Nouran Alwisi

Celiac disease (CD) is a chronic autoimmune enteropathy triggered by gluten ingestion in genetically predisposed individuals. Beyond gastrointestinal (GI) symptoms, CD can present with diverse systemic complications, yet ophthalmic manifestations remain poorly studied. The Middle East is a high-prevalence region due to genetic susceptibility and wheat-based diets. This review aimed to evaluate CD research in the Middle East and North Africa (MENA) region, focusing on gastroenterological features and ophthalmic involvement. We conducted a systematic review of published studies on CD in MENA populations. PubMed, Scopus, Embase, and Web of Science were searched from inception to September 2025. Eligible studies included original data on CD diagnosis, clinical characteristics, and reported ophthalmic manifestations. Study quality was appraised independently by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tools. A total of 24 studies were included, encompassing both pediatric and adult populations across multiple MENA countries. Half of the studies (12/24) reported at least one ophthalmic manifestation. Reported ocular findings ranged from inflammatory and neuro-ophthalmic conditions, including uveitis, optic neuritis, optic neuropathy, and orbital myositis, to vascular and retinal abnormalities such as central retinal vein occlusion and pachychoroid spectrum disease. Dry eye disease was among the most frequently reported manifestations. Several studies also identified subclinical ocular changes, including alterations in choroidal thickness, retinal nerve fiber layer thickness, tear film parameters, and retinal microvascular perfusion. However, the available evidence was heterogeneous, predominantly derived from cross-sectional studies and isolated case reports, and varied considerably regarding diagnostic methods and ophthalmic assessment protocols. Ophthalmic abnormalities have been reported across several MENA populations with CD, involving the ocular surface, uveal tract, optic nerve, and retinal structures. However, the available evidence is insufficient to determine their true prevalence, establish causality, or confirm an increased risk compared with the general population. The predominance of studies from a limited number of countries, particularly Türkiye, further restricts regional generalizability. Future multicenter prospective studies using standardized CD diagnostic criteria and ophthalmic assessment protocols are needed to determine the prevalence and clinical significance of ocular involvement in CD.

Adipose tissue remodeling is a dynamic process essential for metabolic homeostasis, enabling tissue expansion, extracellular matrix (ECM) turnover, angiogenesis, and coordinated immune adaptation. In obesity, however, maladaptive remodeling characterized by fibrosis, chronic low-grade inflammation, and hypoxia disrupts adipose plasticity and promotes systemic insulin resistance. Central to these processes is the tightly regulated homeostasis between proteases and their inhibitors, in which the serine protease inhibitor (serpin) superfamily represents an important yet underappreciated regulatory axis. Beyond their classical roles in coagulation and fibrinolysis, serpins regulate ECM remodeling, macrophage recruitment and polarization, cytokine signaling, angiogenic responses, adipokine activity, and insulin sensitivity, thereby orchestrating immune–metabolic crosstalk within adipose depots. Emerging evidence indicates that individual serpins exert distinct and context-dependent effects, with some promoting fibrosis, inflammation, and metabolic dysfunction, whereas others preserve adipose tissue homeostasis and metabolic function. This review synthesizes current knowledge on the structural and functional diversity of the serpin superfamily and examines their mechanistic roles in adipose tissue remodeling during obesity, with particular emphasis on how adipose-associated serpins regulate adipose tissue homeostasis, depot-specific remodeling, and immune–metabolic crosstalk. The review further discusses the experimental and translational applications of emerging single-cell and spatial transcriptomics, multi-omics, and computational approaches that may advance the understanding of serpin biology, improve the investigation of human adipose tissue, and accelerate the identification of clinically relevant serpin-related biomarkers and therapeutic targets for obesity and related metabolic disorders. By positioning serpins as key regulators of adipose tissue remodeling and immune–metabolic integration, this review highlights protease–antiprotease balance as a central determinant of metabolic health and identifies serpins as promising biomarkers and therapeutic targets for obesity and related metabolic disorders.

