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"Non-steroidal anti-inflammatory drugs (NSAIDs) is a group of drugs used to treat pain, inflammation, and fever. High consumption of NSAIDs associated with high gastrointestinal side effects. Common complaint from patients, which ranging from mild heartburn to the onset of gastrointestinal bleeding, often complicates the adequate administration of NSAIDs. Various methods have been developed to reduce the likelihood of gastroenteropathy complication. Early diagnosis, appropriate prompt treatment, as well as adequate monitoring will reduce morbidity and mortality from complications due to NSAIDs. This paper will discuss the diagnosis and management of gastro-enteropathy NSAID through approaching the underlying pathophysiology."

"Gastropathy refers to the damage of the epithelial cells of the gastric mucosa and disturbance of epithelial cell regeneration unaccompanied by inflammation. Gastropathy occurs due to irritation by chemical agents (such as non-steroidal anti inflammatory drugs - NSAIDs and alcohol), bile reflux, hypovolemic conditions, and chronic obstruction.NSAIDs in general are chemical agents that cause irritation of the upper gastrointestinal tract through direct and indirect topical effects and by inhibiting prostaglandin synthesis through inhibition of COX-1 and COX-2. There are many data that demonstrates that the anti-inflammatory function of NSAIDs is mainly through inhibition of COX-2, while many of their side effects are due to inhibition of COX-1.In general, there is a correlation between the influence of NSAID and the administered dose. The higher the dose, the higher the risk for upper gastrointestinal tract disorder. NSAID users who frequently switch drugs have a risk twice higher than those only receiving one kind of NSAID. Those who use NSAID with corticosteroids have 15 times the risk. Use ofNSAID simultaneously with anticoagulants increases the risk of bleeding from ulcer 13 times compared to control subjects. NSAID use in a patient with history of bleeding from the gastrointestinal tract is 17.2 times non-users. Smoking also increases the percentage of gastroduodenal ulcer due to NSAID.Clinical symptoms ofNSAID gastropathy are often only dyspepsia syndrome. There is no correlation between symptoms and endoscopic findings.The first step in the therapy ofNSAID gastropathy is termination ofNSAID administration. To treat and prevent risks of gastropathy due to NSAID, mucosal protection agents may be used. Out of the various kinds of medicine available, proton-pump inhibitors turn out to be more effective compared to H2 receptor antagonists or cytoprotectiveagents."

"Non-steroid anti-inflammatory drugs (NSAID) can cause gastropathy and gastric mucosa, especially the mucous may play an important prevention role. This cross-sectional, single group study was conducted to evaluated the difference of mucous thickness in antrum or corpus mucosa and the correlation of gastric mucous thickness to gastropathy. Patients who received NSAID from the rheumatology clinic were studied. Healthy subjects of 14 - 65 years old who never received NSAID were included as normal controls. Piroxicam 20 mg daily was given to the patients for 7 days, then gastroscopy and gastric mucosa biopsy with frozen section were performed. Specimens were stained with haematoxyline eosin and thickness of the mucous layer was measured using ocular micrometer. Thirty-two out of 70 patients participated in the study. All cases had hyperemia on gastroscopy with erosions and ulcer in 32 and 9 cases, respectively. The mean thickness of mucosa in distal antrum, proximal antrum and corpus was 28.5 ± 9, 37.4 ± 13.1 and 43.3 ± 13.1 microns, respectively. There was significant relationship between gastric mucosa mucous thickness with gastroscopic findings. In conclusion, this study confirmed that thickness of gastric mucosa mucous has an important role in preventing NSAID gastropathy and dyspeptic complaints in this kind of patients does not suggest abnormalities of gastric mucosa."

