Common complications induced by diabetes.😰😰😰

Diabetes is a chronic metabolic disease. Diabetes can easily lead to other disorders. Most patients with diabetes generally have other unhealthy conditions or diseases, not just diabetes. Diabetes can also exacerbate these unhealthy conditions or diseases. Complications that diabetes can easily induce are pointed out below.

1. Eye disease.

Diabetes is a risk factor for many eye diseases.

Cataracts: Cataracts are closely related to age. It is one of the leading causes of blindness in the elderly. Apart from age-related, diabetes is also a risk factor for cataracts.

Glaucoma: People with diabetes are more likely to have glaucoma than people without diabetes.

Dry Eye: It is a very common eye disease. People with diabetes are also more likely to suffer from dry eye syndrome. Diabetes is a significant risk factor for dry eye disease.

2. Oral disease.

People with diabetes are more likely to have oral disease than people without diabetes. And they have a significantly increase in disease severity and duration. Diabetes is a risk factor for periodontitis. Periodontitis is also a common complication of diabetes. The risk of periodontitis in people with diabetes is nearly three times greater than in people without diabetes.

3. Kidney disease.

One of the main causes of chronic kidney disease is kidney disease caused by diabetes. Although the research on the pathogenesis and etiology of diabetic nephropathy is not complete, it is generally believed that it is caused by many risk factors, such as age, blood pressure, obesity, genetic susceptibility, glycemic control, glomerular filtration rate. 

4. Neuropathy.

Another common chronic complication of diabetes is diabetic neuropathy. Both the central and peripheral nerves may be affected. It is a heterogeneous group of diseases with a variety of different clinical manifestations. The most common diabetic peripheral neuropathy is distal symmetrical polyneuropathy. About 75% of diabetic neuropathy is this neuropathy, and it is one of the major risk factors for diabetic foot ulcers. It is also the leading cause of falls and fractures in people with diabetes.

5. Fractures.

People with diabetes have a significantly higher fracture risk than people without diabetes. Fractures in people with diabetes are not due to calcium or vitamin D deficiency. Some studies have pointed out that in the case of long-term hyperglycemia, changes in collagen cross-linking and glycosylation products can cause changes in the microstructure of bones. It causes bone to become brittle and more prone to fractures.

6. Mental illness.

Although mental illness is not a particularly common complication of diabetes, it can also occur due to the effects of diabetes on the central nervous system and cerebrovascular. Especially in older people with diabetes, they are prone to symptoms of memory loss and diabetes may exacerbate this condition. In addition, depression is the most common symptom of mental illness.

7. Cancer.

There are many studies showing that the risk of various cancers such as gastrointestinal cancer, liver cancer, pancreatic cancer, ovarian cancer, etc. is increased in diabetic patients. Among them, the risk of pancreatic cancer, colorectal cancer, bladder cancer, endometrial cancer and breast cancer is more than twice that of the general population. In addition, studies have shown that for every 1% increase in HbA1c in diabetic patients, the risk of cancer will increase by 18%.

8. Cardiovascular and cerebrovascular disease.

People with diabetes are more likely to have atherosclerosis and it progresses more rapidly than the normal population. It can in turn cause other cardiovascular diseases such as coronary heart disease. Studies have shown that patients with type 1 diabetes significantly increase the prevalence of myocardial infarction, heart failure, coronary heart disease, and atrial fibrillation. Increasing age and duration of diabetes also increases the prevalence of lower extremity atherosclerotic disease. It increases the risk of death from cardiovascular disease in people with diabetes. Cardiac autonomic neuropathy may also occur in people with diabetes. The risk of stroke increases by 1.5 to 4 times with type 2 diabetes. One of the risk factors for stroke is diabetes. The risk of cerebrovascular disease such as ischemic stroke is highly correlated with type 2 diabetes and high levels of HbA1c.

9. Infection.

The risk of many infections, such as head and neck infections, respiratory infections, skin and soft tissue infections, gastrointestinal infections, blood infections, etc., is significantly increased with diabetes. Blood vessels and neuropathy in the distal lower extremities can lead to diabetic foot infections and ulcers in the feet of people with diabetes. Severe cases can lead to amputation and death.

10. Hepatobiliary disease.

Because people with diabetes have a higher area of visceral adipose tissue than normal people, they are more likely to develop hepatic steatosis, which can lead to liver disease. People with diabetes are also more likely to have gallstones.

11. Blood disease.

Adults with diabetes have a higher risk of anemia. It is related to the patient's gender, disease course and comorbidities. Women have a higher risk of anemia than men. Patients with longer disease duration and comorbidities are also more likely to develop anemia.

12. Others.

Diabetes increases or worsens the risk of many diseases such as thyroid disease, dementia, and electrolyte disturbances. Clinical treatment should also pay attention to these problems.

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How to choose which glucocorticoid to use?😵😵😵

There are many clinical situations where glucocorticoids are needed. But
which one should be used among so many glucocorticoids? How should glucocorticoids be interchanged?

Effect period of glucocorticoids.

Glucocorticoids can be divided into short-acting, medium-acting and long-acting according to their effect period.

1. Short-acting glucocorticoids: Commonly used are cortisone and hydrocortisone. They are natural and endogenous hormones. They have a short duration of action and weak anti-inflammatory effects. Therefore, they should not be used to treat rheumatism. It is generally used for replacement therapy of adrenal insufficiency.
2. Medium-acting glucocorticoids: Commonly used intermediate-acting glucocorticoids are prednisone, prednisolone, triamcinolone, and methylprednisolone. They are often used to treat rheumatism.
3. Long-acting glucocorticoids: Commonly used long-acting hormones are betamethasone and dexamethasone. They are long-acting and have strong anti-inflammatory properties. However, they significantly inhibit the hypothalamic-pituitary-adrenal axis and should not be used long-term. They should only be used as a temporary medication such as for treating allergies. Intermediate-acting and long-acting glucocorticoids are both exogenous and synthetic hormones.

Efficacy of different dosage forms of glucocorticoids.

Oral corticosteroids:

Equivalent dose: 

25mg cortisone = 20mg hydrocortisone = 5mg prednisone = 5mg prednisolone = 4mg triamcinolone = 4mg methylprednisolone = 0.6mg betamethasone = 0.75 dexamethasone.

