Real-world evidence of the effects of sodium-glucose co-transporter 2 inhibitors on the dosing of diuretics in patients with heart failure: a retrospective cohort study

Background: Heart failure (HF) was estimated to impact approximately 64 million individuals worldwide in 2017 and is predicted to rise in the coming years. Therefore, the aim of our study was to evaluate the effects of sodium-glucose transport protein 2 (SGLT2) inhibitors on the dosing of diuretics among individuals diagnosed with HF.Methods: A retrospective cohort study was conducted at Security Forces Hospital in Riyadh, Saudi Arabia, between January 2018 and August 2022. The study included adult patients who were diagnosed with heart failure and received dapagliflozin and/or diuretic. A descriptive analysis was conducted to identify significant differences between both groups by using the chi-square test for categorical variables and the Student’s t-test for continuous variables. A logistic regression model was also run to identify the odds of each event. Statistical significance was indicated by p values less than .05.Results: Overall reduction in diuretics was reported in 68 patients in the SGLT2 inhibitors plus diuretic therapy group, while in the diuretic therapy group 25 patients reported overall reduction in diuretics (OR = 4.81, 95% [2.74–8.45]). The reduction of the loop dose level was reported by 58 patients in the SGLT2 inhibitors plus diuretic group and by 25 patients in the diuretic group (OR = 3.48, 95% [1.98–6.11]). The discontinuation of thiazide was reported by 16 patients in the SGLT2 inhibitors plus diuretic therapy group, but by only two patients in the diuretic group (OR = 9.04, 95% [2.03–40.19]). After 6 months, ejection fraction was increased by 2.74 in the SGLT2 inhibitors plus diuretic group (p = .0019) and decreased by 2.56 in the diuretic group (p = .0485), both of which were statistically significant. The mean dose changes were decreased by 14.52 in the SGLT2 inhibitors plus diuretic group (p < .0001), which was statistically significant.Conclusion: Treatment with SGLT2 inhibitors plus diuretic significantly reduced the patients’ diuretic requirements. Therefore, our finding supports the theoretical concept of minimizing the level of diuretic upon the initiation of SGLT2 inhibitors

Taphonomic and zooarchaeological investigations at the middle Pleistocene site of Ti's al Ghadah, western Nefud Desert, Saudi Arabia

In recent years, the Arabian Peninsula has emerged as a key region for elucidating hominin and faunal evolution and dispersals between Africa and Eurasia. Central to this research is the middle Pleistocene site of Ti's al Ghadah (TAG) which has yielded a diverse and abundant fossil faunal assemblage and the earliest chronometrically dated evidence for hominins in this part of the world. Here, we present the first detailed taphonomic study of the large Unit 5 fossil assemblage from the site. We aim to assess which actor/s were responsible for the accumulation of the assemblage and evaluate evidence that might be consistent with the accumulation of fauna by hominins. We also describe, for the first time, fossils and lithic artefacts from stratigraphic horizons not previously considered, providing taphonomic insights into their accumulation. The taphonomic work shows that the Unit 5 faunal assemblage was accumulated by ambush predators, likely large felids and hominins, in a lake side environment, and that carcasses were subsequently scavenged by more durophagus carnivores such as hyenas and canids. Less can be reliably said regarding the newly described fossil assemblages given their poor preservation and significant wind abrasion, but large carnivores again appear to have played a role, and hominins probably played a role in the accumulation of at least one of these. This study provides the first detail insights into the interplay between hominins, carnivores, and herbivores in Arabia, and suggests that watering holes have been a focus on the Arabian landscape for resources since the middle Pleistocene

First evidence for human occupation of a lava tube in Arabia: The archaeology of Umm Jirsan Cave and its surroundings, northern Saudi Arabia

Recent advances in interdisciplinary archaeological research in Arabia have focused on the evolution and historical development of regional human populations as well as the diverse patterns of cultural change, migration, and adaptations to environmental fluctuations. Obtaining a comprehensive understanding of cultural developments such as the emergence and lifeways of Neolithic groups has been hindered by the limited preservation of stratified archaeological assemblages and organic remains, a common challenge in arid environments. Underground settings like caves and lava tubes, which are prevalent in Arabia but which have seen limited scientific exploration, offer promising opportunities for addressing these issues. Here, we report on an archaeological excavation and a related survey at and around Umm Jirsan lava tube in the Harrat Khaybar, north-western Saudi Arabia. Our results reveal repeated phases of human occupation of the site ranging from at least the Neolithic through to the Chalcolithic/Bronze Age. Pastoralist use of the lava tube and surrounding landscape is attested in rock art and faunal records, suggesting that Umm Jirsan was situated along a pastoral route linking key oases. Isotopic data indicates that herbivores primarily grazed on wild grasses and shrubs rather than being provided with fodder, while humans had a diet consistently high in protein but with increasing consumption of C3 plants through-time, perhaps related to the emergence of oasis agriculture. While underground and naturally sheltered localities are globally prominent in archaeology and Quaternary science, our work represents the first such combined records for Saudi Arabia and highlight the potential for interdisciplinary studies in caves and lava tubes

Homo sapiens in Arabia by 85,000 years ago.

