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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Some habits of getting up may be harmful to your health.👿👿👿

Studies have shown that about 40% of myocardial infarction and 29% of sudden cardiac death occur in the early morning. This is because blood pressure rises rapidly in the early morning hours. From 6 to 10 in the morning, the blood pressure of most people will reach the highest level in a day, and the occurrence of cardiovascular and cerebrovascular diseases is directly related to the increase in blood pressure in the morning. Therefore, some habits of waking up may induce these risks.

1. Alarm clock is too loud.

Most people wake up by an alarm clock. The sound of the alarm clock will stimulate the nerves and physiology of the human body, thereby interrupting normal sleep and awakening people. However, if this sound is too loud, it will cause the body's protective conditioned reflex and increase the body's adrenaline level. If things go on like this, it may lead to a series of problems such as high blood pressure and mental depression. Especially middle-aged and elderly people with heart disease and high blood pressure, if they wake up suddenly in their sleep, they are prone to nervousness, vasoconstriction and increased blood pressure. In severe cases, they may even lead to heart attack or cerebral infarction.

Therefore, the sound of the alarm clock should be as soft as possible or music, which is less irritating. Older people sleep more lightly, so they don't need an alarm clock. If there are special circumstances, they need to get up early to go out, so that their family members can wake them up quietly.

2. Get up too rapid.

As soon as the alarm sounds, get up quickly to go to the toilet or wash to catch up with work. This practice is bad for the body. When a person is sleeping, the cerebral cortex is in a dormant, inhibited state. Various physiological functions maintain low-speed operation, lower metabolic level, slower heartbeat, lower blood pressure, etc. 

When you wake up, if you get up immediately, the body's various functions have not been functioning normally. For example, the blood flow is relatively slow, and oxygen cannot be delivered to the brain in time. This is prone to dizziness, vertigo and other discomforts. If you are middle-aged and elderly people, you are also prone to cardiovascular and cerebrovascular risks. In addition, the neck muscles are in a relaxed state after a night of rest. If you get up hard, it is easy to damage the neck muscles, fascia and ligaments.

Getting up should be slow and soft.

3. Do not eat breakfast.

After one night, the stomach is emptied. If there is no food to supplement in time, stomach acid and various digestive enzymes will digest the gastric mucosa. If this happens, you will be prone to gastritis, gastric ulcer and other diseases. In addition, skipping breakfast for a long time will also cause low-density lipoproteins to deposit on the inner walls of blood vessels. This can lead to arteriosclerosis. A large number of studies believe that skipping breakfast is related to obesity, diabetes, and gallstones.

Every day after waking up, you should have breakfast.

4. Forced bowel movements.

Get up in the morning and want to go to the toilet to defecate. But you are about to be late for work, so you have to repeatedly forced bowel movements, try hard and try to finish quickly and leave home quickly. This is not good for your health. Because of forced defecation, the intestinal tract's ability to actively contract during defecation will be weakened. This can cause or aggravate constipation, hemorrhoids, and even cause anal prolapse. In addition, when people defecate, their blood pressure tends to rise. Excessive force can easily cause abdominal pressure to increase sharply, and blood pressure will increase, heartbeat will increase, and myocardial oxygen consumption will increase, which may induce severe acute ischemia and even myocardial infarction. Therefore, when you wake up in the morning to defecate, you must relax. If you have difficulty defecation, try abdominal breathing.

Abdominal breathing: When you breathe in, you bulge your belly, and when you breathe out, your belly dents. Inhale and exhale, pay attention to the slow rhythm, which can activate the spleen and stomach in the abdomen, promote intestinal peristalsis, and smooth defecation.

5. Strenuous exercise.

Many people like to go for a run in the nearby park after getting up, get some fresh air, and then come back to take a shower and eat breakfast. It looks good, but it is not recommended. According to statistics, among the sudden deaths from exercise in the elderly, the number one is the sudden death from exercise in the morning. This is because the blood viscosity of the human body in the morning is relatively large, the flow is not smooth, and too vigorous exercise can easily induce cardiovascular attacks.

It is recommended not to do such strenuous exercise in the morning exercise, especially for middle-aged and elderly people. Just take a walk and practice yoga after getting up.

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Vitamin B12 deficiency may increase the risk of depression.😣😣😣

Depression is the most common type of mental illness. It is characterized by continuous and long-term depression and is the most important type of mental illness in modern people. Recently, a longitudinal study in the Ireland found that vitamin B12 deficiency can increase the risk of depression. The study investigated the relationship between the levels of folic acid and vitamin B1 levels in the elderly and depression. Research results show that the low levels of vitamin B12 are related to depression symptoms, but the levels of folic acid are not significantly related to depression. The research results provide relevant information for the elderly and public health to better understand how to identify risks and take protective measures to improve health outcomes for people 50 years and older.

The levels of participant's vitamin B.

Low levels or deficiencies of vitamin B such as folic acid and vitamin B12 are common in the elderly. Studies have pointed out that one-eighth of the local elderly have low levels of vitamin B12. People of all ages have also reported that the dietary intake and blood concentration of vitamin B12 are low. Some of the negative consequences of low vitamin B12 levels may include impaired cognitive function, megaloblastic anemia or damage to the protective layer (myelin sheath) that surrounds the nerve fibers of the brain. It is important to understand the relationship between the low levels of folic acid or vitamin B12 and depression in later life. It is because depression is a risk factor for cognitive decline, hospitalization, and premature death. The study surveyed participants aged 50 years and older. The plasma folic acid and plasma vitamin B12 levels were measured and screened for depression. Researchers have observed that those with low levels of vitamin B12 are 51% more likely to develop depressive symptoms within 4 years.

Research result.

1. The study found that over a four-year period, low levels of vitamin B12 were associated with a significant increase in the risk of depressive symptoms, but no such association was observed with folic acid.
2. Researchers have observed that those with low levels of vitamin B12 are 51% more likely to develop depressive symptoms within 4 years.
3. These findings are still valid even after controlling for related adjustment factors such as physical activity, vitamin D levels, burden of chronic disease, cardiovascular disease and use of antidepressants.
4. Other factors that affect the nutritional status of the elderly include smoking, drug use, obesity, gender, financial ability and place of residence.
5. With age, the risk of depression decreases.
6. In the surveyed elderly population, the incidence of sudden depression is very high, and their level of vitamin B12 is very low.
7. These findings show that the level of these vitamins can be increased by improving the diet and may have potential benefits for preventing depression.

