What is the difference between unfractionated heparin, low molecular weight heparin and fondaparinux❓❓❓

Heparins are one type of the most commonly used anticoagulant drugs in clinical practice. Unfractionated heparin, low molecular weight heparin and fondaparinux are very commonly used heparins. Thrombosis or embolic diseases such as myocardial infarction, vascular embolism and pulmonary embolism can be prevented and treated with these drugs. They have similar therapeutic uses and belong to the same type of drug, so what is the difference between them?

Thrombotic disease.

Thrombotic disorders can be divided into venous thromboembolism and arterial thromboembolism. Common venous thromboembolisms include deep vein thrombosis and pulmonary embolism. Common arterial thromboembolisms include myocardial infarction and acute cerebral infarction.

Mechanisms of heparin anticoagulants.

The liver can synthesize antithrombin which is a natural anticoagulant. Its anticoagulant effect is by binding to coagulation factors Xa and IIa and inhibiting their activity. However, heparin has no direct anticoagulant ability. Its anticoagulant effect is through binding to antithrombin, thereby enhancing the inhibitory ability of antithrombin on coagulation factors Xa and IIa. 

Unfractionated heparin has a longer molecular chain. The molecular weight range is about 3000 to 30000KD. Heparin with a molecular weight greater than 5400KD can be combined with thrombin and antithrombin. It inhibits coagulation factors Xa and IIa.

Enoxaparin, nadroparin and dalteparin are commonly used low molecular weight heparins. Their molecular weight is less than 8000KD. They mainly inhibit coagulation factor Xa. They inhibit coagulation factor Xa and IIa in a ratio of (2 to 4):1.

The molecular chain of fondaparinux is very short. Its molecular weight is 1728. It only inhibits coagulation factor Xa.

Pharmacokinetics of unfractionated heparin, low molecular weight heparin and fondaparinux.

The smaller the molecular weight of heparins, the longer their half-life.

• Unfractionated heparin: Only a small amount of unfractionated heparin is excreted by the kidneys, so patients with creatinine clearance less than 30ml/min can also use it. It can be administered by intravenous or subcutaneous injection, but the bioavailability of subcutaneous injection is only 30% and the intravenous administration has immediate effect. Its half-life is about 1 to 2 hours.
• Low molecular weight heparin: Because it is excreted by the kidneys, it should be used with caution in patients with renal insufficiency. It can be administered intravenously or subcutaneously, but subcutaneous injection has better bioavailability (about 90%). It works 3 to 4 hours after subcutaneous injection. Its half-life is about 5 to 7 hours.
• Fondaparinux: The kidneys are its main route of excretion. In patients with creatinine clearance of 30 to 50 ml/min, the dose should be halved. It is contraindicated in patients with creatinine clearance less than 30. It can be given by intravenous or subcutaneous injection. The bioavailability of subcutaneous injection can reach 100%. It works 2 to 3 hours after subcutaneous injection. It has a half-life of 17 to 21 hours, so only one subcutaneous injection per day is required.

They can be administered intravenously or subcutaneously, but intramuscular injection is prohibited. They cannot penetrate the placenta, so they do not cause teratogenicity. Protamine can completely eliminate the anticoagulant effect of unfractionated heparin with larger molecular weight. However, it can only eliminate part of the anticoagulant effect of low molecular weight heparin and is ineffective against fondaparinux.

Indications.

In the thrombosis process of ST elevation myocardial infarction, coagulation factor IIa plays an important role. Unfractionated heparin has a strong inhibitory effect on coagulation factor IIa. It can effectively and rapidly inhibit coagulation and prevent the expansion of infarct size. Therefore, unfractionated heparin is an important basic treatment for the thrombolysis of ST elevation myocardial infarction and before percutaneous coronary intervention.

Unfractionated heparin: It can be used to prevent venous thromboembolic disease associated with surgery, treat established deep vein thrombosis, treat unstable angina pectoris and acute phase of non-Q-wave myocardial infarction, treat acute ST elevation myocardial infarction, combined use with thrombolytic agents or concurrent use with percutaneous coronary intervention, treatment of disseminated intravascular coagulation of various causes, prevention of clot formation in extracorporeal circulation during hemodialysis.

Low molecular weight heparin (nadroparin, enoxaparin, dalteparin): it can be used to prevent venous thromboembolic disease associated with surgery, treat established deep vein thrombosis, treat unstable angina and non-Q-wave myocardium In the acute phase of infarction, prevention of clot formation in cardiopulmonary bypass during hemodialysis. Only enoxaparin can be used to treat acute ST elevation myocardial infarction, in combination with thrombolytics, or concomitantly with percutaneous coronary intervention.

