How to treat postherpetic neuralgia?🔨🔨🔨

Herpes zoster is an infectious disease caused by a virus. The varicella-zoster virus can remain latent in the human body for a long time. They can be reactivated to cause infectious skin disease. Postherpetic neuralgia is one of the complications of shingles. Pain that persists for 1 month or more after clinical healing of the shingles rash is considered postherpetic neuralgia. Its prevalence ranges from approximately 9% to 34%. Patients with postherpetic neuralgia suffer from severe pain for a long time, which can easily lead to depression and their quality of life will be seriously reduced.

What are the clinical manifestations of postherpetic neuralgia?

1. Clinical manifestations of pain:

The clinical presentation of postherpetic neuralgia is complex and varied. It can be continuous or discontinuous. It has the following characteristics:

• Pain location: common in trigeminal nerve (mainly ophthalmic branch), neck or unilateral chest. About 50% of the patients occurred in the chest. Occurrence in the head and face, neck and waist accounted for 10% to 20% respectively. Occurs in the sacrum about 2% to 8%. Other parts are less than 1%. The painful area of postherpetic neuralgia is usually larger than the area of herpes zoster. Bilateral herpes is rarely seen in patients.
• The feeling of pain: Different patients experience different pain sensations. It can be like burning, knife cutting, needle sticking, shocking or tearing. Patients may experience one type of pain or possibly multiple pains at the same time.

2. Features of Pain:

• Spontaneous pain: Pain occurs in the rash distribution area and the surrounding area without any stimulation.
• Hyperalgesia: The patient's response to a noxious stimulus is prolonged or intensified.
• Allodynia: Nonnoxious stimuli cause pain in the patient. Such as small changes in temperature, clothing rubbing against the body, etc. will cause pain to the patient.
• Paresthesia: The patient will have some paresthesias such as numbness, itching and tightness in the painful area. Patients may also experience objective sensory abnormalities such as hypoesthesia, abnormal temperature and vibration sensations. 

3. Course of disease:

Postherpetic neuralgia persists for more than a year in 30% to 50% of patients. In some patients, the course of the disease can even reach ten years or more.

4. Other clinical manifestations:

Patients with postherpetic neuralgia are often accompanied by decreased mood, sleep and quality of life. Anxiety, depression, inability to concentrate, etc. are manifestations of moderate to severe disturbance of their emotions. Studies have pointed out that about 60% of patients have had or often have suicidal thoughts. More than 40% of patients have moderate to severe disturbance of daily life and sleep disturbance. Various systemic symptoms such as chronic fatigue, anorexia, weight loss and lack of activity may also appear in patients. 

Drug therapy for postherpetic neuralgia.

Gabapentin: It is a first generation calcium channel modulator. Its pharmacokinetic profile is non-linear and its bioavailability decreases with increasing dose. Its initial oral dose is 300 mg daily and patients need about several weeks to slowly titrate to the effective dose. Its effective dose is generally 900 to 1800 mg daily. The dose of gabapentin should be reduced in patients with renal insufficiency. In order to avoid adverse reactions of dizziness and drowsiness in patients, the dose should be started, slowly increased or gradually decreased at night.

Pregabalin: It is a second-generation calcium channel modulator. It can relieve postherpetic neuralgia. It can also improve sleep and mood disorders. Its pharmacokinetic profile is linear and has a rapid onset of action. Its oral initial dose is 150 mg daily. Its dose can be increased to 300 mg daily within a week and its maximum dose is 600 mg daily.

Amitriptyline: It is a tricyclic antidepressant. It inhibits the reuptake of serotonin and norepinephrine by the presynaptic membrane. It also blocks alpha adrenoceptors and sodium channels. The descending pathway of pain conduction will be regulated by the above mechanism to play an analgesic effect. However, its onset is slow. Its first dose should be taken at bedtime. Take two to three times a day, 12.5 to 25mg each time. The dose can be gradually increased according to the patient's response to amitriptyline. It recommends a maximum daily dose of 150mg, but in some patients up to 300mg is available. Amitriptyline should be avoided in patients with ischemic heart disease or at risk of sudden cardiac death. Patients with high risk of glaucoma, urinary retention and suicide should also use amitriptyline with caution.