In view of the high incidence of depression among the elderly living in Ireland, especially after there is evidence that one in eight elderly people report a high level of vitamin B12 deficiency, this study is highly relevant. In Europe and the United Kingdom, there is a growing trend for governments to implement food policies to increase vitamin B intake. In particular, the practice of increasing folic acid in food in the United States has shown a positive effect. Among people aged 60 and above, the low levels or deficient folic acid is only 1.2%. Research results indicate that food fortification policies can provide a potential way to help prevent depression in the elderly and benefit overall health through foods such as breakfast cereals rich in vitamin B12 and folic acid. The main advantage of this study is that it is based on a large amount and representative sample of elderly people observed for more than four years. In addition, the researchers examined a group of well-characterized patients and incorporated a series of confounding factors, including lifestyle, chronic diseases, medications, and other nutritional blood biomarkers to reveal strong research results. In view of the increase in loneliness and depression in the elderly since the beginning of COVID-19 restrictions. The study emphasizes the importance of increasing vitamin B12 intake or supplement to help reduce potential risk factors for depression in the elderly.

For more detail, you can read this article.👇

Laird, E., O’Halloran, A., Molloy, A., Healy, M., Hernandez, B., O’Connor, D., . . . Briggs, R. (2021). Low vitamin B12 but not folate is associated with incident depressive symptoms in community-dwelling older adults: A 4 year longitudinal study. British Journal of Nutrition, 1-22. doi:10.1017/S0007114521004748

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Anti-aging function of vitamin B2.👴👵

Previous studies have shown that the accumulation of aging cells in the body can lead to aging-related diseases and aging. Using supplements or drugs containing vitamin B2 can inhibit cell senescence. This may prevent and improve age-related diseases and extend people's healthy lifespan. Recently, researchers from Kobe University in Japan stated that adding vitamin B2 to cells exposed to the stress of aging will increase the ability of mitochondria to produce energy and prevent cell aging.

1. The mechanism of human aging.

Aging research is becoming more and more important to solve the medical and welfare problems that come with it and to help people live healthier lives. The process of body aging is not fully understood, but the aging of the cells that make up the body has been proven to be a factor. As the cell division cycle repeats, the telomere region at the end of each chromosome becomes shorter, which eventually leads to cell senescence. It is the cell loses the ability to divide. The reduction of telomere area is not the only relevant factor. Various types of stress on cells (such as DNA damage and reactive oxygen bursts) can also cause cell senescence. Aging cells caused by these stresses accumulate in the body with age. Aging cells have the harmful ability to cause the decline of the function of every organ in the body. By preventing the accumulation of senescent cells, age-related diseases such as Alzheimer's disease, cancer, cardiovascular disease and diabetes can be prevented or improved. 

2. The original intention of the research.

Vitamins are micronutrients necessary to maintain the normal functioning of the human body. Since the human body cannot synthesize vitamins, it must be absorbed from food and drinks. Vitamin B2 (also called riboflavin) is widely found in foods such as eggs, meat, and dairy products. It is an important vitamin for energy production and metabolism. Lack of vitamin B2 can cause symptoms such as mouth swelling and anemia. In addition, excessive intake of vitamin B2 generally has no negative effects, because it is a water-soluble vitamin that can be excreted from the body very quickly. Although vitamin B2 is an essential nutrient for maintaining health, its relationship with aging has not been studied. The research team began to study the effect of vitamin B2 on aging, hoping that if daily vitamins can inhibit cell aging, this will help provide low-cost and safe anti-aging drugs.

3. Research methods.

The research team found that by increasing the amount of SLC52A1 produced, the phenomenon of cell aging can be resisted. SLC52A1 is a vitamin B2 transporter. It is responsible for transporting vitamin B2 to the cell. When the production of SLC52A1 increases, even under stress conditions (treatment of human cells with drugs to damage DNA and induce senescence), cellular senescence does not occur immediately. On this basis, the researchers exposed the cells to a stressful environment, and then increased the vitamin B2 content in the culture medium. They found that the ability to resist aging increases with the content of vitamin B2 in the solution. In the cell, vitamin B2 is converted into a substance called flavin adenine dinucleotide (FAD), which is a coenzyme that promotes the chemical reactions necessary for biological activities (such as energy production). In stressed cells, mitochondrial activity temporarily increases and then decreases in activity leading to senescence. By increasing the content of vitamin B2 in the culture medium, maintaining a high level of stress-mediated mitochondrial activity, this also has anti-aging effects. Studies have found the activity of AMPK enzyme, which can detect energy deficiency in cells, and found that AMPK activity is inhibited by mitochondrial activity. On the contrary, using drugs to inhibit mitochondrial activity will cause AMPK to be activated and send a signal to the p53 (inducing cell senescence) protein to prevent cell division, leading to a state of senescence. The above results indicate that vitamin B2 can increase the mitochondrial activity of stressed cells and prevent aging by inhibiting the functions of AMPK and p53.

Summary: Cells under stress will produce SLC52A1 and increase their absorption of extracellular vitamin B2. Once in the cell, vitamin B2 will be converted into FAD, and increase the production of mitochondrial energy by becoming a coenzyme of the mitochondrial respiratory chain complex II. Therefore, AMPK and p53 (inducing cellular senescence) are inactivated, so stress-mediated cellular senescence is suppressed.

👉Vitamin B2 is easily absorbed from food and supplements, and even if it is taken too much, it will be quickly excreted from the body. Therefore, based on the cellular anti-aging properties of vitamin B2, treatment methods for age-related diseases have been developed. This drug is believed to be relatively cheap and safe.

For more detail, you can read this article.👇

Nagano T, Awai Y, Kuwaba S, Osumi T, Mio K, Iwasaki T, Kamada S. Riboflavin transporter SLC52A1, a target of p53, suppresses cellular senescence by activating mitochondrial complex II. Mol Biol Cell. 2021 Nov 1;32(21):br10. doi: 10.1091/mbc.E21-05-0262. Epub 2021 Sep 15. PMID: 34524871.

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The benefits of several vegetables.🍱🍱🍱

Everyone knows that eating more vegetables is good for your health. But not everyone knows what is good. Now let's introduce the benefits of several vegetables.

