#Acid reflex disease

[ind-site11]

About the causes of bad breath and its treatment - 8 proven methods

[themanwhowouldbefruit]

going to the dentist tomorrow. my dentist is such an asshole and i think he hates the entire planet and i think when i talk he is exploding me in his mind. however he fills teeth like a nascar pit crew changing tires i swear to god he did like 7 fillings in an hour once

[thecreaturecodex]

Xiangliu

Image © deviantArt user YunaXD, accessed at her gallery here

[Sponsored by @coldbloodassassin. The xiangliu appears in Guideways through Mountains and Seas as an individual, Xiangliu, who is the minister of the malevolent water god Gonggong. I did consider making it a native or even extraplanar outsider because of that, but ended up going with aberration to stress its connection to nagas. Not that nagas are very aberrant as far as aberrations go...]

Xiangliu CR 14 NE Aberration This creature is an oversized serpent with nine heads and slime coating its scales. Its heads are disturbingly humanoid, but still bear fangs and forked tongues.

Xianglius are sadistic water serpents that delight in spreading disease and stagnant water. They are native to swampy lands, and fight violently against any attempt to drain such swamps or make them suitable for cultivation. Nearby fields are likely to be subject to their attacks, including flooded crops, summoned clouds of malarial mosquitoes and fouling wells and springs. Xianglius sometimes find allegiances with evil druids, daemons of pestilence and famine, or even gods of water who are hostile to civilization.

A xiangliu rarely hesitates to fight. Their bites are not fully venomous, but carry a foul slime that renders creatures bitten weak and queasy. They can spit jets of water with lethal force, and often split their attacks, biting creatures up close while barraging enemies that are more distant. Fighting a xiangliu is often quite frustrating, as the monsters create moats of mud and water to slow anyone approaching on foot, and can manipulate water to isolate and capsize boats. Wise adventurers approach a xiangliu’s lair from the air.

Despite their nine heads, a xiangliu has only one personality; peevish, cruel and sadistic. They are notorious gluttons; one legend is that they have nine heads in order to eat nine different meals at the same time. A xiangliu grows to about twenty feet long. Their lifespans are measured in centuries.

Xiangliu              CR 14 XP 38,400 NE Large aberration (aquatic) Init +6; Senses all around vision,darkvision 60 ft., Perception +22, scent

Defense AC 29, touch 15, flat-footed 23 (-1 size, +6 Dex, +14 natural) hp 190 (20d8+100) Fort +13, Ref +15, Will +16 DR 10/magic; Immune acid, disease, poison, sickness and nausea effects; SR 25

Offense Speed 30 ft., swim 40 ft. Melee 9 bites +20 (1d6+4 plus sickening slime) Ranged 9 water jets +20 (1d8 bludgeoning plus push) Space 10 ft.; Reach 10 ft. Special Attacks combined arms, mud wave, push (5 ft.) Spell-like Abilities CL 15th, concentration +20 (+24 casting defensively) At will—contagion (DC 18), putrefy food and drink 3/day—control water, insect plague 1/day—plague storm (DC 21), transmute rock to mud

Statistics Str 19, Dex 23, Con 20, Int 18, Wis 19, Cha 20 Base Atk +15; CMB +20; CMD 36 (cannot be tripped) Feats Blind Fight,Combat Casting, Combat Reflexes (B),Deadly Aim, Great Fortitude, Improved Critical (bite), Lightning Reflexes, Point Blank Shot, Precise Shot, Skill Focus (Stealth), Weapon Finesse Skills Acrobatics +22, Climb +20, Heal +18, Intimidate +21, Knowledge (arcana, geography) +18, Knowledge (nature) +20, Perception +22, Sense Motive +17, Spellcraft +20, Stealth +24, Swim +28; Racial Modifiers +2 Perception Languages Aquan, Common, Draconic SQ amphibious, improved swamp stride, multiheaded reflexes

Ecology Environment any swamps and aquatic Organization solitary Treasure standard

Special Abilities Combined Arms (Ex) When using a full attack action, a xiangliu can divide its nine attacks up between bites and water jets. Improved Swamp Stride (Su) A xiangliu can move without penalty through natural or magically manipulated mud, water, or vegetation native to swamp environments. Insect Plague (Sp) When a xiangliu uses its insect plague spell-like ability, it summons mosquito swarms instead of wasp swarms. Mud Wave (Su) As a standard action, a xiangliu can create a burst of mud and water in a twenty foot radius centered on itself. All creatures in the area take 14d6 points of bludgeoning damage and are knocked prone. A DC 25 Reflex save halves the damage and negates the prone effect. The area affected by the mud wave becomes difficult terrain for the next minute. A xiangliu can use this ability three times per day, but must wait 1d4 rounds between uses. The save DC is Charisma based. Multiheaded Reflexes (Ex) A xiangliu gains Combat Reflexes as a bonus feat. It can make as many attacks of opportunity in a round as it has heads. Sickening Slime (Ex) A creature bitten by a xiangliu must succeed a DC 25 Fortitude save or be sickened for 1 round. Failing additional saves increases the duration of the sickened effect by 1 round per save failed. The save DC is Constitution based. Water Jet (Su) A xiangliu can spit water from one of its mouths as a standard action, and up to all nine as a full attack. Treat each water jet as a ranged attack from a projectile weapon with a range increment of 20 feet. Attacks with water jets do not provoke attacks of opportunity. A creature struck by a water jet takes 1d8 points of bludgeoning damage and is exposed to the xiangliu’s push attack.

[soylent-crocodile]

Plague Spitter (Monster)

(Plague Spitter by Chippy)

(The plague spitter is meant to be closer to an environmental hazard than a creature per se; designed to sit upwind of a town and poison everyone. Personally I think it's cool and incredibly nasty of original phyrexia to have creatures designed specifically to blight an entire region. That is hardcore evil.

Also, if it's not clear, people catching smoke plague outside the 100ft radius would be an Act Of GM; get a few townsfolk infected and let the PCs not be exposed until they're in combat range.)

CR6 N Huge Aberration (Phyrexian)

Plague spitters are massive reservoirs of an engineered disease known as the smoke plague, designed to blight and destroy population centers so they can be rebuilt in phyrexia's glory.

The spitters themselves are mindless beasts, guided by an engineered instinct to stand firm wherever a phyrexian places them and respire their noxious disease, defending themselves by ramming with their armored face if any threat comes near. Despite their great bulk, spitters are capable of short sprints when stirred into action, something which surprises many adversaries of Phyrexia. Spitters are often placed near cliffs, both so that their airborn plague can travel, and so that spitters can use their weight to shove enemies off the cliff if need be.

A bloated, tick-like monster clings tightly to its perch, spewing black smoke from holes in its swollen back.

Misc- CR6 N Huge Aberration (Phyrexian) HD10 Init:-2 Senses: Perception:+10 Aura: 

Stats- Str:24(+7) Dex:6(-2) Con:20(+5) Int:1(-5) Wis:14(+2) Cha:4(-3) BAB:+7/+6 Space:15ft Reach:10ft

Defense- HP:95(10d8+50) AC:16 (-2 Dex, -2 Size, +10 Natural) Fort:+8 Ref:+3 Will:+9 CMD: Resist: Cold 10, Fire 10, Electricity 10 Immunity: Acid, Curse, Disease, Poison

Offense- Slam +11(1d8+7 plus 1d3 Con damage) CMB:+14 Speed:30ft

Feats- Lightning Reflexes, Power Attack (-2/+4), Greater Bull Rush, Vital Strike, Awesome Blow

Skills- Climb +12, Perception +10

Special Qualities- Smoke Plague (100ft)

Ecology- Environment- Plains, Mountains (Any) Languages- None Organization- Host (3-5) Treasure- None

Special Abilities- Smoke Plague (Ex)- A plague spitter, as its name suggests, is constantly producing and spewing a black smoke of viral disease. This smoke remains virulent when dispersed by wind, and may travel up to a mile before the disease is neutralized. Creatures starting their turn within 100ft of a plague spewer are exposed to the smoke plague; Type: Disease, Inhaled Save: Fort DC16 Onset: Instantaneous Effect: 1d3 Con and Str damage, victim is exhaling black smoke in a 10ft radius that exposes all creature within it to smoke plague Cure: two consecutive saves.

