#Acid reflex disease

[ind-site11]

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

[monstersdownthepath]

Homebrew Horror: Qlippoth, Gor'glurin

(Art by @chasm-connected!)

Also called "Gore Orbs" or "Gorgans" by those with a hideous sense of humor, Gor'glurin are a breed of qlippoth which were created as a weapon of traumatic transformation by Yamasoth, the Polymorph Plague, in an attempt to scour mortal worlds of sinful life, though they work just as well against their hated demonic foes. The first of their numbers were created with cooperation from Oaur-Ooung, and they have been purposely spread by mad cultists of both entities ever since, sometimes in the form of a "blessing," sometimes as a curse, for both ally and enemy alike.

Gor'glurin begin their lives as tiny, microscopic flakes no larger than a mote of dust, easily slipping into others through their eyes, nose, or mouth, or even an open wound. They act as a disease within the body, causing tremors, fever, and nausea, appearing as a stomach bug as they slowly construct a larger body nestled within the victim. After just a few days, the qlippoth's growing body is visible as a lump rising from the stomach, and at this point only surgical or magical intervention can save the host's life. Wait too long and it will be too late, as tendrils of infected tissue will begin to weave around the victims' other organs to contaminate them like some eldritch, living tumor, turning them into parts of the qlippoth's body rather than the host's. Weaving itself a body from the stolen viscera, the Gor'glurin emerges from the host in a sickening display, but remains firmly attached, pulling the hapless victim behind them or even into the air as abyssal gas fills them like a gory balloon to finish the transformation. In just a short few minutes, the hosts' bodies are reduced to a limb of the qlippoth instead of the other way around while their minds are imprisoned within, unable to do anything but watch as the parasite lashes out at friends, family, and neighbors.

Once emerged, Gor'glurin exist to spread their infection to as many creatures as they possibly can while they use their host as both a vehicle and sustenance, slowly transmuting unneeded flesh and bone into more infectious cells. Worse still is that the qlippoth also steadily drains the victims' soul to prevent their sin from passing into the Abyss, rendering the soul down into a corrupted form of positive energy that allows the invader to sustain not only its life, but the lives of its qlippoth kin. Their spearing limbs and sprays of blood and bile carry their transformative infection, but once they've fully consumed the victims' soul, the qlippoth finds as high a perch as they can and detonates in a dramatic and disgusting display, casting their tiny, infectious brood into the winds to spread them for miles around.

GOR'GLURIN CR 7 Chaotic Evil Medium Outsider (Chaotic, Evil, Qlippoth) Init: +10; Senses: Darkvision 60ft; Perception +15

------ Defense ------

AC 20, touch 17, flat-footed 13 (+6 Dex, +1 Dodge, +3 Natural Armor) HP 82 (9d10+36) fast healing 5 Fort +10 Ref +9 Will +9 DR 5/Lawful; Immune Cold, disease, mind-affecting effects, poison; Resist Acid 10, Electricity 10, Fire 10 Weaknesses Curative Vulnerability

------ Offense ------

Speed 30ft, fly 20ft (clumsy), climb 20ft Melee 4 stings +15 (1d6+1 plus disease) Ranged Bile spray +15 touch (1d8 Acid plus disease) Special Attacks Horrific Appearance (DC 17), Infectious Detonation Spell-like Abilities (CL 10; Concentration +12)

3/day--Cure Light Wounds 1/day--Cure Moderate Wounds

------ Statistics ------

Str 12 Dex 22 Con 18 Int 11 Wis 17 Cha 14 Base Atk: +9; CMB +10; CMD 26 Feats Combat Reflexes, Dodge, Improved Initiative, Power Attack, Weapon Finesse Skills Climb +20, Escape Artist +18, Fly +10, Knowledge (Nature) +12, Perception +15, Stealth +18 Languages Abyssal, primary language spoken by the host; Telepathy 80ft SQ Flailing Host

------ Ecology ------

Environment any (Abyss) Organization Solitary, pair, outbreak (3~10), or pandemic (20~60) Treasure Incidental (host's belongings)

------

Combat: Gor'glurin seek to spread their infection to as many creatures as possible, and will stealthily spray or stab victims when able. Once in combat proper, they divide their stings between as many targets within their reach as they can. They have no special ability to tell when a creature has been successfully infected, and thus tend to continue to attack until their victims fall unconscious before seeking new prey. When among other breeds of qlippoth, they will briefly pause their assaults to heal their injured kin with stolen life energy.