Fondaparinux: It is used to prevent venous thromboembolic events in patients undergoing major orthopedic surgery of the lower extremity, such as hip fractures, major knee surgery, or hip replacements. It treats unstable angina pectoris or non-ST elevation myocardial infarction for not indicated urgent (less than 120 minutes) percutaneous coronary intervention. It is used to treat patients with ST elevation myocardial infarction who are on thrombolytics or who are not initially receiving other forms of reperfusion therapy. It significantly increases the risk of catheter thrombosis, so it is not suitable for patients undergoing percutaneous coronary intervention.

Adverse effects.

Although they have similar side effects, they occur at different rates. In general, lower molecular weight heparins are safer.

Hyperkalemia: Heparin drugs inhibit the synthesis of aldosterone. Therefore, even in small doses, it may cause an increase in serum potassium.

Bleeding: The higher the molecular weight of heparin, the higher the risk of bleeding. Therefore, unfractionated heparin has the highest bleeding risk. Activated partial thrombin time should be monitored when using it.

Thrombocytopenia: Unfractionated heparin may cause fatal thrombocytopenia. Low molecular weight heparin has a low incidence of thrombocytopenia. Patients should have their platelet counts monitored when using both of them. Thrombocytopenia caused by fondaparinux is rare.

Osteoporosis: Patients receiving long-term (3 to 6 months) or high-dose (>20,000 units/day) unfractionated heparin are at risk for spontaneous vertebral fractures or osteoporosis. Low molecular weight heparin and fondaparinux are less risky.

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Several medicines that can cause coughing.😷😷😷

Cough is a very common symptom of respiratory disease. There are many
reasons for a cough. In addition to illness, drugs can also cause coughing. It's called a drug-induced cough. The following medicines can easily cause coughing.

Angiotensin-converting enzyme inhibitors.

Angiotensin-converting enzyme inhibitors such as captopril and enalapril increase prostaglandins. The increase in prostaglandins can make coughing easier. In addition, they increase the amount of bradykinin and cell fiber stimulators such as substance P in the lungs. These substances induce bronchoconstriction leading to a severe dry cough. Such dry coughs are generally irritating and persistent in character. No secretions are excreted when coughing. Sometimes it appears paroxysmal. Symptoms can be worsened by lying down and at night. This can affect the patient's sleep. Symptoms of dry cough usually appear within 3 to 7 days of taking an angiotensin-converting enzyme inhibitor. It will get worse over time. This cough cannot be cured with cough suppressants or antibiotics. It usually resolves gradually with discontinuation of the drug.

Antiarrhythmic drugs.

Among the antiarrhythmic drugs that most commonly cause dry cough is amiodarone. It is mainly used to prevent or treat ventricular arrhythmia, atrial fibrillation, etc. Its most common side effect is pulmonary toxicity-related symptoms, occurring in approximately 1 to 17%. Generally, hypersensitivity pneumonitis or interstitial pneumonitis will occur after continuous use for 3 to 12 months. In patients with lung disease, excessive doses or prolonged courses of amiodarone are more likely to develop pulmonary toxicity. Its most common clinical manifestation is dry cough. Therefore, monitoring of lung function is recommended within 3 to 6 months of taking amiodarone. In addition, it is necessary to pay attention to the adjustment of the drug dosage when using it.

Diuretic drugs.

Diuretics such as hydrochlorothiazide can increase urine output and lower blood pressure. One of its common side effects is a dry cough. Most coughs are induced within a few hours of taking the medicine. In severe cases, it can even lead to asthma. The cough usually gets better after the drug is stopped.

Nitroimidazole antibiotics.

Among the nitroimidazole antibiotics, nitrofurantoin is the most likely to induce cough. Its most common side effect is acute pneumonia injury. If the patient has pneumonia or is allergic, it will be more likely to induce pneumonia damage. Its clinical manifestations are mainly dry cough. Most acute pneumonia injuries occur within 1 month of taking nitrofurantoin. If a dry cough develops after more than 6 months of use, it should be considered as possible pulmonary toxicity. Symptoms usually get better when the drug is stopped. If the symptoms do not improve after stopping the drug, oral antihistamines and glucocorticoids can be used to relieve the symptoms.

Antituberculosis drugs.

Among the anti-tuberculosis drugs, para-aminosalicylic acid is the most likely to cause dry cough. Most of the irritating coughs it causes appear within 3 weeks of taking the drug and usually get better when the drug is stopped.

