Purpura nephritis of varying degrees is mainly based on hormones, MMF, tripterygium and emodin as the core

   Henoch-Schonlcinpurpuranephritis (Henoch-Schonlcinpurpuranephritis, HSPN) refers to the damage of renal parenchyma in Henoch-Schonlcinpurpuranephritis. Clinically, hematuria and/or proteinuria can be diagnosed as HSPN in the course of allergic purpura (including within 6 months of the disease). The incidence of HSPN is calculated by urine changes, which is about 30%-60% , But if calculated by renal pathological changes, it is almost 100%. HSPN is a common disease in pediatrics. It has been reported in China, ranking third after acute nephritis and nephrotic syndrome. This disease is also the most common secondary glomerular disease in childhood. Although most patients have a good prognosis, about 1% of patients will have persistent kidney disease, and about 8% of patients will develop renal failure, so it should be paid close attention to.  1. Mild purpuric nephritis    Oral prednisone 0.6mg (kg·d) after 4 weeks of taking, gradually reduce the dose to the next day, the maintenance dose is 10mg every other day. At the same time, take tripterygium glycosides mg/(kg·d) and new nephritis capsules (emodin capsules) 100mg, 2 times/d. After the above treatment, the urinary protein continues to become negative, the hormone can be stopped, and the tripterygium wilfordii polyglycoside tablets and the new’nephritis capsule can be used for continuous maintenance. The total course of treatment shall not be less than 1 year.  2. Moderate purpuric nephritis  Methylprednisolone 0.5g intravenous drip, once a day for 3 days. Then take prednisone 0.5 mg/(kg·d) orally, and gradually reduce the dose to the next day after 4 weeks, and the maintenance dose is 10 mg every other day. At the same time, take tripterygium wilfordii polyglycoside tablets 1mgl (kg-d) and new nephritis capsules 100mg. 2 times/d.   After the above-mentioned treatment, the urinary protein continues to become negative, the hormone can be stopped, and the tripterygium wilfordii polyglycoside tablets and new nephritis capsules can be used to maintain the maintenance period. Add ACE or ARB during the maintenance period. The total treatment course should not be shorter than 2 years.  3. Severe purpuric nephritis in the acute stage    use mycophenolate mofetil (MMF) regimen. Methylprednisolone 0.5g intravenous drip, once a day for 3 days (additional course of treatment can be added according to the condition), then oral prednisone 0.5mg/(kg-d), gradually reduce the dose to the next day , The maintenance dose is 10mg, once every other day. After the end of the methylprednisolone intravenous infusion, MMF was started. The initial dose of MMF is 2.0 g/d, and the dose is reduced to 1.5 g/d after 6 months of continuous use, and the dose is reduced to 1.0 g/d after 6 months of continuous use. The total treatment course is 2 years.   If patients use MMF unconditionally, cyclophosphamide (CTX) can be used instead. When the disease is controlled and enters the chronic phase, the hormone is stopped, and Tripterygium wilfordii R tablets 1mg/(kg·d) are added. New nephritis capsule 100mg, 2 times/d and ACEI or ARB, the total course of treatment takes more than 2 years.

Remember “1 less and 1 more” for high urine egg diet

Appropriate reduction of high-protein foods and large proteinuria patients are often in the severe stage of glomerular damage, the permeability of the filter membrane increases, and too much high-protein diet will leak out more, which will undoubtedly aggravate the urine protein. So it’s not that the more protein in urine, the more high-protein food you eat. Instead, you should appropriately reduce your intake of high-protein foods and choose foods that contain high-quality protein. For example, meat, eggs, milk, beans and products with these four types of food as the main raw materials can be selected. But the intake should be controlled well. In principle, the more protein in the urine, the less the intake. If you have hypoproteinemia, you can consider increasing the amount appropriately. The specific intake is as follows: 24h urine protein quantitative is below 1g, protein intake is 1-1.2g/kg, basically the same as normal people; 24h urine protein quantitative is below 1-3.5g, protein intake drops to 0.8 -1g/kg; 24h urine protein quantitative is greater than 3.5g, protein intake drops to 0.6-08g/kg. Generally, after the urine protein is stabilized, the diet can be restored to normal, and nutrition is also very important to stabilize the immune system. After adjusting the protein intake for patients with high-calorie diet and high urine protein, some patients may feel not full. To avoid nutritional deficiencies, the calorie intake must be enough. The sources of calories and carbon water are mainly staple foods such as rice, steamed bread, noodles, etc. Some patients are worried about the problem of excessive calories and protein, causing weight, high blood fat and other problems. They can use low-protein rice, wheat starch, and lotus root flour as staple food materials that contain relatively little protein. If you don’t have these raw materials, you can also use common staple foods. The thickness is the best. In addition to wheat, you can also add corn, millet, oats, black rice, red beans, black beans and other cereals to eat together, which is more beneficial to the disease and is full of crude fiber. Abdominal feeling is stronger, also helps promote digestion and absorption.

Shi Shurong’s medical words: The immune thrombocytopenia you want to know is here!

