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On the international day to mark awareness of substance abuse, Ahram Online investigates Egypt's growing drug problem. The head of the rehabilitation centre which treated Ahmed confirmed to Ahram Online that Tramadol is the most common drug used by his patients, while heroin, which is much more costly, comes in second. His group of friends in Mahalla all used the popular painkiller, which he claims made it very hard to stop. He describes needing the feeling of 'escape, elation and energy' Tramadol afforded him, which shifted his problem from a psychological addiction to a physical dependency. These include a number of 'macro' factors such as the availability of drugs, the cultural environment which promotes or condones its use, and mainstream culture, in addition to some 'micro' factors such as peer pressure, and more individual factors like curiosity, boredom and seeking escape. It is easily found on Egypt's streets. After the Egyptian revolution, there was a large influx of Tramadol in shipments from China, adds Dr. Consequently people were easily able to access the drug through the black market instead of having to go to a pharmacy with a prescription and get the pills. According to a recent but unpublished report by the National Centre for Criminological and Social Studies, which was conducted across 10 of Egypt's governorates and studied some 25, cases, 50 percent of all psychotropic substance abusers in Egypt use Tramadol, Hegazy explains. The country's most popular drug, which has become increasingly prevalent in the lower-income bracket as it has become more available, is hashish or cannabis. It is so engrained in society that it has become normalised in some parts Egyptian popular culture, including appearing in films. Classification of cannabis in Egypt has varied from it being labelled a 'soft drug' to a 'gateway drug' meaning there is a fear of it leading to dependence on a harder substance such as heroin. AUC academic Amer believes it should not be dealt with lightly. She says it has a highly addictive potential. Egypt is considered a main transit country for the most important drugs in the world, as it lies between the Mediterranean Sea, the Red Sea and the Suez Canal. Additionally, opiates and cannabis are grown in areas in the Sinai Peninsula and Upper Egypt, with most being locally consumed. Cairo, in particular, seems to be a key epicentre of drug abuse. According to a report by the Cairo Medical College in collaboration with the ministry of health, the percentage of drug abuse in Cairo is 7 percent higher than the world average of 5 percent. Abuse is most prevalent in the impoverished districts. The porousness of Egypt's borders and the security vacuum post-revolution has also contributed to the flood of illicit drugs. After the day uprising against former president Mubarak in , she noticed the market open up more, drugs becoming cheaper as dealers laced the original product to sell it quickly to inexperienced users who do not know what it is supposed to taste like. Although there have been no new statistics recorded post-revolution, this figure is expected to have increased, Hegazy concludes. Treating addiction is demanding and complicated, requiring a two-week detoxification period usually in a hospital, in addition to a rehabilitation phase, which takes months, Sherif explains. In Egypt, Sherif adds, a large part of the population knows nothing about treatment options or even where to seek help. Sherif asserts that rehabilitation is an essential part of the treatment because it is important for 'the mind not just the body to be clean', and ensures that the patient is 'ready to face life with its conditions' without resorting to drugs again. Through a number of activities as well as spiritual and psychological treatments, the recovering addicts 'start to understand that happiness does not have to be achieved through the use of drugs. For Ahmed the rehabilitation centre was a lifeline and a place he continues to visit after traumatic events, like the death of his father last month, to counter relapsing. I knew that as soon as I stepped out of this house I would straightaway go and get my fix,' Ahmed says. However, after locking himself up for three days, a friend, also a recovered addict, was able to bring him back to the rehabilitation facility where he could stop the downward spiral. Public hospitals and some treatment centres give help and space for those unable to pay to be supported. While UNODC's Hegazy sees a positive increase in the number of those seeking treatment, AUC assistant professor Amer believes that there are two segments of the population who are often left out: the large bulk of the middle class, and women. He sees this as a product of ignorance in society, associated with not understanding addiction as an illness. In Egyptian culture, if a member of a family is an addict this is seen as direct reflection on the failure of