Anti-cancer drugs.

Among the anticancer drugs, bleomycin is one of the drugs that is more likely to cause lung damage. It produces reactive oxidative products that cause direct damage to lung tissue. This results in massive infiltration of leukocytes, increased release of proteases, proliferation of fibroblasts, and pulmonary fibrosis. The common clinical symptom is dry cough. It occurs in about 2 to 4 percent. Lung damage can still occur weeks, months, or even years after the drug is stopped. If lung injury occurs while taking the drug, the drug should be discontinued immediately. If symptoms do not improve after stopping the drug, intravenous glucocorticoids should be administered to inhibit fibroblast activity. Patients can also supplement with oxygen to improve the symptoms of dyspnea.

Antibiotics.

Antibacterial drugs such as penicillins, cephalosporins, macrolides, etc. can cause cough. Patients with allergies are more likely to induce cough. Symptoms generally improve when the drug is stopped.

Anticoagulant drugs.

The most common adverse effect of anticoagulant drugs is bleeding. If the bleeding is in the chest cavity or lung parenchyma, it can damage lung tissue and cause coughing. Therefore, it is recommended to observe whether there is bleeding during taking the medicine, and adjust the dose in time. It is recommended to start with a low dose and then gradually increase the dose.

Sodium cromoglycate

Sodium cromoglycate can be used to prevent asthma attacks and the prevention and treatment of allergic symptoms. However, inhaled sodium cromoglycate tends to irritate the mucous membranes of the airways and cause coughing when used. Coughing may occur a few minutes after taking the medicine. Symptoms can be improved with dose reduction or discontinuation.

Aspirin.

Aspirin can increase the production of leukotrienes. It irritates the mucous membranes of the airways causing coughing. Cough usually occurs within 30 minutes of taking the medicine. Symptoms will gradually relief after the drug is discontinued.

Drug-induced cough usually improves when the drug is discontinued. If it does not improve, it should be promptly treated according to the patient's condition.

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Diagnosis and treatment of sarcopenia.🔬🔬🔬

As populations around the world tend to age, sarcopenia has gradually become a public health concern. Recent studies have shown that middle-aged and elderly people with sarcopenia have a higher incidence of cardiovascular disease than the general population. They had a 72% and 33% increase in the incidence of cardiovascular disease and the risk of cardiovascular events, respectively. 

What is sarcopenia?

In clinical practice, sarcopenia generally refers to the continuous decrease in the number, strength and function of skeletal muscle caused by aging. It can make the patient slow and unsteady. It also makes people prone to falls and fractures. Organ function may also be affected. It can lead to heart and lung failure, and even death. Its pathogenesis and etiology are complex. It is currently believed that sarcopenia is associated with the following pathological changes: Autophagy of skeletal muscle stem cells, excessive inflammatory state, oxidative stress, muscle mitochondrial dysfunction, protein breakdown and synthesis disorders, microvascular endothelial dysfunction and metabolic disorders, etc. Risk factors for sarcopenia include physical inactivity and malnutrition.

Diagnosis of sarcopenia.

Appendicular skeletal muscle mass index (ASMI) is a determining index. Appendicular skeletal muscle mass can be measured by dual-energy X-ray absorptiometry and divided by the square of height to calculate the index. The presence of sarcopenia was considered if it was less than 7.0 kg/m2 in men and 5.4 kg/m2 in women. The diagnostic process for sarcopenia is as follows:

If the patient is 65 years or older, perform a pace test.

If the pace is greater than 0.8m/s, measure the patient's grip strength. There is no sarcopenia if the grip strength is >25kg in men or >18kg in women. If the grip strength of men is ≤25kg or the grip strength of women is ≤18kg, ASMI should be measured. Sarcopenia was diagnosed if ASMI < 7.0 kg/m2 in men or ASMI < 5.4 kg/m2 in women.

If the pace is smaller than 0.8m/s, measure ASMI. Sarcopenia was diagnosed if < 7.0 kg/m2 in men or < 5.4 kg/m2 in women.

Nutritional interventions for sarcopenia.

Nutritional interventions for sarcopenia require adequate supplementation of these three.

Protein: Human skeletal muscle stores large amounts of various forms of protein. An important solution for the treatment of sarcopenia is to supplement high-quality protein. It improves muscle mass. Among them, leucine whey protein is widely believed to stimulate muscle protein synthesis, thereby it can maintain muscle mass. Therefore, foods rich in whey protein such as eggs, soy products and milk are recommended.