Morale: Gor'glurin always fight to the death in the hopes their Infectious Detonation spreads their spores to their killers. The sole exception is if they are in combat with Undead or Constructs, which they will flee as swiftly as possible from to seek viable hosts.

------ Special Abilities ------

Bile Spray (Ex): The Gor'glurin's bile spray is a ranged touch attack with a range of 40ft.

Curative Vulnerability (Ex): Gor'glurin are harmed by any spell or effect which attempts to cure diseases. If it fails its saving throw against the spell or effect, it takes 1d8 damage per caster level of the creature using the spell/effect. A Heal spell cast upon it slays it instantly without offering a saving throw. It never regains hit points from any such effects. If this damage reduces its HP to 0 or less, it dies instantly without triggering Infectious Detonation (see below) as its body shrinks back to nothingness, and the host regains control of their body, though the damage and drain done do them is not instantly undone.

Disease (Ex): Sting, bile spray, Infectious Detonation--Injury, inhaled; save Fortitude DC 19, onset 1d6 days, frequency 1/day, effect 1d4 Str and 1d4 Con damage, cure 2 consecutive saves. A creature that would be reduced to 0 or less Con by this disease instead stabilizes at 1 Con, stops taking damage from the disease, and transforms into a Gor'glurin Qlippoth over the course of 1d4 minutes. This disease has no effect on other qlippoth.

Flailing Host (Ex): The host of the Gor'glurins infection (see disease, above) remains attached to the qlippoth, but cannot take any actions, even purely mental ones. The qlippoth cannot use any of the host's abilities and uses its stats instead of the host's in all cases; the host is nothing more than a puppet. It uses the host's limbs to move, perform combat maneuvers, or manipulate objects. Despite this, the host is still alive, and the qlippoth feeds from them to sustain itself. The host suffers 1d6 points of Charisma drain each day as the qlippoth consumes its soul, and when the host reaches 0 Charisma, the qlippoth seeks a high place to use its Infectious Detonation ability (see below). If the Gor'glurin is slain, the host is slain as well unless the qlippoth was slain by its Curative Vulnerability.

Horrific Appearance (Su): A creature that succumbs to the Gor'glurin's Horrific Appearance feels as though their organs are shifting around within their body, becoming nauseated for 1 round, and sickening them for 1d4 rounds after.

Infectious Detonation (Ex): When the Gor'glurin is reduced to 0 HP, it explodes gruesomely. All creatures within 10ft of it must make a DC 19 Reflex save or take 2d8 bludgeoning and 1d8 Acid damage from the spraying viscera, and all creatures within 30ft must save against its disease as its spores spray in every direction. A Gor'glurin which has fully consumed its host's soul (see Flailing Host, above) can use this ability at any time it wishes by destroying itself as a full-round action, causing the same damaging explosion but spraying its spores in a 100ft cloud instead. In addition, the qlippoth will typically seek a high position to use this ability from, spreading its spores to the wind and potentially infecting creatures miles away (at the DMs discretion).

[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.

[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.

[eirdoc]

5 Prescription Medications That Help Manage Acid Reflex

Prescription medication for acid reflux is designed to treat chronic or severe cases of GERD (gastroesophageal reflux disease). These medications, including proton pump inhibitors (PPIs) and H2 blockers, work by reducing the production of stomach acid, offering long-term relief from heartburn, regurgitation, and other symptoms of acid reflux.

[sidshrek6]

What You Need to Know About Cough When To Seek Medical Attention :

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.

[iikciim]

Nutritional Supplements

Anatomy, Physiology, and Pathophysiology Overview  

Nutrients are dietary products that undergo chemical changes when metabolized that cause tissue to be enhanced and energy to be liberated. Nutrients are required for cell growth and division; enzyme activity; protein, carbohydrate, and fat synthesis; muscle contraction; secretion of hormones; wound repair; immune competence; gut integrity; and numerous other essential cellular functions. Providing these nutritional needs is known as nutritional support. 

Malnutrition is a condition in which the body’s essential need for nutrients is not met by nutrient intake. The purpose of nutritional support is the successful prevention, recognition, and management of malnutrition. 

