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Joshua Garing Deiparine, RN - SunLife Licensed Financial Advisor, Legazpi (2025)

21/09/2020

3 practical tips in budgeting you money

1.calculate your expense-
✅compute all your expenses in a month.

2.reduce what can be reduced-
✅if you're eating in a restaurant twice or thrice a week, make it just once a week or once every two weeks.

3.increase your income-
✅if there is nothing else to reduce, you need to find other ways to increase your income.

23/04/2020

Very informative!!

POST MORTEM RESULTS ARE GRADUALLY REVEALING THE PATHOPHYSIOLOGY OF COVID 19 DISEASES.

Based on observations in USA, Spain, Italy, France and UK, and from postmortem of lungs involvement in COVID 19 , all revealed pulmonary thrombosis which is not typical ARDS , but more alarming that it is patient hypoxemia that is not responding to PEEP but high oxygen flow.

Like methemoglobin, the COVID 19 virus structural protein, sticks to heme - displaces oxygen - which release iron-free ion , that leads to toxicity and causes inflammation of alveolar macrophages- that results in bilateral CT scan changes as it is a systemic response.

There is No benefit of invasive ventilation, but patients May require frequent blood transfusions or plasmapheresis.

The COVID 19 virus attacks beta chain, dissociates heme, removing iron and converting it to porphyrin. The virus can dissociate oxy-Hb, carboxy-Hb and
glycosylated Hb.

Lung inflammation results from the inability of both oxygen and CO2 exchange, leading to the ground glass on x rays, it mimics CO2 poisoning as an invisible enemy.

Chloroquine competes for the binding to porphyrin.

Favipiravir binds to the virus envelope protein with very high affinity, prevents entry into the cells as well as binding of the structural protein to porphyrin.

If free radicals scavengers and iron chelating agents are added to the protocol of management, it may lessen the inflammation process.

COVID 19, SARS2 is not 'pneumonia' nor ARDS. Invasive ventilation is not only the wrong solution, but emergency intubation can harm and result in more damage, not to mention complications from tracheal scarring and stiff lung during the duration of intubation.

Furthermore, a new treatment protocol needs to be established, so we stop treating patients for the wrong disease.

COVID-19 causes prolonged and progressive hypoxia by binding to the heme groups in the red blood cells.

People are desaturating due to failure of the blood to carry oxygen.

This will lead to multi-organ failure and high mortality.The lung damage seen on CT scans is due to the oxidative iron released from the haemolysed red blood cells which in turn overwhelm the natural defences against pulmonary oxidative stress and causes what is known as Cytokine storm.

There is always-bilateral ground-glass opacity in the lungs. Recurrent admission for post-hypoxic leukoencephalopathy fortifies our findings that COVID-19 patients are suffering from metabolic hypoxia due to blood capacity failure.

COVID-19 glycoproteins bond to the heme in RBC, and in doing so, the toxic oxidative iron ion is disassociated and released. The freely roaming iron in the blood without any physiological function will culminate into the following;

1) Without the iron ion, haemoglobin can no longer bind to oxygen. Once the haemoglobin is impaired, the red blood cell is essentially none functioning in carrying and delivering oxygen to any tissues.

RBC's Become useless and a burden on the patients as they circulate around with COVID-19 virus attached to its porphyrin. This lead to the destruction of the red blood cells and the patient's oxygen saturation levels drop significantly.

What is happening equates to carbon monoxide poisoning, in which carbon monoxide is bound to the haemoglobin with the failure of gas exchange.

Ventilations will not manage the root cause, which is blood organ failure.

COVID 19 patients, unlike CO poisoning in which eventually the CO can break off, the affected haemoglobin is permanently stripped of its ability to carry oxygen where the body compensates by secreting excess erythropoietin to stimulate the bone marrow to secrete new red blood cells. This is the reason we will find thrombocytosis and decreased blood oxygen saturation as one of the three primary indicators of COVID 19 severity score.

2) The freely floating iron ion are highly reactive and causes oxidative damage. This always happens physiologically and naturally to a limited extent in our bodies and such cleanup is a defence mechanism to keep the balance.

The Three primary Lung defences to maintain "iron homeostasis", 2 of them are in the alveoli.

The first of the two are macrophages that roam around and scavenge up the free radicals of the oxidative iron. The second is a lining on the epithelial surface which has a thin layer of fluid packed with high levels of antioxidant molecules such as ascorbic acid (Vitamin C) among others.

