CHAPTER XIV: THE JAPANESE OCCUPATION AND LIBERATION (Philippine History)

•      Commonwealth of the Philippines (Ten-year transition period) was interrupted when Japan started war in the Pacific Region.

•      On December 8, 1941 Pres. Roosevelt declared war with Japan after the attack in Pearl Harbor.

A. Japan’s Foreign Policy

Japan’s Expansion Program:

-   1930-1941 Japan was expanding its surrounding area

-    1932 ( Manchuria was occupied)

-    1937 ( China was invaded)

-   1941 ( French colony was occupied)

General Araki explained that the spirit of Japanese nation must be propagated across the five continents and to all who’ll hinder the progress must be abolished by force if necessary.

Japan’s Operation Of Attack

-          July 26, 1941 the PH regular and reserve forces were merged with the US Army.

-          General Douglas McArthur was the military adviser of the Commonwealth.

B. THE JAPANESE INVASION

Early Japanese Attack On The Philippines

The Escape of Quezon, Sayre and McArthur

-          Bataan fell on April 9, 1942.

-          Japan’s strength was too much for Fil-American forces.

-          Gen. Edward King surrendered in order to stop further killing.

-          After the fall of Bataan came the infamous Death March

-          Prisoners were forced to march from Marivelles, Bataan to San Fernando, Pampanga.

-          As the fall of Corregidor was imminent, Gen. Wainwright ordered the burning of secret documents and PH money.

-          Gen. Wainwright ordered the complete surrender of all Filipinos and American forces on May 06,1942.

The Heroic Stand in Bataan and Corregidor

C. Philippine CONDITIONS DURING THE JAPANESE OCCUPATION

Japanese Military Government

Economic Condition

Social Condition

D. The SECOND Philippine REPUBLIC

Drafting of the Constitution

•      June 18 1943- the Japanese High Command in Manila ordered creation of the PCPI (Preparatory Commission of for Philippine Independence) for the purpose of drafting the constitution.

Inauguration of The Second Philippine Republic

E. Liberation of the Philippines

Battle of the Philippine Sea

The Landing’s At Leyte

SUBSEQUENT BATTLES

THE COMMONWEALTH GOVERNMENT IS BACK

-          August 1, 1945 the US Air Force dropped the first atomic bomb in Hiroshima and the second one in Nagasaki City.

-          On the same day Russia declared war against Japan

-          Japan surrendered unconditionally on August 15, 1945 due in realizing the total annihilation was possible

-          September 02, 1945 board the battleship Missouri at Tokyo Bay

-          The remaining Japanese forces headed by General Yamashita and Admiral Okochi also surrendered in Bagiuo on September 3, 1945. Thus, the end of war.

Laws of Chemical Combination Experiment 11

 I.         Introduction

            Chemistry is the study of the transformation of matter from one form to the other. These transformations often occur as a result of the combination of two different types of matter. The combination of different elements to form compounds is governed by certain basic rules. These rules are referred to as laws of chemical combination. There are five basic laws of chemical combination that govern the chemical combinations of elements:

a. Law of Conservation of Mass

In simple terms, this law states that matter can neither be created nor destroyed. In other words, the total mass, that is, the sum of mass of reacting mixture and the products formed remains constant. Antoine Lavoisier gave this law in the year 1789 based on the data he obtained after carefully studying numerous combustion reactions.

b. Law of Definite Proportions

Joseph Proust, a French chemist stated that the proportion of elements by weight in a given compound will always remain exactly the same. In simple terms we can say that, irrespective of its source, origin or its quantity, the percent composition of elements by weight in a given compound will always remain the same.

Objectives: The objective of this experiment is for the students to be able to explain the laws of chemical changes through experimentation.

II.       Results and Discussion

A.     Law of definite proportion

Weight of Magnesium Ribbon 0.10g

Weight of Crucible and Cover 30.09g

Weight of Crucible and Cover with ash 31.07g

Weight of ash 0.17g

Formula:                                                                                Computation:

%Mg = weight of Mg ribbon x 100                                       %Mg = 0.10 x 100 = 58%

             weight of ash MgO                                                               0.17

%O = 100%-%Mg                                                                   %O₂ = 100% - 58% = 42%

Question: Does the product or ash weigh more or less than the original magnesium ribbon?