Immune thrombocytopenia (ITP) is an acquired autoimmune disease. It is the most common hemorrhagic disease caused by the decrease in platelet count seen clinically. Clinical manifestations of platelet count decreased to varying degrees, with or without skin and mucous membrane bleeding symptoms. ITP can occur at all ages. Generally, children are acute and adults are chronic. Director Shi Shurong consulted WeChat zkxk9999&nbsp.&nbsp. Most children with immune thrombocytopenia had a good prognosis. Here we have a comprehensive understanding of some common sense of immune thrombocytopenia: incentive: ITP: children have a history of infection before onset, which can be as high as 60%. Respiratory tract infections are common, mainly viral infections. In terms of bacteria, Helicobacter pylori infection may be one of its pathogenic factors. In children with acute ITP, the positive rate of HpIgG antibodies is 40.54%, and the positive rate of Hp IgG antibodies in children with chronic ITP is higher. There is no need to eradicate it. A unified statement of Hp infection, but a few reports show that Hp eradication can shorten the course of ITP and reduce recurrence, even if Hp eradication has no effect on the long-term treatment effect of ITP. In terms of immunization, the measles-rubella-mumps mixed vaccine (MMR) can induce the occurrence of ITP, but most of them have a good prognosis. The diagnosis has no specific diagnostic criteria and is an exclusive diagnosis. Generally, at least two blood routine tests show a platelet count of 100×109L, with or without skin bleeding, and other clinical manifestations. Excluding other secondary thrombocytopenia, such as hypoproliferative leukemia, Aplastic anemia and infection can only be diagnosed. Among them, whether a newly diagnosed ITP patient undergoes bone marrow aspiration examination to rule out other hematopoietic system diseases is currently inconclusive, and this examination is not recommended abroad, but domestic scholars recommend that those with clinical symptoms and signs and laboratory tests are not typical Before the use of glucocorticoids, refractory ITP and splenectomy before bone marrow puncture, repeat puncture if necessary. Classification New diagnosis ITP: course of disease 3 months; persistent ITP: course of disease 3-12 months; chronic ITP: course of disease 12 months. Treatment increases the number of platelets to a safe range to prevent major bleeding, without raising platelets to normal levels. It is generally believed that those with a platelet count of 30x109L and no obvious bleeding manifestations should not be treated and observed closely. Platelet count 30x109L, or with bleeding symptoms, or those with bleeding tendency can be treated regardless of the degree of platelet reduction. 1. First-line treatment (1) Prednisone, a glucocorticoid 2 mg (kg.d), can be administered intravenously at the beginning. After the platelet rebounds, it should be taken orally, and the dose should be gradually reduced to 3 to 4 weeks. If prednisone does not respond after 4 weeks of treatment, it should be rapidly reduced to discontinuation to assess whether the diagnosis is correct. (2) The common dose of gamma globulin (IVIG) is 0.4 to 1 g (kg.d) for 2 to 5 days, which can quickly increase the number of platelets. (3) Anti-D immunoglobulin 75ug (kg.d), 1 to 3 days, suitable for non-splenectomy children with Rh+, but it is not recommended for hemorrhagic anemia or autoimmune hemolytic anemia. 2. Second-line treatment (1) Glucocorticoid shock treatment of dexamethasone 1.5~2.0mg (kg.d) shock for 4 days or methylprednisolone 15~30mg (kg.d), change to prednisone 3 days after shock 1~2mg (kg.d) is taken orally. For the treatment of persistent or refractory ITP. (2) Anti-CD20 monoclonal antibody rituximab 375mgm2 intravenously, once a week, a total of 4 times, this is the standard regimen, the low-dose regimen dose was changed to 100mgm2. (3) 1mg (kg.d) of thrombopoietin recombinant TPO, used for 2 weeks, is used to treat refractory ITP. (4) Immunosuppressants such as cyclophosphamide, azathioprine, etc. (5) The indications for splenectomy are: those who are ineffective after regular medical treatment; platelet count 10X109L, those with life-threatening severe bleeding or urgent need for surgery; the course of disease is 1 year, age 5 years old; there are contraindications for the use of glucocorticoids By. Inoculation of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae 2 weeks before surgery. Prophylactic use of penicillin after surgery can reduce the mortality of postoperative children. 3. When emergency treatment of severe ITP shows a life-threatening bleeding manifestation, methylprednisolone may be given a shock of 10-30 mg (kg.d) in combination

Many kidney diseases require long-term use of hormones. How does it treat kidney disease? In-depth interpretation

