Treatment options for Helicobacter pylori.👀

Helicobacter pylori (Hp) is a bacterium with a high infection rate in clinical practice. It can cause stomach ulcers and chronic gastritis and other stomach diseases. The long-term effects of these stomach problems can even lead to stomach cancer. Some studies have pointed out that the incidence of stomach disease caused by Hp is about 6 times that of stomach disease caused by other reasons. About 90% of patients with chronic gastritis and gastric ulcers carry Helicobacter pylori.

Indications for Helicobacter pylori.

The infection rate of Helicobacter pylori in the world is very high. Hp infection rates in some countries exceed 50%. Gastritis caused by Hp is an infectious disease. Treatment is generally necessary for Hp-positive patients. For Hp-positive patients with the following indications, they should undergo Hp eradication therapy. 

Eradication therapy is strongly recommended for Hp-positive patients with the following indications:

1. Peptic ulcer with or without activity and with or without a history of complications.
2. Gastric mucosa-associated lymphoid tissue.

Eradication therapy is recommended for Hp-positive patients with the following indications:

1. Has a family history of gastric cancer.
2. Chronic gastritis is accompanied by symptoms of gastric mucosal atrophy, erosion or indigestion.
3. Long-term use of proton pump inhibitors (PPIs).
4. The treatment plan requires long-term use of non-steroidal anti-inflammatory drugs.
5. Early gastric tumors have undergone endoscopic resection or subtotal gastrectomy.
6. Idiopathic thrombocytopenic purpura.
7. Unexplained iron deficiency anemia.
8. Other Hp-related diseases such as hyperplastic gastric polyps, lymphocytic gastritis.
9. Hp infection has been confirmed.

Drugs that can eradicate Helicobacter pylori.

The main treatment regimen for empirical eradication of Helicobacter pylori is PPI + 2 kinds of antibacterial drugs + bismuth. It is recommended to use for 10 or 14 days. Eradication rates with these regimens can reach 85 to 94%.

1. Proton pump inhibitors.

PPIs can inhibit the secretion of gastric acid and increase the pH of the stomach. It will increase the chemical stability of antibiotics, the concentration of antibiotics in the stomach and reduce the minimum inhibitory concentration to enhance the effect of antibiotics. In order to improve the eradication rate, it should generally be used the drugs with high curative effect, stable action and less influence by CYP2C19 gene polymorphisms, such as rabeprazole. They are generally recommended to be taken twice a day, half an hour before meals. 

1. Omeprazole: It is a first-generation PPI. Its recommended dose is 20mg daily. Its onset is slower.
2. Lansoprazole: It is a first-generation PPI. Its recommended dose is 30mg daily. It onset is faster than omeprazole.
3. Pantoprazole: It is a first-generation PPI. Its recommended dose is 40mg daily. It onset is similar to that of omeprazole.
4. Rabeprazole: It is a second-generation PPI. Its recommended dose is 10mg or 20mg daily. It onset is the fastest.
5. Esomeprazole: It is a second-generation PPI. Its recommended dose is 20mg daily. It onset is similar to that of lansoprazole.

2. Antibacterial drugs.

Acidic environments reduce their efficacy. It is generally recommended to take it after meals. The following are commonly used antibacterial drug combinations:

• Amoxicillin 2 times a day, 1000mg each time + Clarithromycin 2 times a day, 500mg each time.
• Amoxicillin 2 times a day, 1000mg each time + Levofloxacin 500mg once a day or 200mg twice a day.
• Amoxicillin 2 times a day, 1000mg each time + Furazolidone 2 times a day, 100 mg each time.
• Tetracycline 3 or 4 times a day, 500mg each time + Metronidazole 3 or 4 times a day, 400 mg each time.
• Tetracycline 3 or 4 times a day, 500mg each time + Furazolidone 2 times a day, 100 mg each time.
• Amoxicillin 2 times a day, 1000mg each time + Metronidazole 3 or 4 times a day, 400 mg each time.
• Amoxicillin 2 times a day, 1000mg each time + Tetracycline 3 or 4 times a day, 500mg each time.

Gastric acid had relatively little effect on the activity of tetracycline, metronidazole, and furazolidone. The other effects of gastric acid were amoxicillin > clarithromycin > levofloxacin.

3. Bismuth.

Bismuth pectin (undetermined standard dose) and bismuth citrate (220 mg) are recommended to be taken twice a day, half to one hour before meals. Stools will turn black after taking bismuth. Short-term use of bismuth for 1 to 2 weeks has a high safety. Helicobacter pylori is not resistant to bismuth because it is directly killed by bismuth. Bismuth can additionally increase the eradication rate of resistant strains of Hp by 30 to 40%. A quadruple regimen containing bismuth should be used whenever possible in the empirical treatment of Hp, unless the patient has a contraindication to bismuth or resides in a low resistance rate.

How to choose a treatment plan?

The choice of treatment regimen is to choose a combination of antibiotics. The choice of PPI and bismuth is generally not limited unless the patient has a contraindication or intolerance. The selection of antibiotics should be based on the patient's allergy history, medication history, and local Hp antibiotic resistance. Efficacy, cost, convenience, and adverse reactions should also be considered.

1. Initial empirical treatment.

The above combinations of antibacterial drugs are not divided into first-line or second-line. The combination with high efficacy should be used in the initial treatment. However, Combinations containing levofloxacin are not intended as initial treatment regimens. The main reason for the decrease in eradication rate is the increased drug resistance of Hp. If Hp is resistant to one of the two antibacterial drugs, the eradication rate drops to 50 to 60%. If Hp is resistant to both antibiotics, the eradication rate is only about 10%. Antibiotics were selected according to the resistance of local Hp. Drug susceptibility testing can be performed if necessary. Amoxicillin generally has a strong effect on Hp and is not easy to develop drug resistance. Patients without allergies have fewer adverse reactions. It can be considered as the first choice. Furazolidone has more serious adverse reactions. It is only used for Hp infections that are difficult to eradicate.

