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COVID-19 is an emerging viral infection of zoonotic origin that is closely related to the severe acute respiratory syndrome coronavirus (SARS-CoV) that caused an outbreak in 2003. Therefore, scientists named the new virus SARS-CoV-2. On March 11, 2020, The World Health Organization (WHO) recognized COVID-19 as a global pandemic. At present, three vaccines have been approved or are being considered for approval by national regulatory agencies to immunize against COVID- 19. However, the vaccines do not remain widely available, and no specific treatment against the virus is available. The pathogenesis and proliferation pathways of SARS-CoV-2 are still not well known. Thus, in this article, the saponin glycyrrhizin is discussed as a new potential therapeutic agent of natural origin (licorice root, Glycyrrhiza glabra) for the potential treatment of COVID-19 infections.

The present meta-analysis sought to investigate the potential association between zinc levels and recurrent aphthous stomatitis (RAS). A comprehensive search of online databases (PubMed, Scopus, Web of Science, and China National Knowledge Infrastructure (CNKI)) was conducted to identify all English and Chinese studies published up to August 2020. All case-control studies that assessed plasma/serum zinc levels were eligible for inclusion. Data were analyzed using Comprehensive Meta-Analysis software version 2.2.046 (Biostat, Englewood, NJ, USA). Trial sequential analysis (TSA) was conducted with the trial sequential analysis program. Nineteen case-control studies, involving 1079 RAS cases and 965 controls, were included in the meta-analysis. The pooled results of 19 studies showed that zinc level was significantly lower in RAS patients than in healthy controls (weighted difference in means = − 21.092, 95% CI − 26.695 to − 15.490, I2 = 95.375%, P < 0.001). Upon subgroup analysis by geographic distribution of the sample (Chinese vs. others), the association remained significant in each individual subgroup, although the association was more pronounced among Chinese populations. TSA indicated that the current studies surpassed the required information size, confirming that the differences were reliable. The results suggest a significant association between low serum zinc levels and the occurrence of RAS. Although TSA confirmed a solid conclusion, conducting large-scale studies with the highest standards of quality is encouraged. Determining zinc levels should be considered in diagnosis, management, and prevention of RAS.

BackgroundThis systematic review of randomized clinical trials aimed to evaluate the available evidence regarding the efficacy of propolis-based mouthwash on dental plaque and gingival inflammation.MethodsPubMed, Scopus, and Web of Science databases were searched up to November 2019. Clinical trials that evaluated the efficacy of propolis mouthwashes compared with chlorhexidine (CHX) were included. The primary outcomes comprised dental plaque and/or gingival inflammation. Two authors assessed the risk of bias using the Cochrane tool. Due to marked heterogeneity of the available data, studies were assessed qualitatively, and no metaanalysis was performed.ResultsNine clinical trials, comprising 333 subjects, fulfilled the eligibility criteria. Most of the included studies showed high risk of bias. Overall, propolis mouthwashes showed good efficacy on plaque and gingivitis in all of the included studies. Out of the eight studies that reported on plaque index, 5 studies found equal efficacy of propolis and CHX in reducing plaque, two studies found superior efficacy in favor of CHX, while one study found superior efficacy in favor of propolis. Six studies assessed gingival inflammation outcome, four of which reported better results with propolis, while two studies reported comparable results.ConclusionsThe results suggest that propolis-based mouthwashes have potential benefits in reducing plaque and gingival inflammation. However, methodological limitations along with small sample sizes in some of the included studies weaken the strength of the evidence. Therefore, further well-designed clinical trials with large sample sizes and adequate follow-up period are recommended to discern the efficacy of propolis mouthwash on plaque and gingivitis.