1. Cabbage-Good for stomach.

Traditional Chinese medicine believes that cabbage is calm in nature and sweet in taste. It belongs to the spleen and stomach meridians. It can clear away heat and relieve pain, moisturize the viscera, and relieve the pain of the gastric cavity. Nutrition believes that the vitamin K1 and vitamin U contained in cabbage can promote the metabolism of the gastric mucosa, and to a certain extent can protect the gastrointestinal mucosa and repair damaged gastrointestinal tissues.

There are many ways to cook cabbage. Among them, fried cabbage is considered to be more nutritious. However, don't stir-fry the cabbage for too long when it is stir-frying, otherwise it will not only taste bad, but also a lot of nutrients will be lost.

2. Eggplant-Weight loss.

Eggplant itself is a low-fat and low-sugar food. The fat content of 100 grams of eggplant is less than 1 gram and the calories are only 2 to 30 kcal. It is good for weight loss. 

Eggplant is loose and porous, so it is easy to absorb oil. Therefore, it is best not to put too much oil when cooking eggplant. The best way to cook eggplant is steaming. Eggplant contains solanine, so don't eat it raw. Excessive intake of solanine can cause food poisoning.

3. Tomato-Good for prostate.

Tomatoes are rich in lycopene, which has strong antioxidant capacity and anti-cancer effect. It can prevent prostate disease. Studies believe that eating tomatoes often helps prevent prostate cancer. Not only that, regular intake of lycopene can also reduce the risk of breast cancer, colon cancer and other cancers.

Eating cooked tomatoes is more nutritious than eating raw. Lycopene is combined with protein and there is a lot of cellulose wrapped around it. It must be heated to a certain degree before lycopene can be released. Therefore, if you want to better absorb nutrients and give full play to the anti-cancer effect of tomatoes, you must eat them cooked. In addition, it is best not to eat green tomatoes. Solanine is contained in immature green tomatoes. After eating, it will make the mouth bitter and stomach upset, and eating too much may lead to poisoning.

4. Fennel-Good for kidney and stomach.

Chinese medicine believes that fennel is warm in nature. It can warmly invigorating the kidney. It is suitable for people who are afraid of cold in winter and have cold hands and feet. Fennel can also warmly invigorate the stomach and the spleen, and aid digestion. People with weak functions of the spleen and stomach and who are prone to abdominal pain and diarrhea can eat some fennel for nourishment. 

People with allergies should not eat fennel. When the skin is injured and the wound has not healed, it is best not to eat fennel, otherwise it is not conducive to wound healing.

5. Shepherd's Purse-Calcium Supplement

Shepherd's purse is rich in vitamins, cellulose, calcium, iron, phosphorus, potassium and other minerals. The nutritional value is quite high. Especially for calcium, the calcium content of shepherd's purse is higher than that of milk. The calcium content of shepherd's purse per 100 grams is 294 mg, while milk is only 120 mg. Therefore, people who need calcium supplementation, especially the elderly and children, in addition to drinking more milk, can also eat shepherd's purse.

Oxalic acid in vegetables interferes with calcium absorption. You can boil it in water before cooking to remove most of the oxalic acid.

6. Flammulina velutipes-Good for children's intellectual development.

Flammulina velutipes contains more essential amino acids than other mushrooms, especially arginine and lysine. It is very good for the intellectual development of children in the growing period. Moreover, Flammulina velutipes has relatively high zinc and iron content. It can also promote the child's bone development.

Flammulina velutipes has a high purine content, so patients with gout should not consume too much.

7. Daylily-Good for brain health.

Daylily is rich in lecithin. Appropriate supplementation of lecithin can enhance and improve brain function. It can also improve concentration and memory. For children, it can promote brain development. For office workers who often use their brains, it is also suitable to eat daylily to protect their brain health. For the elderly, eating daylily can helps to improve memory.

Fresh daylily contains colchicine. It will be oxidized in the gastrointestinal tract to the highly toxic dicolchicine, which may cause food poisoning. Dried daylily has already dissolved the colchicine during the processing process, which is relatively safer. It is not suggest you eat fresh daylily. If you have to eat it, it must be blanched in boiling water and then soaked in water for more than two hours. The dried daylily should also be soaked in water before using them for cooking.

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Drugs for varicose veins of the lower extremities.👀

Primary superficial varicose veins of the lower extremities are a common clinical manifestation and the superficial varicose veins of the calf are the most common. The prevalence of varicose veins of the lower extremities is as high as 10-25%, and the prevalence of women is slightly higher than that of men. The patients are mostly athletes, waiters and teachers who stand for a long time. When they are standing, the gravity drops and the blood returns to the heart from the farthest point. If the veins are insufficiency, the veins will expand and become varicose, leading to venous hypertension in the lower extremities.

1. Pathogenesis.

Veins are responsible for bringing blood from all parts of the body back to the heart. To prevent the backflow of blood, there are valves in the veins. If the venous valve is not fully closed, the blood will flow back. It leads to blood stasis in the veins of the lower extremities. The venous lumen will be dilated, irregularly bulged, twisted and degenerated. 

Normal                                    Varicose veins

People who stand for a long time, sit for a long time, smoke and often tight clothing are high-risk groups for varicose veins of the lower extremities.

2. Evaluation.

The early manifestations are soreness and discomfort of the limbs, and the superficial veins are tortuous. As the disease progresses, skin itching, skin pigmentation in the boot area, seborrheic dermatitis, ulcers and even superficial thrombophlebitis, as well as pain along the veins caused by superficial thrombophlebitis, and bleeding from varicose veins can occur.

Clinically, varicose veins are divided into six grades:

1. The first level is the dilation of capillaries. Many women have some red spider web-like capillaries in the thighs and calves.
2. In the second level, the green tendons resembling earthworms are exposed on the calves, with a little protrusion, netting or lump-like, and the number is also significantly increased.
3. The third level is edema in addition to varicose veins, swelling and discomfort after walking for a long time.
4. In the fourth level, hyperpigmentation and eczema will appear. Many patients will go to the dermatologist for treatment, but the external medicine will not be effective. In fact, it is caused by the changes of the great saphenous vein, thickening of the skin, and nutritional disorders.
5. Ulcers will appear on the fifth-level skin, but the ulcers can heal.
6. The sixth level is the most serious. Unhealed skin ulcers usually occur in the medial malleolus. The most serious situation is ulcers, ulcers, hard skin, and blackened whole feet.