Vitamin D: Vitamin D plays a key role in the process of bone mineralization. It regulates the absorption of calcium and phosphorus in the body. Maintaining healthy bones and muscles depends on vitamin D. Therefore, vitamin D supplementation is great significance for improving and strengthening the muscle function of the elderly.

Omega-3 Fatty Acids: Studies have shown that both muscle mass and synthesis of muscle protein can be improved by omega-3 fatty acids. 

Exercise intervention for sarcopenia.

While muscle mass in older adults declines with age, exercise can slow or even reverse the decline in muscle function and mass. Since sarcopenia also increases the risk of cardiovascular disease, many patients with sarcopenia have cardiovascular disease. Moderate exercise can reduce the incidence of adverse cardiovascular events and help prevent cardiovascular disease. However, patients with cardiovascular disease also have certain risks when exercising. Their exercise should be done after evaluation and advice. 

• For healthy people: Get at least 150 minutes of moderate-intensity physical activity per week, or 75 minutes of vigorous-intensity physical activity per week, or a combination of the two. Studies have shown additional benefits of increasing moderate-intensity exercise to 300 minutes per week, or high-intensity exercise to 150 minutes per week. It is recommended to exercise several times a week, and daily exercise would be more recommended.
• For those with other medical conditions: Patients should be diagnosed and treated for their disease, as well as undergo a cardiopulmonary exercise test to assess exercise capacity. According to the patient's physical condition, cardiopulmonary capacity, disease, etc. to develop an individualized exercise program. The patient's Borg Scale of Perceived Exertion can be used to determine whether the intensity of exercise is appropriate.

Medical treatment of sarcopenia.

Medications for sarcopenia include hormones, omega-3 fatty acids, osteocalcin, stem cell transplantation, and more. They are of great help in the prevention and treatment of sarcopenia.

The basis of sarcopenia prevention and treatment lies in diet and exercise, and then combined with drug treatment depending on the patient's condition. A healthy diet and exercise can also reduce the risk of cardiovascular disease. Seniors and their families should pay more attention.

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How can you improve heart health from your diet?💖💖💖

The health of the body is closely related to the daily diet, especially some chronic diseases such as cardiovascular disease. Eating patterns should not focus on just one nutrient or food, but should emphasize the entire eating pattern. Although nutritional requirements will vary at each stage of life, we should all take care of our heart health. Regardless of your age, a heart-healthy eating pattern can be beneficial. Eating patterns refers to the combination, type and quantity of foods and drinks that individuals often consume in their daily lives. The following dietary recommendations take into account the influence of age, ethnicity, culture, dietary restrictions and taboos on dietary patterns in different populations. It can provide useful dietary guidance to more people. 

The balance of energy expenditure and intake maintains an appropriate body weight.

An unhealthy weight greatly increases the risk of cardiovascular disease. Many people in today's society do little exercise and eat a lot. People's energy intake can vary widely based on personal factors such as their gender, age, size, and level of activity. Under normal circumstances, adults reduce their energy requirements by 70 to 100 calories every 10 years, and then adjust the balance of energy intake and expenditure according to the individual's physical activity. This is critical for maintaining a healthy weight.

Eat more vegetables and fruits of different types.

The risk of death is reduced by eating more vegetables and fruits on a daily basis. In order to absorb more comprehensive nutrition, the more types of vegetables and fruits you eat, the better. They provide the body with the nutrients it needs and keep it healthy. Some experts recommend that the brighter the color of vegetables and fruits, the better for the body. It recommends not juicing vegetables or fruits, but eating them whole.

Eat less refined foods and more whole grains.

There are many studies that show that eating refined foods is bad for your health and whole grains are good for your health. Therefore, it is recommended to eat more foods containing at least 51% whole grains.

The source of protein should choose healthy protein.

Plant-based protein provides more health benefits than animal-based protein. Plant-based protein can be obtained from legumes (such as soybeans, lentils, peas, chickpeas, etc.), nuts (such as walnuts, almonds, peanuts, etc.), algae (such as spirulina). In addition, replacing animal food with plant food can also reduce animal breeding, thereby reducing animal carbon emissions and protecting the environment. However, many plant-based foods on the market are processed. They may have added sugar, salt, preservatives, etc. In addition, it also recommends eating more low-fat dairy products (full-fat dairy products should be avoided), fish and shellfish. If you want to eat chicken or red meat, you should choose lean meats and avoid processed meats.

Liquid vegetable oil should be used.