Objectives This cross-sectional comparative study investigated the effects of qat chewing habit on the radiographic bone density (RBD) and trabecular microstructure of temporomandibular joint condyles using cone beam computed tomography (CBCT). Study Design In total, 85 systemically healthy Yemeni males were included and divided into qat chewers (QCs; n = 41); and non-qat chewers (NQCs; n = 44). The participants responded to a structured questionnaire and underwent standardized clinical examination and CBCT scanning of the temporomandibular joint. Measurements of RBD and trabecular microstructure (trabecular thickness, trabecular separation, bone volume fraction, and fractal dimension) were performed. Statistical significance was established at P ≤ .05. Results No statistically significant differences were found between QCs and NQCs in RBD or trabecular microstructure. The mean standard deviations and maximum values of trabecular separation on the nonchewing side for QCs were significantly lower compared to the corresponding values for NQCs (0.60 and 2.68 for QCs vs 0.72 and 3.05 for NQCs; P = .025 and .05, respectively). A comparison between chewing and nonchewing sides in QCs revealed no significant differences. Conclusions Qat chewing habit induces insignificant changes in condylar RBD and trabecular microstructure as detected by CBCT. Further studies using advanced radiographic techniques are warranted.

The social habit of chewing qat (also known as khat) is widely practised in East Africa and the Arabian Peninsula. It has been linked with various oro-facial conditions, including temporomandibular joint disorders (TMD). This cross-sectional, comparative study sought to investigate the effects of qat chewing on temporomandibular joint (TMJ), using cone beam computed tomography (CBCT). A total of 85 Yemeni males were included. The participants were divided into two groups: Qat chewers (QC; n = 41) and non-qat chewers (NQC; n = 44). Relevant data were obtained using a structured questionnaire and standardised clinical examination. Additionally, CBCT images of the TMJs were obtained, and then, osteoarthritic changes and TMJ dimensions were analysed. SPSS 21 was used for statistical analyses, with a significant level was set at 0.05. Compared to NQC, a significantly higher proportion of QC presented with clinical signs of TMDs. The qualitative CBCT findings revealed significantly higher osteoarthritic changes in QC than in NQC: osteophyte (51.2% vs 22.7%; P = .008), subcortical sclerosis (48.8% vs 27.3%; P = .047), articular surface flattening (46.3% vs 6.8%; P = .009) and subcortical cysts (43.9% vs 4.5%; P < .001). However, CBCT quantitative findings (condylar dimensions) did not show significant differences between the two groups. The chewing side of the QC group showed slightly more changes compared to the non-chewing side. The results demonstrate that qat chewing has detrimental effects on TMJ manifested mainly as osteoarthritic changes. Further large-scale studies are recommended.

Background Recurrent aphthous stomatitis (RAS) is a very common oral ulcerative disease with no definitive cure. Growing evidence suggests a significant association between zinc deficiency and RAS. Objectives To assess the efficacy of systemic zinc supplementations in the prevention and management of RAS. Methods Five databases were searched for all English and Chinese studies published up to November 2020. All clinical trials that assessed the efficacy of zinc supplementations in the management and/or prevention of RAS were included. Results Seven clinical trials comprising 482 RAS patients (250 in zinc group) fulfilled the inclusion criteria. The follow-up period ranged from three months to one year. Five studies showed significantly better efficacy of zinc in reducing the recurrence rates of RAS, whereas two studies did not report any significant differences compared to the controls. Four studies reported on signs/symptoms of RAS, three of which showed superior outcomes in favour of zinc, while one study reported comparable results. Conclusion Zinc supplementation seems to be efficacious in the management and prevention of RAS. However, further clinical trials with standardized methodologies and adequate follow-up periods are required to confirm the efficacy of zinc supplementations.

Leishmaniasis, a widely prevalent disease throughout tropical and subtropical regions of the world, is a chronic protozoan infection of humans and mammals that remains grossly underreported and causes significant global morbidity and mortality. Different species of the intracellular protozoan parasites of the genus Leishmania can cause human leishmaniasis, resulting in various visceral, cutaneous, and mucocutaneous manifestations. The risk of leishmaniasis manifesting as a more severe entity is dependent on the infecting parasites’ immune evasion potential. Some causal associations between leishmaniasis and malignancy have been evidenced in experimental animals and humans. Leishmania spp. infection can play a significant, direct or indirect, role in the pathogenesis and prognosis of some malignant disorders through numerous pathophysiologic cascades. Aging, chronic ultraviolet radiation exposure, and popular treatment abuse (eg, chameleon saliva, cactus recipes, corrosive chemicals, and topical steroids) have been proposed as the principal triggering factors. Malignancy should be considered in the differential diagnosis of leishmaniasis in endemic regions, such as Yemen. Understanding this relationship could enrich the provision of early diagnosis, proper management, and prompt control of cancer.