Background: Gestational diabetes mellitus (GDM), defined as hyperglycaemia first identified during pregnancy, is associated with increased risks of adverse maternal and neonatal outcomes. Standard screening is typically performed at 24–28 weeks’ gestation; however, earlier screening before 20 weeks has been proposed to improve outcomes. Evidence supporting early screening or diagnosis remains inconsistent. We aimed to evaluate whether early screening or early diagnosis of GDM (before 20 weeks) influences maternal and neonatal outcomes compared with standard screening or diagnosis at 24–28 weeks.Methods: We conducted a systematic review and meta-analysis of analytical studies comparing early versus standard timing of GDM screening or diagnosis. A systematic search of PubMed, Embase, Web of Science, and Cochrane CENTRAL was performed from inception to 2025. Eligible studies included those comparing early versus usual screening in unselected pregnant populations and/or early versus usual diagnosis among women with GDM; these comparisons were carefully predefined to minimize potential bias. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the MASTER scale. Pooled effects were generated using the quality-effects model. Publication bias was assessed using Doi plots. For binary outcomes, odds ratios were calculated and converted to absolute measures (risk differences and numbers needed to treat or harm) across a range of baseline risks to enhance interpretability. Outcomes assessed included gestational weight gain, preterm delivery, preeclampsia or eclampsia, macrosomia, neonatal hypoglycemia, neonatal intensive care unit admission, large-for-gestational-age infants, and caesarean delivery.Finding:14 studies met the inclusion criteria. Early diagnosis was not associated with a statistically divergent difference from usual diagnosis in terms of pregnancy-weight gain (WMD -1.08 kg), preterm delivery (OR 1.09), preeclampsia/eclampsia (OR 1.81), macrosomia (OR 0.97), PIH (OR 1.06), neonatal hypoglycemia (OR 1.61), NICU admission (OR 1.27), LGA (OR 0.98) and cesarean section (OR 1.18). Across the general obstetric population, early screening did not demonstrate a statistically divergent difference in any maternal or neonatal outcome including preterm delivery (OR 1.54), preeclampsia/eclampsia (OR 1.24), neonatal hypoglycemia (OR 1.19), Cesarean section (OR 0.87), macrosomia (OR 0.96) and LGA (OR 1.15). Translation of relative effects into absolute measures indicated no absolute clinical benefit for either early diagnosis or early screening. For early diagnosis, absolute risk differences were generally small and baseline-dependent, with directionally harmful effects for only few outcomes, particularly preeclampsia/eclampsia and neonatal hypoglycemia (NNH = 7 to 20), whereas most other outcomes demonstrated risk differences close to zero. Additionally, for early screening, absolute risk differences were largely neutral, with only preterm birth showing a small increase in absolute risk and all other outcomes indicating negligible differences.Interpretation: Early diagnosis of GDM does not identify a group with substantially different maternal and neonatal risks, likely reflecting a population for which intervention is unnecessary. Early screening, when applied to the general population of pregnant women, also does not improve outcomes and offers no absolute interventional benefit. Current evidence does

Background: There is ongoing debate about the ideal blood glucose thresholds for the diagnosis of gestational diabetes mellitus (GDM), as individual randomized controlled trials (RCTs) comparing the lower International Association of Diabetes and Pregnancy Study Groups (IADPSG) blood glucose to criteria which use higher blood glucose thresholds have not been conclusive.Objectives: This meta-analysis compared lower to higher blood glucose thresholds for GDM diagnosis in terms of GDM prevalence and adverse maternal and neonatal health outcomes.Methods: We searched Cochrane CENTRAL, PubMed, Scopus, CINAHL, and preprint archives up to May 30, 2025, for RCTs that compared lower to higher glucose thresholds in the diagnosis of GDM in pregnancy. Endpoints were GDM prevalence and adverse pregnancy outcomes. After study quality assessment, meta-analysis was done using an inverse variance heterogeneity model, heterogeneity was assessed using I2, and publication bias by funnel plots. The quality effects model was used to synthesize evidence that was presented using forest plots.Results: Ten RCTs, comparing IADPSG to higher blood glucose thresholds, with a total of 88,311 pregnant women, were included. After meta-analysis, the lower glycemic criteria compared to the higher glycemic criteria was associated with almost double the prevalence of GDM diagnosis (13.7% vs 8.04%, respectively) and the odds of GDM diagnosis (OR = 1.87, 95%CI 1.47-2.37, I2 = 93.4%), with moderate certainty GRADE evidence. For adverse pregnancy outcomes, the lower glycemic criteria compared to the higher glycemic criteria were associated with a trend towards lower odds for gestational hypertension (OR 0.57, 95%CI 0.30-1.07), and neonatal hypoglycemia (OR 0.35, 95%CI 0.06-1.93, I2=88.2%). However, there were no differences between the glycemic thresholds for cesarean section (OR 0.94, 95% 0.78-1.13, I2= 0%). For all the outcomes, there was low certainty GRADE evidence.Conclusion: While the lower glycemic threshold results in close to double the prevalence of GDM and potentially higher workload for the healthcare system, this meta-analysis suggests that there may not be a difference in maternal and fetal outcomes when using lower vs higher thresholds in diagnosing GDM. However, the very low to low GRADE certainty suggests that further RCTs are needed to improve the certainty of evidence.

Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality worldwide, with limited therapeutic progress due to challenges such as impermeability of the blood–brain barrier (BBB) and the multifactorial nature of secondary neurodegeneration. Nanoparticle-based platforms, owing to their tunable physicochemical properties, surface modifiability, and multifunctionality, have emerged as promising tools for both diagnosis and therapy. A wide range of inorganic, organic, and carbon-based nanoparticles has demonstrated improved imaging contrast, enhanced biosensing capabilities, and potential for targeted, real-time diagnostics. On the therapeutic front, nanoparticles have shown the ability to concentrate therapeutic agents at or near injury sites; however, achieving precise delivery remains a major challenge. Indeed, nanoparticle-based therapies are still limited by off-target accumulation in peripheral organs, incomplete BBB penetration, and heterogeneous tissue distribution. Addressing these barriers requires optimizing particle size, surface charge, ligand conjugation, and degradability to improve site-specific targeting and minimize systemic toxicity. In this review, we examine major classes of nanoparticles, including organic, inorganic, carbon-based, and biologically derived nanocarriers, and discuss the key physicochemical properties governing their interactions with the central nervous system. We evaluate their applications in TBI diagnosis, neuroimaging, and therapy, emphasizing the design principles influencing blood–brain barrier penetration, targeting specificity, biodistribution, and clearance. We further assess emerging nanoparticle-based strategies to improve site-specific delivery and mitigate secondary brain injury, and highlight key translational challenges and future clinical directions. Continued research into biodegradable, biomimetic, and environmentally sustainable synthesis methods is essential to advancing nanoparticle design and ensuring their safe and effective integration into the clinical management of TBI.

Purpose: To compare the quality and efficiency of an AI-powered research automation (AIPRA) workflow with a conventional human-led workflow for producing a full systematic review manuscript on the same question. Methods: Two independent pipelines (human-led vs. AIPRA) each generated a complete manuscript addressing "What is the role of large language models in glaucoma diagnosis?". No protocols or templates were shared. Three blinded domain experts rated five domains on 5-point Likert scales. The primary endpoint was the overall quality of each workflow from query to final manuscript. Results: Mean total scores: human 74.7%, AIPRA 65.3%. The mean difference (AIPRA - Human) was -9.3% (95% CI, -18.8% to 0.0%), meeting the pre-specified non-inferiority criterion. Domain means were identical for query development (66.7% each); the human-led pipeline scored higher in screening, field selection, full-text extraction, and manuscript writing. AIPRA completed the workflow in approximately 2 hours versus about 1 month for the human pipeline (375x faster). Conclusion: AIPRA was non-inferior to human experts on overall quality while drastically reducing time to completion. Appropriate human oversight remains important, especially for screening and extraction tasks.

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as a global health crisis in early 2020, leading to widespread morbidity and mortality. In Qatar, as of December 2024, the disease burden has reached over 500,000 cases and more than 600 deaths. While conventional treatments have evolved throughout the pandemic, the use of Complementary and Alternative Medicine (CAM), particularly herbal medicine, has also become prevalent. This study investigated the prevalence, reasons, uses, types, self-reported benefits, and sociodemographic determinants of utilising herbal medicine among COVID-19 patients in Qatar. A cross-sectional study was conducted among patients attending Qatar Primary Health Care Corporation (PHCC) clinics. Of the 10,000 SMS invitations that were sent, 882 survey responses were received from patients diagnosed with COVID-19 between 1 March 2020, and 30th April 2022. Following the exclusion of 31 participants due to missing data, sociodemographic data from 851 participants were analysed using logistic regression to assess predictors of herbal medicine use. Prevalence, patterns, types, and self-reported benefits were analysed using descriptive statistics. Of the 851 respondents included in the analysis, 440 (51.7%) reported herbal medicine use. Herbal medicine use was associated with better-perceived health outcomes. Women were more likely to use herbal medicine than men (OR = 1.90, 95%CI: 1.30-2.77, p = 0.001). The most used herbal remedies were ginger (n = 347), turmeric (n = 207), and garlic (n = 155). Family tradition (42%), the belief that herbs are natural (34.8%), and the desire to improve health and survival (31.1%) were the leading drivers of herbal medicine use. Herbal medicine use was prevalent (51.7%) during COVID-19 in Qatar, with a higher prevalence of use among women. This prevalence was driven by cultural beliefs and perceived health benefits. The study contributes insights to guide future research, policy, and practice toward safe and evidence-informed integration of herbal medicine in pandemic preparedness and broader healthcare strategies.