Anti-inflammatory potency: 

• Cortisone = 0.8
• Hydrocortisone = 1
• Prednisone = 3.5 to 4
• Prednisolone = 4
• Triamcinolone = 5
• Methylprednisolone = 5
• Betamethasone = 25 to 35
• Dexamethasone = 30

Potency of mineralocorticoids:

• Cortisone = 0.8
• Hydrocortisone = 1
• Prednisone = 0.8
• Prednisolone = 0.8
• Triamcinolone = 0
• Methylprednisolone = 0.5
• Betamethasone = 0
• Dexamethasone = 0

Duration of action:

• Short-acting glucocorticoids: 8 to 12 hours.
• Medium-acting glucocorticoids: 12 to 36 hours.
• Long-acting glucocorticoids: 36 to 54 hours.

Inhaled corticosteroids:

Drug	Low dose(μg)	Medium dose(μg)	High dose(μg)
Beclomethasone dipropionate	200 – 500	500 – 1000	1000 - 2000
Budesonide	200 – 400	400 – 800	800 – 1600
Fluticasone propionate	100 – 250	250 - 500	500 - 1000
Ciclesonide	80 – 160	160 – 320	320 - 1280

Equivalent dose: 

1000μg Beclomethasone dipropionate = 800μg Budesonide = 500μg Fluticasone propionate.

Topical corticosteroids:

Topical corticosteroids are frequently used in dermatology.

Weak glucocorticoids: 1% hydrocortisone acetate, 0.25% methylprednisolone.

Moderate glucocorticoids: 0.5% prednisolone acetate, 0.05% dexamethasone acetate, 0.05% clobetasone butyrate, 0.025%-0.1% triamcinolone acetonide, 1% hydrocortisone butyrate, 0.025% fludrocortisone acetate , 0.01% fluocinolone.

Potent glucocorticoids: 0.025% beclomethasone propionate, 0.1% mometasone furoate, 0.025% fluocinolone, 0.025% cloflusolone, 0.05% betamethasone valerate.

Super potent glucocorticoids: 0.02%-0.05% clobetasol propionate, 0.1% cloflubutasone, 0.1% betamethasone valerate, 0.05% halometasone, 0.05% diacetate difluorosone.

Therapeutic use.

1. Alternative therapy for primary adrenal insufficiency: Adrenal insufficiency causes Addison disease. Hydrocortisone is effective in improving cortisol deficiency. Deficiencies in insufficient cortisol can lead to death.
2. Alternative treatment for secondary adrenal insufficiency: Deficiency of adrenocorticotropic hormone synthesized by the pituitary gland or corticotropin-releasing hormone synthesized by the hypothalamus can cause this disorder. It can be treated with hydrocortisone.
3. Diagnosis of Cushing syndrome: Excessive release of adrenocorticotropic hormone from the pituitary gland or tumor of the adrenal gland. This can cause too much cortisol and cause Cushing syndrome. In addition, long-term use of high-dose glucocorticoids can also cause iatrogenic Cushing syndrome. The release of cortisol is suppressed with dexamethasone under normal conditions, but not in patients with Cushing syndrome. Therefore, a test for the inhibition of cortisol by dexamethasone can be used to diagnose Cushing syndrome.
4. Alternative Treatment for Congenital Adrenal Hyperplasia: It is a group of disorders caused by a deficiency in one or more of the enzymes that synthesize adrenal steroids. It causes the body to overproduce adrenaline androgen. Adrenocorticotropic hormone and corticotropin-releasing hormone release can be suppressed with adequate corticosteroids, thereby maintaining normal hormone levels in the body.
5. Relieve inflammatory symptoms: Glucocorticoids can significantly reduce inflammation-related symptoms such as redness, swelling, heat, and pain in inflamed areas of rheumatoid arthritis or the skin. It can be used to treat asthma attacks and control persistent asthma symptoms. It is also used to treat inflammatory bowel disease. In addition, for some non-inflammatory diseases such as osteoarthritis, it can be administered intra-articularly to treat the onset of osteoarthritis.
6. Treating Allergic Reactions: Glucocorticoids are used to treat a variety of allergic reactions such as drug-induced allergy and allergic rhinitis. In addition, when used for allergic rhinitis and asthma, topical administration is generally used to reduce the occurrence of systemic adverse reactions.
7. Promoting fetal lung maturation: Premature infants may develop respiratory distress syndrome. Fetal lung maturation is regulated by fetal cortisol. Inject dexamethasone or betamethasone subcutaneously to the mother within 48 hours before delivery. It promotes fetal lung maturation.

Glucocorticoids have a wide range of clinical uses, and they are also used to treat other diseases such as cancer.

Side effect.

Although glucocorticoids are widely used and effective, their side effects are numerous and related to the timing and dosage of use. Side effects of long-term use of glucocorticoids include osteoporosis, increased appetite, hypertension, glaucoma, increased risk of infection, mood disorders, peripheral edema, central obesity, increased risk of diabetes, and hypokalemia.

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How to tell the difference between the common cold and the flu.💫💫💫

Winter is flu season. During this season, many patients with cold symptoms think they have the flu. Patients diagnosed with the common cold after examination may even worry that the examination was not careful enough. They will question the doctor's examination. So what is the difference between the common cold and the flu?

Etiological differences.

Common cold:

The common cold can be caused by different pathogens. They include
coronavirus, respiratory syncytial virus, ECHO virus, adenovirus, rhinovirus, influenza virus, and parainfluenza virus, among others. Common colds in children are caused by respiratory syncytial virus and parainfluenza. Adult colds are mainly caused by rhinoviruses.

Flu: 

Influenza is caused by the influenza virus. It is a single-stranded, negative-stranded, segmented RNA virus. It belongs to the Orthomyxoviridae family. Influenza viruses are classified into four types: A, B, C, and D according to their matrix proteins and nucleoproteins. The main causes of influenza in humans are types A and B. There are many glycoprotein protrusions such as hemagglutinin (H) and neuraminidase (N) on the outer membrane of the virus. Influenza A viruses are named according to the difference between these two glycoproteins, such as H1N1, H2N2, H5N1, etc. Influenza B is divided into two strains, Victoria and Yamagata. 

Epidemiology of the common cold and flu.