Leishmaniasis and malignancy are emerging public health threats, manifested by a myriad of clinical presentations, and are responsible of substantial morbidity and mortality. Association of cutaneous leishmaniasis (CL) and cutaneous T cell lymphoma (CTCL) is an unusual syndrome that has rarely or even not been reported. Hereby, I report a challenging and an exceedingly rare entity of CTCL superimposed on disseminated CL (DCL) in an immunocompromised woman from Yemen. Hence, many of the questions raised in the context of parasitic carcinogenesis and the supposed potential of Leishmania parasites as oncogenes and/or risk factors for neoplastic development. Understanding this type of relationship between such skin intracellular parasites and carcinogenesis may enrich the provision of prevention, diagnosis and management of these challengeable and very hazardous diseases.

This study aimed to demonstrate subgingival microbial changes associated with development, prevention, and treatment of experimental gingivitis using chlorhexidine (CHX) and N-acetylcysteine (NAC) mouthwashes. This randomized clinical trial comprised two parts: a 3-week prevention sub-study in which 30 study subjects were equally assigned to either mouthwash or placebo while developing experimental gingivitis; followed by a 2-week treatment sub-study in which 20 subjects with experimental gingivitis were assigned to either mouthwash. Subgingival samples were collected at the beginning and end of each sub-study for microbial profiling with 16S rRNA gene sequencing. As expected, CHX was effective in both preventing and reversing experimental gingivitis; NAC had a modest effect. Gingivitis was associated with enrichment of TM7 HOT-346/349, Tannerella HOT-286, Cardiobacterium valvarum, Campylobacter gracilis, Porphyromonas catoniae, Leptotrichia HOT-219, and Selenomonas spp. At the phylum/genus level, TM7 showed the strongest association. Gingival health was associated with increased abundance of Haemophilus parainfluenzae, Lautropia mirabilis, Rothia spp., Streptococcus spp., and Kingella oralis. CHX demonstrated largely indiscriminate antimicrobial action, resulting in significant drop in biomass and diversity. Our results substantiate the role of specific oral bacterial species in the development of gingivitis. They also indicate that NAC is not a promising mouthwash at the concentration tested.

Stigma is synonymous with leishmaniasis, an endemic deadly flesh-eating disease in Yemen that affects predominantly poor rural women and children. Women with leishmaniasis often present late and experience not only physical deformities and the risk of death, but also the painful stigma of the disease and its consequences, a similar situation to that of leprosy decades ago. The International Society of Dermatology–sponsored community dermatology project Eradication of Leishmaniasis from Yemen Project has made a difference in the leishmaniasis situation in Yemen and addressed its magnitude. The program eradicated leishmaniasis from some areas, dealt with and improved its alarming prevalence among children and women who are the neglected and highest risk groups, and solved some issues associated with poor access to proper drugs. Medicine donation has enabled women with leishmaniasis to freely receive medicine they otherwise would not have been able to afford, reduced their mortality and morbidity, and minimized the extensive impact the socio-aesthetic stigma has on their lives. Our cause has attracted local and global attention to these problematic issues. Keywords: ELYP, Impact, Leishmaniasis, RLCC, Women, Yemen

Bullous pemphigoid (BP) is an acquired, inflammatory, sub-epidermal, immunobullous disease. It usually occurs in the elderly population and reported cases of BP in adults are very rare. This report describes an adult Yemeni female who was clinically diagnosed to have BP, and successfully treated with a steroid containing short term regimen. It concludes the possibility of reaching a clinical diagnosis of BP in disadvantaged areas based on the clinical criteria, and the importance of considering a diagnosis of BP in young adults and even in children who present with itchy tense blisters of forearms, hands and feet. When accessible, further immunofluorescence studies are important to confirm the accuracy of the clinical diagnosis of BP.

