The most severe cases of COVID-19, and the highest rates of death, are among the elderly. There is an urgent need to search for an agent to treat the disease and control its progression. Boswellia serrata is traditionally used to treat chronic inflammatory diseases of the lung. This review aims to highlight currently published research that has shown evidence of potential therapeutic effects of boswellic acids (BA) and B. serrata extract against COVID-19 and associated conditions. We reviewed the published information up to March 2021. Studies were collected through a search of online electronic databases (academic libraries such as PubMed, Scopus, Web of Science, and Egyptian Knowledge Bank). Several recent studies reported that BAs and B. serrata extract are safe agents and have multiple beneficial activities in treating similar symptoms experienced by patients with COVID-19. Because of the low oral bioavailability and improvement of buccal/oral cavity hygiene, traditional use by chewing B. serrata gum may be more beneficial than oral use. It is the cheapest option for a lot of poorer people. The promising effect of B. serrata and BA can be attributed to its antioxidant, anti-inflammatory, immunomodulatory, cardioprotective, anti-platelet aggregation, antibacterial, antifungal, and broad antiviral activity. B. serrata and BA act by multiple mechanisms. The most common mechanism may be through direct interaction with IκB kinases and inhibiting nuclear factor-κB-regulated gene expression. However, the most recent mechanism proposed that BA not only inhibited the formation of classical 5-lipoxygenase products but also produced anti-inflammatory LOX-isoform-selective modulators. In conclusion a small to moderate dose B. serrata extract may be useful in the enhancing adaptive immune response in mild to moderate symptoms of COVID-19. However, large doses of BA may be beneficial in suppressing uncontrolled activation of the innate immune response. More clinical results are required to determine with certainty whether there is sufficient evidence of the benefits against COVID-19.

Recent evidence points to a potential therapeutic role for glycyrrhizin(GR) and boswellic acids (BA) in the treatment of COVID-19 but conclusive evidence is lacking. Our aim is to investigate the efficacy of GR + BA versus placebo for the treatment of hospitalized patients with moderate SARS-CoV-2 or COVID-19 variants infection. The current study is a randomized, double-blind, placebo-controlled, single-center trial. Patients with SARS-CoV-2 or COVID-19 variants diagnosed by PCR test who were admitted to Sohag University hospital were eligible if they were at least 18 years of age and had moderate symptoms. Patients were randomly assigned to receive oral GR capsule (60 mg) and BA (200 mg) twice daily for 14 days or a matching placebo. All patients also received treatment with the institutional protocol for COVID-19. The primary outcome was mortality and time to recovery. Secondary outcome was clinical status score, 14 days after receiving study drugs. Adverse events from use of study drugs have been evaluated for up to 14 days. The trial is registered at ClinicalTrials.gov (Identifier NCT04487964). During the 6-month enrollment period (June-November, 2021) only 50 patients (54% women; median age 60 years, IQR 54–65) met eligibility and were randomly assigned. Evaluation of the primary outcome at 14 days showed that there were five deaths in the placebo group and no deaths in the GR + BA group. With regard to recovery time, it was significantly shorter (p = 0.0001) in the group receiving GR + BA capsule compared to the placebo group (median 7.0; IQR 6.0–8.0 days vs. median 12.5; IQR 12–20 days). Clinical status on the ordinal score scale as a secondary outcome showed a significant difference between the GR + BA group (median (IQR) score, 2 [2–3]) and placebo groups (mean (IQR) score, 3 [3–5.5]). There was a significant decrease in CRB (p = 0.000041) in GR + BA compared with the placebo group. In conclusion, this safe, inexpensive, antiviral, immunomodulating and anti-inflammatory combination may be considered for use in mild to moderate infections of SARS-CoV-2 or COVID-19 variants. The study is limited by the small sample size; therefore, larger randomized trials are required.

