What are the manifestations of various vitamin deficiencies and excesses?😵😵😵

Vitamins are a class of organic compounds that are necessary in the process of human life activities. They have three characteristics:

1. Exist in natural foods.

2. The human body generally cannot be synthesized and must be supplied by food.

3. It is neither a raw material for body tissues nor does it provide energy. Its physiological needs are small, but it is indispensable for the human body.

Deficiency or excess of vitamins will have a strong effect on human health.

Name	Origin	Solubility
Vitamin A (Retinol)	Cod liver oil, green vegetables	Fat soluble
Vitamin B1 (Thiamine)	Liver, yeast, cereal, meat, soy	Water soluble
Vitamin B2 (Riboflavin)	Liver, yeast, egg, vegetables	Water soluble
Vitamin B3 (Niacin)	Liver, cereal, yeast	Water soluble
Vitamin B5 (Pantoic acid)	Liver, yeast, vegetables, cereal	Water soluble
Vitamin B6 (Pyridoxine)	Liver, yeast, dairy products, egg, cereal	Water soluble
Vitamin B7 (Biotin)	Liver, yeast, cereal	Water soluble
Vitamin B9 (Folic acid)	Liver, vegetable leaf	Water soluble
Vitamin B12 (Cobalamins)	Liver, egg, fish, meat	Water soluble
Choline	Liver, dairy products, soy, yolk	Water soluble
Inositol	Meat	Water soluble
Vitamin C (Ascorbic acid)	Fruit, fresh vegetables	Water soluble
Vitamin D (Calciferol)	Cod liver oil, yeast, dairy products, yolk	Fat soluble
Vitamin E (Tocopherol)	Liver, vegetable oil, egg, fish	Fat soluble
Vitamin K (Naphthoquinones)	Liver, spinach	Fat soluble

Vitamin deficiency

Vitamins participate in all links in the process of life activitie. It maintains the normal
function of the nervous system, participate in the synthesis and metabolism of protein and fat, participate in the synthesis of various enzymes and antibodies and so on. Vitamin deficiency will seriously affect the normal metabolism of physiological functions and even threaten life.

Causes of vitamin deficiency:

Vitamin A: Night blindness, dry skin, dry cornea and desquamation.

Vitamin B1 (Thiamine): The oxidation of sugar in the tissue is affected by Vitamin B1. It also has the effect of inhibiting cholinesterase activity. When it is lacking, the enzyme activity is too high. Acetylcholine (one of the neurotransmitters) is destroyed in a large amount and nerve conduction is affected. It can cause slow gastrointestinal peristalsis, reduced secretion in the digestive tract, indigestion, loss of appetite, neuritis, beriberi and growth retardation.

Vitamin B2 (Riboflavin): Oral ulcers, glossitis, angular cheilitis, cleft lip, keratitis, dermatitis, etc.

Vitamin B3 (Niacin): It is manifested as neurotrophic disorder. The whole body is weak at first and then symmetrical dermatitis appears on the hands, cheeks, left and right forehead and other exposed parts.

Vitamin B5 (Pantoic acid): Because of its ubiquity, no typical cases of deficiency have been found in the human body.

Vitamin B6 (Pyridoxine): Causes vomiting, cramps and other symptoms. Since food is rich in vitamin B6 and can also be synthesized by intestinal bacteria, vitamin B6 deficiency rarely occurs.

Vitamin B7 (Biotin): Including eczema, dermatitis, hyperesthesia, atrophic glossitis, fatigue, muscle pain, anorexia, hair loss and mild anemia.

Vitamin B9 (Folic acid): White blood cells are reduced, the volume of red blood cells become larger and giant cell anemia occurs. Neutrophils are abnormal. Human intestinal bacteria can synthesize folic acid, so deficiency diseases are generally less likely to occur. However,  when malabsorption, metabolic disorders or tissue requirements are too high, and long-term use of intestinal antibacterial drugs (such as sulfonamides), etc., can cause folic acid deficiency.

Vitamin B12 (Cobalamins): Megaloblastic anemia.

Choline: Abnormal liver function, the liver accumulates a large amount of lipids (mainly triglycerides), which eventually fills the entire liver cells. It also harms kidney function. Genetic damage and mutant cell can form tumors cell survive and proliferate. Infertility, growth retardation, bone abnormalities, hematopoietic disorders and hypertension related to dietary low choline have also been reported.

Inositol: Hair is easy to turn white and eczema.

Vitamin C: Scurvy and decreased resistance.

