Patients Undergoing Dental Surgery who are Taking Antiplatelet Medications

For the undergoing dental surgery patients taking antiplatelet medications, physicians and dentists must weigh the bleeding risks in continuing antiplatelet medications versus the thrombotic risks in interrupting antiplatelet medications. Bleeding complications requiring more than local measures for hemostasis are rare after dental surgery in patients taking antiplatelet medications. Conversely, the risk for thrombotic complications after interruption of antiplatelet therapy for dental procedures apparently is significant, although small. When a clinician is faced with a decision to continue or interrupt antiplatelet therapy for a dental surgical patient, the decision comes down to “bleed or die.” That is, there is a remote chance that continuing antiplatelet therapy will result in a (nonfatal) bleeding problem requiring more than local measures for hemostasis versus a small but significant chance that interrupting antiplatelet therapy will result in a (possibly fatal) thromboembolic complication. The decision is simple: It is time to stop interrupting antiplatelet therapy for dental surgery

Asthenosphere–lithosphere interactions in Western Saudi Arabia: Inferences from ³He/⁴He in xenoliths and lava flows from Harrat Hutaymah

Extensive volcanic fields on the western Arabian Plate have erupted intermittently over the last 30 Ma following emplacement of the Afar flood basalts in Ethiopia. In an effort to better understand the origin of this volcanism in western Saudi Arabia, we analyzed ³He/⁴He, and He, CO₂ and trace element concentrations in minerals separated from xenoliths and lava flows from Harrat Hutaymah, supplemented with reconnaissance He isotope data from several other volcanic fields (Harrat Al Birk, Harrat Al Kishb and Harrat Ithnayn). Harrat Hutaymah is young (< 850 ka) and the northeasternmost of the volcanic fields. There is a remarkable homogeneity of ³He/⁴He trapped within most xenoliths, with a weighted mean of 7.54 ± 0.03 R[subscript]A (2σ, n = 20). This homogeneity occurs over at least eight different xenolith types (including spinel lherzolite, amphibole clinopyroxenite, olivine websterite, clinopyroxenite and garnet websterite), and encompasses ten different volcanic centers within an area of ~ 2500 km². The homogeneity is caused by volatile equilibration between the xenoliths and fluids derived from their host magma, as fluid inclusions are annealed during the infiltration of vapor-saturated magmas along crystalline grain boundaries. The notable exceptions are the anhydrous spinel lherzolites, which have a lower weighted mean ³He/⁴He of 6.8 ± 0.3 R[subscript]A (2σ, n = 2), contain lower concentrations of trapped He, and have a distinctly depleted light rare earth element signature. ³He/⁴He values of ~ 6.8 R[subscript]A are also commonly found in spinel lherzolites from harrats Ithnayn, Al Birk, and from Zabargad Island in the Red Sea. Olivine from non-xenolith-bearing lava flows at Hutaymah spans the He isotope range of the xenoliths. The lower 3He/4He in the anhydrous spinel lherzolites appears to be tied to remnant Proterozoic lithosphere prior to metasomatic fluid overprinting. Elevated ³He/⁴He in the western harrats has been observed only at Rahat (up to 11.8 R[subscript]A; Murcia et al., 2013), a volcanic field situated above thinned lithosphere beneath the Makkah-Medinah-Nafud volcanic lineament. Previous work established that spinel lherzolites at Hutaymah are sourced near the lithosphere-asthenosphere boundary (LAB), while other xenolith types there are derived from shallower depths within the lithosphere itself (Thornber, 1992). Helium isotopes are consistent with melts originating near the LAB beneath many of the Arabian harrats, and any magma derived from the Afar mantle plume currently appears to be of minor importance.Keywords: Noble gases, Harrat volcanism, Arabia, Lithosphere-asthenosphere boundary, Helium isotopes, SCL

Advice on assistance and protection from the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons : Part 2. On preventing and treating health effects from acute, prolonged, and repeated nerve agent exposure, and the identification of medical countermeasures able to reduce or eliminate the longer term health effects of nerve agents

The Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) has provided advice in relation to the Chemical Weapons Convention on assistance and protection. We present the SAB’s response to a request from the OPCW Director-General in 2014 for information on the best practices for preventing and treating the health effects from acute, prolonged, and repeated organophosphorus nerve agent (NA) exposure. The report summarises pre- and post-exposure treatments, and developments in decontaminants and adsorbing materials, that at the time of the advice, were available for NAs. The updated information provided could assist medics and emergency responders unfamiliar with treatment and decontamination options related to exposure to NAs. The SAB recommended that developments in research on medical countermeasures and decontaminants for NAs should be monitored by the OPCW, and used in assistance and protection training courses and workshops organised through its capacity building programmes.Peer reviewe

Advice from the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons on riot control agents in connection to the Chemical Weapons Convention

Compounds that cause powerful sensory irritation to humans were reviewed by the Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) in response to requests in 2014 and 2017 by the OPCW Director-General to advise which riot control agents (RCAs) might be subject to declaration under the Chemical Weapons Convention (the Convention). The chemical and toxicological properties of 60 chemicals identified from a survey by the OPCW of RCAs that had been researched or were available for purchase, and additional chemicals recognised by the SAB as having potential RCA applications, were considered. Only 17 of the 60 chemicals met the definition of a RCA under the Convention. These findings were provided to the States Parties of the Convention to inform the implementation of obligations pertaining to RCAs under this international chemical disarmament and non-proliferation treaty.Peer reviewe

advice from the scientific advisory board of the organisation for the prohibition of chemical weapons on isotopically labelled chemicals and stereoisomers in relation to the chemical weapons convention

