Background: Hypothyroidism is an endocrine disorder that affects 10 times more females than males, with substantial health impacts. The role of estrogen‐containing oral contraceptives (OCPs) in influencing thyroid function remains relatively underexplored. This study investigated the association between estrogen‐containing OCP use and hypothyroidism in the female population in Qatar. Methods: We utilized data from the Qatar Biobank to conduct a cross‐sectional study of 1001 female participants with a current or previous history of estrogen‐containing OCP use. The thyroid function of the participants was evaluated via thyroid function test parameters (thyroid stimulating hormone (TSH) and free tetraiodothyronine (fT4)) as outcomes, and sex hormone‐binding globulin (SHBG) levels as a proxy indicator of OCP use. We adjusted for confounders such as age, ethnicity, and type 2 diabetes mellitus status via multivariable logistic regression to determine the odds of hypothyroidism associated with SHBG levels. Results: Among the 1001 participants, 34 (3.4%) met the diagnostic criteria for hypothyroidism. Multinomial logistic regression revealed no increased odds of hypothyroidism at the 90th percentile cutoff for SHBG levels (OR 1.00, 95% CI 0.29–3.50). However, at the 95th percentile of SHBG values, there was 46% higher odds of hypothyroidism (OR 1.46, 95% CI 0.33–6.54) and an over tenfold increase at the 99th percentile (OR 10.07, 95% CI 1.94–52.45, p = 0.006). Other variables, such as age, ethnicity, and diabetes status, were not associated with SHBG levels. Non‐Qatari Arabs had higher odds of hypothyroidism compared with that of Qataris (OR 8.06, 95% CI 0.84–77.54, p value 0.071). Conclusion: This study offers evidence that SHBG levels can be used to indicate estrogen‐containing OCP use. Furthermore, higher SHBG levels are associated with higher odds of hypothyroidism among OCP users, and the odds of hypothyroidism vary across different ethnicities. These findings highlight the need for further research to explore the mechanisms linking OCP use to thyroid dysfunction and to investigate other potential risk factors.

Purpose: The COVID-19 pandemic has led to the publication of numerous primary studies and meta-analyses; however, conclusive evidence on whether HIV infection influences COVID-19 outcomes among people living with HIV (PLHIV) is still lacking. This research uses a novel technique, the exit meta-analysis, to conclusively update the evidence of HIV’s impact on COVID-19-related mortality, hospitalization, and need for Intensive Care Unit (ICU) admission in severe disease. Methods: A search of PubMed, EMBASE, Cochrane Reviews (CDSR), SCOPUS, CINAHL reviews and Google Scholar databases was conducted up to the 18 January 2024 for meta-analyses and observational studies that reported adjusted associations for the effect of HIV on COVID-19 related mortality, hospitalization, and ICU admission. Evidence from existing meta-analyses was summarized narratively, and an updated meta-analysis was carried out using a bias-adjusted inverse variance heterogeneity model. Subgroup analysis was carried out for age groups and geographical regions. Results: Of 3153 records identified, 20 meta-analyses and 56 primary studies, with a total of 27,936,428 participants, including 655,882 PLHIV, were included. A review of the meta-analyses showed conflicting results for all outcomes. In the updated synthesis, HIV was associated with higher odds of mortality (aOR 1.43, 95% CI: 1.01–1.86, I² = 90.7%) and ICU admission (aOR 1.49, 95% CI: 0.67–2.30, I² = 88.8%), but not hospitalization (aOR 1.11, 95% CI: 0.78–1.48, I² = 97.5%). The results for both ICU admission and hospitalization include the null value, leading to lower certainty. The exit meta-analysis suggested conclusive results for mortality (DAts score = −0.012) and hospitalization (DAts score = −0.014), but not for ICU admission. Conclusions: This exit meta-analysis provides conclusive evidence that HIV increases mortality in people with COVID-19; however, more studies may be required to address ICU admission and hospitalization.