When too much iron is in circulation, it begins to overwhelm the lungs' counter measures begins, the process of pulmonary oxidative stress. This leads to damage and inflammation, which leads to the so-called Cytokine storm; this can be documented on high-resolution CT scans of

In COVID-19 patient lungs, It is a fact that it affects both lungs at the same time and Pneumonia rarely ever does that, but COVID-19 does every single time.

The liver is attempting to do its best to remove the iron and store it in its 'iron vault'. Only its getting overwhelmed too. It is starved for oxygen and fighting a losing battle from all the haemolysis haemoglobin and the freed iron ion. The liver will start releasing alanine aminotransferase (ALT) which is the second of 3 primary COVID 19 severity score indicators.

A patient must be managed on maximum oxygen flow through a hyperbaric chamber on 100% oxygen at double or multiple atmospheres of pressure, for 90 minutes twice per day for five days.

This is in order to give what has left of their functioning haemoglobin a chance to carry enough oxygen to the organs and keep them alive.

We do not have nearly enough of those hyperbaric chambers, and we might use all parked grounded aeroplanes as a ready-made functional hyperbaric chamber with the advantage of providing double atmospheric pressure with an aerosol of prostacyclin as pulmonary hypertension modulator.

Blood transfusion with packed fresh red blood cells to patients after plasmapheresis may ameliorate the cytokine storm.

The main point that patients will require ventilators if they present late with multi-organ system failure to tie them over this life or death scenario. However, intubation is futile unless the patient's immune system modulates the situation. We must address the root of the illness and avoid using traditional teachings to manage a failing system.

3) No longer armchair pseudo-physicians sit in their little ivory towers, proclaiming "Chloroquine use is stupid as malaria is bacteria, COVID-19 is a virus, anti-bacteria drug no work on the virus!". A drug does not need to act on the pathogen to be effective directly. Chloroquine lowers the blood pH and interferes with the replication of the virus.

We advise that if COVID-19 positive patients are conscious, alert, compliant, they must be kept on maximum oxygen and initiate hyperbaric oxygen as early as possible.

If we reach the inevitably to ventilate, it must be done at low pressure but with maximum oxygen flow. We must avoid tearing up the lungs with maximum PEEP as we are doing more harm to the patient because we are managing the wrong organ.

There is a small village in northern Italy where the majority of its population suffers from thalassemia. They had no deaths and no cross-community spread. Moreover, parts of Nepal which are 1km above sea level are COVID-19 free. All points that we are chasing the wrong organ; it is not the lungs; it is a blood problem.

We recommend the following :

1. Inhibit viral growth and replication by the adjuvant use of CHQ+ZPAK+ZINC or other retroviral therapies being studies. The less virus load we have, the less haemoglobin is losing its iron, the less severity and damage with the prevention of cytokine storm.
2. Hyperbaric medicine utilization in any shape or form for anyone with thrombocytosis and elevated ALT can prevent the rapid ascent to the abyss.
3. Plasmapheresis and Blood transfusions will give supportive symptomatic relief.
4. No international Travel until an effective vaccine is available.
5. Cessation of to***co, va**ng and alcohol products.

Stay safe and Self Isolate

Sincerely

Prof Sherif Sultan MD, FRCS, FACS, PhD

16/04/2020

207 New cases of COVID19 in the Philippines!

25/10/2011

Cheyne-Stokes respirations are characterized by alternating periods of apnea and deep, rapid breathing. They occur in patients with central nervous system disorders.

Hyperventilation can result from an increased frequency of breathing, an increased tidal volume, or both.

Apnea is the absence of spontaneous respirations.

Before a thyroidectomy, a patient may receive potassium iodide, antithyroid drugs, and propranolol (Inderal) to prevent thyroid storm during surgery.

The normal life span of red blood cells (erythrocytes) is 110 to 120 days.

Visual acuity of 20/100 means that the patient sees at 20' (6 m) what a person with normal vision sees at 100' (30 m).

Urinary tract infections are more common in girls and women than in boys and men because the shorter urethra in the female urinary tract makes the bladder more accessible to bacteria, especially Escherichia coli.

Penicillin is administered orally 1 to 2 hours before meals or 2 to 3 hours after meals because food may interfere with the drug’s absorption.

Mild reactions to local anesthetics may include palpitations, tinnitus, vertigo, apprehension, confusion, and a metallic taste in the mouth.