The purpose of nutritional supplements is to promote anabolism (tissue building), nitrogen balance, and maintenance or improvement of body weight. 

Nutritional supplements are dietary products used to provide nutritional support. 

Enteral nutrition is the provision of food or nutrients via the gastrointestinal (GI) tract. 

Parenteral nutrition is the intravenous administration of nutrients. Its purpose is to promote anabolism (tissue building), nitrogen balance, and maintenance or improvement of body weight. It is used when the oral or enteral feeding routes cannot be used.

https://bb-csuohio.blackboard.com/bbcswebdav/pid-7116316-dt-content-rid-80385617_1/xid-80385617_1

Pharmacology Overview  

Enteral Nutrition 

The most common and least invasive route of administration for enteral nutrition is oral consumption. A feeding tube is used in the other five enteral routes. 

Patients who may benefit from feeding tube delivery of nutritional supplements include those with abnormal esophageal or stomach peristalsis, altered anatomy secondary to surgery, depressed consciousness, or impaired digestive capacity. The enteral route is considered to be the superior route of administration. 

Various enteral feeding formulations with different nutritional content are available, including some that are lactose-free. Different combinations and amounts of these nutrients are used based on the individual patient’s anabolic needs. 

Enteral nutrition can be used to supplement an oral diet that is insufficient for a patient’s nutrient needs or used alone to meet all of the patient’s nutrient needs. It supplies complete dietary needs through the GI tract by the normal oral route or by feeding tube. 

The most common adverse effect of nutritional supplements is GI intolerance, manifesting as diarrhea. Infant nutritional formulations are most commonly associated with allergies and digestive intolerance. Other supplements are associated with osmotic diarrhea. 

Rapid feeding or bolus doses can result in dumping syndrome, which produces intestinal disturbances. Tube feeding increases the risk of aspiration pneumonia. This is especially true in patients in whom mental status, gag reflexes, and general mobility are compromised. 

The enteral formulation groups are elemental, polymeric, modular, and altered amino acids. 

Elemental formulations contain dipeptides, tripeptides, or crystalline amino acids. Minimal digestion is required with these. They are indicated for pancreatitis, partial bowel obstruction, irritable bowel disease, radiation enteritis, bowel fistulas, and short bowel syndrome. 

Polymeric formulations contain complex nutrients derived from proteins, carbohydrates, and fat. Polymeric formulations are some of the most commonly used enteral formulations because they most closely resemble normal dietary intake. They are preferred over elemental formulations if patients have fully functional GI tracts and no specialized nutrient needs. 

The most commonly used enteral supplement in the polymeric formulation category of enteral nutrition products is Ensure. 

Moducal and Polycose are examples of commonly used enteral supplements in the carbohydrate modular formulation category that supply carbohydrates only. They are used in addition to monomeric or polymeric formulations to provide more specialized nutrient mixes. 

Microlipid and MCT Oil are the formulations available in the fat category of modular formulations. Microlipid is a fat supplement supplying only fats. These drugs help individualize nutrient formulations. They may be used in malabsorption, pancreatitis, and other GI disorders. 

Prosource TF and ProMod are examples of protein modular formulations and are used to increase patients’ protein intake and provide additional proteins. They are used to increase patients’ protein intake and are derived from whey, casein, egg whites, and amino acids. 

Specialized amino acid formulations are used most commonly in patients who have metabolic disorders such as phenylketonuria, homocystinuria, and maple syrup urine disease. They are also used to supply nutritional support to patients with illnesses such as renal impairment, eclampsia, heart failure, or liver failure.

https://bb-csuohio.blackboard.com/bbcswebdav/pid-7116316-dt-content-rid-80385615_1/xid-80385615_1

Parenteral Nutrition 

Parenteral nutrition (PN) supplementation (intravenously administered) is total parenteral nutrition (TPN) or hyperalimentation. PN or TPN may be administered through a central vein or through a peripheral vein (PPN). 

Parenteral nutritional supplementation (also called total parenteral nutrition [TPN] or hyperalimentation; intravenous administration) is the preferred method for patients who are unable to tolerate and/or maintain adequate enteral or oral intake. Vitamins, minerals, amino acids, dextrose, and lipids are administered intravenously directly into the circulatory system. This bypasses the entire GI system, which eliminates the need for absorption, metabolism, and excretion.  