3. Oral medicine for varicose veins of lower extremities.

Oral drugs play an important role in the conservative treatment of varicose veins of the lower extremities. 

Mechanism of action:

1. Reduce capillary permeability, anti-inflammatory and anti-exudation.
2. Protect veins, improve vein elasticity and increase vein tension.
3. Anti-oxygen free radicals protect damaged tissue cells.

Relieve clinical symptoms such as venous edema, soft tissue swelling, pain, and thrombophlebitis. The recommended use time is 3-6 months.

Diosmin is a commonly used drug. Take 1 tablet at a time, 2 times a day, at lunch and dinner.

Sodium aescinate is taken 1-2 tablets each time, once in the morning and once in the evening, orally after meals.

4. External medication for varicose veins of lower extremities.

Mucopolysaccharide polysulfate cream

Main ingredient: mucopolysaccharide polysulfate

Mucopolysaccharide polysulfate has anticoagulant effect. It can prevent the formation of superficial thrombus and promote their absorption. It has anti-inflammatory effect. It prevent the development of local inflammation and accelerate the absorption of hematoma.

Usage and dosage: Apply the cream to the skin of the affected area 1-2 times a day.

Compound sodium aescinate gel

Main ingredients: sodium aescinate, diethylamine salicylate.

Sodium aescinate can promote the body to increase the plasma concentration of ACTH and cortisone. It can promote the secretion of PGF2α in the blood vessel wall. It can clear the free radicals in the body, thus play a role in anti-inflammatory, anti-exudation, increase venous tension and speed up venous blood flow. It promotes lymphatic reflux, improve blood circulation and microcirculation, and protect the blood vessel wall.

Diethylamine salicylate can enhance the anti-inflammatory effect and has analgesic effect.

Usage and dosage: Apply the gel to the skin of the affected area once or several times a day. When treating ulcers, apply the gel to the skin around the ulcer to avoid touching the ulcer surface.

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Several common questions about hyperlipidemia.❓❓❓

Hyperlipidemia can be the result of a single genetic defect in lipoprotein metabolism. Or more commonly, it is the result of a combination of genes and lifestyle habits. This article will answer some common questions about hyperlipidemia. For example, how much does blood lipids need to be treated? Do you have to take hypolipidemic agents? What should you do if you have high triglycerides and cholesterol?

1. What's on the blood lipid test?

Blood lipids refer to the lipids in the blood circulation of the human body. Common blood lipid test include four basic items: total cholesterol, triglycerides, low-density lipoprotein cholesterol ("Bad" cholesterol, lower values ​​are better), and high-density Lipoprotein cholesterol ("Good" cholesterol, higher numbers are better). What we call hyperlipidemia is actually a kind of dyslipidemia, which can be an increase in one or more blood lipid components. For example, hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia (both of the above), high and low density lipoproteinemia. It can also be a decrease in a certain component, such as hypo-high-density lipoproteinemia. Generally speaking, doctors pay more attention to the level of low-density lipoprotein cholesterol. It is because this indicator is more closely related to cardio-cerebrovascular events such as myocardial infarction and cerebral infarction. Severe hypertriglyceridemia is associated with an increased risk of pancreatitis. Some tests will also have non-high-density lipoprotein cholesterol, apolipoprotein B, apolipoprotein A1, lipoprotein, etc. These indicators are also related to the risk of cardiovascular disease.

2. If the test does not exceed the standard, does it mean that the blood lipids are normal?

This may also be dyslipidemia. According to the disease and risk factors of each person, the standard value of blood lipids is also different. For example, the target values of low-density lipoprotein cholesterol for different groups of people are as follows:

• Diabetic patients over 40 years old: < 2.6mmol/L.
• Hypertension patients who smoke at 45 years old (male) and 55 years old (female): < 2.6mmol/L.
• People who smoke and are obese (weight/height square ≥28): < 2.6mmol/L.
• Patients with stable coronary heart disease, acute coronary syndrome, stroke, transient ischemic attack, and peripheral atherosclerosis: < 1.8mmol/L.

Most blood lipid tests do not give different standard values for different groups of people. Low-density lipoprotein cholesterol < 3.4mmol/L is the normal value, and blood lipids are often abnormal at this time. Therefore, even if the blood lipid test shows normal. You also need to follow up, and the doctor will determine the blood lipids.

3. Cholesterol and triglycerides are both high, which one should be lowered first?

It is generally recommended that statins are the first choice based on the characteristics of dyslipidemia. If hypertriglyceridemia is combined, a combination of statins and fibrates can be used. Since the metabolic pathways of statins and fibrates are similar. They both have the potential to damage liver function and there is also the risk of myositis and myopathy. Therefore, a small dose is required when starting to use them together. Take fibrates in the morning and statins in the evening, and closely monitor muscle enzymes and liver function. If there are no adverse reactions, gradually increase the statin dose.

4. Is it possible to stop the medication if I am worried about the side effects of statins?

Statins are the basic drugs for lipid-lowering therapy. Most people tolerate statins well. The occurrence of adverse reactions is very low. The following are the risks of potential adverse reactions:

Long-term use of statins increases the risk of new diabetes, with an incidence of about 10% to 12%. But because the benefits of statins for cardiovascular disease far outweigh the risk of new-onset diabetes. Therefore, regardless of whether you have diabetes or not, as long as you need lipid-lowering treatment, you must insist on taking statins.

• Long-term use of statins increases the risk of new diabetes, with an incidence of about 10% to 12%. But because the benefits of statins for cardiovascular disease far outweigh the risk of new-onset diabetes. Therefore, regardless of whether you have diabetes or not, as long as you need lipid-lowering treatment, you must insist on taking statins.
• The incidence of abnormal liver function is about 0.5% to 3.0%. More common in patients receiving high-dose statin therapy. If serum alanine aminotransferase (ALT) and (or) aspartate aminotransferase (AST) does not increase more than 3 times, it can be observed on the basis of the original dose or reduced dose. Some patients with transaminase can recover on their own normal.
• Cognitive dysfunction, also known as memory loss, is generally transient and can recover on its own.

5. If the blood lipid level is still up to standard after taking statin, can I double the dose?

Doubling the dose of statins can only further reduce low-density lipoprotein cholesterol by 6%, while the risk of adverse reactions is greatly increased. Therefore, it is not recommended to increase the dose of statins. The combined application of cholesterol absorption inhibitors such as ezetimibe can be used to further reduce the level of low-density lipoprotein cholesterol.