[herosorchids]

vampire anatomy

so basically this post is a bit of an anatomy lesson (specifically for my oc world) and maybe a bit confusing if you don’t have an anatomical background or basic knowledge of anatomy systems so beware … comment / use my q/a for any explanation or anything tho

to think of vampires is to think of humans but. genetically advanced ??? think of it this way:

let’s say humans are … sustainers ! they need food , water , anything to keep their body running . they have a lot of body systems going on and a lot of maintaining to do for it so everything is very precise

now let’s say vampires are defenders. the only thing they really need is blood due to their deficiency of it , and only about 2 pints a week at that. their immune system is superior and they don’t ahve to worry about sustainability in the meantime

keep that in mind as u continue

for vampires , they have the same circulation system , though their hearts are smaller (there’s not as much red blood cells or anything to circulate) . their blood is like uber thin and really acidic , so one reason why they need to GET blood from humans is to balance it out (blood is a slightly basic substance!!)

fangs are a whole separate spongy bone called “dentes” (fangs in latin) that diffuse blood when a vampire bites a human . there’s a specific vein that transports the blood directly into the heart attached to the dentes (vein name still in workshop) . it’s also specifically attached to the left ventricles of the heart (those lead straight into the body) . normally , they bite the jugular vein (external , incoming blood) and suck through the small holes in the bone

(silly fact me n my best friend came up with: when a human has sickle cell disease (normally red blood cells r shaped like (0) but with sickle cell they’re shaped like (C like a sickle), the rbcs will clog and clot the spongy bone and give the receiving vampire a fang cavity)

each body system is slightly more advanced (etc the skeletal system being more strong to avoid acidic corrosion , or the muscular system being more flexible due to adaptation) .in this world , vampires turning into bats is just a myth (though they do have a special connection to bats, due to some part of their dna being intertwined with them) . digestive system is the same though they need blood for some key components (such as iron , or anything thag rbcs specically transfer through the body) the endocrine system develops slower (due to lifespan) but it works about the same

basically every single vampire is iron deficient 😭

nervous system . fun. okay. so. neurotransmitters work faster (action potential / nerve charges go really fast and they have faster reaction / reflex time) . no drugs that are used directly in the blood work (so no intravenous) though anything that is uo the nose or works with the cns specifically (etc benzodiazepines) work perfectly fine (yes vampires can do cocaine and xanny… but not heroin)

(another silly best friend and me thing ; vampires platelets work extremely well and fast so if any needle or iv is left in their skin for more than 10 minutes , the platelets will heal AROUND it. fun!)

that’s about all i had so far.

[queenofcandynsoda]

Carmine the Bloodshed

(Thank you @jknerd~)

TW; Self-harm

Carmine the Bloodshed

Other Names: Carmine the Bloodshed (カーマイン・の・さっしょう Chimamire no Carumin), The Psycho’s Son, The Red Devil, Carmine Spini, R-O-001

Age: 7

Affiliation: Deepground; Shinra Electric Power Company (Formerly), Weiss’ Army

Occupation: Child Soldier, Sniper, Assassin (trainee)

Residence: Deepground Offspring Nursery (formerly), None/Nomadic (currently)

Family: Rosso the Crimson (mother), Cerise (younger sister), Eerie (younger sister), Cordovan and Maroon (younger twin brothers), Jasper (younger brother), Peach (youngest sister), Madder (younger brother), Cardinal (younger brother), Chili (youngest brother), The Restrictor (biological father)

Abilities: Firearm Proficiency (Rifle, Sniper Rifle, Shotgun, Handgun, Assault Rifle), Supernatural Gunmanship (Supernatural Accuracy, Supernatural Reflexes, Supernatural Dexterity, Quick Draw), Glowing Eyes, Knife Proficiency (Switchblade, Razor, Scalpel, Clever, Kitchen Knife), Superior Human Physiology (Flash Step, Supernatural Stealth, Afterimage Creation, Bulletproof Durability, Self-Sustenance, Disease Resistance, Enhanced Intelligence, Supernatural Strength, Healing Coma [after blood loss], Mental Regeneration), Blood Manipulation (Bleeding Inducement, Flammable Blood, Corrosive Blood, Haemokinetic Combat, Blood Bullets), Adaptive Regeneration [after MANY attempts to euthanize him] (Acid Immunity, Poison/Venom Immunity, Water Immunity, Fire Immunity, Explosion Immunity, Blunt Force Immunity, Cutting Immunity), Feign Death, Supernatural Cells, Killing Mastery, Killing Instinct (reluctant), Anatomical Mastery, Weakness Detection, Humanity Retainment, Indomitable Loyalty (to his mother and Weiss), Mathematics Mastery (Geometry, Shatterpoint, Numerical Precision, Calculation, Ricochet), Temporal Sense, Combat Adaptation

Likes: His family, Freedom, Daylight, Collecting souvenirs, Girl-in-the-Picture (Vermillion), Guns, Hot Chocolate, Burgers, Pizzas, Loyalty to Weiss, Target Practice

Dislikes: THE RESTRICTOR, Shinra Company, Professor Hojo, Doctor Fiorenzo Rosales, His Murderous Thoughts, Being controlled, Intense Training, Greedy People, Spoiled Brats

Origins: Carmine is a member of the Off-Color Tsviets and the first son and child of Rosso the Crimson. His biological father is the Restrictor, the cruel overseer of Deepground. From birth, Carmine was forced to train to be the most effective killer that could surpass his mother’s abilities. His body has been pushed beyond its limits to the point it is a wonder how Carmine lived past the age of five. After his birth, his mother attempted to hide him but he was quickly taken away and placed in the Offspring Nursery. Since then, he was subjected to torturous experiments as Rosso gave birth to his siblings due to her body being modified to be pregnant for three months. The mother and son would communicate at every opportunity, even having the chance to see his younger siblings. 

Due to the brutal experience he suffered, Carmine has become mentally unstable. He has become hostile to “Shinrites,” meaning people who work for Shinra”, and would aim his rifle at them, believing they intend harm regardless. He tends to be vulgar whenever he feels defensive, especially when it comes to his siblings and mother. This would also lead to profanity and threats of violence. 

Despite these frightening traits, he does his best to create and maintain his humanity. He would make himself bleed daily to remind himself that he is still a living person, not a weapon. Carmine had developed a reputation for trying to escape since he was about four years old. His common method is to use the air vent. This led him to enter various places in the Shinra Tower, such as the Materia Research Facility, SOLDIER Floor, Visual Entertainment Hall, the President’s Office, executives' offices, Hojo's laboratory, and the Skyview Hall, his favorite place. He would collect items, such as office supplies, Shinra/SOLDIER merch, souvenirs, and human teeth from Hojo’s lab. He also managed to collect Lazard’s pens, the Turks’ weapons, Palmer’s luxury eating utensils, Heidegger’s medals, Hojo’s lab equipment, Scarlet’s picture of her daughter, Vermillion, Rochelle’s makeup, Rufus’ coins and shotgun bullets, Junio’s handbags, and President Shinra’s car keys to one of his sports cars. He would then give most of them to the other children in Deepground, such as his siblings and his peers like Fuchsia. There are even times that he took jewelry and fur coats to Rosso in secret. 

When Sonon and Yuffie got captured, Carmine was one of the first to interact with the former. Though their first interaction was brief, the ninja intrigued the young boy. Once they get to meet more formally, Sonon is assigned to fight him, later, he tells him about the “Outside”. Sonon said how Wutai was a great nation before Shinra ruined it and that there was so much freedom. Carmine was amazed by this and would repeat it to the other children. 

Once Yuffie becomes pregnant, Carmine overhears conversations about a potential dissection of the baby, which would lead to its death as they are deemed “disposable”. The boy immediately told Sonon, who then told Nero, Weiss, and Yuffie. The Pure White Emperor then created an escape plan that would lead them into Wutai. Days later, Carmine hit his head hard enough that he got a concussion during training. In the infirmary, when Shelke is assisting in examining him with the doctors, she discovers that Carmine's “obedience” chip has been destroyed. This allows him to go against the Restrictor and gain free will. From there, Weiss sees him as essential to the escape. Soon after, Weiss secretly told the young boy how he could help. 

There are three tasks he needs to do once he escapes;

Seek out Viceroy Sarruf for Weiss to remove him from power for the Kisaragi Family to reclaim control over Wutai

Search for Wutai’s materia, especially the Leviathan materia

Return to help with the breakout once he gets Shelke’s message 

As a way to escape, Carmine forced his body into “Bleeding Sleep” to give the appearance of being dead as blood came out of his mouth and his heart stopped. Several Deepground children, including some of his siblings, pretend to mourn for him. The Restrictor, disgusted by Carmine’s “corpse”, threw him away in the trash truck. Carmine uses “Bleeding Sleep” long enough to wake himself and crawl out of the trash. He looks out of the trash truck to see the sun for the first time, amazed by the sight of freedom. Using this as an opportunity, he jumped out and headed to the nearest town outside of Midgar, Kalm. From there, he learns more about 

Along with getting a red hoodie, black pants, and slightly ragged white sneakers, he also gets a small rifle and stolen materia for any self-defense. 

Now, with all of his equipment, Carmine hopes to complete his tasks to ensure the escape from Deepground and the rescue of his family. As he travels, he learns to become more human and gain experience. 

[paperanddice]

Rust Drake

A rust drake's body seems to be composed of nothing but crumbling, rusted metal, constantly shedding small reddish-brown scales as it moves and flies. Their fangs and claws are the color and hardness of fresh iron, tearing into its foes, though much of what they actually feed on is old metals. They swallow whole chunks of rusty metal, letting it continue to corrode and ferment in their stomach while leaching off the nutrients they gather from the rust. These chunks of metal also provide a strong defensive weapon for the drake, as it can spit them out to burst on impact and scatter shreds over its foes.

