Introduction: The aim of the present study was to evaluate the effect of inhalation aromatherapy with sweet-scented geranium essential oil on pain and physiological indices after appendectomy. Methods: This double-blind clinical trial was performed on 120 patients undergoing appendectomy. Aromatherapy was performed with 1% sweet-scented geranium and sweet almond oil in the experimental placebo groups, respectively. Physiological symptoms were recorded before induction of anesthesia, before surgery, 30 min and 4 h after surgery. The control group received no intervention and only pain intensity and physiological indices were recorded in the mentioned stages. The placebo group underwent sweet almond essential oil aromatherapy. Data collection tools included demographic information form, physiological index checklist, and visual pain scale. Results: Results of 7 measurements showed significant differences between the experimental and placebo groups as well as the experimental and control groups in terms of mean heart rate, systolic and diastolic blood pressure, blood oxygen percentage, and pain (P < 0.001). Conclusion: Results of the present study showed that the effect of inhalation aromatherapy with sweet-scented geranium essential oil after appendectomy reduces pain and physiological indices. Therefore, the above aromatherapy can be used as a complementary treatment along with other treatments. Highlights

Introduction and importance Friedreich's Ataxia is an autosomal recessive disease and is usually associated with arterial dysfunction, muscle weakness, spasm in the lower extremities, scoliosis, bladder dysfunction, lack of reflexes in the lower extremities, and imbalance. Approximately 2.3 people have cardiomyopathy. In this article, we have reviewed a case of Friedreich's Ataxia with hypertrophic cardiomyopathy. Case presentation A 19-year-old woman with Friedreich's Ataxia has been protesting since she was 11 years old and complained of chest pains, dyspnea, and heart palpitations without a medical history. In ECG, Asymmetrical invert T wave diffuse, diffuse ST-segment depression, and left ventricular hypertrophy were observed. In echocardiography, the left ventricle was reported as hyperimmobile with increased EF (70–75%). Clinical discussion In the present study, a patient with Friedrich Ataxia was diagnosed with chest pain, dyspnea, and palpitations without any medical history, and was discharged from the hospital after treatment. In the patients introduced and our patient, there was significant fibro-myocardial hypertrophy, in which the ventricular septal hypertrophy was marked by hypertrophic cardiomyopathy. Conclusion Because early diagnosis of the disease is difficult, clinical signs and the patient's current profile at the time of referral will be very helpful.

Objectives: To explore the challenges and experiences of Prehospital Emergency Personnel in the context of the COVID-19 pandemic in Iran. Design: Qualitative study Setting: Prehospital Emergency Medical Services (EMS), Iran. Participants: 15 Prehospital Emergency personnel were invited to participate. Semi-structured in-depth interviews were conducted between Januarys to March 2021. Results: Themes relating to challenges of Prehospital Emergency Personnel in COVID – 19 were: Lack of preparedness of EMS for the pandemic, shortage of Personal Protective Equipment (PPE), psychological distress and negative emotions, shortage of staff and challenges associated with delivering care for patients using PPE. Conclusions: The current study found that Health Care Workers (HCWs) in the prehospital emergency field had multiple challenges in caring for their patients during COVID-19. Therefore, they are vulnerable in this situation. These challenges must be addressed in order to protect them in pandemics.

Background The aim of the present study was to investigate the effect of heparin (1000 IU/mL) in the blood sample on the results of venous blood gases of patients admitted to the cardiac intensive care unit. Materials and methods The present double-blind randomized clinical trial study was performed on 282 samples from 141 patients admitted to the cardiac intensive care unit. Insulin syringes with heparin (1000 IU/mL) and heparin (5000 IU/mL) and 1 cc of blood sample were taken from the peripheral vein, then distributed in two syringes and given to the analyzer. Results In the present study, the mean age of the samples was 49.96 ± 9.58. There was a statistically significant difference between the two groups in terms of values of partial pressure of carbon dioxide (PCO2) (P < 0.001), partial pressure of oxygen (PaO2) (P < 0.001), blood oxygen saturation (P < 0.001), bicarbonate ion (P < 0.001), excess base (P < 0.001), hemoglobin (P < 0.001), calcium (P < 0.001), potassium (P < 0.001), and sodium (P < 0.001) in the two groups. Conclusion Overall, heparin (1000 IU/mL) led to a less disruption in the results of venous blood gases, and since it has not significantly increased the risk of clots, it is recommended to be used for venous blood gas sampling.

In this paper, a case of undifferentiated pleomorphic sarcoma in a patient with right-sided heart failure has been explored. A 61-year-old woman complaining from cough and dyspnea for a week following indistinctive surgery on right buttock area with reported pathology of malignant undifferentiated tumor presented to the hospital. Laboratory results indicated negative TPi enzyme and D.dimer of 4127.81 mg/L. In transthoracic echocardiography, a mass filling the entire right ventricular space was observed. A resection surgery was performed and the pathology was reported as primary cardiac sarcoma.