Gender difference in chronic hepatitis C (CHC) infection is not previously well studied. We aimed to analyze the effect of gender difference on the risk factors of CHC, disease progression, and outcome after oral direct acting antiviral (DAA) therapy. The study was conducted at Tropical Medicine and Gastroenterology Department, Sohag University, Egypt, in the period between 2018 and 2020. 775 patients were evaluated for hepatitis C virus (HCV) risk factors. Laboratory investigations, abdominal ultrasound and liver Shear wave elastography (SWE) were done. The patients were given antiviral therapy and followed up to assess the response and side effects of DAA therapy. 434 (56%) of study patients were males and 341 (44%) were females. Catching infection from blood transfusion and intravenous (IV) injection of tarter emetic was significantly higher in males, while catching infection from surgical operation was significantly higher in females. Hepatic fibrosis was significantly more extensive in males. Side effects were reported more in females. Sustained virological response (SVR) 12 was reported in 98.6%. Females had a slightly better SVR12 than males (99.4% versus 97.9%). In conclusion males were different from females in exposure to HCV risk factors. After introduction of blood screening and stoppage of parenteral anti-bilharzial therapy the risk of HCV infection could be greatly prevented in males, while the exposure of females to obstetric procedure is increasing nowadays which hides a risk of ongoing infection in females. So, HCV surveillance programs in females retain their importance in early detection and management of CHC. Although hepatic fibrosis progression was more in males, females were more liable to adverse events of DAA therapy. So, researchers should consider the gender of their patients in drug design and administration.

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Background: Obesity is related to multiple risk factors of cardiovascular disease (CVD) including hypertension, diabetes mellitus (DM), metabolic syndrome, and dyslipidemia, while also likely being an independent risk factor for CVD. Through multiple pathways including increased angiotensin, circulating blood volume, and total peripheral resistance, excess weight increases hypertension (HTN) risk.Objective: This study aimed to reveal the relationship between body weight and the severity of coronary artery disease (CAD) in patients referred for coronary angiography at Sohag University Hospital. Patients and methods: This was a cross-sectional hospital-based study performed on 200 patients, at Sohag University Hospital. Mean age was 56.94 ± 10.30 years. Among them, there were 175 patients (87.5%) who were overweight or obese with higher prevalence of HTN, hyperlipidemia, and diabetes. Normal weight patients were 25 (12.5%) with lower prevalence of HTN, hyperlipidemia, and diabetes. Results: According to BMI in our study, 175 patients (87.5 %) were overweight or obese, 162 patients (92.57%) of the overweight had significant coronary artery disease. 162 patients (81%) had significant coronary angiography findings (> 70% stenosis in any of the coronary arteries). They were classified to 63 patients (31.5%) had single vessel diseased, 53 patients (26.5%) had two vessels diseased, and 46 patients (23%) had three vessels diseased. Conclusion: Obesity, diabetes, hypertension, hyperlipidemia, aging and male gender were correlated with severity of CAD. Thus, reduction of weight, stoppage of smoking and control of diabetes, hypertension and hyperlipidemia will improve outcome of coronary artery disease.

Background: One of the most significant modifiable risk factors for coronary artery disease (CAD) is dyslipidemia. Acute coronary syndromes (ACS) were shown to be a key contributing factor to patients being admitted to the Coronary Care Unit (CCU) at Sohag University Hospital. Objectives: To analyze lipid profile in patients with ACS who presents at Sohag university hospital, and its clinical and complications pattern. Patiets and methods: This study involved 100 patients above 18 years old diagnosed with ACS. Patients were classified into 3 groups; ST-elevation MI (STEMI), non-ST-elevation MI (NSTEMI) and unstable angina (UA) group. All participants were subjected to history taking, clinical assessment and measuring complete lipid profile values. Results: STEMI group has higher significant total cholesterol (TC), low-density lipoprotein cholesterol LDL-C (P < 0.001), Triglycerides (TG) (P =0.022), TC/HDL (P =0.027 ) and TG/HDL levels (P = 0.001) and lower significant high-density lipoprotein cholesterol (HDL-C) (p=0.006) than other groups. There was a significant correlation between age groups and TC (P<0.001), LDL-c (P=0.009), very low-density lipoprotein cholesterol (VLDL-c) (P=0.016), HDL (P=0.001), Triglycerides (P=0.008), TC/HDL (P<0.001) and TG/HDL (P=0.040). Furthermore, there was no significant correlation between gender and TC, LDL-c, VLDL, HDL, TG, TC/HDL and TG/HDL (P>0.05). Conclusion:Patients with ACS have a significant prevalence of dyslipidemia as a risk factor. These individuals are more likely to have low HDL than high LDL values; nevertheless, they are more likely to have high TG values than low HDL values.