Primary resistance rate of Hp:

	Resistance rate
Amoxicillin	0-5%
Clarithromycin	20-50%
Furazolidone	0-1%
Levofloxacin	20-50%
Metronidazole	40-70%
Tetracycline	0-5%

Eradication rates and incidence of adverse effects of treatment regimens:

	Eradication rate	The incidence of adverse reactions
Amoxicillin + Clarithromycin	85-94%	Low
Amoxicillin + Levofloxacin	85-89%	Medium
Amoxicillin + Tetracycline	85-89%	Medium
Tetracycline + Metronidazole	85-94%	Medium to high
Tetracycline + Furazolidone	85-94%	Medium to high
Amoxicillin + Metronidazole	85-94%	Medium to high
Amoxicillin + Furazolidone	85-94%	Medium to high

2. After failure of initial treatment.

Choose one of the remaining treatment options for treatment. The selection should refer to past treatment regimens. It is generally not reused. 

Metronidazole at conventional doses is fully functional when Hp is not resistant, but it is completely ineffective when resistant. Its dose can increase to 1600mg daily in 4 divided doses to overcome drug resistance. Therefore, if repeated use of metronidazole is required, its dose needs to be increased to 1600 mg per day. When this dose has been used for the initial treatment, it should not be used again. 

In addition, increasing the dose of metronidazole (1600mg/day) or furazolidone (300mg/day) can improve the efficacy, but the adverse reactions will also increase.

3. Treatment of patients with penicillin allergy.

Tetracycline can be used instead of amoxicillin. It is recommended to use tetracycline in combination with furazolidone or metronidazole. Tetracycline combined with levofloxacin is also effective.

When tetracycline cannot be used, clarithromycin can be used instead. Such as clarithromycin combined with furazolidone, metronidazole or levofloxacin.

Prevention of Hp.

The main route of Hp infection is the digestive tract. Saliva can be its carrier. Therefore, pay attention to the hygiene of tableware and disinfect regularly.

Studies have shown that Hp can survive in fresh water for at least 3 years. It also survives 4 to 10 days in tap water. Water should be cooked thoroughly before drinking.

The development of an Hp vaccine may be the best way to prevent infection in the future.

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Several causes and treatment options for coughing.😷😷😷

Cough is a very common symptom. Although coughing is generally not very harmful, chronic coughing can be very annoying and damage the respiratory tract. Many different diseases can cause cough symptoms. This article will introduce the diagnosis, pathogenesis of coughs, and guidelines for their treatment.

1. Cough caused by the common cold.

The most common cause of colds is a viral infection. In addition to coughing, its clinical manifestations are also accompanied by upper respiratory tract-related symptoms such as throat irritation or discomfort, runny nose, nasal congestion, sneezing, postnasal drip, and fever. There are usually few systemic symptoms. Postnasal drip is often associated with coughing of the common cold.

Treatment method: 

• Central antitussive drugs such as codeine are generally not recommended for routine use alone in coughs of the common cold. 
• Antitussives in combination with decongestants and first-generation antihistamines are recommended for adults with the common cold with cough.
• For the common cold with cough, first-generation antihistamines alone have no obvious therapeutic benefit. Combining first-generation antihistamines and decongestants can effectively improve symptoms such as sneezing, nasal congestion, and relieve cough.
• It is not recommended to use NSAIDs if a patient with the common cold has no symptoms of headache, muscle pain, and fever.

2. Cough caused by acute tracheitis and bronchitis.

Most of acute tracheitis and bronchitis are caused by viruses and a few are caused by bacteria. Its initial clinical manifestations are symptoms of upper respiratory tract infection. The cough then gradually intensifies and with or without expectoration. The expectoration caused by bacterial infection is yellow and purulent sputum. 

Treatment method: 

• Antitussives should be used in patients with severe cough without sputum. Mucolytic or expectorant is recommended for patients who have sputum but cannot expectorate it. 
• Symptoms of acute respiratory infection can be relieved with extended-release guaifenesin. It can irritate the gastric mucosa and reflexively cause an increase in airway secretions. Increased secretions reduce the viscosity of phlegm. It also has a bronchodilator effect, which can enhance the effect of expectoration.
• Routine antimicrobial therapy is generally not recommended unless the patient has yellow and purulent sputum. Antibiotics may also be considered in patients with elevated peripheral white blood cell counts.

3. Cough after a cold.

The cough persist for 3 to 8 weeks after the acute respiratory symptoms of the cold disappeared, and the chest X-ray examination was no significant abnormal. 

Treatment method: 

• In the short term, decongestants, antihistamines, and antitussives can be recommended to treat some patients with obvious cough symptoms.
• Inhaled montelukast and corticosteroids are not recommended.

4. Cough caused by postnasal drip syndrome.

The nose produces secretions due to disease and the secretions flow back to the back of the nose and throat. It stimulates the cough receptors and causes coughing. The main clinical manifestation of postnasal drip syndrome is chronic cough. Coughing more during the day or during postural changes and less after falling asleep.

Treatment method: 

• Oral first-generation antihistamines and decongestants are the first recommended treatment for postnasal drip syndrome caused by the common cold and nonallergic rhinitis.
• Oral second-generation antihistamines and nasal inhaled corticosteroids are recommended first for the treatment of postnasal drip syndrome caused by the common cold and allergic rhinitis. For allergic rhinitis, leukotriene receptor antagonist therapy is also effective.
• To avoid unnecessary surgery, nasal inhaled corticosteroids are recommended for the treatment of chronic sinusitis with nasal polyps.
• Sequential treatment of oral corticosteroids and topical nasal inhaled corticosteroids is more effective than nasal inhaled corticosteroids alone in patients with chronic rhinosinusitis with nasal polyps.
• Nasal decongestants can relieve nasal congestion. It will reduce the congestion and edema of the nasal mucosa, thereby facilitating the drainage of secretions. However, patients should be alert to its adverse reactions when using it. It can cause drug-induced rhinitis and should not be used for a long time. Its course of treatment is generally less than 1 week. It recommends a combination of nasal decongestants and first-generation oral antihistamines. Their course of treatment is 2 to 3 weeks.
• For the treatment of patients with chronic sinusitis, mucolytics (such as carbocisteine, erdosteine) may be beneficial. It can also be used to flush the nasal cavity with saline.

5. Gastroesophageal reflux cough.

One of the common causes of chronic cough is the reflux of stomach acid and other stomach contents into the esophagus, which causes a cough. This cough occurs mostly during the day, with upright and postural changes. It generally has no phlegm or a small amount of white sticky phlegm. Greasy and acidic foods can trigger or aggravate a cough. 40 to 68% of patients also experience typical acid reflux symptoms such as acid reflux, belching and retrosternal burning.