TPN is administered through a central venous catheter because of the hyperosmolarity of the substances used and the need for dilution provided by a larger-diameter vein to prevent damage to the vein. 

Parenteral nutrition given through a peripherally inserted central catheter (PPN) line is another option but uses a solution with a lower concentration of dextrose and other ingredients. 

PPN is used to administer nutrients to patients who need more nutrients than their current oral intake can supply or to provide complete daily nutrition. It is meant only as a temporary means (less than 2 weeks) of delivering TPN. Long-term administration may cause phlebitis. 

PPN is limited to solutions with a lower dextrose concentration, generally less than 10%, to avoid sclerosing of the vein. Thus, large volumes are needed to meet daily requirements. 

In central TPN, a large central vein, such as the subclavian or internal jugular vein, is used to deliver nutrients directly into the patient’s circulation. Central TPN is used when nutritional supplements are required for longer than 7 to 10 days and can be used in the home setting. 

With central TPN, there is a greater potential for infection, more serious catheter-induced trauma and related events, metabolic alterations, and other technical or mechanical problems than with PPN. 

Rarely, a patient who is allergic to eggs may have cross-sensitivity to lipid formulations. TPN is used only when the GI tract cannot be used. 

Parenteral feedings may result in air embolism, fever, infection, fluid volume overload, hyperglycemia, or hypoglycemia. If they are discontinued abruptly, rebound hypoglycemia may result. 

The risks associated with the insertion of the infusion line, as well as the use and maintenance of the central vein for the administration of TPN, can create some complications. The most devastating adverse effect is phlebitis.

https://bb-csuohio.blackboard.com/bbcswebdav/pid-7116316-dt-content-rid-80385616_1/xid-80385616_1

Nursing Process 

Conduct a thorough nursing history and survey of all systems, including questions about any unusual symptoms, possible nutritional concerns, nausea, vomiting, loss of appetite, and weight gain or loss. Of most concern is assessing the patient’s cardiac and renal status and ensuring that the ingredients and the amount of solution are not too taxing on these systems. 

A thorough nutritional assessment and possible consultation with a registered dietitian or nutritionist are essential for adequate intervention for the malnourished patient. 

Consultation with a registered dietitian is crucial to identify the nutrients that are missing in a particular patient’s diet. Total body metabolic rate, body mass index, muscle mass, and other variables linked to nutritional status are assessed. 

Because these are given orally, either by mouth or via tube feedings, it is most important to assess the ability to swallow, gag reflex, and bowel sounds, and to note any nausea or vomiting. 

Protein-based formulations are avoided in patients with allergies to egg whites and whey. 

Parenteral feedings may result in air embolism, emboli related to protein or lipid aggregation (associated with central catheter intravenous lines), pneumothorax, fever, infection, septicemia related to the nutrient-rich solutions and invasive intravenous route of administration, fluid volume overload, metabolic imbalances due to the solution ingredients, vomiting (seen with lipid administration in the parenteral nutrition), hyperglycemia, or hypoglycemia. If they are discontinued abruptly, rebound hypoglycemia may result. 

Assess parenteral nutrition infusions every hour or per the facility’s policies and procedures. 

With tube feeding solutions, check for proper placement and detect gastric residuals to ensure that the tube is in the stomach and to avoid aspiration and other complications. 

Newer tubes for nasogastric and other enteral feeding have smaller diameters and are thinner (5 French to 10 French) and more pliable for better patient tolerance. However, the smaller-diameter tubes make checking for gastric aspiration more difficult. 

Although more rapid feeding increases the risk for hyperglycemia, dumping syndrome, and diarrhea continue to increase the patient’s intake because the total volume and number of calories to achieve recommended daily allowances are very important. 

Keep tube feeding formulas at room temperature, and never administer cold or warm. 

Enteral feedings can interact with quinolone and tetracycline antibiotics, and phenytoin and need to be separated by 2 hours. 

Check the patient frequently for signs and symptoms of hyperglycemia, such as polydipsia (excessive thirst), polyuria (excessive urination), polyphagia (excessive hunger), headache, dehydration, nausea, vomiting, and weakness. Never accelerate these infusion rates to increase plasma volume, because the rapid increase in the amount of dextrose solution may precipitate hyperglycemia and other related complications. 

Insulin replacement may be needed with the increase in dextrose; therefore, measure serum glucose levels by glucometer so that hyperglycemia may be recognized and treated. 