the parents and the child's upbringing. Sherif's centre caters only to male addicts, when he attempted to set up a treatment facility for females only, neighbourhood members objected, claiming it would be associated with a brothel. Youth and teenagers, starting from as young as twelve, are the age group most affected by addiction in Egypt. This huge population creates a significant demand for drugs and attracts most of the cartels in terms of opening new markets and finding new users', asserts UNODC's Hegazy. Tawfiq claimed that in their 'Stop Drugs: Change your life' campaign, a key segment was visiting schools and attempting to talk to students in classes. She describes the negative backlash they faced from the schools they visited, as teachers and heads would either deem it an 'unacceptable' topic to discuss with children, or something that was not even an issue since they claimed only a small part of the population were abusing drugs. On the other hand, one of the major challenges faced by those trying to combat addiction is the normalisation of drugs in society to the extent that characters in movies are filmed casually taking drugs for no particular purpose, as if they were smoking cigarettes, Amer asserts. As drug use becomes more acceptable and consumption and addiction appear to be on the rise, combating the illicit drug trade in Egypt is becoming increasingly important. The drug is part of a web of illicit activities contributing to wider problems in society. A shift in understanding of drug users and abusers is much-needed in an increasingly unstable Egypt. FR AR. Books Home Reviews News. Outcast: Egypt's growing addiction problem. Reuters Photo. This has contributed to its widespread abuse. However, Tramadol is not the only illegal substance plaguing Egypt. Egypt: A main transit spot The geographical positioning of Egypt has contributed to the nation's growing drug issue. Opiates and heroin comes through Egypt from Afghanistan to supply the European market. Short link:. Latest News Ancelotti wants goals over pressing from Madrid star Mbappe. Egypt signs 4 MoUs with int'l companies to enhance oil cooperation. Hany Shaker, Tamer Ashour to give concerts in Kuwait. Egypt to allocate exceptional allowance for pensions and salaries: MP Elfiky. Van Dijk talking to 'right people' over Liverpool contract renewal. Most Viewed. Rising demand for practical learning. We have to reassess the situation with the IMF to ease pressures on the public US activists demolish Israeli narrative on Sinwar last moments: 'What else Also In Features. Charity at a distance: Egyptians rethink Ramadan traditions amid coronavirus restrictions. Memories of Italian Alexandria. Reminiscing about Ramadan TV shows. Ethyl alcohol prices soar in Cairo as supplies disappear from shelves. Egypt in the process of going plastic-free: The little things that make a big difference. Plastics ban in the Red Sea. Ancelotti wants goals over pressing from Madrid star Mbappe.

Outcast: Egypt's growing addiction problem

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Official websites use. Share sensitive information only on official, secure websites. Mohamed elham. To treat anal fissure, internal anal sphincterotomy may be associated with surgical risks and incidence of incontinence. Botulinum toxin injection into the anal sphincter is invasive and expensive. Headache and hypotension hindered topical treatment with glyceryl trinitrate. Greater patient compliance, potentiated efficacy, reduced side effects, and lower cost are the major advantages offered by the combination therapy. Therefore, combination topical gels of nifedipine NIF , lidocaine hydrochloride LDH and betamethasone valerate BMV were prepared and evaluated regarding viscosity, pH, drug content, and in vitro release. Compatibility study of drug—drug and drug-excipient mixtures preceded the formulation. Stability study was performed. A prospective randomized clinical trial was conducted for six weeks to assess the efficacy of the optimized formula in the treatment of anal fissure either acute AAF, 37 patients or chronic CAF, 34 patients in comparison with three single drug market products. The gels showed acceptable viscosity ranges, tolerated pH values, and drugs content limits complying with the pharmacopeial limit. Keywords: Nifedipine, lidocaine hydrochloride, betamethasone valerate, anal fissure, combination topical therapy. Anal fissure is one of the most painful anal disorders that inversely affect the life quality of the patients. Internal anal sphincterotomy has been used to heal the anal fissures through lowering the resting anal pressure. Yet, surgical risks and late permanent incidence of incontinence are the main complications during the post-operative period Haq et al. Hence, alternative therapy regimens are necessary for the treatment of anal fissure. Chemical sphincterotomy has been induced by different agents including botulinum toxin, glyceryl trinitrate, and calcium