Hello everyone, I am a nephrologist. When it comes to hormones, nephrologists probably have the right to speak, because many nephropathy patients are hormone users. For the special drug “hormone”, some say it is good, some say it is bad. Our sayings are good, we have real knowledge in practice, and the more we use and the more we see, the more experienced we are. As a nephrologist who has been dealing with hormones for a long time, today I will unveil the mysterious veil for everyone. What are hormones? ●Many rumors on the Internet say that hormones are life-threatening, @头条开谣, saying what will happen if you eat it. In fact, I might as well tell you that many of them don’t even know “what is a hormone”, just because there is a rhythm. If I think that “hormones” are just a class of drugs, I can only say that the understanding is too superficial. Hormones are actually secreted by our body all the time, like parathyroid hormone, growth hormone, glucagon, and cortisol are all “hormones” secreted by the body itself, it plays an important role in our life activities, and we also Use it. Due to the relatively large space, today I focus on explaining “glucocorticoid” and its application in kidney disease. ●The adrenal glands of our normal people (a small organ of the human body) can secrete about 10-20mg of cortisol (also known as glucocorticoid) every day. It has a characteristic of secretion, that is, it is released in a pulsating manner, with obvious day and night laws. It is the lowest during sleep at night. It begins to rise after 3-5 hours of falling asleep. It wakes up in the morning and reaches its peak, and then begins to decline again. It is such a cyclic process that its secretion is mainly affected by our high-level center (hypothalamus- Pituitary-adrenal) control. ●What are the types of glucocorticoid preparations of the drug? The classification of the drugs is mainly based on the half-life of the drug. According to its pharmacological characteristics, it can be divided into three types: short-acting, medium-acting and long-acting. Short-acting half-life is about 6-12 hours, more representative drugs such as cortisone, hydrocortisone; medium-acting half-life is about 12-30 hours, more representative drugs such as prednisone , Prednisolone, methylprednisolone, etc.; long-acting half-life is about 48-72 hours, more representative drugs such as dexamethasone, betamethasone, etc. How to use hormones in patients with kidney disease? ●According to the pathology of renal puncture, nephrotic syndrome can be divided into multiple types. Like effective pathological types of glucocorticoid alone: ​​minimally diseased nephropathy (more common in children), mesangial proliferative nephritis (more common in adolescents, including IgA nephropathy), focal segmental glomerulosclerosis FSGS (child More common in adolescents); the type of cytotoxic drugs that need to be combined (such as cyclophosphamide CTX): idiopathic membranous nephropathy & nbsp. (This is only a general division, and may be slightly different in clinical practice) ●However, hormone therapy is not Speaking of nephropathy, it is all right. According to the response after treatment, it can be roughly divided into three categories, that is, sensitive type: that is, clear pathology. After active and sufficient medication, the symptoms of nephrotic syndrome (edema, proteinuria, etc.) are quickly relieved; Dependence: that is, the effect is good during the treatment, and it begins to relapse after the reduction. (We talk about recurrences can be divided into 2 subcategories: infrequent recurrence: that is, once in the first 6 months and less than 3 times in 1 year. Frequent relapse: more than or equal to 2 times in 6 months and more than 3 times in 1 year) ● The last one is the hormone resistance type. Simply put, it is useless to use hormone therapy. Our evaluation standard is that the puncture is in accordance with a certain type of nephrotic syndrome, but you use it regularly and reach the treatment cycle of 8-12 weeks without remission. , Need to actively find the cause, such as whether it is complicated by infection, thrombosis, unspecified medication, gastrointestinal edema, etc. If there is no above-mentioned predisposing factors, consider adding immunosuppressive agents or other special treatment options. Personal experience of using hormones in patients with primary kidney disease ●For patients with kidney disease who need to use hormones, this medication principle must be followed. First, the starting amount should be sufficient. I take methylprednisolone as an example. The general therapeutic dose is 0.8-1.0mg. kg.d, roughly 40-60mg/day, mainly oral, and some slower reactions such as FSGS can reach 16-24 weeks (some people are afraid of side effects of hormones and reduce their doses by themselves. ) ● Second, reduce the drug slowly, that is to say, it will start to decrease every 2 weeks after reaching the time of full use

Chemotherapy for chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is caused by a group of inactive lymphocytes, which have a long survival period, slow proliferation, and gradually accumulate and infiltrate bone marrow, blood, lymphocytes and various organs, eventually leading to hematopoietic failure. It can be divided into two types of chronic lymphocytic leukemia, T cells and B cells. First introduce its chemotherapy.   1. Single chemotherapy    ①Phenylbutyric acid mustard is the first choice drug, with the best effect, the remission rate is 50-98%, the general adult dose is 0.08-0.1mg/kg·d, and it should be discontinued when the blood picture is lower than normal. For those who need maintenance treatment, the dosage should be adjusted to 0.04~0.08mg/(kg·d) until it is relieved. The literature also advocates the use of intermittent high-dose chlorambucil 0.4-0.8mg/(kg·d), even for 4 days, intermittent for 4-6 weeks, as an induced remission, may be a smaller dose is better, but should be alert to bone marrow toxicity reaction.  ②The therapeutic effect of cyclophosphamide is similar to that of chlorambucil. It is commonly used for phenpropionate insensitivity, serious disease, more juvenile lymphocytes or thrombocytopenia. The usual dosage is 1~3mg/(kg·d), orally or 20mg/kg, intravenously, once every 2~3 weeks. ③ Fludarabine monophosphate (fludarabinemonophosphate), the mechanism of action is related to the interference of adenosine ribonucleotide metabolism, and it is effective for half of the progressive chronic shower, which can be 25~30mg/(m2·d), 5 days, intravenous infusion, Repeat the course every 4 weeks.   ④ 2-chlorodeoxyadenosine (2-chlorooxyadenosine), according to 0.05~0.2mg/kg·d×7, continuous intravenous infusion, the effective rate is 55%. ⑤Deoxycoformycin (Deoxycoformycin) is effective in 25% of patients, for B-chronic shower, 4mg/m2 intravenous injection every week or every 2 weeks; for intractable T-chronic shower can be 5-19mg/(m2·d) , 3 to 5 days, intravenous injection. Complicated autoimmune hemolytic anemia or thrombocytopenic purpura and those resistant to alkylating agents are indications for the use of prednisone. They can specifically dissolve chronic lymphocytes. The usual dose is 20 to 60 mg/d. Can be maintained intermittently, taking 2 days a week, 40 ~ 60mg/d, generally do not advocate long-term application. There is also a proposal to use a short-term (5 days) prednisone more (80mg/d) regimen as a combined treatment with chlorambucil.   2. Combined chemotherapy can try multiple myeloma M2 program, complete remission is 15%. Liepmen (1978) et al. applied anti-lymphoma cop to treat 36 patients with chronic lymphoma, completely remission in 16 patients, and had a median survival of more than 2 years; the CHOP regimen for patients with chronic lymphoma of stage C has an effective rate of 50 to 70%, and the dose For methods, please refer to related diseases.

