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Introduction: Stroke is known as a common cause of disability all over the world. Stroke prognosis estimation has always been a topic of interest. In this study, it was tried to investigate the prognostic value of laboratory findings of complete blood count in a systematic review. Methods: In this systematic review, literature from Medline via (PubMed, Ovid) Embase, Scopus, Cochrane Library, and ProQuest between 1988 and 2020 were included. A combination of Mesh and free terms were included in the search strategy: “Stroke”, “Red Cell Distribution Width”, “Blood Cell Count”, “Mean corpuscular hemoglobin”, and “Mean Corpuscular Volume” and with the abbreviation, in all fields. Data synthesis was achieved using content analysis. Results: Elevated red blood cell distribution width was associated with stroke, cardiovascular events, and all-cause deaths among patients with prior stroke. Mean platelet volume has not any prognostic significance in ischemic stroke. There was a poor association between mean corpuscular volume (MCV) and stroke prognosis. Globulin and hemoglobin level predicted short-term mortality following acute ischemic stroke. Conclusion: Complete blood count as a routine and efficient test performed in health care centers can be used to estimate the prognosis of stroke.

Background: The COVID-19 pandemic transformed healthcare delivery with the expansive use of telemedicine. However, health disparities may result from lower adoption of telehealth among African Americans. This study examined how under-resourced, older African Americans with chronic illnesses use telehealth, including related sociodemographic and COVID-19 factors. Methods: Using a cross-sectional design, 150 middle-aged and older African Americans were recruited from faith-based centers from March 2021 to August 2022. Data collected included sociodemographics, comorbidities, technological device ownership, internet usage, and attitudes toward COVID-19 disease and vaccination. Descriptive statistics and multivariable regression models were conducted to identify factors associated with telehealth use. Results: Of the 150 participants, 32% had not used telehealth since the COVID-19 pandemic, with 75% reporting no home internet access and 38% having no cellular/internet network on their mobile device. Age, access to a cellular network on a mobile device, and wireless internet at home were significantly associated with the utilization of telehealth care. Higher anxiety and stress with an increased perceived threat of COVID-19 and positive attitudes toward COVID-19 vaccination were associated with telehealth utilization. Discussion: Access and integration of telehealth services were highlighted as challenges for this population of African Americans. To reduce disparities, expansion of subsidized wireless internet access in marginalized communities is necessitated. Education outreach and training by healthcare systems and community health workers to improve uptake of telehealth currently and post-COVID-19 should be considered.

Background and Aims: Medical errors are important in all fields of medicine and have larger consequences in risky and stressful fields like emergency medicine. Social carelessness can cause these errors. On the other hand better understanding of time perception can lead to increased power of management and better decision making. In this study, we aim to evaluate the effect of time management education on social procrastination among emergency medicine residents.Material and Methods: In this interventional study, 25 residents in intervention group had a time management workshops for two weeks and we evaluated them for social procrastination before and after intervention. 25 residents were studied and compared as control group. Results: Both groups were matched according to baseline findings. Married residents compared to single ones had significantly lower procrastination score (p=0.02). The serial changes in procrastination score after the workshop in intervention group was significantly higher that control group (p=0.006). Conclusion: Education time management skills workshops could be effective in reducing social procrastination among emergency medicine residents. Married residents possibly due to responsiveness in their marriage and management skills have low procrastination.

Introduction: Stroke is sixth leading cause of death in the world. Economically taking care of stroke patients and rehabilitating costs more than those with acute and complicated diseases. Today, recurrent stroke is one of the leading causes of death in those survived stroke previously. Diagnosing the causes of early recurrence would help us promoting secondary prevention and accurately selecting the high risk patients in stroke recurrence. Methodology: In this article, as a cross-sectional descriptive one, is tried to study, extract the demographic data and length of hospitalization of about 600 stroke patients hospitalized in Tabriz Imam Reza Hospital during 2016. Eventually, abstracted data analyzed by spss15.0.0. Result: In this study 617 stroke patients, 403 men and 214 women, were examined. The age average was 62.63 and the average number of hospital days was 19.10. Among 617 patients studied, 22(19men and 3 women) had recurrent stroke. Average age of these patients was 61 and the average of hospital days was 14. Conclusion: Generally, It is worth mentioning that because of data distortion in patients with recurrent stroke, it was impossible to compare those patients with the primitive society.

