Hard Times Essay

Dickens presents his analysis of the instruction for the working class in a wry way. He has made the study hall as a production line. The reason for the instruction in Coketown is to uncover the blamelessness and creative mind of little youngsters so they will develop into utilitarian robots anticipating just the drudgery of modern life. Dickens utilizes explicit strategies to put his point across of ‘bad education’ by utilizing negative perspectives. This is finished with embellishment since he needs the peruser to think equivalent to what he suspects as much it appears as though training was extraordinary and serious. In ‘Hard Times’, the instructors satisfy the extreme showing aptitudes as they simply need the ‘little vessels’ to be loaded up with realities. Dickens likewise presents a difference between two youngsters to show how distinctively every kid gets rewarded on account of their experience or their disposition towards things other than realities. Another strategy that he utilizes is making the characters stand apart through their names to represent their character. All through parts 1-3, Dickens stresses on the word ‘facts’ on the grounds that he needs to ceaselessly present and condemn the training for the working class. ‘Now, what I need is, Facts. Show these young men and young ladies only Facts. Realities alone are needed in life†¦ ‘ This is the initial sentence of the novel and straight away you have an obscure thought of the fanaticism of instructing. Additionally the word ‘fact’ is in capital letters and this means the significance of adapting only realities. The presentation of the educator has a great deal of distortion close by. Thomas Gradgrind is a white collar class, independent man. ‘A man of realities†¦ a man of realities and calculations’. Dickens has made this character an exceptionally hard and cold educator who realizes what he needs from the understudies. ‘He appeared to be a sort of gun stacked to the gag with facts†¦ ‘ Dickens utilizes military symbolism to show how the educator needs to dispose of youth creative mind. ‘He appeared to be a stirring contraption, as well, accused of a terrible mechanical substitute for the delicate youthful minds that should have been raged away’. Dickens has depicted this as a material science test on the grounds that ‘galvanising’ is the procedure named after Galvan in the incitement of creature tissue by electric flows. Be that as it may, for this situation it is the little youngsters that are being animated with genuine flows. Dickens has made the educator to be exceptionally coldblooded and unfeeling and this is to introduce his analysis on the training for the working class since he obviously can't help contradicting this idea of instructing and he needs the perusers to feel a similar path by utilizing the diverse language strategies and this is for the most part done through misrepresentation.

Marketing Journal Personal Statement Example | Topics and Well Written Essays - 750 words

Showcasing Journal - Personal Statement Example It empowers me to welcome the very much made advertising technique of Starbucks rather than simply marking it as a forte espresso retailer concentrated on getting cups of espresso the market. I presently observe that the accomplishment of Starbucks is because of its very much organized and far reaching promoting system. It gives that Starbucks experience by having great feel, great espresso, and great baristas. I would need to state that I value its journey in utilizing green espresso permitting it to help little ranchers whose fundamental employment is delivering naturally developed espresso which are devoured by Starbucks customers. I like the organization's exertion in guaranteeing that beans are green and moral as this increase the value of their items. As a separating client, I would happily pay a premium for an item which is fabricated by a socially capable business association believing that I am having a decent item as well as is likewise given the chance and connect with oth ers through my buys. I accept that showcasing has a decent effect in us. ... Showcasing isn't terrible in itself. Showcasing just reacts to our developing needs taking note of that the accomplishment of a crusade is reliant on our responsiveness. Subsequently, I accept the damage that it can perpetrate on people and society is subject to our acknowledgment of it. The predominance of corporate social obligation as a decent method of promoting a business association is useful for the general public. As we clients keep on inclining toward items which are made by socially mindful makers and specialist organizations, we additionally keep on asking organizations to offer back to the general public that they work in. The more noteworthy interest of organizations in job, instructive, and money related advancement of less advantaged social orders just shows how showcasing helps the economy and society in general. Through advertising, we get educated regarding what organizations do and how they add to feasible turn of events. For me, the most significant issue that organizations should concentrate on in this time is the current financial stoppage. Perceiving that it is influencing all countries both created and creating, organizations should try to limit the pass up aiding in their own particular manners. This should be possible by straightforwardly mediating in countries where help is required. Another is through keeping their laborers and concentrating on other cost-cutting activities. I figure it will be silly to concentrate on ecological worries right now when our concern is in financial food. I will be a lot of satisfied to see business associations planning with government and different establishments in making the financial downturn progressively tolerable for everybody in the globe. This is a pressing issue and a business association which calls