      Why?

The product weighs more than the magnesium ribbon because magnesium and oxygen synthesizes when heated then the oxygen’s mass will add to magnesium’s mass.

Equation:

            2Mg + O₂ à 2MgO

B.     Law of conservation of mass

Weight of NaCl solution and beaker 47g

Weight of AgNO3 solution and graduated cylinder g

Weight of AgNO3 solution and graduated cylinder 110g

Weight of the two solutions & containers 157g

Equation:

            NaCl + AgNO₃ à Na₂NO₃ + AgCl₂

III. Conclusion

An element can neither be created nor destroyed, therefore, an element cannot be divided but only combined. Because they don’t divide, the mass of a certain atom will always be the same even if you will do combine it with another atom. The compound will derive a mass that come from the added masses of the compound/molecules component.

IV. References

Abayon, Ester O. Integrated & Inorganic Chemistry

http://byjus.com/chemistry/laws-of-chemical-combination-for-elements-and-compounds/

Wine Making Project (Chemistry)

Ingredients:

·         Concentrated Grape Juice

·         Honey

·         Lemon Fruit

·         Orange Fruit

·         ½ Kilo Sugar

·         Wine/Bread Yeast

Procedure:

First

Ready the ingredients.

Woooh, all is set!

Next

Mix all the ingredients except for the yeast and dissolve them properly. After it completely dissolved, add 1 tbsp. of yeast.

Dissolve the ingredients to the concentrated juice

Next

Put a balloon with small holes from needle pins for it to let the gas inside escape but won’t let the outside particle to get inside. Let it sit for a week to let the yeast do the process of fermentation.

Let it stand for 2-3 weeks 

Next

After fermentation, filter it using a filter paper to segregate the yeast from the solution.

filter it until the liquid becomes clear

Lastly

Place your solution in a glass container and your wine is ready.

And voila, the wine is ready to the tastebuds!

Reaction Paper: "My Sister's Keeper" Movie

            

  Throughout the movie, I’ve realized something, you really shouldn’t judge a book by its cover. I thought the movie is about a younger sister, Kate, who just refuses in helping her sister in her sickness – leukemia, but I have to admit that I am wrong. In fact, Anna is more than willing to help her older sister out. She is very open to surgeries and needles and all because she loves her sister and she thought it is her very reason and purpose of living. She thought that her life is solely to become an aide or to become a donor for her sister’s survival. The older sister, Kate, on the other hand, doesn’t want to fight for life anymore. She already gave up after a boy, Taylor, which eventually became her boyfriend, died in most likely, the same fate as her. Taylor was like a miracle drug to her that gave her a whole new perspective in life and which led to her wanting to be alive, unfortunately, it was gone. Afterwhich, Kate gave up her reasons to be alive and fight for her life. She decided to rebel and almost committed suicide but was stopped by her younger sister. Her whole family is ever supportive to her recovery especially her mom Sara. Through this movie, I’ve realized the extent and limitless love of a mother to her child. Sara did everything she could to the extent of having an engineered baby to become a perfect donor for her sister. Unfortunately, even with the willingness of the donors, the love and support of everyone, all other reasons to live, as long as the one holding the life doesn’t want to go further, all will become futile and leads to nothing.

         

   The values I’ve learned in this movie are many but these three (3) values outshine all: mother’s love; sister’s love; and self-love. We all know that a mother’s love knows no limits and will go through any obstacle and hindrances just to save her family even to the expense of her own life. Due to her love for Kate, her mother did every things possible just to save Kate’s life. Anna’s love for her sister also knows no boundaries because she did her sister’s favors eventhough it is against her will. Lastly, nothing can save you from an illness if you yourself have lost your will to live.

            

The movie was titled “My Sister’s Keeper” because it was Anna , Kate’s sister, who kept and did her sisters favors which is to sue her parents for becoming an organ donor at a very young age to stop the organ transplant that would save her sister’s life because her sister already wants to leave.

