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The victims were standing on the side of the road when the driver lost control of the steering wheel, causing the bus to crash into the crowd, state-run Ahram Online reported. The Public Prosecution has initiated an investigation into the accident, while the bus driver was taken into custody and ordered to be tested for drugs. Road accidents claim thousands of lives every year in Egypt as a result of speeding, poor maintenance of roads and lax enforcement of traffic laws. Over the past few years, Egypt has upgraded its road network to reduce traffic accidents. Egypt Source: Xinhua Editor: huaxia

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By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. To browse Academia. This article reviews the current status of H2receptor antagonists, omeprazole, sucralfate and misoprostol as therapeutic options for the prophylaxis and treatment of nonsteroidal anti-inflammatory drug NSAID -induced gastrointestinal ulceration. The efficacy of the Hz receptor antagonists appears to be restricted to prophylaxis and treatment of NSAID-induced duodenal ulcer disease. Sucralface improves symptoms, but does not appear to have any effect on improving gastric mucosal damage when compared to placebo. Misoprostol is effective in both the prophylaxis and treatment of NSAID-induced gastric ulcers; however, its exact role in the prophylaxis and treatment of NSAlD-induced duodenal International journal of clinical practice. Supplement, The risk of gastrointestinal mucosal injury with non-steroidal anti-inflammatory drugs NSAIDs is dose-dependent. Epidemiological studies have clearly demonstrated a rank order of risk of ulcer complications for commonly used NSAIDs, with ibuprofen consistently associated with the lowest risk and piroxicam with the highest. Antacids, H2 receptor antagonists and misoprostol all have drawbacks as prophylaxis. Of the cyclo-oxygenase COX -2 selective NSAIDs, rofecoxib is associated with a lower risk of gastrointestinal toxicity but there is uncertainty about the long-term risk associated with celecoxib. Rofecoxib has been associated with a significantly higher incidence of myocardial infarction than naproxen that may counteract the benefit of greater gastrointestinal safety. At over-the-counter doses, the short duration of use and the low dose reduce the risk of a serious adverse event compared with chronic use at prescribed doses. Site Destruction in Georgia and the Carolinas. David G. Anderson and Virginia Horak, editors. Journal of Progressive Law and Legal Studies, Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Related papers Misoprostol in the treatment of duodenal ulcer refractory to H2-blocker therapy Alan Safdi. Misoprostol in the treatment of duodenal ulcer refractory to H2-blocker therapy A placebo-controlled, multicenter, double-blind, randomized trial Alan Safdi. Protection by misoprostol against naproxen-induced gastric mucosal damage Helen cohen. Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage Benjamin Krevsky. Ulcerating and stenosing enteropathy treated with misoprostol Troels Havelund. Downloaded from gut. This study assessed the effect of coadministration of prostaglandins with NSAIDs on the histology of the gastroduodenal mucosa. Both groups of patients were comparable with regard to clinical and demographic details. Reactive gastritis was not associated with H pylori. These results show two different patterns of gastric damage in patients receiving NSAIDs, namely chronic and reactive gastritis. Misoprostol treatment was associated with a significantly reduced prevalence of reactive gastritis and it is suggested that this, along with its antisecretory action, may explain the reduced prevalence of gastroduodenal lesions when coadministered with NSAIDs. Accepted for publication 25 November anti-inflammatory drugs NSAIDs are the most frequently prescribed of the anti-rheumatic drugs, which attests to their efficacy in reducing joint pain and inflammation. The main concern about their use is the frequency of gastrointestinal damage and its attendant complications. Collectively the data to date suggest that prostaglandins, H2 receptor antagonists, and proton pump inhibitors are all of comparable efficacy in healing of NSAID associated gastric and duodenal ulcers and in preventing duodenal ulcers when given concomitantly with NSAIDs. The longterm safety of such treatment is evident clinically, but no study has looked at the possible adverse effect of misoprostol on the histology of the gastric mucosa when given longterm with NSAIDs. This could be important in view of the fact that prostaglandins play an important part in the regulation of cell proliferation. We therefore compared the histological appearances of gastric biopsy specimens from patients receiving longterm NSAID treatment without misoprostol with those from patients receiving NSAIDs and concomitant misoprostol for periods of either one or two years. This was to limit any observer bias created by knowledge of the origin of the slides. At the