channel blockers, such as diltiazem and nifedipine NIF Perrotti et al. Factors that limit the use of topical nitrates are infrequent with CCBs making them an attractive alternative therapy. The use of either oral or topical NIF significantly improved the healing rates in patients with anal fissures providing comparable efficacy Agrawal et al. Topical NIF at concentrations of 0. Fixed-dose combination drugs are formulations of two or more active ingredients in a single dose. Such combination is beneficial when the active ingredients are incorporated in the intended doses and in such way that the combination is safe and effective for a significant population of patients. Fixed combination therapy offers some advantages over concurrent administration of different single active ingredient preparations Shenfield Among these improved patient compliance, enhanced efficacy, reduced side effects, and lower cost. Fixed combination topical preparations containing a corticosteroid and a local anesthetic are extensively used to alleviate symptoms and improve the life quality of patients with inflammatory anal diseases. Local anesthetics provide immediate relief of pain and itching after application. Therefore, an additive or synergistic effect in the fixed combinations of corticosteroids and local anesthetics is obtained Havlickova According to the Anatomical Therapeutic Chemical classification system developed by the World Health Organization, betamethasone is classified as a potent corticosteroid Havlickova Subsequently, lidocaine has been commonly used in combination products with different corticosteroids including betamethasone 0. As well, combination products of NIF 0. In the light of the above-mentioned facts, it was worth to prepare, evaluate, and optimize a combination topical gel containing NIF, LDH, and betamethasone valerate BMV. In addition, a prospective randomized clinical trial was performed to investigate the efficacy of the optimized combination formula in the treatment of AAF and CAF. Nifedipine NIF was kindly supplied by E. O pharmaceutical Co. Other chemicals were of fine analytical grade. The mobile phase was filtered 0. Separation was carried out isocratically at a flow rate of 1. All assays were performed at ambient temperature. Serial dilutions were made to obtain concentration ranges of 8—80, 80—, and 1. The standard calibration curve of each drug was constructed by plotting its concentrations in the prepared solutions versus the corresponding peak areas recorded. Titanium dioxide has been employed as a photostabilizer Yang et al. Temperature calibration was performed using indium To prevent any loss of material, the glass rod was broken and left inside the vial. The controls were mixtures without added water and stored in refrigerator. To detect the physical instability, organoleptic parameters of samples, such as color and odor, were observed at the end of the test. To identify the chemical instability, each sample was divided into two parts at the end of the fourth week. Samples were analyzed quantitatively using the previously described HPLC method in triplicate. The second part was used to record FT-IR spectrum. The gel was carefully spread to give a layer as homogenous as possible with a suitable thickness. The first gel formulation F1 was prepared by dispersing CP 1. NIF 0. The pH was adjusted to 5. The supernatant was filtered through 0. PH measurement was accomplished using a calibrated digital pH meter Beckman Instruments Fullerton, CA , Krefeld, Germany in triplicate and the average values were calculated. The viscosity was estimated using a calibrated cone and plate rotary viscometer Haake Inc. Two grams of each formulation were equally spread on the cellophane membrane. The donor cells height was adjusted so that the membrane was just below the release medium surface. The cells were shaken at 25 strokes per min. One-milliliter samples were withdrawn from the receiver compartment at 0. The intercept and slope of the linear portion of the plots were derived by linear regression. The steady-state permeation flux J ss for each drug in each formula was calculated as the slope divided by the membrane surface area Das et al. In order to determine the release mechanism of drug, in vitro release data of each drug from the studied formulations were analyzed according to zero-order, first-order Martin et al. Percentage remaining of each drug in the tested optimized combination gel was plotted against time in days to determine its shelf life t 90 and half-life t 50 at each storage temperature using Sigma Plot 12 software Cranes Software International, Bangalore, India Hooda et al. The study was performed to evaluate the efficacy of the optimized topical combination gel of the investigated drugs in the treatment of acute and chronic anal fissures in comparison with three single drug topical market products. The market products were GTN cream that contains 0. Research Ethics Committee of Faculty of