Give an example: the weight of children with leukemia has changed, how to adjust the medication?

Chemotherapeutic drugs are a common treatment for leukemia, and are also commonly used as first-line therapy in the early stage. Family members of children with leukemia often do not understand the amount of drug adjustment for the child’s weight change, which is mainly calculated based on body surface area. Relevant analysis below. ——When the weight is less than 30 kg: body surface area (m2)=0.035×weight (kg)+0.1 Example: when the body weight is 20 kg, the body surface area=0.035×20+0.1=0.8m2——When the body weight is 30 kg: the body surface area is 1.15 m2——When the body weight is more than 30 kg: every 5 kg of body weight increase, the body surface area increases by 0.1 m2 Example: If the body surface area of ​​40 kg body weight = 1.15 + 0.1 × 2 = 1.35 m2, the weight of the child with leukemia changes, what is the dosage of the drug? Adjustment? 6mp dosage: 50-75mg/m2 (50-75mg per square meter of body surface area). Note: The amount of 6mp should be adjusted according to the blood. Generally speaking, it is more appropriate to control the number of white blood cells at 3.0×109/L and the absolute number of neutrophils at 1.0-1.5×109/L (that is, 1000-1500/ul). Some children lack the amount of enzymes that metabolize 6mp in the body, which makes the amount of 6mp less than the theoretical calculation value. However, foreign studies have shown that as long as the white blood cells are controlled within the above-mentioned range, the purpose of treating leukemia can be achieved. MTX dosage: 20mg/m2 (20mg per square meter of body surface area), intramuscular injection or oral once a week. Dexamethasone dosage: 6mg/m2/day (6 mg per square meter of body surface area per day), taken twice a day. Vincristine dosage: 1.5mg/m2 (1.5mg per square meter of body surface area), but the maximum amount each time does not exceed 2mg. There are also common dosages of the compound Xinnuomin, which is mainly calculated according to body weight, 25 mg/kg/day (25 mg per kg of body weight per day). However, if the body weight exceeds 40 kg, the dose will not be increased, that is, the total daily dose of 1000 mg = 2 tablets. If you have any questions about this article or the disease, please feel free to follow us on WeChat and search for leukemia patients: dxbby120

#普通皮肤病猜##健康科普# Ichthyosis Vulgaris

What is ichthyosis? Ichthyosis is a skin disease characterized by dry skin and scaly scales. It is named because the skin resembles “fish skin.” What is the cause of ichthyosis? &nbsp.&nbsp.&nbsp. The etiology is unclear, but scholars recognize that ichthyosis is a hereditary disease with obvious genetic tendency; some scholars believe that it is a manifestation of skin keratosis. What are the manifestations of ichthyosis? &nbsp.&nbsp.&nbsp. Ichthyosis is divided into many types according to its various manifestations combined with inheritance. Ichthyosis vulgaris is characterized by dry, desquamated skin with prismatic or polygonal scales. It can also be described as: white translucent scales, reticulated white grooves between scales. At what age does ichthyosis vulgaris develop? &nbsp.&nbsp.&nbsp. generally develops at 1 to 4 years of age, but rarely occurs within 1 year of age. Where does ichthyosis vulgaris grow? &nbsp.&nbsp.&nbsp. Generally grow on the extremities and back of the limbs. What factors are related to the increase and remission of ichthyosis vulgaris? &nbsp.&nbsp.&nbsp. has a more obvious relationship with the seasons, with heavy winters and light summers. How is the treatment of ichthyosis vulgaris? &nbsp.&nbsp.&nbsp.&nbsp.1. Topical medicines&nbsp.&nbsp.&nbsp.10% lactic acid ointment and 20% urea cream alternate outside the loyalty. &nbsp.&nbsp.&nbsp.2. Oral medicines&nbsp.&nbsp.&nbsp. Tretinoin preparation: first-generation retinoic acid, daily dose 0.5~2mg/kg body weight: second-generation retinoic acid, dose 0.5~1mg/ kg body weight. &nbsp.&nbsp.&nbsp. Although the retinoic acid preparation has a certain effect on the treatment of ichthyosis vulgaris, it has the following side effects: teratogenicity, elevated blood lipids, gastrointestinal reactions, and early healing of bone scale, so it is rarely used in clinic. &nbsp.&nbsp.&nbsp.3. Receiving ultraviolet radiation in winter has a certain therapeutic effect. Can I cure ichthyosis vulgaris? &nbsp.&nbsp.&nbsp. No, because the disease is a genetic disease, it is currently not possible to find and replace the “pathogenic gene”. The current treatment principle is moisturizing to increase the moisture of the skin and improve the degree of keratinization, mild exfoliation and reduce scale. Furthermore, ichthyosis vulgaris generally does not affect study and work. Patients and their families do not have to be depressed and pessimistic. They should face life like normal people. &nbsp.

