Canagliflozin: from glycemic control to improvement of cardiovascular and renal prognosis in patients with type 2 diabetes mellitus. Resolution of Advisory Board

Inhibitors of the sodium-glucose cotransporter type 2 (SGLT2i) are a modern class of antihyperglycemic drugs with an insulin-independent mechanism of action. Due to its ability to effectively lower blood glucose levels, improve a number of other cardiometabolic parameters (body weight, blood pressure, uric acid), as well as reduce cardiovascular and renal risks, SGLT2i have become drugs of choice for many of patients with type 2 diabetes mellitus (T2DM). Meanwhile, along with the generally recognized classes-effects of this group of drugs, there are intragroup features, including those associated with their different selectivity in sodium-glucose cotransporters of types 1 and 2 (SGLT1 and SGLT 2). For example, one of the most studied SGLT2i, canagliflozin, in addition to its inhibitory activity against SGLT2, can also moderately block SGLT1 in the intestine and kidneys that could give a maximum efficiency in the control glycemia and others cardiometabolic parameters. In addition, canagliflozin improves not only cardiovascular, but also renal prognosis in patients with T2DM, which is reflected in the corresponding indications in the summary of product characteristics of the drug. This document summarize the established and new data regarding the efficacy and safety of canagliflozin, as well as its place in the treatment of T2DM.

Upaya Penerapan Imajinasi Terbimbing Untuk Menurunkan Tekanan Darah Pada Pasien Hipertensi

ABSTRAK Data world health organization (WHO) menunjukkan sekitar 1,13 Miliar orang di dunia menyandang hipertensi, artinya 1 dari 3 orang di dunia terdiagnosis hipertensi. Hipertensi disebut sebagai silent killer karena pada sebagian besar kasus tidak menunjukkan tanda dan gejala apapun, sehingga penderita tidak mengetahui jika dirinya terkena hipertensi. Tujuan Setelah diberikan penerapan imajinasi terbimbing diharapkan adanya perubahan tekanan darah pada penderita yg mengalami hipertensi pada Lansia dan mengetahui cara mengatasi hipertensi tanpa menggunakan obat. Pelaksanaan kegiatan ini dengan cara melakukan sebelumnya pengukuran tekanan darah pada lansia selanjutnya melakukan imajinasi terbimbing. Ditemukan lansia menderita hipertensi tetapi blm tau cara pengobatan menggunakan non farmakologi dan Imajinasi Terbimbing ini belum pernah diterapkan di Desa lingsar. Dengan demikian program kesehatan ini sangat mendukung dan sangat efektif untuk dilakukan khususnya kegiatan Imajinasi Terbimbing ini agar dapat dijadikan sebagai program rutin seperti sosialisasi, program kesehatan. Pelaksanaan Imajinasi Terbimbing Ini sangat bagus untuk menurunkan tekanan darah pada pasien Hipertensi. Oleh karena itu perawat di Puskesmas juga dapat mengaplikasikan teknik Imajinasi Terbimbing dalam membantu menurunkan tekanan darah pada pasien yang mengalami hipertensi Kata Kunci: Imajinasi Terbimbing, Tekanan Darah, Pasien Hipertensi ABSTRACT World Health Organization (WHO) data shows approx 1.13 billion people in the world have hypertension, meaning that 1 in 3 people in the world is diagnosed with hypertension. Hypertension is called the silent killer because in most cases it does not show any signs and symptoms, so the patient does not know if he has hypertension. Objectives After being given the application of guided imagination, it is hoped that there will be changes in blood pressure in patients who have hypertension in the elderly and know how to treat hypertension without using drugs. The implementation of this activity is done by first measuring blood pressure in the elderly and then doing guided imagination. It was found that the elderly suffered from hypertension but did not know how to use non-pharmacological treatment and this Guided Imagination had never been applied in Lingsar Village. Thus this health program is very supportive and very effective to be carried out, especially this Guided Imagination activity so that it can be used as a routine program such as socialization, health programs. Implementation of Guided Imagination This is very good for lowering blood pressure in hypertensive patients. Therefore nurses at the Puskesmas can also apply the Guided Imagination technique to help lower blood pressure in patients with hypertension Keywords: Guided Imagination, Blood Pressure, Hypertension Patients