Pharmacy, Mansoura University, Egypt approved the study and the included informed consents of all patients. The patients were allocated into four groups: group A; with acute anal fissure AAF treated with the optimized topical combination gel F2 , group B; with AAF treated with the three single drug topical market preparations within 0. Exclusion criteria were: Presumed or confirmed pregnancy; lactating women; any history of reaction to topical agents and associated co-morbidity, such as ischemic heart disease, hypertension, diabetes mellitus, inflammatory bowel disease, HIV-related fissure, tuberculosis ulcer and leukemic ulcer; and associated complications warranting surgery abscess, fistula, hemorrhoids, and cancer as well as unwillingness of the patient to participate in the study Tsunoda et al. Anoscopy was performed at baseline and during the sixth week. Healing of anal fissure was defined at anoscopy when epithelialization or formation of a scar achieved at the sixth week of the therapy. Bleeding response, discharge, and pruritus: Patient scored the severity of their symptoms at baseline and weeks 1, 3, and 6, on numeral rating scales NRS range: 0—10 Tsunoda et al. Adverse effects of the medicines: such as itching, headache, and dizziness were recorded at every visit. The end-point of the study: it was complete healing of the fissure after treatment. Treatment was considered successful if the fissure had healed within 6-week treatment. With respect to the data of compatibility, drug release, and stability, statistical analysis was done through ANOVA one-way analysis of variance followed by Tukey—Kramer multiple comparisons test employing Graph Pad Prism-6 software Graph Pad Software Inc. Regarding the clinical study, the collected data were coded, processed, and analyzed. Mann—Whitney U test was used to compare the continuous data. Chi-square test was used to compare the categorical data of the studied groups. An excellent linearity was observed in a concentration range of 8—80, 80—, and 1. DSC thermograms of the three drugs individually, in their binary mixtures and ternary system as well as binary mixtures with each of the solid excipients are represented in Figure 1 a—e. While the larger shift in T peak of BMV can be referred to the partial dissolution of this drug in the molten mass of the other two drugs. Thus, disappearance of NIF and BMV endothermic peaks may be attributed to the dissolution in the molten excipient P, methylparaben, or propylparaben of much lower melting point Liu et al. Disappearance or shift of the drugs peaks did not confirm the incompatibility particularly there were no new peaks. FT-IR spectra of different blends of the three drugs and each of them with the excipients retained all characteristic bands of the drugs without appearance of new bands suggesting that these compounds are compatible data are not shown. As well, FT-IR spectra of stressed test samples were compared to those of corresponding control samples and only spectra that encountered changes are illustrated in Figure 1 f—h. Both individual drugs and drug—drug mixtures exhibited insignificant changes in percentage drug remained after being subjected to IST. These samples did not show any changes in the organoleptic parameters color and odor throughout the storage period. In accordance, FT-IR spectra of stressed drugs and drug—drug binary mixtures did not show a shift or a disappearance of absorption bands when compared to those of control samples. Also, no appearance of new bands was noted. This furtherly indicated the compatibility of the three drugs. There was no alteration in the organoleptic parameters of the stressed binary mixtures of the drugs with the above-mentioned excipients throughout the storage period. Accordingly, FT-IR spectra of stressed samples showed characteristic absorption bands comparable with those of control samples. In spite of the insignificantly different LDH content in the control and test samples, incompatibility of LDH with each of P, methylparaben, and propylparaben can be suggested by characteristic odor and viscous liquid observed in case of stressed binary systems with each of these excipient possibly due to the acid degradation of the excipients in the acidic microenvironment provided by acid content in LDH without affecting LDH content in the binary mixtures Rowe et al. This may indicate the incompatibility between LDH and these excipients. It can be said that NIF was compatible with these excipients as clarified by insignificantly different drug content of control and stressed test mixtures Table 1 b as well as unchanged organoleptic properties on the storage. In addition, FT-IR spectra of these mixtures after storage at stress condition did not show new bands, band shift or absence of bands existing in spectra of control mixtures. BMV formed a milky liquid with P only on the storage. Yet, there was insignificant difference in BMV content in test and control mixtures with P Moreover, there