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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. Keywords: Ginger (Zingiber officinale Roscoe), Postoperative nausea and vomiting, Cholecystectomy, Laparoscopic

Abstract Background and objectives: Pathogens can be transferred via the hands of the personnel not only to themselves but also to their families or to the patient causing infection especially nosocomial infections. Microbial contamination of hand is caused by contact with patients and their environments or usual devices in the workplace. It seems that contamination of computer devices and handsets are more in hospital than official buildings. The aim of this study was to assess and compare the microbial contamination of computer keyboards, mouse and telephone receivers in a hospital department and an official building. Material and Methods: the sterile swab samples obtained from 32 keyboards, 31 computer mouse and 30 telephone receivers in the official building of Mashhad medical university and central laboratory of Imam Reza hospital were cultured on Blood agar and MacConkey agar plates. Results: Out of 64 samples from the official building, we identify 83 microbial germs. The most common ones are gram-positive Bacilli (n =34, 40.95%) and coagulase-negative Staphylococci (n = 32, 32.53%). Of 29 samples of central laboratory, there are 33 microbial germs .The most common of them are grampositive Bacilli (n = 19, 57.57%) and coagulase-negative Staphylococci (n = 7, 21.21%). Overall, microbial contamination of the computer equipment and handsets is not statistically meaningful (P< 0.05). Some germs like diphtheroid are not existed in laboratory, but two cases of Aspergillus are found. Conclusion: The presence of most of the germs on these devices is due to dusting or normal flora transferred via staffs’ hands. Only two of them, coagulase-positive Staphylococci and Aspergillus, should be considered carefully because they may cause serious infections in staff, their families or patients. Key words: contamination , workers’ desk, microorganism, computer keyboard and mouse

Background: The exact role of different immune cells and cytokines in control or promotion of intracellular growth of leishmania has still remained a controversial topic. The aim of the present study was to study effects of cellular changes and relevant cytokines in cell mediated immunity by diphencyprone (DCP) in pathogenicity of acute L.major infection in BALB/c mice., Methods: 45 healthy female BALB/c mice were injected with L. major promastigotes under the base of tail. The mice were randomly divided to three groups of 15 mice: (1) control group without any treatment. (2) acetone group: Acetone was applied topically on the cutaneous lesions weekly and (3) DCP group: DCP was applied topically on the cutaneous lesions with increasing concentrations to induce local allergy. The mice were followed by the end of eighth week, and then macroscopic changes, histopathology, immunology studies, and organ parasite burden were determined., Results: In DCP group, in comparison to other groups the ulcer size and parasite burden in ulcer site and spleen increased, significantly. There was a deep lymphohistiocytic infiltration in the ulcer site. Total IgG, IgG1, and IgG2a levels as well as IgG2a/IgG1 ratio and intracellular IFN-gamma in CD8 + lymphocytes were significantly higher. IL4 and T CD8 + lymphocytes were significantly lower in DCP group. The IgG2a/IgG1 ratio was more than 1 in all groups., Conclusion: Our findings demonstrated that DCP reduced the CD8 + lymphocytes and IL-4 production. In spite of increased IgG2a/IgG1 ratio, the parasite burden and inflammation severity increased in infected mice. The results can show the pivotal role of CD8 + lymphocytes in conjunction with Th1 lymphocytes in the control of acute leishmania infection in mice., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Biliary leakage after T-tube removal is an important complication which can be lethal especially in patients who received immunosuppressant agents. The purpose of the study is to determine a method which can evaluate the completion of tract formation in high-risk patients. Participants include 46 patients who were candidates for open cholecystectomy and common bile duct (CBD) exploration and T-tube insertion. Twelve of patients received corticosteroids and were divided into two groups. In the first group, T-tube was removed conventionally, but in the other group, we performed a "fistulography" 1 month postoperative to evaluate maturity of tract between CBD and the skin. Biliary peritonitis was seen in half of patients who are managed conventionally, but no complication was detected in patients who underwent fistulography. Fistulography is suggested to be done before T-Tube removal in immunocompromised patients in order to detect tract formation, which is effective in reduction of postremoval complications.

Aim: This study was designed to identify the risk factors of transient and permanent hypoparathyroidism in patients undergoing thyroidectomy. We also studied the duration of transient hypoparathyroidism following thyroid surgery., Methods: A prospective study was conducted on 163 consecutive patients undergoing thyroidectomy. Serum Levels of calcium and parathyroid hormone (PTH) were determined the day before surgery and then on the 1st and 10th postoperative day to determine the postoperative course of serum PTH and calcium. Patients were followed for six months after surgery., Results: The incidence of transient and permanent hypoparathyroidism was 8.6% and 0%, respectively. Among all of variables, only the extent of surgery had a significant relationship with postoperative hypoparathyroidism (P=0.010). PTH measurement at 10th day postoperatively became normal, except in one patient in whom it continued to be low until two months., Conclusion: The extent of surgery is the leading cause of postoperative hypoparathyroidism, though, in most of the patients this is a transient complication and PTH level revert to normal within 10 days after surgery.

Aim: To determine the effects of pentoxifylline (PTX) on clinical manifestations and evaluate arterial blood gas data in hepatopulmonary syndrome (HPS) in children., Methods: In a pilot study of 10 children with chronic liver disease, who had HPS, 20 mg/kg/d PTX was administered for 3 mo. Clinical data and arterial blood gas parameters were evaluated at baseline, the end of the treatment period, and 3 mo after drug discontinuation., Results: Six patients could tolerate PTX, while four patients experienced complications. Among patients who could tolerate PTX, there was a significant increase in arterial oxygen pressure (PaO(2)) (P = 0.02) and oxygen saturation (SaO(2)) (P = 0.04) and alveolar-arterial oxygen gradient (P = 0.02) after 3 mo of treatment. Significant decreases in PaO(2) (P = 0.02) and alveolar-arterial oxygen gradient (P = 0.02) were also seen after drug discontinuation., Conclusion: PTX may improve PaO(2), SaO(2) and alveolar-arterial oxygen gradient in the early stage of HPS.