Background: Diabetic ketoacidosis (DKA) is considered one of the pathological developments resulting from diabetes mellitus (DM), which threatens the patient's life. In Egypt, many factors participated in DKA prevalence, which increases the need for further deep studies. Objectives: The current study aimed to measure and evaluate clinical profiles, the possible risk factors for DKA in Sohag Governorate, Egypt. Patients and Methods: 60 patients diagnosed with DKA were recruited for six months between September 2018 and March 2019. The medical history and clinical investigations were applied to all participants. Data were collected and analyzed. Results: The participants had a mean age of 32.76±18.8 years, and 62 % were females. Most of the patients had a medical history of DM, and only 11.7% of them had a recent diagnosis. 55% of DKA patients had either respiratory tract or urinary tract infections (26.6% and 16,6%, respectively), where noncompliance for treatment was reported in 50% of cases. Lack of awareness about the DKA disease and its complication was reported in 45% of patients. Other comorbidities such as stroke (6.7%), myocardial infarction (MI) (8.3%), and acute pancreatitis (3.3%) were reported, as well. Conclusion: Many of the DKA patients from Sohag University Hospital, Sohag, Egypt, lack awareness about the disease and its risk factors. The major risk factors for DKA were either infection or less commitment to the medical regimens. More efforts should be paid to accommodate the health education weakness of diabetes and DKA risk factors.

To evaluate the impact of using Nano-hydroxyapatite on post-bleaching hypersensitivity after using two different bleaching techniques. Twenty-eight patients were enrolled in this study according to inclusion and exclusion criteria. The patients were randomly assigned into four groups (n=7). G1; bleaching was performed using photo-catalyzed bleaching technique (Philips, zoom), followed by application of Amorphous Calcium phosphate based desensitizing agent (ACP, Relief ACP). G2; bleaching was performed using chemo-catalyzed bleaching technique (Philips, Dash), followed by application of ACP. G3: bleaching was performed using zoom, followed by application of nano-hydroxyapatite based desensitizing agent (Nano p), G4: bleaching was performed using Dash, followed by application of Nano-hydroxyapatite. Post bleaching hypersensitivity was assessed using “Visual analogue scale”. Hypersensitivity was evaluated after: bleaching immediately, application of the desensitizing agent immediately, 24 hours, 48 hours and after one week. Cases with severe hypersensitivity were relieved immediately after Nano p application, meanwhile in case of ACP, cases with severe pain were relieved after 24 hours after its application. Statistically significant difference was evident with the photo catalyzed group immediately after Nano p application than before its application. Reduction in hypersensitivity by time was evident in both the chemo and photo catalyzed groups. In addition, it was found that after one week, all pain scores disappeared with all tested groups. Nano hydroxyapatite particles have an immediate (just post application) relief effect of severe pain with both used bleaching systems. However, the post bleaching hypersensitivity diminished completely after 1 week, irrespective of the desensitizing agent used. The application of Nano hydroxyapatite paste after bleaching is a valid method for diminishing severe post bleaching hypersensitivity when applied with either a photo or chemo catalyzed bleaching agents.