The strongest theory as to the origin of rust drakes is a corruption of metallic dragon eggs, though no solid evidence of this has been uncovered yet. Others propose a corruption of young dragons, with some malady that afflicts their scales and turns them to rust, stunting the creature's growth and transforming it into a drake. Actual dragons take great offense to this theory, and refuse to collaborate with humanoids investigating it.

Inspired by the Tome of Beasts 1. This post came out a week ago on my Patreon. If you want to get access to all my monster conversions early, as well as access to my premade adventures and other material I’m working on, consider backing me there!

Pathfinder 2e

Rust Drake Creature 8 Uncommon, Medium, Dragon Perception +15; darkvision Languages Common, Draconic Skills Athletics +17, Stealth +14 Str +5, Dex +2, Con +4, Int +1, Wis -1, Cha -1 AC 27; Fort +18, Ref +14, Will +13 HP 125; Immunities paralyzed, poison, sleep; Weaknesses acid 10 Speed 30 feet, burrow 5 feet, fly 100 feet Melee fangs +19, Damage 2d8+9 piercing plus rust drake lockjaw Melee tail +19 (agile), Damage 2d6+9 bludgeoning Draconic Frenzy [2 actions] The rust drake makes one fangs Strike and two tail Strikes in any order. Rust Drake Lockjaw (disease, virulent); Saving Throw DC 26 Fortitude; Onset 1d4 days; Stage 1 clumsy 1 (1 day); Stage 2 clumsy 2 (1 day); Stage 3 clumsy 3 and can't speak (1 day); Stage 4 paralyzed with spasms (1 day); Stage 5 death Rust Gorge [3 actions] The rust drake devours a chunk of metal of bulk 5. It immediately recharges Spit Scrap. Spit Scrap [2 actions] The rust drake spits a bundle of rusty scrap metal to a range of 30 feet that explodes in a 10-foot burst. Creatures in the burst take 3d6 bludgeoning, 3d6 piercing, and 3d6 slashing damage (DC 26 basic Reflex save). A creature that fails this save is also exposed to rust drake lockjaw. The rust drake can't use Spit Scrap again for 1d6 rounds.

13th Age

Rust Drake 6th level spoiler [dragon] Initiative: +8 Vulnerability: Acid Rusty Bite +10 vs. AC – 18 damage. Natural Roll is Above Target’s Constitution Score: The target is affected by rust drake lockjaw (see below). C: Spit Scrap +10 vs. PD (1d3 nearby enemies in a group) – 10 damage. Natural Roll is Above Target’s Constitution Score: The target is affected by rust drake lockjaw (see below). Limited Use: Roll a d6 when the rust drake uses this attack. The attack recharges when the escalation die reaches that value. If it’s already at or above that value, this attack doesn’t recharge again for the rest of the battle. Flyer. Limited Escalator: The rust drake adds half the escalation die to its attacks. Rust Drake Lockjaw: The target is hampered (hard save ends, 16+). First Failed Save: The target is hampered and stuck (hard save ends both, 16+). Second Failed Save: The target is helpless (hard save ends, 16+). Speed Surge: 1/battle, the rust drake can move as a quick action. It doesn’t provoke opportunity attacks and can’t be intercepted when it moves this way. Resist Poison 16+. AC 20 PD 20 MD 16 HP 110

[pathfinderunlocked]

Bog Hulk - CR 10 Plant

A big mushroomy fella.

Artwork is official art from World of Warcraft, copyright Blizzard Entertainment.

Though relatively non-aggressive, these lumbering behemoths are savagely efficient at dispatching their adversaries when provoked. They are omnivores that feed on other native swamp creatures and their rotting remains.

Bog hulks sometimes form when fungal infestations take over the corpses of giants.  The rotting plant and fungal matter occupy the shape of the giant’s body, and swell up to build even more bulk, growing even more enormous than the original giant.  Perhaps as a result of absorbing and incorporating the remains of the dead giant’s brain matter, or perhaps as a property of the type of fungus that is capable of growing in such a way, they have a limited intelligence; more than most other plant creatures, at least.

Bog Hulk - CR 10

The muddy ground gradually gives way to a pool of stagnant water, in the center of which stands a gigantic fungal creature covered with a thick layer of green algae.  Its humanoid-shaped body seems to be made of a mass of mushrooms and algae.

XP 9,600 N Huge plant Init +2 Senses low-light vision, tremorsense 40 ft.; Perception +9 Aura spore cloud (50 ft.)

DEFENSE

AC 22, touch 10, flat-footed 20 (+2 Dex, +12 natural, -2 size) hp 147 (14d8+84) Fort +14, Ref +6, Will +5 Immune plant traits Weaknesses vulnerable to fire

OFFENSE

Speed 40 ft. Melee 2 slams +16 (2d6+7/19–20 plus grab) Space 15 ft.; Reach 15 ft. Special Attacks bog spray, vine pull

STATISTICS

Str 25, Dex 14, Con 20, Int 4, Wis 12, Cha 7 Base Atk +10; CMB +19 (+25 grapple); CMD 32 Feats Cleave, Improved Critical (slam), Improved Grapple, Power Attack, Skill Focus (Stealth), Toughness, Weapon Focus (slam) Skills Climb +10, Perception +9, Stealth +6 (+12 in swampy areas); Racial Bonuses +6 stealth in swampy areas Languages Giant (can’t speak)

SPECIAL ABILITIES

Bog Spray (Ex) Once every 1d4 rounds, as a standard action, a bog hulk can blast a spray of diseased acidic slime from its mouth in a 20 foot cone, dealing 8d6 acid damage (Reflex DC 22 halves).  Creatures that take any amount of damage from this must then also succeed on a DC 16 Fortitude save, or be afflicted with the Bog Rot disease with an immediate onset.  The Reflex save DC is Constitution-based.

Spore Cloud (Ex) A bog hulk is always surrounded by a barely visible cloud of noxious spores in a 50 ft. radius, which moves with the bog hulk.  A DC 20 perception check is enough to see the exact radius of the cloud of microscopic spores.  All living creatures that end their turn within 50 ft. must make a DC 22 Fortitude save or become sickened for 1d4+1 rounds.  A creature that is already sickened and fails its save becomes overwhelmed for 1 round. The save DC is Constitution-based. This is a disease effect.

An overwhelmed creature is staggered and cannot concentrate.  If an overwhelmed creature attacks or casts a spell, it falls prone and becomes helpless until the beginning of its next turn after doing so.   Effects that would remove or prevent the paralyzed or nauseated conditions also remove or prevent the overwhelmed condition.

Vine Pull (Ex) In place of a melee attack, a bog hulk can extend the vines from its arm up to a 30 foot reach to grapple a creature, pulling the target adjacent to itself if successful (as normal for a successful grapple).  When it successfully moves its target to an adjacent space in this way, the target takes 1d8 points of bludgeoning damage for every 5 feet it moves.

A bog hulk does not threaten this additional reach.  If it uses its vine pull as an attack of opportunity, it can only do so against targets within its normal reach.

[myrawjcsmicasereports]

 360° spinal fixations through posterior only approach in a child with pott’s disease: a case report by Md. Rezaul Amin in Journal of Clinical Case Reports Medical Images and Health Sciences.

Abstract

Tuberculosis (TB) is caused by acid-fast bacilli Mycobacterium tuberculosis and rarely by M. bovis, which is very common in developing countries like Bangladesh. Vertebral bodies are common site of extra-pulmonary involvement by TB. Although spinal TB is not very common in young children, pott’s disease affecting children and requiring surgical intervention have been reported. But in children, this surgery is often challenging due to greater technical difficulty with instrumentation. A 9-year-old girl presented with paraplegia due to compressive dorsal myelopathy due to pott’s disease at D4- D5 level. Anti-TB medication was started and two weeks later she underwent decompression of neural elements by D5 Laminectomy and corpectomy and stabilization by bilateral trans-pedicular screws and rods at D3, D4, D6 and D7 and fusion by mesh cage filled with autologous bone chips. Her post-operative recovery was uneventful. Histopathology report shows Granulomatous inflammation, compatible with tuberculosis. At the last follow-up, the patient was clinically and radiographically stable.

Keyword: 360° spinal fixation, Pott’s disease, Posterior only approach, Childhood spinal TB, Spinal instrumentation.

Introduction

Tuberculosis is a granulomatous inflammation involving various organs. The prevalence of TB is high in developing countries 1. High risk groups include the IV drug abusers, immunocompromised and HIV-infected people, prisoners and nursing home residents2. Vertebral tuberculosis, also known as Pott disease, is relatively common in certain regions of the world and is found in 1%–2% of TB cases worldwide3,4. Spinal TB is the most common site of extrapulmonary TB. The majority of Pott’s disease patients present with destruction and collapse of vertebrae and involvement of adjacent tissue. The disease may end up with spinal deformity and neurological complications like arachnoiditis, intramedullary tuberculoma and epidural abscesses5.

