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Corona Virus Disease-2019 (COVID-19) has become one of the most serious diseases in the history of mankind. It has captured the entire world and solutions are yet to be discovered to fight this global crisis. The outcomes of COVID-19 are influenced by a variety of pre-existing factors. The secondary microbial infections are one of the prominent ones that are major contributors for Antimicrobial Resistance (AMR) as they warrant the use of antimicrobial medications. The present review aimed at exploring the potential relationship between AMR under such circumstances and COVID-19 related outcomes. The published literature across the globe has delineated that the impact of COVID-19 may have worsened by a great degree due to the presence of secondary infections majorly bacterial ones. The consequences of COVID-19 have been fatal and a significant proportion can be a major attributor to AMR, either directly or indirectly. Although, there is a dearth of studies that can establish a very strong and direct relationship between AMR and negative COVID-19 outcomes so in-depth research on this topic is required to further explain this relationship in detail. 

Introduction: Intraductal Papillary Neoplasm of the Bile ducts (IPNB) is a rare entity characterized by exophytic growth of the bile ducts.Case presentation: In this report, we present a 57-year-old male with no prior medical history consulted for upper right abdominal pain, jaundice and pruritus. Abdominal Ultrasound (US) and magnetic resonance imaging/Bili-magnetic resonance were performed. They revealed that the circumferential parietal thickening of the common hepatic duct had extended approximately 4 cm with moderate dilatation of the left intrahepatic bile ducts. Computed tomography showed no evidence of distant metastasis.Biopsy revealed a high-grade intraductal papillary neoplasm. After 40 days, the patient had left hepatectomy with resection of the main bile duct and the gallbladder. Macroscopic examination of the surgical specimen showed a dilatation duct at the hilum with thickening of their walls.The histopathology report revealed multiple intra-hepatic papillary neoplasms with high-grade dysplasia with an invasive carcinoma component in the left hepatic duct without extending to the biliary wall, classified as pT1N0.Conclusion: This premalignant lesion has the potential to transform into invasive carcinoma if not properly diagnosed.Our case illustrates how early identification can lead to potential surgical resection.

Aim of study: In terms of treatment, it is essential to consider the correct use of preservatives and epoxy resin. Lumber pretreated with these substances can protect the wood from biodegradation or insect attack for exceeding three-year life expectation periods.Methods: To further increase durability and structural integrity, Posttreatment like painting or lamination on wood surfaces helps keep moisture out and carries a higher yield compared to traditional methods. In addition, chemical treatments to make timber resistant to fungal infestations as well has been gaining traction recently which makes it possible for lumber to be used in even more applications safely than ever before. Results: Thus, proper treatment plays a major role when considering the implications of using lumber as a resource both structurally and functionally over time. Conclusion: Lumber remains one of the most sought-after resources due to its versatility; likewise finding ways how impart maximum longevity necessitates research into new treatments available so that we can optimally exploit such abundant supplies without compromising the durable nature of good quality timber source.

Rotavirus induced disease are a main source of dreadful, serious and drying out gastroenteritis in kids (less than five years old). Instead of the worldwide presentation of immunizations for rotavirus longer than 10 years back, rotavirus infections still result in more than 200,000 yearly passings, generally in developing countries. Rotavirus basically infects enterocytes and cause diarrheal through the demolition of absorptive enterocytes. Intestinal secretions are invigorated by rotavirus (non-auxiliary/structural protein) to enactment of the enteric sensory system. Rotavirus diseases can prompt viraemia and antigenaemia (term related with more serious indications of intense gastroenteritis). Rotavirus reinfections are regular throughout the life, even though the sickness seriousness is diminished with rehash contaminations. The resistant relates of assurance against rotavirus reinfection and recuperation from disease is inadequately perceived. This study takes a step forward to the administration of rotavirus disease centers, primarily on control and cure of dehydration, even though the utilization of antiviral and hostile to purgative medications can be demonstrated at some cases.

Recent clinical, experimental and epidemiological studies report that ALS is thought possibly due to a multi-stage process, arising from a combination of genetic susceptibility and environmental factors, which alone or superimposed, perhaps on genetic polymorphism yet to be identified, may contribute to the incidence rate of sporadic ALS. In particular, a large amount of evidence suggests that mercury is toxic to motor neurons and may be a risk factor for ALS, playing a part in its pathogenesis. In fact, there have been case reports of ALS or ALS-like symptoms associated with mercury exposure, thus raising the possibility that mercury could be one of the non-genetic factors of the multistep process that is thought to underlie ALS. In order to give recent elucidations on the putative relationship between mercury exposure and ALS, we reviewed all the papers reported in the literature and published on Pubmed from 2006 to 2022. Despite a number of pathogenetic mechanisms that have been linked to mercury, evidence linking exposure to mercury to ALS is not consistent and discordant and, based on the evaluation of the articles, which emerged from our analysis that to date no convincing correlation between mercury and ALS has been established and no conclusive evidence has been enlightened suggesting increased mercury exposure is associated with ALS.