5% lidocaine patch: It inhibits voltage-gated sodium channels and reduces ectopic impulses of primary afferent nerves after injury. This reduces pain perception in people with postherpetic neuralgia. Its onset of efficacy is ≤4 hours. Patients can apply 1 to 3 patches to the painful area. Each patch can be used for up to 12 hours.

Tramadol: It acts on μ-opioid receptors, serotonin receptors, and norepinephrine receptors to achieve analgesic effects. It can relieve burning pain, pin prick pain and allodynia caused by postherpetic neuralgia. However, it has no obvious analgesic effect on lightning-like and knife-like pain. Its initial dose is 25 to 50 mg once or twice daily. The maximum daily dose is 400mg. Nausea, vomiting, dizziness, constipation and other adverse reactions are dose-related.

Opioid analgesics such as morphine, oxycodone, and fentanyl are effective in the treatment of postherpetic neuralgia, but their addiction and tolerance limit them to second-line treatment. In addition, neurotrophic drugs can help relieve nerve pain and neuroinflammation. Commonly used drugs are methylcobalamin, vitamin B1 and vitamin B12. They can be given orally or injected intramuscularly.

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What is the difference between zopiclone and eszopiclone?💤💤💤

Insomnia is one of the most common types of sleep disorders in clinical practice. Almost all psychiatric patients may be accompanied by insomnia. The main manifestations of insomnia are: difficulty falling asleep (falling asleep for more than 30 minutes), difficulty maintaining sleep (the number of awakenings throughout the night ≥ 2 times), total sleep time reduction (total sleep time ≤ 6 h), sleep quality reduction and early awakening. At present, the clinical treatment of insomnia drugs is mainly divided into three categories: benzodiazepine receptor agonists (that is, traditional benzodiazepine drugs and new non-benzodiazepine drugs), melatonin receptors agonists and antidepressants with hypnotic effects. Previously used traditional benzodiazepines, such as alprazolam, lorazepam. They can also shorten the patient's sleep latency and increase the total sleep time. However, due to continuous use will produce dependence and obvious adverse reactions,  it is now gradually withdrawing from the clinical stage. The new non-benzodiazepine drugs, such as zolpidem, zopiclone and zaleplon. These drugs have short half-life and the residual effect of the next day is minimized. Therefore, they generally do not produce daytime drowsiness. The dependence caused by long-term use is also greatly reduced compared with traditional benzodiazepine drugs. In addition, these drugs are safe and effective in the treatment of insomnia. Among non-benzodiazepine drugs, zopiclone and eszopiclone are commonly used clinical sedatives and hypnotics. What is the difference between them?

1. Medicinal effect.

Zopiclone is a racemate. It is consisting of S-Zopiclone (Eszopiclone) and R-Zopiclone (L-zopiclone). It is a non-benzodiazepine sedative and hypnotic, which mainly exerts sedative and hypnotic effects by selectively activating the α1 subunit on the γ-aminobutyric acid receptor.

The affinity of eszopiclone to the γ-aminobutyric acid receptor is 50 times that of L-zopiclone. The hypnotic effect of 3mg eszopiclone is equivalent to that of 7.5mg Zopiclone.

2. Toxicity.

The results of animal experiments showed that the LD50 of eszopiclone was 1500mg/kg, the LD50 of L-zopiclone was 300mg/kg and the LD50 of racemate was 850mg/kg.

3. Pharmacokinetics.

Eszopiclone is absorbed faster and has a longer half-life than L-zopiclone. However, zopiclone contains 50% of eszopiclone, so there is not much difference between the onset time and maintenance time of zopiclone and eszopiclone. 