About 22% of cardiac output goes to the kidneys.

To ensure accurate central venous pressure readings, the nurse should place the manometer or transducer level with the phlebostatic axis.

A patient who has lost 2,000 to 2,500 ml of blood will have a pulse rate of 140 beats/minute (or higher), display a systolic blood pressure of 50 to 60 mm Hg, and appear confused and lethargic.

Arterial blood is bright red, flows rapidly, and (because it’s pumped directly from the heart) spurts with each heartbeat.

Venous blood is dark red and tends to ooze from a wound.

Orthostatic blood pressure is taken with the patient in the supine, sitting, and standing positions, with 1 minute between each reading. A 10-mm Hg decrease in blood pressure or an increase in pulse rate of 10 beats/ minute suggests volume depletion.

A pneumatic antishock garment should be used cautiously in pregnant women and patients with head injuries.

After a patient’s circulating volume is restored, the nurse should remove the pneumatic antishock garment gradually, starting with the abdominal chamber and followed by each leg. The garment should be removed under a physician’s supervision.

Most hemolytic transfusion reactions associated with mismatching of ABO blood types stem from identification number errors.

Warming of blood to more than 107° F (41.7° C) can cause hemolysis.

Cardiac output is the amount of blood ejected from the heart each minute. It’s expressed in liters per minute.

25/10/2011

Salivation is the first step in the digestion of starch.

A patient who has a demand pacemaker should measure the pulse rate before rising in the morning, notify the physician if the pulse rate drops by 5 beats/minute, obtain a medical identification card and bracelet, and resume normal activities, including sexual activity.

Transverse, or loop, colostomy is a temporary procedure that’s performed to divert the f***l stream in a patient who has acute intestinal obstruction.

Normal values for erythrocyte sedimentation rate are 0 to 15 mm/hour for men younger than age 50 and 0 to 20 mm/hour for women younger than age 50.

A CK-MB level that’s more than 5% of total CK or more than 10 U/L suggests a myocardial infarction.

Propranolol (Inderal) blocks sympathetic nerve stimuli that increase cardiac work during exercise or stress, which reduces heart rate, blood pressure, and myocardial oxygen consumption.

After a myocardial infarction, electrocardiogram changes (ST-segment elevation, T-wave inversion, and Q-wave enlargement) usually appear in the first 24 hours, but may not appear until the 5th or 6th day.

Cardiogenic shock is manifested by systolic blood pressure of less than 80 mm Hg, gray skin, diaphoresis, cyanosis, weak pulse rate, tachycardia or bradycardia, and oliguria (less than 30 ml of urine per hour).

A patient who is receiving a low-sodium diet shouldn’t eat cottage cheese, fish, canned beans, chuck steak, chocolate pudding, Italian salad dressing, dill pickles, and beef broth.

High-potassium foods include dried prunes, watermelon (15.3 mEq/ portion), dried lima beans (14.5 mEq/portion), soybeans, bananas, and oranges.

Kussmaul’s respirations are faster and deeper than normal respirations and occur without pauses, as in diabetic ketoacidosis.

25/10/2011

Fat embolism is likely to occur within the first 24 hours after a long-bone fracture.

Footdrop can occur in a patient with a pelvic fracture as a result of peroneal nerve compression against the head of the fibula.

To promote venous return after an amputation, the nurse should wrap an elastic bandage around the distal end of the stump.

Water that accumulates in the tubing of a ventilator should be removed.

The most common route for the administration of epinephrine to a patient who is having a severe allergic reaction is the subcutaneous route.

The nurse should use Fowler’s position for a patient who has abdominal pain caused by appendicitis.

The nurse shouldn’t give analgesics to a patient who has abdominal pain caused by appendicitis because these drugs may mask the pain that accompanies a ruptured appendix.

The nurse shouldn’t give analgesics to a patient who has abdominal pain caused by appendicitis because these drugs may mask the pain that accompanies a ruptured appendix.

As a last-ditch effort, a barbiturate coma may be induced to reverse unrelenting increased intracranial pressure (ICP), which is defined as acute ICP of greater than 40 mm Hg, persistent elevation of ICP above 20 mm Hg, or rapidly deteriorating neurologic status.

The primary signs and symptoms of epiglottiditis are stridor and progressive difficulty in swallowing.

25/10/2011

Required surgery is recommended by the physician. It may be delayed, but is inevitable.

Urgent surgery must be performed within 24 to 48 hours.