surgery on amputations :: essays research papers

Removal is a medical procedure to expel an appendage or part of an appendage. Removal can likewise occur as a mishap, which is known as a horrible removal. Who is a contender for the method? Removal is regularly utilized for one of four conditions:  · gangrene, which is an extreme appendage contamination with death of tissue  · absence of enough blood course through the corridors that gracefully blood and oxygen to the influenced appendage  · serious injury or injury of an appendage  · malignant growth or a tumor including an appendage Removal has genuine enthusiastic and physical impacts. Consequently, appendage evacuation is generally exhorted just when different alternatives are impractical or have minimal possibility of progress. How is the system performed? There are a wide range of approaches to play out a removal. A solitary finger or toe might be evacuated, or a whole arm or leg. The specialist will for the most part attempt to evacuate as meager of the appendage varying to treat the condition. A removal is done in a working room. By and large, general sedation is utilized to take care of the individual totally with meds. Provincial sedation may likewise be utilized. For this situation, an individual is alert yet has no vibe of agony. The zone of skin where the cut will be made is cleaned. The specialist at that point slices into and through the skin. Much of the time, the specialist will evacuate the appendage or part of the appendage at a point where there is a joint. For example, the whole leg beneath the knee might be expelled. The knee territory is picked mostly in light of the fact that this is the place the shinbone, or tibia, meets the thighbone, or femur. Expelling the part or entire appendage at a joint forestalls the need to break one of the bones. After the part or entire appendage is evacuated, the skin is shut with stitches. A swathe or dressing is then put over it. What happens directly after the strategy? The individual is taken to a medical procedure recuperation room while the person in question awakens from the medical procedure. Torment medicine is given if necessary. Anti-infection agents and different drugs may likewise be given. At the point when the individual is alert and their indispensable signs are inside ordinary cutoff points, the person in question is typically reclaimed to a bed in the careful inpatient unit. Much of the time, the individual should remain in the medical clinic for at any rate 1 or 2 additional days.

Essay Topics For a Hero of Our Time

Essay Topics For a Hero of Our TimeToday, essays are a part of school curriculums that are required for a hero of our time topic. An essay is a large document and must contain detailed information that can be very technical in nature. It will require the assistance of an expert in the field to write an essay that is suitable for the hero of our time topic. An essay needs to include the things that the hero must do to reach the goal, goals that the hero must pursue and the methods that the hero has to use in achieving the goals.The essay should be interesting and in-depth with a lot of information. It can be a long term project or it can be a short term project, it can even be as short as ten minutes. It must include the basic elements that are very important for a hero of our time essay topics. The essay should discuss goals, and how the hero will reach those goals. It should include the technologies that are available today that will make the world a better place.The essay should co ver different aspects that the hero will use to achieve the goals, such as the hero's skills, how the hero will cope up with the situations, the technologies that will enable the hero to solve problems, how the hero will interact with other people in the society, the physical environment where the hero will have to go, what type of relationships will the hero have with the people around him, etc. The essay also should discuss the heroes in history.A key part of the essay should be to state the important point about the hero. This is important to show the readers how the hero is an inspiration to other people. It is important to highlight the problems the hero will face.The hero's characteristics such as ambition, courage, determination, morality, love for his family, etc. must also be highlighted in the essay to make the reader aware of the hero's character.It is not enough to give details about the hero but the readers must also be able to relate to the hero. They must see how the hero will face hardships and succeed.So many people will be expecting the hero to become the hero of our time. They will be waiting for the hero to take control of all the situations and become the true leader.

Unemployment in the US Essay - 3827 Words