It takes about 1 hour for eszopiclone to reach its peak value. Taking it with food can delay the peak time by 1 hour. The half-life in adults is 6 hours, and the half-life in the elderly is 9 hours. It is metabolized by the liver, and CYP3A4 is the main metabolic enzyme. 10% is excreted in urine in its original form.

• For adult patients: The recommended dose is 1-3 mg before going to bed. 
• For elderly patients who have difficulty falling asleep (It takes more than 30 minutes to fall asleep): The recommended starting dose is 1 mg, and can be increased to 2 mg if necessary. 
• For elderly patients with sleep maintenance disorders (The number of awakenings throughout the night ≥ 2 times): the recommended dose is 2 mg before going to bed.

Zopiclone takes about 1.5-2 hours to reach its peak, and food does not affect its peak time. The half-life in adults is 5 hours, and the half-life in the elderly is 7 hours. It is also metabolized by the liver, and CYP3A4 is also its main metabolic enzyme. 4-5% is excreted in urine in its original form.

• For adult patients: the recommended dose is 3.75-7.5 mg before going to bed. 
• For elderly patients: the recommended dose is 3.75 mg.

The total absorption of the two drugs in the elderly (≥65 years) is 41% higher than that in adults, and the half-life is longer. Therefore, elderly patients should start with a low dose.

4. Adverse effects.

The most common adverse effect of zopiclone and eszopiclone is abnormal taste (bitter mouth, metallic taste), which is dose-related and can disappear after stopping the drug. There are also stomach burning and sedation, dizziness, and dose-related amnesia. Some patients also experience symptoms such as dry mouth, headache, and nervousness. Some long-term studies believe that they will not show obvious dependence.

Non-benzodiazepine drugs may cause sleepwalking, sleepwalking and driving. Although it is rare, it can cause serious injury or death. If the above sleep behavior occurs, please seek medical attention immediately and stop such drugs under the guidance of a doctor.

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What should you do if your eyes are tired?😵😵😵

During the 24 hours a day, our eyes are in use at other times except for sleeping time. If you look at mobile phones, computers, TVs or books for a long time, I believe you will see things blurred sometimes. For example, the handwriting is blurred and confusing when reading or the wrong line is read when reading. In fact, this is some manifestations of asthenopia. In addition, if long-term asthenopia is not effectively alleviated, it can lead to a decline in visual function.

Causes of asthenopia.

Asthenopia is very common in clinical practice. It is caused by the sudden relaxation or convulsive contraction of the temporary ciliary muscle. There are many factors that cause asthenopia:

1. Use your eyes for too long.
2. The effect of object color.
3. Nervous.
4. Sleep disorder.
5. The effect of light.
6. Excessive smoking and drinking.
7. It is related to physical fitness.

Methods to prevent asthenopia.

1. In daily life, we can do more eye exercises.
2. Eyes should be used wisely to avoid using eyes for too long.
3. Exercise to enhance physical fitness. 
4. Avoid staying up late to ensure adequate sleep time.
5. Participate in outdoor activities. Let your eyes see the distance and green plants more.
6. Eliminate the unfavorable factors in the work and study environment, so that the eyes are in a comfortable eye environment.

Drugs to relieve asthenopia.

In addition to improving daily eye habits, we may also need to use drugs at certain times. However, there are many kinds of eye drops on the market and not every one is suitable for us. If we choose the wrong one, it will cause irreversible damage to our eyes.

1. Artificial tears

Artificial tears are currently the safest medicine to relieve eyesight fatigue. It mainly simulates natural tears, which can form a protective film of tears on the surface of the eyes and reduce the loss of water in the eyes. When the eyes are dry, artificial tears can appropriately relieve the symptoms and do not contain any anti-allergic or anti-inflammatory ingredients. In addition, some artificial tear products contain antiseptic ingredients. Long-term use of artificial tears containing antiseptic ingredients will cause damage to the eyes.

