الفهرس 
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Abstract
Coronavirus disease is a highly contagious viral illness with symptoms ranging from asymptomatic to acute respiratory distress syndrome and multi-organ failure. COVID-19 harmed several organs, including the cardiovascular system, causing myocardial damage, acute myocardial infarction dysrhythmias, myocarditis, and heart failure
Azithromycin is a widely used broad-spectrum antibiotic that has been postulated to have particular activity against Coronavirus in compared to other antibiotics. However, due to the widespread use of azithromycin in COVID-19 cases, cardiac adverse effects of the medicine became a more major worry, particularly QT interval prolongation and torsade de pointes, which were the most common complications.
Rosuvastatin is a lipid-lowering medicine that belongs to the statin class of medications used to minimize the risk of cardiovascular disease and manage high lipid levels by inhibiting endogenous cholesterol synthesis in the liver. Rosuvastatin also displayed anti-inflammatory, antioxidant, ion channel stabilizing, and autonomic nervous system regulating effects, supporting the use of statins in COVID-19 patients.
Nigella sativa, a well-known medicinal plant with excellent medical potential, has a variety of historical origins. Several preclinical and clinical researches have shown that N. sativa has antiviral properties against a variety of viruses. Some N. sativa compounds inhibited coronavirus replication, and some clinical research suggest that N. sativa and thymoquinone have antiviral, anti-inflammatory, and immunomodulatory characteristics, as well as bronchodilatory benefits, in the treatment or control of COVID-19
The current prospective study was conducted on adult patients diagnosed with COVID-19 who were admitted to isolation canters in Minia Governorate during the period of one year from June 2021 to May 2022. The study was performed to assess the cardiotoxicity in patients with COVID-19 treated orally with Azithromycin, to evaluate the protective effect of Rousvastatin and Nigella sativa oil and to compare between them. So, the study included a total of 160 COVID-19 patients of both sexes who were divided into 4 groups (n=40) and treated for 5 days as follows: group (I) Azithromycin group received Azithromycin, group (II) Azithromycin + Rosuvastatin received Azithromycin plus Rosuvastatin, group (III) Azithromycin + Nigella sativa oil group received Azithromycin plus Nigella sativa oil and group (IV) Azithromycin + Rosuvastatin + Nigella sativa oil group received Azithromycin, Rosuvastatin plus Nigella sativa oil .
All the included participants were subjected to history taking , laboratory investigations Including: CBC, RBS, Prothrombin time and concentration, blood urea and creatinine, AST, ALT, albumin and Total protein, serum electrolytes (Na, K, Ca and Mg), serum Ferritin, CRP, lactate dehydrogenase (LDH), D-Dimer, CKMB and Troponin and Electrocardiogram (ECG).
Medications used in the study Azithromycin (Zithromax 250 mg, Pfizer, Germany) by 500 mg for 5 days by oral route, Rosuvastatin (Rosuvast 20 mg, Chemipharm, Egypt) 20mg/day by oral route and Nigella sativa oil (Baraka Capsule 450mg, Pharco, Egypt) 4 ml/ kg/ day by oral route.
The obtained results can be summarized as follows: No significant differences were noticed among groups regarding age , sex , smoking , diabetes, hypertension and pulse rate .
Also, there were no significant differences were observed among groups as regards electrolyte elements (K, Na, Ca and Mg) and urea & createnine levels.
The ALT level was significantly higher in group (IV) versus group (III), however, group (I) recorded higher AST level versus group (IV). Also, there were significant differences among groups as regards albumin level (group IV had the highest level and group III had the lower one).
Ferritin and D-Dimer levels were almost similar among groups with no significant differences as regards serum level. While, group (II) had significantly higher CRP level and the lowest level was noticed in group (IV) however group (I and III) did not differ significantly.
Regarding LDH, there were no significant differences among groups on admission (before treatment) while, a significant elevation was shown after treatment in all groups. While, after treatment LDH level was significantly lower in group (II), (III) and (IV) compared with group AZ group (group I).
Baseline values of CKMP level were comparable among groups with no significant differences however after treatment, group (I) had significantly higher CKMB level versus the other three groups.
Regarding the results of ECG, on admission, sinus rhythm was found in all cases in all four groups with no significant changes, although there were extremely significant differences between pre and post-treatment ECG in all groups. After treatment, there were 16 cases of extended QT in the AZ group, 6 cases in the AZ+RS group, and 10 cases in the AZ+NS group, compared to just 2 cases in the AZ+RS+NS group, while there were 3 cases of tachycardia in the AZ group, 1 case in the AZ+RS group, and 4 cases in the AZ+RS+NS group.
No significant differences were observed among groups as regards Troponin level after treatment, positive cases were only one case in group (I) and another case in group (IV).
Conclusion
• The present results conculeded that Azithromycin had cardiotoxic effect, it causes QT prolongation and altering and stress markers and cardiac enzymes (LDH and CKMP)
• Administration of Rosuvastatin had protective effect against Azithromycin induced cardiotoxicity (ameliorated biochemical and ECG changes).
• Adminstrition of Nigella sativa also ameliorated the cardiotoxic effect of Azithromycin.
• The combination of Rosuvastatin + N. sativa (with the mentioned doses) had the best effect.