COVID-19 created a public health crisis shutting down many normal day-to-day activities and adversely affecting life, as we know it. Not only did this affect vulnerable, senior populations and people with poorly managed diabetes and hypertension [1-4], it displaced nursing students from clinical experiences putting them at risk of not graduating. Given the projected shortages of RNs in 2030, in California alone of 44,500 FTEs [5], this delay would have added a ripple effect increasing already dire predictions. This displacement created an emergency and with the aid of the Board of Registered Nursing, Assembly Bill 2288 [6] passed allowing student nurse clinical experience requirements to be revised to help meet graduation requirements.

Owing to the ever westernizing lifestyles in developing countries like India, the escalation of oral cancer patients are in need of urgent plan of action. With tobacco being the commonest cause for causation of oral cancer, Global Adult Tobacco Survey, 2016-17 revealed that almost 28% of whole population of India is consuming tobacco in either smoking or smokeless form. With these increasing numbers, the expected death toll to be expected to touch 1-2 million mark by the year 2035 [1]. Although, the current Onco-medicine fraternity excels in rendering care to oral cancer patients in the form of surgeries, chemotherapy and radiation-therapy. Often, these treatment modalities impart some unwanted adverse effects like, docetaxel (DCT) is known for its hepatotoxicity [2,3] whereas, one of the commonly used cisplatin (CIS) presents with nephrotoxicity, neurotoxicity, bone marrow suppression and vomiting [4,5]. Literature suggests of many non conventional medicaments being tested in past for their anti onco-genic effect, where few being effective and others being questionable ones. Chlorhexidine being one among them showing some how promising anti onco-genic activity with feeble amount of studies being conducted in past. Chlorhexidine, one of the most commonly prescribed mouthrinse in the field of dentistry, with varying concentrations of 0.12% and 0.2% concentrations. Although, apart from being broad spectrum antibiotic, its capability to dismantle the protein – protein bond between anti – apoptotic Bcl-2 family protein Bcl-xL and its pro – apoptotic binding partners [6]. The current study was conducted on three cell lines of squamous cell carcinoma (SCC-4, SCC-9, SCC -15) and two pharynx carcinoma cell lines (FaDu and Detroit 562). The compounds induced apoptosis through mitochondria dependent apoptotic pathway in oral tumour cell lines. Another study conducted to assess the similar anti – oncogenic activites of chlorhexidine mouthrinse along with cranberry [7]. It was evident from results that, with increasing concentrations of chlorhexidine mouthrinse, there was increase in mean percent growth inhibition. The authors concluded saying, chlorhexidine has showed both anti cancerous as well as anti bacterial activity required to tackle common oral infections, part of common anti cancer therapy. Fernando Martínez-Pérez et al (2019) conducted study, where antitumor activity of Lipophilic Bismuth Nanoparticles (BisBAL NPs) and chlorhexidine on human squamous cell carcinoma was assessed using energy dispersive X – ray spectroscopy in conjunction with scanning electron microscopy (EDS-SEM). Study revealed, BisBAL NPs and chlorhexidine both showed cell growth inhibition on both cancer cell line (CAL-27) and human gingival fibroblasts (HGFs). Although, chlorhexidine showed non specific cytotoxicity for both tumoral and non tumoral control cells. The suggestive mechanism of action might be loss of cell membrane integrity [8]. Although Eliot MN (2013) conducted study, to assess the risk of head and neck squamous cell carcinoma secondary to use of alcohol containing and non alcoholic mouthwashes including chlorhexidine. The study was concluded with an assumption based on chlorhexidine mouthwash alters the oral flora [9], thus resulting in increasing risk exponentially through diverse change in oral bacteria and altered immune response with contribution towards genesis or promotion of cancer [10]. On the contrary, alcohol consumption and smoking are predisposing factors towards upper digestive tract cancer. The main causative factor being the first metabolite of alcohol, acetaldehyde. And much higher levels are derived from oral bacteria and thus, same can be altered in favour through usage of chlorhexidine mouthwash, to avoid excessive production of acetaldehyde intra orally. In conclusion, chlorhexidine mouthwash has been into dental practice since long and the role it plays in either ways has to be assessed by a multi dimensional study with cell lines including that of control to derive better compared conclusions.