Dietary Intake of Hydrolyzable Tannins and Condensed Tannins to Regulate Lipid Metabolism

Lipid metabolism disorder is a multifactor issue, which contributes to several serious health consequences, such as obesity, hyperlipidemia, atherosclerosis diabetes, non-alcoholic fatty liver etc. Tannins, applied as natural derived plant, are commonly used in the study of lipid metabolism disease with excellent safety and effectiveness, while producing less toxic and side effects. Meanwhile, recognition of the significance of dietary tannins in lipid metabolism disease prevention has increased. As suggested by existing evidence, dietary tannins can reduce lipid accumulation, block adipocyte differentiation, enhance antioxidant capacity, increase the content of short-chain fatty acids, and lower blood lipid levels, thus alleviating lipid metabolism disorder. This study is purposed to sum up and analyze plenty of documents on tannins, so as to provide the information required to assess the lipid metabolism of tannins.

Evaluation of a Pneumatic Vest to Treat Symptoms of ARDS Caused by COVID-19

Critical care patients who experience symptoms of acute respiratory distress syndrome are commonly placed on mechanical ventilators to increase the oxygen provided to their pulmonary systems and monitor their condition. With the pulmonary inflammation typically accompanying ARDS, patients can experience lower ventilation-perfusion ratios resulting in lower blood oxygenation. In these cases, patients are typically rotated into a prone position to facilitate improved blood flow to portions of the lung that were not previously participating in the gas exchange process. However, proning a patient increases the risk of complications, requires up to seven hospital staff members to carry out, and does not guarantee an improvement in the patient's condition. The low-cost vest presented here was designed to reproduce the effects of proning while also requiring less hospital staff than the proning process. Additionally, the V/Q Vest helps hospital staff predict whether patients would respond well to a proning treatment. A pilot study was conducted on nine patients with ARDS from Coronavirus disease 2019 (COVID-19). The average increase in oxygenation with the V/Q Vest treatment for all patients was 19.7 ± 38.1%. Six of the nine patients responded positively to the V/Q Vest treatment, exhibiting increased oxygenation. The V/Q Vest also helped hospital staff predict that three of the five patients that were proned would experience an increase in oxygenation. An increase in oxygenation resulting from V/Q Vest treatment exceeded that of the proning treatment in two of these five proned patients.

Penerapan Terapi Relaksasi Otot Progresif Untuk Menurunkan Tekanan Darah Pada Lansia Yang Mengalami Hipertensi

Hypertension in the elderly is the elderly who experience an increase in blood pressure above normal with a normal range of 120/80 mmHg on blood pressure examinion using a blood pressure measuring device. One of the actions to lower blood pressure is the progressive musle relaxation technique. The purpose of this scientific paper is to apply progressive muscle in Proto Tambahrejo village, Bandar sub district,Batang district. Case study method by applying muscle relaxation therapy progressive blood pressure reduction in the elderly with hypertension in Proto Tambahrejo Village Bandar Distract Batang Regency. The data Collection.The results of the application showed that during the 6-day visit, two elderly people were able to lower blood pressure, on the first day the client was 170/100 mmHg and the sixth day it was 130/90 mmHg, while on the second day the client was 160/100 mmHg and the sixth day 120/90 mmHgm Conclusion This case study shows that progressive muscle relaxation therapy is effective in the elderly with hypertension. Suggestions from the authors are expected that progressive muscle relaxation therapy can be used as an effective application in the elderly who have hypertension.Keywords: Hypertension, Progressive muscle relaxation, the elderly. AbstrakHipertensi pada lansia adalah lansia yang mengalami peningkatan tekanan darah diatas normal yaitu dengan rentang normal 120/80 mmHg pada pemeriksaan tensi darah menggunakan alat pengukur tekanan darah.Tindakan untuk menurunkan tekanan darah salah satunya adalah dengan teknik relaksasi otot progersif. Tujuan Karya Tulis Ilmiah ini adalah mengaplikasikan tindakan teknik relaksasi otot progresif untuk menurunkan tekanan darah pada lansia yang mengalami hipertensi. Metode studi kasus dengan menerapkan terapi relaksasi otot progresif untuk menurunkan tekanan darah pada lansia yang mengalami hipertensi. Subyek studi kasus yang digunakan adalah dua lansia yang mengalami hipertensi. Metode pengumpulan data yang digunakan berupa wawancara dan observasi. Hasil penerapan menunjukkan selama 6 hari kunjungan dua lansia mampu menurunkan nyeri tekanan darah, pada klien I hari pertama skala nyeri 7 tekanan darah 170/100 mmHg dan hari keenam menjadi skala nyeri 1 tekanan darah 130/90 mmHg, Sedangkan pada klien II hari pertama skala nyeri 5 tekanan darah 160/100 mmHg dan hari keenam menjadi skala nyeri 1 tekanan darah 120/90 mmHg. Kesimpulan dari studi kasus ini menunjukkan terapi relaksasi otot progresif efektif digunakan untuk menurunkan tekanan darah pada lansia yang mengalami hipertensi. Kata kunci: Hipertensi, relaksasi otot progresif, lansia