To compare the efficacy of N-acetyl cysteine (NAC) mouthwash with chlorhexidine (CHX) in prevention and treatment of experimental gingivitis MATERIALS AND METHODS: Sixty subjects were assigned randomly and blindly into one of three equal groups: NAC, CHX, or placebo group. The study was conducted in two stages: preventive and treatment substudies. Professional prophylaxis was performed ahead of starting the preventive substudy. Then, the subjects were instructed to stop oral hygiene practices and begin rinsing twice/day with 15 ml of the assigned mouthwash (1.25% NAC, 0.2% CHX, or inert base). Plaque index (PI), gingival index (GI), and papillary bleeding index (PBI) were measured at baseline, 7, 14, and 21 days. The treatment substudy started on day 21 in which the subjects in the placebo group (now with established experimental gingivitis) were assigned to NAC (n = 10) or CHX (n = 10); the abovementioned indices were measured at 28 and 35 days. Efficacy of these interventions was compared.All groups accumulated plaque and developed some degree of gingivitis: full-blown in the placebo group and remarkably mild in the CHX group. NAC had slight preventive properties at days 14 and 21. In the treatment substudy, CHX was associated with remarkable reduction in plaque and gingivitis while NAC resulted in insignificant reductions.1.25% NAC is marginally effective in prevention and treatment of experimental gingivitis.When compared with the placebo, NAC showed promising preventive and treatment effects of gingivitis that deserve further development and studies.ISRCTN31352091.

The author presents a case of BCC developed on an active lesion of mucocutaneous leishmaniasis as one of many cases of skin cancer frequently seen at the Regional Leishmaniasis Control Center (RLCC) clinics in Yemen.

Background Surveys that have been carried out to determine the prevalence of skin diseases in rural Yemen are scarce or not available. Objective To investigate the spectrum of winter dermatoses in a rural Yemeni community. Methods A retrospective study was conducted at the dermatology outpatient clinic of the Al-Helal Specialized Hospital (Radaa' district of Al Bayda' Governorate) using data analysis of 700 selected records of patients managed during four months of the 2013–14 winter season. Results Seven hundred patients with 730 diseases were reported in this study; the major bulk of patients (46.57%) were in the >18–40-year age group, and females outnumbered males. By far, dermatitis, eczematous, and allergic disorders (38.49%) topped the list of the most frequent skin disorders groups, followed by skin infections and infestations (20%) and the pigmentary disorders (13.70%) group. Contact dermatitis (10.68%) was the most prevalent skin disorder, followed by hyperpigmentations (8.77%), acne (8.08%), viral infections (5.75%), atopic dermatitis (5.62%), and parasitic infestations (5.34%). Conclusion This survey has documented the spectrum of winter dermatoses in a rural Yemeni community but also reflects the pattern of common dermatoses in the whole country. Dermatitis, eczematous, and allergic disorders, skin infections, and pigmentary disorders are the commonest groups. Contact dermatitis is the most prevalent disorder, and leishmaniasis is the most prevalent skin infectious disease. Climate, occupational, social, and environmental factors are the main contributors. Such statistics can form an important basis for community-based health policies.

