الفهرس 
Relation between violence and drug abuse:
AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Interpersonal violence and drug abuse are major challenges that are strongly connected. Drug abuse can elevates the dangers of being both a victim and/or assailant of violent acts, whereas involvement in violent acts may increase the dangers of starting illegal drug use. Argument precedes whether the relationship between drugs and violence is causal or an association, as both share the same risk factors. Substance abuse has been implicated as a contributing factor to nearly all types of injuries and related trauma including motor vehicle accidents, firearm, homicides, suicides, sexual trauma, interpersonal violence and assault.
The aim of this work was to study the patterns of alleged violent injuries presenting to Menoufia University Hospital during one year; with emphasis on the prevalence and pattern of use of substances of dependence among these cases; and to study experimentally the effect of the most common substance of dependence supposed to be involved in violent injuries (which was revealed to be cannabis) on adult male albino rats.
In order to achieve our aim; this study was carried out in two parts; a clinical part and experimental part.
I- FIRST PART: CLINICAL PART:
The clinical part of the present study was a prospective cross sectional study carried out on 500 cases presenting to Menoufia University Hospital with alleged violent injuries asking for medicolegal report during one year (from 1st of June 2016 to 31th of May 2017), with emphasis on its relation with use of dependence substances. After that a follow up study of the injured cases was done to detect outcome of the injury. The study was conducted after approval from ethical committee of Faculty of Medicine, Menoufia University.
Methods used are:
1- A valid informed written consent was taken from each patient or his guardian before the study.
2- Medicolegal reports (primary, follow up and final medicolegal reports).
3- A questionnaire on drug dependence was fulfilled by every case.
4- A clinical sheet was designed for all patients including: sociodemographic data, history, clinical assessment, type, site and severity of injury, outcome and complications at time of discharge from hospital and follow up.
5- Urine samples were collected from cases of violent injuries for toxicological laboratory screening tests to detect substances of dependence.
The results of this study showed that:
Sociodemographic pattern of the studied cases:
As regards age; the most affected age group was 18 - < 30 years (34.6 %); followed by age group 30 - < 40 years (29.6 %). The least one was <7 years (0.6 %). According to gender; males represented the majority of cases (90%). As regard to residence; 65% of the cases were from rural areas; while 35% were from urban areas.
Regarding distribution of the cases according totheir jobs; 45.2 % of the cases were not working or not employed; followed by laborers (29.6 %). Individuals with professional jobs were the least (1.8%). As regard to educational level; 38 % of cases had technical education; followed by cases that could just read and write (33.2 %).
According to circumstances of the injury; 54 % of the cases were victims to assaults, and 46% of the cases were involved in a fight (aggressors).
On asking patients about practicing religious rituals, 77.4 % answered they practice it to some extent and only 12.6 % practice it regularly.
Regarding history of previous legal troubles; 29.2 % of the cases had positive histories either related to violent acts or drug dependence. Among cases of positive history; young adults (age group 18-< 30 years) had the highest percent (34.9%).
On asking about cigarettes smoking history; 62.6 % of the cases were moderate to heavy smokers.
More than half of the cases (52.4%) tested positive for illegal drugs; where cannabis was the most widespread (22.2%); followed by combination of cannabis and tramadol (13%) and tramadol only in 10% of the cases. Sedatives (BDZs + barbiturates) and a combination of cannabis and BDZs were found in nearly equal percentages (2.2% and 2.4% respectively). The least percent was of opiate in 0.6% of the cases. Negative screening was found in 47.6% of the cases.
The relation between different age groups and results of drug screening tests was highly significant; where the highest percent of positive screened cases was in the age group 18-< 30 years (38.1%); followed by age group 30-< 40 years that represented (27.5%). No one of children <7 years was found to be positive (0%). In tramadol dependent group; the age group 30-40 years was the highest (42%).
A highly significant relation between gender of the patients and results of drug screening tests was found; where males represented 99.2% of the positively screened cases; they absolutely predominate in cannabis, tramadol, stimulants, combined cannabis and tramadol and combined cannabis and BDZs dependent groups (100%). Female cases were almost negative; except one positive for sedatives (BDZs abuse after a long history of using it as a treatment of insomnia) and the other case was positive for opiate (she was a nurse and abused naluphine 2 years ago).
The relation between type of drug dependence and jobs was highly significant; where the highest percent in different drug groups were of individuals who are not working or not employed. On the contrary; in sedatives dependent group the highest percent was of civil employee (41.7%), followed by cases who don’t work (33.3%).
According to the relation between type of drug dependence and education level; it was highly significant. Most of the drug dependent cases had technical education: 75% of combined cannabis and BDZs dependence group, followed by 66.7% of stimulants dependence group; then 40% of tramadol group and finally 35.1% of cannabis dependent group .On the other side; 41.7% of sedatives dependent group had higher education, and 66.7% of opiate dependence group and 47.7% of combined cannabis and tramadol dependence could just read and write.