Penerapan Terapi Relaksasi Otot Progresif Untuk Menurunkan Hipertensi Di Desa Glandang Bantarbolang

Hypertension is the increase of blood pressure which is higher than or equal to 140 mmHg at systolic blood pressure and higher or equal to 90 mmHg at diastolic blood pressure. The purpose of this study is to implement actions of progressive muscle relaxant therapy to lower blood pressure on hypertensive patients. This research uses descriptive method and tye subjects of this research are two hypertension clients with blood pressure higher than 140/100 mmHg at Glandang Village, Bantarbolang. Intervention is done by giving progressive muscle relaxation therapy for six days and is done once a day. The result of the study shows a drop in blood pressure on both clients, for client 1 to drop blood pressure from 160/100mmhg to 130/90mmhg and for the second client to drop in blood pressure from 170/100mmhg to 130/100mmhg. The study of the case indicates that progressive muscle relaxation therapy reduces blood pressure on hypertensive people. It is recommended for nurses or people working in health field to provide therapy in order to lower blood pressure in the form of progressive muscle relaxation therapy in hypertensive people.Keywords: Progressive Muscle Relaxation, Hypertension AbstrakHipertensi merupakan penyakit the silent killer yang menyebabkan 1 dari 3 orang dewasa terkena penyakit hipertensi dan diperkirakan 7,5 juta kematian didunia ini akibat hipertensi. Pada umumnya penyakit hipertensi ini tidak disadari oleh penderitanya, 50% penderita hipertensi tidak memperlihatkan pertanda yang pasti, terutama apabila sedang dalam taraf awal. Tujuan studi kasus ini adalah untuk mengaplikasikan tindakan terapi relaksasi otot progresif untuk menurunkan tekanan darah pada penderita hipertensi. Rancangan Karya Tulis Ilmiah ini menggunakan metode studi kasus deskriptif dengan subyek dua klien hipertensi yang mengalami tekanan darah tinggi diatas 140/100mmHg di Desa Glandang Bantarbolang. Intervensi yang dilakukan adalah pemberian terapi relaksasi otot progresif selama enam hari dan dilakukan satu kali sehari. Hasil studi ini menunjukan adanya penurunan tekanan darah pada kedua klien, untuk klien 1 mengalami penurunan tekanan darah dari 160/100mmHg menjadi 130/90mmHg dan untuk klien kedua mengalami penurunan tekanan darah dari 170/100mmHg menjadi 130/90mmHg jadi rata-rata penurunan tekanan darah dari kedua klien adalah untuk tekanan darah sistolik sebanyak 30-40mmHg dan untuk tekanan diastolik sebanyak 10mmHg. Simpulan studi kasus ini menunjukan bahwa terapi relaksasi otot progresif mampu menurunkan tekanan darah pada penderita hipertensi. Saran bagi tenaga kesehatan diharapkan dapat memberikaan tindakan terapi untuk menurunkan tekanan darah yang berupa terapi relaksasi otot progresif pada penderita hipertensi.Kata kunci: Relaksasi Otot Progresif, Hipertensi

Glycemic control is associated with lower odds of mortality and successful extubation in severe COVID-19

