Dose Determination of Activated Charcoal in Management of Amitriptyline-Induced Poisoning by Reversed-Phase High-Performance Liquid Chromatography

Purpose: To assess the doses of activated charcoal currently used in the management of acute amitriptyline-induced drug poisoning and explore the possibility of using lower doses.Methods: Albino male Wistar rats, weighing 200 ± 20 g, were used for the study. The animals were divided into four groups of eight animals each. The concentration of amitriptyline in rat plasma was measured by high performance liquid chromatography (HPLC) for dose determination of activated charcoal. Chromatograms were established with acetonitrile: 70 mM KH2PO4 buffer (60: 40, v/v) solvent system on an Xterna® ms C18 SUM column (5 μm, 3.9 × 150 mm) and pH was adjusted to 4.5 with ortho-phosphoric acid. Mobile phase flow rate was 1 ml/min and ultraviolet (UV) detection was at 293 nm. Validation of the method was performed to determine its selectivity, linearity, precision, as well as limits of detection (LOD) and of quantification (LOQ).Results: Standard curves were linear, r2 = 0.996, for amitriptyline over the concentration range 10 - 60 ng/ml. Recovery (98.3 to 100.85 %) was in the selected concentration range of 10 - 60 ng/ml. The LOD and LOQ of the method for amitriptyline were 0.109 and 0.332 μg/ml, respectively. The validated method was successfully applied to measure plasma concentrations of amitriptyline and to measure the doses of activated charcoal currently used in the management of acute amitriptyline drug poisoning.Conclusion: The proposed RP-HPLC method enables determination of amitriptyline with good separation and resolution of the chromatographic peaks. Validation revealed that the method is sensitive, accurate and selective. Using half of the standard dose of the activated charcoal gave a comparable effect to the standard dose in reducing drug concentration in the blood. While, using quarter of the standard dose of activated charcoal does not have a cleared effect.Keywords: Amitriptyline, Activated charcoal, Drug poisoning, Reversed-phase high-performance liquid chromatograph

External Vs Internal e-Referrals: Results from a Nationwide Epidemiological Study Utilizing Secondary Collected Data

Nawfal A Aljerian,1,2 Abdullah A Alharbi,3 Hani A Alghamdi,4 Meshary S Binhotan,5,6 Reem S AlOmar,7 Ali K Alsultan,1 Mohammed S Arafat,1 Abdulrahman Aldhabib,1 Mohammed K Alabdulaali1 1Medical Referrals Centre, Ministry of Health, Riyadh, Kingdom of Saudi Arabia; 2Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 3Family and Community Medicine Department, Jazan University, Jazan, Kingdom of Saudi Arabia; 4Department of Family and Community Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 5Emergency Medical Services Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 6King Abdullah International Medical Research Centre, Riyadh, Kingdom of Saudi Arabia; 7Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi ArabiaCorrespondence: Hani A Alghamdi, Department of Family and Community Medicine, College of Medicine, King Saud University, P.O Box 12372, Riyadh, 7065, Kingdom of Saudi Arabia, Tel +966507022266, Email [email protected]: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA).Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals.Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25– 64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value < 0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25– 64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50).Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.Keywords: e-referrals, health policy, epidemiology, public healt

Assessing Mental Illness Referral Request Acceptance: A Nationwide E-Referral Data From Saudi Arabia

Abdullah A Alharbi,1 Nawfal A Aljerian,2– 4 Hani A Alghamdi,5 Meshary S Binhotan,4,6 Ali K Alsultan,2 Mohammed S Arafat,2 Abdulrahman Aldhabib,2 Ahmed I Aloqayli,2 Eid B Alwahbi,2 Ronnie D Horner7 1Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Kingdom of Saudi Arabia; 2Medical Referrals Centre, Ministry of Health, Riyadh, Kingdom of Saudi Arabia; 3Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Science, Riyadh, Kingdom of Saudi Arabia; 4King Abdullah International Medical Research Centre, Riyadh, Kingdom of Saudi Arabia; 5Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 6Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 7Health Services Research and Administration Department, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USACorrespondence: Meshary S Binhotan, Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 22490, Kingdom of Saudi Arabia, Email [email protected] and Objective: Mental disorders significantly impact quality of life and life expectancy, representing a leading cause of global disease burden. Healthcare systems worldwide face challenges in meeting mental health service demands, particularly due to specialist shortages and geographical barriers. Saudi Arabia has implemented an innovative nationwide electronic referral system (SMARC) as part of its digital health transformation strategy to enhance mental healthcare accessibility. This study examined SMARC’s effectiveness in facilitating mental health service access by analyzing patient transfer acceptance rates between healthcare facilities and identifying factors influencing these rates.Methods: This retrospective cross-sectional study analyzed 9722 mental health electronic referrals within SMARC from January 2020 to December 2021. Descriptive statistics characterized referral patterns, while bivariate and multivariable logistic regression analyses identified factors associated with referral acceptance, calculating adjusted odds ratios (aORs) and 95% confidence intervals.Results: The system achieved an overall acceptance rate of 82.5%, with different patterns across age groups and regions. Lower acceptance rates were observed for ages 15– 25 years (aOR = 0.84; 95% CI = 0.70– 0.99) and 46– 65 years (aOR = 0.83; 95% CI = 0.70– 0.99) compared to ages 26– 35 years. Life-saving referrals showed the highest acceptance (aOR = 2.60; 95% CI = 1.51– 4.48), while psychiatrist availability significantly influenced acceptance rates (aOR = 1.36; 95% CI = 1.17– 1.58). External referrals were half as likely to be accepted as internal ones (aOR = 0.51; 95% CI = 0.42– 0.64).Conclusion: SMARC demonstrates effectiveness in optimizing mental healthcare access through strategic matching of patient needs with available resources. The system’s selective acceptance patterns reflect its capability to prioritize care based on clinical urgency and resource availability. These findings provide valuable insights for policymakers to keep enhancing digital health infrastructure and mental healthcare delivery. The SMARC model offers a promising framework for implementing similar digital referral systems globally to improve mental healthcare coordination and accessibility.Keywords: mental health, psychiatry, referral systems, acceptance rates, health policy, Saudi Arabia, regional variation, Saudi Medical Referral Cente

β-Lactamase Production in Key Gram-Negative Pathogen Isolates from the Arabian Peninsula

Infections due to Gram-negative bacilli (GNB) are a leading cause of morbidity and mortality worldwide. The extent of antibiotic resistance in GNB in countries of the Gulf Cooperation Council (GCC), namely, Saudi Arabia, United Arab Emirates, Kuwait, Qatar, Oman, and Bahrain, has not been previously reviewed. These countries share a high prevalence of extended-spectrum-β-lactamase (ESBL)- and carbapenemase-producing GNB, most of which are associated with nosocomial infections. Well-known and widespread β-lactamases genes (such as those for CTX-M-15, OXA-48, and NDM-1) have found their way into isolates from the GCCstates. However, less common and unique enzymes have also been identified. These include PER-7, GES-11, and PME-1. Several potential risk factors unique to the GCC states may have contributed to the emergence and spread of β-lactamases, including the unnecessary use of antibiotics and the large population of migrant workers, particularly from the Indian subcontinent. It is clear that active surveillance of antimicrobial resistance in the GCC states is urgently needed to address regional interventions that can contain the antimicrobial resistance issue