Unemployment in the US Why I Chose These Indicators I chose these indicators because all are something that ordinary people deal with every day. All of us have control over our own spending and how far into debt we go. If we are not making the salary we want then we are free to look for a new job or an additional job. There is also the possibility of going back to school to raise your educational level in order to get a better job. This may, of course, put us deeper into debt. We are in debt as a country, and as individuals, but with the economy as strong as it is people have no qualms about going deeper into debt. There are increases in delinquency rates on consumer loans, record numbers of bankruptcy filings, and an†¦show more content†¦In addition, good credit can enhance young people=s chances of getting good jobs. Borrowers who pay on time and in full may be able to convince potential employers that they are responsible and can manage their own finances (Shafer 1997). However, missed payments on bank credit card debt reached a new high of 2.13% of outstanding credit card debt in the 4th quarter of 1997. The American Bankers Association reported a decline in the percentage of accounts more than 30 days overdue during the quarter, although there was a rise in the percentage of loaned dollars delinquent. Consumer debt represents about 20.6% of disposable income (Kingson-Bloom 1998). The debt-service ratio can be used as an accurate predictor of future consumer spending growth or a source for explaining aggregate consumer spending. Furthermore, the ratio of debt service to income, if analyzed together with other economic indicators, will reveal future income growth. This ratio analysis is beneficial to financial service institutions as through this, they can determine debt payment capacities of clients (Murphy 1998). On the whole the Generation Xers have a gloom and doom attitude towards money, and maybe with good reason. Social security will probably be out of money by the time they reach retirement age and most feel that they will never be out of debt, soShow MoreRelatedUnemployment On The Us Economy Essay963 Words   |  4 PagesName: Instructor: Subject: Date: Unemployment in US economy The unemployment turnover view has a strong base on the contemporary thinking about unemployment in the entire United States. Joblessness or unemployment takes place when an individual searches for another new job and devotes most of time searching for another job. Moreover, unemployment comes into being if an individual goes in search of a new employment after being out of labor force for a long time. The individuals in search of employmentRead MoreRising Us Unemployment and the Canadian Dollar1609 Words   |  7 PagesIs there a relationship between rising US unemployment and the rise of the Canadian dollar? Canada’s financial stability depends on the health of America’s economy, as international trade accounts for 45% of Canada’s Gross Domestic Product (GDP) and 79% of exports are to the United States. Canadian and American unemployment rates are positively correlated for that reason, as exemplified in early 2009. Canada’s unemployment rate quickly steepened as the United States’ rate gradually increased toRead MoreThe Factors Affecting Unemployment : A Study Of Us Economy Essay1679 Words   |  7 PagesEffecting Unemployment: A Study of US Economy in 1985-2014 Introduction In the past few years, the US unemployment rate dynamically fluctuated: more than five millions jobs were cut in November 2008 due to economic crisis, but recently, the unemployment rate dropped by 0.3 point after eight years. Figure 1 revealed how the US unemployment rate fluctuated over the last three decades. On the other hand, one of the major signs of an economy’s health and the testimony of economic growth, unemployment rateRead MoreEssay Causes Associated with the Unemployment Problems in the US807 Words   |  4 Pages The unemployment rate is getting out of control. The bad part is no one is doing anything about it! The country is going through rough times as it is the last thing that these people need is losing or not having a job. It’s pretty bad when people who graduated college and got their diploma can’t find or lose their jobs. â€Å"Ylan Q. Mui and Amrita Jayakumar, September 06, 2013† Nearly 90 million people are now considered out of the labor force, up 1.7 million from August 2012. The unemployment is gettingRead MoreRelationship Between Rising Us Unemployment and the Canadian Dollar1632 Words   |  7 PagesIs there a relationship between rising US unemployment and the rise of the Canadian dollar? Canada’s financial stability depends on the health of America’s economy, as international trade accounts for 45% of Canada’s Gross Domestic Product (GDP) and 79% of exports are to the United States. Canadian and American unemployment rates are positively correlated for that reason, as exemplified in early 2009. Canada’s unemployment rate quickly steepened as the United States’ rate gradually increased toRead MoreThe Effects Of Unemployment On The United States942 Words   |  4 PagesStates in the aspect of unemployment, but the US currently has a very low rate of 4.8% (List of Countries). The country that is currently doing the best is Qatar with a rate of 0.4%. This could be for many reasons such as population (List of Countries). One thing that I have found is that there is a direct correlation to standard of living and unemployment rate. Many of the poorer countries in the world have a much higher unemployment, such as Zimbabwe with an unemploy ment rate of 95%, which is extremelyRead MoreThe Decline in the Rate of Unemployment Is Due to Adverse Factors in the United States Economy1360 Words   |  6 PagesStreet Journal dated September 6th 2013, an article titled, ‘Unemployment Drops for the Wrong Reasons’ describes how unemployment has dropped in the United States based on the latest Bureau of Labor Statistics population survey. According to Izzo (2013), there was a drop in unemployment rate to 7.3% by 0.1% in August 2013. This was coupled with a drop of broader measure of unemployment by 0.3% to 13.7%. On closer scrutiny, the drop in unemployment came from wrong reasons (Izzo, 2013). The arguments inRead MoreThe Labor Market1090 Words   |  5 Pagesmarket in the