Commonly used drugs are: sodium hyaluronate eye drops, polyethylene glycol eye drops, sodium carboxymethyl cellulose eye drops, hydroxysugar eye drops and so on.

The main component of sodium hyaluronate eye drops is sodium hyaluronate, which imitates the normal components of human tears. It can moisten the cornea and promote the healing of corneal wounds. It is mainly used for the treatment of dry eye and alleviating symptoms of eye dryness. Therefore, if there are symptoms such as dryness, soreness and foreign body sensation in the eyes, and it is clear that it is dry eye after examination, you can choose sodium hyaluronate eye drops to relieve the symptoms. However, although artificial tears are safe, they cannot be abused. Generally, it should be controlled 3-4 times a day. Some patients with severe dry eye can increase the number of medications depending on the situation. Under normal circumstances, no more than 6 times a day is appropriate.

2. Chondroitin sulfate eye drops

There are many different products on the market for chondroitin sulfate eye drops. For example, chondroitin sulfate + taurine, chondroitin sulfate + taurine, chondroitin sulfate + vitamin E + vitamin B6 + allantoin + taurine, etc., can all improve the symptoms of eye fatigue and dry eye.

Chondroitin sulfate is an acidic mucopolysaccharide, which is one of the important components in eye tissue. It has the functions of improving microcirculation, regulating cell growth, protecting the cornea and promoting the repair of corneal tissue damage. At the same time, it can also promote corneal water metabolism, form a protective film on the surface of the cornea, prevent water from dissipating, effectively relieve eye fatigue and dry eye symptoms. 

Taurine is an amino acid antibacterial and anti-inflammatory drug. In addition to its antibacterial and anti-inflammatory effects, it also participates in a variety of physiological activities in the eye tissues, promotes metabolism and improves asthenopia symptoms.

👉In addition, we can eat foods rich in lutein such as carrots, cabbage, corn, spinach, and kiwi. Lutein is an antioxidant. It is the main pigment that constitutes the macular area of the retina of the human eye. If it is lacking, vision will decrease and the eyes are easily dim. Therefore, it is very important to properly supplement foods containing lutein.

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When these signs of cerebral infarction appear, you should be careful.📡📡📡

The brain can control different functions such as language, vision, emotions, breathing, and physical activity. This can be said to be the human CPU. Because its role and functions are very important, it is very necessary for us to prevent brain diseases. But even if we try to protect our brain, as we age, the brain will decline. Cerebral infarction is a common disease of the brain. Cerebral infarction is also called ischemic stroke. This disease is caused by the ischemia of the brain tissue. It leads to necrosis of the brain tissue which can lead to sudden death in severe cases. Even after cerebral infarction is treated, there may still be sequelae such as hemiplegia and inability to take care of yourself. Timely treatment can reduce the chance of sequelae. If the following symptoms occur, you should be alert to cerebral infarction.

1. Headache and dizziness

Headaches and dizziness must have occurred in everyone, especially in middle-aged and elderly people. When the cerebral infarction is about to appear, the brain will also have symptoms first which are dizziness and headache. These two symptoms come very quickly and may return to normal in just a few minutes. This is caused by insufficient blood supply to the brain. If you often have similar problems in the recent period, you must be alert to the occurrence of cerebral infarction.

2. Stiffness on one side of the body and numbness in the face

Stiffness on one side of the body and numbness in the face are the most obvious symptom of a cerebral infarction. The patient will feel abnormal numbness on one side of the face and deviated mouth and eyes. This is because the brain can control the entire body. All the actions and languages we do must pass through the brain. When the brain is abnormal, it will affect the whole body. If there is a sudden deviated mouth and eyes and one side of the body is weak and uncontrollable, these are the major symptoms of a cerebral infarction. Once it occurs, you need to go to the hospital for examination immediately. After the diagnosis is confirmed, appropriate treatment measures should be taken to avoid cerebral infarction further developing.