6. Do statins need to be taken at night?

Since the liver synthesizes more cholesterol at night, the reduction in low-density lipoprotein cholesterol can be slightly increased when statins are taken at night. However, atorvastatin, rosuvastatin and fluvastatin sustained-release tablets can be taken once a day at any time of the day due to the longer action time.

7. Can I eat grapefruit while taking statins?

Atorvastatin, simvastatin and lovastatin need to be metabolized in the body through a pathway called hepatic cytochrome P450 enzyme (CYP) 3A4. Grapefruit may inhibit the metabolic clearance of drugs, thereby increasing the concentration of statins in blood pressure and increasing the risk of serious side effects. Therefore, you should avoid grapefruit or grapefruit juice when taking the above statins. In addition, citrus fruits such as oranges and tangerines can also inhibit the metabolism of statins to a certain extent. For high-risk populations (such as the elderly, patients with reduced liver and kidney function, thin body, and more types of medications), it is also necessary to control the amount of those fruits. In addition to fruits, many drugs metabolized by CYP may also affect the blood concentration of statins. You should consult your doctor before taking the drug.

8. Is fish oil useful?

The main component of high-purity fish oil is omega-3 fatty acids, which are mainly used to treat hypertriglyceridemia. Studies have shown that high-
dose high-purity fish oil (4 g/day) can significantly reduce triglycerides and reduce the occurrence of adverse cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD). However, studies have used large doses of fish oil. It is difficult for the health products on the general market to achieve such a high dose. Small doses of fish oil may not be effective. Moreover, studies have shown that high-dose fish oil may increase the risk of atrial fibrillation, limiting its application.

9. How often do I need to check after receiving lipid-lowering treatment?

Patients who are taking lipid-lowering drugs for the first time and adjusting the type or dosage of lipid-lowering drugs: recheck blood lipids, transaminase and creatine kinase within 6 weeks of taking the drug.

Patients whose blood lipids can reach the target value and have no adverse drug reactions: gradually change to a review every 6 to 12 months.

Patients whose blood lipids are not up to standard and have no adverse drug reactions: monitor once every 3 months.

10. After taking a statin, blood lipids are normal, can the drug be stopped?

The answer is no. If there are no contraindications or adverse reactions, statins should be taken for a long time. To reduce the level of "bad" cholesterol and avoid further progress of atherosclerosis.

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Several common questions about antihypertensive drugs.💊💊💊

Antihypertensive drugs are very commonly used drugs. Here are some practical knowledge about antihypertensive drugs and answer some common questions about antihypertensive drugs.

1. What is high blood pressure and its treatment goals?

Hypertension refers to the systolic blood pressure exceeding 140mmHg or the diastolic blood pressure exceeding 90mmHg. It is caused by the increased tension of peripheral vascular smooth muscle. This will increase the resistance of the arterioles and decrease the volume of the venous system. The goal of antihypertensive therapy is to reduce cardiovascular and renal morbidity and mortality. The target blood pressure for the treatment of hypertension is systolic blood pressure less than 140mmHg and diastolic blood pressure less than 90mmHg.

2. Which antihypertensive drug has the strongest antihypertensive effect?

On the whole, angiotensin II receptor blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, diuretics and β-receptor blockers have similar antihypertensive effects. Therefore, there is no obvious difference in strength between them. However, specific to each person, the antihypertensive effect of different drugs may be significantly different. For example, some people use angiotensin II receptor blockers to have a significant blood pressure lowering effect, but some people have very little blood pressure reduction after using it. There may be significant differences in the response to antihypertensive drugs between individuals. When starting to take antihypertensive drugs, medication should be administered under the guidance of a doctor.

3. How much can an antihypertensive drug reduce blood pressure?

The degree of blood pressure reduction of the drug mainly depends on the current blood pressure. For example, the patient's blood pressure is 140/90mmHg, and the blood pressure reduction after taking an antihypertensive drug generally does not exceed 10/5mmHg. The blood pressure of another patient is 180/110mmHg and the blood pressure may drop by 20/10mmHg after medication. 

In general, the higher the current blood pressure, the greater the drop in blood pressure after medication.

4. If the patient's systolic blood pressure is very high and the diastolic blood pressure is close to normal, will the diastolic blood pressure drop too low after using antihypertensive drugs?

It is possible. However, the decreasing level in systolic blood pressure and diastolic blood pressure are not the same. If the systolic blood pressure is reduced by 10mmHg, the diastolic blood pressure may only be reduced by 5-6mmHg. So, although the systolic blood pressure and the diastolic blood pressure will drop after the medication, the diastolic blood pressure drop is relatively small. 

5. Will antihypertensive drugs be resistant?

Generally not. Some people use the same antihypertensive drug for several years and their blood pressure is well controlled, but it has recently increased again. Is it because of drug resistance? It is generally not. As we age, our systolic blood pressure will gradually increase. The reason why blood pressure is not well controlled is that your blood pressure is higher than before, rather than drug resistance. In this case, it is generally necessary to add another medicine or increase the dose of original medicine, instead of trying to change another medicine.

6. After a period of medication, the blood pressure becomes normal. Can the medication be stopped?

If your blood pressure is not too high before the medication and you have been exercise, weight loss and less salt recently, you can try to stop the medication after a few months and monitor blood pressure closely. Some patients can maintain their blood pressure at normal level. If the blood pressure rises again after stopping the drug, you need to re-administer the drug and do not try to stop the drug by yourself.

7. Does an antihypertensive drug need to be replaced after being used for a long time?

Some people worry about side effects of a kind of antihypertensive medicine after being used for a long time. Therefore, they will ask for changing another drug. In fact, it is not necessary. The side effects of antihypertensive drugs generally appear within a few weeks to a few months of the medication. If there are no side effects after that, it indicates that it can be well tolerated. As long as the blood pressure is well controlled, there is no need to change the medication.

8. Should antihypertensive drugs be taken before or after a meal?

Follow the instructions, different medicines have different requirements. If there is no special requirements on the instructions, they are usually eaten after a meal.

9. Antihypertensive drugs that are taken once a day should be taken in the morning or at night?

Most people can take it in the morning. It is best to do 24-hour ambulatory blood pressure monitoring. If blood pressure is high at night or in the morning, you can take medicine at night. If blood pressure is high during the day, you can take medicine in the morning. If you drink frequently at night, it is best to take medicine in the morning. It is because alcohol may has interaction with the drugs.