My Stand on Death Penalty

When we hear the words “Death Penalty” what we immediately think about is the brutal and merciless killing of a convicted criminal. People especially human rights advocates and the church can be heard everywhere because they think it as “immoral.” But before we jump into conclusions, let’s first know more about what death penalty really is. According to USLegal.com, “Death penalty is the sentence of execution for murder and some other capital crimes (serious crimes, especially murder, which are punishable by death). The death penalty, or capital punishment, may be prescribed by Congress or any state legislature for murder and other capital crimes. The Supreme Court has ruled that the death penalty is not a per se violation of the Eighth Amendment's ban on cruel and unusual punishment. Furthermore, the Sixth Amendment does not require a jury trial in capital crime cases.” Therefore, death penalty is a punishment upheld and decided by the Supreme Court which is to be applied to someone who is convicted of the heinous crime he committed.

Death penalty as a capital punishment should be applied to heinous criminals who did brutal crimes (e.g Rape and Murder not only for the adults but most especially to children and even infants; Mass murder; Drug Manufacturing [that may cause mass destruction to the society]), because people as we are, if we think that we can still get out from a crime we did, we will do that crime as many times as possible. Those criminals don’t think about the welfare of the people they victimize as long as they can suffice their needs and cravings. Setting these criminals on loose will lead to much more victims. Let me site this article I’ve read, “All over the country, news stories bemoan and hype the countdown to execution number 1,000. But where are the stories regarding the ripple effects of the heinous crimes that these murderers were executed for committing? Who is counting the victims? A conservative estimate puts the number of victims of these 1,000 murderers at 1,895. Why do we hear so much about the killers and so little about the victims and their loved ones who are left behind to pick up the pieces?” As we hear today the human rights advocates who are really against death penalty, where are they when an estimation of one (1) criminal being able to victimize two (2) innocent individuals not just by doing something terrible to them, but unfortunately, mercilessly killing them? Are the lives of the innocent invaluable to them? Are the criminals only the ones that can avail the benefits of the term “HUMAN RIGHTS?”

Good things can also come in BIG PACKAGES

"I was never a little kid, but my mom always let me took all the vitamins and she always stuff my school bag with all the food stuffs, that's why I became this big."

This is how I always start my story when asked the dreadful question, "Why are you fat?" Believe me, I have already answered this question a lot of times-so much that I've memorized the answer.

I'm not totally blaming my mom that I became this big. I understand that she just don't want me to be sickly and all, being her eldest child, she became overprotective. So she took all the vitamins the drugstore can offer and never forget to remind me that it's already "eating time". So I developed this bad habit of overeating even though I'm already full and bloated, and my size continue to double.

So when I entered school in kindergarten it became obvious that I was bigger than kids my age. My kindergarten classmates started calling me baboy ,piggy, and bok. Even strangers would tease me and gave me names.

I became a loner because of all the teasing. I always distant myself out of the crowd to avoid creating attention and to avoid being a laughingstock in school again. One time, my parents had to talk to my teacher because I don't want to go to school anymore. They don't know that I was being bullied by my female classmates and they even reached the point that they locked me in the CR cubicle just to made fun of me.

So in high school I transferred school, to lessen the trauma I got from grade school. Still, I was the only plus-sized girl in class, but my classmates already respect me. They never made me feel like I was different. I created friends there and my barkada even encourage me to step up and lose some weight. Personally, I also wanted some changes in my lifestyle but I don't want to undergo in a 'crash diet' or to any fad diets that are popular nowadays because I wanted it slowly but surely. In the end, I realized that having issues with my body doesn't have to drag me down-It's a matter of realizing that for every fault found, there's something you can admire and I know that the people who love me will still think I am beautiful regardless of my size.

#LoveYourCurves #PlusSize #beautiful

Vascular Dementia Case Study on a 78 year old woman

CASE STUDY 

Mrs A is 78 years old and has dementia of the vascular type; she came to Aranlaw from hospital where she had been admitted when attempts to support her to remain in her own home were unsuccessful due to her failing memory, disorientation and lack of understanding of risks. These problems caused her to neglect herself and frequently leave her own home and get lost, often in the middle of the night. One of the things that made her particularly vulnerable was her tendency to talk to complete strangers, telling them that she lived alone and where her home was. When Mrs A arrived at Aranlaw she was very frightened and angry and did not understand why she was not able to remain in the flat that she had lived in for over 20 years, she was suspicious of everyone believing that we were all in some way to blame for what was happening to her. We started to gather as much information as we could about Mrs A’s life history and significant events. We were given useful information by neighbours, a friend of many years and Mrs A’s GP who had known her for over 20 years.