Why do some patients with leukemia fail to reach the standard dose?

This is a common worry for leukemia patients and their families. If the patient does not achieve the standard dose of treatment, does it mean that the probability of future disease recurrence is high? In fact, this problem cannot be analyzed in this way, nor is it fully recognized. For example, different people have different abilities to carry packages, that is to say, their strength is different. If this person can only carry 10 kilograms of weight, then if you let him carry 20 kilograms, he will be crushed; some people can carry 20 kilograms, then it will be very easy to carry 10 kilograms. In other words, the doctor will determine the actual dosage of the drug according to the patient’s tolerance, not all standard patients are applicable. In this regard, it is recommended that the inspection items (commonly emphasized by the attending committee) that are compatible with the medication phase should be completed. In addition, it also depends on the relevant indicators, such as the number of white blood cells in the patient’s peripheral blood / the absolute value of neutrophils. Adjust the dosage of the drug according to the blood indicators. In this way, even if patients do not take the standard dose, as long as the bone marrow is maintained in an ideal or within a reasonable range of inhibition, these patients are also likely to achieve long-term disease-free survival. If you have any questions about this article or the disease, please feel free to follow us on WeChat and search for leukemia patients: dxbby120

What is the relationship between isotretinoin dosage and acne recurrence?

Current acne vulgaris includes changes in androgen-induced sebum production, abnormal growth and differentiation of epidermal cells leading to hyperkeratosis of hair follicle sebaceous ducts, abnormal growth of P. acnes and subsequent autoimmune reactions. This autoimmune response appears to be mediated by the release of toll-like receptors 2 and 4 and proinflammatory mediators (interleukins IL-1a, IL-8 and tumor necrosis factor-a). These lead to neutrophil recruitment, lysosomal enzyme release and subsequent destruction of the hair follicle epithelium. In addition, human β-defensins 1 and -2 are up-regulated. The recurrence of acne vulgaris is still a problem, but new research has found that this has a small relationship with the cumulative dose, and is related to the length of the sebaceous gland suppression time. Important factors for relapse include: • stopping isotretinoin before acne is completely cleared; • the severity of acne; • excessive seborrhea after completing isotretinoin; • smoking; • young age (under 14 years) ; • Older (women over 25 years old); • Polycystic ovary syndrome. Another reason for the apparent relapse is a change in the patient ’s perception of acne, and the patient begins to rely on isotretinoin psychologically. Rather than the daily or cumulative dose of isotretinoin. Since isotretinoin was registered in the United States in 1982, it has completely changed the treatment of acne vulgaris. Early dose range studies showed that within the dose range of 0.1-1.0 mg / kg per day, the improvement rate and total clearance rate of acne were the same as 0.1 mg / kg per day and 1.0 mg / kg per day. However, subsequent studies have shown that patients taking isotretinoin at 0.1 mg / kg / d after 16 weeks of use have a greater chance of relapse within 1-2 years than patients taking 1.0 mg / kg / d. The dosage of isotretinoin has been determined to be 0.5-1.0 mg / kg per day for 16-20 weeks, and the cumulative dose is 120-140 mg / kg. Recently, a study showed that compared with placebo, 5mg isotretinoin per day can be very effective in removing persistent acne in adults with minimal side effects. The disadvantage of further increasing the dose is the common acne outbreak, which may be related to the degree of sebaceous gland cell apoptosis. Big. In the clinic, we often recommend that patients use isotretinoin until acne is cleared, and then 3-4 months of treatment: This may mean that some patients only need 6 months of facial acne treatment, while the trunk is obviously The acne needs more than 18 months of treatment. It is now recognized that high-dose isotretinoin not only induces sebaceous cells, but also induces apoptosis of sebaceous stem cells. Even after discontinuation of the drug, this will lead to an extension of the inhibition time of sebaceous gland activity. A small dose of 0.1 mg / kg per day cannot induce the same degree of sebaceous stem cell apoptosis. With lower doses sebaceous gland recovery occurs faster. This means that under the same treatment time, 0.1mg / kg per day for 16 consecutive weeks can effectively inhibit the sebaceous glands than 1.0mg / kg per day. To achieve the same length of sebaceous gland suppression, you may need to continue with 0.1mg / kg isotretinoin per day for 4-6 months instead of 1mg / kg per day. The length of time for sebaceous gland suppression better explains the increase in recurrence at lower daily doses over the same period of time compared to the cumulative dose. However, a larger dose of isotretinoin does mean that isotretinoin can be discontinued earlier. Therefore, we suggest that a lower daily dose of isotretinoin can be used for a long time. 10-20 mg per day for 3-12 months, depending on the severity of acne and the characteristics of the patient. Adult patients can achieve good long-term seborrheic control, as low as a dose of 20 mg isotretinoin twice a week. A recently completed 42-week study of isotretinoin 5 mg per day versus placebo in persistent adult acne showed that low-dose isotretinoin was very effective in this patient group with few adverse reactions.