3. Drooling on one side

This is one of the common signs of patients with cerebral infarction, especially when drooling in sleeping and it is to one side. This is a typical sign of cerebral infarction. Due to cerebral vascular infarction, the nerves of muscles are not coordinated, especially the oral cavity which leads to drooling and difficulty swallowing. 

4. Blurred vision

In addition, cerebral infarction can also cause damage to the optic nerve. It leads to retinal ischemia and hypoxia. Patients will usually experience blurred vision suddenly or the situation in front of the eyes will be dark. It will recover after a few seconds. This is one of the typical signals of cerebral infarction.

👉Once the above four abnormalities occur, it is absolutely necessary to be alert to the onset of cerebral infarction. Especially for middle-aged and elderly people suffering from hyperlipidemia and hypertension. It is very necessary to go to the hospital for examination if there is any abnormality.

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People who love to eat fish may have fewer cerebrovascular diseases.🐟🐟🐟

It is well known that eating more fish is good for the body. Recently, a research show that elderly people who love to eat fish have fewer cerebrovascular diseases. Cerebrovascular disease involves harm to cerebral blood vessels and is a risk factor for stroke and vascular dementia. The University of Bordeaux conducted a large-scale research of the relationship between vascular disease and dementia. 

They analyzed the results of MRI scans of more than 1600 people over 65-year-old who had no history of cardiovascular disease,  dementia or stroke in the research. The participants also filled out a questionnaire about their eating habits. The participants were divided into four groups based on their frequency of eating fish: four or more times a week, two to three times a week, once a week or less than once a week. Then the researchers compared their signs of cerebrovascular disease.

Eating more fish may have fewer cerebrovascular diseases

In the MRI scans, the participants who ate fish more frequently showed fewer signs of damage in their brain than the participants who ate fish less frequently. Compared with the elderly in the study, the association between vascular disease and fish intake was stronger in 65 to 69-year-old people. However, there was no significant connection between vascular disease and fish intake in over 75-year-old people.

Experts believe that for most people, the risk of dementia depends on the different complex factors, such as environmental and genetic factors. People understood which aspects of lifestyle have the greatest influence on brain health. It is the key to enabling them to make the good decisions of their lifestyle. This observational research cannot determine the reason and result relationship. Although the researchers try to control for other factors that may lead to differences in signs of cerebrovascular disease, it is still difficult to clearly ensure the relationship between cerebrovascular disease and the number of fish intake. Based on the study, it is also unclear about the relevance of the findings to long-term brain health. Although fish is a important source of essential fatty acids and the National Health Service in the United Kingdom also recommends eating two servings of fish a week as part of a balanced diet, no single specific food or supplement can be maintaining the brain healthy.

Not smoking, drinking within the recommended range, eating balanced diet, exercising moderately and have a healthy lifestyle are all lead to a healthier brain and body.😁

Reference：

Fish Intake and MRI Burden of Cerebrovascular Disease in Older Adults 11 2021,
10.1212/WNL.0000000000012916; DOI: 10.1212/WNL.0000000000012916

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The cognitive of breastfeeding women show better than non-breastfeeding.👶👶👶

It is well known about breastfeeding is good for the babies, but there were few studies have focused on the health effects of breastfeeding on mothers. Recently, a research showed that breastfeeding may also have long-term benefits for the mother's own health. Compared with women who have not breastfed their children, women who have breastfed their children carried out better performance on cognitive ability after the age of 50. 

The relationship between cognitive ability and Alzheimer's disease

Cognitive ability is closely related to the health of the elderly. However, cognitive ability will continue to be declined after the age of 50 and it may also become a important factor in predicting Alzheimer's disease (AD). Alzheimer's disease is one of the main manifestations of dementia and one of the main causes of damage to the health of the elderly. Moreover, women are more likely to suffer from AD than men. 