Hypoglycemia associated with parenteral nutrition may be prevented by a gradual reduction of the intravenous feeding rate to allow the pancreas time to adapt to the changing blood glucose levels. If parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur. This can be prevented by providing infusions of 5% to 10% glucose in situations in which parenteral nutrition must be discontinued immediately. 

Therapeutic responses to nutritional supplementation include improved well-being, energy, strength, and performance of activities of daily living; an increase in weight; and laboratory test results that reflect an improved nutritional status. Cautious and skillful nursing care may prevent or decrease the occurrence of complications associated with enteral or parenteral nutritional supplementation.

[drraviclinic]

🤧 Causes of Cough 🌿

A cough is a common reflex that helps clear your airways. But when it lingers, it can be a sign of an underlying issue. Here are some common causes:

1️⃣ Cold & Flu: Viral infections are the top culprits behind that persistent cough. 🦠 2️⃣ Allergies: Pollen, dust, pet dander – they can trigger coughing if you’re sensitive. 🌸 3️⃣ Asthma: Tightness in the chest and wheezing often accompany this cough. 🌬️ 4️⃣ Post-Nasal Drip: Mucus dripping down your throat can irritate and cause coughing. 🌀 5️⃣ Gastroesophageal Reflux Disease (GERD): Acid reflux can lead to a chronic cough. 🍔 6️⃣ Smoking: Smoking irritates the lungs, causing a cough, especially in the morning. 🚬 7️⃣ Infections: Bacterial infections like pneumonia or whooping cough can also be the cause. 🔬

If your cough persists or is accompanied by other symptoms, it’s best to see a doctor! 🩺 DR. K. RAVI VISAKHAPATNAM CONTACT :9390398062

[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.

[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.

[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

[pathfinderunlocked]

Writhing Sludge Demon - CR19 Demon

A high level demon based on a Magic: The Gathering card.

Artwork by Lie Setiawan on ArtStation.  From Magic: The Gathering, copyright Wizards of the Coast.

This creature is based on the artwork from the MtG card Archfiend of the Dross, but Magic cards don’t really have enough abilities for a high level demon.  Despite the card’s name, I didn’t actually make this an archfiend in Pathfinder terms, since creating CR 28 stat blocks for demigods sounds pointless and exhausting to me.  Also it’s only a 6/6 creature, not that I really made any attempt to accurately replicate the MtG creature here.  I just wanted to take some ideas from it in order to make a useful and interesting high level demon.

Writhing sludge demons come from layers of the Abyss full of hazardous chemicals, toxic waste, swamplands, and filth.  They are among the most powerful demons, and fly high over these foul lands, watching them from afar.  They descend when they see other creatures trying to escape from the caustic muck, whether those creatures are demons, unfortunate souls forced to spend their afterlife in that layer of the Abyss, or invaders from elsewhere.  Anyone trying to escape the horrid quagmires is forced back down into the acidic swamps by the writhing sludge demons, after which they return to their lofty oversight from the skies.  It’s good to be on top.

The Greater Blighted Critical feat inflicts a random major spellblight on a successful crit.  The table of random major spell spellblights is here.

Between the unbound ability, summonstriker ability, and ability to cast Banishment, summoners would be advised to have as little to do with writhing sludge demons as possible.  Honestly, though, so would everyone else.  These things are nasty.

Writhing Sludge Demon - CR 19

Two massive wings made from what look like ragged muscle tendons hold an almost humanoid-shaped creature aloft, though no one could mistake this misproportioned, skinless, corpse-like figure covered in a blackened carapace for a living person.  Dozens of thin, red, writhing tentacles spread downward from its massive shoulders.