Vitamin D: Kids: Rickets; Adults: Osteoporosis.

Vitamin E: Infertility, abortion, muscle atrophy, etc.

Vitamin Overdose

Excessive intake of vitamins will not only destroy the stability of the human body's environment, but even cause poisoning.

Vitamin A overdose: 

Adults who consume more than 50,000 IU a day for several months can cause poisoning. If children intake more than 18500IU in a day, it will cause poisoning.

Main manifestations: Due to the enhanced activity of osteoclasts, bone decalcification, increased bone fragility, growth inhibition, thickening of long bones and bone and joint pain. dry skin, itching, scaly skin, rash, peeling, hair loss, finger (toe) nails are fragile. Irritability, fatigue, headache, nausea, vomiting, muscle weakness, restlessness. Reduced appetite, abdominal pain, diarrhea, hepatosplenomegaly, jaundice. Blood hemoglobin and potassium are reduced, clotting time is prolonged and bleeding is easy.

Vitamin D overdose:

Vitamin D is an important medicine for the prevention and treatment of rickets, but the consequences of overdose are more dangerous than suffering from rickets. If a child takes 20,000 units a day for a few weeks or months, it causes headache, anorexia, nausea, vomiting, thirst, drowsiness, polyuria, dehydration, high fever and coma, protein and red blood cells appear in the urine. If it is not stopped in time, death can be caused by hypercalcemia and renal failure.

Vitamin A and D poisoning has the highest incidence in infants and children aged 6 months to 3 years. It is mostly caused by parents taking too much cod liver oil for children.

Vitamin B1 overdose:

Large amount of vitamin B1 intaking can cause dizziness, diarrhea, edema, arrhythmia and so on. If the intramuscular injection is overdose, erythema, rubella, contact dermatitis, bronchial asthma and even anaphylactic shock can occur. Overdose in pregnant women can cause postpartum hemorrhage.

Vitamin B2 overdose:

Large dose injection of vitamin B2 can block the renal tubules and resulting in renal dysfunction such as oliguria.

Vitamin B3 overdose:

It can cause skin flushing, fever, itching and fotmication (Feeling like there are some ant walking on skin). Symptoms such as palpitation, vomiting and nausea can also occur.

Vitamin B6 overdose

If pregnant women use a large dose of 25 mg or more, it can affect the supply of fetal nutrition and cause fetal development obstacles. Anaphylactic shock can also occur if the intramuscular injection is overdose.

Vitamin B9 overdose

There will be bitter taste in the mouth, anxiety and abnormal sleep patterns.

Vitamin B12 overdose

Allergic reactions such as asthma, urticaria, eczema, drug rash and facial edema can occur, as well as precordial pain and palpitation. Therefore, it can aggravate the condition of patients with angina or increase the number of attacks.

Vitamin C overdose

Long-term large intaking can cause nausea, vomiting, abdominal pain and diarrhea. If reducing the dosage suddenly, it is more likely to suffer from scurvy than before taking vitamin C. The urine is acidified and oxalate increases rapidly, causing kidney stones are easily formed. Rapid intravenous injection of large doses of vitamin C can cause red blood cell lysis or venous thrombosis, which is fatal. Babies who take a lot of vitamin C often suffer from restless sleep, indigestion, edema, diarrhea, and urticaria. Repeated intravenous injections of vitamin C can cause itchy papules and even anaphylactic shock and death.

Vitamin E overdose

If the daily dosage is more than 400 mg, long-term application may cause thrombosis and also cause menorrhagia or amenorrhea. When the dose is 2000 to 12000 mg, it will affect the fertility. For diabetic patients with severe hypertension, myocardial damage and insulin therapy, vitamin E should be used with extreme caution. At the beginning, 100 mg per day, then gradually increase the dose, otherwise it is easy to cause platelet aggregation and thrombosis.

Vitamin K overdose

It can cause hemolytic anemia and liver cell damage, as well as allergic reactions.

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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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Use body signals to alert for diabetes complications👴👵

Diabetes is a chronic metabolic disorder based on genetics and the environment, which can cause damage to capillaries, large blood vessels, eyes, feet, heart, brain and other organs. The patient will produce some corresponding symptoms due to persistent hyperglycemia. If doctors and patients can recognize these changes early and intervene in time. It can effectively delay the development of diabetes to a more severe degree.