10. How long does it have the effect after taking antihypertensive drugs?

It is different. Sublingual drugs can begin to exert a blood pressure-lowering effect within a few minutes (although the effect is fast, it can cause fatal and serious adverse reactions. Generally, it is only used for critical acute attacks). Oral short-acting drugs usually take effect after one or two hours. Long-acting drugs may need to be administered continuously for one to two weeks to gradually exert their maximum effect (although it is slow, but blood pressure fluctuations are small, which is good for hypertensive patients).

11. Will antihypertensive drugs hurt the liver and kidneys?

Most drugs have the potential to damage liver or kidney function. However, the overall safety of commonly used antihypertensive drugs in clinical practice is very good. Proper medication under the guidance of a doctor will generally not have a significant adverse effect on liver or kidney function.

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Why do women age faster than men, but live longer?👨👩👫

Aging is a process that everyone has to go through, but observing the people around us, we will find that aging seems to be a bit of "female preference". At the same age, men tend to look younger, but women always look older. Research has also found that although women age faster than men, they tend to live longer. What is going on?

Why do women age faster than men?

1. Collagen is lost faster than men.

Studies have found that under the same conditions of sun exposure and natural aging, the loss of collagen in the skin of women is faster than that of men. This also means that women are more likely to have problems such as wrinkles, enlarged pores and sagging skin.

2. Pregnancy and childcare.

Women usually take on the heavy responsibility of having children and pay a lot for pregnancy and raising babies. From a medical point of view, pregnancy and raising babies will not directly lead to aging. However, the fatigue of the process of pregnancy and raising babies can easily accelerate female aging. For women who are employed, they need to work during the day and take care of their children at night. They are often prone to lack of sleep and exhaustion. This is also the reason why married women look older.

3. Decline in estrogen during menopause.

Menopause is a necessary process for women and it is also an important turning point for women to age. During this period, women's menstruation naturally fails, ovarian function gradually declines, estrogen secretion is reduced, endocrine disorders, the balance of collagen synthesis will also be imbalanced. Wrinkles, osteoporosis and other aging manifestations are more likely to occur. 

👵Although women age faster than men, women tend to live longer than men in terms of life span. Why does this happen?

Why do women live longer than men?

According to data, the average life expectancy of men is 70.31 years, and that of women is 75.33 years in 2021 in 224 countries and regions around the world. Women live 5 years longer than men on average. What is the reason? In fact, this has both innate factors and acquired factors.

1. Genetic.

Human genetic differences, especially differences in genes or chromosomes may determine the lifespan of men and women. Studies have pointed out that the existence of the Y chromosome may shorten the life span. Females are made up of two X chromosomes. Males are made up of one X chromosome paired with one Y chromosome. Two X chromosomes can complement each other. If one X chromosome goes wrong, there is another one available for backup. However, this is not the case with men's chromosomes. When a certain X chromosome goes wrong, corresponding diseases will occur.

2. Hormonal differences.

The difference between male and female hormones also makes women live longer than men. The cholesterol levels of men and women before puberty are similar. But after the age of 40, men are at the risk of heart disease, while the risk of women is after the age of 50. Women's heart disease risk generally begins after menopause. It is because women's estrogen levels are lowered after menopause. Estrogen can reduce the concentration of low-density lipoprotein, a cholesterol in the blood that is harmful to the heart. At the same time, it can also increase the level of high-density lipoprotein, another cholesterol in the blood that is benefit to the heart. The male androgen does not have this function.

3. Lifestyle and mental health.

Compared with women, men are more likely to have bad habits such as smoking, drinking, overeating and staying up late. Therefore, men's physical health is often not as good as women's, which also affects life expectancy.

Women also have an advantage in emotional release, and men rarely vent to the outside even when they are under great pressure. This can seriously damage physical and mental health.

4. Relatively fewer women choose high-risk occupations.

In some high-risk industries, such as construction and mining, there are relatively fewer female employees than male employees. Any injury or disability in these dangerous industries will affect the life expectancy of men in the future.

👇Do the following to make you look younger than your peers:

1. Sun protection.

Sunlight is the biggest cause of wrinkles. Because the long-wave ultraviolet in the sun can brown and age people, and the short-wave ultraviolet can sunburn. Sunlight is the biggest cause of wrinkles. Because the long-wave ultraviolet (UVA) in the sun can tan and age people, and the short-wave ultraviolet (UVB) can sunburn. Therefore, if you don't want to age in advance, you must first minimize your exposure to ultraviolet rays and always pay attention to sun protection. You can try physical sun protection, such as wearing a sun hat and long clothes. You can also try wiping off sunscreen.

2. Enough sleep.

Long-term lack of sleep will not only accelerate the aging of the human body. It can also cause yellowing of the skin, swollen eyes, etc. It can also affect the health of the human body and reduce life span. Therefore, if you want to delay aging and prolong your life, you must first have enough sleep. It is recommended to go to bed before 11 o'clock in the evening to ensure 6-8 hours of sleep.

3. Balanced diet.

Modern people's lifestyle of overeating is really harmful to health. The diet should be balanced and appropriate. Usually eat potatoes, beans and other foods rich in dietary fiber. Also pay attention to supplementing milk, soybeans or their products. Drink yogurt in moderation to supplement probiotics. Eat moderate amounts of fish, poultry, eggs and lean meat. Reduce the amount of cooking oil and eat light and salt-less meals. Brightly colored fruits and vegetables are often rich in anthocyanins, vitamin C and vitamin E. It can effectively remove harmful free radicals in the body and help the body to resist oxidation and delay aging. These fruits and vegetables can be eaten more appropriately.

4. Regular exercise.

Common sports can be divided into four basic types: endurance sports, strength sports, balance sports and flexible sports. You can randomly combine exercise methods according to your own physical condition and don't be limited to one type of exercise.

5. Develop a good attitude.

You should also pay attention to adjusting your emotions and keep your mood cheerful.

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What is the difference between epinephrine, norepinephrine and isoproterenol?💉💉💉

Have you played some survival video games? In these games, epinephrine (also call adrenaline) is often an emergency medicine. It can bring your character back to life. And it will also strengthen your character's state like a stimulant. In reality, adrenaline is also a commonly used emergency medicine in clinical practice. And there are two more medicines which are also adrenaline agonists. They are norepinephrine and isoproterenol. All of them can act directly on adrenergic receptors and activates them to produce therapeutic effects. What is the difference between the chemical structure, mechanism of action, strength of action, and clinical application of these three drugs?

