Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

Abstract Background Reduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality. Methods We conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model. Results From 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 - 83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias). Conclusions Reduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium

Palaeozoic-Recent geological development and uplift of the Amanos Mountains (S Turkey) in the critically located northwesternmost corner of the Arabian continent

<p>We have carried out a several-year-long study of the Amanos Mountains, on the basis of which we present new sedimentary and structural evidence, which we combine with existing data, to produce the first comprehensive synthesis in the regional geological setting. The ca. N-S-trending Amanos Mountains are located at the northwesternmost edge of the Arabian plate, near the intersection of the African and Eurasian plates. Mixed siliciclastic-carbonate sediments accumulated on the north-Gondwana margin during the Palaeozoic. Triassic rift-related sedimentation was followed by platform carbonate deposition during Jurassic-Cretaceous. Late Cretaceous was characterised by platform collapse and southward emplacement of melanges and a supra-subduction zone ophiolite. Latest Cretaceous transgressive shallow-water carbonates gave way to deeper-water deposits during Palaeocene-Eocene. Eocene southward compression, reflecting initial collision, resulted in open folding, reverse faulting and duplexing. Fluvial, lagoonal and shallow-marine carbonates accumulated during Late Oligocene(?)-Early Miocene, associated with basaltic magmatism. Intensifying collision during Mid-Miocene initiated a foreland basin that then infilled with deep-water siliciclastic gravity flows. Late Miocene-Early Pliocene compression created mountain-sized folds and thrusts, verging E in the north but SE in the south. The resulting surface uplift triggered deposition of huge alluvial outwash fans in the west. Smaller alluvial fans formed along both mountain flanks during the Pleistocene after major surface uplift ended. Pliocene-Pleistocene alluvium was tilted towards the mountain front in the west. Strike-slip/transtension along the East Anatolian Transform Fault and localised sub-horizontal Quaternary basaltic volcanism in the region reflect regional transtension during Late Pliocene-Pleistocene (<4 Ma).</p

Isotopic Grand Unification with the Inclusion of Gravity (revised version)

We introduce a dual lifting of unified gauge theories, the first characterized by the isotopies, which are axiom- preserving maps into broader structures with positive-definite generalized units used for the representation of matter under the isotopies of the Poincare' symmetry, and the second characterized by the isodualities, which are anti-isomorphic maps with negative-definite generalized units used for the representation of antimatter under the isodualities of the Poincare' symmetry. We then submit, apparently for the first time, a novel grand unification with the inclusion of gravity for matter embedded in the generalized positive-definite units of unified gauge theories while gravity for antimatter is embedded in the isodual isounit. We then show that the proposed grand unification provides realistic possibilities for a resolution of the axiomatic incompatibilities between gravitation and electroweak interactions due to curvature, antimatter and the fundamental space-time symmetries.Comment: 20 pages, Latex, revised in various details and with added reference

EDTA-DEPENDENT PSEUDOTHROMBOCYTOPENIA AFTER DASATINIB TREATMENT IN A PATIENT WITH PHIDELPHIA CHROMOSOME POSITIVE CHRONIC MYELOID LEUKEMIA

6th International Eurasian Hematology Congress -- OCT 14-18, 2015 -- Antalya, TURKEYWOS: 00037317510003

METASTASIS OF BREAST CANCER IN BONE MARROW WITH LEUKOERYTHROBLASTIC REACTION: A CASE REPORT

5th International Eurasian Hematology Congress -- OCT 15-19, 2014 -- Antalya, TURKEYWOS: 00034724420013

COLD AGGLUTININ DISEASE ASSOCIATED WITH PROSTATE CANCER: A CASE REPORT

6th International Eurasian Hematology Congress -- OCT 14-18, 2015 -- Antalya, TURKEYWOS: 00037317510003

An alternative method to free flap for distal leg and foot defects due to electrical burn injury: Distally based cross-leg sural flap [Elektrik yanigina bagli distal alt ekstremite ve ayak defektleri onariminda serbest flebe alternatif bir metod: Karsi ekstremite beslemeli distal bazli sural flep]

PubMedID: 27135078BACKGROUND: High voltage electrical injuries can cause devastating results especially in distal extremities. Although free flaps are the golden standards for the reconstruction of these defects, sometimes local flap alternatives are more useful. One of the most favorable local flap is distally based sural flap (DBSF), which can be used in cross-leg fashion when ipsilateral extremity is affected by a high voltage electrical injury. The purpose of this study was to evaluate long term results of eleven patients who underwent a reconstruction to the lower extremity with cross-leg DBSF due to high voltage electrical burn injury between the years of 2003–2013. METHODS: Eleven patients suffering from high voltage electrical injury from 2003 to 2013 were evaluated retrospectively. All patients were male and had deep 2nd and 3rd degree electrical burns on many parts of their bodies, including their lower legs and feet. Seven of the defects were located on the right limb and four of them on the left. Defects were located in the ankle area in five patients, dorsum of the foot in four patients, achilles area in one patient, and the plantar region in one patient. RESULTS: The adaptation of flaps to the recipient site, colour, and quality were all acceptable. CONCLUSION: As an alternative to free flaps, the cross-leg DBSF has good tissue compliance, provides tissue of adequate quantity and quality, and has low complication rates in the long term in high voltage electrical injuries of the leg and foot. © 2016 TJTES