end of the study the slides were decoded. Interpretation was carried out independently by two pathologists and there was good observer agreement in classifying the biopsy specimens appearances. In cases of disagreement this was resolved by the third histopathologist. Statistics Statistical differences between demographic data were assessed with the Wilcoxon's rank sum test and histopathological data by the x2 test. Methods There were two sources of histological material. These patients had initially been recruited in a multicentre study assessing the short term two weeks effect of prostaglandins in the prevention and healing of NSAID induced gastroduodenal lesions. The study at Northwick Park Hospital and the multicentre study both had common entry and exclusion criteria Table I. Histological assessment All patients underwent endoscopy under sedation. Two biopsy specimens were taken from each of three sites; the duodenal bulb, the greater curve of the antrum at least 2 cm from the pylorus, and the mid greater curve of the body. In a case with ulceration close to the landmarks the samples were taken 2 cm from the crater. All samples were treated in an identical fashion, routinely formalin fixed, and paraffin processed. Sections 3 ,um were cut and stained with haematoxylin and eosin. A Cresyl fast violet stain was used to facilitate the identification of H pylori like organisms. For the purposes of this study only the antral and body biopsy specimens are reported in detail. Gastritis was assessed according to the Sydney system. In particular there was no significant difference between the male to female ratio, mean SD age 62 12 v 59 8 years, respectively , age range or number of patients in each age group , , and over 61 years old , number of patients with osteoarthritis, rheumatoid arthritis or other arthritides, type of NSAID received, prevalence of gastroduodenal ulcers before this study or duration of NSAID treatment. Histological assessment Table II The abnormal histological categories identified were chronic gastritis, reactive gastritis, and mixed patterns of the two. The number positive for Hpylori is shown in parenthesis. Because of the different chemical nature of NSAIDs and bile acids, reactive gastritis probably does not represent specific biochemical abnormality. Rather the histological changes may represent a tissue reaction in response to an effect on cell membranes, as both the drugs and bile have Figure 1: Typical H pylon associated chronic antral detergent properties. There is moderate chronic inflammation in the Our studies show that longterm coadminissuperficial hal of the mucosa, an intact surface, and tration of misoprostol with NSAIDs specifiminimal or no activity in the form of neutrophil infiltration haematoxylin and eosin, original magnification X Eight ing the adverse mucosal effects of NSAIDs, patients had a mixed picture of chronic does not influence the prevalence of H pylorn and reactive gastritis and none of these was gastritis in this cohort of patients also suggests associated with Hpylori. No biopsy sample showed any signs of dys- therefore have been expected that the plasia or neuroendocrine cell hyperplasia. Helicobacter colonisation rate and concomitant chronic gastritis would have increased in the misoprostol treatment group. That this was Discussion not seen supports the broad epidemiological This study has shown that longterm misopros- concept that reinfection by H pylori is a rare tol ingestion together with NSAIDs is not event in the adult population. The clinical associated with any new pattern of gastric implications of the study are more uncertain. The last factor was a theo- prevalence of reactive gastritis in patients retical possibility because of the importance receiving misoprostol may somehow underlie of prostaglandins in the regulation of cell its effect to reduce the incidence of ulcers when given concomitantly with NSAIDs. Nevertheless by analogy with classic pepsimilar' or slightly reduced carriage tic ulcer disease, which is almost invariably rate of the organism compared with that of associated with the presence of Hpylori related chronic gastritis not associated with NSAIDs, suggesting that the lesion is incidental rather than caused by NSAIDs. Changes of reactive gastritis are in most instances incompatible with H pylori infection17 27 28 and vice versa, but it is not presently possible to say whether chemical gastritis is associated with changes that are unfavourable to H pylori colonisation or whether the histopathological changes associated with H pylori associated chronic gastritis overshadow the subtle changes of reactive gastritis. In a few paucity of inflammatory cells haematoxylin and eosin, it may be difficult to distinguish between original magnification X In this context it may be relevant that misoprostol has anti-secretory properties even at comparatively low doses. In summary, we saw no worrying histopathological changes in gastric biopsy specimens of patients receiving longterm NSAIDs treatment and misoprostol. Indeed misoprostol specifically reduces the