Treatment method: 

• Acid-suppressing drugs, including potassium-competitive acid blockers (such as vonoprazan) and proton pump inhibitors (such as omeprazole), are the first choice of treatment.
• Gastroprokinetic agents (such as mosapride) can relieve symptoms associated with acid reflux. It can be used in combination with acid-suppressing drugs. The anti-reflux course of treatment is at least 8 weeks, and then the dose is gradually reduced.

6. Cough variant asthma.

It is a specific type of asthma. It is also one of the most common causes of chronic cough. Its main clinical manifestation is irritating dry cough. The cough is generally severe and occurs at night and in the early morning. It generally has no obvious symptoms such as shortness of breath or gasp for breath, but there will be airway hyperresponsiveness. 

Treatment method: 

• Treatment with inhaled corticosteroids alone or in combination with bronchodilators (such as long acting β2-agonist) is recommended.
• Classic asthma may be prevented with long-term use of inhaled corticosteroids.
• Leukotriene receptor antagonists, such as montelukast, reduce symptoms of airway inflammation and cough. It improves quality of life and is effective in treating cough variant asthma.

7. Eosinophilic bronchitis.

About 13 to 22% of chronic coughs are caused by eosinophilic bronchitis. The necessary basis for diagnosis is elevated sputum eosinophils. Chronic irritating cough is usually the only clinical symptom. It is usually a dry cough or with a little white mucus sputum. Cough is more common during the day, and occasionally at night. Cough triggers are mostly cold air, dust, odors or smoke. The patient had no associated symptoms of airway restriction such as dyspnea and gasp for breath.

Treatment method: 

• Cough was significantly relieved or disappeared soon after glucocorticoid treatment. Inhaled corticosteroids such as fluticasone propionate aerosol are the recommended first-line therapy. It should be used continuously for more than 8 weeks.
• Oral prednisone (10 to 20 mg daily for 3 to 5 days) can be combined for initial treatment.
• More than half of patients still relapse after treatment. Patients with persistent eosinophilic inflammation and rhinitis are risk factors for recurrence.

8. Allergic cough.

Some patients with chronic cough have normal sputum eosinophils and no hyperresponsive airways, but the patients are atopic. Effective with antihistamines and glucocorticoid therapy. This type of cough is called allergic cough. Cough occurs during the day or night, mostly paroxysmal and irritating dry cough. Cold air, dust, smoke, and talking can all induce coughing and often an itchy throat. 

Patients with allergic cough have one of the following indications:

1. Antihistamines or glucocorticoids are effective.
2. Positive skin test for allergens.
3. Increased serum total IgE or specific IgE.
4. History of allergic disease or exposure to allergens.

Treatment method: 

• Initial treatment can be short-term low-dose oral glucocorticoids for 3 to 5 days. Oral antihistamines and/or inhaled corticosteroids for more than 4 weeks.

9. Refractory chronic cough.

Clinically, there are some patients with underlying chronic cough etiology, but the cough has no obvious relief after targeted treatment. This cough is called refractory chronic cough. 

Treatment method: 

• The neuromodulator drug gabapentin is effective in the treatment of refractory chronic cough. It can also choose other drugs such as baclofen, amitriptyline, pregabalin, and carbamazepine.
• Patients with refractory chronic cough can use aerosol inhalation of lidocaine to achieve a certain temporary relief effect.

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Although eggs are rich in nutrients, some cooking methods can reduce their nutrients.🥚🥚🥚

Eggs are a nutrient-dense food. It can be cooked in a variety of ways, tastes great, and is cheap. Many people love to eat eggs. Because of its simple and quick cooking method, many people like to choose eggs for breakfast. It is a source of high-quality protein. It is also rich in a variety of essential amino acids, a variety of vitamins and selenium and other nutrients needed by the human body. Eating eggs regularly can help children's physical and mental development. Young people eat eggs regularly to help balance nutrition. The elderly often eat eggs, which can provide enough choline. This can help prevent Alzheimer's disease. Although there are many benefits to eating eggs regularly, if they are not cooked properly, eggs may be harmful to the body.

It is not recommended to cook eggs like this.

There are many ways to cook eggs, but raw or soft-boiled eggs are the least recommended. Many people mistakenly believe that when an egg is cooked, it will lose its nutrients significantly. Therefore, there are many people who would choose to eat raw eggs or soft-boiled eggs. Undercooked eggs can cause food poisoning if they are contaminated with salmonella. Undercooked eggs also contain avidin and anti-enzyme protein. Both of these two proteins are harmful to the body. Avidin binds to biotin in food. It causes the body to fail to absorb biotin and lead to biotin deficiency. It can cause muscle soreness, mental exhaustion and other symptoms. Anti-enzyme proteins can disturb with protein digestion and absorption. Both of them will be destroyed when cooked. In addition, raw eggs contain antitrypsin. It inhibits the absorption of protein from the gastrointestinal tract. Antitrypsin allows large amounts of undigested protein to enter the large intestine. These proteins become putrefied under the influence of E. coli. It produces toxic substances. Some of these toxic substances are excreted from the body. The rest of the toxic substances are metabolized in the liver. It will significantly increase the burden on the liver. Therefore, it is recommended to fully cook eggs when eating them, so as not to be harmful to health.

The best way to cook eggs like this.

Uncooked eggs are certainly harmful to the body. There are many ways to hard boil an egg. They will of course be healthier than uncooked eggs. Omelet, scramble, steamed, fried eggs, which cooking method is the healthiest and most recommended? Among so many cooking methods, there is no doubt that hard-boiled eggs are the healthiest. Hard-boiled eggs not only remove the above hazards, but it retains all the nutrients. Hard-boiled eggs are also easier to digest and absorb. 

How long is the best time to cook a hard-boiled egg?

In fact, in addition to the dangers of undercooked eggs, overcooked eggs are not good either. If an egg is boiled for more than 10 minutes, it loses some of its nutrients and becomes indigestible.

Method of boiled eggs: First add cold water and eggs to the pot, the water must soak the eggs. Then boil the water over medium heat. Wait 6 to 10 minutes after the water boils. This way the eggs will not be overcooked. It can relatively completely retain the nutrition of eggs, and can kill harmful pathogenic bacteria and substances in eggs.

How many eggs should be consumed per day?