Common cold:

The common cold is less contagious and not classified as an infectious disease. It is mainly infected by inhaling infected droplets or touching infected secretions and then touching the nose. The population is generally susceptible. Severely ill patients are rare. It can happen all year round and has no apparent seasonality.

Flu:

Influenza is highly contagious and spreads quickly. Influenza viruses are mainly spread by droplets from sick and latently infected persons. It is also spread by aerosols in crowded and poorly ventilated spaces. The population is generally susceptible. The following groups of people are more likely to develop severe disease after infection:

1. Children under 5 years old. In addition, children younger than 2 years are more likely to develop serious complications.
2. Seniors 65 and older.
3. Patients with cardiovascular disease (except hypertension), chronic respiratory disease, liver disease, kidney disease, blood system disease, endocrine system disease, nervous system disease, immunosuppressed, cancer, etc.
4. Obesity: BMI>30.
5. Pregnancy and perinatal women.

Influenza mostly occurs in summer and winter. It is generally seasonal.

Clinical manifestations.

Common cold:

The common cold has a shorter incubation period and a more acute onset. Common symptoms are nasal congestion, sneezing, coughing, sore throat and chest discomfort. Fever, headache and other complications are rare. Symptoms of generalized pain and fatigue are mild. In the absence of complications, it usually takes 5 to 7 days to heal.

Flu:

The incubation period of influenza is generally 1 to 7 days, and most is 2 to 4 days. The patient's body temperature can reach 39 to 40 degrees. It can be accompanied by chills, marked headache, and generalized pain is common and severe. The flu is sometimes accompanied by nasal congestion, sneezing, sore throat, mild to moderate chest discomfort and coughing. The most common complication of influenza is pneumonia. Others include heart and nervous system damage, myositis, rhabdomyolysis, shock, etc. Laryngitis, otitis media, and bronchitis are more common in children with influenza than in adults. In uncomplicated patients, systemic symptoms generally improve 3 to 5 days after onset, but physical recovery and cough usually take longer. 

Treatment.

Common cold:

There are no effective antiviral drugs for the common cold. Generally, decongestants, antihistamines, expectorants, antitussives, antipyretic analgesics, etc. are used for symptomatic treatment. Isolation and hospitalization are generally not required.

Flu:

Common anti-influenza virus drugs for influenza include M2 ion channel blockers (such as Amantadine), neuraminidase inhibitors (such as Zanamivir, Oseltamivir), and hemagglutinin inhibitors (such as Arbidol). Fever patients can undergo physical cooling and take antipyretics. Sputum expectorants and antitussives may be prescribed for patients with severe sputum and cough. Symptomatic treatment according to the patient's condition. If the patient's symptoms are severe or the underlying disease is significantly aggravated, the patient needs to be hospitalized. Both clinically diagnosed and confirmed patients should be treated in isolation.

Prevention.

Good personal hygiene is an important measure to prevent all respiratory infections such as frequent hand washing, keeping the environment clean and well ventilated, wearing a mask, etc.

Common cold:

There is no need for drug prophylaxis and no specific vaccine for the common cold. The best way to prevent it is to practice good personal hygiene.

Flu:

The best way to prevent the flu is to get the flu shot. Key groups such as healthcare workers, patients with chronic diseases, pregnant women, the elderly over 60 years old, children 6 months to 5 years old, and those who need to take care of children less than 6 months old should be vaccinated annually. Post-exposure drug prophylaxis is available for close contacts who have not been vaccinated or have not yet acquired immunity after vaccination and who are at high risk for severe influenza. It recommends taking oseltamivir or zanamivir once daily for 7 days within 48 hours of exposure.

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Some commonly used medical terminology explained.📝📝📝

There are many professional terms in clinical medicine. Some professional terms look similar, but they mean different things. Misunderstanding these terms when taking medication may reduce the efficacy and even cause unnecessary side effects. This article will explain some common medical terms.

Dosages and maximal dose.

Dosage is the amount of a drug that is effective in treating a disease. The dosage is related to the different indications, the severity of the disease, and the patient itself. The dosage of the drug needs to be adjusted according to the above points.

Maximal dose is the maximum therapeutic dose of the drug. If the dose is over than maximal dose, it can become poison and produce toxic side effects. In addition, maximal dose does not necessarily refer to a single dose. It will also have a daily maximum dose and other conditions.

The clear meaning of before meal, during meal, after meal and on an empty stomach.

Before meal means taking the drug 0.5 to 1 hour before the meal. It can be to reduce food-drug interactions, to make the drug more effective, or to reduce the incidence of adverse reactions.

During meal means taking the drug immediately before the meal or during the meal. It is mainly for the drug to work better.

After meal means taking the drug 0 to 0.5 hour after the meal. It can be to reduce the irritation of the drug to the gastrointestinal tract or to increase the absorption of the drug.

On an empty stomach means fasting for 10 hours before taking the medicine. It is mainly to avoid the effect of food on the drug.

The difference between taking it every 8 hours and taking it three times a day.

Dosing every few hours is because some medicines need to be taken at precise intervals in order to be effective. Therefore, patients need to take the drug every 8 hours, 12 hours, 24 hours or other.

Medications that are taken several times a day are less precise about the time interval between dosing. Medication is usually taken according to the patient's meal time.

Contraindication.

Contraindications mean that the drug cannot be used with these symptoms. Otherwise, some serious adverse reactions may occur or are very likely, and even certain adverse reactions will occur. Take NSAIDs as an example:

• Ibuprofen: Its contraindication is in patients with active peptic ulcer. In these patients, the use of ibuprofen will definitely worsen the gastrointestinal ulcers and the adverse reactions of gastric bleeding are likely to occur.
• Etoricoxib: It is contraindicated in patients diagnosed with ischemic heart disease or cerebrovascular disease. Etoricoxib may induce serious adverse reactions (cardiovascular and cerebrovascular events) in patients.

Use with caution.

Use with caution means use under conditions. For example, aminoglycoside antibiotics are generally avoided in children younger than 6 years of age because of clear ototoxicity and nephrotoxicity. However, aminoglycoside antibiotics can be used in children in the following situations.

• Aminoglycoside antibiotics can be used when other less toxic antibiotics cannot be used and the child has a clear clinical indication for use.
• Adverse reactions should be closely monitored during treatment. When conditions permit, blood drug concentration monitoring should be implemented in patients and medication should be adjusted according to the results.

Definition of the incidence of adverse reactions.