Breastfeeding benefit to the mother's cognitive ability

There were some studies have found that breastfeeding can help improve baby's emotion, reduce mother's stress and the risk of postpartum depression. This suggests that breastfeeding may be have great benefit to the mother's neurocognitive ability and may strengthen the mother's long-term cognitive ability.

In that research, the researchers investigate more than a hundred women with or with out depression. All participants completed a series of comprehensive psychological tests that measured learning ability, executive function, processing speed and so on. They also answered a questionnaire about their reproductive life history which included the age at they began menstruation, the number of complete and incomplete pregnancies, the length of time each baby was breastfeeding and their menopausal age. None of the participants were diagnosed with dementia or other mental illnesses such as bipolar disorder, alcohol or drug dependence, neurological disorders. They had been prevented to take any psychoactive drugs during the research. There were also no significant differences between depressed and non-depressed participants in terms of age, race, education or other cognition. Whether they were depression, the results also showed that women who had breastfed performed better than women who had not breastfed.

Whether they were depression or not, the results also showed that women who had breastfed was performed better than women who had not breastfed.

Researches need to explore the relationship between breastfeeding history and cognitive performance in a larger and more diverse group of women. It is important to better understand the impact of breastfeeding on women's health.

For more detail, read the research article👇👇👇

Women who breastfeed exhibit cognitive benefits after age 50. https://doi.org/10.1093/emph/eoab027

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What does alcohol do to your brain?🍸🍸🍸

We always know alcohol is harm for the brain and memory, but what does alcohol actually do to your brain? This time, we will discuss about it. 

1. Gray matter is decreasing

An article published in the American Journal of Psychiatry (AJP) studied the effects of alcohol consumption on brain growth and development in adolescents aged 12-21. They tracked the brains of the participants before and after the study via magnetic resonance imaging (MRI) and it was found that the volume of gray matter in the participants who drank a lot of alcohol decreased more quickly. The growth of central white matter was slower than the low-drinking group.

During the maturation of the brain, the gray matter of the cerebral cortex will normally increase during the first ten years of life and then it will continue to decline. Throughout adolescence stage, the volume of white matter increases and only slows down in the third decade. The results of the study show that alcohol clearly deviates the teenagers' brains from normal developmental rules. Because the prefrontal area of the brain is the latest to mature, the prefrontal cortex gray matter has the most obvious effect. The frontal cortex is the brain area responsible for cognitive function. The accelerated decline of the prefrontal cortex will lead to accelerated impairment of cognitive function. The damage caused by alcohol to these areas may also affect their  self-control, decision-making ability and judgment.

2. Hippocampus is shrinking

A study published in the British Medical Journal (BMJ), 550 adult participants repeatedly measured cognitive performance, weekly alcohol consumption and performed MRI. 

Participants who consumed 30 units of alcohol per week (1 unit is about 8g of alcohol) had the highest risk of hippocampal atrophy. It was 5.8 times non-drinkers. Moderate drinkers (male: 7-21 units/week, female: 7-14 units/week) have 3.4 times the risk of hippocampal atrophy to non-drinkers. Light drinking (1-7 units/week) cannot still prevent hippocampal atrophy.

3. The brain is shrinking and it is not far from dementia

Researchers believe that heavy drinking is the most important risk factor for dementia, especially early-onset dementia. They found more than 1 million cases of dementia, ruled out patients with rare forms of dementia and early mental disorders. They finally found that there are over nine hundred thousand people actually suffer from alcohol use disorders. It can be seen that there is a strong correlation between alcohol and dementia. In early-onset dementia, 57% of patients under 65 years of age have a history of alcohol abuse suffer from dementia.

4. There may be gender differences, men are probably more serious

The long-term effects of alcohol on the brain are mediated by 𝛾-aminobutyric acid and brain potential changes are caused by transcranial magnetic stimulation of the motor cortex. A study compares with the brain potential changes between drinkers and non-drinkers. It was found that the amplitude of brain potential changes in men was more obvious. This indicates that the harm of long-term drinking in men may be higher than that in women. The changes of brain function are more likely to occur.

