By:
Hend N. Esawwaf & Ikram M. Ihmaid
Supervisors:
Dr. Abderaouf A. Elmanama
Ms. Noor E. S. Abu Tayyem
May 2014 م – 1435 ـهIslamic University-Gaza
Faculty of Health Science
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.
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 50-100 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.
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.
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.
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.
Sample Collection
Sample size
Fifty tramadol abusers (cases) aging from 15 to 35 year from the addiction treatment clinic against 50 normal control.
Study subjects were from
Psychiatric Hospital of Gaza – Al Naser district
The Palestinian Society for the Treatment Addiction of
Victims – Jabalia
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.
Sample processing
Biochemical tests were performed using BS-200 Chemistry
auto-analyzer.
Hepatitis tests (A, B and C) were performed
Thawing at room temperature
Freezing at -20oC until whole samples were collected
Serum was removed immediately
Whole blood samples were collected in plain tubes
ALT, AST,ALP, LDH, Total Bilirubin, Direct Bilirubin, Blood urea nitrogen, creatinine, uric acid
IF -ve
Biochemical tests Hepatitis
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
Questionnaire results:
Frequency distributions:8%
56%
24%
12%
Age
15 -20 25-21 30-26 35-31Elementary Preparatory Secondary University 18% 14% 50% 18%
Education
(27) 55% Single (23) 45% Married (48) 96% Smoking (2) 4% No smoking
Marital status
Smoking status
unemployed student worker
14%
4%
82%
Occupation
0% 5% 10% 15% 20% 25% 30% 35% < 500 500 -1000 1001 -1500 1500 -2000 > 2000
34%
26%
14%
10%
16%
Dose (mg/day)
Biochemical tests results
1
st
; Liver function tests
P value Control Abusers Test name Abnormal Normal Abnormal Normal
0.000
(0)0% (50)100% (14)28% (36)72% ALT0.001
8(16)% (42)84% (24)48% (26)52% AST 0.153 (0)0% (50)100% (2)4% (48)96% ALP 0.069 (33)66% (17)34% (24)48% (26)52% LDH 0.315 (0)0% (50)100% (1)2% (49)98% Total Bilirubin 0.153 (0)0% (50)100% (2)4% (48)96% Direct bilirubin2
nd; Kidney function tests
P value Control Abusers Test name Abnormal Normal Abnormal Normal 0.079 (0)0% (50)100% (3)6% (47)94% Blood Urea Nitrogen ---(0)0% (50)100% 0% (50)100% Creatinine0.022
(0)0% (50)100% (5)10% (45)%90 Uric AcidConclusions:
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 21-25 years old,
workers and smokers.
Limitations:
We couldn't get blood samples from people
who are still abuse tramadol.
26% of abusers used to be addicted to
Hashish.
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.
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.
