabolic abnormalities contributing to cardiovascular morbidity and mortality. Washed microbiota transplantation (WMT), a refined form of fecal microbiota transplantation, has emerged as a novel therapeutic option targeting gut-liver axis dysregulation. This systematic review and meta-analysis, registered on PROSPERO (CRD42025645142), evaluated the efficacy of WMT in modulating lipid profile parameters. A comprehensive search was conducted across PubMed, Scopus, EMBASE, CENTRAL, Google Scholar, and ClinicalTrials.gov for studies assessing WMT effects on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Eligible studies included adults receiving WMT without concurrent lipid-lowering or microbiota-modifying therapies. Data were pooled using random-effects meta-analysis. MINORS tool was used to assess methodological quality. Results: Seven studies encompassing 1,163 participants were included. Across all study groups, WMT significantly reduced short-term TC (MD = –0.18; 95% CI –0.32 to –0.03) and long-term TG (MD = –0.08; 95% CI –0.11 to –0.05). LDL-C showed a significant long-term decrease (MD = –0.24; 95% CI –0.46 to –0.02), whereas HDL-C changes were non-significant overall. In participants with baseline hyperlipidemia, WMT consistently improved TC (short- and medium-term) and HDL-C (short-term), while effects on LDL and TG remained non-significant. Meta-regression demonstrated that higher baseline TC, HDL-C, and TG levels predicted greater post-WMT improvements (all p < 0.01). The overall certainty of evidence was low for most outcomes due to heterogeneity and observational study design. Conclusion: WMT may improve lipid profiles, especially in patients with elevated baseline lipids, offering a microbiota-based adjunct for dyslipidemia management. High-quality RCTs and optimized protocols are needed to confirm long-term efficacy.

Introduction: Medical students face a unique set of challenges, including high academic stress, irregular schedules, and clinical responsibilities, which place them at increased risk for sleep disturbance, particularly insomnia. Methods: This study aimed to assess the prevalence of insomnia using the DSM-5-TR core symptoms, evaluate sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and investigate the use and safety of sleep aid medications in this population. A cross-sectional survey was conducted among 1,640 Kasr Al Ainy medical students, Cairo, Egypt. Data collected included demographic characteristics, medical history, insomnia symptoms, and PSQI scoring. Sleep aid utilization, including off-label use of medications like quetiapine, was specifically examined. Results: The mean age of participants was 20.53 ± 2.08 years, with 58.7% being female. A total of 80% reported at least one insomnia symptom, and 93.7% had poor sleep quality (PSQI ≥ 5). Psychiatric conditions were reported by 29.2% of participants, significantly more common among females ( p < 0.001). Although 259 participants were taking medications with sedative properties, only 8.8% sought medical advice for insomnia and just 157 explicitly reported using sleep aids. Melatonin was the most used ( n = 121), followed by herbals, eszopiclone, and diphenhydramine. Seventeen participants reported using quetiapine, of whom 13 (76.5%) experienced adverse effects. Among the 12 participants who reported on its effectiveness, 5 (41.7%) perceived it as having limited efficacy. Conclusion: This study reveals the burden of sleep disturbance among medical students, with a major gap between the prevalence of insomnia and the utilization of professional sleep interventions. The off-label use of quetiapine, even among a small subset of our sample, raises notable safety concerns. This finding serves as an important pharmacovigilance signal and underscores the need for further investigation into the risks associated with this potentially hazardous practice. Non-pharmacological strategies such as sleep hygiene education and cognitive-behavioral interventions are needed.

Infertility is a disease of the reproductive system which is defined as the inability to conceive after more than 12 months of unprotected intercourse. It affects millions of people and has far-reaching impacts on quality of life, sexual dysfunction, marital impact, and societal implications. Despite advancements in understanding infertility, the cause of infertility in around 28% of cases remains unclear. This review addresses the pivotal relation between Gut microbiota (GM) and infertility. GM is now believed to interplay with the human body at different levels and is essential for our well-being. The abnormal translocation of GM to the systemic circulation, known as dysbiosis triggers an over-stimulated immune response associated with a marked increase in pro-inflammatory cytokines. This inflammatory situation may disrupt the hypothalamic-pituitary-gonadal axis and lead to disseminated inflammation ending in adhesions and obstructive lesions of the reproductive tract. Dysbiosis can also predispose individuals to obesity and insulin resistance, where both are risk factors for diabetes, hypertension, polycystic ovary syndrome (PCOS), impaired spermatogenesis, erectile dysfunction, and infertility. GM has an inevitable role in the pharmacokinetics of many drugs and can regulate the expression of many cytochrome P450 enzymes and several transporters. Further research is needed to validate the possible implication of GM in the pathophysiology of infertility, the efficacy of infertility medications, and the potential of GM-based therapies to treat infertile couples.