prevalence of reactive gastritis. Comparison of the findings from NSAID treated patients and those who were concomitantly taking misoprostol adds additional weight to the concept of dual gastric pathology in patients receiving NSAIDs: the reactive changes being a direct consequence of NSAIDs and largely reversible with prostaglandin treatment, and that of H pylori positive chronic gastritis, which seems to be an incidental finding in patients receiving NSAIDs and not related to NSAID treatment. Current controversies in rheumatology. Controversies and management of nonsteroidal anti-inflammatory drug induced side effects on upper gastrointestinal tract. Arthritis Rheum ; Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine. Gastroenterology ; Contrasting presentation and findings between patients with rheumatic complaints taking non-steroidal anti-inflammatory drugs and a general population referred to endoscopy. Epidemiological evidence on the association between peptic ulceration and antiinflammatory drugs. Endoscopic evaluation of cimethidine and sucralfate for prevention of naproxen-induced gastroduodenal injury: effects of scoring method. Dig Dis Sci ; Nonsteroidal anti-inflammatory drugs and life threatening complications of peptic ulcer disease. Gut ; Q Jf Med ; NSAIDs - should every prescription carry a government health warning? Aliment Pharmacol Ther ; Prevention and treatment of gastrointestinal damage by misoprostol. Hospital Pharmacy Practice ; 2: Indomethacin accelerates clearance of labelled cells and increases DNA synthesis in gastrointestinal mucosa of rat. Inhibitory effect of non steroidal antiinflammatory drugs on mucosal cell proliferation associated with gastric ulcer healing. Lancet ; Nonsteroidal antiinflammatory drug induced intestinal inflammation in humans. Comparison of leukocyte excretion and blood loss in inflammatory disease of the bowel. BrJRheumatol ; The Sydney System: histological division. J Gastroenterol Hepatol ; 6: Gastritis in patients on non-steroidal anti-inflammatory drugs. Histopathology ; Campylobacter pylori associated gastritis in patients with rheumatoid arthritis taking nonsteroidal anti-inflammatory drugs. Br J Rheumatol ; Long-term nonsteroidal antiinflammatory drug use and Helicobacter pylori infection. Helicobacter pylori: a risk and severity factor of non-steroidal anti-inflammatory drug induced gastropathy. Relationship between Campylobacter pylori and gastritis in healthy humans after administration of placebo or indomethacin. Long-term nonsteroidal anti-inflammatory drug use and gastroduodenal injury: the role of Helicobacter pylori. The presence of Campylobacter pylori in nonsteroidal antiinflammatory drug associated gastritis. Jf Rheumatol ; Chemical gastritis and Helicobacter pylori related gastritis in patients receiving non-steroidal anti-inflammatory drugs: comparison and correlation with peptic ulceration. J Clin Pathol ; Campylobacter-like organisms, nonsteroidal anti-inflammatory drugs and gastric lesions in patients with rheumatoid arthritis. Digestion ; Helicobacter pylori-besiedlung der magenschleimhaut bei rheuma-patienten. Z Gastroenterol ; Campylobacter like organisms and relux gastritis. Reflux gastritis in the intact stomach. Jf Clin Pathol ; Reflux gastritis: a distinct histopathological entity? Laxative-like effects of nonsteroidal anti-inflammatory drugs on intestinal fluid movement and membrane integrity. Y Pharmacol Exp Ther ; Effects of anionic surfactants on hamster small intestinal membrane structure and function: relationship to surface activity. Treatment of peptic ulcers caused by Helicobacter pylori. Prevention of NSAID-induced gastric ulcer with misoprostol: multicenter double blind, placebo-controlled trial. Lancet ; ii: Double-blind, placebo-controlled, endoscopic comparison of the mucosal protective effects of misoprostol versus cimethidine on tolmetin-induced mucosal injury to the stomach and duodenum. The clinical significance of Campylobacter pylori. Ann Intern Med ; Peptic ulcer disease: medical treatment. The stomach. Edinburgh: Churchill Livingstone, Intermittent treatment of duodenal ulcer for long-term medical management: a review. Postgrad Med J ; 64 suppl 1 : Histamine H2-receptor antagonists versus prostaglandins in the treatment of peptic ulcer disease. Drugs ; Helicobacter pylori: current status. Gut doi: Sign up in the box at the top right corner of the online article. Psicologia Positiva carmen leoin. Recommendation for the review of biological reference intervals in medical laboratories Irina Ghita. David G Anderson. Jonathan D. Tommaso Francesco Giupponi. Leader delegation in global software teams: occurrence and effects Suling Zhang. Peer group and parental influence as correlates of carrier choices in science among senior secondary school adolescents in imo state DR Ndidiamaka R. Educating Managers with Tomorrow's Technologies. Re-thinking inclusivity in music learning: The implications of multiple Ghanaian languages in Western-leaning music theory Alfred Patrick Addaquay.

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