US, EU, Japan and China Unemployment Rates As per August 2016 the unemployment rate was reported to be at 4.9% percent by the Bureau of Labor Statistics and this is the first time the unemployment rate fell below 5% since 2008. However, despite the fall in unemployment rates it is worth considering that only a few of the adults are working. Only 62.7% of the adult Americans are working and this has been so since the late 1970s.n On the other hand, the unemployment rate in the EU wasRead MorePredictive Sales Report1420 Words   |  6 Pagespaper is to use the unemployment rate data in the following excel files to estimate the total inventory that the company will keep at the store. The Excel files are: Local_Area_Unemployment_Statistics_for_Texas.xls BUS_308_Unemployement_Data_Final_Project2.xlsx The data in the Excel files contain the US unemployment rate starting from 1948 to 2013. By calculating the Mean of the yearly data from 1948 to 2013, the report has been able to determine yearly US unemployment rates between 1948Read MoreThe Problem of Structural Employment1274 Words   |  5 Pagesrecovery in the US in 2011 has been characterized as a jobless recovery and the primary factor contributing to this is the structural unemployment that is present in the country. The figures best speak for themselves both as to the existence of structural unemployment and the importance this is getting in the United States in socio-economic terms. The data published by the US Bureau of Labor Statistic in January 2012, reflecting the employment in November 2011, showed that the unemployment rate fell to

The Meaning of A White Heron Essay - 790 Words

The Meaning of A White Heron Through life experiences we learn that some things in life are more important than money. By using the Archetypal Cycle of Human experience I will be able to explain the importance of each stage in the story A white Heron by Sarah Orne Jewett. The story A white Heron is about a nine-year-old girl named Sylvia. The author starts the cycle/framework by implying through the characters age that Sylvia has a certain innocence that only a young child early in life can possess. This is the first stage in the cycle of human experiences, the innocence stage. Sylvia had moved from the city to the country in order to live with her grandmother when she was eight years old. Sylvia used to live in a†¦show more content†¦This sparked an interest in the man, and he talked about his bird collection and that he was out there to get a white heron. The man asked if Sylvia had seen a white heron, but she did not reply. The man said that he would pay ten dollars to anyone who could show him the location of the white herons nest. Sylvia thought of all the treasures that she could buy with that wealth. This paragraph contains the third step in the cycle because of the range of emotions that she experienced and the choices she made. The third step is all about experiences, trial an error and temptations. Sylvia was no longer thinking/acting with a good heart; she had been taken control of by greed. The next day the man goes out in search for the white heron and Sylvia accompanied him. While they were looking for the heron the man gives Sylvia a jack-knife. Sylvia starts to like the man because he is kind and sympathetic. Sylvia could not understand why he killed the birds that he liked so much. Sylvia has now started to develop certain feelings for the man. The man stayed the night again at the house and all that Sylvia could think about was climbing the pine tree to find the white heron so she could gain the mans approval of her. This paragraph is the fourth step in the c ycle because of the internal emotions that she had created. The fourth step is death, psychologically or internally (what you believed about your standards). The author has Sylvia develop feeling for the manShow MoreRelatedThe White Heron By Sarah Jewett1496 Words   |  6 PagesIn the short story â€Å"the White Heron† (1886), Sarah Jewett portrays a young little girl, Sylvia, bear the temptation of money and affection from the young man with mental struggle, and resolutely determined to protect the fairy of nature – a white heron. Through describing Sylvia’s authentic emotions and using of vivid theme colors and exquisite word choice, Jewett delivers the story like showing a lifelike 19-century country-life drama in front of the readers. The beauty of the story is about authenticallyRead More Femininity against Masculinity in A White Heron Essay1699 Words   |  7 Pagesthe 1886 collection A White Heron and Other Stories, the short story A White Heron has become the most favorite and often anthologized of Sarah Orne Jewett. Like most of this regionalist writers works, A White Heron was inspired by the people and landscapes in rural New England, where, as a little girl, she often accompanied her doctor father on his visiting patients. The story is about a nine-year-old girl who falls in love with a bird hunter but does not tell him the white herons place becauseRead MoreInnocence: The White Heron by Sarah Orne Jewett Essay example1189 Words   |  5 PagesExperience, which destroys innocence, also leads one back to it (Baldwin). All experiences spring out of innocence. Sarah Orne Jewett expresses this through the story â€Å"The White Heron.