1. Chemical structure

Adrenaline, norepinephrine and isoproterenol all contain phenolic hydroxyl groups, which are easily deteriorated by sunlight or in contact with air. Therefore, they need to be stored in a sealed, protected from light and cool place (below 20°C).

Epinephrine

Norepinephrine

Isoproterenol

Compared with the structure of norepinephrine, there is a methyl group on the amino nitrogen of adrenaline, and an isopropyl group on the amino nitrogen of isoproterenol.

Commonly used injections: Epinephrine 1ml : 1mg, Norepinephrine 1ml : 2mg, Isoproterenol 2ml : 1mg.

2. Mechanism

Adrenergic receptors can be divided into two types: α and β. Among them, α-adrenergic receptors have α1 and α2, and β-adrenergic receptors have β1, β2, and β3. They are distributed differently in various organs and have different effects. Adrenergic agonists are used as first aid drugs, mainly acting on α1, α2, β1 and β2 (β3-adrenergic receptor are mainly related to lipolysis). The activation of α1-adrenergic receptor will cause vascular smooth muscle to contract, which has the effect of raising blood pressure. α2-adrenergic receptor will produce feedback inhibition and will reduce the self-release of norepinephrine. In the market, α2-adrenergic receptor agonists (such as Clonidine) can treat high blood pressure. β1-adrenergic receptor are mainly distributed in the heart. Activation of it can increase the contractility and heartbeat of the heart. β2-adrenergic receptor mainly relax the smooth muscles of bronchial and skeletal muscle blood vessels. 

Epinephrine acts on α1, α2, β1 and β2 receptors. Norepinephrine acts on α1, α2 and β1 receptors. Isoproterenol acts on β1 and β2 receptors and has no obvious effect on α-receptor. 

• The ability to raise blood pressure: norepinephrine> epinephrine (its ability to relax skeletal muscle blood vessels is stronger than norepinephrine)> isoproterenol (It has no effect on the α-receptor.).
• Effect on heart rate: isoproterenol> epinephrine> norepinephrine (The effect of norepinephrine on β1-receptor is weaker than that of epinephrine).
• The effect on the bronchus: epinephrine ≈ isoproterenol> norepinephrine.

3. Clinical application

Cardiogenic shock, septic shock and shock due to hypovolemia

Norepinephrine mainly acts on α-receptors. It has a slight effect on heart β1-receptors and has almost no effect on β2-receptors. Compared with epinephrine, its vasoconstriction effect is better and it reflexively causes the heart rate to slow down. Therefore, norepinephrine is recommended for cardiogenic shock, septic shock, and shock caused by hypovolemia.

Because norepinephrine has a strong vasoconstriction effect. It is also used for non-varices upper gastrointestinal bleeding. 

Cardiac arrest

The effect on the heart β1 receptor: isoproterenol ≈ adrenaline. But the recommended drug is adrenaline. Main reason: Studies have confirmed that isoproterenol can cause myocardial inflammatory swelling and focal infarction.

Anaphylactic shock

The effect on bronchial smooth muscle β2 receptor: isoproterenol ≈ adrenaline. However, isoproterenol has a low affinity for α-receptors.

Adrenaline stimulates α-receptors and constricts blood vessels. It can raise blood pressure in patients with anaphylactic shock and eliminate bronchial mucosal edema. Adrenaline can also stimulate β2-receptors, which can expand bronchial smooth muscle. 

Therefore, epinephrine is recommended as the first choice.

• Note: Epinephrine can contract skin, mucous membrane blood vessels and expand skeletal muscle blood vessels. Subcutaneous injection of epinephrine is slower than intramuscular injection.

Complete atrioventricular block

Isoproterenol has a high affinity for heart β1-receptors. Compared with epinephrine, isoproterenol has a stronger effect on accelerating heart rate and accelerating conduction, but has a weaker effect on ectopic pacemaker. Therefore, the chance of causing arrhythmia is less than adrenaline. 

Isoproterenol is recommended for patients with complete atrioventricular block.

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Which one is better, milk or yogurt?🐄🐄🐄

Teenagers often drink more milk for physical growth. Milk is rich in nutrients, which is well known. The yogurt is also made from milk, and it can also regulate gastrointestinal digestion. Is yogurt better than milk?

What nutrition does milk contain?

The nutritional content of pure milk is actually very "normal". 

• The protein content of milk is not as good as chicken breast. There are only 3 grams of protein per 100 grams of pure milk, while chicken breast has about 20 grams of protein per 100 grams. 
• The vitamin A content of milk is not as good as that of some animal livers. Each 100 grams of milk contains about 24 micrograms of vitamin A, and the same weight of pig liver contains more than 4000 micrograms. 
• The vitamin C content of milk is not as good as lemon. Every 100 grams of milk contains about 1 mg of vitamin C and lemon contains about 20 mg.
• The potassium content of milk is not as good as that of bananas. Every 100 grams of bananas contains more than 200 mg of potassium, while milk is less than half of it.
• The calcium content of milk is not as good as that of sesame. 

In contrast, milk seems to have very little nutrition. But in fact, the nutrition of milk is very comprehensive. Each 100 grams of milk calories 54 (kcal), carbohydrate 3.4 (g), protein 3 (g), fat 3.2 (g), cholesterol 15 (mg), vitamin A 24 (μg), vitamin C 1 (mg), vitamin E 0.21 (mg), carotene 4.7 (μg), niacin 0.1 (mg),riboflavin 0.73 (mg), thiamine 0.11 (mg), retinol equivalent 2.3 (μg), calcium 104 (mg), iron 0.3 (mg), sodium 37.2 (mg), magnesium 11 (mg), manganese 0.03 (mg), zinc 0.42 (mg), copper 0.02 (mg), potassium 109 (mg), phosphorus 73 (mg), selenium 1.94 (μg). The protein of milk is high-quality protein. It contains all essential amino acids for humans. The calcium content of milk is also sufficient, and the ratio of calcium to phosphorus is also very appropriate. It is one of the best foods for calcium supplementation. Although the vitamin content of milk may not be sufficient, it is quite complete. It also has a variety of trace elements that people need. Moreover, milk is very cheap compared to many nutritious foods.

