الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 148 |  |  |
| | | from | 148 | | |
Abstract
SUMMARY AND CONCLUSION
I
njection drug users (IDUs) are at increased risk for acute and chronic pulmonary complications. These sequelae may be due to pharmacodynamic properties of the drugs, effects of intravenous contaminants, or complications of the intravenous route of administration.
This was a prospective comparative study was conducted on 60 addicts among civilian patients at Maadi Military Hospital during the period between January 2017 to June 2017.
The aim of this work was to study the respiratory complications of addiction among civilian patients at Maadi Military Hospital.
The 60 study cases were classified according to type of drug abuse into 5 independent groups; 11 patients with alcohol abuse, 12 patients with cannabis abuse, 14 patients with heroin abuse, 12 patients with opioid abuse, and 11 patients with poly substance abuse.
According to American Psychiatric Association, (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision), patients who met the criteria of substance addiction, were investigated for (socio-demographic, clinical, laboratory, radiological and functional data), and outcome e.g. mortality, was assessed in these patients.
The following results were obtained:
The majority (75%) of addicts were males; while (25%) were females, with mean age was (31.98 ± 7.07) years.
90% of patients were smokers with highly significant increase in ex-smokers in heroin group (p = 0.0002), 55% were single with significant increase in divorced status in heroin group.
18.3% of patients were un employed.
On comparison, there was highly significant increase in unemployment in cannabis, opioid and poly substance groups.
This study demonstrated that (23.3%) had heroin abuse, (20%) had cannabis abuse, (20%) had opioid abuse, (18.3%) of patients had alcohol abuse, and (18.3%) had poly substance abuse.
The average duration of abuse in all patients was (7.63 ± 2.62) years with non-significant difference as regard duration of drug abuse between the 5 group.
(61.7%) of patients had IV drug abuse, (20%) had inhalation abuse, and (18.3%) had oral drug abuse.
The majority of addicts were (40%) had secondary education and highly educated (33.3%). There was highly significant increase in educational level in alcohol, heroin and poly substance groups.
(33.3%) had HCV infection and (20%) of patients had comorbid DM. There was significant increase in DM in alcohol, opioid and poly substance. There was significant increase in HCV in heroin group compared to other groups.
55% of patients had previous history of hospital admission with highly significant increase in previous hospital admission in heroin and opioid groups, while 41.7% were currently admitted with highly significant increase in current admission in alcohol, heroin, opioid and poly substance groups.
There was highly significant increase in current admission in alcohol, heroin, opioid and poly substance groups; compared to cannabis group.
all patients had cough & expectoration, 81.7% had chest pain, 80% of patients had dyspnea, and 41.7% had hemoptysis,
There was highly significant increase in dyspnea and hemoptysis in heroin and opioid groups.
83.3% of patients had airway disease, 51.7% had parenchymal disease, 18.3% had vascular disease and only 26.7% had pleural disease, while no had malignancy.
There was highly significant increase in DVT/PE in heroin group.
Bacterial lung abscesses for 16.7%, TB for 21.7% and pneumonia for 33.3% and finally pulmonary emboli for 18.3%.
Regarding sputum C/S, (28.3%) had Klebsiella, (13.3%) of patients had Pseudomonas, and (3.3%) had Staph aureus. 45% of the patients had bronchoscopy with BAL C/S of Pseudomonas (6 from 27), Klebsiella (6 from 27) and Staph aureus(2 from 27) (22.2%, 22.2%, 7.4%) respectively. And 12.5% Staph aureus (2 from 16) in pleural fluid C/S.
There was highly significant increase in sputum and BAL bacterial growth in heroin, opioid and poly substance groups.
33.3% of addicts had infective endocarditis. With highly significant increase in IEC in heroin, opioid and poly substance groups.
There was highly significant decrease in hemoglobin in opioid group.
There was highly significant decrease in platelets in alcohol, heroin and opioid groups.
There was highly significant decrease in TLC in alcohol, heroin and opioid groups.
There was highly significant increase in BUN in cannabis group; compared to other groups.
There was highly significant and significant increase in ALT and AST in heroin group; compared to other groups.
There was highly significant decrease in K in opioid and poly substance groups; compared to other groups.
In this work 47 of the patients did or have previous spirometry report, (36.2%) of patients had obstructive pattern, (34%) had restrictive pattern and (29.7%) had mixed pattern. With highly significant increase in obstructive pattern in alcohol, cannabis and poly substance groups.
In this study mortality rate was (25%). With (15%) early and (10%) late mortality. (6.6%) of patients died from DVT/PE, (13.3%) from sepsis, and (5%) from respiratory failure. there was increased mortality rate in heroin, opioid and poly substance groups, but not reaching statistical significance.
In this study some predictor variables can be assessed to predict mortality, it was found that the decrease in educational level, the increase in DVT/PE, ALT, and AST and the increase in heroin, opioid and poly substance abuse had an independent effect on increasing the probability of mortality occurrence.
Mean survival time was markedly decreased in poly substance group (8 months); compared to other groups; but there was no statistical difference in survival curves of the 5 groups.
from the present study it was concluded that:
Pleuropulmonary complications associated with illicit drug abuse represents one of the most serious medical and social problems of our time.
Unemployment and poor social conditions are strong drive for addiction.
Drug users remain a group at high risk of TB infection and various aggressive bacterial infections.
Continued attention must be paid to drug users and intravenous drug users to decrease TB prevalence and to help arrest TB epidemics worldwide.
Intravenous drug users have been an important factor in HCV transmission worldwide and specifically in Egypt as a national problem.
Many pathological pulmonary processes associated with intravenous drug misuse whether it is direct lung injury or indirect effect. The toxicity depends on both the material, the purity and the regularity of administration