Problems with the quality of the drug are not the cause of adverse reactions. Adverse effects are an inherent property of every drug. No matter how good the quality of the drug is, there will be adverse reactions. 

• Very rare: the incidence of adverse reactions < 0.01%.
• Rare: 0.01% ≤ the incidence of adverse reactions < 0.1%.
• Not common: 0.1% ≤ the incidence of adverse reactions < 1%.
• Common: 1% ≤ the incidence of adverse reactions < 10%.
• Very common: The incidence of adverse reactions ≥ 10%.

Statins: Common side effects are myalgia (about 1.5 to 5%) and liver damage (about 1 to 2%). Rhabdomyolysis is a rare side effect of it.

Thiazide diuretics: Raising blood uric acid levels is a very common side effect of these drugs. Therefore, it is contraindicated in patients with gout and should be avoided in patients with hyperuricemia.

Expiry date and period of use.

Expiry dates are generally marked as Exp. year/month or year/month/day. If the expiry date is only marked with the year and month, the medicine can be used until the last day of the month in that year. Such as Exp. 2022/02, the medicine can be used until 28th February 2022. If the expiry date is marked with the year, month and day, the medicine can be used until that date. Such as Exp. 2022/02/11,  the medicine can be used until 14th February 2022.

Period of use refers to the period during which the medicine can be used after the original packaging of the medicine is opened. The original packaging of ophthalmic preparations, nasal preparations, etc. is generally only used within 28 days after opening. 

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Several foods that are good for the liver.👍👍👍

The liver is an important organ of the human body. It plays an important role in human physiology and life activities. It is also one of the largest and most functional organs in the human body. The liver is the center of human metabolism and the largest organ of the digestive glands. It plays an irreplaceable role in the catabolism of sugar, fat, protein and other substances and the storage of glycogen. The liver is also an important detoxification organ in the human body. During human metabolism, blood flows from the abdominal cavity to the liver through the portal vein. Microorganisms and harmful substances contained in the blood are metabolized and detoxified in the liver into more water-soluble or non-toxic substances. These metabolites are then excreted in bile or urine. If the liver is diseased, it can lead to impaired liver function. When the liver function is damaged, the body's material metabolism will be disordered. It may cause metabolic diseases such as diabetes and hyperlipidemia. Therefore, it is important to keep the liver healthy. Eat these foods regularly to keep your liver healthy.

1. Coffee.

Studies have shown that coffee can prevent fatty liver and be beneficial to the liver. Drinking coffee every day can effectively reduce the risk of chronic hepatitis, thereby preventing liver cancer. It increases liver transaminases and antioxidant levels. This reduces fat accumulation in the liver and helps remove carcinogens.

2. Oat.

Oatmeal is one of the easiest and most convenient foods to consume dietary fiber. Dietary fiber can help the body digest food very well. Oats are also rich in β-glucan. It has high biological activity in the human body. It promotes the regulation of the immune system to fight inflammation more effectively. Studies have shown that the β-glucan in oats can reduce the amount of fat stored in the liver of mice and play a role in protecting the liver. In addition, it may also be effective in the treatment of diabetes and obesity.

3. Green tea.

Green tea has long been thought to have weight loss benefits. This effect has also been confirmed by many studies. Studies have pointed out that green tea has antioxidant effects, reduced body fat absorption and symptoms associated with non-alcoholic fatty liver disease.

4. Garlic.

Garlic gets the most attention for its anticancer abilities. However, it also has the effect of protecting the liver. In the daily diet, people should eat garlic properly.

5. Grape.

Grapes, grape juice and grape seeds have all been found to be rich in antioxidants. It protects the liver by preventing liver damage and reducing inflammation.

6. Grapefruit.

Naringin and naringenin are the two major antioxidants found in grapefruit. They can protect liver cells and reduce inflammation to prevent liver damage. They can also prevent fat from accumulating in the liver and reduce symptoms of nonalcoholic fatty liver disease.

7. Berry.

Polyphenols are found in many dark berries, such as cranberries, raspberries, and blueberries. It is also an antioxidant. Studies have shown that regular consumption of berries can boost immunity and help prevent liver damage.

8. Other fruits and vegetables that are good for the liver.

Studies have shown that these fruits and vegetables are good for the liver:

• Avocado.
• Banana.
• Ficus carica.
• Cactus fruit.
• Lemon.
• Pawpaw.
• Watermelon.
• Radish.
• Beets and beet juice.
• Broccoli.
• Kale.
• Barley.
• Brown rice.

9. Nut.

Most nuts contain a variety of antioxidants, vitamin E, and unsaturated fatty acids. These substances can reduce inflammation and help prevent non-alcoholic fatty liver disease. This has also been confirmed that nuts can protect the liver. Eating the right amount of almonds, walnuts and other nuts every day can prevent liver disease. However, nuts are high in fat and should not be eaten in excess.

10. Olive oil.

Studies have pointed out that olive oil is rich in unsaturated fatty acids. It can help reduce the occurrence of oxidative stress and improve liver function. Adding olive oil to food can prevent excess fat intake and prevent liver damage.

11. Deep sea fish.

Deep-sea fish are rich in omega-3 fatty acids. It prevents inflammation and excess fat from accumulating in the liver. It also maintains adequate levels of transaminases in the liver. Studies have shown that consuming deep-sea fish or fish oil supplements can be effective in preventing liver disease. It also recommends eating deep-sea fish no less than 2 times a week. If you don't like eating fish, you might consider taking a fish oil supplement.

In addition, you should avoid eating too many foods that are harmful to the liver:

• Starchy foods: such as bread, cakes or baked goods.
• High-fat foods: such as fried foods, fatty meat, etc.
• Sugar: Excessive sugar intake should be avoided to reduce the stress on liver metabolism.
• Salt: Avoid too much salt intake. Processed foods such as sausage and bacon should be avoided.
• Alcohol.

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Comparison between various commonly used angiotensin receptor blockers.👀

Angiotensin receptor blockers (ARBs) are commonly used blood pressure
lowering drugs. The more common among them are allisartan, azilsartan, candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan. What is the difference between them and what is their usage?

Indications.

There are five commonly used antihypertensive drugs: angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), β-blocker, calcium channel blocker (CCB) and diuretics. Although they have the effect of lowering blood pressure, they are used differently in different situations. Depending on the patient's physical condition, risk factors, and comorbidities, there will be different priorities for the selection of antihypertensive drugs.