† She uses the story to show how easily innocence can be influenced. For Jewett, it seems to have been a personal myth that expressed her own experience and the experience of other women in the nineteenth century who had similar gifts, aspirations, and choices (Griffith). Her personal experiences include her livingRead MoreMy Psychoanalytic Views of Two Short Stories1454 Words   |  6 PagesPsychoanalysis In order to understand the true meaning of some stories we must understand the what psychoanalysis is. Psychoanalysis was thought up by a man know as Sigmund Freud also know as the Founding Father of Psychoanalysis. Being a major cocaine addict, his theories were often ridiculed and were thought to be perceived as hallucinations as a result of the cocaine use. Freud’s theories however sparked an all new era of Psychology. Although Freud’s theories seemed very radical, when put intoRead MoreCritical Analysis of White Heron Essay1447 Words   |  6 PagesCritical Analysis of White Heron The White Heron is a spiritual story portraying great refinement and concerns with higher things in life. A 9 year old girl once isolated in the city found fulfillment in a farm surrounded by nature. Too those less unfortunate, money charm and other attractions can be intoxicated; Sylvia did not bite. She could have helped her situation and found a way to wealth but in the end she realized that it wouldn’t help her to be the person she wanted to be. This paperRead MoreColor Analysis And Research Of Artwork Abroad1227 Words   |  5 PagesResearch of Artwork Abroad The painting I chose to analyze was Azalea Garden by Patrick Heron. Heron was born in 1920 in Leeds (near West Yorkshire). His beginnings in art started at a young age creating textiles with his father and then started being influenced by Post- Impressionist artist Paul Cezanne whose works he saw in London’s National Gallery. Post- Impressionists were focused on emotions and the deeper meanings in life and how it translates to the canvas. In addition to, Cezanne he was deeplyRead MoreIn A White Heron , the author, Sarah Orne Jewett, describes a young girl who interacts with a900 Words   |  4 PagesIn A White Heron , the author, Sarah Orne Jewett, describes a young girl who interacts with a number of elements that cause her to discover who she is and what she stands for. Sylvia, being only nine years old and coming from a large family from the demanding city life , is moved to her grandmother’s remote farm where she finds herself to be comfortably isolated from the rest of the world. This, in fact, suits her lack of social ability, and so she finds herself becoming one with nature: both theRead MoreAnalysis Of The Narrative The Of The Farm 915 Words   |  4 PagesSylvia is the protagonist of the narrative. From her name alone one can gather that she is a very rural girl, her name meaning woodsy. She is a young, nine year old girl, previously from a busy manufacturing town who moves in with her grandmother to a calm, peaceful farm. Sylvia has a true bond with nature and â€Å"it seemed as if she never had been alive at all before she came to live at the farm† (Jewett 527). Her youth and love for nature make Sylvia such an innocent girl who does not have to experienceRead MoreThe And Its Effects On Society1072 Words   |  5 Pagesbeen countless individuals who were willing to use their own voice to empower and support causes that they felt were just. Artists that were able to apply their talents to spark change and cause an impact , include, but are not limited to, Gil Scott-Heron, Bob Marley, and Killer Mike. Through their music, these artists were able to stand for those whose legs were too frail to hold their stance. 2015 has been the year with some of the most impactful massacres and scandals. With constant murders, attacksRead MoreAllen Ginsbergs Howl Summary1260 Words   |  6 PagesIf a man does not keep pace with his companions, perhaps it is because he hears a different drummer.† (Thoreau pg. 930) To Thoreau and many other Transcendentalists, being your own person or individualism was of utmost importance. Thoreau’s true meaning behind this statement is if someone acts differently than you or in a strange manner, they may have different values and norms in their life than your own. Those people are simply reacting in a way that their values deem as morally right. Thoreau

Case Study Report Co-Morbidities

Question: Discuss about theCase Study Report for Co-Morbidities. Answer: Introduction: There is ample evidence available for the link between type 2 diabetes, obesity, hypertension, renal disease and comorbid conditions of these disease conditions are well researched. People with obesity are 2.3 billion and type 2 diabetes are 365 million (Kawano and Arora, 2009). Particularly, in the older age people, there is the occurrence of chronic comorbid conditions of the above mentioned disease conditions rather than the occurrence of the individual disease. These comorbid diseases are more serious health issues and it is difficult to control these conditions. In this report, a patient with the occurrence of comorbid conditions of type 2 diabetes, overweight, hypertension, renal dysfunction, retinopathy and oedema is presented. The question here is how would a person develops different disease conditions? Is there any connecting link among these comorbid disease conditions? Pathophysiology of each of these conditions is being described and different pathways and biomarkers con necting these disease conditions are being mentioned. Also evidence for the occurrence of these comorbid conditions is described. Discussion: Type 2 Diabetes: This patient is diagnosed with type 2 diabetes. Type 2 diabetes mellitus is the most common form of diabetes i.e. increases in sugar level in the body. Fasting glucose level should be below 140 mg/dl and random blood glucose level should be below 180 mg/dl. Type 2 diabetes occurs either due to the resistance to the action of insulin or insufficient secretion of insulin from the beta cells of the islets of Langerhans. This