Emergency surgery must be performed immediately.

About 85% of arterial emboli originate in the heart chambers.

Pulmonary embolism usually results from thrombi dislodged from the leg veins.

The conscious interpretation of pain occurs in the cerebral cortex.

To avoid interfering with new cell growth, the dressing on a donor skin graft site shouldn’t be disturbed.

A sequela is any abnormal condition that follows and is the result of a disease, a treatment, or an injury.

During sickle cell crisis, patient care includes bed rest, oxygen therapy, analgesics as prescribed, I.V. fluid monitoring, and thorough documentation of fluid intake and output.

A patient who has an ileal conduit should maintain a daily fluid intake of 2,000 ml.

In a closed chest drainage system, continuous bubbling in the water seal chamber or bottle indicates a leak.

Palpitation is a sensation of heart pounding or racing associated with normal emotional responses and certain heart disorders.

25/10/2011

Patients who have thalassemia minor require no treatment. Those with thalassemia major require frequent transfusions of red blood cells.

A high level of hepatitis B serum marker that persists for 3 months or more after the onset of acute hepatitis B infection suggests chronic hepatitis or carrier status.

Neurogenic bladder dysfunction is caused by disruption of nerve transmission to the bladder. It may be caused by certain spinal cord injuries, diabetes, or multiple sclerosis.

Oxygen and carbon dioxide move between the lungs and the bloodstream by diffusion.

To grade the severity of dyspnea, the following system is used: grade 1, shortness of breath on mild exertion, such as walking up steps; grade 2, shortness of breath when walking a short distance at a normal pace on level ground; grade 3, shortness of breath with mild daily activity, such as shaving; grade 4, shortness of breath when supine (orthopnea).

A patient with Crohn’s disease should consume a diet low in residue, fiber, and fat, and high in calories, proteins, and carbohydrates. The patient also should take vitamin supplements, especially vitamin K.

In the three-bottle urine collection method, the patient cleans the meatus and urinates 10 to 15 ml in the first bottle and 15 to 30 ml (midstream) in the second bottle. Then the physician performs prostatic massage, and the patient voids into the third bottle.

Findings in the three-bottle urine collection method are interpreted as follows: pus in the urine (pyuria) in the first bottle indicates anterior urethritis; bacteria in the urine in the second bottle indicate bladder infection; bacteria in the third bottle indicate prostatitis.

Signs and symptoms of aortic stenosis include a loud, rough systolic murmur over the aortic area; exertional dyspnea; fatigue; angina pectoris; arrhythmias; low blood pressure; and emboli.

Elective surgery is primarily a matter of choice. It isn’t essential to the patient’s survival, but it may improve the patient’s health, comfort, or self-esteem.

25/10/2011

Patients with adult respiratory distress syndrome can have high peak inspiratory pressures. Therefore, the nurse should monitor these patients closely for signs of spontaneous pneumothorax, such as acute deterioration in oxygenation, absence of breath sounds on the affected side, and crepitus beginning on the affected side.

Adverse reactions to cyclosporine (Sandimmune) include renal and hepatic toxicity, central nervous system changes (confusion and delirium), GI bleeding, and hypertension.

Osteoporosis is a metabolic bone disorder in which the rate of bone resorption exceeds the rate of bone formation.

The hallmark of ulcerative colitis is recurrent bloody diarrhea, which commonly contains pus and mucus and alternates with asymptomatic remissions.

Safer sexual practices include massaging, hugging, body rubbing, friendly kissing (dry), ma********ng, hand-to-genital touching, wearing a condom, and limiting the number of sexual partners.

Immunosuppressed patients who contract cytomegalovirus (CMV) are at risk for CMV pneumonia and septicemia, which can be fatal.

Urinary tract infections can cause urinary urgency and frequency, dysuria, abdominal cramps or bladder spasms, and urethral itching.

Mammography is a radiographic technique that’s used to detect breast cysts or tumors, especially those that aren’t palpable on physical examination.

To promote early detection of testicular cancer, the nurse should palpate the te**es during routine physical examinations and encourage the patient to perform monthly self-examinations during a warm shower.

25/10/2011

In stage I of anesthesia, the patient is conscious and tranquil.

Dyspnea and sharp, stabbing pain that increases with respiration are symptoms of pleurisy, which can be a complication of pneumonia or tuberculosis.

Vertigo is the major symptom of inner ear infection or disease.

Loud talking is a sign of hearing impairment.