1. For hypertensive patients with diabetes or chronic kidney disease: ACEI or ARB is the first choice drug. If patients need combination therapy, they should also be based on ACEI or ARB.
2. For patients with hypertension and myocardial infarction: patients should use ACEI or ARB combined with β-blocker.
3. For hypertensive patients with dyslipidemia or atrial fibrillation prophylaxis: ACEI or ARB is the first choice drug.
4. For patients with hypertension and heart failure: ACEI is the first drug of choice. If patients are intolerant to ACEI, ARB can be used instead. Both ACEIs and ARBs can reduce the risk of hospitalization and mortality in patients with Heart Failure with Reduced Ejection Fraction (HFrEF). They can improve the patient's exercise capacity and related symptoms. Unless patients are intolerant to or have contraindications to ACEIs, patients are recommended to use ACEIs first. For patients who cannot use ACEIs, it recommends the use of ARBs with clear evidence of benefit in HFrEF, such as candesartan, losartan, and valsartan. For patients who can tolerate ACEIs or ARBs, it recommends sacubitril/valsartan tablets instead of them. It can further reduce morbidity and mortality in patients with heart failure.

A common adverse reaction of ACEI is cough. If the patient cannot tolerate it, ARB can be used instead.

Among various ARB antihypertensive drugs, losartan is the only one that has the effect of lowering blood pressure and also lowering uric acid. Therefore, it reduces gout attacks.

Dosage.

Allisartan: Its recommended dosage is 240 mg once daily. Food can significantly reduce its absorption. Its bioavailability is reduced by 35.5%. Therefore, it is not recommended to be taken with food and should be taken on an empty stomach.

Azilsartan: Its recommended dosage is 20 to 40 mg once daily. Food does not have a significant effect on its absorption. Therefore, it can be taken with or without food.

Candesartan: Its recommended dosage is 4 to 12 mg once daily. It can be taken with or without food.

Irbesartan: Its recommended dosage is 150 to 300 mg once daily. It can be taken with or without food.

Losartan: Its recommended dosage is 50 to 100 mg once daily. It can be taken with or without food.

Olmesartan: Its recommended dosage is 20 to 40 mg once daily. It can be taken with or without food.

Telmisartan: Its recommended dosage is 40 to 80 mg once daily. Food will slightly reduce its absorption. However, it can be taken with or without food.

Valsartan: Its recommended dosage is 80 to 160 mg once daily. Food reduces its absorption by 48%. However, when it was taken with or without food, there was no significant change in its blood levels after 8 hours. Therefore, it can also be taken with or without food, but it is recommended to take it at the same time each day.

Pharmacokinetics.

Allisartan and losartan are metabolized to the active product EXP-3174 by gastrointestinal esterases and hepatic CYP2C9, respectively. The half-life of EXP-3174 is approximately 10 hours. EXP-3174 has a stronger affinity for angiotensin receptors than they do. However, some studies indicate that only a small amount of losartan can be converted into the active metabolite in a small number of people. The efficacy of losartan may be reduced in these people.

Telmisartan has the longest half-life of these drugs. Its half-life is more than 20 hours. Therefore, an occasional missed dose of telmisartan has little effect on blood pressure.

Affinity to angiotensin receptors:

• Candesartan = Olmesartan > Irbesartan > Telmisartan = Valsartan = EXP-3174 > Losartan

In addition, studies have shown that the maximum dose of azilsartan has a stronger blood pressure lowering ability than the maximum dose of olmesartan and valsartan.

Interaction.

Same points:

1. NSAIDs: In combination with NSAIDs such as etoricoxib and ibuprofen, the antihypertensive ability of ARBs decreases and increases the risk of renal impairment.
2. Diuretics: It may cause severe hypotension in combination with diuretics. If the patient is already taking a diuretic, the ARB should be started at a low dose. In addition, ARBs reduce the secretion of aldosterone. It has the side effect of causing hyperkalemia. Therefore, patients' potassium levels need to be closely monitored when co-administered with potassium-sparing diuretics such as spironolactone.
3. Lithium: The plasma concentration of lithium is increased by ARBs. It may cause lithium poisoning. They should be avoided in combination.

Difference points:

1. Losartan: Although the clinical significance is unclear, studies have shown that fluconazole and rifampicin reduce the metabolism of losartan. They may reduce the blood pressure-lowering effects of losartan. Be careful when using them together.
2. Telmisartan: Since telmisartan will increase the steady state minimal concentration of digoxin by about 20%, the plasma concentration of digoxin should be monitored when it is co-administered with digoxin.

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Some lifestyle habits may be harming your health.💫💫💫

Healthy lifestyle habits are of course good for your health. However, if some details are wrong, healthy habits may become unhealthy. In the long run, it may harm your body. Especially when the weather is cold, some comforting habits may be unhealthy habits.

Drink less or do not drink of these things.

1. Overheated drinks.

When the weather is cold in winter, many people will like to drink hot drinks, such as hot water, hot tea and hot coffee. Although hot drinks can warm your body, overheated drinks can actually be bad for your body. If a person frequently drinks overheated beverages, it can repeatedly burn the mucous membranes of the mouth and digestive tract. These mucous membranes undergo repeated processes of injury and recovery. During this process, more and more abnormal mucosal cells may be generated. It increases the risk of developing esophageal cancer. 

Studies have shown that hot drinks at 65 to 75 degrees can scald the throat and may cause esophageal cancer. The International Agency for Research on Cancer has also defined hot drinks over 65 degrees as a Category 2A carcinogen. Therefore, we should not drink beverages above 65 degrees. But we can't use a thermometer to measure the temperature every time. It is recommended that we drink a small amount of beverages first. If you don't feel hot and you can drink it directly, then the temperature is more suitable. If you feels too hot, you should let the beverage cool down a little bit before drinking it.

2. Double-boiled soup.

In Chinese society or in Asia, many people would like to eat double-boiled soup. It is known for its deliciousness and health benefits. However, you should also be careful not to eat the soup when it is too hot. And not everyone can eat double-boiled soup. Double-boiled soup takes a long time to cook for it to taste good. But the longer the soup is cooked, the higher the purine and nitrite content in the soup. Purines may increase uric acid in the body and induce gout. Nitrite has also been linked to cancer. If you eat soup for a long time or in large quantities, the kidneys may not be able to metabolize all of them, and then induce renal failure. Double-boiled soup generally has meat, and the fat content is not less. The disadvantages of fat are believed to be needless to say. 