Objective: The aim of this study was to estimate some tumor markers such as caspase-3, caspase-8 and annexin-v levels in blood and tissue of patients with breast cancer and establishing the relation between these apoptotic markers level and response to chemotherapy. Materials and Methods: A number of 150 females were divided into four groups, malignant neoplasm of breast cancer included 50 females, that were diagnosed into stage I, II, III, and IV and included inflammatory breast carcinoma, infiltrating ductal carcinoma, infiltrating lobular carcinoma, ductal carcinoma in situ and lobular carcinoma in situ, control group included 50 females with normal breast, benign neoplasm of breast cancer included 25 cases that contained a heterogeneous group of lesions including developmental abnormalities, epithelial and stromal proliferations and neoplasms and follow up group (after chemotherapy) include 25 cases that her surgery was done and taken chemotherapy. Flow cytometry was used to analyze cell cycle, caspase-3, caspase-8 and annexin-v among the study groups. Results: The results showed that caspase 3 and caspases-8 expressions were significantly decreased in malignant group compared with the control group (P = 0.0028 and P =0.008), respectively; caspase 3 and caspase-8 levels decreased significantly in malignant group compared with the follow up group (P =0.001and P =0.0105), respectively; caspase 3 and caspases-8 levels were decreased in benign group compared with the control group (P = 0.041and P =0.512). Annexin-v was highly expressed in both tissues and blood of malignant groups in viable stage than benign compared with the normal groups (P = 0.01 and P = 0.006) respectively. Annexin-v level was highly expressed in both tissues and blood of malignant groups in necrotic stage compared with the control and follow up groups (P = 0.0001 and P = 0.01). But in early and late apoptotic phase follow up group annexin-v level was significantly increased more than the malignant group with (P=0.0001 and P=0.0026) respectively. Sub G1 apoptosis level in malignant and benign group significantly decreased compared with the follow up group (P = 0.0001 and P = 0.003) respectively. Our data showed that S phase level was significantly increased among malignant group compared with the control and follow up groups (P = 0.0001), also S phase level was increased significantly among benign group more than the control and follow up groups (P= 0.9 and P=0.003) respectively; and S phase was significantly decreased in benign group compared with the malignant blood and tissue groups (P = 0.03 and P=0.05) respectively. Conclusion: Annexin-v, caspase-3 and caspase-8 level in blood and tissue may serve as markers for the diagnosis of breast cancer and the response to chemotherapy. Also, S phase of cell cycle is one of the significant factors in the development of breast cancer.

This report is a part of many articles and studies published by the Regional Leishmaniasis Control Center (RLCC). Willing that this review might enrich understanding of the global epidemiological profile of CL, the author relied on research evidence, his experience and a social survey to highlight historical and current concepts of cutaneous leishmaniasis (CL) as a globally most prevalent and highly stigmatizing form of leishmaniasis disease, introduce new ideologies upon CL-related stigmata, review the most common determinants and implications of CL stigmata; and report a short survey illustrating stigmata experience among some affected patients from Yemen. He also reviewed a successful community-led action to reduce the burden of CL and its related stigmata in Yemen.

Xeroderma pigmentosum (XP) is a rare, progressive, degenerative, autosomal recessive genodermatosis. Keratoacanthoma (KA) is a rapidly growing skin tumor, occurring primarily in older men. XP associated with KA has been infrequently reported. Here, We report a rare case of KA of the nose associated with XP in an 8-year-old Yemeni child. A KA in child should suggest consideration of XP. Early medical follow up can prevent developing, and help to diagnose tumors at a curable stage before they spread out.

Objectives: To assess self-reported oral health attitudes and behavior among undergraduate dental and medical students, and to analyze the variations in oral health attitudes based on gender, level of education, study discipline, academic average, and type of university.Methods: A self-administered questionnaire based on the Hiroshima University-Dental Behavioural Inventory (HU-DBI) was distributed to 1269 undergraduate dental and medical students at two universities (one public and one private) in Sana’a, Yemen.Results: Overall, the mean questionnaire score for the total sample was markedly low (4.91±1.58), with no significant difference between dental and medical students (P>0.05). Females had better oral health attitudes and behavior, especially towards visiting the dentist, tooth-brushing habits and oral hygiene practices (P0.05).Conclusion: Yemeni dental and medical students have shown markedly poor oral health attitude and behavior. Further studies are required to reveal possible shortcoming in these schools’ education process. Dental and medical curricula should emphasize the importance of proper oral hygiene, and further participation of medical and dental students in oral hygiene seminars is highly encouraged.