Understanding the timing and character of the expansion of Homo sapiens out of Africa is critical for inferring the colonization and admixture processes that underpin global population history. It has been argued that dispersal out of Africa had an early phase, particularly ~130-90 thousand years ago (ka), that reached only the East Mediterranean Levant, and a later phase, ~60-50 ka, that extended across the diverse environments of Eurasia to Sahul. However, recent findings from East Asia and Sahul challenge this model. Here we show that H. sapiens was in the Arabian Peninsula before 85 ka. We describe the Al Wusta-1 (AW-1) intermediate phalanx from the site of Al Wusta in the Nefud desert, Saudi Arabia. AW-1 is the oldest directly dated fossil of our species outside Africa and the Levant. The palaeoenvironmental context of Al Wusta demonstrates that H. sapiens using Middle Palaeolithic stone tools dispersed into Arabia during a phase of increased precipitation driven by orbital forcing, in association with a primarily African fauna. A Bayesian model incorporating independent chronometric age estimates indicates a chronology for Al Wusta of ~95-86 ka, which we correlate with a humid episode in the later part of Marine Isotope Stage 5 known from various regional records. Al Wusta shows that early dispersals were more spatially and temporally extensive than previously thought. Early H. sapiens dispersals out of Africa were not limited to winter rainfall-fed Levantine Mediterranean woodlands immediately adjacent to Africa, but extended deep into the semi-arid grasslands of Arabia, facilitated by periods of enhanced monsoonal rainfall

The Holocene humid period in the Nefud Desert: Hunters and herders in the Jebel Oraf palaeolake basin, Saudi Arabia

Archaeological surveys and excavations in the Jebel Oraf palaeolake basin, north-western Saudi Arabia, have identified a well-preserved early- to mid-Holocene landscape. Two types of occupation site can be distinguished: nine small and ephemeral scatters from single occupation phases on the slopes of sand dunes and three hearth sites indicative of repeated occupation on palaeolake shorelines. In addition, 245 rock art panels, 81 cairns, and 15 stone structures were recorded. This diverse dataset provides an opportunity to reconstruct occupation patterns and changes in landscape use. A particularly important site, Jebel Oraf 2, documents two episodes of lake high stands at ca. 6500 BC and 5300 BC, flooding parts of the locality. Neolithic pastoralists likely occupied the site after the end of the wet season, when the terrain was dry. Earlier sites are located in dune embayments some 7–14 m above the shore of the palaeolake. These locations are consistent with hunting strategies identifiable in the rock art that suggest wildlife was ambushed at watering places. Later rock art at Jebel Oraf also documents the hunting of wild camel in the Iron Age. The lithic industries documented in the Jebel Oraf basin support arguments of repeated contact with Levantine populations

Iron catalyst for decomposition of methane: Influence of Al/Si ratio support

20% iron catalysts supported on combined alumina and silica through different proportions (Al2O3:SiO2: 100:0.00, 90.0:10.0, 80.0:20.0 and 0.0:100.0) were tested for the catalytic decomposition of methane to produce H2 and carbon. The catalysts were prepared via impregnation technique. The physicochemical properties of the catalysts were characterized with TGA, XRD, H2-TPR, and TEM techniques. The results specified no reaction for all temperatures when the catalysts were supported with bare silica. Indeed, the 20%Fe/(Si-80)-800 catalyst with 20% silica support operated at 800 °C produced CH4 conversion profile that rapidly descended from 64% to 5% due to the high content of silica. Plain alumina supported catalyst demonstrated the best conversion and stability operated at 800 °C. The CH4 conversion started from 83.4% and lasts at 82.2% after 300 min on stream. Keywords: Alumina, Fe catalyst, Hydrogen production, Methane decomposition, Silic

Epipalaeolithic occupation and palaeoenvironments of the southern Nefud desert, Saudi Arabia, during the Terminal Pleistocene and Early Holocene