It is generally not recommended to cook meat soup for more than 2 hours, and it is best to control it to about 1 hour. Fish soup should be within 1 hour. When you eat soup, you should also eat residual from soup, which is also very nutritious. Patients with gout, hypertension, hyperglycemia, hyperlipidemia, poor stomach and kidney function, obesity, etc. should eat less double-boiled soup.

3. Strong tea.

Some people will enjoy drinking strong tea to help remove oil and refresh themselves. But in fact, strong tea is harmful to the body. Strong tea contains a lot of tea polyphenols. It causes calcium loss in the body. It can harm bones. There is also a lot of oxalic acid in strong tea. Oxalic acid can form stones with calcium in the urinary tract, which can easily lead to kidney stones. Strong tea contains a lot of theophylline and caffeine. They stimulate the secretion of stomach acid. This can easily damage the gastric mucosa and induce gastritis and gastric ulcers. Caffeine also stimulates the nervous system. It can lead to palpitations and arrhythmia by causing increased blood flow and heart rate.

Strong tea generally refers to about 3 grams of tea leaves per 150ml of water. It is generally darker in color and more bitter in taste.

Bad sleeping habits.

Besides going to bed late, there are some bad sleep habits that are not good for your body.

1. Sleep after eating.

Some people prefer to lie down or sleep directly after eating. It can lead to proneness to acid reflux. Stomach acid is very corrosive. When it backs up into the esophagus and throat, it can harm them.

2. The blanket covers the head.

Some people like to sleep with the blanket over their heads. This could be because it's too cold or feels more safety. But doing it may affect the quality of sleep and seriously cause hypoxia. So, if the reason is too cold, you can consider adding an extra blanket. If you feel unsafety, maybe you can try to hugging something to sleep.

3. Sleep curled up.

When it's cold, some people find the bed and blanket too cold, so they curl up to sleep. You may feel stiffness and muscle aches when you wake up. Because when they slept curled up, they stayed in that position all night. The muscles will remain in a tight state, and the cold weather may make the muscles in a tighter state. 

Therefore, when the weather is too cold, you can add an extra blanket or use a heater. This can improve the quality of sleep.

Bad bathing habits.

1. The water temperature is too hot.

Some people will like to take a very hot bath in the winter. In winter, human skin can be very dry. If the water is too hot, it will flush more oil from the surface of the skin. The skin becomes overly dry, itchy and cracked. Too hot water can also increase the dilation of blood vessels near the skin. Blood will flow more to the skin. It reduces blood supply to vital organs such as the brain and heart. Patients with cardiovascular and cerebrovascular diseases are more likely to develop ischemia.

Therefore, the water temperature should not be too hot when bathing.

2. The bathroom is poorly ventilated.

If the bathroom is poorly ventilated, this can result in too little oxygen in the bathroom. If the bathing time is too long, it may cause a coma due to lack of oxygen. This kind of news comes out every year. So make sure the bathroom is well ventilated.

3. Take a shower after drinking.

Some people go to the shower immediately after drinking. They may want to take a bath to remove the smell of alcohol or to refresh themselves. However, bathing will speed up blood circulation and increase energy consumption. Glucose consumption also increases and may cause hypoglycemia. The ethanol in alcohol reduces the storage of glucose in the body. Therefore, bathing immediately after drinking alcohol increases the chance of coma.

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Dietary guidelines for cancer patients during Chinese New Year.👍👍👍

It's the Chinese New Year recently, and there are celebrations in many places. Many people will change their eating habits in order to celebrate Chinese New Year. Normal people may only eat slightly unhealthy during the festival days and not be affected too much. However, some patients cannot eat too freely. Cancer patients should also pay attention to a reasonable diet during this period to avoid exacerbation of the disease. This article will summarize some doctors' dietary recommendations for them.

Health products.

During Chinese New Year, some relatives and friends will give gifts to each others. Health products are one of the popular gifts. Do those health products really make you health? Are they suitable to every one?

1. Ginseng.

Ginseng has a good effect on the prevention and treatment of cancer. It can fight tumors through multiple mechanisms of action. It regulates the body's immune system and increases resistance to disease. This can achieve the effect of inhibiting tumor growth. In addition, it can also reduce the drug resistance of cancer cells and enhance the efficacy of drugs. However, not all cancer patients are suitable for eating ginseng. In some patients, consuming ginseng may worsen the condition. Therefore, cancer patients should consume appropriate ginseng according to their personal constitution under the guidance of a doctor.

Ginseng acts on the nervous system. It can cause insomnia, tremors, neurasthenia, euphoria and other excitation symptoms of central nervous system. Cancer patients with insomnia should not eat ginseng. It can make the patient's sleep quality worse. Drugs such as cardiac glycosides, anticoagulants, steroids, and sedatives have synergistic or inhibitory effects with ginseng. Drugs such as chloral hydrate and phenobarbital in combination with ginseng can enhance the inhibitory effect of the central nervous system. Therefore, cancer patients should not consume ginseng if they are taking the above medicines.

2. Royal Jelly.

Sex hormones are associated with the occurrence and development of breast cancer. Long-term maintenance of high levels of estrogen in the body will significantly increase the incidence of breast cancer. Royal jelly contains sex hormones. Therefore, breast cancer patients should avoid royal jelly and other foods that contain more sex hormones.

3. Protein powder.

The daily protein intake target for cancer patients is 1-2 grams of protein per kilogram of body weight per day. That is, if the patient weighs 70 kg, he needs to consume 70 to 140 grams of protein per day. However, the liver and kidneys will be burdened too much by excessive protein intake. This can be detrimental to the recovery of cancer patients. 

Protein powder supplementation is not recommended for patients who are able to absorb protein through their diet. Patients should consume adequate protein through food whenever possible. Protein powder contains a lot of protein, so patients with liver and kidney insufficiency should not take protein powder. Additionally, most protein powders are primarily composed of soy protein. They generally contain high amounts of purines, which can aggravate the symptoms of gout.

Should cancer patients eat more meat or vegetables?