The Aranlaw team immediately adopted the helping techniques recommended for managing behaviours that are the result of the person feeling uncomfortable and fearful at this stage of the illness. These include ensuring that staff do not expose the person’s weaknesses, working with all feelings expressed including anger which can be frequent and sudden in onset, keeping our distance until invited to get closer, acknowledging and validating feelings rather than ignoring them or taking things personally. Most importantly we acknowledged Mrs A’s lifetime of experience as a senior nurse, asking her opinion on simple issues where we knew she would be able to feel that her input was valued and helpful. We gave her a key to her own room and encouraged her to choose what colour she would like it painted and where she would like to hang her pictures.

Within 4 weeks Mrs A behaviour started to change in a way that suggested our care strategy was having a positive impact on her and helping to make her feel more secure and comfortable; she started to confide in two staff she now trusted, she admitted that she was frightened of not being in control and of having memory difficulties. Mrs A became increasingly humorous, wanted to help staff and other residents as much as she could and was engaging and affectionate towards those staff she trusted. Mrs A no longer seemed uncomfortable when in the company of residents in Stages 2 and 3 of their illness instead she tried to help them as she was now feeling confident that she was respected for her professional skills and knowledge.

Mrs A has been with us for nearly a year now, she continues to live her life to the full despite her dementia; she likes to ‘work’ a full shift with the day staff only taking herself off to bed when the night staff have arrived and she feels that things are running smoothly, she goes out regularly for walks with carers and enjoys nothing more than accompanying Managers when they go to collect prescriptions etc from GP surgeries.

 Reference: http://www.luxurycare.co.uk/home/dementia-case-studies/

ANATOMY AND PHYSIOLOGY

BRAIN

The cerebral cortex is an extremely convoluted and complicated structure associated with the "higher" functions of the mind—thought, reasoning, sensation, and motion. Each hemisphere of the cerebral cortex contains areas that control certain types of activity. These areas are referred to as the frontal lobe, parietal lobe, temporal lobe, and occipital lobe.

·         The frontal lobe, located behind the forehead, is involved with controlling responses to input from the rest of the central nervous system (brain and spinal cord). It is responsible for voluntary movement, emotion, planning and execution of behavior, intellect, memory, speech, and writing.

·         The parietal lobe, located above the ear, receives and interprets sensations of pain pressure, temperature, touch, size, shape, and body part awareness.

·         The temporal lobe, located behind the ear, is involved in understanding sounds and spoken words, as well as emotion and memory.

·         The occipital lobe, located at the back of the head, is involved in understanding visual images and the meaning of the written word.

The hippocampus plays a crucial role in learning and in processing various forms of information as long-term memory. Damage to the hippocampus produces global amnesia.

 Diagnostic Evaluation:

Various diagnostic tests may be done to determine the cause. A comprehensive neuropsychiatric evaluation must be completed to make an accurate diagnosis. Basic laboratory examination, including CBC with differential, chemistry panel (including blood urea nitrogen, creatinine, and ammonia), arterial blood gas values, chest x-ray, toxicology screen (comprehensive), thyroid function tests, and serologic tests for syphilis.  Additional test may include CT scan, MRI, additional blood chemistries (heavy metals, thiamine, folate, antinuclear antibody, and urinary porphobilinogen), lumbar puncture, PET/ single photon emission computed tomography scans. Complete mental status examination. Comprehensive physical examination.

Treatment:

1.    Treatment is generally community focused; the goal of treatment is to maintain the quality of life as long as possible despite the progressive nature of the disease. Effective treatment is based on:

·         Diagnosis of primary illness and concurrent psychiatric disorders.

·         Assessment of auditory and visual impairment

·         Measurement of the degree, nature, and progression of cognitive deficits.

·         Assessment of functional capacity and ability for self care

·         Family and social system assessment.

2.    Environmental strategies in order to assist in maintaining the safety and functional abilities of the patient as long as possible.

Pharmacologic Treatment

Pharmacologic therapy used for the person with DAT is directed toward the use of anticholinesterase drugs to slow the progression of the disorder by increasing the relative amount of acetylcholine. Available drugs include donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon) and tacrine (Cognex). An NMDA-receptor antagonist memantine (Namenda) may be provided in an attempt to improve recognition. Other drugs may be used for behavioral control and symptom reduction.