What nutrition does yogurt contain?

Yogurt is made from fresh milk fermented by lactic acid bacteria. After the milk is fermented into yogurt, the nutrient content will slightly change.

During the fermentation of milk into yogurt, about 20% of the sugar and protein in the milk are broken down into small molecules.

The content of fat in milk is generally 3% to 5%. After fermentation, the fatty acids in yogurt can be increased twice as much as milk, which makes the yogurt easier to digest and absorb. The utilization rate of various nutrients is therefore improved.

In addition to yogurt retains all the nutrients of milk, lactic acid bacteria can also produce more essential vitamins during the fermentation process, such as vitamin B1, vitamin B2, vitamin B6, and vitamin B12.

Although the calcium content in milk will not change much after fermentation, the lactic acid produced after fermentation can effectively increase the utilization of calcium and phosphorus in the human. Therefore, the calcium and phosphorus in yogurt are more easily absorbed by the body.

In the process of making yogurt, certain lactic acid bacteria can synthesize vitamin C, which increases the vitamin C in yogurt.

👉Summarize, milk and yogurt can be substituted for each other. Under normal circumstances, you can choose to drink milk or yogurt according to your preferences. But some people need to choose according to their own situation:

Lactose intolerance - drink yogurt

Some people will have symptoms of abdominal discomfort after drinking milk. These people may have lactose intolerance. They cannot absorb the lactose in milk. At this time, lactose enters their intestines, but it cannot be absorbed. Their bodies may have abdominal pain, diarrhea, etc. So for such people, the more suitable dairy product is yogurt.

Hyperlipidemia patients - skimmed milk

Although the taste of skimmed milk may be slightly worse, but it contains lower cholesterol content. Therefore, it is very suitable for patients with hyperlipidemia. If you think the taste of skimmed milk is poor, you can actually choose low-fat milk. However, you need to pay attention to the amount of low-fat milk you drink.

Diabetics - pure milk

If diabetic patients do not have lactose intolerance, they can choose to drink pure milk. Pure milk contains lower carbohydrates. However, if diabetic patients have lactose intolerance, pure milk is not the right choice. At this time, it is recommended to choose yogurt, but the yogurt needs to be sugar-free. Patients should also drink in moderation. 

Elderly - Yogurt

The elderly have poor ability to absorb nutrients, so they should choose yogurt that is easier to absorb. The nutrients in yogurt are easier to be absorbed by the body and the calcium supplement effect is relatively good.

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Drink enough water when taking these drugs.💧💧💧

In general, almost all medicines are taken with water. However, the amount of drinking water is various when taking different medicines. There are some medicines require drinking a lot of water. Most of medicines taken by the human body are eliminated by the kidneys. Drinking plenty of water when taking medicines can reduce the burden on the kidneys, excrete toxins and enhance metabolism of medicines. The following types of drugs should be noted to drink a lot of water when taking:

1. Antipyretic and analgesic

When you have a cold and you are taking antipyretic and analgesics, you should drink more water. Your urine output should not be less than 1.5 liters per day. You should pay more attention when you have a high fever or in summer. First of all, since these drugs can irritate the stomach at high concentrations, this irritation can be reduced by drinking more water. In addition, drinking water during a cold helps the body to urinate a lot to metabolize toxins in the body. Finally, antipyretic drugs have the effect of reducing fever and sweating occurs during the process of reducing fever. When sweat evaporates, it can take away a large amount of body temperature and water, thereby returning body temperature to normal. It is necessary to properly supplement water. If you drink too little water, it is not conducive to sweating and reducing fever. It will also cause collapse because the body's water is not replenished in time.

2. Antibacterial drugs

Aminoglycoside antibiotics: such as amikacin, gentamicin, etc. Aminoglycoside antibiotics are highly toxic to the kidneys. The higher the concentration, the greater damage to the renal tubules. Therefore, it is advisable to drink more water to dilute and accelerate the excretion of the drug.

Sulfonamide antibacterial drugs: Sulfonamide drugs and their metabolites are mainly excreted through the kidneys. Sometimes they precipitate out from the urine and form crystals, causing low back pain, proteinuria and hematuria. In severe cases, the crystals can block the urinary tract and obstruct urine excretion. Drinking a lot of water can increase urine output and reduce the concentration of drugs in the urine. It can also combine with some drugs that can alkalize urine at the same time, such as sodium bicarbonate, to avoid precipitation of crystals and damage the kidneys.

Quinolone antibacterial drugs: such as levofloxacin, ciprofloxacin, etc., are mainly excreted through the kidneys. Crystal urine may occur when large doses of fluoroquinolones are used or the urine pH is above 7. In order to avoid the occurrence of crystal urine, you should drink more water and maintain a 24-hour urine output above 1200ml.

3. Antiviral drugs

Antiviral drugs such as acyclovir and famciclovir can cause crystalline renal failure. Therefore, it is advisable to drink more water during the medication period, especially the elderly. Due to the decline of physiological renal function, the dosage should be reduced. Combined use with zidovudine can cause nephrotoxicity. It manifests as fatigue, deep lethargy. It also competitively inhibit the secretion of organic acids with probenecid, which can slow down the excretion of this class of drugs. It will accumulate the amount of drugs in the body.

4. Anti-gout drugs

When you are taking anti-gout drugs such as benzbromarone, allopurinol, etc., you should drink more water and ensure that the drinking amount is not less than 2 liters. It can reduce the irritation to the digestive tract. At the same time, enough water can alkalize the urine to prevent the formation of stones in the urinary tract during the excretion of uric acid.

5. Bisphosphate

Bisphosphonates such as alendronate sodium, clodronate disodium, etc. In the treatment of hypercalcemia, bisphosphonates can cause electrolyte disturbance and water loss. Therefore, you should pay attention to supplement body fluids and make the daily urine output reaching more than 2000ml. Bisphosphonates are also very irritating to the gastrointestinal tract. Drinking plenty of water when taking it can help reduce the irritation of bisphosphonates to the gastrointestinal tract. In addition, it is not advisable to lie down immediately after taking the medicine and keep the upper body upright for at least 30 minutes (Ibandronate should keep the upper body upright for 60 minutes).

👉In addition to drinking plenty of water when taking these drugs, you should also drink enough water at ordinary times.

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