Background: Diabetic patients are at a significantly higher risk of delayed and impaired wound healing, with increased susceptibility to wound infections and dehiscence. The pathophysiology of abnormal wound healing in diabetes is multifactorial, involving impaired vascularization, reduced cellular proliferation, and prolonged inflammation, all associated with hyperglycemia. This randomized controlled trial (ClinicalTrials.gov registration: NCT06400082) included 74 type 2 diabetic patients undergoing elective abdominal surgeries with wound lengths ≥ 10 cm. Patients were randomized into two equal groups to receive either topical saline dressings or topical regular insulin. Wound dressing and assessments were performed daily until complete closure. Outcomes included percentage reduction in wound surface area, healing days, and unit healing time (UHT). Skin sections were collected on days 0 and 7 to evaluate e-cadherin, Ki67, IL-6, 8-hydroxy-2’-deoxyguanosine (8-OHdG), and histological architecture. Results: Topical insulin significantly enhanced wound healing outcomes, demonstrating a greater percentage reduction in wound surface area (p < 0.001) and a lower UHT at day 7 in the insulin group (4450.00 [3000.00–5460.00]) compared to the saline group (2594.00 [2090.00–7560.00]), p = 0.001). Insulin-treated wounds exhibited increased tissue expression of collagen, e-cadherin, and Ki67, along with significantly reduced levels of IL-6 and 8-OHdG (p < 0.05). Conclusion: Topical insulin is a promising therapeutic strategy for improving postoperative wound healing in diabetic patients. It enhances tissue repair by modulating inflammation, oxidative stress, and cellular proliferation.

Pregnant women are at heightened risk for severe COVID-19 outcomes. However, treatment options during pregnancy remain limited due to concerns over their safety and efficacy. This systematic review and meta-analysis assessed the safety and efficacy of nirmatrelvir-ritonavir in pregnant women diagnosed with mild-to-moderate COVID-19. The analysis focused on cases where the treatment was initiated within five days of symptom onset. A single-arm meta-analysis was performed to comprehensively evaluate outcomes across maternal, delivery, and neonatal domains. In line with PRISMA guidelines, six studies involving a total of 427 pregnant patients were included in the analysis. Hospitalization was reported in 2% of patients (95% CI: 1%-5%), with low heterogeneity across studies (I² = 21.9%). Drug discontinuation and new-onset gestational diabetes (NOGDM) had a pooled estimate of 0.7% (95% CI: 3% to 15%) and 4.0% (95% CI: 1% to 16%), respectively, with substantial heterogeneity (I² = 64.7% and 66.5%), respectively. New-onset gestational hypertension (NOGHTN) had a pooled estimate of 4% (95% CI: 1% to 26%), with considerable heterogeneity (I² = 78.81%). For neonatal outcomes, the pooled estimate for birth weight was 3186 g (95% CI: 3123-3248 g; I² = 0%), and no maternal or neonatal deaths were reported across the included studies. Nirmatrelvir-ritonavir appears safe and effective for mild-to-moderate COVID-19 in pregnant women, with low rates of hospitalization and adverse maternal outcomes. Larger, randomized studies are crucial to confirm these findings and ensure safety in diverse populations.

Diabetes mellitus (DM) and premenstrual syndrome (PMS) are global health challenges. Both disorders are often linked to a range of physical and psychological symptoms that significantly impact the quality of life of many women. Yet, the exact relation between DM and PMS is not clear, and the management of both conditions poses a considerable challenge. In this review, we aimed to investigate the interplay between DM, anti-diabetic drugs, and the different theories and symptoms of PMS. Female sex hormones are implicated in the pathophysiology of PMS and can also impair blood glucose control. In addition, patients with diabetes face a higher susceptibility to anxiety and depression disorders, with a significant number of patients experiencing symptoms such as fatigue and difficulty concentrating, which are reported in patients with PMS as well. Complications related to diabetic medications, such as hypoglycemia (with sulfonylurea) and fluid retention (with thiazolidinediones) may also mediate PMS-like symptoms. DM can, in addition, disturb the normal gut microbiota (GM), with a consequent loss of beneficial GM metabolites that guard against PMS, particularly the short-chain fatty acids and serotonin. Among the several available anti-diabetic drugs, those (1) with an anti-inflammatory potential, (2) that can preserve the beneficial GM, and (3) possessing a lower risk for hypoglycemia, might have a favorable outcome in PMS women. Yet, well-designed clinical trials are needed to investigate the anti-diabetic drug(s) of choice for patients with diabetes and PMS.

Inflammatory bowel disease (IBD) is a serious illness that negatively affects the human health due to its chronic course and serious complications. Glucagon like peptide (GLP-1) and its degradation enzyme inhibitor; dipeptidyl peptidase (DPP)-IV inhibitor, are used primarily as anti-diabetic drugs in patients with type 2 diabetes mellitus. However, current evidence suggests that both; GLP-1 (e.g. liraglutide) and the DPP-IV inhibitor (e.g. sitagliptin) may have a potential anti-inflammatory effect on various organ systems. This study was aimed to evaluate the potential of liraglutide and sitagliptin to improve colitis induced experimentally in mice using intra-rectal acetic acid, in comparison with sulfasalazine. Intra-rectal acetic acid was used to induce colitis in mice. The degree of inflammation was assessed using disease activity index, histopathological scoring, colonic length measurement as well as the colonic tissue expression of: the transcription factor; nuclear factor kappa B (NFκB), tumor necrosis factor alpha (TNFα), the oxidative stress marker; malondialdehyde and the inflammatory parameter; C-reactive protein. Moreover, random blood glucose was measured to ensure the safety of the tested drugs. Our results showed the positive impact of both liraglutide and sitagliptin on the assessed inflammatory parameters and their tolerability compared with sulfasalazine. Further clinical studies are needed to investigate the possibility to consider GLP axis as therapeutic adjuvants for IBD in the future.