Background: Diabetes is a chronic metabolic disease which affects large number of population all over the world. Such disease is associated with many complications which may leads finally to patient’s mortality. More than 400 traditional medicinal plants have been recorded for helping in controlling such disease. So this study was planned to evaluate the effect of one of the famous plant mixture used in Saudi Arabia and some other Arab countries as hypoglycemic agent. Material and methods: Fourty adult male Albino Rats were divided into 8 experimental groups: The first group was considered as a control group. The rest of groups were affected by induction of experimental diabetes by subcutaneous injection of Alloxan. The second group was consisted of diabetic rats without any treatment.The third group was treated by water mixture of the plants used. The fourth group treated with Nigella sativa while the fifth group treated with Aloe vera. The sixth one treated with Feruls assa foetida. The seventh group was treated with Boswellia carterii Birdw and finally the last group was treated with Commiphora myrrha. The used plant dose was 1ml / 100gm body weight. After four weeks of treatment different physiological parameters were performed including estimation of the body weight, blood sugar level and serum insulin level. Pancreatic samples were obtained and processed for microscopic and quantitative evaluation after staining the prepared sections with both Heamatoxylin and eosin as well as special stain for demonstration of the different pancreatic cells in the Islet of the Langerhans. Results: The obtained results showed that the induced diabetes was diagnosed by laboratory assessment. The usage of the mixture or each plant alone was correct the glucose level,body weight gain and the insulin level. Microscopically there was definite decrease in the number and diameter of beta pancreatic cells in the diabetic group while the other pancreatic cells were not affected (alpha and delta cells). The use of medicinal plants in the different groups of this study greatly improves such cellular changes and the level of blood sugar level was corrected. The results obtained by the use of Commiphora myrrha was the best when compared with the rest of other plants. Delta cells were reduced in number and diameter with such treatment. Conclusions: It is recommended from such study that the use of the plant mixture as a hypoglycemic agent may be of good results than the use of each plant separately besides repeating such study with the use of variable doses may be helpful in better evaluation for the required doses.

The present study aimed to clarify antidiabetic activity of aqueous extract from Aloe vera on thirty adult male albino rats were divided into three groups, the first served as a control group, the second was injected with alloxan (120mg / kg B.wt. ) and served as diabetic group and the third was injected with alloxan and treated with Aloe vera water extract ( 0.5 ml / 100 g B.wt. ). After thirty days of treatment half of each group were scarified and the other one were left for 15 days without any additional treatment as a recovery period . The results revealed highly significant decrease ( p> 0.01) in blood glucose, and highly significant increase in both liver glycogen content and serum insulin level in the diabetic group treated with aqueos extract of A. vera when compared with the diabetic untreated group. It seems, therefore that water extract of A. vera results in a definite hypoglycemic, hyperinsulinemic effect. On the other hand, a significant increase of body weight gain and liver glycogen content was achieved. The results of this study clarify the role of Aloe vera active as antidiabetic plant and suggest a relationship between drenching. A. vera extract and insulin production which needs further investigation .

Background Leishmaniasis is a serious public health problem in Yemen. Objectives This study was designed to identify clinical and epidemiological features of leishmaniasis in Yemen. Methods The study was conducted at the Regional Leishmaniasis Control Center in central Yemen. Data sourced from the medical records of 152 patients with confirmed active leishmaniasis, managed during April–August 2013, were analyzed. Results A total of 94.1% of patients were rural residents. Al Bayda was the most endemic governorate (59.9%). Children represented the group at highest risk (57.2%), followed by adult females (32.9%); together these groups accounted for 90.1% of all patients. Mucocutaneous leishmaniasis was the most prevalent form (49.3%), followed by cutaneous leishmaniasis (47.4%), and visceral leishmaniasis (3.3%). The wet ulcer was the most common type of lesion (49.7%) and the single lesion (69.4%) represented the most common presentation. All patients were ignorant of the nature of the disease, and 55.9% had a history of using “popular” treatments. Conclusions Cutaneous, mucocutaneous, and visceral leishmaniases have significant endemicity in Yemen, especially in central areas. Al Bayda is the governorate with the highest endemicity, and rural children and women represent the populations at highest risk. Mucocutaneous leishmaniasis seems to be the most prevalent form and a single wet ulcer is the most common presentation. Infected refugees may represent new foci for imported Leishmania species. Ecology, geography, climate change, cultural gender- and age-specific duties, urban night activities, and use of popular treatments are among proven risk factors.