There are many people who think that you can only eat one egg a day. In fact, how many eggs can you eat in a day? Many people think that they should not eat more than one egg a day. The main reason is because the egg yolk contains cholesterol. It is also relatively high in cholesterol. Absorbing too much cholesterol over a long period of time can be harmful to the body. Coupled with the general dietary recommendation that adults eat no more than 7 eggs per week, many people think that they can only eat one egg a day. In fact, healthy adults eating three eggs a day will not affect their health. The dietary guidelines in the United States point out that the cholesterol content in the human body is mainly produced by the body itself (about 80%). Only about 20% comes from food. Therefore, they removed the daily cholesterol intake limit. This also means that the cholesterol in eggs is less harmful to human health. In addition, the cholesterol in egg yolks is mainly high-density lipoprotein cholesterol. It is a good cholesterol. It protects our cardiovascular system. However, it is generally recommended to eat one egg per day and not to exceed 7 eggs per week. Adolescents, breastfeeding women or other people who need more nutritional supplements can eat a few more eggs.

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Some symptoms in your body may imply that you have the risk of cancer.😨😨😨

Cancer is a disease that everyone fears. Once you have cancer, it has a big impulse on your whole family. Although cancer is scary, its progression is slow. Therefore, if the patient can be checked early, detected early and treated early, the patient has a good chance of being cured of the cancer. The following will briefly introduce when patients should start cancer screening? Under what circumstances should they be screened?

1. Bowel cancer.

Adults over the age of 40 should preferably have a fecal occult blood test and a routine stool examination every year. Colonoscopy and related tumor marker tests should also be performed if necessary.

Additionally, if people have the following symptoms, they should get tested as soon as possible:

1. Changes in the regularity of bowel movements: It is the most common performance of bowel cancer. It is mainly manifested as sudden diarrhea, constipation, or alternating between the two, and the symptoms are not relieved even for a long time. 
2. Blood in the stool: Bowel cancer causes stools that may be mixed with blood and often mucus. If the blood is only on the surface of the stool, it is generally bleeding from hemorrhoids.
3. Abdominal discomfort: Bowel cancer may also have persistent abdominal pain, bloating and other abdominal discomfort.
4. Systemic symptoms: Rapid weight loss, unknown fever, anemia, etc.

Recommendations for the prevention of bowel cancer: The diet should be regular and balanced. People should eat 400-800 grams of fruits and vegetables every day, and eat less grilled or fried food. Sitting for long periods should also be avoided.

2. Liver cancer.

People over the age of 40 should have liver function tests and abdominal ultrasound scans at least once a year. Close relatives with liver cancer, patients with chronic hepatitis or long-term alcohol consumption should increase hepatitis B and alpha-fetoprotein tests according to the doctor's recommendation.

Additionally, if people have the following symptoms, they should get tested as soon as possible:

1. Liver pain: Its main symptom is persistent pain in the right upper quadrant. It often worsens at night or after exertion. If the cancer nodule ruptures and bleeds, it may cause severe pain and even shock.
2. Spider nevus: It is a type of telangiectasia. The body of nevus has a central point surrounded by small blood vessel branches. It looks like a small spider. It is commonly found on the face, neck, hands and upper chest.
3. Liver palm: It manifests as flaky hyperemia, red spots or plaques on the skin at the thenar area of the palm.
4. Jaundice: The skin and the whites of the eyes turn yellow. In severe cases, stool may turn gray and sweat, urine, and tears turn yellow. Sometimes it is accompanied by itching of the skin.
5. Other symptoms: decreased appetite, weight loss, exhaustion and fatigue, etc.

Recommendations for the prevention of liver cancer: People should drink less or no alcohol. Raw food should not be eaten, especially raw freshwater fish. Leftovers should be eaten less. Do not eat food that has a change in taste or texture. Do not take medicine indiscriminately.

3. Gastric cancer.

The high-risk groups for gastric cancer are people with a history of chronic gastritis, gastric ulcer and Helicobacter pylori infection, people have undergone gastric cancer resection, their close relatives with gastric cancer and they are over the age of 40. It is recommended to have gastroscopy annually.

Additionally, if people have the following symptoms, they should get tested as soon as possible:

1. Upper abdominal discomfort: The common symptoms of early gastric cancer include abdominal distension and pain that will worsen after eating, hiccups, loss of appetite, etc.
2. Acid reflux and heartburn: Gastric cancer may reduce gastric motility. Stomach acid may flow back into the esophagus after eating. It causes symptoms of heartburn.
3. Dark stools, blood in the stool and anemia: Gastric cancer can cause bleeding in the stomach. It may cause symptoms such as dark stools, blood in the stool and anemia.
4. Rapid weight loss.

Recommendations for the prevention of gastric cancer: The daily diet should be regular. The food should be chewed and swallowed slowly. Processed foods such as pickled and smoked should be eaten less. Processed foods, such as pickled and smoked, as well as fried and grilled foods should also be avoided. Cutlery and drinking glasses should be used independently and should not be shared with others. Daily routine should be healthy and regular.

4. Lung cancer.

Adults aged 55 and older who have smoked for more than 30 years or who have quit smoking for less than 15 years should have annual low-dose CT scans. Adults 50 years and older who have smoked for more than 20 years, have a family history, or have a work environment with dust pollution should also have a low-dose CT scan every year.

Additionally, if people have the following symptoms, they should get tested as soon as possible:

1. Cough: It is mostly an irritating dry cough.
2. Hemoptysis or blood in sputum: A ruptured blood vessel or vasculitis can cause blood in the sputum when coughing. If the blood vessel is bleeding heavily, it may have hemoptysis symptoms.
3. Chest pain: Surrounding tissue can be invaded by tumor cells. It often causes irregular pain in the chest. If the pain is sharp and severe, it indicates that the tumor cells have spread outward.
4. Others: Chest tightness, shortness of breath, hoarseness and so on are possible symptoms.

Recommendations for the prevention of lung cancer: Patients should quit smoking and avoid inhalation of second-hand smoke, oil fumes and other fumes. They should use masks appropriately.

5. Cervical cancer.

Women aged 25 to 29 should have a cytology test every 3 years. Women aged 30 to 64 should undergo combined screening for high-risk HPV and cytology every 5 years. Screening can be discontinued in women aged 65 years and older with normal results in previous test.