😣For your health, don't drink too much at least.😣

For more detail, click the links below👇👇👇

https://www.medscape.com/viewarticle/888268#vp_4

https://www.medscape.com/viewarticle/882497

https://www.medscape.com/viewarticle/892918

https://www.medscape.com/viewarticle/885290

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Inventory of various new discoveries of metformin😎😎😎

Metformin is an anti-diabetic drug and a classic oral hypoglycemic agent. Since its inception in 1957, it has been used clinically for more than 60 years. It is currently one of the most widely used oral hypoglycemic drugs in the world. Even though there are many new hypoglycemic drugs, metformin is still the primary drug for type 2 diabetes.

Metformin was born in 1929 and originated from galega officinalis. In 1957, French diabetologist professor Jean Sterne first used metformin for clinical hypoglycemic reduction. Then its application value is still being discovered. Let us take a look at what new discoveries have been made recently.

1. Cancer

Acidic phospholipids play an important role in regulating electrostatic membrane association of programmed cell death ligand 1 cytoplasmic domain (PD-L1-CD). Metformin can competitively dissociate PD-L1-CD from the membrane and affect the stability of PD-L1. This revealed that the molecular mechanism of metformin's anti-tumor effect and provided new ideas for related immunotherapy targeting PD-L1.

There are many studies that supporting metformin can decrease the risk or improve the symptoms of cancer patients. Such as esophageal squamous cell cancer, pancreatic cancer, primary bone cancer.

2. Obstetrics & Gynecology

a. Improve neonatal obesity

    Metformin has many benefits for mother's blood glucose and neonatal obesity, including improved blood glucose, reduced caesarean section, reduced mother's weight, lower insulin requirements,  lower birth weight and obesity measurements of newborns.

b. Prevent adverse pregnancy outcomes in patients with polycystic ovary syndrome

    Metformin can prevent late period abortion and premature birth in women with polycystic ovary syndrome.

3. Metabolic diseases

Metformin can improve the metabolic status of patients treated with systemic glucocorticoids. It can not only reverse the metabolic complications caused by the use of systemic glucocorticoids, but also reserve the anti-inflammatory effects of glucocorticoids. It benefits many patients taking systemic glucocorticoids.

4. Cardiovascular System

 a. Heart failure

    Non-diabetic heart failure patients with reduced ejection fraction (HFrEF) use metformin to reduce myocardial oxygen consumption and improve myocardial efficiency.

b. Left ventricular hypertrophy

    Metformin treatment significantly reduced the left ventricular mass index. Patients taking metformin reduced left ventricular thickening by two time less. In addition, metformin also reduced blood pressure, oxidative stress, and weight. Metformin has the potential to improve cardiovascular health.

c. Air-pollution-induced thrombosis

    Atmospheric particulate matter can induce alveolar macrophages to release pro-inflammatory factors including interleukin 6 (IL-6), leading to arterial thrombosis and death.

    Metformin blocks the mitochondrial electron transport and inhibits the production of reactive oxygen species, thereby blocking the release of IL-6 and inhibiting the formation of arterial thrombosis. This confirms that metformin can be used as a potential therapeutic drug to prevent cardiovascular diseases caused by air pollution.

5. Nervous system

a. Cognitive and nerve recovery after brain tumor surgery

    For children with brain tumor patients who have received craniocerebral radiotherapy, metformin can significantly improve their statement memory and working memory function, repairing white matter damage. Metformin is also safe and tolerable in this population.

b. Multiple Sclerosis

    After treatment with metformin, oligodendrocyte precursor cells can restore their response to the signal of promoting-differentiation, promote the regeneration of nerve myelin. This is useful for the treatment of central nerve demyelination such as multiple sclerosis.

c. Cognitive decline and dementia

    Patients with type 2 diabetes who take metformin have slower cognitive decline and a lower risk of dementia.