4 things mothers must know when they have a baby in their belly

Pregnant, many expectant mothers began to take care of the fetus for granted. The daily task is to eat, eat and eat more. In fact, in addition to more nutritional supplements, there are several more important things: First, adhere to 30 minutes of exercise every day. For the average person, walking is a good choice. In addition, if possible, you can swim or practice yoga. 2. Prepare cooling measures in advance. Seeing that summer is coming soon, many expectant mothers are afraid to suffer from air conditioning disease and dare not turn on the air conditioner. But the body is too hot is not very beneficial to the development of the fetus, so it is necessary to use a fan and cool white to keep the body cool. 3. Sleep must be adequate. The expectant mother sleeps soundly and the baby grows strong. Getting up on time every day allows the body time to help the fetus develop healthier. At the same time, conditional expectant mothers can also take a nap every day around 3 pm. Fourth, control weight within a reasonable range. Everyone knows that weight gain during pregnancy is a good thing, but being overweight can have an adverse effect on the fetus and pregnant women, so weight must be controlled within a reasonable range. Here is a reference standard: for girls with a BMI below 18.5, the weight gain range is 13-18 kg. For girls with a BMI between 18.5-24.9, the weight gain range is 11-16 kg. For girls with a BMI between 25-29.9, the weight gain ranges from 7-11 kg. For girls with a BMI above 30, the weight gain ranges from 5-9 kg.

How much weight gain during pregnancy? The United States, Japan, and China have different indicators. Which one is more scientific?

& nbsp. & nbsp. & nbsp. & nbsp. Every woman who loves beauty will have a problem after pregnancy: how much weight should be gained during pregnancy, which can protect the nutrition of the fetus and not make your body fat? When it comes to how much weight gain during pregnancy is appropriate, there is no precise standard, and countries have different indicators. The American Institute of Medicine (IOM) recommends that for women who are underweight, that is, women with a body mass index (BMI) of less than 18.5, the IOM guidelines recommend weight gains of 12.7 to 18.1 kg during pregnancy. Japan has set weight gain targets at 9 to 12 kg. In China, during pregnancy, it is more appropriate to gain weight between 12-15 kg. From the above three indicators, we can see that China takes the middle value, which is neither high nor low. & nbsp. & nbsp. & nbsp. & nbsp. Some people think that women in Europe and the United States are tall, and it is normal for women to gain more weight during pregnancy. The Chinese are also Asians. Why not use Japan’s weight gain indicators? & nbsp. & nbsp. & nbsp. & nbsp. At first, in order to worry about the fetus being too large and causing pregnancy complications such as eclampsia, some Japanese obstetricians recommended that pregnant women adopt a low-calorie diet to reduce the risk. Guidelines for the year. In the past, expectant mothers were told to ‘eat two people’, but now it is “try to have a smaller baby and raise him”. Therefore, Japan’s pregnancy weight gain index is relatively low, and pregnant women’s weight control is relatively strict, which has led to an increase in the number of newborns born with low height and low weight. Newborns with low birth weights are more likely to suffer from diabetes and hypertension when they grow up. & nbsp. & nbsp. & nbsp. & nbsp. Based on the above factors, it is more appropriate to control the weight gain index at 12-15 kg. It not only guarantees the nutrition of the fetus in the stomach, but also does not cause the fetus to become obese, which is within the normal range. If the weight gain during pregnancy exceeds 15 kg, it is easy to cause many dangerous complications, such as chronic hypertension, pre-eclampsia, gestational diabetes, pyelonephritis, thrombosis, expired pregnancy, and excessive fetal size. It is not conducive to the smooth delivery of the baby during childbirth and the recovery of the woman’s body after delivery. You need to adjust your diet and control your weight. & nbsp. If a pregnant woman gains less than 12 kg during pregnancy, she is underweight. It is easy to give birth to low-weight babies, which is also detrimental to the baby’s development. & nbsp. & nbsp. & nbsp. Specific to how much weight gain each month, in the first three months, you need to gain 2 kg. In the middle of pregnancy, the weight gain is 5 kg, and in the late pregnancy, the weight gain is 5 kg. Such a weight gain rhythm is scientific, because the fetus needs these nutrient intakes. & nbsp. & nbsp. & nbsp. & nbsp. Some pregnant mothers are puzzled and the baby is born, that is, 3 or 4 kg. Why do you have to gain so much weight during pregnancy? We can calculate a specific account: the full-term fetus is about 3 or 4 kg, the amniotic fluid does not exceed 1 kg, the uterus increases by about 1 kg, the placenta increases by 500 to 650 grams, the breast increases by about 500 grams, and the blood volume increases by about 1.5 kg. The lower body weight gain comes from the increase in fat reserves and interstitial fluid after edema. It should be noted that if a pregnant woman is too heavy or too light before pregnancy, the application of this weight gain indicator will increase or decrease according to her actual situation, and you do n’t have to be too specific about specific indicators. & Nbsp.