Which is healthier, meat or vegetables? This is a long-standing debate. Some people think that eating red meat increases the risk of cancer. Some people think that eating meat will make you live longer. Some of the following studies may explain this.

Does eating red meat increase the risk of cancer?

Red meat is red because it is rich in heme iron. It includes frequently eaten meats such as beef, pork and lamb. Studies have pointed out that dairy products and red meat contain a particular type of sugar. It is directly linked to the development of antibodies in the blood that increase the incidence of tumors. Eating large amounts of red meat produces large and different types of antibodies. This increases the incidence of cancer, especially colorectal cancer. In addition, the World Health Organization classifies red meat as a Group 2a carcinogen. This also confirms that long-term consumption of large amounts of red meat is harmful to health.

Will eating meat make you live longer?

A study across 11 countries found that older adults who ate higher amounts of protein (mainly eggs and meat) had lower cancer rates and lived longer than those who ate more vegetables. 

To sum up, eating meat in moderation may be healthier, but too much red meat should be avoided. When eating meat, you can choose to eat more white meat such as chicken.

What should cancer patients eat during Chinese New Year meals?

The staple food should be paired with more whole grains such as brown rice. But don't just eat whole grains, which can easily cause indigestion. 

Eat more vegetables and choose several different colors of vegetables, you can absorb more and different nutrients.

The meals during this period generally consist of a lot of different meats. Cancer patients should eat more high-quality protein foods such as chicken, duck, fish, and eggs. It boosts immunity and maintains muscle mass in the body. But avoid eating too much red meat, fatty meats, and offal. In addition, it is necessary to properly consume soy products. Plant protein and animal protein will complement each other.

Avoid fried, grilled and pickled foods. These foods contain carcinogens.

Pay attention to salt intake and should not consume more than 6 grams per day.

It is not recommended for cancer patients to drink beverages high in sugar. It also does not recommend drinking pure juice. Substitute vegetable and fruit juices. In addition, cancer patients can drink green tea in moderation. Green tea contains ingredients that remove oil and prevent cancer.

Cancer patients try not to drink alcohol and smoke.

In fact, the above advice also applies in general.😂

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People should never drink alcohol while taking these drugs.💀💀💀

Many people already know that drinking alcohol while taking medicine can cause adverse reactions. But you should never drink alcohol while taking the following medicines. In severe cases it can even lead to death.

1. Disulfiram-like reactions occur with cephalosporins and alcohol.

Ethanol is the main component of alcohol. It is converted to acetaldehyde in the liver. Acetaldehyde is converted to acetic acid by the action of acetaldehyde dehydrogenase. Finally, it is converted into carbon dioxide and water and discharged from the body.

Disulfiram is a drug used to stop drinking alcohol. It inhibits acetaldehyde dehydrogenase and reduces the degradation of acetaldehyde. This increases the concentration of acetaldehyde in the body, resulting in an acetaldehyde poisoning reaction. Drinking even a small amount of alcohol while taking disulfiram can cause a strong reaction. It includes headache, dizziness, flushing, shortness of breath, laryngeal edema, nausea, vomiting, increased heart rate, low blood pressure, etc. This reaction is called a disulfiram-like reaction. Cephalosporins also have disulfiram-like effects in the body. It can produce a disulfiram-like reaction. Almost all cephalosporins have been reported to cause disulfiram-like reactions.

In addition, drugs that can cause disulfiram-like reactions include nitroimidazole antibiotics such as chloramphenicol, furazolidone, griseofulvin, metronidazole, secnidazole and tinidazole.

• Cefoperazone and Furazolidone: No alcohol should be consumed 1 day before taken it and up to 5 days after discontinuation.
• Cefuroxime, Ceftriaxone, Cefmetazole, Cefminox and Latamoxef: No alcohol should be consumed 1 day before taken it and up to 1 week after discontinuation.
• Cefmandole, Metronidazole and Tinidazole: No alcohol should be consumed 1 day before taken it and up to 3 days after discontinuation.
• Secnidazole: No alcohol should be consumed 1 day before taken it and up to 1 day after discontinuation.

2. Stomach bleeding and liver failure can occur with antipyretic analgesics and alcohol.

Some people have a headache the day after drinking alcohol and then they treat it with aspirin, acetaminophen or an NSAID. In fact, this is a very wrong usage. Some people have a headache the day after drinking alcohol, and then they treat it with aspirin, acetaminophen, or an NSAID. In fact, this is a very wrong usage. 

The above drugs can irritate the gastric mucosa when used with alcohol. It causes bleeding of the gastric mucosa and causes acute hemorrhagic gastritis. 

Although acetaminophen has few side effects at normal doses, alcohol can increase its liver toxicity. This increases the risk of liver failure.

3. Orthostatic hypotension can occur with antihypertensive drugs and alcohol.

Alcohol increases heart rate and dilates blood vessels. It is synergistic with most antihypertensive drugs and increases the risk of orthostatic hypotension. Drinking alcohol while taking dihydropyridine antihypertensive drugs increases the risk of cardiac arrhythmias, especially nifedipine.

4. Hypoglycemic coma can occur with hypoglycemic drugs and alcohol.

Due to the partial hypoglycemic ability of ethanol and it also slows down the metabolism of hypoglycemic drugs, drinking alcohol while taking hypoglycemic agents increases the risk of hypoglycemia and even hypoglycemic coma.

Sulfonylurea antidiabetic drugs such as glimepiride, glyburide, glipizide, glipizide, and gliclazide also reduce alcohol tolerance in patients. Therefore, it also causes a disulfiram-like reaction.

5. Sedative-hypnotics and alcohol can cause respiratory depression.

Drinking too much alcohol while taking sedative-hypnotics such as diazepam, estazolam, nitrazepam, phenobarbital, zopiclone, and zolpidem can cause respiratory depression and can be fatal. In addition, first-generation antihistamines such as chlorpheniramine, cyproheptadine, and diphenhydramine also inhibit the central system. Therefore, drinking alcohol should be prohibited while taking the above drugs.

6. Seizures can occur with antiepileptic drugs and alcohol.

Phenytoin sodium increases metabolism under the action of ethanol, which reduces blood drug concentration and bioavailability. Drinking alcohol while taking this medicine can cause seizures.