XP 204,800 CE Large outsider (aquatic, chaotic, demon, evil, extraplanar) Init +10 Senses darkvision 120 ft., low-light vision, murksight, true seeing; Perception +36 Aura sludge aura (100 ft., DC 29)

DEFENSE

AC 36, touch 24, flat-footed 29 (+6 Dex, +1 dodge, +12 natural, +8 profane, -1 size) hp 332 (19d10+228); fast healing 15 Fort +22, Ref +17, Will +18 Defensive Abilities horrible recovery, rusting acid armor, unbound DR 15/cold iron and good Immune acid, death effects, disease, electricity, poison Resist cold 10, fire 10 SR 30

OFFENSE

Speed 40 ft., fly 90 ft. (perfect), swim 40 ft. Melee 2 claws +27 (2d8+8/19-20 plus 4d8 acid plus infection), 6 tentacles +24 (1d8+4 plus grab) Space 10 ft.; Reach 5 ft. (10 ft. with tentacles) Special Attacks infection, summonstriker

Spell-Like Abilities (CL 19th; concentration +29)     Constant—true seeing     At will—arcane eye, greater teleport (self plus 50 lbs. of objects only), rusting grasp (touch +26), touch of slime (touch +26, DC 24)     3/day—banishment (DC 26), reach rusting grasp (ranged touch +24), summon (level 9, 1d2 fiendish bog scums 75%, see text)     1/day—cursed earth, mass suffocation (DC 29)

STATISTICS

Str 26, Dex 23, Con 35, Int 19, Wis 25, Cha 31 Base Atk +19; CMB +28 (+32 grapple); CMD 53 Feats Blighted Critical, Combat Reflexes, Dodge, Greater Blighted Critical, Improved Critical (claw), Improved Initiative, Mobility, Multiattack, Reach Spell-like Ability (rusting grasp), Weapon Focus (claw) Skills Fly +34, Intimidate +29, Knowledge (dungeoneering) +23, Knowledge (planes) +26, Perception +28, Spellcraft +23, Stealth +24, Survival +26, Swim +37, Use Magic Device +29 Languages Abyssal, Celestial, Draconic; telepathy 100 ft. SQ amphibious

SPECIAL ABILITIES

Horrible Recovery (Su) If a writhing sludge demon is subjected to ability damage or ability drain, it recovers 1 point per round.  It chooses each round which ability score to recover, and whether to recover damage or drain.

If a writhing sludge demon is subjected to any harmful condition, at the start of its turn, it can lower its spell resistance by 5 points for 24 hours in order to end the condition.  This is a standard action, but a writhing sludge demon can do this even if subjected to a condition that would normally prevent it from taking standard actions.

Infection (Ex) A writhing sludge demon’s claws inflict a disease against targets they hit.  A target that dies while affected by a writhing sludge demon’s infection transforms into a bog scum with the fiendish template, and cannot be resurrected except with a Wish spell.  The save DC is Constitution-based.

Writhing Sludge Infection: disease — claw;  save Fort DC 31;  onset immediate;  frequency 1/day;  effect 1d3 Str and 1d3 Dex, target cannot recover hit points while disease persists;  cure 2 saves.

Murksight (Ex) A writhing sludge demon can see through natural and magical fog, mist, and rain without penalty, ignoring any concealment bonuses gained from such effects.  This ability functions underwater as well, allowing a writhing sludge demon to see in murky water as though it were clear.

Rusting Acid Armor (Su) A writhing sludge demon gains a +8 profane bonus to armor class and a +4 profane bonus to Fortitude saves; these bonuses are already included in its statistics.

Additionally, creatures that strike a writhing sludge demon with an unarmed or natural weapon attack must succeed on a DC 31 Reflex save or take 4d8 acid damage.  Creatures that strike a writhing sludge demon with a manufactured weapon must succeed on a DC 31 Reflex save or the weapon takes 4d8 acid damage, and if made of metal, is immediately destroyed by a rust effect.  The save DC is Constitution-based.

Sludge Aura (Su) Creatures within 100 feet of a writhing sludge demon must succeed on a DC 29 Reflex save each round at the start of their turns, or be coated in thick sludge, affecting them as though with the Slowing Mud spell with a caster level of 19.  The save DC is Charisma-based.

Summon (Sp) When a writhing sludge demon uses the Summon universal monster ability, it has a range of long (typically 1160 feet) instead of short.

Summonstriker (Su) Any time a writhing sludge demon deals damage to a summoned or called creature, the caster of the summoning or calling spell takes half as much damage.  Damage in excess of a summoned/called target’s remaining hit points is not transferred to the caster.

Unbound (Su) If a writhing sludge demon is bound using a calling or summoning spell, it is only bound to the caster’s service for 1 minute, after which it receives a Will saving throw each round to break free (even if the spell does not normally allow for a saving throw).  If it breaks free, it turns against the caster, and can choose to return to its home plane and end the calling or summoning spell early at any time as a free action.