Is there a scientific basis for kidney disease patients to quit meat?

Patients with nephrotic syndrome have a large amount of protein in the body that is lost from urine, so there is a scientific basis for quitting meat (eg eggs, lean meat, fish, milk, etc.). This has no scientific basis. Whether to abstain from meat actually involves the intake of protein, especially animal protein. Although a high protein diet, especially a high animal protein diet (& gt.1.6 g / kg / day) can accelerate glomerulosclerosis, it is not good for the kidneys, and the protein in the urine is lost due to eating more. But conversely, too little protein intake, such as a daily intake of less than 0.3 grams per kilogram of body weight, can only reduce plasma protein further, making patients more susceptible to infection, repeated aggravation of edema, and malnutrition, which is also undesirable. Therefore, it is recommended to eat protein in moderation, that is, a low-protein diet (0.8 to 1 g / kg / day). Studies have shown that both normal people and patients with nephrotic syndrome can adapt to a low-protein diet. The body adapts to a low-protein diet through the compensation of amino acid oxidation. The more urine protein excretion, the less amino acid oxidation; and can stimulate the body’s protein synthesis , Inhibit protein degradation and maintain nitrogen balance. Therefore, as long as sufficient calories are guaranteed (35 kcal / kg / day), a low-protein diet is safe and reliable. For extremely severe hypoproteinemia (& lt. 20 g / L), the protein limit can be relaxed, 1-1.2 g / kg / day.

Nutrition during pregnancy is very important for optimizing the health of mother and child!

During pregnancy, the fetus grows and develops rapidly, and the mother also undergoes physiological changes. Ingesting sufficient macro and micronutrients during pregnancy can promote the above process, and poor nutrition and overnutrition can cause adverse pregnancy outcomes. Therefore, it is important to evaluate, monitor, and intervene at appropriate times to improve maternal nutrition before and during pregnancy. History of nutritional status assessment ● Medical and surgical – Medical history may help reveal behavioral and medical issues that may pose nutrition-related health risks to women and their fetuses. For example, smoking, drinking, and using illegal drugs can cause direct health hazards. ● Fertility-Nutritional or supplement recommendations for a previous pregnancy history that can affect future pregnancy. ● Meal-asking the patient to complete a self-filled questionnaire helps to assess their typical diet and finds a significant deficiency. Physical Examination & nbsp .— & nbsp.Physical examination focuses on measuring height and weight to calculate BMI and assess whether a woman is at a healthy weight. Women should be asked about their weight at the last menstrual cycle (pre-pregnancy weight). This weight should be used as a baseline calculation. For Caucasians, Hispanics, and Blacks, the BMI before pregnancy is normal at 18.5-24.9kg / m2; but for Asians, the normal upper limit of BMI is & lt; 23kg / m2. Recommended key points for healthy diet during pregnancy include: ● Appropriate weight gain during pregnancy ● Appropriate intake of diverse foods, including unprocessed natural foods, to ensure that pregnant women gain sufficient weight but not excessive ● Appropriate vitamin supplements And minerals ● Avoid drinking, smoking and ingestion of other harmful substances ● Safely handle foods before pregnancy weight and weight gain during pregnancy & nbsp. ● BMI & lt. 18.5kg / m2 (low weight) early pregnancy weight gain 1-4 pounds ( 0.5-2kg), then about 1 pound (0.5kg) of weight gain per week ● Those with a BMI of 18.5-24.9kg / m2 (normal weight) gain 1-4 pounds (0.5-2kg) of early pregnancy, and then about 1 pound of weight gain each week ( 0.5kg) ● BMI is 25.0-29.9kg / m2 (overweight), the early pregnancy gains 1-4 pounds (0.5-2kg), and then about 0.5 pounds (0.25kg) weekly weight gain ● BMI≥30.0kg / m2 (obese) The weight gain in early pregnancy is 1-4 pounds (0.5-2kg), and then the weight gain per week is about 0.5 pounds (0.25kg). The recommended calorie intake is the key nutritional factor to determine the birth weight of the baby. Single-weight pregnant women with normal weight need to increase daily calorie intake by 340kcal and 450kcal in mid-term and late pregnancy, respectively, to achieve proper weight gain, but do not need to increase calorie intake in early pregnancy. Protein & nbsp .— & nbsp. During pregnancy, the fetus / placenta consumes about 1 kg of protein, most of which occurs during the last 6 months of pregnancy. In order to meet this demand, IOM recommends that the reference dietary intake of protein for pregnant women is 1.1g / (kg · d), which is slightly higher than the recommended protein intake for non-pregnant adult women [0.8g / (kg · d) ]. Carbohydrates & nbsp .— & nbsp. The carbohydrate requirements of pregnant women rose from 130g / d to 175g / d for non-pregnant women. Should focus on intake of multiple natural foods (fruits, vegetables and whole grains). Daily supplements of micronutrients should contain at least key vitamins / minerals that are often unsatisfactory by diet alone, for example: ● iron – 27 mg ● calcium – at least 250 mg (elemental calcium 1000 mg / d) ● folic acid – at least 0.4 mg (mid-term pregnancy and In late pregnancy 0.6mg) ● Iodine–150μg ● Vitamin D–200-600U (the exact amount is controversial) In addition to these key ingredients, pregnant women also need to consume sufficient amounts of vitamin A, vitamin E, vitamin C, B vitamins And zinc. Healthy dietary recommendations during pregnancy .— & nbsp. Pregnant women should consume rich fruits and vegetables, as well as whole grains, low-fat dairy products, and a variety of proteins. Recommendations for common dietary precautions during pregnancy & nbsp .— & nbsp. If the diet lacks essential nutrients or lacks weight gain, then pregnant women make their own dietary control