The use of cooking oil should avoid animal oils (such as lard, butter), tropical vegetable oils (such as palm oil, coconut oil) and partially hydrogenated oils. It is recommended to use corn oil, sunflower oil, flaxseed oil, olive oil, peanut oil, canola oil and most nut oils.

Avoid ultra-processed foods and choose for lightly processed foods.

Ultra-processed foods add a lot of salt, sugar, additives, and preservatives to make them taste better. It can cause people overweight, metabolic disorders and other adverse health effects. This increases mortality. Therefore, people should avoid eating too many ultra-processed foods (such as chocolate, ready-to-eat foods, etc.). It is recommended to eat foods with little or no processing.

Sugary diets should be minimized.

Foods and beverages that are high in sugar, whether they contain glucose, fructose or other sweeteners, should be avoided as much as possible. In addition, it also recommends eating less low-energy sweeteners.

Avoid high-salt foods.

Foods high in salt have long been considered bad for heart health. Therefore, it is recommended that people reduce their salt intake. In addition to adding less salt when cooking, you should also pay attention to the salt content of some canned and processed foods. In addition, it may also consider replacing ordinary table salt with potassium-rich salt.

Limit alcohol.

People should avoid alcohol as much as possible. Even if you want to drink, you should try to reduce the amount of alcohol you drink. Alcohol is not only harmful to the cardiovascular system, it can also damage other organs. The risks posed by alcohol also vary by age, gender and amount of intake.

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Some common misconceptions of gout that many people have.🙀🙀🙀

Some people eat too much meat, seafood or drink a lot of alcohol at a
dinner party, and their toes or joints will suddenly experience redness, swelling and pain. Most of this is a gout attack. Many people think that only the elderly develop gout. In fact, gout not only occurs in the elderly, but young people are also at risk of gout. Here are some common misconceptions about gout.

The difference between gout and hyperuricemia.

In fact, gout and hyperuricemia are two different concepts.

Hyperuricemia is defined as serum uric acid levels greater than 420 μmol/L measured twice on different days in men or women. Hyperuricemia can be divided into three types according to the patient's serum uric acid level and uric acid in urine: too much uric acid production, poor uric acid excretion, and mixed type. About 90% of patients with primary hyperuricemia are caused by poor uric acid excretion.

Gout is due to the deposition of urate crystals, which causes uric acid nephropathy, uric acid nephrolithiasis and gouty arthritis in patients with hyperuricemia. Gout is more commonly referred to as gouty arthritis. When a patient is diagnosed with hyperuricemia, he should be actively treated with medication or lifestyle intervention. This avoids developing gout.

Do only the elderly get gout?

With the improvement of living conditions in today's society, the incidence of hyperuricemia and gout is getting higher and higher, and the patients are also getting younger. Although the incidence of hyperuricemia and gout increases with age, younger people are also at risk. Males have a higher incidence than females.

Serum uric acid levels rise during a gout attack?

Serum uric acid is temporarily reduced because of acute gout attack caused by the deposition of serum uric acid in the joints. At the same time, the acute phase of gout will increase the excretion of uric acid through the kidneys. Therefore, serum uric acid levels do not necessarily increase during a gout attack. 

Does only gout require treatment and hyperuricemia does not require treatment?

In fact, chronically high levels of serum uric acid can cause or worsen damage to many organs. Hyperuricemia is also an independent risk factor for many diseases such as hypertension, diabetes and chronic kidney disease. Therefore, hyperuricemia also requires treatment. The basis for the treatment of hyperuricemia is lifestyle intervention. It is a recommended lifestyle intervention for 3 to 6 months, with the addition of medication if there is no improvement. Additionally, if the patient has a serum uric acid level >540 μmol/L or has risk factors for cardiovascular disease, drug therapy is recommended.

Can diet alone control serum uric acid?

In the human body, serum uric acid is converted from purines. In general, 80% of serum uric acid is converted from purines in the body, while only 20% is converted from purines in the diet. Therefore, even severely restricting purine intake from the diet can only reduce the conversion of purines to uric acid by about 20%. Serum uric acid is not well controlled by diet alone.

Diet control means not eating meat and eating more fruits and vegetables?

Dietary control includes a low-purine diet, drinking more water, and limiting alcohol.