Background and Aims: There is still uncertainty about the efficacy and safety of subcutaneous compared to intravenous administration of biologics for inflammatory bowel disease (IBD) remission. Methods: In this systematic review and meta-analysis, we searched Cochrane, PubMed, SCOPUS, CINHAL, and preprint archives for trials that compared the efficacy and safety of subcutaneous and intravenous biologics for the induction and maintenance of IBD remission. Meta-analysis was carried out with a subgroup analysis for Crohn’s disease (CD) and Ulcerative Colitis (UC), heterogeneity using I², and publication bias using funnel plots. Results: A total of 14 randomized controlled trials, 9 on CD, 4 on UC, and 1 with data on both were included Subcutaneous, compared to intravenous administration, was less efficacious for the induction of remission; overall (OR 0.68, 95%CI 0.35–1.31, I² = 83%), worse in UC (OR 0.35, 95%CI 0.07–1.79, I² = 91.2%), and showed similar efficacy in CD (OR 0.97, 95%CI 0.73–1.30, I² = 0%). For the maintenance of remission, subcutaneous biologics were almost similar to intravenous biologics; overall (OR 0.97, 95%CI 0.63–1.49, I² = 57.1%), with less efficacy in UC (OR 0.82, 95%CI 0.54–1.23, I² = 52%), but superior efficacy in CD (OR 1.81, 95%CI 1.09–3.01, I² = 0%). Subcutaneous, compared to intravenous biologics, showed slightly higher odds of treatment discontinuation (OR 1.32, 95%CI 1.02–1.71, I² = 14.2%), worse in UC (OR 1.52, 95%CI 1.17–1.98, I² = 13%), and was similar to intravenous for CD (OR 1.03, 95%CI 0.65–1.62, I² = 0%). Conclusion: Subcutaneous administration has lower efficacy for the induction of remission but can achieve almost similar efficacy and safety in maintaining remission in IBD. Subcutaneous injection has better efficacy and safety in CD than in UC.

Background/Objectives: Interleukin 12/23 inhibitors are a newer class of monoclonal antibodies used to induce and maintain remission for Crohn’s disease (CD), a chronic inflammatory bowel disease, when patients do not respond to conventional immunomodulatory drugs or first-line monoclonal antibody therapies. Although biologics are best administered intravenously, subcutaneous administration has been trialed, with mixed results. This research synthesized evidence on the efficacy and safety of subcutaneous compared to intravenous administration of interleukin 12/23 inhibitors for moderate to severe CD. Methods: In this systematic review and meta-analysis, we searched Cochrane, PubMed, SCOPUS, CINHAL, and preprint archives for randomized controlled trials (RCTs) that compared the efficacy and safety of subcutaneous to intravenous interleukin 12/23 inhibitors for the remission of CD. After study quality assessment, a meta-analysis was carried out using a bias-adjusted inverse variance heterogeneity model, heterogeneity was assessed using I², and publication bias was performed using Doi plots. Evidence certainty was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results: Seven RCTs, with 2179 participants, all with moderate to severe CD, were included. After meta-analysis, subcutaneous compared to intravenous administration showed similar efficacy for the induction of remission (OR 0.77, 95%CI 0.53–1.12), with no-to-low heterogeneity (I² = 0%, p = 0.97). For the maintenance of remission, only two studies had analyzable data, and they showed that subcutaneous interleukin 12/23 inhibitors were equal or better compared to intravenous administration. Further syntheses showed that subcutaneous compared to intravenous administration of interleukin 12/23 inhibitors had almost similar odds of adverse events (OR 0.91, 95%CI 0.63–1.32, I² = 39%), serious adverse events (OR 0.97, 95%CI 0.61–1.53, I² = 0%), and treatment discontinuation (OR 1.06, 95%CI 0.67–1.68, I² = 0%). Conclusions: In individuals with moderate to severe CD, subcutaneous administration has similar efficacy for inducing remission with comparable safety. More RCTs are needed to confirm these findings.

GATA binding protein 3 (GATA3), a member of the GATA family transcription factors, is a key player in various physiological and pathological conditions. It has been known for its binding capacity to DNA sequence “GATA” enabling its involvement in critical developmental and functional processes occurring in multiple tissues and organs including the immune system, endocrine system, and nervous system. GATA3 also modulates cell differentiation, proliferation, and apoptosis via controlling gene expression. In physiological instances, GATA3 is crucial for maintaining immunological homeostasis by mediating the development of naïve T cells into T helper 2 (Th2). In addition, GATA3 is proposed to play a variety of cellular roles in the growth and maintenance of mammary gland, neuronal, and renal tissues. Conversely, the presence of impaired GATA3 is associated with a variety of diseases, including neurodegenerative diseases, autoimmune diseases, and cancers. Additionally, the altered expression of GATA3 contributes to the worsening of disease progression in haematological malignancies, such as T-cell lymphomas. Therefore, this review explores the multifaceted roles and signalling pathways of GATA3 in health and disease, with a particular emphasis on its potential as a therapeutic and prognostic target for the effective management of diseases.