were no detectable differences in FT-IR spectra of control and test mixtures. This may reflect only a physical incompatibility between BMV and P According to Figure 2 a , there was an improvement in NIF photostability on the increase in titanium dioxide concentration. The formulations possessed acceptable viscosity ranges Garg et al. Accordingly, there was insignificant difference between J ss values of these drugs in the two gel formulations Table 2 a. In vitro release of LDH from the prepared gels was comparable with that of the market gel Figure 2 c. In case of BMV, the drug permeation from these gels was superior to that seen with the market product Figure 2 d. The values of J ss for these drugs reflected such behavior Table 2 a. The data of kinetic analysis are represented in Table 2 b. The drugs release mechanism followed either zero kinetics or diffusion transport. To verify it, the release data were analyzed via Korsmeyer—Peppas equation. Non-Fickian diffusion 0. In comparison with the initial measurements, there were insignificant changes in pH 5. Generally, there was a sharp decline in t 90 and t 50 of the drugs on the elevation of storage temperature particularly with BMV. Moreover, the optimized gel preparation stored at the three storage temperatures did not encounter bacterial or fungal growth. Baseline characteristics of the study population are listed in Table 3 a. Prevalence of fissure healing, pain, bleeding, discharge, and itching among patients with AAF and CAF at first, third, and sixth weeks post-treatment are demonstrated in Table 3 b. Clinical study a Baseline characteristics of the study population. There was no significant difference in the baseline characteristics of the participated patients. The mean age of patients was Regarding the symptomatology, pain, discharge, and itching were more frequent than rectal bleeding Table 3 a. Complete healing of AAF occurred in Three patients in group D were unsatisfied and subjected to anal dilation and sphincterotomy. The effective healing of patients suffering from either AAF or CAF after treatment with the optimized combination gel F2 for six weeks is illustrated in Figure 3. Representative photographs of patients suffering from either AAF a before treatment baseline , b after treatment for six weeks with the optimized combination gel F2 or CAF, c before treatment baseline , and d after treatment for six weeks with the optimized combination gel F2. Although there were equal medians of pain baseline scale in case of group A and B patients on one side and group C and D patients on the other side Table 3 a , the severity of pain reflected by the median that became lower among groups A and C patients treated with the optimized gel in comparison with groups B and D treated with the market products Table 3 b. Regarding the basic characteristics of the population, there was a higher prevalence of rectal bleeding among patients with CAF in comparison with those with AAF. Although there was a higher severity of anal discharge and itching among AAF patients in comparison with CAF patients, equal medians of their scales were observed between groups A and B patients on one side and between groups C and D patients on the other side. In comparison with groups B and D treated with market products, the severity of rectal bleeding, anal discharge, and itching became lower among groups A and C patients treated with the optimized combination gel formulation. No patients in groups treated with optimized gel reported side effects groups A and C. While mild headache was experienced by Perianal itching was another side effect, which was reported by 9. Both headache and perianal itching were reported by 6. There was no significant difference in healing of anal fissure as well as relief of pain, rectal bleeding, anal discharge, and itching following treatment with the optimized formula among AAF patients group A in comparison with CAF patients group C. The compatibility among the three drugs and between the drugs and tested excipients was confirmed except with LDH and each of P, methylparaben, and propylparaben as well as BMV and P The gels containing compatible excipients showed acceptable viscosity and pH ranges as well as pharmacopoeial complying drugs content limits. In addition, no side effects were reported by patients treated with the optimized combination gel in contrast to those treated with the market products. As a library, NLM provides access to scientific literature. Drug Deliv. Find articles by Amgad E Salem. Find articles by Elham A Mohamed. Find articles by Hosam M Elghadban. Find articles by Galal M Abdelghani. Received Jun 5; Accepted Jul 29; Collection date Open in a new tab. Group B; with acute anal fissure AAF treated with the market topical preparations. Group D; with chronic anal fissure CAF treated with the market topical preparations. Similar articles. Add to Collections. Create a new collection. 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