insulin resistance, mainly occurs in the liver, skeletal muscle and adipose tissue. Binding of insulin to its receptor results in the tissue specific actions such as inhibition of glucose production by liver, promotion of glucose uptake by skeletal muscle and inhibition of lipolysis in adipose tissue. In case of insulin resistance, there is the disturbance in the suppression of glucose production by liver, clearance of glucose by the liver and promotion of lipolysis by adipose tissue (Olefsky and Glass, 2010). In type 2 diabetes, beta cells become dysfunctional and there is no control of hyperglycaemia. Free fatty acids also induces, insulin resistance specifically in muscle by disturbing insulin signalling pathway. One of the intermediate products of triglyceride metabolism, diacylglycerol activates protein kinase C, which phosphorylate serine and threonine residues located at the insulin receptor and insulin receptor substrate, which results in the insulin resistance. Incretins are metabolic hormones, which stimulate insulin release and inhibit glucagon release. Hence, deficiency of incretins leads to the type 2 diabetes. Glucagon is a peptide hormone secreted by the alpha cells of the pancreas and it increases the glucose level by gluconeogenesis (glucose synthesis by liver and kidney) and glycogenolysis (breakdown of glycogen in glucose). Type 2 diabetes mellitus affects different body organs and their respective systems. It procures dyslipidaemia and hypertension. In case of dyslipidaemia, there is the increase in cholesterol (~60 %), low density lipoprotein (LDL)-cholesterol (~41 %) and triglycerides (~51%) of the total cases. In another study, it has been quoted that about 65 % people have increased triglyceride and decreased high density lipoprotein (HDL) (Mayer-Davis et al., 2009; Tryggestad and Willi, 2015). Type 2 Diabetes and Renal Complication Comorbidity: With this mentioned patient, there is the renal complication due to the type 2 diabetes. In the previous studies, it is evident that around 18-72 % type 2 diabetes patients developed nephropathy in the form of microalbuminuria and abnormal albumin to creatinine ratio (Tryggestad and Willi, 2015). Elevated levels of protein and glucose in the urine reflect proteinuria and diabetes, respectively and both these conditions leads to the renal failure. This proteinuria is associated with obesity and diabetes. In these type 2 diabetes patients there is the increase in the renal plasma flow and 25-50 % increase in the glomerular filtration rate. Increased reabsorption of the glucose and sodium in the proximal tubule is responsible for the increased glomerular filtration rate (Helal et al., 2012; Vallon, and Thomson, 2012). Hyperglycaemia also begins formation of advanced glycation end products (AGEs), increased expression of AGE receptor (RAGE), activation of polyol, hexosamine pathways and activation of protein kinase C (pkc) pathway. Oxidative stress in the mitochondria leads to the production of inflammatory cytokines like Interleukin-1 (IL-1), IL-6 and Tumor necrosis factor alpha (TNF-) and profibrotic growth factors like Transforming growth factor (TGF) and Vascular endothelial growth factor (VEGF). All these factors lead to the renal injury (Navarro-Gonzlez et al., 2011; Muskiet et al., 2014). This complex health condition affects patient and his family very seriously. Three can be possibility that patient can feel social withdrawal. That can be due to the frequent urination due to the renal complication in the patient. Also, patient loses his freedom on the food to be consumed due to diabetes. This also makes patient family low, however patient family should try to uplift patient moral. Overweight Condition: It is observed that mentioned patient is overweight. In overweight patient body mass index (BMI) should be between 25-30. Overweight condition results due to the imbalance in the energy intake and expenditure. There is the increase in the adipose tissue in the overweight people. There is the increase in the level of leptin, TNF-alpha, IL-6, angiotensin, plasminogen activator inhibitor and resistin in the overweight people. On the other hand, there is a decrease level of adiponectin in overweight people. Leptin is produced by the adipose tissue and considered as the satiety factor which gives signals of excess fat reserve in the body and bring about appetite control. However, most of the overweight people are leptin resistant. Along with the function as energy reservoir, adipose tissue also secrets adipokines like cytokines, hormones, growth factors, acute phase proteins, prostaglandins, glucocorticoids and sex steroids. In overweight people macrophages are permeated into the adipose tissue and consequently shift from macrophage M2 to macrophage M1 occurs. These hypertrophied adipose tissue along with M1 secrets proinflammatory cytokines like TNF-alpha and IL-6 (Maury and Brichard , 2010 ; Schmidt et al., 2015). Renin-angiotensin system in adipose tissue is an important connects for the association of obesity and hypertension. Angiotensin II plays a role in adipose tissue growth and differentiation (Mehri et al., 2010; Kalupahana and Moustaid-Moussa, 2012). Adiponectin is a collagen-like protein secreted by adipose tissues. Adiponectin induces energy expenditure. As there is less secretion of adiponectin in overweight people, energy expenditure is less. In mentioned patient there is the comorbid condition of overweight and type 2 diabetes. Occurrence of type 2 diabetes is more in the overweight people as compared to the type 1 diabetes. It is found that around 30 % overweight people are susceptible to the development of type 2 diabetes (Wang et al., 2015). Due to increase in the free fatty acids in the overweight patients, there is the decompensation of insulin producing beta cells and insulin resistance. These fatty acids get oxidised and produces reactive oxygen species, which activates IKK, NFk, TNF and JNK pathway. This JNK phosphorylate insulin receptor and produces decreased insulin signalling and insulin resistance. Overweight and Hypertension Comorbid Condition: Along with the overweight condition and type 2 diabetes, there is the elevated blood pressure in the mentioned patient. Around 25 % overweight people developed hypertension as compared to the normal people (Luo et al., 2013). Overweight people are associated with increased blood flow and hypertension. Increased leptin in the overweight people also produces hypertension through sympathetic activation. There is the increased renin activity in the overweight people, which activates renin-angiotensin system and results in the hypertension through sympathetic activation. Also there is the increased secretion of insulin in the overweight people, this insulin also stimulate renal reabsorption of sodium and leads to the hypertension (Richard., 2009). In overweight people renal dysfunction is more as compared to the normal people (Franchini et al., 2015). Increased level of the leptin in the obesity is responsible for the proteinuria. In overweight people, adipocytes exert inflammatory and en docrine function and produces vascular damage in the kidneys. Hence, there is the increased hyperfiltration and glomerular filtration rate (GFR), albumin excretion rate (AER) and microalbuminuria (Sanad and Gharib, 2011). In overweight people adipose tissue releases leptin, this stimulates aldosterone release from adrenal gland which is responsible for sodium retention and hypertension. Due to overweight and hypertension comorbid condition, patient cannot do more physical activity and cannot tolerate more stress. Patient may feel isolated in the social life. Due to this inactive state of patient, one of the family members should always be with the patient to take care of him. In this case family members cannot concentrate on their personal and professional work. This affects social and financial status of the family. Diabetic Retinopathy: Diabetic retinopathy, which is caused due to the increased retinal vascular permeability resulted in the vascular proliferation and vision loss. Diabetic retinopathy occurs in around 40-60 % patients with non-existing retinopathy and progression of retinopathy in around 30 % patients with existing retinopathy (Mayer-Davis et al., 2012). Hypertension: Normal blood pressure range is 100-140 mmHg systolic and 60-90 mmHg diastolic. Hypertension is considered if blood pressure is consistently above 140 mmHg systolic and 90 mmHg diastolic (Mancia et al., 2013). In hypertension, there is the increased resistance to blood flow i.e. increased peripheral resistance due to the narrowing of the small arteries and arterioles and also due to the less number of capillaries. Reduced peripheral venous compliance also plays role in hypertension, which causes venous return, elevate cardiac preload and finally results in the diastolic dysfunction. Main mechanisms involved in the hypertension are dysfunctional renin-angiotensin system, atypical sympathetic nervous system, insulin resistance, endothelial dysfunction and vascular inflammation. Renin stimulates adrenal gland to secret more aldosterone through reninangiotensinaldosterone system (RAAS), which induces sodium retention, which is responsible for hypertension. The sympathetic nervous system a lso acts through the same pathway by activating the RAAS system in the kidney. Excessive oxidative stress and vascular inflammation are responsible for the hypertension in the endothelial dysfunction. There is the increased activity of oxidative stress marker i.e. nicotinamide adenine dinucleotide phosphate (NADPH) oxidase in the hypertension (Dharmashankar and Widlansky, 2013). There is the increased production of inflammatory cytokines like Interleukin-17 (IL-17), IL-1, IL-6, IL-8 and TNF in the hypertensive patients. (Gooch and Sharma, 2013). Hypertension has been reported to be in the range of 30-65 % patients with type 2 diabetes (Mayer-Davis et al., 2009; Ruhayel et al., 2010). Oedema: Ankle swelling is associated with loss of protein in the urine, which indicates renal failure, which is again due to the diabetes, hypertension and obesity. Due to the loss of protein in the urine, there is lower protein level in the blood of the patient, which leads to the ankle swelling. Due to hypoalbuminea there is the low capillary colloid oncotic pressure, which leads to the transfer of fluid from the vascular system to the interstitial fluid compartment and decreased circulatory volume. As a result, there is the compensatory renal sodium and water reabsorption, which leads to the development of oedema. Also kidney failure leads to the accumulation of fluid in the ankle region, which leads to the ankle swelling (Ellis, 2016). Metformin: Metformin is the first line treatment for the type 2 diabetes. Mentioned patient is consuming 500 mg BD metformin. Main action of metformin is through AMP-activated protein kinase (AMPK) activation, which prevents CREBCBPCRTC2 complex formation, resulting in the inhibition of gene transcription for gluconeogenesis. Along with hepatic glucose synthesis, metformin also enhances peripheral glucose uptake through the phosphorylation of Glucose transporter type 4 (GLUT4) (Pryor and Cabreiro, 2015). In addition to the type 2 diabetes, metformin is proved to be effective in the albuminuria in patients with