We report upper thoracic Pott’s disease in a 9-year-old girl with myelopathy. She was treated surgically with vertebral column resection and 360º reconstruction via a posterior-only approach to prevent the progression of neurological deficit and stabilize the deformity.

Case Report

History and Presentation

A 09 years old girl, 2nd issue of her non-consanguineous parent presented with the complaints of pain in the upper back for 02 months, weakness in both lower limbs for 2 weeks. Her weakness of lower limbs was sudden, asymmetrical (Left>right) and non-ascending type. Weakness was progressive and she became unable to walk or stand even with support 01 week later. She had no history of fever, convulsion, diarrhoea, vomiting, and headache. There was no history of contact with TB patient. Her bowel and bladder functions were normal.

Physical examination

Her lower limbs reveal visible muscle wasting of both legs, muscle tone was slightly increased, muscle power was MRC grade 0 in both lower limbs, deep tendon reflexes were exaggerated, planter were bilaterally extensor, sensory and autonomic function were intact. Upper limbs were neurologically intact, cerebellar sign absent, cranial nerve palsy absent; gait could not be assessed.

Investigations

CBC: Hb% 12gm/dl, ESR 47 mm in 1st hour, TC of WBC 7000/cmm, Neutrophil 65%,

Imaging: MRI of D/L spine with screening of whole spine shows T1 hypo & T2 hyperintense signal change with heterogenous contrast enhancement at D4 & D5 vertebral bodies and intervening intervertebral disc with almost complete collapse of D5 vertebral body with similar signal intensity pre and para vertebral soft tissue swelling at the same level with epidural extension causing spinal canal stenosis with cord compression and bilateral nerve root compression. Similar lesion is also present at S1 vertebral body.

Operative Procedure

Anti-TB medication started and two weeks later she underwent decompression of neural elements by D5 Laminectomy and corpectomy and stabilization by bilateral trans-pedicular screw and rod at D3, D4, D6 and D7 and fusion by mesh cage filled with autologous bone chips (Fig.2).

Postoperative course

Her post-operative recovery was uneventful. Her back pain was improved and she could walk without support. Histopathology report shows Granulomatous inflammation, compatible with tuberculosis. An 18 months antitubercular therapy was planned. During the first 3 months she got 4 drug regimen and for the rest of the 15 months, 2 drug regimen was advised. Pyridoxin was advised throughout the course of anti-TB therapy.

Follow Up

On 2nd post-operative day her lower limb muscle power improved to 3/5 and 02 weeks post op muscle power was 4-/5 and became able to walk without support and became pain-free. The patient was advised for follow-up in every 3 months (Fig. 3).

Discussion

Spondylitis is the most common manifestation of osseoarticular TB, and 1%–3% of patients with TB have skeletal involvement. It is most common in the first 3 decades of life and is a leading cause of paraplegia6. Vertebral body involvement usually occurs through the extensive venous plexus of Batson, spreading infection to multiple spinal segments while characteristically sparing the disc space7,8. Tuberculous spondylitis without any spinal cord compression or neurological deficits can be treated conservatively with anti-TB medications. Surgery is considered for patients with spinal cord compression or neurological compromise, significant spinal deformity, persistent severe axial pain or disease progression on maximal medical therapy9,10. Multiple surgical approaches are available for treatment of TB spondylitis in the pediatric age group. Outcomes of extensive surgery is similar to debridement alone except better correction of kyphosis and deformity in case of extensive surgery11. In addition, extensive surgery reduces the duration of chemotherapy12. Although Pott’s disease affecting young children are rare but it’s surgical management is technically challenging13. Presentation of vertebral TB in children are often insidious in onset and include back pain, fever and motor, sensory or autonomic dysfunction. Although chemotherapy is the first line of treatment, but surgery may be warranted if spinal cord compression or kyphotic deformity is present. Around 3% of children with pott’s disease develop severe kyphosis (> 60°)14 .Risk factors for kyphotic deformity includes age <10 years; involvement of ≥ 3 VBs; or involvement of  thoracic spine15. Severe kyphosis is cosmetically unacceptable and causes spinal cord compression over the apex of the deformity and cardiopulmonary dysfunction from restrictive lung disease. Skeletal immaturity of young children must be taken into account during surgical intervention and number of fused segments should be minimized (particularly in dorsal spine) to avoid complications such as iatrogenic short stature, crankshaft deformity, and restricted growth of the rib cage causing pulmonary hypoplasia. Younger patients exhibit a more aggressive form of TB, with severe extra-pulmonary involvement and progressive VB collapse13, placing them at a higher risk for disabling complications in comparison to adults. So we performed surgery which halted progression of kyphotic deformity and improved neurological symptoms in our patient. The surgical technique of choice for spinal TB has been a matter of continuous debate16. Posterior-only surgical approaches in these cases had unfavorable outcomes because they were usually limited to laminectomy with or without fusion but spinal cord compression is located anteriorly17.  In our patient, we performed extensive surgery with vertebral column reconstruction with an anterior titanium cage and posterior instrumentation extending from 2 levels above and 2 levels below the lesion, even in the setting of acute infection which resulted in debridement of infectious focus and a reduced and stabilized kyphotic deformity. Our patient represents one of the few young patients treated with a single-stage, 360 vertebral column reconstruction with an anterior titanium cage and posterior pedicle screw fixation through posterior only approach. At follow-up, our patient’s neurological examination and kyphotic deformity were stable. However, she needs to be followed for the next several years, given her young age and skeletal immaturity, to check for development of complications.

Conclusion

Pott’s disease with spinal cord compression in children is very uncommon. Various treatment options may be considered. We report the successful use of single-stage, 360 vertebral column reconstruction with an anterior titanium cage and posterior pedicle screw fixation through posterior only approach to reconstruct a 9-year-old child’s vertebral column for radical removal of the infectious TB focus and reduction of the kyphotic deformity. Although limited number of literature is available, surgical debridement and spinal fusion via posterior approach appear to provide a safe alternative to conservative treatment with prolonged bed rest.

DECLARATIONS

Authors Contributions:

Conception, Diagnosis and Design, Radiological Diagnosis and Final approval of manuscript:

Dr KM Tarikul Islam, Dr Md Rezaul Amin,  Dr Md Ataur Rahman,  Dr. Shamsul Alam, Prof. Moududul Haque

Manuscript Preparation, Technical Revision, and Manuscript editing and revision:

Dr KM Tarikul Islam, Dr Md Rezaul Amin, Dr Md Ataur Rahman,

Literature Review: Dr. Md. Rezaul Amin, Dr. Ataur Rahman

ACKNOWLEDGEMENTS: None

FUNDING SUPPORT AND SPONSORSHIP: This research didn’t receive any specific grant from funding agencies in public, commercial or not for profit sector.

CONFLICT OF INTEREST: There are no conflict of interest.

[sidshrek6]

Persistent Cough? What You Need to Know

A cough is a natural reflex that helps clear the airways of irritants, but when it persists, it can be frustrating and debilitating. Understanding the causes, symptoms, and treatment options is crucial to managing coughs effectively.

A cough is a common symptom that can have many causes, ranging from a minor cold to a more serious infection. While most coughs can be managed with over-the-counter medications and rest, some may require medical attention. Knowing when to seek urgent care for a cough can save you time, reduce anxiety, and ensure proper treatment.

Types of Coughs:

Acute cough: Lasts less than 3 weeks

Subacute cough: Lasts 3-8 weeks

Chronic cough: Lasts more than 8 weeks

Common Causes of Coughs:

Respiratory infections (common cold, flu)

Allergies (asthma, hay fever)

Acid reflux (GERD)

Smoking or exposure to secondhand smoke

Environmental factors (pollution, dust)

Medications (ACE inhibitors, beta blockers)

Symptoms:

Persistent coughing

Coughing up mucus or blood

Chest pain or tightness

Difficulty breathing

Fatigue

While most coughs can be managed at home, knowing when to seek urgent care can ensure proper treatment and prevent complications. If you're unsure about the severity of your cough or experience concerning symptoms, err on the side of caution and visit urgent care. Remember, it's always better to be safe than sorry when it comes to your health.

When to Seek Medical Attention:

Cough persists or worsens

Coughing up blood or rust-colored mucus

Difficulty breathing or chest pain

Fever over 102°F (39°C)

Underlying medical conditions (heart disease, diabetes)

Prevention:

Practice good hygiene (handwashing)

Avoid smoking and secondhand smoke

Manage allergies and acid reflux

Stay hydrated and get enough rest

Conclusion

And It’s a good rule of thumb to make an appointment with a specialist for cough and cold if your cough hasn’t gone away. A doctor can study your cough and help identify any underlying conditions that may be causing or contributing to it.

By being mindful of these guidelines, you'll be able to make informed decisions about your health and seek the appropriate level of care when needed. Don't hesitate to reach out to urgent care if your cough requires attention – your health is worth it!