"ABSTRAKObat anti-inflamasi nonsteroid (OAINS) nonselektif banyak digunakan oleh lansia. OAINS nonselektif oral memiliki efek samping terhadap gastrointestinal baik lokal maupun sistemik. Oleh karena itu, diperlukan rute untuk menghantarkan OAINS nonselektif yang nyaman dan efek samping yang minimal. Salah satunya rute alternatif yaitu penghantaran melalui kulit yang disebut rute transdermal. Stratum korneum menjadi tantangan utama dalam rute transdermal. Hal ini dapat dibantu dengan adanya peningkat penetrasi agar jumlah obat dapat mencapai efek terapeutiknya. Peningkat penetrasi sintesis menyebabkan berbagai masalah. Terpen, minyak atsiri, dan asam lemak dapat diperoleh dari alam. Minyak atsiri daun zodia (Evodia suaveolens) memiliki kandungan terpen yaitu linalool, alfa-pinen, dan limonen. Tinjauan ini membahas mengenai hubungan antara OAINS nonselektif dengan sistem penghantaran transdermal, pengaruh peningkat penetrasi dari alam terhadap OAINS nonselektif, serta potensi minyak atsiri daun zodia sebagai peningkat penetrasi pada OAINS nonselektif. Sistem penghantaran transdermal dapat mengurangi efek samping lokal yang terdapat pada gastrointestinal, selain itu sistem transdermal nyaman dan mudah digunakan. Peningkat penetrasi dapat menjadi alternatif untuk peningkat penetrasi sintesis OAINS nonselektif. Dari beberapa penelitian menunjukkan bahwa peningkat penetrasi dari alam mampu meningkatkan penetrasi obat melalui kulit. Kandungan minyak atsiri daun zodia mengandung linalool, alfa-pinen, dan limonen yang dapat berpotensi untuk menjadi peningkat penetrasi OAINS nonselektif. Untuk memperbaiki dari penelitian-penelitian sebelumnya, maka disarankan penelitian dilengkapi dengan membandingkan pengaruh dari kontrol, peningkat penetrasi sintesis (sebagai standar), serta peningkat penetrasi uji; uji kompatibilitas; penggunaan membran hewan (tikus/kelinci) pada uji in vitro; serta uji mekanisme kerja dari peningkat penetrasi

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ABSTRACT

Non-selective anti-inflammatory drugs (NSAIDs) are widely used by the elderly. Oral non-selective NSAIDs have side effects on both local and systemic gastrointestinal. Therefore, a route is needed to deliver convenient non-selective NSAIDs and minimal side effects. One alternative route is delivery through the skin called the transdermal route. The stratum corneum is the main challenge on the transdermal route. This can be helped by increasing penetration so that the amount of drug can reach its therapeutic effect. Synthesis penetration enhancers causes various problems. The terpenes, essensial oil, and fatty acid can be obtained from nature. Zodia (Evodia suaveolens) contain terpenes namely linalool, alpha-pinene, and limonene. This review discusses the relationship between non-selective NSAIDs and transdermal delivery systems, the effect of penetration enhancers from nature on non-selective NSAIDs, and the potential of Zodia as penetration enhancers in non-selective NSAIDs. The transdermal delivery system can reduce the local side effects in the gastrointestinal, besides that the transdermal system is comfortable and easy to use. Penetration enhancers can be an alternative to synthesis penetration enhancers nonselective NSAIDs. Several studies shown that natural penetration enhancers can increase drug penetration through the skin. The zodia leaf oil contains linalool, alpha-pinene, and limonene which can be potential to increase penetration of non-selective NSAIDs. To improve from previous studies, it is recommended that research should be completed by comparing the effects of controls, synthetic penetration enhancers (as a standard), and penetration enhancer test; compatibility test; use of animal membranes (mice/rabbits) for in vitro tests; and the mechanism action of penetration enhancers testing.