• Low-purine diet: Patients should limit total daily calorie intake and eat a balanced diet. Limit consumption of high-purine foods such as seafood, meat, and organ meats. Eat more foods such as eggs, fresh vegetables, and low-fat or skim milk. Beans and soy products should be consumed in moderation. Some studies have pointed out that some high-purine vegetables such as spinach and mushrooms have no significant correlation with hyperuricemia and gout attacks. In addition, patients should maintain good eating habits and avoid overeating.
• Drinking more water: Drinking plenty of water can reduce the symptoms and duration of gout attacks. Patients with normal heart and kidney function are advised to drink plenty of water. Daily urine output should be maintained at 2000 to 3000ml. Avoid sugar-sweetened beverages or high-fructose fruit juices such as apple juice and orange juice. It is recommended to consume fresh fruits such as strawberries, peaches, and cherries that are low in fructose. In addition, proper alkalization of urine (pH of 6.2 to 6.9) can facilitate the dissolution and excretion of urate crystals.
• Limiting alcohol: It is recommended to drink ≤2 alcohol units/day for men and ≤1 alcohol unit/day for women. (1 alcohol unit is about 14g pure alcohol. It is equivalent to 145ml of red wine at 12°, 497ml of beer at 3.5°, and 43ml of distilled wine at 40°)

Is more exercise better?

Regular exercise can reduce gout attacks, but more often or harder is not necessarily better. In addition, activities should be reduced during acute gout attacks. It is recommended to do at least 150 minutes of moderate-intensity aerobic exercise per week (about 30 minutes per day, 5 days a week). Moderate-intensity means heart rate during exercise = (220 - age) × 50% to (220 - age) × 70%. Strenuous exercise may trigger acute gout attacks. Lifestyle interventions also include smoking cessation and weight control.

Are the treatments all the same? Can the medication be stopped once the pain is relieved?

Treatment regimens require individualized dose titration and long-term management.

Gout treatment is divided into two types: acute treatment and uric acid-lowering treatment. 

1. Colchicine, NSAIDs, and glucocorticoids are used in the acute phase. Continuous use of low-dose colchicine or NSAIDs for 6 months is effective in preventing acute gout attacks. If the patient is intolerant, has contraindications or has no effect, it can be switched to continuous use of low-dose glucocorticoids for 6 months.
2. Uric acid-lowering therapy is a long-term treatment process that gradually reduces serum uric acid to the target range. Allopurinol and febuxostat inhibit the production of uric acid. Probenecid and benzbromarone promote uric acid excretion. They are commonly used uric acid-lowering drugs. Uric acid-lowering drugs should be selected according to the type of hyperuricemia of the patient.

Is uric acid down to normal enough?

Serum uric acid should be reduced to <360 μmol/L in patients with hyperuricemia. For gout patients, it is recommended to reduce serum uric acid to <300 μmol/L. This prevents gout from recurring.

Patients with hyperuricemia and gout should maintain a healthy lifestyle and choose appropriate drug therapy. Regularly check uric acid and adjust the serum uric acid level to the target value as soon as possible.

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What should you do if your teeth hurt when you drink cold drinks?👄👄👄

Many people like to drink cold drinks and eat ice cream, but these can make your teeth sore. What's the problem? Is it a cavity? What can you do to improve the situation?

There are many reasons why your teeth may feel sore when you drink cold drinks. The best way is of course to go to a dentist for diagnosis and treatment.

A tooth is actually a closed structure. The ones that are exposed outside the gums are called crowns. Its surface is a hard layer of enamel and the inside is dentin. Below the gums are the roots. From outside to inside, the root is cementum and dentin, respectively. At the innermost part of the entire tooth there is a cavity called the pulp cavity. The pulp cavity contains blood vessels, nerves, lymph and other accessory tissues.

Normally, enamel and dentin protect the nerves of the tooth. They help the nerves of the teeth resist various external stimuli. However, when the enamel and dentin are damaged by abrasion, chipping, cracking, caries and allergies, the nerves of the teeth are forced to be exposed. At this time, when you drink cold drinks or eat ice cream, the tooth nerve will be stimulated and feel sore. 

In addition, there are some people will feel their tooth is sore when they eat or drink some cold things after they had teeth cleanings. However, these symptoms usually resolve on their own within a short period of time. 

After the diagnosis of the cause by a dentist, the appropriate treatment plan is selected according to the cause. In addition to the dentist's treatment, patients should also do the following in their daily life:

1. Try to avoid foods that are too cold, too hot, too sweet, too sour, and too hard.
2. Use a soft-bristled toothbrush and brush with warm water.
3. When brushing your teeth, you should not brush too hard.