[thecreaturecodex]

Ghonathawn

“Monster Hunter Creature “ © Nar Genc, accessed at their ArtStation here

[Commissioned by @tar-baphon​, who wanted a bigger, tougher version of the ghonhatine fleshwarp from Bestiary 4. The trick was making it unique enough for it to be its own sort of creature, but similar enough to make the similarity clear.]

Fleshwarp, Ghonathawn CR 15 CE Aberration This creature looks like an enormous lizard, with armor plating along its back and swollen, luminous cheeks. Oily black liquid oozes from pores along its body, and several rows of long spikes grow from its tail.

A ghonathawn is an improvement on the fleshwarping techniques that produced the ghonhatine, larger and more powerful. They are very rare, as they require the drow fleshwarpers to begin with a troglodyte paragon, the leftovers of the former magical society ruled by the xulgath in millennia past. The ghonathawn retains more of its former personality, viewing itself as a master of other fleshwarps, and some drow even trust them with the autonomy to make tactical decisions on the battlefield.

Ghonathawns are constantly ravenous, and they view most creatures that are not drow or other fleshwarps as food. They move towards the middle of combat, hosing enemies down with diseased acid generated in their cheeks and stomach, and nauseating anyone still standing with their vile, oily musk. A ghonathawn fights until slain, never retreating from a combat unless ordered to by a drow or compelled with magic.

Ghonathawn     CR 15 XP 51,200 CE Huge aberration Init +2; Senses darkvision 120 ft., Perception +6, scent Aura powerful stench (20 ft., DC 28) Defense AC 28, touch 6, flat-footed 28 (-2 size, -2 Dex, +22 natural) hp 232 (16d8+160) Fort +15, Ref +5, Will +9 DR 5/- ; Immune acid, critical hits, disease, poison, sneak attack Defensive Abilities ferocity Offense Speed 40 ft., climb 20 ft. Melee bite +20 (2d8+10 plus 2d6 acid plus disease plus grab), 2 claws +20 (1d8+10), tail slap +18 (1d10+5) Space 15 ft.; Reach 15 ft. (20 ft. with tail) Special Attacks breath weapon (Ref DC 28, 16d6 acid plus disease, 1d4 rounds), fast swallow, feed, swallow whole (AC 21, 23 hp, 2d6+15 bludgeoning plus 4d6 acid) Statistics Str 31, Dex 7, Con 30, Int 6, Wis 9, Cha 12 Base Atk +12; CMB +24 (+28 grapple); CMD 36 (40 vs. trip) Feats Cleave, Defensive Combat Training, Great Cleave, Improved Initiative, Intimidating Prowess, Lightning Reflexes, Multiattack, Power Attack Skills Climb +29, Intimidate +22, Perception +10, Stealth +2 (+6 underground); Racial Modifiers +4 Stealth underground Languages Draconic (cannot speak) SQ thagomizer Ecology Environment underground Organization solitary or squad (1 plus 2-8 ghonhatines) Treasure none Special Abilities Feed (Su) By spending a full-round action devouring the body of a dead or unconscious creature, or when a swallowed creature is killed in its stomach, a ghonathawn gains 1d8+10 temporary hit points and a +2 bonus on attack and damage rolls for 1 minute. The bonus to hit points is Constitution-based. Filth Fever (Ex) Disease—injury; save Fort DC 28; onset 1d3 days; frequency 1 day; effect 1d3 Dex damage and 1d3 Con damage; cure 2 consecutive saves. The save DC is Constitution-based. Powerful Stench (Ex) An enraged ghonathawn secretes a tarry, musk-like chemical. Any living creature besides ghonhatines and ghonathawns within 20 feet must succeed at a DC 28 Fortitude save or be nauseated as long as it remains within the affected area and for 1d4 rounds afterward. A creature that saves is sickened as long as it remains in the area, and can't be affected again by the same ghonathawn’s stench for 24 hours. This is a poison effect. The save DC is Constitution-based. Thagomizer (Ex) A ghonathawn’s tail slap deals bludgeoning and piercing damage.

[soylent-crocodile]

Converter Beast (Monster)

(Converter Beast by Uriah Voth)

CR9 LE Huge Aberration (Phyrexian) HD14

A converter beast is exactly what it sounds like- a creature engineered by Phyrexia to assimilate and convert enemies and captives on the fly, the collective’s ultimate goal of conversion of flesh and eradication of culture manifest in a single squamous form. Creatures swallowed by the converter beast are trapped in its cage of bone and drenched in choking phyrexian oil, their flesh and minds slowly corrupted into phyrexian soldiers of compleation.

Converter beasts are ill-equipped to work alone, however, with their blindsight limited and their minds dull and obedient. Most frequently they are accompanied by a huntmaster, a phyrexian ranger trained to thrive in whatever environment they and the converter beast are assigned to. Notably, huntmasters are frequently converts from the populace and region they return to besiege, one of the highest ranks such a phyrexian can reach without having been born a newt or sculpted from scratch. It is the role of these huntmasters to guide them to suitable prey and keep their instincts leashed when the time does not call for it. The beasts, for their part, are obedient servants who know better than to challenge their master’s commands.

Some converter beasts, however, are simply dropped into their environment with no such commander. This is done when subtlety and precision is unneeded, as an unleashed converter beast is just as likely to convert a target as it is to shred it with its tails and jaws.

This large, lizard-like creature has an array of spikes forming a thick cage on its back and a tail that splits into three lashing segments. Misc- CR9 LE Huge Aberration (Phyrexian) HD14 Init:-1 Senses: Perception:-1, Blindsight 60ft, Scent Stats- Str:26(+8) Dex:8(-1) Con:25(+7) Int:3(-4) Wis:8(-1) Cha:13(+1) BAB:+10/+5 Space:15ft Reach:10ft Defense- HP:161(14d8+98) AC:20(-1 Dex, -2 Size, +13 Natural) Fort:+11 Ref:+5 Will:+10 CMD:29 Immunity: Acid, Curse, Disease, Poison Weakness: Special Defenses: Mycosynth Flesh Offense- Bite +16 (1d10+8 plus Grab), 3 Tail +14(2d4+4, 18-20/x2, 20ft reach) CMB:+20 Speed:60ft Special Attacks: Lashing Rend, Swallow Whole (40hp, AC16, 1d4+1 Wis damage), Fast Swallow Feats- Multiattack, Lightning Reflexes, Iron Will Skills- Survival +10 Spell-like Abilities- (Caster Level 11, Concentration +12) Deathwatch, Psychic Link /Constant Acid Spray (DC16) 3/day Ecology- Environment- Any Languages- Necril (Can’t talk) Organization- Solitary, Attended Beast (1 Converter Beast, 1 Compleated Ranger 11) Treasure- Standard Special Abilities- Lashing Rend (Ex)- A creature hit by two or more of a converter beast’s tail attacks in one turn must make a DC18 Reflex save or be knocked prone and moved 10ft towards the converter beast as with the Drag maneuver. Psychic Link (Sp)- A bound converter beast has a mental link with its huntmaster, as with the spell Mental Link. Swallow Whole (Ex)- A converter beast can hold 4 medium creatures, 16 small creatures, or 1 large creature in its stomach. Additionally, if a creature breaks free of its stomach, that does not free any others and it can still use its swallow whole ability, as sharp trapping horns erupt to fill any gaps. If a creature is brought to 0 Wisdom by a converter beast’s swallow whole ability, it makes a DC12 Constitution check. If it succeeds, it removes all damage and gains the Phyrexian template. If it fails, it is rendered unconscious as usual.

[toothcareguide]

Common Pediatric Dental Issues and How to Prevent Them

Your child's dental health is the most important part of his or her well-being. The pediatric Dentist in Hamilton can deal with problems that may be minor to serious, however, many of these problems can be avoided with preventive measures. In this guide, we'll talk about the most common pediatric dental issues and we'll also see how you can help avoid them.

1. Tooth Decay: The Most Common Issue

Understanding Tooth Decay

Tooth decay is the most prevalent dental issue among children. It occurs when plaque, a sticky film of bacteria, builds up on the teeth and produces acids that erode the enamel.

Preventing Tooth Decay

Tooth decay is the main cause of the problem, so it is very important to have a good oral care routine. Monitor your child's teeth brushing and ensure they use fluoride toothpaste and floss daily, brushing it twice a day. Also, limiting the consumption of sugary snacks and drinks can be beneficial in the fight against decay. A Hamilton Dental Clinic in Hamilton such as Rosewood Dentistry will be helpful in all these procedures, including monitoring and preventing decay

2. Early Tooth Loss: A Preventable Problem

Causes of Early Tooth Loss

Early tooth loss can result from tooth decay, injury, or inadequate oral hygiene. Losing primary teeth prematurely can lead to issues with spacing and alignment of permanent teeth.

Preventing Early Tooth Loss

Encourage your child to wear a mouthguard during sports to protect against injuries. Additionally, maintaining good dental hygiene practices and regular dental check-ups with a dentist in Hamilton will help preserve your child's teeth.

3. Gum Disease: An Overlooked Concern

Recognizing Gum Disease

Gum disease, or gingivitis, is less common in children than adults but can still occur. Symptoms include red, swollen, and bleeding gums.