1. Skin: Abnormal sweat secretion and pigmentation

Skin lesions can occur in the skin of the whole body and occurring in various periods of diabetes. It is manifested as hyperhidrosis on the trunk, less sweat on the limbs, dry skin and itching, cracked hands and feet, erythema on the anterior tibia of the calf, and gradually progressing to a circular pigmented area (anterior tibial spot).
Mechanism: Autonomic nerves can not regulate sweat glands normally. It result in abnormal sweat gland secretion. Coupled with long-term metabolic disorders, it causes neuropathy, microvascular disease, arteriosclerosis and skin infections, which in turn leads to skin lesions.

2. Eyes: pain and blurred vision

Diabetic retinopathy can cause blurred vision, decreased vision. Some patients may have color recognition disorders or eye pain.
Mechanism: Eye basement membrane thickened, capillary capillaries, and impaired blood retinal barrier function caused abnormal penetration. It would lead to retinal edema and the formation of new blood vessels over a period time.

3. Oral: periodontal abscess and periodontitis

Patients with poor blood sugar control lead to severe inflammation of the periodontal tissue, red and swollen gingival margins can be granulomatous hyperplasia, easy to bleed, periodontal pockets often have pus and periodontal abscesses. In severe cases, multiple periodontal abscesses and rapid destruction of alveolar bone can occur.
Mechanism: Diabetes and periodontitis affect each other. The high-sugar environment of diabetic patients will cause the microbes grow rapidly in the oral and causing a variety of oral diseases. The failure of effective control of oral diseases will further worsen the condition of diabetes.

4. Foot: infection and ulceration

Diabetic feet are manifested by infections of varying severity, ulcers, neurological disorders, damage or lesion of soft tissues and bones and joints of the foot. Severe cases may require amputation. The probability of foot ulceration or necrosis in diabetic patients is 20~30%.
Mechanism: Diabetic foot is caused by peripheral neuropathy, infection and vascular stenosis or occlusion.

5. Bone: bone pain and osteoporosis

Diabetes combined with osteoporosis will cause bone pains. Convulsions of the limbs may occur due to increased urinary calcium excretion. People with severe osteoporosis are prone to fractures. If there is a significant compression fracture of the spine, there will be a hunchback, height shorter and a reduction in the distance between the costal margin and the iliac ridge.
Mechanism: Poor blood sugar controlling caused increaseing urinary sugar excretion, a large loss of blood calcium with urine, inhibition of bone formation, bone transformation at a low level. The end products of glycosylation may increase bone fragility.

6. Joints: pain and limited mobility

It shows joint pain, swelling, tenderness, joint morning stiffness, rub of joint and limited joint movement.
Mechanism: Diabetes can cause joint neuropathy. It result in vascular nutritional dysfunction, hypoesthesia, bone destruction, articular cartilage damage and even fractures.

7. Lower limbs: pain and numbness

Diabetes more than 10 years are prone to obvious peripheral neuropathy. The clinical manifestations are pain, numbness, burning or needle sensation in the limbs. The symptoms are often bilaterally symmetrical and are more obvious at the ends of the hands and feet. Severe pain at the proximal end of one lower extremity is more common and it can be involved with both distal motor nerves at the same time. It accompanied by rapidly progressing muscle weakness and muscle atrophy.
Mechanism: The risk of occurrence is related to factors such as the level of blood sugar control and the course of diabetes. The occurrence of pathology involves multiple mechanisms such as oxidative stress, polyols and microcirculation disorders.

8. Gastrointestinal: hiccups, diarrhea and constipation

Patients will have stomach symptoms such as hiccups, dysphagia, stomach upset, full upper abdomen, constipation, diarrhea and bowel disorders.
Mechanism: Diabetic autonomic neuropathy can manifest in multiple systems of the human body and then appear corresponding symptoms.

9. Urine: special smell and foamy urine

There is an increase in foam in the urine which looks like beer foam. The urine appears a special smell, frequent and incomplete urination.
Mechanism: Foamy urine is due to increased urine albumin excretion. It results in increased urine tension and foam. The special smell in urine is due to the increased amount of ketones produced by the body under the influence of high blood sugar. It is always seen in diabetic ketosis or ketoacidosis.

10. Cardiovascular: syncope and orthostatic hypotension

It manifests as syncope, orthostatic hypotension, painless myocardial infarction, abnormal coronary systolic function, cardiac arrest or sudden death.
Mechanism: Diabetes is a cardiovascular complication caused by increased blood sugar and blood lipids. High blood pressure and lipid and calcium deposits in the coronary arteries of the heart. These make hardening and stenosis of the arteries.