Context Corticosteroids, specifically dexamethasone, have become the mainstay of treatment for moderate to severe COVID-19. Although the RECOVERY trial did not report adverse effects of corticosteroids, the METCOVID (Methylprednisolone as Adjunctive Therapy for Patients Hospitalized with COVID-19) study reported a higher blood glucose level in patients receiving methylprednisolone. Objectives This study aims to analyze the association between corticosteroids and COVID-19–related outcomes in patients admitted to the medical ICU (MICU) for COVID-19 pneumonia. Methods This is an observational study of 141 patients admitted to the MICU between March 18 and June 7, 2020. Data on demographics, laboratory and imaging studies, and clinical course were obtained, including data on corticosteroid use. Bivariate analyses and logistic regression were performed between patient characteristics and mortality and successful extubation. Results Of the 141 patients, 86 required mechanical ventilation, 50 received steroids, and 71 died. Regarding demographics, patients had a median age of 58 (interquartile range [IQR] 48, 65), Hispanic (57.4%, n=81), and non-Hispanic Black (37.5%, n=53). The most prevalent comorbidities were hypertension (49.6%, n=70) and diabetes (48.2%, n=68). Lower blood glucose levels on admission (125.5 vs. 148 mg/dL, p=0.025) and lower peak blood glucose levels on corticosteroids (215.5 vs. 361 mg/dL, p=0.0021) were associated with lower prevalence of mortality. Patients who were successfully extubated had a lower admission blood glucose (126.5 vs. 149 mg/dL, p=0.0074) and lower peak blood glucose on corticosteroids (217 vs. 361 mg/dL, p=0.0023). Conclusions Lower blood glucose on admission and lower maximum blood glucose on corticosteroids were associated with lower odds of mortality and successful extubation, regardless of preexisting diabetes. Hyperglycemia may be negating any potential benefit of corticosteroid therapy. These findings suggest that glucose control could be a parameter that impacts the outcome of patients receiving corticosteroids for COVID-19 pneumonia.

Effects of Imperata cylindrica on Anti-hyperlipidemia: A Review

Imperata cylindrica is a well-known species of perennial rhizomatous grass native to tropical South East Asia, which possesses extensive medicinal value. It has major constituents such as saponin, flavonoid, phenols, and glycosides, efficacious as an anti-hyperlipidemia. Studies of pharmacological activities of I. cylindrica, a nutritious, medicinal herb, showed that it could cause blood lipid levels to be reduced. This systematic review article was designed to determine the existing studies related to the efficacy of I. cylindrica to lower blood lipid levels. PubMed and Scopus databases were used to search for suitable keywords such as Imperata cylindrica, cogongrass, hypolipidemic, triglyceride, cholesterol, low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL). Based on provided protocol, in this systematic review, we extracted the data and evaluated the quality of articles by two reviewers. (4) Results 73 articles were the search results and based on the inclusions and exclusions criteria, 8 articles were included in the final review. These studies demonstrated that two active compounds of I. cylindrica: flavonoids and saponins, were beneficial to reduce blood lipid levels. However, further clinical studies are urgently required to provide adequate evidence on the use application of I. cylindrica in medicinal properties.

PELATIHAN PEMBUATAN TEPUNG SIAP SAJI BERBAHAN DASAR UMBI PORANG (Amorphopallus oncophyllus P.) SEBAGAI PANGAN FUNGSIONAL BAGI LANSIA DI PANTI WERDHA TRESNO MUKTI TUREN

