Islamic University-Gaza Faculty of Health Science The Medical laboratory science

Transcription

1 Islamic University-Gaza Faculty of Health Science The Medical laboratory science By: Hend N. Esawwaf & Ikram M. Ihmaid Supervisors: Dr. Abderaouf A. Elmanama Ms. Noor E. S. Abu Tayyem ه 1435 م May 2014

2 Dedication To our University which we are proud of belonging to it. " The Islamic University -Gaza " To the Medical Technology Department in IUG and to all members of staff in this department. To the our beloved parents: thank for giving us a chance to prove and improve ourselves through all our walks of life. Finally, To our beloved homeland " Palestine " and to the Palestinian prisoner may Allah grant them freedom soon.

3 Introduction Tramadol (Tramal ) is a synthetic drug, classified as opioid. It is a centrally acting analgesic used for the treatment of moderate to severe pain. The recommended oral dosage is mg every four to six hours. Tramadol may be habit forming and should be used only by the person it was prescribed for, by the physician. Since, misuse of tramadol drug leads to serious problems and side effects.

4 Tramadol tablets

5 Many drugs has been associated with hepatotoxicity due to the pivotal role of the liver in drug metabolism. Further, biotransformation by liver results in inactive metabolites, which are excreted by kidneys. Recently, Tramadol abuse are becoming widely spread among youth in the Gaza strip, Palestine. Most of them are taking this drug with no awareness of its destructive side effects on their bodies.

6 objectives General objective The objective of our study is to determine the effects of tramadol abuse. Specific objectives To assess the effects of tramadol abuse on kidney and liver function. To assess the effect of socioeconomic factors (age, sex, occupation, economic status and level of education) on Tramadol abuse.

7 Significance Tramadol abuse is widely spread among youth and between the educated ones. The spread of tramadol abuse, the lack of studies in this area, motivated the study of the effects of this phenomena on liver and kidney functions. This research is the first in Gaza strip that study the Tramadol abuse as a possible risk factor of non-viral hepatitis and kidney failure which may help public to realize the dangers of tramadol abuse.

8 Materials & Methods

9 Sample Collection Study subjects were from Psychiatric Hospital of Gaza Al Naser district The Palestinian Society for the Treatment Addiction of Victims Jabalia Ansar s prison Gaza strip Sample size Fifty tramadol abusers (cases) aging from 15 to 35 year from the addiction treatment clinic against 50 normal control.

10 Permission for this study was obtained from Ministry of health (MOH), the Helsinki Committee, and other concerned authorities. An informed consent was obtained from participants (cases and controls) A questionnaire was administrated to patients and controls. Personal, socioeconomic data in addition to data related to tramadol abuse, were collected.

11 Sample processing Whole blood samples were collected in plain tubes Serum was removed immediately Freezing at -20oC until whole samples were collected Thawing at room temperature Hepatitis tests (A, B and C) were performed Biochemical tests were performed using BS-200 Chemistry autoanalyzer. ALT, AST,ALP, LDH, Total Bilirubin, Direct Bilirubin, Blood urea nitrogen, creatinine, uric acid

12 Hepatitis tests IF - ve Biochemical tests

13 Data analysis Data was collected, Results of cases were compared with results of a normal control of matched age, gender, chronic diseases and smoking status, summarized, tabulated and analyzed using Statistical Package for Social Sciences (SPSS) software and then presented through tables, charts and Chi-square test.

14 Questionnaire results: Frequency distributions: Age % 8% 24% 56%

15 Education 50% 18% 14% 18% University Secondary Preparatory Elementary

16 Marital status Single 55% (27) Married 45% (23) Smoking status Smoking No smoking 96% (48) 4% (2)

17 Occupation 82% 4% 14% worker student unemployed

18 Dose (mg/day) 34% 35% 26% 30% 25% 16% 10% 14% 20% 15% 10% 5% 2000> < 0%

19 Biochemical tests results 1 st ; Liver function tests Test name Abusers Control P value Normal Abnormal Normal Abnormal ALT (36)72% (14)28% (50)100% (0)0% AST (26)52% (24)48% (42)84% 8(16)% ALP (48)96% (2)4% (50)100% (0)0% LDH (26)52% (24)48% (17)34% (33)66% Total Bilirubin (49)98% (1)2% (50)100% (0)0% Direct bilirubin (48)96% (2)4% (50)100% (0)0% 0.153

20 2 nd ; Kidney function tests Test name Abusers Control P value Normal Abnormal Normal Abnormal Blood Urea Nitrogen (47)94% (3)6% (50)100% (0)0% Creatinine (50)100% 0% (50)100% (0)0% --- Uric Acid (45)%90 (5)10% (50)100% (0)0% 0.022

21 Conclusions: Statistically significant increased serum activities of ALT and AST in tramadol abusers as compared to control results. Tramadol causes drug-induced impaired liver function. Statistically significant increase in uric acid measurements as compared to control results, this increase may be due to high degradation of purines or an increase of uric acid level by inability of its excretion by urinary system. Most of abusers are single, aging between years old, workers and smokers.

22 Limitations: We couldn't get blood samples from people who are still abuse tramadol. 26% of abusers used to be addicted to Hashish.

23 Recommendations: Using this study results, educational programs should be initiated to increase awareness of the risk of tramadol abuse. We recommend using larger sample size for more reliable results. Further studies are required to measure the effects of tramadol abuse on other organs as CNS, optical nerve and levels of body hormones.

24 Acknowledgment Thank to Allah To our university Special thank to our supervisors, Dr. Abderaouf A. Elmanama and Ms. Noor E. S. Abu Tayyem To all the staff members of Medical Technology Department; specially Mr. Ahmed Selmi, Mr. Nasir al-din Abu Shaban, Ms. Reham El-Hayya, Ms.Alaa Khudair, Ms. Islam Hassona and Abdulkarim El-asally. Thanks extends to the stuff of Psychiatric Hospital of Gaza, The Palestinian Society for the Treatment Addiction of Victims, Palestinian Medical Relief Society PMRS and The Ministry of Interior department. To Mr. Ahmed Alaswad for his great help. To our family especially our parents and our true friends for their support.

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