Liver fibrosis is a liver disease in which there is an excessive buildup of extracellular matrix proteins, including collagen. By regulating cytokine production and the inflammatory response, heat shock proteins (HSPs) contribute significantly to a wider spectrum of fibrotic illnesses, such as lung, liver, and idiopathic pulmonary fibrosis by aiding in the folding and assembly of freshly synthesized proteins, HSPs serve as chaperones. HSP70 is one of the key HSPs in avoiding protein aggregation which induces its action by sending unfolded and/or misfolded proteins to the ubiquitin–proteasome degradation pathway and antagonizing influence on epithelial-mesenchymal transition. HSP47, on the other hand, is crucial for boosting collagen synthesis, and deposition, and fostering the emergence of fibrotic disorders. The current review aims to provide light on how HSP70 and HSP47 affect hepatic fibrogenesis. Additionally, our review looks into new therapeutic approaches that target HSP70 and HSP47 and could potentially be used as drug candidates to treat liver fibrosis, especially in cases of comorbidities.

Purpose: COVID-19 lockdown changed social habits and lifestyle, including dietary habits, of people worldwide. However, limited information is available about these changes in Egypt. This cross-sectional study investigates the effects of COVID-19 lockdown on dietary habits among the Egyptian populations. Methods: An online questionnaire, based on sociodemographic data and dietary adherence in accordance with the validated PREDIMED MedDiet Adherence Screener (MEDAS), was used all over the Egyptian governorates. The dietary changes were statistically evaluated for significance in relation to age, gender, body mass index (BMI), education level and governorates. Results: A total of 1010 participants (76% aged below 36 years, 77% female, 22% obese, and 62% university-level education) answered the questionnaire. Respondents ≤ 20 years had a significant increase in weight and consumption of carbonated beverages, commercial pastries, fried and fast food. Egyptians > 50 years old had a significant decrease in physical activity. Underweight people (less than 3% of participants) increased their fast food intake with a prominent rise in weight. However, obese people increased cooking frequency and increased eating times with a decrease in physical activity. Male participants reported increased intake of carbonated beverages and fast food, while female participants increased the intake of homemade pastries with a significant decrease in physical activity. Approximately 50% of participants with postgraduate education reported decreased intake of fast food and carbonated beverages as well as decreased body weight. Residents of Cairo showed a significant increase in vegetable intake, and fried food intake with a decrease in seafood consumption. Participants from the Delta region had a significant increase in pastries intake. Conclusion: The findings of this study explored the need for increasing awareness about healthy lifestyle in future lockdown periods.

Background: Non-alcoholic steatohepatitis (NASH) is characterized by increased production of proinflammatory cytokines, fibrosis, and hepatocyte apoptosis. This study aimed to assess the efficacy of N-acetyl cysteine (NAC), rosuvastatin (RSV), and vitamin E (VE) in patients with NASH. Methods: A double-blinded, parallel, randomized, controlled study was conducted and registered on clinicaltrials.gov (Identifier: NCT06105060), involving 135 NASH participants, who were divided into three groups: the control group (group 1), consisting of patients receiving standard therapy VE at a dosage of 400 IU twice daily. In the treated group (group 2), patients were administered NAC at a dosage of 1200 mg twice daily, while treatment (group 3) received RSV at a dosage of 20 mg once daily. FibroScan^® examination of liver tissue and fibrosis scores, along with tests for liver aminotransferases, lipid profile, glycemic parameters, and renal and hepatic functions, were assessed before and after six months of treatment. Results: The analyzed groups demonstrated a significant reduction in steatosis and lipid peroxidation (p < 0.05). The NAC group demonstrated greater anti-inflammatory and anti-apoptotic effects compared to the RSV group, although this difference was not significant in the control group. NAC is conceded as the only significant antifibrotic agent in liver stiffness measurement (LSM), biological marker findings, and non-invasive liver fibrosis scores (p < 0.05), in addition to its improvement of several metabolic parameters and health-related quality of life. Conclusions: Patients receiving NAC demonstrated safety and efficacy in enhancing steatosis, fibrosis, and metabolic parameters, representing a novel strategy in the management of NASH.

In clinical practice, drug–drug interactions (DDIs) pose significant risks to a large number of patients. Consequently, healthcare providers are required to diligently identify, monitor, and effectively handle these interactions in order to enhance patient outcomes. In Egypt, DDIs are poorly addressed, with no reports for DDIs in primary care. In our cross-sectional, retrospective, observational study, we collected a total of five thousand, eight hundred and twenty prescriptions across eight major governorates in Egypt. Prescriptions were collected over a span of 15 months between 1 June 2021 and 30 September 2022. These prescriptions were analyzed for potential DDIs using the Lexicomp^® drug interactions tool. The prevalence of DDIs was found to be 18%, with 22% of the prescriptions having two or more potential DDIs. Moreover, we found 1447 DDIs of categories C (monitoring therapy recommended), D (therapy modification suggested), and X (avoid combination). The most commonly interacting drugs in our study were diclofenac, aspirin, and clopidogrel, while non-steroidal anti-inflammatory drugs (NSAIDs) were the most reported therapeutic class implicated in pharmacologic DDIs. Pharmacodynamic agonistic activity was the most common mechanism of interaction. Therefore, it is crucial to conduct screenings, detect early signs, and closely monitor drug–drug interactions (DDIs) to enhance patients’ overall health outcomes, medication responses, and safety. In this regard, the clinical pharmacist assumes a vital role in implementing these preventive measures.

Objectives: Osteosarcoma (OS) is one of the aggressive bone tumors commonly diagnosed in adolescents and young adults. The study investigated the effect of 9 single nucleotide polymorphisms (SNPs) in 5 genes on methotrexate (MTX) plasma level and its impact on the patients’ clinical outcomes. Methods: One hundred and thirty-three patients with OS (68 boys and 65 girls with age range 4.00-17.86 years) were enrolled and treated with four weeks of high-dose methotrexate (HDMTX) as neo-adjuvant therapy in children’s cancer hospital (CCHE-57357). Blood samples were collected and genotyped for the studied SNPs (MTHFR rs1801133, SLCO1B1 rs11045879, rs4149081, rs2306283, ABCC3 rs4793665, rs4148412, rs733392 ABCG2 rs2231142, and ABCC2 rs717620 using Taqman® (RT-PCR) assay. Plasma concentrations of MTX were measured using the enzyme multiple immunoassay technique (EMIT®). The clinical outcomes included toxicities that were evaluated based on the common terminology criteria for adverse events - version 5 (CTCAEv5.0.), besides the studying of survival analysis and tumor necrosis (TN %). Results: Older patients experienced increased risk of delayed MTX elimination at 72-hour, OR=1.19 (95% CI=1.09-1.29, p=0.00059). The studied SNPs weren’t associated with MTX elimination. Patients with ABCC2 HW (Homozygous wild) genotype group showed a high statistically significant association with higher grade hyperbilirubinemia, OR= 2.05(95% CI=1.05-4.01, p=0.037). Moreover, the patients with ABCC3 (rs4793665) HV and HT (Homozygous variant and Heterozygous) genotypes had a significant association with severe nephrotoxicity, OR= 0.34(95% CI=1.6-0.72, p=0.005). Conclusions: ABCC2 (rs717620), ABCC3 (rs4793665) genotyping with age and gender could help in predicting patients at risk of toxicities due to HDMTX.