International audienceThe transition from the Terminal Pleistocene to the Early Holocene is poorly represented in the geological and archaeological records of northern Arabia, and the climatic conditions that prevailed in the region during that period are unclear. Here, we present a new record from the site of Al-Rabyah, in the Jubbah basin (southern Nefud desert, Saudi Arabia), where a sequence of fossiliferous lacustrine and palustrine deposits containing an archaeological assemblage is preserved. Sedimentological and palaeoenvironmental investigations, both at Al-Rabyah and elsewhere in the Jubbah area, indicate phases of humid conditions, during which shallow lakes developed in the basin, separated by drier periods. At Al-Rabyah, the end of a Terminal Pleistocene phase of lake expansion has been dated to ∼12.2 ka using optically stimulated luminescence (OSL), with a mid-Holocene humid phase dated to after ∼6.6 ka. Palaeoecological reconstructions based primarily on non-marine molluscs and ostracods from the younger lacustrine deposits indicate a relatively shallow body of freshwater surrounded by moist, well-vegetated environments. A lithic assemblage characterized by bladelets and geometric microliths was excavated from sediments attributed to a drier climatic phase dated to ∼10.1 ka. The lithic artefact types exhibit similarities to Epipalaeolithic industries of the Levant, and their occurrence well beyond the ‘core region’ of such assemblages (and at a significantly later date) has important implications for understanding interactions between Levantine and Arabian populations during the Terminal Pleistocene–Early Holocene. We suggest that the presence of foraging populations in the southern Nefud during periods of drier climate is due to the prolonged presence of a freshwater oasis in the Jubbah Basin during the Terminal Pleistocene–Early Holocene, which enabled them to subsist in the region when neighbouring areas of northern Arabia and the Levant were increasingly hostile

Remote sensing and GIS techniques for reconstructing Arabian palaeohydrology and identifying archaeological sites

International audienceFreshwater availability is critical for human survival, and in the Saharo-Arabian desert belt repeated fluctuations between aridity and humidity over the Quaternary mean the distribution of freshwater was likely a primary control upon routes and opportunities for hominin dispersals. However, our knowledge of the spatio-temporal distribution of palaeohydrological resources within Arabia during MideLate Pleistocene episodes of climatic amelioration remains limited. In this paper we outline a combined method for remotely mapping the location of palaeodrainage and palaeolakes in currently arid regions that were formerly subject to more humid conditions. We demonstrate the potential of this approach by mapping palaeochannels across the whole Arabian Peninsula, and palaeolakes and marshes for select regions covering c. 10% of its surface. Our palaeodrainage mapping is based upon quantitative thresh-olding of HydroSHEDs data, which applies flow routing to Digital Elevation Model (DEM) data, while our palaeolake mapping uses an innovative method where spectral classification of Landsat Thematic Mapper (TM) imagery is used to detect palaeolake deposits within endorheic (closed) basins, before modelling maximum lake extents by flooding the basin to the level of the elevation of the highest detected deposit. Field survey in the Nefud desert and the Dawadmi and Shuwaymis regions of Saudi Arabia indicates accuracies of 86% for palaeodrainage mapping, and 96% for identifying former palae-olake basins (73% accuracy of classification of individual deposits). The palaeolake mapping method has also demonstrated potential for identifying surface and stratified archaeological site locations, with 76% of the surveyed palaeolake basins containing archaeological material, including stratified Palaeolithic archaeology. Initial examination of palaeodrainage in relation to archaeological sites indicates a relationship between mapped features and previously recorded Palaeolithic sites. An example of the application of these data for period-specific regional palaeohydrological and archaeological reconstructions is presented for a region of Northern Saudi Arabia covering the southern Nefud desert and adjacent lava fields

The expansion of later Acheulean hominins into the Arabian Peninsula

The Acheulean is the longest lasting cultural–technological tradition in human evolutionary history. However, considerable gaps remain in understanding the chronology and geographical distribution of Acheulean hominins. We present the first chronometrically dated Acheulean site from the Arabian Peninsula, a vast and poorly known region that forms more than half of Southwest Asia. Results show that Acheulean hominin occupation expanded along hydrological networks into the heart of Arabia from Marine Isotope Stage (MIS) 7 until at least ~190 ka ̶ the youngest documented Acheulean in Southwest Asia. The site of Saffaqah features Acheulean technology, characterized by large flakes, handaxes and cleavers, similar to Acheulean assemblages in Africa. These findings reveal a climatically-mediated later Acheulean expansion into a poorly known region, amplifying the documented diversity of Middle Pleistocene hominin behaviour across the Old World and elaborating the terminal archaic landscape encountered by our species as they dispersed out of Africa.peer-reviewe