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How should anticoagulants and thrombolytics be used in patients with pulmonary embolism❓❓❓

Coronary heart disease, stroke and pulmonary embolism are the top three
causes of death in patients with cardiovascular disease. Pulmonary embolism includes pulmonary thromboembolism, air embolism, fat embolism and tumor embolism. Among them, pulmonary thromboembolism is the most common type of pulmonary embolism. Deep vein thrombosis of the lower extremities is the main cause of pulmonary thromboembolism. Pulmonary thromboembolism has a high morbidity and mortality rate. Therefore, the correct and rational use of anticoagulant and thrombolytic drugs in the treatment of pulmonary thromboembolism is very important.

Treatment of acute pulmonary thromboembolism.

Risk classification for acute pulmonary embolism.

	Hypotension or shock	Right ventricular insufficiency	Elevated cardiac biomarkers
Low risk	-	-	-
Low to moderate risk	-	Either is positive.
Moderate to high risk	-	+	+
High risk	+	+	+/-
Cardiac biomarkers: Markers of heart failure (eg, B-type Natriuretic Peptide, N-terminal pro-brain natriuretic peptide) and markers of myocardial injury (eg, cardiac troponin T, cardiac troponin I)

The treatment regimen is administered according to the risk classification.

Low risk: Anticoagulant therapy is used in low-risk patients. It is recommended for clinical observation in patients with subsegmental pulmonary embolism without proximal deep vein thrombosis of the lower extremities and in patients with a low risk of recurrent venous thromboembolism.

Low to moderate risk: Low to moderate risk patients are treated with anticoagulants.

Moderate to high risk: Patients at moderate to high risk are initially treated with anticoagulants. When the clinical symptoms of the patients worsen after treatment and there are no contraindications for thrombolytic drugs, the patients can be treated with thrombolytic drugs.

High risk: Treat high-risk patients with thrombolytic drugs. If the patient has contraindications to thrombolytic drugs, the patient should be treated with surgery or interventional therapy.

Thrombolytic therapy.

Commonly used thrombolytic drugs are alteplase, streptokinase and urokinase. Their thrombolytic effects are similar, and they are selected according to the clinical situation of the patient.

• Alteplase 50 mg is given by continuous intravenous infusion for 2 hours.
• Recombinant streptokinase 1.5 million U is given by continuous intravenous infusion for 2 hours.
• Urokinase 20,000 U/kg is given by continuous intravenous infusion for 2 hours.

Thrombolytic drugs activate plasminogen, which is converted into plasmin. Fibrin is hydrolyzed by plasmin and leads to thrombolysis. Thrombolytics are most effective when started within 48 hours and they can dissolve some or all of the thrombus rapidly. The treatment period is generally within 14 days.

Anticoagulation therapy.

Anticoagulant drugs can promote the action of the fibrinolytic mechanism to dissolve the formed thrombus. They are also effective in preventing the recurrence of embolism and the re-formation of thrombus. There are three recommended anticoagulation regimens for the treatment of pulmonary thromboembolism. Anticoagulation therapy should take at least 3 months.

Monotherapy: The following regimens may be considered for most patients with low to moderate risk pulmonary embolism.

• The loading dose of rivaroxaban was 15 mg twice daily for 21 days, then changed to 20 mg once daily.

• Or a loading dose of 10 mg apixaban twice a day for 7 days, then changed to 5 mg twice a day.

Sequential therapy: Patients are initially treated with a parenteral anticoagulant such as heparin. Because warfarin has a slower onset of action, overlap warfarin within 24 hours of initial treatment to adjust INR values within 2.0 to 3.0. After reaching the INR target, heparin was discontinued.

Sequential therapy: Patients are initially treated with a parenteral anticoagulant such as heparin for 5 to 14 days, and then switched to edoxaban or dabigatran.

Commonly used parenteral anticoagulant drugs are low molecular weight heparin, unfractionated heparin and fondaparinux. Unfractionated heparin is recommended for severely obese patients and with severe renal impairment (creatinine clearance <30ml/min). Unfractionated heparin has the highest risk of inducing thrombocytopenia, followed by low molecular weight heparin. Fondaparinux has the lowest risk of induction. If the platelet count decreases by more than 50% of the baseline value, heparin anticoagulants should be discontinued and non-heparin anticoagulants such as bivalirudin and argatroban should be used instead. 

Warfarin: Its anticoagulant effect is mainly by inhibiting the synthesis of new coagulation factor Xa. Because it has no effect on the already synthesized clotting factors, its onset will be slower.

Edoxaban, Apixaban and Rivaroxaban: Its anticoagulant effect is mainly by inhibiting the activity of coagulation factor Xa thereby reducing the synthesis of thrombin.

Dabigatran: Its anticoagulant effect works by directly inhibiting the activity of thrombin.