Preventing Gum Disease

Teach your child the importance of brushing and flossing correctly to remove plaque from their teeth and gums. Regular cleanings and check-ups at a pediatric dentistry in Hamilton are essential to detect and treat gum disease early.

4. Thumb Sucking: A Habit to Watch

Effects of Thumb Sucking

Though it is a natural reflex in infants, thumb sucking for a prolonged period of time can consequently lead to dental problems like misalignment of teeth and a bite issue.

Preventing Issues from Thumb Sucking

Most children stop thumb sucking on their own by age four. If the habit continues, gently encourage your child to stop and consider seeking advice from your dentist in Hamilton on strategies to help them break the habit.

5. Dental Anxiety: Addressing the Fear

Understanding Dental Anxiety

Dental anxiety is a common childhood problem, and it can lead to the avoidance of dental visits, thus worsening the dental health of children over the years.

Preventing Dental Anxiety

To prevent dental anxiety, start dental visits early to acclimate your child to the dentist. Use positive reinforcement and explain procedures in a child-friendly manner. Rosewood Dentistry provides a welcoming environment for child dental care in Hamilton, making dental visits less intimidating for young patients.

6. Tooth Sensitivity: Managing Discomfort

Causes of Tooth Sensitivity

Sensitivity of the teeth in children can be due to the tearing of the enamel, cavities, or the occurrence of new teeth.

Preventing Tooth Sensitivity

The use of a fluoride toothpaste and a soft-bristled toothbrush can be helpful in protecting the enamel. Moreover, if your child is experiencing sensitivity, consult a pediatric dentistry in Hamilton to find out what is causing it and get it treated.

Conclusion: A Healthy Smile Starts Early

Teaching children proper dental hygiene, making regular dental check-ups, and developing healthy habits are the key measures to prevent pediatric dental problems. By being proactive, you can help ensure your child maintains a healthy smile for life.

For comprehensive child dental care in Hamilton, consider visiting Rosewood Dentistry. They provide expert care and a friendly environment to make your child's dental visits comfortable and effective. To schedule an appointment, call 905-547-8033 today.

[redashtvblog]

A Comprehensive Guide to Cough Treatment

Understanding Coughs

Coughing can be classified into two main types: acute and chronic. Acute coughs last for less than three weeks and are often caused by respiratory infections like the common cold or influenza. Chronic coughs persist for more than eight weeks and may indicate more serious underlying conditions such as asthma, chronic obstructive pulmonary disease (COPD), or gastroesophageal reflux disease (GERD).

Causes of Coughs

Coughs can result from a variety of factors, including:

Infections: Viral or bacterial infections of the respiratory tract.

Allergies: Exposure to allergens like pollen, dust, or pet dander.

Asthma: A chronic condition that inflames and narrows the airways.

Smoking: Irritation and damage to the respiratory system from tobacco use.

Environmental Irritants: Pollution, chemicals, and other irritants in the air.

GERD: Acid reflux causing irritation of the esophagus and throat.

Asthma and Coughing

Asthma is a common cause of chronic coughing. Asthma-related coughs are typically dry and persistent, often worsening at night or early in the morning. This type of cough is due to inflammation and narrowing of the airways, which triggers the coughing reflex.

Asthma Cough Treatment

Treating an asthma cough involves managing the underlying asthma condition. The primary goal is to reduce airway inflammation and prevent asthma attacks. Here are some effective strategies for asthma cough treatment:

Inhaled Corticosteroids: These medications reduce inflammation in the airways, helping to prevent asthma symptoms. Examples include fluticasone, budesonide, and beclomethasone.

Long-Acting Beta Agonists (LABAs): Often used in combination with inhaled corticosteroids, LABAs help relax the muscles around the airways, making breathing easier. Salmeterol and formoterol are common LABAs.

Leukotriene Modifiers: These oral medications help reduce inflammation and prevent asthma symptoms. Montelukast and zafirlukast are popular options.

Short-Acting Beta Agonists (SABAs): Also known as rescue inhalers, SABAs provide quick relief from asthma symptoms by relaxing the airway muscles. Albuterol and levalbuterol are widely used SABAs.

Anticholinergics: These medications help prevent the muscles around the airways from tightening. Ipratropium is a common anticholinergic used for asthma.

Biologic Therapies: For severe asthma, biologic therapies like omalizumab, mepolizumab, and benralizumab target specific molecules involved in the inflammatory process, providing relief from asthma symptoms.

Allergen Immunotherapy: Also known as allergy shots, this treatment involves gradually exposing the patient to increasing amounts of allergens to build tolerance and reduce allergic reactions.

Lifestyle Modifications: Avoiding asthma triggers, maintaining a healthy weight, and managing stress can significantly improve asthma symptoms and reduce coughing.

Asthma Treatments for Adults

Asthma can develop at any age, and managing it effectively in adults requires a comprehensive approach. Adult asthma treatments focus on both immediate relief and long-term control. Here are some key strategies:

Immediate Relief

Rescue Inhalers: Short-acting beta agonists (SABAs) like albuterol provide quick relief from asthma symptoms. They are used as needed during an asthma attack or before exercise.

Oral Corticosteroids: In severe cases, oral corticosteroids like prednisone may be prescribed for a short duration to quickly reduce inflammation and control asthma symptoms.

Long-Term Control

Inhaled Corticosteroids: These are the cornerstone of long-term asthma management, helping to reduce airway inflammation and prevent symptoms. Common examples include fluticasone, budesonide, and beclomethasone.

Long-Acting Beta Agonists (LABAs): When used with inhaled corticosteroids, LABAs provide long-lasting relief by relaxing the airway muscles. Salmeterol and formoterol are commonly prescribed LABAs.

Combination Inhalers: These inhalers contain both a corticosteroid and a LABA, providing comprehensive asthma management. Examples include fluticasone/salmeterol and budesonide/formoterol.

Leukotriene Modifiers: Oral medications like montelukast and zafirlukast help reduce inflammation and prevent asthma symptoms.

Theophylline: This oral medication helps relax the muscles around the airways, making breathing easier. It is less commonly used today due to potential side effects.

Biologic Therapies: For severe asthma, biologic therapies like omalizumab, mepolizumab, and benralizumab target specific molecules involved in the inflammatory process, providing significant relief.

Lifestyle and Home Remedies

Identify and Avoid Triggers: Keeping a diary of asthma symptoms can help identify triggers. Avoiding allergens, irritants, and respiratory infections is crucial.

Maintain a Healthy Weight: Obesity can worsen asthma symptoms, so maintaining a healthy weight through diet and exercise is important.

Quit Smoking: Smoking exacerbates asthma and can lead to severe respiratory complications. Quitting smoking is essential for effective asthma management.

Manage Stress: Stress can trigger asthma symptoms, so practicing stress-reducing techniques like yoga, meditation, and deep breathing exercises can be beneficial.

Regular Monitoring: Regular check-ups with a healthcare provider are important to monitor asthma control and adjust treatment as needed.

Other Common Causes of Cough

Respiratory Infections

Respiratory infections, such as the common cold, influenza, bronchitis, and pneumonia, are frequent causes of acute coughs. Treatment often involves:

Rest and Hydration: Adequate rest and staying hydrated can help the body fight off the infection.

Over-the-Counter Medications: Cough suppressants, decongestants, and pain relievers can alleviate symptoms.

Antibiotics: For bacterial infections like pneumonia or bacterial bronchitis, antibiotics may be necessary.

Gastroesophageal Reflux Disease (GERD)

GERD can cause chronic coughing due to stomach acid irritating the esophagus and throat. Treatment options include:

Lifestyle Changes: Avoiding foods that trigger reflux, eating smaller meals, and elevating the head of the bed can reduce symptoms.

Medications: Antacids, H2 blockers, and proton pump inhibitors (PPIs) can help reduce stomach acid production and alleviate symptoms.

Chronic Obstructive Pulmonary Disease (COPD)

COPD, which includes chronic bronchitis and emphysema, is a leading cause of chronic cough. Treatment involves:

Bronchodilators: Medications that relax the airway muscles, making breathing easier.

Inhaled Corticosteroids: These reduce inflammation in the airways.

Oxygen Therapy: For severe cases, supplemental oxygen may be necessary.

Pulmonary Rehabilitation: A program of exercise and education designed to improve lung function and quality of life.

When to Seek Medical Attention

While many coughs resolve on their own, some require medical attention. Seek professional help if you experience:

Persistent Cough: A cough that lasts more than eight weeks.

Severe Symptoms: Difficulty breathing, chest pain, or coughing up blood.

High Fever: A fever above 100.4°F (38°C) that persists.

Conclusion

Coughing can be a symptom of various conditions, ranging from mild infections to chronic diseases like asthma and COPD. Understanding the underlying cause is essential for effective treatment. For those with asthma, specific asthma cough treatments and asthma treatments for adults can significantly improve symptoms and quality of life. By combining medications, lifestyle changes, and regular monitoring, individuals can manage their coughs effectively and maintain better respiratory health.