Additionally, if people have the following symptoms, they should get tested as soon as possible:

1. Bleeding on contact: Vagina can occur small amounts of bleeding during sex, after a gynecological examination or straining to defecate.
2. Abnormal secretions: Vagina occurs white or bloody secretions. Its texture is thin, watery and often accompanied by a fishy odor.
3. Vagina occurs irregular bleeding after menopause: Menopausal women experience sudden vaginal bleeding.

Recommendations for the prevention of cervical cancer: People should be vaccinated against HPV. Practice hygiene and contraceptive measures during sex. Quit smoking.

6. Breast cancer.

Breast ultrasound and mammography should be done annually after age 40.

Additionally, if people have the following symptoms, they should get tested as soon as possible:

1. Breast lump: It is mostly a single breast. The lump feels hard to the touch, with uneven edges, a rough surface and sometimes feels pain.
2. Swollen lymph nodes in the armpit: Sometimes, swollen lymph nodes can be touched in the front and lower part of the armpit.
3. Nipple discharge: Bright red or dark red fluid from the nipple, sometimes watery.
4. Breast skin changes: The localized skin of the breast becomes rough. It is like an orange peel. Local compression on the breast can create an inward depression.

Recommendations for the prevention of breast cancer: Women can check their breasts on their own. If you have the above symptoms, you should seek medical treatment in time. Contraception should be used if pregnancy is not planned. Quit smoking and limit alcohol consumption.

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Introduction of α-glucosidase inhibitors.📋📋📋

Diabetes is a very common chronic disease. With the development of social economy, the incidence of diabetes is getting higher and higher, and it has a younger trend. There are many types of hypoglycemic drugs. One of the common clinical hypoglycemic drugs is α-glucosidase inhibitors. How does an α-glucosidase inhibitor work and what is the difference between different α-glucosidase inhibitors?

Common α-glucosidase inhibitors.

Acarbose, voglibose and miglitol are common alpha-glucosidase inhibitors. 

• Acarbose is obtained by the direct extraction and isolation of secondary metabolites of Actinomycetes.
• Voglibose is obtained by modifying the structure of secondary metabolites of Actinomycetes.
• Miglitol is obtained by structural modification of secondary metabolites of Bacillus.

Acarbose

Voglibose

Miglitol

Mechanism of action of α-glucosidase inhibitors.

Monosaccharides (such as glucose, fructose, and galactose), disaccharides (such as sucrose, maltose), and polysaccharides (such as starch) are sugars in food. They are the most important energy substances in the human body. Small intestinal epithelial cells can directly absorb monosaccharides. Disaccharides and polysaccharides require α-glucosidase to hydrolyze them into monosaccharides for reabsorption. Therefore, when α-glucosidase activity is inhibited, the absorption of sugar can be reduced. α-glucosidase is a general term for carbohydrases such as sucrase, lactase, maltase, isomaltase, and alpha-critical dextrinase. α-glucosidase inhibitors are structurally similar to disaccharides or polysaccharides. It binds to α-glucosidase and inhibits its activity. It reduces the breakdown of these sugars into simple sugars, thereby reducing sugar absorption. It can effectively reduce glycosylated hemoglobin (HbA_1c) and the fluctuation of blood sugar after meals. 

Differences between acarbose, voglibose and migliitol.

The biggest difference between them is that they inhibit different carbohydrases. 

• Acarbose has the effect of inhibition mainly to glucoamylase, sucrase and pancreatic α-amylase.
• Voglibose mainly has inhibitory effects on maltase and sucrase and the inhibitory activity of acarbose on these two enzymes is much lower than it. Voglibose does not inhibit amylase. The starch in the food will be decomposed into disaccharides in the small intestine and relatively small starch enter to the large intestine. Therefore, gastrointestinal reactions such as bloating are less likely to occur with voglibose.
• Miglitol can inhibit all α-glucosidases. Among them, it has the highest ability of inhibition to glucoamylase and sucrase. The reason may be because its structure is similar to glucose, so it can bind to various α-glucosidases.

Dosage of acarbose, voglibose and migliitol.

• Acarbose should be taken as a whole tablet immediately before a meal or chewed with the first few bites during a meal. Its starting dose is 50mg each time, 3 times a day. Then it was gradually increased to 100 mg each time, 3 times a day. In individual cases, it can be increased to 200 mg each time, 3 times a day.
• Voglibose needs to be taken before meals and have meals immediately after taken it. Adults usually take 3 times a day, 0.2mg each time. If the treatment effect is not obvious, it can be increased to 0.3mg each time after sufficient observation.
• Miglitol needs to be taken before meals and have meals immediately after taken it. Its starting dose is 25mg each time, 3 times a day. Then it was gradually increased to 100 mg each time, 3 times a day. The maximum dosage can be increased to 200 mg each time, 3 times a day.

Differences in hypoglycemic ability.

All α-glucosidases inhibitors can effectively reduce 2-hour postprandial blood glucose and HbA_1c levels in patients with type 2 diabetes. Studies have indicated that their HbA_1c-lowering efficiency is voglitose < miglitol < acarbose. 

Precautions.

Acarbose and voglibose can damage the liver and should not be used in patients with severe liver dysfunction. When the patient's glomerular filtration rate is greater than or equal to 25ml/min, no adjustment of dosage is required. However, when the patient's glomerular filtration rate is less than 25ml/min, it is contraindicated.

Miglitol is not metabolized by the liver, so no dose adjustment is required in patients with hepatic insufficiency. Most miglitol is excreted by the kidneys, so patients with renal impairment will accumulate it in the body. However, no dose adjustment is required in patients with mild to moderate renal insufficiency. It is not recommended for patients with severe renal insufficiency.

Common adverse reactions of α-glucosidase inhibitors.

The pharmacological effects of α-glucosidase inhibitors can cause gastrointestinal reactions. In theory, after α-glucosidase inhibitors works, all the sugar is absorbed before it reaches the terminal ileum. But in reality, undigested sugars and starches are broken down by enzymes in the large intestine. It produces acids such as lactic acid and acetic acid. As a result, the pH in the intestine will drop and the osmotic pressure will increase. It causes diarrhea. The decomposition reaction also produces gases such as hydrogen and carbon dioxide, which can cause bloating. Therefore, α-glucosidase inhibitors are recommended to start with small doses. Patients will generally gradually tolerate it after 2 weeks of treatment.