·         Agitation management: neuroleptic drugs

·         Psychosis: neuroleptic drugs

·         Depression: antidepressants, ECT

Complications:

1.    Without accurate diagnosis and treatment, secondary dementias may become permanent.

2.    Falls with serious orthopedic or cerebral injuries.

3.    Self-inflicted injuries

4.    Aggression or violence to self, others, or property.

5.    Wandering events, in which the person can get lost and potentially suffer exposure, hypothermia, injury, and even death.

6.    Serious depression is demonstrated in caregivers who receive inadequate support.

7.       Caregiver stress and burden may result in patient neglect or abuse.

NURSING MANAGEMENT          

            There will always be a time for medical care for Mrs. A but nursing care should also come into play for her welfare and being. There are a number of measures to indicated in regards of the care to Mrs. A such as identifying behaviors and functional capacity, providing  techniques appropriate for the enhancement of care for Mrs. A., and also establishing a relationship that is deemed healthy and satisfying. These steps are just a part of the nursing care to be given to Mrs. A and are to provided holistically to ensure the paradigms of nursing such as nursing, health, person, and environment are relevant. It is in our job description to deliver the best possible care and attention to Mrs. A and for that every little details of her health is important.

            It is always better to assess her overall condition before any interventions are to be considered. Always inspect her room when entering as to assess if there are any improvements or decline to her behavior. If her room seems disorganized and untidy then there is a possibility that her forgetfulness and wandering behavior is getting worse therefore certain measures has to implemented. If ever her room is tidy and organized then these are signs that her condition is either improving or unforeseen circumstances happened so it is always good to check up with any patients who are having dementia. Her appearance is also vital to assess for any changes in her ADL routine like if she is either well-groomed or not and make the appropriate teachings and discuss possible ways for her to live comfortably and hygienic such as daily baths, brushing her teeth slowly and gently, and wearing clean clothes.  When interacting with dementia patients such as Mrs. A it is best to listen to her speech pattern if there are changes like slurring, incoherence, flight of ideas, loose association and etc. Assessment should always be the first to identify key possible problems regarding Mrs. A condition and other interventions will follow. Taking baseline vital signs everyday is also an essential part towards the continuation of care for Mrs. A such as pulse rate, respiratory rate, blood pressure and temperature.

            Safety is also one of the valuable measures to be considered in taking care of Mrs. A due to a number of reasons such as advanced age and her present disease condition so it is important to ensure a safe environment. Avoiding over stimulation of a new environment is a must because too much stimulation of new objects such as cellphones, computers, or any equipment will make the patient confused and irritable so therefore a routine schedule should  always be followed when taking care of the patient. Always make sure that she is wearing the proper paraphernalias and equipment for any emergencies that will arise like her medic-alert bracelet, locks and wander guards if ever her condition starts to decline but for Mrs. A it seems like it is going well for her. Also eliminate any environmental hazards that you may encounter in the room or in the facility to provide a precautionary measure and to lower the risks of injury to dementia patients like Mrs. A

                It is always best to not skip the medications as prescribed for Mrs. A because if there is a delay in her medications her condition will not improve over time. Medications like Donezepril (Aricept), Rivastigmine (Exelon), and Galantamine (Razadyne) are just a number of medications that are called cholinesterase inhibitors that slows or decreases the progress of the disease. If ever there is a skippage then it is best for the patient to take it the next day but it should always be avoided so as to not aggravate the condition and progression of dementia. Lastly nothing is more important than family and visits are appreciated but not to be frequented due to the possible over stimulation from the guests. Always integrate community services toward the care to provide the best possible outcomes with new discoveries and researches that will make a mark for future treatment of mental disorders like Alzheimers, and Dementia as well.