[molsons112000]

The liver and kidneys are two vital organs that work together to maintain homeostasis and metabolic regulation in the body. They communicate closely and perform many functions, including:

Excretion: The liver breaks down harmful substances and excretes the by-products into the bile or blood. Bile by-products leave the body in feces, while blood by-products are filtered by the kidneys and leave in urine. For example, the liver converts ammonia into urea, a less toxic substance that's released into the blood and then transported to the kidneys. Urea is the main waste product in urine and isn't reabsorbed by the kidneys.

Metabolism: The liver metabolizes glucose, protein, and lipids.

Homeostasis: The kidneys maintain homeostasis of water, electrolytes, and acid-base balance. 



Johns Hopkins Medicine

Liver: Anatomy and Functions | Johns Hopkins Medicine

When the liver has broken down harmful substances, its by-products are excreted into the bile or blood. Bile by-products enter the intestine and leave the body in the form of feces. Blood by-products are filtered out by the kidneys, and leave the body in the form of urine.



SpringerLink

Physiological and Pathological Interactions Between Liver and Kidney | SpringerLink



News-Medical

Where are the Kidneys and Liver Located? - News-Medical

Breast Cancer. ×Top Health Categories. Coronavirus Disease COVID-19. Breast Cancer. Sleep. Contact. 68. Currently rated 4.2 by 68 people. 31. Where are the Kidneys and Liver Located? Download PDF Copy. By Dr. Liji Thomas, MDReviewed by Susha Cheriyedath, M.Sc. The liver and the kidneys are some of the most essential and hardworking organs in the body. They carry out numerous functions such as excretion of waste, metabolism of many substances, hormonal regulation, and proper digestion, as well as proper coagulation. The location of the liver. The liver is the second largest organ in the body, weighing in at approximately 3 pounds.



ncbi.nlm.nih.gov

In brief: How does the liver work? - InformedHealth.org - NCBI Bookshelf

Feb 28, 2023 — The liver cells convert ammonia to a much less toxic substance called urea, which is released into the blood. Urea is then transported to the kidneys and passes out of the body in urine.



bbc.co.uk

Maintaining water balance in the body - OCR Gateway - BBC Bitesize - BBC

Urine contains water, urea and mineral ions. Urea is produced in the liver when excess amino acids. are broken down. Urea is the main waste product removed in the urine, as it is not reabsorbed in the kidney.



The liver and kidneys also work together through reflexes, such as the hepatorenal reflex, which helps regulate volume balance. 

In some pathological conditions, kidney-liver interactions can lead to renal-induced liver damage or liver-induced kidney diseases. These interactions can be caused by systemic conditions such as ischemia and reperfusion, cytokine release, metabolic acidosis, and oxidative stress. 

This is for informational purposes only. For medical advice or diagnosis, consult a professional. Generative AI is experimental.

So if you're doing kidney surgery or liver surgery or you're removing both to get to something, then you need to put the person on dialysis. This way, you can remove any toxins buildup from the blood. Remember you put them to sleep. You don't want them to all of a sudden, not wake up. Because the anesthesia will build up in the blood. Why do you think people who do anesthesia have the highest rate of malpractice? They also have the highest cost of malpractice insurance. Because when they put people under, they might not wake up. And the reason for this is the build up in the circulatory system. If you're having difficulty reviving somebody sometimes it's good to filter the blood. So this is another way to save a life is to move the toxins out of the blood and add hemoglobin. So you would put them on a dialysis system. Removing toxins and then on the other side, putting in hemoglobin.

Liver dialysis is a treatment for liver failure that uses a machine to remove toxins from the blood and allow the liver and other organs to recover. The procedure involves:

Removing blood from the body through a vein in the arm

Treating and cleaning the blood to remove toxins

Returning the blood to the body 

Jefferson Health

Liver Dialysis | Jefferson Health

Royal Free London NHS Foundation Trust

Liver dialysis device proved safe and effective for treating severe liver failure | Royal Free London

Jun 1, 2023

The filtration process can last up to six hours, and one or two sessions may be enough to restart a damaged liver. Liver dialysis can also help control plasma urea and creatinine levels. 

Liver dialysis is considered a temporary solution to sustain patients until a liver transplant can be done. However, complications of dialysis are common, including hypotension, gastrointestinal bleeding, and intraperitoneal sepsis. A study found that dialysis is only worth attempting in patients where recovery of the underlying liver lesion is possible. 

Anesthesiologists can face lengthy and costly medical malpractice claims due to the high-risk nature of the specialty. Of the 53,000 anesthesiologists practicing in the country, 36% will be sued at least once in their careers.Feb 20, 2024

https://medpli.com › Specialties

Anesthesiologist Malpractice Insurance | Get a Quote - MEDPL

Anesthesiologists are considered to be in a high-risk specialty and can face costly medical malpractice claims. In 2020, anesthesiologists had an annual rate of 11.7 paid malpractice claims per 1,000 physicians-years, with 10% of those claims reaching over $1 million. However, improvements in operating room technology and education in recent decades have led to fewer anesthesia mishaps that result in critical events like death or coma. 



NCBI

Medical Malpractice Lawsuits Involving Anesthesiology ... - NCBI

Oct 1, 2020 — 3. Surgical specialties (ie, neurosurgery, orthopedics, plastic surgery) account for the largest rates of malpractice claims, ranging from 30 to 53.1 per 1000 physicians-years with neurosurgery accounting for the highest paid claims (13%) of over one million dollars. In contrast, anesthesiologists experience an annual rate of paid malpractice claims of 11.7 per 1000 physicians-years with a similar percentage of paid malpractice claims (10%) reaching over one million dollars. Malpractice claims can have even more profound consequences to medical trainees.



The anesthesia consultant

DO ANESTHESIOLOGISTS HAVE THE HIGHEST MALPRACTICE ...

How high are anesthesiologist malpractice rates? Do anesthesiologists have the highest malpractice insurance rates? In a word, “No.” Anesthesia mishaps can lead to critical events such as death or coma, but in recent decades improvements in operating room technology and education have led to fewer such events. Prior to 1985, anesthesia malpractice claims for death or brain death were most often due to lack of oxygen the patient's heart or brain. Two significant breakthroughs arrived in the 1980's to help anesthesiologists care for you: 1) the pulse oximeter, and 2) the end-tidal carbon dioxide monitor.



MEDPLI

Anesthesiologist Malpractice Insurance | Get a Quote - MEDPLI

Feb 20, 2024 — Home. Anesthesiologist Medical Malpractice Insurance. Anesthesiologists can face lengthy and costly medical malpractice claims due to the high-risk nature of the specialty. Of the 53,000 anesthesiologists practicing in the country, 36% will be sued at least once in their careers. An extensive medical malpractice insurance policy protects them from the significant costs of a claim. MEDPLI helps anesthesiologists find comprehensive malpractice coverage from an A-rated carrier and save up to 28% on premiums. Anesthesiologist Medical Malpractice Insurance Rates. Insurance premiums for anesthesiologists differ by city and state.



Medical Malpractice Insurance

Anesthesiologists Malpractice Insurance | Cunningham Group

Due to the high-risk nature of the specialty, anesthesiologists can face lengthy and costly medical malpractice claims. Anesthesiologists are responsible ...

The most common reasons for lawsuits against anesthesiologists are:

Complications from treatment and surgery: 48%

Abnormal injury of a patient: 27%

Wrongful death: 18% 

In contrast, physicians overall are most commonly sued for failure to diagnose or delayed diagnosis, which only accounts for 10% of lawsuits against anesthesiologists. 

Anesthesiologists also pay some of the highest malpractice premiums across all specialties. In 2022, nearly a quarter of anesthesiologists reported paying between $10,000 to $15,000 annually for malpractice insurance, and 17% said they paid between $15,000 to $20,000. 

See, this can be used by anesthesiologists to remove the toxins from the system if somebody is having trouble waking up from surgery.... Forty percent of them will be sued at least once. It is a high risk profession that I'd been trying to take out of the high risk category..... That way, when people go under, they know they're going to wake up....

The NxStage System One is the first and only truly portable hemodialysis system cleared for home use in the United States, including solo hemodialysis during waking hours, and nocturnal hemodialysis, while both the patient and care partner sleep.

https://www.nxstage.com › patients

System One Portable Hemodialysis Machine - NxStage

This is why you do liquid oxygen. You're not trying to inject air bubbles air into the bloodstream? You're trying to inject oxygen liquid oxygen...

Injecting oxygen into the circulatory system can be done in a few ways, including:

Microparticles

Researchers at Boston Children's Hospital have developed tiny, gas-filled microparticles that can be injected into the bloodstream to quickly oxygenate the blood. The microparticles are made of a fatty molecule shell that surrounds a small pocket of oxygen. Once injected, the flexible coating passes the oxygen directly to red blood cells before the gas can form bubbles. In theory, this method could allow doctors to safely inject oxygen into patients who can't breathe through their nose or mouth, such as those with acute lung failure or an obstructed airway.