ABSTRAKPanti Werdha Tresno Mukti berada di Desa Pagedangan Kec. Turen, Kab. Malang. Perubahan aspek fisik, mental dan sosial yang terjadi pada lansia mempengaruhi kondisi kesehatan para lansia baik secara mental maupun fisik. Munculnya berbagai penyakit pada lansia akan meningkatkan resiko kekurangan nutrisi akibat kehilangan nafsu makan. Tambahan asupan makanan pendamping diperlukan sebagai pangan fungsional yang memberi manfaat kesehatan bagi para lansia. Porang (Amorphophallus oncophyllus. P) mengandung glucomannan berbentuk tepung atau serat alami yang larut di dalam air dan sering diolah menjadi produk makanan seperti mie shirataki, konnyaku, bahan campuran kue, roti, jeli, selai, es krim dan lain sebagainya. Mengkonsumsi umbi porang diketahui dapat menurunkan lipida darah, menurunkan glukosa darah, mencegah dan menghambat kanker, menurunkan obesitas dan mengatasi sembelit. Tujuan pelatihan ini untuk menambah pengetahuan dan ketrampilan para pengasuh lansia sebagai mitra dalam pemanfaatan umbi porang menjadi alternatif makanan sehat bagi lansia. Adapun metode yang digunakan adalah pelatihan secara on-line dengan pendekatan partisipatif. Kegiatan ini telah terlaksana selama bulan Juli 2021, dari 17 pengasuh lansia yang melihat video pembuatan tepung siap saji berbahan dasar umbi porang ada 14 pengasuh lansia atau 82% telah dapat membuat dengan benar. Secara keseluruhan kegiatan berjalan lancar serta antusiasme pendamping sangat baik Kata Kunci : Amorphophallus oncophyllus; glukomanan: iles-iles; lansia; porang ABSTRACTThe Tresno Mukti Nursing Home is located in Pagedangan Village, Kec. Turen , Kab. Malang. Change in physical, mental and social aspects that occur in the elderly affect the health condition of the elderly both mentally and physically. The emergence of various diseases in the elderly will increase the risk of nutritional deficiencies due to loss of appetite. Additional intake of complementary foods is needed as functional food that provides health benefits for the elderly. Porang (Amorphophallus oncophyllus. P) contains glucomannan in the form of flour or natural fiber that is soluble in water and is often processed into food products such as shirataki noodles, konnyaku, cake mix ingredients, bread, jelly, jam, ice cream and so on. Consuming porang tubers is known to lower blood glucose prevent and inhibit cancer, reduce obesity and treat constipation. The purpose of this training is to increase the knowledge and skills of elderly caregivers as partners in using porang tubers as an alternative to healthy food for th elderly. This activity has been carried out during July 2021, from 17 elderly caregivers who saw the video of making ready to eat flour made from porang tubers, 14 elderly caregivers or 82 % were able to make it correctly. Overall the activity went smoothly and the enthusiasm of the companion was very good. Keywords: Amorphophallus oncophyllus; elderly; glucomannan; iles-iles; porang

Penerapan Isometric Handgrip Exercisedan Slow Deep Breathing Exercise Untuk Menurunkan Tekanan Darah

Hypertension is an increase in blood pressure with systolic above 140 mmHg and diastolic above 90 mmHg. One of the non-pharmacological methods to lower blood pressure is to do isometric handgrip exercise and slow deep breathing exercise. The purpose of this case study is to evaluate blood pressure by implementing isometric handgrip exercise and slow deep breathing exercise toward hypertensive patients within five day of training (twice per day). There were two hipertensive patients involvid in this study. The results of this case study showed that the blood pressure of both patients dropped to normal. The firt patients blood pressure dropped to normal from 160/100 mmHg to 130/80 mmHg after the intervention. Similarly, the second patients blood pressure reduced from 170/100 mmHg to 120/80 mmHg. This study conclusion that the isometric handgrip exercise and slow deep breathing exercise can lower blood pressure.Keywords: Hypertension; Isometric Handgrip; Slow Deep Breathing AbstrakHipertensi adalah peningkatan tekanan darah dengan sistolik diatas 140 mmHg dan diastolik diatas 90 mmHg.salah satu tindakan nonfarmakologi yang dapat menurunkan tekanan darah adalah dengan melakukan latihan isometric handgrip exercise dan slow deep breathing exercise. Tujuan dilakukannya penerapan studi kasus ini adalah untuk menurunkan tekanan darah dengan menggunakan latihan isometric handgrip exercise dan slow deep breathing exercise pada keluarga dengan hipertensi. Metode yang digunakan adalah dengan penerapan latihan isometric handgrip exercise dan slow deep breathing exercise. Hasil dari studi kasus ini menunjukkan adanya penurunan tekanan darah pada klien I dan II yang disertai dengan penurunan rasa nyeri, klien I dengan tekanan darah 160/100 mmHg turun menjadi 130/80 mmHg dan klien II dengan tekanan darah 170/100 mmHg turun menjadi 120/80 mmHg. Kesimpulan dari penerapan isometric handgrip exercise dan slow deep breathing exercise adalah bahwa penerapan latihan isometric handgrip exercise dan slow deep breathing exercise dapat menurunkan tekanan darah selama 5 hari latihan dengan 2 kali pertemuan setiap harinya.Kata kunci: Hipertensi; Isometric Handgrip; Slow Deep Breathing