11. Peripheral large blood vessels: cold skin and walking weakness

The pulsation of the dorsal artery of the foot disappeared, the skin of the lower extremities was cold and the walking fatigue disappeared after 2 to 3 minutes of rest. Then the calf pain during walking may appear which relieved after rest.
Mechanism: Diabetes leads to peripheral vascular disease which is stenosis and occlusion of blood vessels except coronary arteries and cerebral blood vessels. There are corresponding ischemic spasm or necrosis of distal tissues. It is mainly involving lower extremity arteries.

12. Sexual dysfunction

Men are manifested as retrograde ejaculation, erectile dysfunction, delayed ejaculation, premature ejaculation, non-ejaculation and so on. Women present with symptoms such as decreased vaginal lubrication, low libido, female orgasm disorders and dyspareunia.
Mechanism: In men, erectile and ejaculation disorders are caused by autonomic nervous diseases. Erectile disorders are caused by vascular diseases. In women, because women are in a state of chronic hyperglycemia, antioxidant defense effectiveness is reduced. It is leading to aggravation of the disease and various sexual dysfunctions.

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The impact of COVID-19 pneumonia on children may be seriously underestimated👪👪👪

Long-term symptoms of COVID-19 refer to a series of symptoms appearing after infection with COVID-19, including organ inflammation, shortness of breath, fatigue, behavior changes and so on. Studies have shown that about 30% of people infected with the COVID-19 will have long-term symptoms, even though most people can recover quickly. A recent study in the United Kingdom showed that only 4.4% of children with COVID-19 pneumonia will have symptoms for more than 4 weeks. Only 2% will last for more than 8 weeks. However, another study pointed out that 14% of 11 to 17-year-old children still have symptoms after 15 weeks. The child is older, the situation seems more serious.

Compared with adults, it is more difficult to diagnose long-term symptoms of COVID-19 pneumonia in children. Although most symptoms are similar between adults and children, it is just more difficult to detect. Experts believe that children's bodies have a lot of functional reserves. Therefore, if a 5-year-old child loses 20% of his physical functions, it is hard to find out. Some children with long-term symptoms of COVID-19 suffer from multisystem inflammatory syndrome in children (MIS-C), which may cause organ damage. There are also adolescents with long-term symptoms of COVID-19 who have developed Tourette's syndrome, which is characterized by convulsions and sometimes involuntarily cursing. These are very serious symptoms, not only for the children, but also for their family and related people around them will cause great mental stress. 

Risk and benefit balance

However, some experts believe that the benefit of unblocking is greater than that. They think that infections in children are not unacceptable because their symptoms are usually not serious. 

Without fully understanding the mechanism of this disease, and if its consequences may not slowly appear until many years later, it seems a bit reckless to risk the children. Although it is necessary of reopening the economy, it should adopt certain simple measures, such as wearing masks in schools and enhancing ventilation. Taking these measures can effectively protect the next generation. 

Protect the children from COVID-19

The risk of long-term symptoms of COVID-19 does exist. Schools should improve their preventive measures to protect their students from infecting the COVID-19 virus. It is recommended to provide vaccines to all suitable children. It is not mandatory. Their parents can choose if their children received the vaccines. Doctors need to recognize the severity of the long-term symptoms of COVID-19, rather than just treating it as a psychological problem and asking patients to see a psychologist. This is a physiological problem, so there must be some methods of physiological solution. People often ignore related issues. 

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The COVID-19 epidemic is far from over😷😷😷

Recently, the counter-attack of COVID-19 epidemic will cause schools to be forced to close and classes to be suspended. People received the COVID-19 vaccine will still face a new round of infection. When the hospital is overwhelmed again, office workers will also weigh whether they need to continue working at home. 
Scientists believe that before the end of COVID-19 epidemic, almost everyone has either been infected with the COVID-19 virus or vaccinated with the COVID-19 vaccine or maybe both. A few unlucky people may be infected with COVID-19 more than once. Before all human beings are infected with the virus, the race between the virus mutation and vaccination will not end.
Dr. Michael Osterholm, American Covid-19 consultant, he said that the cases around the world continue to rise and then decline. It may be a sharp decline. However, he think it is likely that there will be a sharp rise again in the autumn and winter of this year. There are still billions of people in the world who have not been vaccinated and there is currently very little chance of eradicating the virus. Then, as the economy reopens, it is expected that more new cases will appear in public transportation, workplaces  schools in the coming months. Even if the immunization rate rises, there will still be people who are vulnerable to COVID-19: newborns, people who are unable or unwilling to receive the vaccine and people have been vaccinated with the vaccine but have breakthrough infections because of the reduced protection of the vaccine. 