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"Obat anti-inflamasi nonsteroid (OAINS) berhubungan dengan meningkatnya insidens komplikasi tukak gastrointestinal yang mendadak dan menetap. Penelitian ini bertujuan untuk menemukan kelainan-kelainan endoskopik yang ditemukan pada duodenum dan jejunum proksimal karena obat OAINS. Tiga puluh delapan pasien yang mengkonsumsi OAINS untuk penyakit arthritis atau rematiknya dimasukkan dalam penelitian ini. Pemeriksaan gastro-duodeno-jejunoskopi dilakukan dengan alat Olympus PCF-10. Gambaran endoskopik entero-gastropati-OAINS dievaluasi dengan sistim skor. Gambaran enterogastropati-OAINS secara endoskopik terlihat berupa hiperemis, erosi dan tukak. Keluhan diare terjadi pada 7,9% pasien dan dispepsia terjadi pada 71,1% pasien. Dari pemeriksaan endoskopi di bulbus duodenum, ditemukan 79% kasus dengan hiperemis, 39,5% kasus dengan erosi dan 7,9% kasus tukak. Di duodenum bagian kedua (pars desendens) ditemukan 28,9% kasus dengan hiperemis, 15,8% kasus dengan erosi dan 2,6% kasus tukak. Di jejunum, ditemukan 7,9% kasus dengan hiperemis, 2,6% kasus dengan erosi dan tidak ditemukan tukak. Disimpulkan bahwa kelainan endoskopik terbanyak yang ditemukan pada enteropati-OAINS yaitu hiperemis. Lokasi kelainan enteropati-OAINS tersering yaitu di bulbus duodenum. (Med J Indones 2005; 14: 225-9)

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Non Steroidal Anti Inflammatory Drugs (NSAID) have been associated with a sudden and sustained rise in the incidence of gastrointestinal ulcer complications. The aim of the study was to reveal the endoscopical abnormalities found in the duodenum & proximal jejunum due to NSAID. Thirty eight patients taking NSAID for their arthritis or rheumatism were included in this study. Gastro-duodeno-jejunoscopy was done with Olympus PCF-10. The endoscopical appearances of NSAID entero-gastropathy were evaluated with a scoring system. The NSAID-entero-gastropathy appearances were endoscopically seen as hyperemia, erosion and ulcer. From all patient recruited, 7.9% complaint of diarrhea and 71.1% complaint of dyspepsia. Endoscopically, in the duodenal bulb we found 79% cases of hyperemia, 39.5% cases of erosion and 7.9% cases of ulcer. In the second part (descending part) of the duodenum we found 28.9% cases of hyperemia, 15.8% cases of erosion and 2.6% case of ulcer. In the jejunum, we found 7.9% cases of hyperemia, 2.6% case of erosion and no ulcer. It is concluded that the most frequent abnormal endoscopical appearances in NSAID- enteropathy was hyperemia. The most frequent site of NSAID-enteropathy abnormal findings was in the duodenal bulb. (Med J Indones 2005; 14: 225-9)"

"Objective: Garcinia xanthochymus extract has been reported to have several pharmacological properties. This study was conducted to evaluate cytotoxic and anti-inflammatory activities of G. xanthochymus extracts on cell lines. Methods: The roots and stem barks of plant were extracted using maceration method with n-hexane, dichloromethane and methanol, successively. Cytotoxic activity of the extracts was tested against MCF-7 breast adenocarcinoma using MTT assay. Anti-inflammatory study was evaluated using RAW 264.7 mouse macrophage cells. The nitric oxide production in LPS-stimulated cells was measured using Griess reagent. Results: The results of cytotoxic and anti- inflammatory study showed that dichloromethane and n-hexane extracts of root and stem bark exhibited cytotoxic activity in dose-dependent manner. Meanwhile, for anti-inflammatory study, all root extracts together with stem bark dichloromethane and n-hexane extracts reduce NO production in LPS-stimulated cells in dose dependent manner. Conclusions: This finding indicated that G. xanthochymus extracts might become interesting candidate for treatment of cancer and inflammation.;"

"Images in urology is a unique book that integrates images of urological conditions within their clinical context. Improvements in imaging techniques have meant greater diagnostic power and a dramatic rise in the number and quality of images obtained and viewed by practicing clinicians. None more so than in the field of urology, where static and dynamic images are fundamental to the diagnosis and treatment of almost all conditions. This book presents images of radiological and radionucleotide scans, macroscopic and microscopic histopathology specimens, urodynamic traces and photographs of dermatological conditions relating to urology. Each section has a series of questions, often relating to a clinical scenario, about the images. A comprehensive answer provides a description of each image and of the condition shown. Details of how to interpret the image and the use of contrast or staining methods to help differentiate normal anatomy from pathology are included. Images in Urology is an essential tool for urology, radiology and histopathology trainees and consultants, as well as being an excellent exam preparation guide."