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Some dietary advice for cancer patients.🍱🍱🍱

As mentioned in the previous article, nutrition intake for cancer patients is
very important. This article will share some dietary advice for cancer patients.

Directions for an anticancer diet.

At present, no single food can prevent or treat cancer, but the right combination of food may have the effect of adjuvant treatment or prevention. For a balanced diet, the human body generally needs no more than one-third of animal protein and at least two-thirds of plant food.

The richer the color of the food, the better the anti-cancer effect.

Vegetables and fruits are rich in anticancer nutrients. The more colors they have, the more nutrients they contain. These foods can also reduce cancer risk in other ways. They can help patients maintain a healthy weight. Being overweight increases the risk of several cancers, such as esophageal, stomach and colon cancers. Eating a variety of fruits and vegetables can help prevent cancer, especially orange, red and dark green fruits and vegetables.

Eating foods rich in folic acid for breakfast can help anticancer.

Folic acid is one of the important B vitamins. It can help resist breast, rectal and colon cancer. Breakfast foods rich in folic acid, such as whole grains, melons, strawberries and oranges are also good sources of folic acid. Other good sources of folic acid are eggs. It can also be consumed in sunflower seeds, beans and green leafy vegetables such as spinach. The best way to get folic acid is to eat enough grain products, vegetables and fruits. It should not rely on folic acid supplements to get folic acid.

Cancer risk from processed foods.

Eating a hot dog or ham sandwich occasionally does not increase cancer risk. However, eating less processed foods like ham, sausage, and bacon can help reduce the risk of stomach, colon, and rectal cancers. Also, studies have pointed out that cured or smoked meats contain chemicals that can cause cancer.

Anticancer potential of tomatoes.

Studies have found that eating tomatoes can reduce the risk of several cancers, such as prostate cancer. Studies have also shown that ketchup or tomato juice can activate the anti-cancer potential in the body.

Tea and cancer.

Although the quality of research is uneven, tea may have strong anticancer properties, especially green tea. Studies have shown that green tea can delay or prevent the development of cancer cells in the breast, liver, prostate and colon. In addition, similar effects can also observe in lung and skin tissue. Tea may also reduce the risk of stomach, pancreatic, and bladder cancers.

Grapes can fight cancer.

Grapes and grape juice contain resveratrol, especially in fuchsia grapes. Resveratrol has strong anti-inflammatory and antioxidant properties. Studies have shown that it prevents some of the cellular damage that can trigger cancer. However, there is not enough evidence that eating grapes, drinking grape juice, wine or taking supplements can avoid or heal cancer.

Drinking alcohol increases cancer risk.

Alcohol consumption has been linked to cancers of the mouth, throat, esophagus, breast, liver, colon and rectum. The American Cancer Society recommends that men should drink less than two drinks a day and women should drink less than one drink a day. Women at high risk of breast cancer need to ask their doctor what the maximum amount of alcohol they can consume per day, even if they want to drink alcohol, based on personal health. Women at high risk of breast cancer should consult their doctor about the amount of alcohol they can drink.

Water and other fluids have anticancer properties.

Water may reduce the risk of bladder cancer by diluting the concentration of potential cancer carcinogens in the bladder. In addition, consuming more fluids can cause you to urinate more frequently. It reduces the time that the carcinogens are in contact with the bladder mucosa.

Bean and cancer.

Beans are known to be good for the body. They can also help fight cancer. Beans contain chemicals that protect the body's cells and may have anti-cancer effects. Studies have shown that they prevent tumor cells from releasing substances that can damage surrounding cells. It slows the growth of tumor cells.

Cruciferous Vegetables and cancer.

Cruciferous vegetables include cabbage, Chinese cabbage, broccoli, cauliflower, kale and so on. These cruciferous vegetables can be eaten raw or cooked. These vegetables also contain ingredients that can help fight cancers such as lung, breast, cervix, and colon cancer.

Dark leafy greens and cancer.

Dark leafy greens such as kale, mustard greens, spinach are rich in fiber, carotenoids, and folate. These nutrients protect in the mouth, throat, pancreas, lungs, skin and stomach. They can against cancers of those organs.

Curcumin.

Curcumin is the main ingredient in the cooking spice turmeric. It has potential anticancer effects. Studies have shown that it can inhibit the transformation, proliferation and invasion of tumor cells. It can prevent a wide range of cancers.

Cooking methods.

Cooking methods may also increase the risk of cancer. Frying and grilling food at high temperatures can generate harmful chemicals. This may increase the risk of cancer. Cooking methods of stewing, boiling or steaming produce relatively few of these chemicals.

Berries.

Berries such as strawberries, blueberries and raspberries are rich in antioxidants. They are able to eliminate free radicals, which prevent free radicals from harming cells. Thus berries can help prevent or delay the development of cancer.

Sugar.

Although sugar doesn't directly cause cancer, it may inhibit the absorption of other foods that help fight cancer. It also increases the intake of calorie. It leads to overweight and obesity. Overweight is one of the risk factors of cancer. If the patient wants to consume sugar, they can choose to consume sugar from fruit.

Supplements.

Although nutrients such as vitamins may help prevent cancer, they only work when they are absorbed naturally from food. Studies have shown that getting anticancer nutrients from foods such as green leafy vegetables, fruits and beans can be far more effective than their supplements. A healthy diet is better than all nutrition.

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Common nutritional questions about cancer patients.❓❓❓

Nutritional issues are a very important issue for every cancer patient as well as for clinicians. It can affect the effect of cancer treatment. However, how to take nutrition for cancer patients, and how to take nutrition for cancer patients with other diseases will confuse patients. Most cancer patients and their families are affected by rumors or misunderstandings. It will make them fall into various dietary mistakes. This leads to a series of problems such as insufficient nutrient intake, low quality and nutritional imbalance. It leads to aggravation of malnutrition, reduced quality of life and even survival time. The followings are answers to some common cancer diet questions. 

Do anticancer foods really work?

There is currently no evidence that a single food can cure or prevent cancer. During treatment, many patients and their families search the Internet for various anti-cancer foods, such as garlic, blueberries, and green tea. They would expect to rely on these foods for the purpose of treating cancer. Although there are some foods have high levels of natural anticancer ingredients, such as some phytochemicals, none of them are guaranteed to prevent or treat cancer. If the patient consumes an excessive single anticancer food, the diversity of food intake may be affected. It can cause reduced intake of other essential nutrients and lead to nutritional imbalances. Therefore, in order to reduce the risk of cancer or achieve the effect of cancer treatment, it is best to focus on developing long-term healthy eating habits. It should be a balanced diet, more exercise and no smoking.