Nursing Interventions:

Improving communication

1.    Speak slowly and use short, simple words and phrases.

2.    Consistently identify yourself, and address the person by name at each meeting.

3.    Focus on one piece of information at a time. Review what has been discussed with patient.

4.    If patient has vision or hearing disturbances, have him wear prescription eye glasses and/or hearing device.

5.    Keep environment well lit.

6.    Use clocks, calendars, and familiar personal effects in the patient’s view.

7.    If patient becomes aggressive, shift the topic for a safer, more familiar one.

Promoting Independence in Self-care

1.    Assess and monitor patient’s ability to perform activities of daily living.

2.    Encourage decision making regarding activities of daily living as much as possible.

3.    Monitor food and fluid intake.

4.    Weigh patient weekly.

5.    Provide food that patient can eat while moving.

6.    Sit with the patient during meals and assist by cueing.

Ensuring Safety

1.    Discuss restriction of driving when recommended.

2.    Assess patient’s home for safety; remove throw rugs, label rooms, and keep the house well lit.

3.    Assess community for safety.

4.    Alert neighbors about the patient’s wandering behavior.

5.    Alert police and have current picture taken

6.    Install safety bars in the bathroom.

7.    Encourage physical activity during day time

Preventing Violence and Aggression

1.    Respond calmly and do not raise your voice.

2.    Remove objects that might be used to harm self or others.

3.    Identify stressors that increase agitation.

4.    Distract patient when an upsetting situation develops

                                                                                           

Reaction Paper based on Dementia Case Study 

Based on the given Case on Dementia, we can say that the team at Aranlaw clearly recognized their roles, functions and responsibilities to their clients. Seemingly simple adjustments in care routines and approaches can make a significant difference in the experiences of people with dementia.... By focusing on the person rather than on the disease, nurses promote comfort and functional autonomy in older adults whose cognitive impairments have progressed and yet who are very much alive and deserving of respectful, dignified care.

As per Mr. Jones, back in 1984, he worked in a Nursing home as an Orderly, while going to college to become an Emergency Medical Technician (EMT).  There were three shifts, and he rotated in all of them based on openings in his school schedule.  On every shift, one of his main responsibilities was to roll around with a medication cart and assure that all of the patients took their numerous medications such as Haldol, lithium, Vellum.  Almost every patient was on heavy doses of sedatives, muscle relaxants, sleeping pills and anti-psychotics.  Additionally about 10 out of the 60 on his ward received weekly electro-shock therapy treatments. He inquired what it was like from several; they all said it made them feel better.  Unlike the case of Mrs. A, they simply managed clients with dementia, depression, mental problems or no were else to go, with lots of pharmaceuticals and little else for the remainder of their lives.  This meant the Nursing home could Higher EMTs, nursing aids, and college students cheaply instead of social workers, psychologist, nurses, occupational and physical therapist, mental health counselors, etc.  In short the company made money and the pills kept everyone calm and quite with minimal staff, intervention and funding resulting in larger profit margins for the nursing home owner(s). ‘The behavioral management used by the staff at Aranlaw, seems far more humane than that received by the patients were Aaron worked.  Behavioral management seems much more preferable than management by medication.

A calm, predictable environment helps people with dementia interpret their surroundings and activities. Environmental stimuli are limited, and a regular routine is established. A quiet, pleasant manner of speaking, clear and simple explanations, and use of memory aids and cues help minimize confusion and disorientation and give patients a sense of security. Prominently displayed personal pictures along with clocks and calendars may enhance orientation to time. By giving MrsA key to her on room and allowing her to choose what color her room was painted the Aranlaw team is helping to reinforce feelings of contentment, integrity security, independence, safety and self –direction which are important for all adults. This is especially true for people like Mrs A, who are in Erik Erikson's 8th stage, later adulthood (age 60 years and older); “Ego Integrity vs. Despair”. Additionally since the color chose was hers it will make it easier for her to remember and to locate her room. By encouraging active participation from Mrs. A in her personal life, along with participation in physical activity communication in the daily nursing activities of the nursing home, the Aranlaw team is helping Mrs A to maintain cognitive, functional, and social interaction abilities for a longer period. Within 4 weeks of staying in Aranlaw, MrsA, appears to be in the early phase of dementia, as she is still a highly productive member of the nursing home.  Fortunately for Mrs A, minimal cuing and guidance may be all that are needed for her to function fairly independently for a number of years to come, because dementia of any type is degenerative and progressive, patients display a decline in cognitive function over time.

After nearly a year of Mrs A staying in the safe and caring environment provided by the Aranlaw team. Her cognitive, functional, and behavioral skills improved. This safe home and hospital environment allowsMrs A to move freely as possible and relieves the family of constant worry about safety. Mrs A is currently functioning well, and living a productive life because of the interventions of this forward thinking team. However, as Mrs A’s cognitive ability declines in the future, the Aranlaw team will need to provide more and more assistance and supervision in order for her to continue living a full and functional life as possible. 

