Lower back pain is one of the leading causes of disability in the world. The aim of this study was to evaluate the effect of supplementation of dexmedetomidine and neostigmine with lidocaine 1.5% and triamcinolone for epidural block in increasing the duration of analgesia among patients suffering from chronic low back pain. In this double-blind, randomized clinical trial, 33 patients with chronic low back pain were included in three groups of 11 patients for epidural blockage. Triamcinolone (40 mg/ml) was added to lidocaine 1.5% solution (2 cc/segment) for all three groups. In group N, neostigmine was used at a dose of 1 mg (mg), followed by group D (dexmedetomidine 35 μg [0.5 μg/kg]), and grou [ND (neostigmine 0.5 mg, and 35 μg dexmedetomidine, all of which were added to the triamcinolone and lidocaine solution in each group. Medications were injected into the epidural space using an interlaminar approach. Subsequently, scores of pain and duration of analgesia were recorded in questionnaires and analysed using SPSS version 23. One month after the injections, pain scores recorded in the N group were 7.6±1.4, followed by 5.88±1.2 in group D and 5.42 ±1.1 in group ND. Therefore, the pain scores were significantly higher in the neostigmine group than the other two groups (p = 0.02), but no significant difference was found between the two groups that received dexmedetomidine and a combination of dexmedetomidine + neostigmine. Three months after the injections, there was a significant difference in pain scores between the two groups (P = 0.01). Both neostigmine and dexmedetomidine were capable of reducing the pain of patients with chronic low back pain after epidural block. However, neostigmine’s impact is lower compared to dexmedetomidine. The combination of the two drugs also reduced the pain scores of the patients after the intervention.

Background: Children with an overactive bladder typically exhibit urinary frequency, urgency and urge incontinence. The present investigation was conducted to evaluate the relationship between sleep disorders and hyperactive bladders in children.

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Background and Aim: Significant cardiac sequelae may be one of the main causes of death in COVID-19 patients; however, very few reports are available that address these complications and their treatment strategies in children. Case Presentation: A 4-month-old male infant was admitted to the pediatric intensive care unit with sudden tachycardia, tachypnea, and low oxygen saturation after surgery. Laboratory tests and echocardiography revealed elevated troponin I levels and myocardial dyskinesia with decreased Left Ventricular Ejection Fraction (LVEF= 50%) and pulmonary hypertension (30 mm Hg) consistent with the cardiac injury. Despite his normal chest x-ray, the chest CT scan disclosed ground-glass opacities in the periphery of the left lower lobe indicative of viral infection. The patient fulfilled the diagnostic criteria of the “Chinese expert consensus statement for clinical myocarditis”. The viral test for COVID-19 obtained on the first day of admission was found positive a few days later. The patient successfully recovered clinically after receiving anti-failure therapy and IVIG. Trop I level reduced to 0.10 g/L, and the LVEF eventually recovered to 68%. Conclusion: COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. Myocarditis in this patient was treated without antiviral drugs and only with supportive therapies.

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