7. Malignant hypertension occurs with monoamine oxidase inhibitors and red wine.

Both endogenous monoamine transmitters (such as norepinephrine, serotonin) and exogenous monoamine substances (such as tyramine) are deactivated by monoamine oxidase. If monoamine oxidase is inhibited, these substances are not degraded. This can cause excessive accumulation of them. It results in toxic reactions such as vasoconstriction and increased blood pressure.

Monoamine oxidase inhibitors commonly used clinically include antibacterial drugs (such as furazolidone, linezolid), anti-tuberculosis drugs (such as isoniazid), antiarrhythmic drugs (such as procaine), anti-Parkinson's disease drugs (such as selegilin), antidepressants (such as moclobemide), etc. Drinking alcohol while taking these drugs can cause toxic reactions such as dizziness, difficulty breathing, abdominal pain and diarrhea. When drinking red wine which contain high tyramine, blood pressure will increase and even intracranial hemorrhage can lead to death.

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How to choose acetaminophen or other NSAIDs when patient has a cold and fever?😷😷😷

Common cold symptoms are mainly nasal congestion, runny nose, sneezing, coughing and so on. It may also have a sore throat, muscle pain or fever. Clinical treatment is generally aimed at the symptoms and to relieve its symptoms. The following will introduce the dosage and precautions of commonly used antipyretic analgesics.

1. Acetaminophen.

It is an aniline compound. It inhibits prostaglandin synthesis and release in the central nervous system. It is a selective cyclooxygenase-2 (COX-2) inhibitor, which has antipyretic and analgesic effects. Because it selectively inhibits COX-2, it has no significant gastrointestinal irritation. Its oral absorption is rapid and complete. Its metabolic pathway occurs mainly in the liver. It is combined with glucuronic acid in the liver and excreted in the urine.

Dosage and contraindications:

When having pain or fever, children over 12 years and adults take 500mg each time. If the pain or fever does not go away, take another tablet 4-6 hours later. Do not take more than 4 times a day. 

Patients allergic to acetaminophen are contraindicated. To prevent overdose, it should not be taken with other medicines that also contain acetaminophen.

Adverse effects:

When acetaminophen is taken correctly, side effects such as liver and kidney toxicity are less likely to occur. It is also a very safe antipyretic and analgesic drug for pregnant women. The FDA's pregnancy drug classification is Class B.

2. Diclofenac.

Diclofenac is a fenamic acid compound. It is a strong NSAID. It changes the release and uptake of fatty acids. It causes the concentration of free arachidonic acid in leukocytes reducing. 

Dosage and contraindications:

Its recommended dose is 25 mg 1 to 2 times a day after meals.

It is not suitable for children under the age of 16 or breastfeeding women. Pregnant women are forbidden to use it. It should not be used in patients with a history of allergy to aspirin, diclofenac or other NSAIDs, peptic ulcers, urticaria, asthma or other allergies.

Adverse effects:

Gastrointestinal reactions such as epigastric discomfort, gastric bleeding, gastric perforation, etc. are common adverse reactions of diclofenac. It should be used with caution in the elderly or patients with liver and kidney dysfunction. Diclofenac can penetrate the placenta, so it is forbidden for pregnant women.

3. Aspirin.

Aspirin is a salicylic acid compound. Under its action, the hypothalamus thermoregulatory center causes peripheral blood vessels to dilate, increase blood flow to the skin, and sweat. This will increase the body's heat dissipation to achieve antipyretic effect. It also inhibits the synthesis of prostaglandins and other substances that make pain sensitive to external stimuli. It is a peripheral analgesic drug.

Dosage and contraindications:

The recommended dose of aspirin is 50 to 150 mg daily in 1 to 2 divided doses.

Aspirin is contraindicated in patients with aspirin allergy, asthma, hemophilia, thrombocytopenia, peptic ulcer with bleeding symptoms, or other active bleeding. Aspirin is not recommended for use in children, pregnant and breastfeeding women unless directed by a doctor.

Adverse effects:

Since aspirin also inhibits COX-1 and reduces prostaglandin synthesis, it can induce or exacerbate the risk of gastrointestinal ulcers and bleeding. Allergic reactions such as angioedema, asthma, and urticaria also occur in patients with  idiosyncrasy. Use aspirin for flu or chickenpox in children. It may cause Reye's syndrome. It can cause severe encephalopathy and liver damage. Therefore, it is not used to treat colds in children.

4. Indomethacin.

Indomethacin is an indole derivative. It has a strong inhibitory ability on COX, but it is not selective and it inhibits COX-1 and COX-2.

Dosage and contraindications:

Indomethacin is 6.25 to 12.5 mg each time for antipyretic. It should not be taken more than 3 times a day.

Indomethacin is contraindicated in patients allergic to indomethacin, urticaria after taking other NSAIDs or aspirin, asthma or other allergies, undergoing coronary artery bypass grafting, pregnant and lactating women. It is also not suitable for children under the age of 14.

Adverse effects:

Its most common adverse reactions are central nervous system reactions. In addition, gastrointestinal reactions, asthma, skin and mucous membrane allergies also occur. Its incidence of adverse reactions is high. If treatment with indomethacin is required, the lowest dose that can achieve efficacy should be used under the guidance of a doctor.

Medication guidelines for special populations.

Children: The WHO recommended antipyretics for children worldwide are acetaminophen and ibuprofen. In addition, it is not recommended to use the two in combination or alternately for antipyretic in children. Routine use of acetaminophen to prevent fever in children before and after vaccination is also not recommended.

Pregnant: On the basis of physical cooling, water supplementation and corresponding treatment, acetaminophen can be used to reduce fever. Other antipyretics should be avoided.

Patients with gastrointestinal ulcers or a history of gastrointestinal bleeding: For them, acetaminophen is relatively safe. Aspirin and NSAIDs are not recommended. They can irritate the gastrointestinal mucosa and have the risk of gastrointestinal bleeding.

Patients with cardiovascular and cerebrovascular disease: Most of them will need to take aspirin as a preventive medicine. Therefore, it is not recommended to use NSAIDs and is recommended to use acetaminophen.

Elderlies: Be aware of the medications they are taking to avoid interactions. In the absence of clear contraindications, normal doses may be considered.

During the antipyretic period, all patients should be adequately hydrated to avoid the risk of shock. Generally, the symptoms will disappear or improve after 1 week of treatment, otherwise you should seek medical attention in time.

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