Reaction paper (Kidneys: The new targets for type 2 diabetes mellitus treatment?)

Kidneys: The new targets for type 2 diabetes mellitus treatment?

By:SjobergKho

Diabetes undoubtedly is one of the most dreaded diseases. This lifelong illness can come with a host of debilitating complications, including blindness, kidney failure, heart attack and stroke. However, the good news is that these are largely preventable through good control of blood glucose, blood pressure and cholesterol levels.

The battle to achieve good glycemic control is a major therapeutic challenge both for healthcare professionals and their patients. The treatment starts with healthy-living habits that include a balanced diet, 30-minute daily exercise and 5- to 10-percent weight loss for overweight patients.

For decades, medication to control blood glucose levels has centered on improving insulin supply together with regimen that improves insulin sensitivity by the body. Side effects like weight gain, hypoglycemia (low sugars), gastrointestinal symptoms and edema have limited the optimal use of these older drugs. Over this past decade, newer drugs that help regulate food intake and promote better communication between the gut and the pancreas have led to improved glycemic control. The latest drugs to join the market are a group of oral tablets that make patients release excess sugars into the urine.

Yes, you read that right! Where the kidneys just used to be candidates for complications, they are now targets for treatment. For years, experts knew that high blood glucose is partly due to difficulty in expelling excess glucose into the urine. They have discovered the major route by which glucose is reabsorbed by the kidneys, called sodium-glucose transporter-2 (SGLT-2). Blocking this pathway increases glucose excretion; hence the SGLT-2 inhibitors were invented.The SGLT-2 inhibitors or the “gliflozins” excrete about 70 grams a day of glucose into the urine. Seventy grams of glucose translate to a loss of almost 300 calories a day leading to an average of 2- to 3.5-kilogram weight reduction in most clinical investigations. The weight loss includes some reduction in body fat. Hypoglycemia is rare and mild with the gliflozins. They also have the benefit of modest blood pressure reduction of 3 to 5 mm Hg. The excess sugar in the urine however has been associated with a slight increase in genital yeast infection and urinary tract infection, both of which are easily treatable with a low chance of recurrence.

They can be used alone or in combination with insulin or other oral antidiabetic medications. Dapagliflozin, the first SGLT-2 inhibitor in the Philippines, has been a welcome addition to the list of pharmacologic choices available for patients with type 2 diabetes but not approved for use in type 1. It is currently available only through prescription by a physician after an evaluation. These are exciting times as we expect and watch out for more medications that will soon be available.Dr. SjobergKho is the immediate past president of the Philippine Society of Endocrinology, Diabetes and Metabolism. The A to Z of Health Information Advocacy is a joint initiative of a group of medical specialists and supported by AstraZeneca Philippines aimed at raising public awareness on various diseases and providing health information and updates to the healthcare community.

Reference:     

Sjoberg Kho / @inquirerdotnet

12:12 AM August 08, 2015

Read more: http://business.inquirer.net/196668/kidneys-the-new-targets-for-type-2-diabetes-mellitus-treatment#ixzz4NrXfB0cq 

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Reaction paper:

It’s really great that researchers had found a new medication for the management of Diabetes Mellitus. We’ve known that this chronic condition causes a host of complications such as blindness, amputation, cardiovascular disease and chronic kidney damage due to poor glycemic control. The standard pharmacologic management of this condition has always been insulin (Type 1 DM) and oral / injectable hypoglycemic agents (Type 2 DM).Long- term complications of diabetes develop gradually. The longer you have diabetes (not controlling your blood sugar), the higher the risk of complications. Eventually it may be disabling or life-threatening. This new type of drug promotes the excretion of excess sugar in the blood, enabling diabetic patients to maintain normal blood sugar levels. My grandfather from the maternal sidehad Type 2 Diabetes Mellitusfor many years. He is very fond of sweets so my aunt needs to monitor his blood sugar level regularly and regularly take his oral hypoglycemic medications. But, unfortunately he died early this year due to pneumonia which is difficult to treat because of his condition. I can truly relate to this condition because it runs in our blood and we must really watch what we eat and have a balanced lifestyle.