Scan to discover onlineNovel coronavirus disease 2019 (COVID-19) as a potential health risk factor continues to spread worldwide. Although common symptoms include headache and respiratory symptoms, some studies have suggested that COVID-19 may cause coagulation disorders and thrombolytic events, disrupt blood flow to the visceral organs, and cause some complications such as mesenteric ischemia. The authors reported four cases of acute mesenteric ischemia associated with COVID-19 confirmed in patients hospitalized in Imam Reza Hospital (a COVID-19 referral center in Mashhad University of Medical Sciences, Mashhad, Iran). The authors described the pathological findings that may be associated with this infection. The authors collected clinical data, imaging, microscopic, and operative findings of four patients with severe COVID-19 infection and evidence of intestinal necrosis. These four cases of severe COVID-19 pneumonia simultaneously showed intestinal necrosis during the infection process, indicating a relationship between coronavirus and mesenteric vascular events. Physicians should be aware of thrombosis symptoms in the digestive system in patients with severe COVID-19.

One of the most common postoperative problems is nausea and vomiting. Although using some anesthetic materials has been considered as the mainstay of this phenomenon, the exact factors are not known. Because of several morbidities associated with postoperative nausea and vomiting (PONV), its prevention and treatment has been a challenge for physicians, so several drugs have been recommended for this purpose. Based on the documented antiemetic specificity of ginger, we evaluated and compared the effects of preoperative administration of ginger on PONV with ondansetron administration as the standard medication. The participants included 100 patients with cholelitiasis who were candidate for laparoscopic cholecystectomy. Patients were divided into two groups: group A comprised 50 patients who received 500 mg oral ginger 1 h before surgery, and group B included 50 patients who received 4 mg intravenous ondansetron before completion of surgery. Antiemetic efficacy was assessed by visual analogue scale scores of nausea intensity at 0, 4, 8, 16, and 24 h after surgery and frequency of vomiting during the evaluation period. Although multifactor analysis showed that nausea severity was significantly lower in the ginger group, the data indicated that except 16 h after operation, the differences between two groups in the frequency of vomiting was not significant. In conclusion, though complementary studies are needed to have a strong suggestion, based on this study, we recommend administration of oral ginger 1 h before operation to control the severity of PONV in patients undergoing laparoscopic cholecystectomy.

Background: Selection of anesthetic approach for lower extremity operations is often a controversial issue for anesthesiologists. Objectives: The aim of this study was to compare the incidence and severity of back pain between general and spinal anesthesia, and to find effective factors in developing postoperative back pain. Patients and Methods: In a randomized clinical trail, 148 patients with elective lower extremity surgeries were randomly allocated into two groups of 74. The first group received general anesthesia and the second group underwent spinal anesthesia. The incidence of back pain was observed and documented. The severity of back pain was assessed at the first, fourth and eighth postoperative weeks by visual analogue scale. Results: The mean of patients' age was 35.50 ± 13.34 years. The incidence and mean of back pain severity among all participants were respectively 35.80% and 15.95% at the first week, 7.40% and 2.43% at the fourth week, and 1.4% and 0.27% at the eighth postoperative week. The incidence and mean of back pain severity in spinal group were respectively 39.2% and 18.11% at the first, 12.2% and 3.92% at the fourth, and 2.7% and 0.54% eighth postoperative weeks. In general anesthesia group, these figures were respectively 32.4% and 13.78% at the first week and 2.7% and 0.95% at the fourth postoperative week. No back pain was reported at the eighth postoperative week. The incidence and severity of back pain in the first week showed significant difference between the two groups, while the mean severity of back pain showed significant difference at the fourth week after operation. Conclusions: Spinal anesthesia could be probably considered as the sole effective factor in the development of back pain after operation.