COVID-19 vs. Other epidemics

An Epidemiologist pointed out that there were 5 well-documented epidemics in the past 130 years, they provide some inspiration for the future development of COVID-19 epidemic. Although the longest global flu has lasted for five years, the average cycle is two to three years with two to four rounds of infection. However, COVID-19 may not follow the development pattern of past epidemics. This is a new type of pathogen that is potentially more infectious. So far, the death toll from the new crown epidemic has exceeded 4.7 million. Vaccination can effectively reduce the rate of severe illness and mortality.  The vaccination rate continues to increase, but the rise in infection means that the virus is infecting teenagers and other people who have not been vaccinated. It is leading to an increase in the rate of severe illness in these groups. Countries with low COVID-19 vaccination rates are facing the largest outbreak so far due to the emergence of the delta variant strain. With the delta variant strains raging in many countries, another new variant strain is likely to emerge.

Experience has shown that people usually think that the pathogenicity of the virus will diminish over time, so that all hosts will not be completely wiped out, but this idea is not correct. Although the pathogenicity of new mutant strains is not necessarily more serious, as the virus is constantly adapting to new hosts during the epidemic. Its fatality rate may actually be higher.

Some researchers said that the new coronavirus may be completely resistant to the first-generation new coronavirus vaccine. As the virus continues to evolve, we may need to be vaccinated regularly to effectively deal with the new coronavirus just like preventing the flu.

When will the COVID-19 epidemic end?

Experts generally believe that only when most people (approximately 90% to 95% of the global population) have gained a certain degree of immunity through COVID-19 vaccination or infection, the current epidemic can be controlled. They believe that the key to controlling the epidemic should be the vaccination of COVID-19 vaccine. If people are not vaccinated, the virus may spread widely in the autumn and winter of this year and almost everyone will be infected by that time. 

An associate professor of medical history at Oxford University believes that the end of the COVID-19 epidemic will vary in different regions, just like the time of the outbreak. Governments will have to make decisions about the extent to which they can tolerate coexistence with the virus. The response measures taken vary greatly. Although some countries strive to achieve zero cases of COVID-19, it is unlikely that the world will completely eradicate the virus.

🔑We must remain alert and treat the COVID-19 epidemic with caution. If anyone thinks that we will be able to resolve the pandemic in the next few days or months, that would be a big mistake.

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Do the season and temperature affect blood pressure??⛄⛄⛄

Blood pressure is affected by many factors, including season and temperature. A study
has found that the average blood pressure in winter is 12/6mmHg (systolic/diastolic  blood pressure) higher than the average blood pressure in summer. For every 1°C decreases in temperature, the systolic blood pressure rises by 1.3mmHg and diastolic blood pressure rises by 0.6mmHg. 

In winter, the decreasing of temperature and the cold weather lead to increase sympathetic nerve excitement. It causes increasing heart rate, the release of catecholamines, increasing cardiac systolic function and myocardial oxygen consumption, peripheral vasoconstriction, increasing peripheral vascular pressure and blood pressure. At the same time, less sweating in winter lead the blood volume higher.  Those are also the causes of blood pressure fluctuations in winter. 

In summer, as the temperature gradually rises, the blood vessels dilate and blood pressure gradually decreases. The amount of sweating is more than in winter. The water in the body is lost more. The blood volume decreases. In some patients, the blood pressure declines or is close to normal.

Therefore, season and temperature changes may cause blood pressure fluctuations. Patients with hypertension should regularly monitor their blood pressure according to changes in temperature. Based on the changes in blood pressure, consult the doctor to adjust the medicine in time. Make sure to feel relax, avoid anxiety and excitement, eat lightly and avoid complications of hypertension.

👀Winter is here, keep yourself warmer~~

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Can all drugs be taking by breaking or chewing❓❓❓

In clinical, most patients only care about the usage, dosage and side effects of drugs. In fact, except these aspects, some drugs also need special notices, especially for children or the elderly who have difficulty swallowing. For example, whether the drugs can be crushed to take, whether the capsule shell can be opened and mixed drug powder with water to drink. This requires additional instructions from the doctor or pharmacist. Different drugs are made into different dosage forms according to the characteristics of the drugs and clinical requirements. If the drugs are used incorrectly without following the requirements, it may cause no treatment efficacy and even some serious adverse effects.