A patient who has an upper respiratory tract infection should blow his nose with both nostrils open.

A patient who has had a cataract removed can begin most normal activities in 3 or 4 days; however, the patient shouldn’t bend and lift until a physician approves these activities.

Symptoms of corneal transplant rejection include eye irritation and decreasing visual field.

Graves’ disease (hyperthyroidism) is manifested by weight loss, nervousness, dyspnea, palpitations, heat intolerance, increased thirst, exophthalmos (bulging eyes), and goiter.

The four types of lipoprotein are chylomicrons (the lowest-density lipoproteins), very-low-density lipoproteins, low-density lipoproteins, and high-density lipoproteins. Health care professionals use cholesterol level fractionation to assess a patient’s risk of coronary artery disease.

If a patient who is taking amphotericin B (Fungizone) bladder irrigations for a fungal infection has systemic candidiasis and must receive I.V. fluconazole (Diflucan), the irrigations can be discontinued because fluconazole treats the bladder infection as well.

25/10/2011

The first symptom of pancreatitis is steady epigastric pain or left upper quadrant pain that radiates from the umbilical area or the back.

Somnambulism is the medical term for sleepwalking.

Epinephrine (Adrenalin) is a vasoconstrictor.

An untreated liver laceration or rupture can progress rapidly to hypovolemic shock.

Obstipation is extreme, intractable constipation caused by an intestinal obstruction.

The definitive test for diagnosing cancer is biopsy with cytologic examination of the specimen.

Arthrography requires injection of a contrast medium and can identify joint abnormalities.

Brompton’s cocktail is prescribed to help relieve pain in patients who have terminal cancer.

A sarcoma is a malignant tumor in connective tissue.

Aluminum hydroxide (Amphojel) neutralizes gastric acid.

Subluxation is partial dislocation or separation, with spontaneous reduction of a joint.

Barbiturates can cause confusion and delirium in an elderly patient who has an organic brain disorder.

In a patient with arthritis, physical therapy is indicated to promote optimal functioning.

Some patients who have hepatitis A may be anicteric (without jaundice) and lack symptoms, but some have headaches, jaundice, anorexia, fatigue, fever, and respiratory tract infection.

Hepatitis A is usually mild and won’t advance to a carrier state.

In the preicteric phase of all forms of hepatitis, the patient is highly contagious.

Enteric precautions are required for a patient who has hepatitis A.

Cholecystography is ineffective in a patient who has jaundice as a result of gallbladder disease. The liver cells can’t transport the contrast medium to the biliary tract.

In a patient who has diabetes insipidus, dehydration is a concern because diabetes causes polyuria.

In a patient who has a reducible hernia, the protruding mass spontaneously retracts into the abdomen.

To prevent purple glove syndrome, a nurse shouldn’t administer I.V. phenytoin (Dilantin) through a vein in the back of the hand, but should use a larger vessel.

During stage III of surgical anesthesia, unconsciousness occurs and surgery is permitted.

Types of regional anesthesia include spinal, caudal, intercostal, epidural, and brachial plexus.

The first step in managing drug overdose or drug toxicity is to establish and maintain an airway.

Respiratory paralysis occurs in stage IV of anesthesia (toxic stage).

25/10/2011

Mannitol is a hypertonic solution and an osmotic diuretic that’s used in the treatment of increased intracranial pressure.

The classic sign of an absence seizure is a vacant facial expression.

Migraine headaches cause persistent, severe pain that usually occurs in the temporal region.

A patient who is in a bladder retraining program should be given an opportunity to void every 2 hours during the day and twice at night.

In a patient with a head injury, a decrease in level of consciousness is a cardinal sign of increased intracranial pressure.

Ergotamine (Ergomar) is most effective when taken during the prodromal phase of a migraine or vascular headache.

Treatment of acute pancreatitis includes nasogastric suctioning to decompress the stomach and meperidine (Demerol) for pain.

Symptoms of hiatal hernia include a feeling of fullness in the upper abdomen or chest, heartburn, and pain similar to that of angina pectoris.

The incidence of cholelithiasis is higher in women who have had children than in any other group.

Acetaminophen (Tylenol) overdose can severely damage the liver.

The prominent clinical signs of advanced cirrhosis are ascites and jaundice.

Joshua Garing Deiparine, RN - SunLife Licensed Financial Advisor

21/09/2020

23/04/2020

16/04/2020

25/10/2011

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