Presentations of the Injection Drug Users in an Emergency of a Surgical Unit of a Tertiary Care Hospital of Pakistan

Abstract

Background: Drug Abuse is a growing concern in whole world and in Pakistan we are seeing increasing number of people using drugs. There is growing shift towards injection drug abuse. Young generation is falling victim to Injection drug abuse which not only poses serious medical concerns but also present as life threatening emergencies on surgical floor. We have been seeing increasing number of people coming with ruptured pseudo aneurysms on surgical floor with resultant life-threatening hemorrhage for the patient and putting healthcare providers too at risk of getting various infectious diseases like HIV. Objective: The aim was to study the different presentations of injection drug users in surgical emergency and assess the seroprevalence of viral infections and factors associated with injection drug use. Study Design: Retrospective study. Settings: The study was conducted in west surgical ward King Edward medical university Lahore-Pakistan. Duration: Six months from 01-01-2019 to 01-06-2019. Methodology: data of all the injection drug users presenting in surgical emergency was collected. This comprised their sociodemographic profile, presenting disease and blood tests for HIV, Hepatitis B and Hepatitis C virus infections. Results: The mean age of patients was 31 years. Majority (47 %) belonged to Lahore, 21% from Gujranwala and 16 % from Sialkot. Majority (89.5%) had poor socioeconomic status. All patients were males. Majority (63.2 %) were single and illiterate (73.7%). In all the patients route of injection was femoral. Regarding viral serology 84.2 % patients were HIV positive ,15.8% patients were positive for both HIV and HCV. Patients presented with three surgical problems; Ruptured Femoral pseudoanuerysms (42.1%, n=8), Abscesses (31.6 %, n=6), Fournier’s gangrene (26.3 %, n= 5). In all femoral Psuedoanuerysms external iliac artery was ligated. Abscesses were incised and drained. Fournier’s gangrene was debrided with exposure of the testes. Conclusion: The Government should control illegal drug usage, educate the masses through print and electronic media to raise awareness of growing epidemic of HIV and to provide resources to made dedicated centers for surgical emergencies of these patients.