Which oral drugs have the special usage?

1. Sustained and controlled release dosage

    Sustained-release dosage form refers to a dosage form that can continuously release the drug for a long time to achieve a long-acting effect after drug administration. 

    Controlled-release dosage form refers to a dosage form that can automatically release the drug at a predetermined rate within a predetermined period of time, so that plasma concentration of a drug is constantly maintained within the effective concentration range for a long time.

    The principles of sustained or controlled release include dissolution, diffusion, dissolution, osmotic pressure difference, ion exchange and so on. According to different principles, It can be made into microcapsule type, osmotic pump type, framework type, etc. For osmotic pump type sustained or controlled release preparations, breaking or chewing will destroy the semipermeable membrane and fail to achieve the effect of releasing drugs. For a few number of framework type or microcapsule type drugs containing multiple independent units, it can be breaking to take. But it should be splitted according to the scratches on the tablet. 

2. Enteric-coated tablet

    Enteric-coated tablet refers to a tablet that does not disintegrate in the gastric juice, but can be disintegrated and absorbed in the intestinal juice. It is generally coated with an enteric coating on the outside of ordinary tablets. Therefore, only by maintaining the integrity of coat can make the drug be released at a set speed and location to achieve the purpose of slow and controlled release. That make the tablet must be swallowed as a whole, not broken or chewed. If it is broken, it will cause a sudden release of the drug and lead to adverse reactions.

3. Effervescent tablet

    Effervescent tablet uses organic acid and basic carbonate/bicarbonate salt to react as effervescent disintegrant. When placed it in water, an effervescent reaction occurs immediately. It will generate and release a large amount of carbon dioxide. Effervescent tablet must be dissolved in water before it can be taken. It can't be directly taken.

4. Chewable tablet

    Compared with general tablets, chewable tablet does not contain disintegrant. The drug is difficult to disintegrate when swallowed as a whole tablet. The dissolution of the active ingredients is reduced and the drug may not achieve the therapeutic concentration.

Due to different preparation processes, the same kind of medicine produced by distinct manufacturers may require different methods of administration. Read the instruction carefully before taking the medicine, and do not determine by yourself.

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The knowledge of Povidone-iodine for using disinfect wound👀

Povidone-iodine is the most common sterilizer in clinical practice. Its bactericidal effect is excellent and it has almost no irritation to the skin and mucous membranes. It is also painless when patients are using it, so it is a common self-prepared medicine in many families. However, not all wounds are suitable for sterilize with povidone-iodine. In some cases, the chronic wounds are aggravated when the patients had dressing change.

Here are a clinical doctor summarized a few advices for povidone-iodine:

1. Use povidone-iodine less 

Povidone-iodine disinfect acute and chronic wounds and surrounding skin is very common in clinical. Although povidone-iodine has almost no irritation to the skin and mucous membranes, it is also some harmful to the tissue. It will affect the growth of tissues in a relatively short period of time. If povidone-iodine stays in the wound surface, this effect may be further aggravated. 

In most patients with strong self-healing ability, this short-term stimulation may not lead to delayed wound healing. However, for some elderly patients, their skin barrier became weak and healing ability worse. At this time, the side effects of povidone-iodine become prominent and even make the patient painful and unable to sleep.

2. Use saline

Because of the presence of acidic substances such as urea, salt, amino acids, uric acid, free fatty acids and lactic acid on the surface of human skin, the surface of the skin is always performed weakly acidic. The characteristics of the pH value of the skin surface: ①The pH value of the normal skin surface is about 5.0～7.0. ②The lowest pH value can reach 4.0 and the highest pH value can reach 9.6. ③The average skin pH value is about 5.8. Only when the skin is in the normal pH range which is weakly acidic, it can be in the best state of absorbing nutrients. At this time, the skin stay in the best state to resist external erosion. 

Due to the impregnation of wound exudate and topical drugs, the skin around chronic wounds is destroyed the original pH. If it is not washed with saline after povidone-iodine disinfects the skin, the residual povidone-iodine may destroy the pH and humidity of the skin. This will weaken skin resistance.

3. Use antibiotics with caution

People should use antibiotics strictly in accordance with the indications. For infectious wounds, the anti-infective treatment should be adjusted in time based on drug sensitivity. 

For limited wounds, if the patient is generally in good condition, no systemic infection, no osteomyelitis, it is not necessary to take antibiotics intravenously or even orally. It can be considered using topical antibacterial drugs or antibacterial dressings.

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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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