6. Locomotor system

a. Osteoarthritis

    Metformin can prevent the occurrence and development of osteoarthritis, alleviate the pain sensitivity associated with osteoarthritis in mice. Its protective effect on cartilage is mainly through the activation of AMPK signals.

b. Intervertebral disc degenerative disease

    Metformin can promote the release of small extracellular vesicles of mesenchymal stem cells, increase the level of proteins that regulate cell proliferation in the vesicles, and can optimize the application effect of extracellular vesicles in the regeneration and repair of intervertebral discs.

7. Digestive system

Metformin stimulates bile secretion in the intact liver, but this drug can also cause severe damage to bile acid secretion.

8. Infection

a. COVID-19

   Metformin inhibits the activation of NLRP3 inflammasomes and the production of IL-1β in cultured macrophages and alveolar macrophages, as well as the secretion of inflammasome-independent IL-6, thereby attenuating lipopolysaccharide and COVID-19 induced acute respiratory distress syndrome. Metformin can be a potential treatment for severely patients with COVID-19 and other induced acute respiratory distress syndrome.

b. HIV

    Metformin reacted on mitochondrial respiratory chain complex-I and inhibit the oxidative phosphorylation (OXPHOS) pathway. It inhibited the replication of human CD4⁺ T cells and HIV-1 virus in humanized mouse models. It revealed that metformin and others OXPHOS pathway inhibitors may be an adjunct to treat AIDS.

👉Metformin has also anti-aging effect. Most effects still are at the research stage and may not be used on treatment. Therefore, metformin still deserves more in depth research.

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Follow the doctor's advice and use sleeping pills scientifically😷😷😷

To treat insomnia, we should follow the doctor's advice and use sleeping pills scientifically.

Using the hypnotic drugs requires detailed analysis and evaluation by doctors. The patients with insomnia should not use the hypnotic drugs by themselves without the prescriptions. They should have a comprehensive treatment method under the guidance of doctors and pharmacists.

The hypnotic drugs should start with a small dose and the dose should not be easily adjusted after achieving the effective dose. It should be administered as required, intermittently and in sufficient amount. For the special populations such as children, pregnant women, lactating women, as well as patients with liver or kidney damage, severe sleep apnea syndrome or myasthenia gravis, it is not suitable to use sleeping medications.

The treatment program of hypnotic drugs is generally shorter than 4 weeks. If the drug intervention is over 4 weeks, the patient need to go to the hospital for the regular evaluation at least every month.

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Highly processed foods will harm memory in the elderly~~👴👵

A new research found that after only four weeks of a highly processed food diet , the brains of aging rats have a strong inflammatory response, accompanied by behavioral signs of memory loss.

In the study, the diet mimics ready-to-eat product, which are usually packaged for a long time and have a long shelf life (such as potato chips and other snacks), frozen food (such as pasta and pizza), and cooked meats containing preservatives. Highly processed diets are also associated with obesity and type 2 diabetes, which suggests that it is best for elderly to reduce eating ready-to-eat products. 

Eating highly processed foods can cause severe memory deficits. In the elderly, rapid memory decline is more likely to develop into neurodegenerative diseases such as Alzheimer's disease.

The researchers also found that the intake of omega-3 fatty acid dietary supplements can prevent memory problems and almost completely reduce the effects of inflammation in elderly rats. 

Maybe people should limit to eat highly processed foods in the diet and increase the intake of foods rich in omega-3 fatty acids to prevent or slow down this deterioration.

Reference：

Michael J. Butler, Nicholas P. Deems, Stephanie Muscat, Christopher M. Butt, Martha A. Belury, Ruth M. Barrientos. Dietary DHA prevents cognitive impairment and inflammatory gene expression in aged male rats fed a diet enriched with refined carbohydrates. Brain, Behavior, and Immunity, 2021; 98: 198 DOI: 10.1016/j.bbi.2021.08.214

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