AbstractThe Chemical Weapons Convention (CWC) is an international disarmament treaty that prohibits the development, stockpiling and use of chemical weapons. This treaty has 193 States Parties (nations for which the treaty is binding) and entered into force in 1997. The CWC contains schedules of chemicals that have been associated with chemical warfare programmes. These scheduled chemicals must be declared by the States that possess them and are subject to verification by the Organisation for the Prohibition of Chemical Weapons (OPCW, the implementing body of the CWC). Isotopically labelled and stereoisomeric variants of the scheduled chemicals have presented ambiguities for interpretation of the requirements of treaty implementation, and advice was sought from the OPCW's Scientific Advisory Board (SAB) in 2016. The SAB recommended that isotopically labelled compounds or stereoisomers related to the parent compound specified in a schedule should be interpreted as belonging to the same schedule. This advice should benefit scientists and diplomats from the CWC's State Parties to help ensure a consistent approach to their declarations of scheduled chemicals (which in turn supports both the correctness and completeness of declarations under the CWC). Herein, isotopically labelled and stereoisomeric variants of CWC-scheduled chemicals are reviewed, and the impact of the SAB advice in influencing a change to national licensing in one of the State Parties is discussed. This outcome, an update to national licensing governing compliance to an international treaty, serves as an example of the effectiveness of science diplomacy within an international disarmament treaty

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Ambient noise tomography in the upper crust of North Harrat Rahat, Saudi Arabia

Images of Rayleigh-wave group velocity were derived for the 1–15 s period range that is sensitive to shear wave velocities in the crust of north Harat Rahat, Saudi Arabia. We used a continuous dataset of ambient noise that was processed by applying the technique depending on the Rayleigh-wave group velocity tomography. The dataset comprises six months of recordings extracted from 12 broadband seismic stations in north Harrat Rahat, Saudi Arabia. Using a cross-correlation technique, the Rayleigh waves have been generated and stacked along the whole time series. Dispersion curves representing fundamental mode Rayleigh waves were derived by a multiple filter technique. Dispersion curves for each station pair were inverted to obtain the one-dimensional model of corresponding shear wave velocities. The spatial distribution of shear wave velocities was depicted from the inverted one-dimensional models at 138 nodes and a reliable resolution was spatially resolved using grid cells of 0.2° expanded over both latitude and longitude. Images obtained from this study improve our understanding of the tectonic development as influenced by magma upwelling beneath the Arabian Shield. Results obtained from this study revealed two low-velocity zones in the upper crust at depths of 15 km west and shallow 10 km east, respectively. This suggests that high conductivity is present as a result of upwelling magma that flows into the upper crust of Arabian Shield coming from plausible deep sources such as the Red Sea Rift or the Afar plume, which are located to the west of the studied area

Toll-like receptor-4 as a predictor of clinical outcomes of estrogen receptor-negative breast cancer in Saudi women

Abdelhabib Semlali,1 Maroua Jalouli,2 Narasimha Reddy Parine,1 Abdullah Al Amri,1 Maha Arafah,3 Abdulrahman Al Naeem,4 Sanaa Abdullah Ajaj,5 Mahmoud Rouabhia,6 Mohammad Saud Alanazi1 1Genome Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Centre de recherche du CHU de Qu&eacute;bec, L&rsquo;H&ocirc;tel-Dieu de Qu&eacute;bec, Department of Molecular Biology, Medical Biochemistry and Pathology, Universit&eacute; Laval, Quebec, QC, Canada; 3College of Medicine, King Saud University, 4Department of Women&rsquo;s Imaging, King Fahad Medical City, 5Department of Family Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 6Groupe de Recherche en &Eacute;cologie Buccale, Department of Stomatology, Faculty of Dentistry, Universit&eacute; Laval, Quebec, QC, Canada Abstract: The aim of this study was to investigate the association of the common polymorphisms of Toll-like receptor 4 (TLR-4) with breast cancer development in the Saudi Arabian population. Four TLR-4 polymorphisms (rs2770150, rs10759931, rs10759932, and rs4986790) were studied using 127 breast cancer patients and 117 controls. Relative expression of TLR-4 protein in the breast tumor and the matched normal breast tissues was determined in a large cohort of 70 clinical breast samples in a tissue micro-array format by immunohistochemistry using a specific anti-TLR-4 antibody. Our results demonstrated an increase in TLR-4 expression in estrogen receptor (ER)-, postmenopausal breast cancer patients compared to normal. We also demonstrated that the G allele of single-nucleotide polymorphism rs10759931 was found to be significantly higher in frequency among patients (36.3%) compared to the control group (26.7%), suggesting that this polymorphism is strongly associated with the development of breast cancer in this ethnic population. In addition, the TLR-4 polymorphism rs2770150 was shown to be highly correlated with breast cancer in patients over 48 years of age. The TLR-4 polymorphism rs4986790 was also found to be associated with this malignancy in the ER- patient groups. Our results suggested firstly that the variation in TLR-4 gene expression may influence breast cancer development and secondly a closely linked association between TLR-4 gene polymorphism and ER status. Our study provides support for a better understanding of the implication of TLR-4 polymorphism in breast tumorigenesis and for its eventual use as a cancer biomarker. Keywords: Toll-like receptor 4, single-nucleotide polymorphisms, breast cancer, Saudi population, innate immunity, estrogen recepto