Background: GLP-1 receptor agonists (GLP-1 RAs) have been shown to improve glycemic control and insulin sensitivity and reduce body weight in obese patients with type 2 diabetes mellitus (T2D). This trial sought to evaluate the therapeutic effect of oral and subcutaneous semaglutide in NAFLD and its sequelae in obesity and/or T2D. Methods: In an open-labelled intervention study, the sample was 180 patients classified into three parallel groups (1:1:1): group I received oral semaglutide, group II patients received injectable semaglutide, and group III received pioglitazone and/or vitamin E. Patients were evaluated at 6 and 12 months. Results: There was a substantial improvement in lipid profile, liver enzymes, and body mass index, especially in group II. As for HDL, only group II showed a consistent increase at both 6 months (51 ± 4.62 mg/dL) and 12 months (50.08 ± 2.45 mg/dL) compared with baseline (45.6 ± 6.37 mg/dL) (p-value < 0.001). Despite the non-significant difference in NAFLD fibrosis score (NFS) (p-value = 0.45 and 0.63), group II had significantly lower scores of the fibrosis-4 score (FIB-4), liver stiffness measurement (LSM), and controlled attenuation parameter (CAP) at 6 and 12 months (p-value < 0.001). Conclusions: Semaglutide improves lipid profile, liver steatosis, and fibrosis parameters and reduces the BMI in T2D and obese patients with NAFLD.

The emergence of mucormycosis as a life-threatening fungal infection after the coronavirus disease of 2019 (COVID-19) is a major concern and challenge, but there is limited information on the risk factors for mortality in patients. We conducted a prospective cohort study from May 2021 to April 2022 to determine the in-hospital outcomes of post-COVID-19 mucormycosis during the intensive care unit (ICU) stay. The sample of the study was collected as consecutive sampling using all accessible patients in the study period. The Statistical Package for Social Sciences (SPSS), version 25 (IBM, Chicago, Illinois, USA) was used for statistical analysis. Among 150 patients with post-COVID-19 mucormycosis, the majority had a primary sinus infection (86.0 %), while 11.3 % had both sinus and ocular infections, and 2.7 % had sinus and cutaneous infections. Around 21 % (n = 31) of patients deceased after staying in the ICU for a median (range) of 45.0 (10.0-145.0) days. The majority of the patients who deceased had pneumonia patches on computed tomography (CT) (90.3 %) while none of the patients who were discharged had pneumonia patches (p < 0.001). The deceased group had higher rates of pulmonary embolism (93.5 %) compared to the surviving groups (21.8 %). In a multivariate Cox regression analysis, the risk of death was higher in older patients above 60 years old (hazard ratio (95 %CI): 6.7 (1.73-15.81)), increase among patient with history of steroid administration (hazard ratio (95 %CI): 5.70 (1.23-10.91)), who had facial cutaneous infection with mucormycosis (hazard ratio (95 %CI): 8.76 (1.78-25.18)), patients with uncontrolled diabetes (hazard ratio (95 %CI): 10.76 (1.78, 65.18)), and total leukocytic count (TLC>10 ×103 mcL) (hazard ratio (95 %CI): 10.03 (3.29-30.61)). Identifying high-risk patients especially old diabetic patients with corticosteroid administration and detecting their deterioration quickly is crucial in reducing post-COVID-19 mucormycosis mortality rates, and these factors must be considered when developing treatment and quarantine strategies.

Context Type 2 diabetes is prevalent worldwide, and insulin resistance (IR) is considered the main player in its pathogenesis. Previous studies suggested a link between iron and IR.Aim The aim was to study serum ferritin level in nondiabetic offsprings, with and without impaired glucose tolerance, of diabetic patients and its relation to IR.Settings and design This is a cross-sectional case–control study carried out in the Internal Medicine Department, Zagazig University Hospitals.Patients and methods A total of 25 completely healthy individuals as a control group and 50 offsprings of patients with type 2 diabetes as a case group were included in the study. The case group was further divided into normal and impaired glucose tolerant offspring subgroups after glucose tolerance test. All of them underwent thorough clinical examination; routine laboratory investigation including complete blood count, liver and kidney function tests, fasting and postprandial blood glucose, serum ferritin, and fasting insulin by enzyme-linked immunosorbent assay; calculation of BMI; and homeostasis model assessment-estimated insulin resistance (HOMA-IR). Statistical package for the social sciences for windows (version 16) was used for statistical analysis.Results Significant increase in mean±SD of serum ferritin, fasting insulin, HOMA-IR, and fasting and postprandial blood glucose levels in impaired glucose tolerant offspring subgroup was observed as compared with both control group and normal glucose tolerant offspring subgroup. Significant positive correlation was found between serum ferritin versus each of BMI, fasting insulin, fasting, postprandial blood glucose, and HOMA-IR in impaired glucose tolerant offspring subgroup.Conclusion Elevated serum ferritin levels in nondiabetic offsprings with impaired glucose tolerance may play a role in the pathogenesis of IR state, which may progress to type 2 diabetes.

Cardiac arrhythmia in diabetic ketoacidosis (DKA) is a well-known complication that is usually a result of electrolyte imbalance. Another frequently missed cause of arrhythmia is the QT interval prolongation, which is not always attributed to electrolytes disturbance. We aimed to explore the frequency of QTc interval prolongation among patients with DKA in the medical ICU, the association with serum electrolytes and pH, and the implication on the outcome. We carried out a cross-sectional cohort study on patients with DKA admitted to medical ICU. We had worked on 72 patients with DKA by performing the routine investigation including ECG follow-up during the hospital stay. Maximum QT interval in all measured leads (QTmax) and heart rate-corrected QTmax (QTmaxc) were calculated in milliseconds according to Bazett’s formula. We used SPSS, version 20.0, with the following statistical tests: Shapiro–Walk, Student’s t, Pearson’s correlation, logistic regression, receiver operating characteristic curve analysis, and relative risk. The frequency of QTmaxc interval prolongation without electrolyte imbalance was seen in 46 (63.9%) patients. pH revealed to be the most significant independent risk factor for QTmaxc interval prolongation (odds ratio=8.39, 95% confidence interval: 1.67–18.06) with a cutoff value less than 7.03, with sensitivity of 56% and specificity of 44%. QTmaxc prolongation carried a relative risk of ~1.7-fold for mortality in patients with DKA. Acidosis carries an independent risk for QTmaxc interval prolongation in the absence of electrolytes abnormalities, with related poor ICU outcome in patients with DKA.