Objective: Metabolic syndrome (MetS) increases the risk of cardiovascular diseases (CVDs). A combination of MetS with Circadian rhythm disorder (CRD) may be a stronger risk factor for CVDs than MetS alone. We conducted a nationally representative cross-sectional study to compare the associations of CRD and MetS with type 2 diabetes (T2DM) and CVDs in Qatar. Methods: Sociodemographic and health information were collected. MetS status was determined based on standard international criteria. CRD was defined based on either i) short sleep duration (≤ 6 hours per night) and MetS or (ii) short sleep duration, self-reported depression (or PHQ-2 score ≥ 3) and two components of MetS. Results: A total of 2523 respondents completed the interview, with a mean age of 37.1 years (SD = 11.2), women (n=637, 27.3%), and Qataris (n=754, 32.3%). The overall prevalence of MetS and CRD was 6.8% (95% CI: 5.4– 8.5) and 2.4% (95% CI: 1.7– 3.4), respectively; MetS was more prevalent in men (7.0%) compared to women (5.8%); the opposite was true for CRD (women 4.4% vs men 2.4%). Older age was a predictor of both MetS and CRD. Compared to Qataris, blue-collar expatriates had lower odds of MetS (OR = 0.32, 95% CI 0.23– 0.58) and CRD (OR = 0.46, 95% CI: 0.20– 1.05). Current married status was positively associated with MetS, but not CRD. Both MetS (OR=19.08, 95% CI: 10.87– 33.50) and CRD (OR=10.32, 95% CI: 4.60– 23.17) were strongly associated with T2DM. Similarly, MetS (OR = 5.51, 95% CI: 2.33– 13.03) and CRD (OR = 2.01, 95% CI: 0.92– 4.42) were associated with CVDs. Conclusion: MetS showed potentially stronger associations than CRD with T2DM and CVDs in Qatar. Further research is needed into the predictive utility of CRD compared with MetS for these outcomes in different populations including the Middle East.

Background: There is still debate whether ribavirin should be added to direct-acting antivirals (DAAs) for the management of treatment-experienced individuals with non-genotype-1 hepatitis C. This study compared the efficacy and safety of adding ribavirin to sofosbuvir-based combinations compared to sofosbuvir-based regimens alone in treating non-genotype 1 hepatitis C virus (HCV) in individuals who have been previously treated. Methods: We searched Cochrane CENTRAL, PubMed, SCOPUS, CINAHL and preprint databases from inception to September 2023 for randomized controlled trials (RCTs) that compared sofosbuvir-based regimens with ribavirin to sofosbuvir-based regimens alone in previously treated individuals with non-genotype 1 HCV infection. Data extraction and quality of study assessments were performed by two independent authors, and synthesis was performed using bias-adjusted models, heterogeneity using I2, and publication bias using funnel plots. Results: Eight RCTs compared sofosbuvir-based combinations with and without ribavirin were included. Overall, the addition of ribavirin to sofosbuvir, compared to sofosbuvir alone, did not show a benefit in achieving sustained virological response (SVR) (OR 0.91, 95% CI 0.26–3.17, I2 = 70.0%) with moderate certainty in Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence. In subgroup analysis, there was no benefit of adding ribavirin to sofosbuvir in individuals with non-genotype 1 HCV. The additional ribavirin was associated with increased adverse events (OR 2.03, 95% CI 1.58–2.6, I2 = 8.0%) and treatment discontinuation (OR 1.81, 95% CI 0.78–4.28, I2 = 0.0%). Conclusions: The moderate certainty evidence suggests that adding ribavirin to sofosbuvir-based regimens may not confer benefit in achieving SVR in previously treated individuals with non-genotype 1 HCV but increases the odds of adverse events and treatment discontinuation. More evidence is needed on the effect of additional ribavirin in achieving SVR in individuals with decompensated cirrhosis. Registration: The protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022368868).

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.

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.