A highly significant relation was found to exist between type of drug dependence and circumstances of injury. All cases dependent on opiate, stimulants and combined cannabis with BDZs were involved in a fight (aggressors). On the other side; 54% of the tramadol group were victims to assaults, and 46 % were aggressors.
Injury pattern of studied cases:
According to instrumental type; 73.8% of the cases were injured by blunt instruments; 15.6% of the cases were injured by sharp instruments. Cases injured by both types represented 8%; and the least group was that injured by firearm weapons and represented 2.6%
Several types of external injuries were found in nearly half of the cases (49.8%); followed by cases having only contused wounds (13 %). The least percent was that of cases having only stab wounds (3%). As regard to type of internal injuries; factures and hemorrhages were found in equal percent of cases (9.2% for each). 1.8% of the cases had cut tendons and/or blood vessels. Only 1% of the cases had combined internal injuries.
According to site of external injuries; more than half of the cases (52.8%) had injuries distributed in different sites of the body.
On classifying the cases by ISS; most of the cases of the study were of the moderate degree (83.2 %); followed by serious degree cases (9.2%). Severe degree cases represented 6.4 % and minor degree cases were just 0.6 % (who all were in the age group 18-<30 years). Death occurred in 3 cases (0.6 %)
The 3 cases that were of the unsurvivable degree and died were all in the age group 50-<60 years; and cannabis was found in the screening of them all (alone in 2 cases and combined with tramadol in one case).
A strong relation existed between type of drug dependence and type of external injury; where multiple- type external injuries had the highest percent in all drug groups.
The relation between type of drug dependence and type of internal injury was highly significant. In cannabis dependence group; 72.1% of the cases had no internal injury; followed by 12.6% who had hemorrhage; 10.8% had fractures, 2.7% had cut tendons and/or blood vessels and the least percent was for those having combined injury (1.8%). On the contrary; the highest percent in stimulants dependent patients had fractures (66.7%) and 33.3% had no internal injury.
According to the relation between ISS and type of internal injury; it was highly significant; where all cases of minor degree had no internal injuries while all of unsurvivable degree cases had hemorrhage.
A highly significant relation was found between ISS and type of instrument; where all minor degree cases were injured by blunt instrument (100%), the majority of moderate degree cases (80%) were injured by blunt instrument. On the other side; the highest percent of severe degree cases were injured by sharp instrument (37.5%).
The results of this study included a strong relation between results of drug screening (positive or negative) and ISS; where all cases of the unsurvivable degree and majority of severe (90.6%) and serious (89.1%) degree cases were positive on screening. On specification; cannabis greatly over numbered other drugs of abuse in all patient groups of severity according to ISS.
Admission to hospital was significantly related to results of drug screening tests; where 67 out of 72 admitted cases were positive on screening, and were also significantly related to ISS; where none of the cases of minor, moderate and unsurvivable degrees were admitted to hospital; and on the other side, 93.5% of serious degree cases and 90.6% of severe degree cases were admitted to hospital.
A highly significant relation existed between ISS and period of hospital stay, either in ER or internal ward admission. All cases of minor and moderate degrees stayed for less than 1 day in ER. Also, all fatal cases with unsurvivable injuries received CPR trials in ER and died sooner with hospital stay less than 1 day.
Regarding outcome of the cases after the period of follow up (6 months and more); 97.6% of the cases completely cured and only 0.6% of the cases died (3 cases). Complications found were infection (0.6 %), permanent infirmity (1.2%; in the form of loss of teeth in one case and limitation of limb movement resulting from bone fracture malunion / ununion in 5 cases). Minor and moderate degree cases – by ISS – developed no complications.
Regarding the relation between ISS and outcome of the cases after the period of follow up; all cases of minor and moderate degree of ISS had completely cured. In serious degree cases, complications like infection and permanent infirmity (loss of teeth in one case and limitation of limb movement in other 2 cases) occurred in equal percentages (6.5 % for each). In severe degree cases; 9.4 % of the cases were complicated by bone fracture malunion / ununion. All cases with unsurvivable injuries died (100 %).
II- EXPERIMENTAL PART:
The current work aimed to study the toxic effect of chronic repeated doses of cannabis on rat behavior, brain dopamine level and histopathological changes of the brain.
The study was conducted on 50 male albino rats weighing 180-200 gm., obtained from the breeding animal house in Menoufia University.
Rats were divided into 2 main groups: group 1 (control group); group 2 (received cannabis daily for one month ”40 mg cannabis/ 200 gm rat, dissolved in sunflower oil 100% as a vehicle and given by an oral tube with gradually increasing dose by adding half of the initial calculated dose every 3 days till the end of the month”. At the end of the month this group was further subdivided into 4 subgroups: subgroups 2a (sacrificed after the last dose of cannabis i.e. under pharmacological effect of cannabis); subgroup 2b (left one day without giving cannabis after the last cannabis dose, and then sacrificed); subgroup 2c (left 3 days without giving cannabis after the last dose, and then sacrificed); subgroup 2d (left 7 days without giving cannabis after the last dose, and then sacrificed).