Newborn body weight standards and growth patterns

There are many signs to measure the growth and development of children. Such as weight, length, sitting height, head circumference, upper arm circumference, bust, etc., in many projects, weight and height are the most representative, and they are important indicators that reflect growth and development. The growth rule of baby’s weight first understand the baby’s birth weight and the amount of milk. Our treatment: tell the mother doctor to divide the baby’s weight increase into three categories: rapid increase, slow increase, and moderate increase. Formula for calculating weight: birth weight + 6×0.7 + (month age-6) x0.5 These three are different from person to person, the baby’s weight gain is very slow, it does not necessarily mean that he has any problems. It weighs about 3 kg, about 6 kg when it is 5 months to 6 months old, about twice as much as when it was born, but it is 5 months to 6 months old when it is born like a larger newborn baby At this time, his weight gain is not easy to double. Generally, the average baby increases by about 0.5 kg per month from birth to two months, about 0.3 kg per month from 10-12 months, and about 0.2 kg per month after 2 years old. These data can be used as a reference for mothers. The growth of children’s weight and length does not rise linearly, sometimes fast and sometimes slow, which is a physiological phenomenon. Child health care experts suggested that the weight should be weighed once every 2, 4, 6, 9, 12 months after birth; 1-3 years old, once every six months; 3-7 years old once a year. Mark each result on the growth chart, draw a weight curve, and then objectively evaluate the shape and trend of the child’s weight curve. If the child’s weight curve is parallel to the standard weight curve, it means that the growth rate is normal; if the weight curve is flat or downward, it means that the growth is slow, and you should actively look for the cause. & Nbsp. & Nbsp.Reference data: Normal full-term baby is born with a weight of about 2500-3999 grams. In the first 3 months, the baby’s weight gains 180-200 grams per week, 150-180 grams per week at 4-6 months, 90-120 grams per week at 6-9 months, and 9–12 months per week. Weekly growth of 60-90 grams. Calculated according to the weight increase multiple, the baby’s weight at 6 months is twice that at birth, about 3 times at 1 year old, about 4 times at 2 years old, and about 4.6 times at 3 years old. In the second year of life, the baby’s weight increases by an average of 2500-3000 grams. Newborn growth law After 2 years old, the average annual growth is about 2000 grams until the puberty. The formula for calculating the weight of babies in different stages: weight within 6 months = birth weight + month age × 600 grams 7-12 months weight = birth weight + month age × 500 grams 2-7 years old weight = age × 2 + 8000 grams & nbsp. & nbsp. * The content of this article comes from the Internet, only for sharing. If there is any infringement, please contact us to delete it ~

0-3 years old | Standard for calculating infant weight

1 to 6 months: birth weight (kg) + month age × 0 .: 6 = standard weight (kg) 7 to 12 months: birth weight (kg) + month age × 0.5 = standard weight (kg) over 1 year old : 8 + age × 2 = standard weight (kg) However, because the weight of the person is related to many factors, there are differences between different human bodies, and there will be certain changes at different times of the day, plus the geographical location (such as geocentric The cause of gravity), the season, the climate, and their own conditions also have a certain impact on weight, so it is difficult to fully meet the standard weight. In other words, it is difficult to express with a constant value, but it should be a range of values. We call this range of values ​​a normal value, which is generally within the range of standard weight ± standard weight × 10%. Beyond this range, it can be called abnormal weight. Exceeding standard weight + standard weight × 20% is mild obesity, and exceeding standard weight + standard weight × 50% is severe obesity. Below standard weight-standard weight × 15% is mild wasting, below standard weight-standard weight × 25% is severe wasting. Mild obesity and mild wasting are mild malnutrition, and severe obesity and severe wasting are severe malnutrition. Standard weight standards are not exactly the same in all countries. The standard weights of different age groups in a country are usually obtained through a large sample survey of the country, and the body weight range of each age group is calculated based on the person’s age and height, and the upper and lower limits are specified. The Sports Research Institute of the National Sports Commission of China has conducted standardized research on the weight value of children under 15 years old. Check this standard and you will understand whether your child’s weight is standard. * The content of this article comes from the Internet, only for sharing. If there is any infringement, please contact us to delete it ~