الفهرس 
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Abstract
The problem of addiction, in recent years, is one of the most dangerous global health problems that facing most countries in the world. Addicts represent a high percent of national income loss, as a work disability or safety risks against addicts themselves and / or against their society.
According to ASAM, the American Society of Addiction Medicine, addiction is a condition that exists when a person uses a substance, such as drugs, (cocaine, nicotine) or even alcohol, or involved in activity that can may be fun, however its continuation use becomes imperative, and ordinary life accountability, such as work, relationships, or health, may conflict with it.
When pointing to any type of addiction, it is of utmost importance to know that the reason is not just a search for pleasure, and this addiction has nothing to do with morals or strength of personality.
People with addiction do not control what they do, taking or using. Therefore, it can be said that addiction may include, however is not limited to, addiction of drugs, sex addiction, practice addiction, food addiction, gambling, computer addiction and even, TV addiction.
Drug addiction, may represent the most dangerous mode of addiction, since it is directly affects the health status of the addicts. Continuously, new types of drugs appear in the street. Harmful substances in use, are in the form of Amphetamines, Cocaine/Crack, Heroin, Alcohol, Benzodiazepines, Methadone, Nicotine, Barbiturates, Buprenorphine, Ketamine, and Cannabis.
Tramadol, represents a special task in considering drug abuse. This is due to many reasons. Of these, it is used as pain reliever, with moderately low cost, and can be easily obtained. Some researchers do not consider it abuse, but some
others, not. However, in Egypt, the rate of dependence on tramadol and abusers increased significantly. According to the national survey in Egypt, tramadol dependence spread , in 2015, among the participants was 2.4%, i.e., is the second most common substance of dependency between
the Egyptians after hemp (hemp dependence spread is 2.5%.). Furthermore, the study shows that tramadol is most diffuse opioids that cause dependence much higher than heroin. The aim of the present work was conducted to “Study of Some Physicochemical Parameters and Hematometric Indices in Blood of Tramadol Addictive Persons”
A cohort of 80 individuals from the city of Alexandria was recruited to participate in the present study within the period from May 2017 to May 2018. This cohort was divided into the following two groups:
group I: included 15 apparently normal healthy individuals that served as a control group of matched age (range 19 – 65 yrs and mean age of 32.35 ± 11.13 year) and socioeconomic status as group II.
group II: included 30 individuals recently diagnosed as tramadol addicts patients (with age range 18 – 59, and mean age of 31.27 ± 6.44 year). All individuals did not receive any treatment, three days before participating in the study. Tramadol addiction individuals were selected from those admitted to Alexandria Resort Hospital.
A follow up study was performed to estimate the effect of using certain treatment protocol on the measured blood parameters, after two, and three months of treatment.
Inclusion criteria: Both sexes, were included., polydrug dependence except cannabis and tobacco
Exclusion criteria : Patients with known pre-existing blood or medical disease before the beginning of drug dependence, history of alcohol dependence, or medication that may affect blood elements.
Broad spectrum of measurement, on the tramadol addict’s blood, were performed. These are: 1-Biophysical parameters , including; RBCs relative viscosity, hymolysis degree, aggregation shape parameter, and Form Factor 2- Hematological Blood Indices, including ; RBCs, HGB, HCT, MCH, MCMC, Platelets, WBCs, Neutrophils, Lymphocytes, Monocytes, and Eosinophils, 3- Biochemical parameters, including ;MDA, TAC, AST, ALT, and creatinine clearance, and 4- Trace elements levels estimation, including; Cu, Mg, Fe, Zn, and Se, both in serum and RBCs.
At the beginning, for better selection of the tramadol addict individuals, two tests were followed. The first, using RUMA marker, and the other test, known as the multi-drug screening test. These two tests exclude any possibility of enrolling non-addict individual.
The results of the study, can be summarized as follows:
1- The Biophysical parameters:
The biophysical parameters, measured for the first time on the blood of tramadol addicts, including ; the relative RBCs viscosity, the hemolysis degree of the RBCs, the Aggregation Shape Parameter (ASP), and Form Factor (FF), all these parameters increased significantly (at level P < 0.05) above the control level. The increase in the relative RBCs viscosity was . two fold increase. After two and three months of receiving the treatment protocol, tendency to recovery existed only in case of hemolysis degree, but non of the other parameters returned to the control level.
2- The Hematological Blood Indices:
All the hematological counts, estimated in this work, in tramadol addicts, including ; the Red Blood Cell counts (RBCs), Hemoglobin (HGB) concentration, the Hematocrits (HCT) %, Mean Corpuscular Hemoglobin (MCH) concentration, Mean Corpuscular Hemoglobin Concentration (MCHC), Platelets count, White Blood Cell counts (WBCs), Neutrophils count, Monocytes count, and Eosinophils counts, suffered significant reduction in level , (at level P < 0.05), with respect to the control level, on receiving the addicts for the first time. However, after two and three months of receiving the treatment protocol, all of these blood indices, showed tendency towards recovery. Some of these parameters returned to nearly to the control level ,i.e., although lower than the control level, but with no significant difference between them, specially in case of RBCs, HGB, and WBCs, while, the others, including; HCT, MCH, MCHC, Platelets, Neutrophils, Monocytes, and Eosinophils, although showed tendency towards recovery, as judged by the increase in level after two months with more elevation in level after three months of treatment, but the level was still significant below the control level.
However, the only hematological parameter that showed significant elevation in level was the lymphocyte counts, in blood of addicts measured for the first time. After two and three months of treatment, slight tendency towards recovery occurred.
3- The Biochemical Parameters:
a- Oxidative Stress Biomarkers:
The tramadol addicts proved to be under oxidative stress, as judged by significant elevation in the levels of lipid peroxidation (MDA), and significant reduced levels of total antioxidant capacity (TAC), in blood of addicts that received for the first time (at level P < 0.05),. These two parameters, are the biomarkers of oxidative stress. These two parameters, didn’t show any tendency towards recovery, after two or three months of treatment.
b- Liver Enzymes:
Both AST and ALT, showed significant increase (at level P < 0.05), over the control level, with no tendency towards recovery, after two or three months of treatment.
c- Creatinine Clearance: No significant difference existed in the creatinine clearance with the control level or after two and/or three months of treatment.
4- Trace Metals:
a- Serum and RBCs Elements:
Both in serum and RBCs of addict blood, measured for the first time, the estimated elements, i.e., Cu, Fe, Mg, Zn, and Se, were all significantly lower than the control level ,(at level P < 0.05), howver, all of them showed tendency towards recovery, after three months of treatment, but the level was still lower the control level.