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

Introduction: MS is one of the most common inflammatory diseases of the central nervous system, with the destruction of nerves. One of the symptoms of MS disorder is dystonia, fatigue, spasticity, disturbances, lack of sensation in the organs, cognitive impairment, weakness, tremor, pain, bladder and bowel dysfunction. Method: The search was carried out in the Pubmed/Medline database. 63 The study was designed to investigate patients with MS and therapeutic samples that were materially similar to the current research, and are included in this article. Findings: Therapeutic injection methods in MS have responded, but patients are still in trouble. Studies have shown that the use of stem cells for treating patients with MS has been fruitful and can be used to treat MS. Discussion: As it has been said, the most important treatment challenges in this way is to reduce treatment, and moreover, that anti-MS drugs in advanced forms are limited. Hence, the production of new, improved medicines for the complete treatment of MS is essential. Stem cells play a veryw important role in the repair process, and the complications of these cells are low in patients and provide an acceptable response. Reliably, the focus on new immunology methods with more biological properties has a greater impact on the treatment category. They will have patients.

Context Patients with hepatic dysfunction suffer from many problems and associated complications in organs other than the liver. Therefore, it is very important to investigate the effects of different drugs in the treatment of these patients. Due to the high consumption of non-steroidal anti-inflammatory drugs (NSAIDs), studying the effects of these drugs in patients with hepatic dysfunction is particularly important. Evidence acquisition Research studies published from 1958 to 2014 were investigated in the present study. The literature search was conducted based on the following keywords: non-steroidal anti-inflammatory drugs (NSAIDs), liver dysfunction, cirrhosis, pharmaceutical complications, drug-induced liver injury (DILI), and similar words from reliable resources. In total, 63 articles and two books (out of 179 initially identified resources) were included in the study. Results In addition to significant hemostatic disorders and cardiovascular disorders, disorders of the renal, respiratory, and gastrointestinal systems, as well as disorders of the central nervous system, occur in patients with hepatic dysfunction. The various NSAIDs have different effects on different bodily systems. Therefore, the appropriate drug should be chosen based on both the condition of the disease and the severity of the dysfunction. Conclusions Due to the potential adverse effects of NSAIDs in patients with hepatic disease, their impact on all bodily systems should be emphasized when determining whether their use is necessary. Further, the appropriate medication should be selected after a careful assessment of the severity of the disease and any associated complications. It is logical that medicines should only be prescribed by a qualified physician.

Context: Anesthetic drugs including halogenated anesthetics have been common for many years. Consequent hepatic injury has been reported in the literature. The mechanism of injury is immunoallergic. The first generation drug was halothane; it had the most toxicity when compared to other drugs. The issue becomes more important when the patient has an underlying hepatic dysfunction. Evidence Acquisition: In this paper, reputable internet databases from 1957–2014 were analyzed and 43 original articles, 3 case reports, and 3 books were studied. A search was performed based on the following keywords: inhalational anesthesia, hepatic dysfunction, halogenated anesthetics, general anesthesia in patients with hepatic diseases, and side effects of halogenated anesthetics from reliable databases. Reputable websites like PubMed and Cochrane were used for the searches. Results: In patients with hepatic dysfunction in addition to hepatic system and dramatic hemostatic dysfunction, dysfunction of cardiovascular, renal, respiratory, gastrointestinal, and central nervous systems may occur. On the other hand, exposure to inhalational halogenated anesthetics may have a negative impact (similar to hepatitis) on all aforementioned systems in addition to direct effects on liver function as well as the effects are more pronounced in halothane. Conclusions: Despite the adverse effects of inhalational halogenated anesthetics (especially halothane) on hepatic patients when necessary. The effects on all systems must be considered and the necessary preparations must be provided. These drugs are still used, if necessary, due to the presence of positive effects and advantages mentioned in other studies as well as the adverse effects of other drugs.