Introduction - evolution of SARS-CoV-2 variants: With the unrestrained pandemic for over last one-and-half year, SARS-CoV-2 seems to have adapted to its habitat, the human host, through mutations that facilitate its replication and transmission. The G variant incorporating D614G mutation, potently more transmissible than the ancestral virus arose during January 2020 and spread widely. Since then, various SARS-CoV-2 variants of concern (VOCs) and variants of interest (VOIs) with higher infectivity or virulence or both, have evolved on the background of G variant, and spread widely. SARS-CoV-2 infection and the immunodynamics: As the virus becomes more transmissible, its lethality may drop. Apart from the humoral immunity, T-cell recognition from a previous SARS-CoV-2 infection or vaccination may modify the disease transmission correlates and its clinical manifestations. On the other hand, the immunity generated may reduce probability of re-infection as well as limit evolution of adaptive mutations, and emergence of highly infectious and immune-escape variants. There are complex issues related to the SARS-CoV-2 evolutionary dynamics and host’s immunodynamics. Trending etiopathoimmunological correlates: The evolution potential of SARS-CoV-2 is limited because of proofreading function of nsp14. The S protein mutations affect transmissibility, virulence, and vaccine efficacy. The D614G mutation in G variant with higher infectivity has turned the Chinese epidemic into a pandemic. Other SARS-CoV-2 variants, such as Alpha, Beta, Gamma, and Delta seem to have evolved as result of adaptation to selective pressures during periods of prolonged infections and subsequent transmission. Further, there is issue of convergent association of mutations. Basics of immunity and immune system failure: The nature of the immune response after natural SARS-CoV-2 infection is variable and diverse. There are pre-existing neutralizing antibodies and sensitized T cells elicited during previous infection with seasonal CoVs influencing the disease susceptibility and course. The virus has evolved adaptive mechanisms to reduce its exposure to IFN-I and there are issues related to erratic and overactive immune response. The altered neutralizing epitopes in the S protein in SARS-CoV-2 variants modify the immune landscapes and clinical manifestations. Conclusion: current scenarios and prospects: Presently, the SARS-CoV-2 infection is widespread with multiple evolving infectious variants. There is probability of its transition from epidemic to endemic phase in due course manifesting as a mild disease especially in the younger population. Conversely, the pandemic may continue with enhanced disease severity due to evolving variants, expanded infection pool, and changing immunity landscape. There is need to plan for the transition and continued circulation of the virus during the endemic phase or continuing pandemic for indefinite period.

The NIH has published treatment guidelines for treating COVID-19 patients in the hospital. However, as of this writing, there are no established protocols for treating COVID-19 positive patients in primary care. Accordingly, this investigator has taken on the task of reviewing the medical literature to be able to propose evidence-based protocols for treating COVID-19 positive patients in primary care. The CDC is advising people to do nothing when they find out they are positive for COVID-19 unless they have symptoms. The evidence from the literature irrefutably shows COVID-19 infection evokes a massive and deadly hyperinflammatory response called the “Cytokine storm” and that Cytokine levels in the blood have a predictive value in identifying an impending Cytokine storm. With such data primary care providers can effectively lower Cytokine levels and prevent critical illness and death. Accordingly, this paper presents identification of the problem of not having standard practices in primary care for people who are positive for COVID-19 and not knowing who is at risk. Moreover, the evidence shows that knowing vitamin D levels and correcting deficiencies can go a long way in reducing Cytokine levels. Additionally, the literature review presents evidence that undeniably shows the stark possibility that many of the COVID-19 related deaths can be prevented by identifying who is at risk for the Cytokine storm and other complications and providing early treatment even before symptoms appear.

The SARS-Cov-2 virus was firstly identified in Wuhan, China and caused catastrophic destruction all over the world. COVID-19 virus primarily effects lungs of its hosts and impairs it in number of ways. It can also damage multiple organs like Heart, kidney, endocrine glands, skin, brain and several others. Kidneys are also damaged to a great extent. In Heart it can cause acute coronary syndrome, Heart failure, Myocardial infarction. SARS-CoV-2 effect brain especially psychologically. It also causes serious lymphocyte apoptosis. It also neutralizes human spleen and lymph nodes. SARS-CoC-2 can be harmful for those having already liver diseases. Similarly, SARS-CoV-2 has a direct impact on endocrine glands. It is responsible for the various injurious changes in hormones, causes various diseases like acute pancreatitis, decrease in GH, hypoparathyroidism etc. and lead to cause tissues damage in glands. It also some minor effects on nose, and respiratory pathways. It also has some minor effects on eyes and ears whereas it causes several devastations in GIT.