Can low intake of nutrients kill tumor cells?

Some people think that tumor cells need to absorb nutrients just like normal cells. Therefore, as long as you reduce your nutrient intake, you can also kill tumor cells. However, there is no evidence that intaking nutrients will promotes the growth of tumor cell. Instead, when you are undernourished, tumor cells rob the nutrients of normal cells. They even break down human muscle cells and protein to supplement nutrients. In the end, only the patient and not the tumor cells are killed.

Can patients eat fried or grilled food during cancer treatment?

People who are recovering from cancer should not eat fried or grilled food. Healthy people should also not eat these foods too much. Frying and grilling typically involve high temperatures in excess of 200 degrees. High temperature can cause fat to generate free radicals and form carcinogens such as benzopyrenes and polycyclic aromatic hydrocarbons. Starches form acrylamides. Proteins can form strong carcinogens such as heterocyclic amines. They all cause cancer.

Can soup supplement more nutritious?

Many people think that soup is full of nutrients. But in fact, the nutrition of soup is only 5-10% of the raw materials and most of it is fat and some vitamins and minerals. Most of the nutrients (especially protein) are left in the residues from soup. It is recommended to eat the soup with the residues if you want to intake more nutrients.

Can cancer patients intake sugar?

Cancer patients can eat sugar. All cells in the body need sugar for energy. Tumor cells proliferate more rapidly than normal cells. They have a greater need for sugar. Therefore, some people believe that eating too much sugar will provide nutrients to tumor cells and promote them grow rapidly. But this idea is wrong. In fact, as long as the intake is reasonable, cancer patients can consume sugar. A 2009 recommendation by the American Cancer Institute that cancer patients should limit their intake of refined sugars. Female patients should not exceed 25 grams per day. Male patients should not exceed 38 grams per day.

Can eating more vitamins and other health products help treat cancer?

In a balanced diet, a variety of vitamins and minerals will be ingested. Patients do not need to supplement vitamins additional. However, if a cancer patient has a decreased appetite or an unbalanced diet, the patient can take vitamin supplements after evaluation by a professional. If patients rely on supplemental vitamins, it may cause them to reduce their intake of whole foods, such as vegetables and fruits, and thus reduced intaking of other nutrients in these foods.

Is it good for cancer patients to eat more Cordyceps sinensis, ginseng and Ganoderma lucidum?

Due to lack of nutritional knowledge, cancer patients often think that precious medicinal materials such as Cordyceps sinensis, Ganoderma lucidum, ginseng, and bird's nest can help treat cancer. In fact, patients should not pursue the immune effect of a certain food too much, nor should they rely too much on these precious medicinal materials. A balanced diet and comprehensive nutritional supplements are a good way to improve the overall immunity.

Is it recommended to eat vegetables raw or cooked?

There are studies about the raw or cooked vegetables with the risk of cancer. These studies found that raw or cooked vegetables both are low risk of cancer, but raw vegetables have a stronger relation with low risk of cancer. However, if the patients can not tolerant to raw vegetables, they should eat cooked vegetables.

Is organic food healthier than regular food?

Organic food is not healthier than regular food. Organic food refers to food grown on uncontaminated land without pesticides or herbicides. There are many reasons why people choose organic food. However, no studies have shown that there is a significant difference in the nutrient content of organic food and ordinary food. There is also no evidence that organic food reduces cancer risk more than regular food. Although organic foods may be safer than regular foods, there are some foods labeled organic, such as organic cookies, organic potato chips and other snacks, which have the exact same calorie, fat, sugar and other content as regular foods. Therefore, patients should not blindly think that organic food is healthy food.

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What is the difference between metoprolol, carvedilol and labetalol❔❔❔

β-blockers are an important class of cardiovascular drugs. It plays an irreplaceable role in the prevention and treatment of chronic heart failure, ischemic heart disease, hypertension and arrhythmia. Metoprolol, carvedilol and labetalol are three types of beta-blockers commonly used in clinic. What is the difference between them?

1. Mechanism:

Metoprolol is a selective β1-blocker. 

Carvedilol and labetalol are nonselective beta-blockers. The ratios of their α and β receptor blocking effects were about 1:10 and 1:3, respectively. Carvedilol has antioxidant properties. Labetalol has a strong blocking effect on α-receptors. Labetalol has intrinsic sympathomimetic activity and is less lipid soluble. Therefore, labetalol is theoretically less central nervous system adverse effects.

2. Clinical application:

Increased sympathetic excitability will accelerate the occurrence and development of heart failure. 

Metoprolol and carvedilol: Metoprolol succinate, carvedilol and bisoprolol have been shown in clinical trials to reduce the risk of death, sudden death, and hospitalization in patients with chronic heart failure. They can improve patients' cardiac function and quality of life. Labetalol cannot be used in the treatment of chronic heart failure because of its intrinsic sympathomimetic activity.

labetalol: It blocks α1-receptors. It directly dilates blood vessels and lowers blood pressure without affecting placental and renal blood flow. It can also promote fetal lung maturation. It is the preferred antihypertensive drug for pregnancy-induced hypertension.

3. Dosage.

Chronic heart failure:

• Metoprolol succinate sustained-release tablets: The initial dose is 11.875-23.750 mg once a day. The target dose is 190 mg, once a day. Food does not affect its absorption.
• Carvedilol: The initial dose is 3.125 mg, twice a day. The target dose is 25-50 mg, once a day. It must be taken with food to slow absorption and reduce the occurrence of orthostatic hypotension.

The dose at which the resting heart rate is reduced to 60 beats/min is the target dose or the maximum tolerated dose of β-blockers.

Pregnancy-induced hypertension:

• Labetalol tablets: 100-200 mg each time, 2-3 times a day. Dosage needs to be adjusted according to blood pressure. The maximum dose is 2400 mg daily. Take after meals.

4. Adverse effects.

Effects on Peripheral Resistance: Carvedilol and labetalol have α1-blocker effects compared to metoprolol. It dilates peripheral blood vessels and reduces vascular resistance. In theory, it may be more suitable for patients with hypertension and peripheral arterial disease. Labetalol can cause intermittent reductions in nipple blood flow. It may cause nipple numbness, paleness and pain (Raynaud's phenomenon).