Intracoronary injection

Injecting arterial blood that's been supersaturated with oxygen into the heart can increase oxygen levels in an infarcted area. Some clinical studies have shown that this approach can significantly improve cardiac function after 30 days for patients with large damaged areas.

Extracorporeal membrane oxygenation (ECMO)

In this procedure, blood is pumped outside of the body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to the body's tissues. 

NCBI

An Injectable Oxygen Release System to Augment Cell ... - NCBI

Jan 22, 2018 — Intracoronary injection of arterial blood supersaturated with oxygen is also an approach to augment oxygen level in the infarcted

Australian Broadcasting Corporation

https://www.abc.net.au › 2013/07/02

Oxygen injections can save lives - Dr Karl

Jul 2, 2013 — Now while this magic oxygen-containing liquid works, it is not a perfect solution to the problem of a blocked airway. First, the .

Can we inject hemoglobin?

HB-IV Injection is used to regulate hemoglobin levels in the human body. It is usually given to patients who have iron deficient anemia or iron deficiency. The doctor may suggest using this medicine till the hemoglobin level becomes normal. Do consult your doctor to understand the usage of this medicine properly.Nov 29, 2023

https://www.1mg.com › drugs › hb-...

HB-IV Injection: View Uses, Side Effects, Price and Substitutes | 1mg

See, this is a way. Paramedics can get oxygen into the bloodstream. Where doing heart compressions with breath might not get enough oxygen into the system to save the person. So they can use this in combination with chest compressions. And they can still do breaths, but they should put up blood. Oxygen sensor on the finger to measure the oxygen in the blood.

What blood oxygen level do you need to survive?

A normal oxygen level for adults is 95 to 100%. “If oxygen levels are below 88%, that is a cause for concern,” said Christian Bime, MD, a critical care medicine specialist with a focus in pulmonology at Banner - University Medical Center Tucson.Oct 22, 2020

https://www.bannerhealth.com › blo...

What You Need to Know About Your Blood Oxygen Level

See, this has been the problem with saving people. Is they don't measure the blood? Oxygen levels. And they might not get to the right oxygen level to be able to revive somebody. So you have to supplement through injecting either an injection or a I. V intravenous. So this has been a big problem with saving people. Even infants is they don't measure these levels. And now you can do heart bypass. And many other systems are in place that you can save people.... Yes, you can even bypass the brain. And keep the organs going, so you can work on the brain to repair it. So not necessarily brain dead, only temporary brain death...

So even if they're drowned and the brain can't start up again, they're not dead. Just put him on the bypass system. Keep Em alive and then repair the area of the brain that is damaged. No matter how long they been drowned for you can repair the damaged brain.... So people are only temporarily in that situation? And then you'll have to do rehabilitation therapy to retrain that area of the brain, so I'll have to learn again, but it doesn't matter if they've been dead for an hour. They're truly not dead...

National Institutes of Health (NIH) (.gov)

https://www.nih.gov › news-events

Molecule guides stem cells to damaged brain tissue

Dec 8, 2020 — Researchers altered a molecule that is naturally produced by the body to safely guide stem cells to damaged brain tissue.

Confirming deathDeath was said to occur when the heart stopped beating and a person was unresponsive and no longer breathing. The lack of oxygen as a result of no blood flow, quickly led to the permanent loss of brain stem function.Feb 5, 2024

https://www.nhsinform.scot › brain-...

Brain stem death - Illnesses & conditions - NHS inform

So now you keep them alive until you can repair the damage to the area or areas. So if somebody's blown to pieces yes, or you get a head shot. And that means the majority of the brain is spread out everywhere, but if you keep it into helmet, then they could possibly piece it all back together. Well, they keep the body alive. This is neural surgery, but yes, they can put the pieces back together as long as they're not sad and then they can regrow

Stanford Medicine

https://med.stanford.edu › news

Researchers invent way to purify developing human brain cells

Apr 18, 2023 — Researchers created a method of isolating and studying different human neural stem and progenitor cells. Transplanting these

I did like the Israeli commandos. They had a shield that covered the back of their body and covered the back of the helmet area. It was like a straight Bulletproof jacket. That was a rectangular shape that extended out behind the body. So it didn't impede movement, but was narrow, so it didn't get in the way of arm movement..... As I told you, this is why the German soldiers had better survival rates because the helmet was better covering the brain better..... We redesigned our helmet after the German helmet...

So little lead that ship. That's sunk with all those children Drowned in South Korea. They literally could have saved them all... Yes, now all they had to do is put them on life support and then went back in and repaired any brain damage...

[paperanddice]

Last Friday I said a bunch about how demon lords aren't easily converted between the different systems, and this whole section of the book was one I'd been putting a lot of thought into. None of that applies to Akyishigal, who at level 12 in the Tome of Beasts really doesn't count as a real demon lord even by that system's expectations. Akyishigal might announce itself as the lord of cockroaches and a power of the Abyss, but its only real claim to fame is being effectively unkillable, having survived despite its general weakness in comparison to even regular demons. As durable and adaptable as the creatures it claims lordship over, Akyishigal carves out hidden lairs within the realms of true demon lords, remaining below notice and ready to escape at any moment.

In Golarion, Akyishigal can't grant clerical powers like a true demon lord, but it is doing its best to worm its way into being recognized regardless. Its spawn are released into the world to spread the word of the lord of cockroaches, and while few have any respect for that title it does what it can to provide for those who call out its name. So far, small numbers of weaker humanoids, in particular kobolds, goblins, and roachllings, as well as some escaped slaves or thralls, have thrown their lot in with Akyishigal, providing it a hidden but growing base of followers.

In the Dragon Empire, Akyishigal has snuck out from under the attention of both the Diabolist and the Crusader, and makes its own home hidden somewhere under one of the great cities. Managing to avoid drawing too much attention to itself, it skulks among the refuse and the forgotten, offering aid and power to those who live in the garbage, and making plans to grab for its own power without the oversight of any Icon.

Inspired by the Tome of Beasts 1. This post came out a week ago on my Patreon. If you want to get access to all my monster conversions early, as well as access to my premade adventures and other material I’m working on, consider backing me there!

Pathfinder 2e

Akyishigal Creature 12 Unique, Large, Demon, Fiend, Unholy Perception +24; darkvision, scent (imprecise) 60 feet Languages Abyssal, Common, Draconic, Elven, Infernal, telepathy 100 feet Skills Acrobatics +21, Athletics +23, Deception +25, Stealth +25, Survival +22 Str +5, Dex +3, Con +6, Int +4, Wis +2, Cha +7 AC 33; Fort +26, Ref +23, Will +22; +2 status to all saves vs. magic HP 250; Immunities death effects, disease, poison; Resistances acid 15, fire 15, physical 10 (except holy); Weaknesses holy 15 Speed 35 feet, burrow 20 feet, climb 35 feet, fly 35 feet Melee claw +25 (agile, magical, reach 10 feet, unholy), Damage 3d8+13 slashing Divine Innate Spells DC 31, attack +23 ; 6th dispel magic (×3), divine wrath (×3), summon animal (vermin only, x3), summon fiend (demons only), vomit swarm (every 1d4 rounds); 5th translocate; 4th translocate (at will); Constant speak with animals (vermin only) Divine Rituals DC 31; demonic pact, planar ally Claw Flurry [2 actions] Akyishigal makes four claw Strikes, each against a different target. These attacks count toward Akyishigal's multiple attack penalty, but the multiple attack penalty doesn't increase until it makes all its attacks. Cloak of Swarms [2 actions] (aura, divine) Akyishigal emits a cloud of flying, stinging insects in a 5 foot aura. While the aura is active, Akyishigal is concealed, and any living creature that enters the area or starts its turn within it takes 2d10 piercing plus 1d10 poison damage (DC 31 basic Reflex save). The aura lasts for 5 round; it disperses immediately if Akyishigal takes 15 area or splash damage from a single source. Akyishigal can't use this ability again for 1d4 rounds. Skitter [1 action] Akyishigal Strides up to 20 feet, and makes a claw Strike against a creature in its reach at any point during the Stride.

13th Age

Akyishigal  Triple-strength 7th level troop [demon]  Initiative: +14 Claws +12 vs. AC (4 attacks) - 20 damage. Natural 14+: Akyishigal can pop free from the target and move as a free action. If it ends this movement engaged with another target, it can continue making attacks. C: Cloak of Swarms +12 vs. PD (1d4+1 nearby enemies) - 10 damage plus 15 poison damage. Natural 16+: The target is also weakened (save ends). Repeat: Akyishigal can repeat this attack as a quick action at the start of each of its turns, dealing 1d6 damage and 2d6 poison damage instead of the regular damage. If Akyishigal takes 35 or more damage from a non-weapon attack that doesn’t deal acid or poison damage, it can no longer repeat the attack. Limited Use: 1/battle, recharges when the escalation die first reaches 6. Burrower, Flier, and Wall Climber. Teleport: As a move action, Akyishigal can teleport to a nearby location it can see. Resist Acid and Poison 16+. AC 23 PD 21 MD 20 HP 314