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Important points about the use of azithromycin.📜📜📜

Azithromycin is a macrolide antibiotic. The structure of these antibiotics has a giant ring lactone and has one or more deoxysugar linkages. They can be used as replacement drugs in patients allergic to β-lactam antibiotics. Azithromycin has many clinical advantages. There is no need for a skin test before using it. It has a broad antibacterial spectrum. Under normal circumstances, patients only need to take it once a day, which can improve patient compliance. Therefore, it is a very commonly used oral antibiotic. The following will explain how to properly use azithromycin.

Pharmacological effects.

Azithromycin irreversibly binds to the 23SrRNA of the 50S ribosomal subunit of susceptible bacteria, thereby inhibiting the transfer step of bacterial protein synthesis and preventing the assembly of the 50S ribosomal subunit. 

Dosage form and usage.

Azithromycin is clinically available in different dosage forms, but their potency is not necessarily the same. They need to pass the consistency evaluation to be considered equal.

• Tablets ≠ dispersible tablets ≠ enteric-coated tablets. Capsule ≠ soft capsule ≠ enteric-coated capsule.

Different dosage forms are used differently. 

For azithromycin tablets, take orally once daily and swallow the tablet whole. It can be taken with or without food.

For azithromycin capsules, take orally once daily and swallow the tablet whole. It should be taken at least one hour before meal or at least two hours after meal. 

Azithromycin dispersible tablets, enteric-coated tablets or soft capsules are generally taken at least one hour before meal or at least two hours after meal. The actual situation is based on the drug instruction.

The half-life of azithromycin is 68 hours, which is relatively long. Patients stop taking it after 3 days and it will still work in the body for 3 to 4 days. Therefore, mild and moderate infection patients take 500mg once a day for three days, with a total dose of 1500mg. 

Is azithromycin preferred for mycoplasma pneumonia?

In the past, azithromycin was the first choice for mycoplasma pneumonia. However, with the increasing rates of resistance to erythromycin and azithromycin in mycoplasma isolated from adult patients with community-acquired pneumonia. Although these mycoplasmas have increased resistance to macrolides, they remain susceptible to quinolones, doxycycline, or minocycline. When a patient is suspected of having mycoplasma pneumonia, antibiotics are selected according to his age: 

• When the patient is less than 8 years old, azithromycin is the first choice for him.
• When the patient is 8 years or older, azithromycin is preferred for him. Alternatively, doxycycline or minocycline may be used on him.
• When the patient is 18 years or older, doxycycline and minocycline are preferred. In addition, quinolone antibiotics such as moxifloxacin can also be considered for him.

Off-label medication.

In addition to its broad antibacterial effects, azithromycin has many other effects including disruption of biofilms, changes in macrophage phenotype, modulation of the immune system, and regulation of airway surface liquid electrolytes and mucus. Therefore, azithromycin will be used off-label.

1. Prevention and treatment of bronchial asthma: Asthma patients have persistent symptoms despite the use of combined treatment with moderate or high doses of inhaled corticosteroids and long-acting β₂ agonists. Addition of azithromycin can reduce acute asthma attack and improve quality of life in patients. Patients received oral azithromycin 250 to 500 mg three times a week for 26 to 48 weeks.
2. Treatment of adult bronchiectasis: For patients with acute exacerbations of bronchiectasis greater than or equal to 3 times per year, it is recommended that patients receive oral low-dose azithromycin for at least 3 months. The initial therapeutic dose is 250 mg orally, 3 times a week to once a day. Adjust the dose or discontinue the drug according to clinical efficacy and adverse reactions.
3. Treatment of chronic obstructive pulmonary disease: Consider adding azithromycin to patients who still experience acute exacerbations on combination therapy with inhaled corticosteroids, long-acting β₂ agonists and long-acting muscarinic antagonists, especially those with a history of smoking. Studies have shown that cigarette-induced lung inflammation and emphysema in mice can be alleviated by low-dose azithromycin.

Precautions for medication.

The capsule form of azithromycin should not be taken with food.

Azithromycin promotes gastrointestinal motility and may cause dysbiosis in the gastrointestinal tract. Therefore, patients who develop bloody or watery stools during medication or for 2 months or longer after medication should go to see a doctor as soon as possible.

Azithromycin prolongs the QT interval. Patients should go to see a doctor as soon as possible if they experience cardiac discomfort during or after taking azithromycin.

Azithromycin is hepatotoxic and ototoxic. If the patient develops related symptoms, the drug should be discontinued immediately.

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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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