Effects on Respiratory Function: Metoprolol is a selective β1-blocker. It has relatively little effect on β2-receptors. Patients with coronary heart disease and chronic obstructive pulmonary disease can choose metoprolol (or bisoprolol).

Effects on Glucose Metabolism: Catecholamines increase glycogenolysis by agonizing β2-receptors. Therefore, metoprolol has less effect on blood sugar and is less likely to cause hypoglycemia. However, β-blockers can mask symptoms of hypoglycemia, such as tachycardia and tremor. In addition, studies have found that carvedilol has vasodilator and antioxidant effects. It improves insulin resistance and lowers triglycerides.

Orthostatic hypotension: Carvedilol and labetalol have α1-blocker effects. It relaxes vascular smooth muscle, especially in the upright position. A small number of patients may develop orthostatic hypotension 2 to 4 hours after taking the drug.

5. Discontinue medication.

Long-term use of β-blockers can increase the expression of β-receptors. Since a large number of β-receptors are available for catecholamines, it will promote cardiac and vasoconstriction. If β-blockers are suddenly discontinued, a rebound in blood pressure can develop. Patients with ischemic heart disease can induce angina attacks and even myocardial infarction. The entire withdrawal period should be at least 2 weeks. During this period, patients with known ischemic heart disease should be closely monitored.

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Some knowledges of the statin lipid-lowering drugs.📓📓📓

Statins are 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors. It not only potently lowers total cholesterol and low-density lipoprotein cholesterol (LDL-C), but also lowers triglyceride (TG) to a certain extent and raises high-density lipoprotein cholesterol (HDL-C). Therefore, statins are a more comprehensive lipid-lowering drug. The lipid-lowering efficacy and cardiovascular benefits of statins have been repeatedly confirmed and fully affirmed. Rational use of statins requires at least the following knowledges.

Cholesterol control targets for these individuals with statins:

Patients with coronary heart disease and stroke: LDL-C < 1.8mmol/L.

Patients with carotid artery stenosis greater than 50%: LDL-C < 1.8mmol/L.

Hypertensive patients with 2 to 3 risk factors: LDL-C < 2.6mmol/L.

Diabetic patients over age 40: LDL-C < 2.6mmol/L.

Risk factors include:

• Males ≥45 years old.
• Women ≥ 55 years old.
• Smoking.
• HDL-C < 1.0mmol/L.

Diabetic patients are more prone to cerebral infarction. Therefore, most people with diabetes need to take statins. HDL-C is commonly known as good cholesterol. It promotes the transfer of LDL-C (bad cholesterol) from peripheral blood vessels to the liver for elimination.

What do statins do?

Ability to regulate blood lipids:

• Atorvastatin can reduce LDL-C by about 39-50% and TG by about 19-29%. It increases HDL-C by about 6-9%.
• Pitavastatin can reduce LDL-C by about 34-47% and TG by about 23%. It increases HDL-C by about 12%.
• Rosuvastatin can reduce LDL-C by about 45-55% and TG by about 10-35%. It increases HDL-C by about 8-13%.
• Simvastatin can reduce LDL-C by about 23-35% and TG by about 21-39%. It increases HDL-C by about 9-14%.

Stabilize and reverse plaques:

• High levels of LDL-C can lead to inflammatory reactions in blood vessels. Statins play an anti-inflammatory role by lowering the levels of LDL-C in patients. Statins stabilize plaques through their anti-inflammatory effects. When statins significantly lower LDL-C and raise HDL-C, they will reverse atherosclerotic plaque.

Do statins need to be taken long-term? Can statins be discontinued when cholesterol reaches the target level?

Statins are required for taken long-term. As long as the patients have no contraindications and can tolerate statins, patients with cardiovascular and cerebrovascular diseases should insist on taking them. Studies have found that the longer the lipid-lowering treatment in patients with cardiovascular and cerebrovascular disease, the greater the reduction in the risk of cardiovascular and cerebrovascular events. 

Are all statins taken at bedtime?

The liver synthesizes cholesterol throughout the day, but the peaks of cholesterol synthesis are between 0:00 and 3:00. Therefore, some statins are recommended to be taken at bedtime. But their taking time also needs to consider their half-life and whether they will be affected by food.

1. Atorvastatin and rosuvastatin: They have longer half-lives and inhibit cholesterol synthesis throughout the day. Therefore, it has a great lipid-lowering effect and can be taken at any time.
2. Fluvastatin, pravastatin and simvastatin: They are rapidly absorbed orally and have a short half-life. They mainly inhibit the synthesis of cholesterol between 0:00 and 3:00. Therefore, they have little lipid-lowering effect and need to be taken before going to bed.
3. Pitavastatin: It has a longer half-life and is affected by enterohepatic circulation. It is generally required to be taken after dinner.
4. Lovastatin: Absorption is reduced by 30% when it is taken on an empty stomach. Food promotes its absorption, so it should be taken within 0.5 hours after dinner.

What are the precautions for statins?

Myalgia: If you have unexplained myalgia, seek treatment immediately. The incidence of statin-induced myopathy is approximately 1.5 to 5%. The symptoms of myalgia are easily ignored by patients. The main features of statin-induced myalgia are symmetrical hip flexor and thigh pain, symmetrical calf pain, and symmetrical upper extremity proximal muscle pain.

Liver discomfort: If you have liver discomfort, seek treatment immediately. Statins are hepatotoxic. In about 1 to 2% of all patients receiving statin therapy, liver enzyme levels increase above 3 times the upper limit of normal. Liver enzyme levels can drop after stopping the drug.

The interactions of statins with drug and food: 

1. Grapefruit: Try to avoid grapefruit while taking atorvastatin, lovastatin and simvastatin. This can increase the risk of myopathy.
2. Vitamin E: Studies have found that vitamin E significantly accelerates the clearance of simvastatin and reduces its lipid-lowering effect.
3. Erythromycin and clarithromycin: Atorvastatin, lovastatin and simvastatin should be avoided in combination with erythromycin and clarithromycin.
4. Amlodipine and ticagrelor: If used in combination with amlodipine, the dose of lovastatin and simvastatin should not exceed 20 mg/day. If used in combination with ticagrelor, the dose of lovastatin and simvastatin should not exceed 40 mg/day.

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