Patterns of acute poisoning by drugs and substances abuse among addicts: a clinical and laboratory study

The drug dependency problem in Egypt and wordwide is currently one of the major issues of concern to the public as well as the professionals. This study was conducted on all addicts with acute poisoning by drugs and or substances abuse [n= 149]. They were admitted to Alexandria Poison Center [APC] and critical care unit [CCU] at Alexandria Main University Hospital [AMUH] during six months period from January to June 2003. In this study, all addicts were clinically examined. Routine investigations, arterial blood gases and acid base status were done with detection of drug or substance of abuse in urine by Axsym and gas chromatography / mass spectrometry [GC/MS] for negative urine samples. The study showed that 71.2% of addicts were encountered in the age group 20<40 years. adolescents accounted for 15.4% of the addicts. Males outnumbered females with a sex ratio of 17.5:1. The study revealed that the majority of addicts were smokers 95.3% single 71.8% and started drug/ substance abuse in the age group 10<30 years [87.2%]. 43.7% of addicts were of low and very low social class while 28.9% were commercial workers. The duration of addiction ranged from one to 10 years. In the present study cannabis was the first abused substance [24.2%]. Hypnotics whether of benzodiazepine [14.8] or barbiturates [10.7] accounted for 25.5%. Ethyl alcohol either alone or adulterated by methyl alcohol, opiods, constituted 21.5%, 9.4% and 19.5% respectively. Female addicts were more likely to abuse benzodiazepines [75.0%]. 26.2% of addicts presented with severe poisoning and were in need of critical care interventions. The study revealed that postive urine samples for benzodiazepines, oPiates, barbiturates and cannabis accunted for 100%, 96.6% 93.8% and 72.2%, respectively. The majority of addicts recovered completely [83.2%], deaths accounted for 3.4% of the total addicts. It is recommended that, Continuous health education and prevention programs concerning health hazards of drug and substance abuse among adolescents and young adults are highly indicated. In addition the Staff of poison centters and emergency departments, should be well trained to deal with diagnosis and management of overdose in addicts. Also screening immunoassay technique should be done on all urine samples of addicts and better to be confirmed using GC/MS, as the latter is more reliable in legal cases, where it can stand court defense

Impact of a clinical pathway for acute myocardial infarction on length of stay and quality of care in intensive care units of the critical care department of Alexandria Main University Hospital

A clinical pathway defines the optimal care process, sequencing and timing of interventions for a particular diagnosis or procedure. Clinical pathway implementation has the potential to standardize treatment and improve outcomes. Therefore the aim of this study is to determine whether clinical pathway implementation would alter process of care, hospital stay and mortality rates for acute myocardial infarction at Alexandria Main University Hospital. The study consisted of three phases: pre-intervention phase, development and dissemination of a clinical pathway for acute myocardial infarction and post- intervention evaluation phase. Process and outcome indicators were used to assess the quality of care provided to patients with acute myocardial infarction before and after implementation of the pathway. Results revealed that 4 process indicators out of 7 showed significant improvement namely, the utilization of thrombolytic therapy [from 76.9 to 88.5%], B-blockers at admission [from 28.5% to 50.0%], ACE inhibitors at discharge [from 61.2% to 75.2%] and smoking cessation counselling [from zero to 86.7%]. There was also reduction of variation in length of ICU stay as 67.7% achieved length of stay goal of 3 days after implementation of the pathway. ICU mortality was decreased from 20.8% to 6.9% after implementation of the pathway. These data suggest that the implemented acute myocardial infarction pathway lead to improved patient care and utilization of resources by providing a structured framework and educational guide to assist in the delivery of care to patients admitted with myocardial infarction