diabetes mellitus which is one of the complications of the mentioned patient (Nasri and Rafieian-Kopaei, 2014). In previous studies, it has been shown that metformin is effective in weight reduction, however results from these studies were inconsistent (Park et al., 2009). Conclusion: This patient has type 2 diabetes since last 15 years, however it has not been taken care properly. Due to sustained high level of glucose this leads to the different conditions like hypertension, renal failure, blurred vision and oedema. Since, this patient worked as an accountant there is not much physical activity and moreover, there is less control over the diet and sedentary lifestyle, this patient became overweight over the time period. This overweight condition and along with the type 2 diabetes leads to different cardiovascular complications, nephropathy and retinopathy. Due to all these diseases, patient health condition becomes very complex and in this condition patient care should be done using an interdisciplinary team of respective departments. Along with medication, care should be provided to the patient in terms of diet, lifestyle changes and exercise. Because these conditions can be controlled by implementing all these strategies. References: Dharmashankar, K., Widlansky, M.E. (2010). Vascular Endothelial Function and Hypertension: Insights and Directions. Current Hypertension Reports, 12(6), 448455. Ellis, D. (2016). Pathophysiology, evaluation, and management of edema in childhood nephrotic syndrome. Frontiers in Pediatrics, 3, 111. Franchini, S., Savino, A., Marcovecchio, M.L., Tumini, S., Chiarelli, F., Mohn, A. (2015). The effect of obesity and type 1 diabetes on renal function in children and adolescents. Pediatric Diabetes, 16(6), 427-33. Gooch, J.L., Sharma, A.C. (2014). Targeting the immune system to treat hypertension: where are we? Current Opinion in Nephrology and Hypertension, 23(5), 473-9. Helal, I., Fick-Brosnahan, G.M., Reed-Gitomer, B., Schrier, R.W. (2012). Glomerular hyperfiltration: definitions, mechanisms and clinical implications. Nature Reviews Nephrology, 8, 293300. Kalupahana, N.S., Moustaid-Moussa, N. (2012). The renin-angiotensin system: a link between obesity, inflammation and insulin resistance. Obesity Reviews, 13(2), 136-49. Kawano, J., Arora, R. (2009). The Role of Adiponectin in Obesity, Diabetes, and Cardiovascular Disease. Journal of the CardioMetabolic Syndrome, 4, 4449. Luo, W., Guo, Z., Hu, X., Zhou, Z., Zhang, L., Liu, J. (2013). A prospective study on association between 2 years change of waist circumference and incident hypertension in Han Chinese. International Journal of Cardiology, 167(6), 2781-5. Mancia, G. (2013). 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal, 34(28), 2159219. Maury, E., Brichard, S.M. (2010). Adipokine dysregulation, adipose tissue inflammation and metabolic syndrome. Molecular and Cellular Endocrinology , 314, 116. Mayer-Davis, E.J., Ma, B., Lawson, A, et al. (2009). Cardiovascular disease risk factors in youth with type 1 and type 2 diabetes: implications of a factor analysis of clustering. Metabolic syndrome and related disorders, 7(2), 8995. Mayer-Davis, E.J., Davis, C., Saadine, J., et al. (2012). Diabetic retinopathy in the SEARCH for Diabetes in Youth Cohort: a pilot study. Diabetic Medicine, 29(9), 114852. Mehri, S., Koubaa, N., Hammami, S., Mahjoub, S., Chaaba, R., Nakbi, A., et al. (2010). Genotypic interactions of renin-angiotensin system genes with diabetes type 2 in a Tunisian population. Life Sciences, 87, 4954. Muskiet, M.H.A. etal. (2014). The gutrenal axis: do incretin-based agents confer renoprotection in diabetes? Nature Reviews Nephrology, 10, 88103. Nasri, H., Rafieian-Kopaei, M. (2014). Metformin: Current knowledge. Journal of Research in Medical Sciences, 19(7), 658664. Navarro-Gonzlez, J.F., Mora-Fernndez, C., Muros de Fuentes, M., Garca-Prez, J. (2011). Inflammatory molecules and pathways in the pathogenesis of diabetic nephropathy. Nature Reviews Nephrology, 7, 327340. Olefsky, J.M., Glass, C.K. (2010). Macrophages, inflammation, and insulin resistance. Annual Review of Physiology, 72, 219246. Park, M.H. (2009). Metformin for obesity in children and adolescents: A systematic review. Diabetes Care, 32(9), 1743-1745. Pryor, R., Cabreiro, F. (2015). Repurposing metformin: an old drug with new tricks in its binding pockets. Biochemical Journal, 471, 307322. Richard, N. Re. (2009). Obesity-related hypertension. Ochsner Journal, 9(3), 133136. Ruhayel, S.D, James, R.A., Ehtisham, S., Cameron, F.J., Werther, G.A., Sabin, M.A. (2010). An observational study of type 2 diabetes within a large Australian tertiary hospital pediatric diabetes service. Pediatric Diabetes, 11(8), 54451. Sanad, M., Gharib, A. (2011). Evaluation of microalbuminuria in obese children and its relation to metabolic syndrome. Pediatric Nephrology , 26, 21932199. Schmidt, F.M., Weschenfelder, J., Sander, C., Minkwitz, J. (2015). Inflammatory cytokines in general and central obesity and modulating effects of physical activity. Plos One, DOI:10.1371/journal.pone.0121971. Tryggestad, J.B., Willi, S. M. (2015). Complications and comorbidities of T2DM in adolescents: findings from the TODAY clinical trial. Journal of Diabetes and its Complications, 29(2), 307312. Vallon, V., Thomson, S.C. (2012). Renal function in diabetic disease models: the tubular system inthe pathophysiology of the diabetic kidney. Annual Review of Physiology, 74, 351375. Wang, C., Li, J., Xue, H., Li, Y., Huang, J., Mai, J., et al. (2015). Type 2 diabetes mellitus incidence in Chinese: contributions of overweight and obesity. Diabetes Research and Clinical Practice, 107(3), 424-32.