#Acid reflex disease

[ind-site11]

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

[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.

[pathfinderunlocked]

Narcis Devil - CR15 Devil

You're so disgusting. You should try to be more like me. You'll fail, obviously, but still, at least put in some effort.

Artwork by D_elite on Twitter.

Narcis Devil - CR 15

Standing six and a half feet tall and wearing only a cape and jewelry is an attractive horned man with gray skin and glowing red eyes. He looks at you smugly.

XP 51,200 LE Medium outsider (devil, evil, extraplanar, lawful) Init +12 Senses darkvision 60 ft.; Perception +23

DEFENSE

AC 28, touch 16, flat-footed 22 (+6 Dex, +12 natural) hp 199 (19d10+95) Fort +13, Ref +21, Will +17 DR 10/good Immune fire, poison Resist acid 10, cold 10 SR 26

OFFENSE

Speed 30 ft., fly 40 ft. (perfect) Melee 2 claws +27 (2d8+7 plus 1d8 bleed plus scar (DC ) Space 5 ft.; Reach 5 ft. Special Attacks gaze, touch of irony, waxen image, withering Spell-Like Abilities (CL 15th; concentration +26) Constant—detect scrying, seek thoughts (DC 24, thoughts concerning self only, see text), true seeing At will—charm monster (DC 25), enter image, mirage arcana (DC 26), mirror image, persistent image (DC 26), resist energy, scorching ray (3 rays, ranged touch +27), smug narcissism (DC 26) 3/day—dimensional anchor (DC 25), phantasmal killer (DC 25), scrying 1/day—dominate monster (DC 30), geas/quest, greater false vision, summon (level 5, 2 bone devils 75%) 1/month—simulacrum (self only, cannot have more than one)

STATISTICS

Str 24, Dex 26, Con 20, Int 16, Wis 19, Cha 32 Base Atk +19; CMB +26; CMD 44 Feats Blind-Fight, Combat Reflexes, Deceitful, Great Fortitude, Improved Initiative, Improved Great Fortitude, Iron Will, Lightning Reflexes, Persuasive, Weapon Focus (claw) Skills Acrobatics +21, Bluff +43, Diplomacy +43, Disguise +23, Fly +12, Intimidate +43, Knowledge (local, nobility, planes) +12, Perception +26, Perform (oratory) +15, Sense Motive +12; Racial Modifiers +8 Bluff, +8 Diplomacy, +8 Intimidate Languages Abyssal, Celestial, Common, Draconic, Elven, Infernal; tongues, telepathy 100 ft.

SPECIAL ABILITIES

Gaze (Su) Creatures within 30 feet that gaze upon a narcis devil must succeed on a DC 30 Will save or be unwilling to physically harm him. Affected creatures may not willingly inflict hit point damage, physical ability score damage/drain, or diseases to the narcis devil, nor any other harmful effect that would leave a physical mark. They may inflict other harmful effects, and are not compelled to prevent others from attacking the narcis devil. This gaze is a mind-affecting charm effect. The save DC is Charisma-based. The narcis devil can enable or disable this gaze effect as a free action.

Seek Thoughts (Sp) A narcis devil is permanently affected by seek thoughts, as a constant spell-like ability, but can only use this to notice creatures thinking about the narcis devil.

Scar (Su) A creature damaged by a narcis devil's claw attacks must succeed on a DC 26 Fortitude save or be scarred, as the witch hex. The save DC is Strength-based.

These scars do not interfere with the target's senses or prevent it from using abilities, but may affect social interactions. The narcis devil can use its Waxen Image and Withering hexes on the scarred target at a range of up to 1 mile, and is considered to have a body part from the target for the purpose of scrying and similar divination spells. The scars persist through disguises and shapechanging.

The narcis devil can withdraw this hex from a target as a move action at any range. The number of supernatural scars the narcis devil can maintain at once is equal to its Intelligence bonus (typically 3); once the narcis devil reaches this limit, it must remove the scar from a current victim in order to mark another. Effects that remove curses can remove the scar.

Touch of Irony (Su) A narcis devil can make a touch attack (typically with +26 to hit) to immediately transform a living creature into a walrus for 10 minutes. A successful DC 30 Fortitude save negates the transformation. This effect otherwise functions as beast shape II. A creature who successfully saves is not subject to the same narcis devil's touch of irony for 24 hours. If the target transforms into a walrus, it must also succeed on a DC 30 Will save to retain its personality. On a failed save, the target is affected as if it failed its secondary Will save against a baleful polymorph spell. The effect can be negated by break enchantment (DC 26 — using the narcis devil's caster level), but cannot be dispelled. The save DC is Charisma-based.

Waxen Image (Su) A narcis devil can spend a full-round action to create a crude and unnerving wax duplicate of a creature it can see within 30 feet, or one affected by its Scar ability. Once the image is complete, the subject must make a Will save (DC 22). If the subject fails, the narcis devil gains a small measure of control over the creature. Whenever the narcis devil exercises this control, the creature receives a new Will save to end the effect. This effect occurs on the narcis devil's turn and does not impede the creature's actions on its own turn. The narcis devil can use the waxen image a number of times equal to its Intelligence modifier (typically 3) before it melts.

As a standard action, the narcis devil can cause the subject to do any one of the following things: move up to the creature's speed in any direction, attack itself once with any weapon in hand (this attack automatically hits), lay down on the ground, or drop anything held. Alternatively, the narcis devil can spend one of its uses to simply torture the image, causing the creature to be both sickened and staggered on its turn. As soon as the creature has succeeded on a saving throw against this effect, it is immune to it for 24 hours. This is an enchantment (compulsion) effect. The save DC is Intelligence-based.

Withering (Su) As a standard action, the narcis devil can cause a creature within 30 feet, or one affected by its Scar hex, to age rapidly, empowering itself in the process.

The target ages to the next age category (adult to middle-aged, and so on). The narcis devil gains 1d10+19 temporary hit points and a +2 enhancement bonus to either Strength, Dexterity, or Constitution for a number of hours equal to its Intelligence modifier (typically 3 hours). The aging effect lasts for 19 hours.

A creature cannot be aged past venerable age by this hex, and it can attempt a Fortitude save (DC 22) to negate the effect altogether. Once a creature has successfully saved against the withering hex, it cannot be affected by the same narcis devil's withering hex again. The save DC is Intelligence-based.

[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

[nursingwriter]

Tay-Sachs Teaching Plan Desired patient outcomes The patient to understand the genetic nature of Tay-Sachs disease. Patient to understand the treatment options for Tay-Sachs disease. Patient to understand the prognosis of Tay-Sachs. Patient to know about support groups available and appropriate referrals. Patient to understand information about Tay-Sachs in pregnancy. Educational content Genetic nature of Tay-Sachs Tay-Sachs is a fatal genetic disorder that is related to storage of genetic lipids in quantities that are harmful leading to the tissues and nerve cells in the brain. The lipid involved is ganglioside GM2. Tay-Sachs is caused by insufficient action of beta-hexosaminidase A enzyme which is a catalyst for the biodegradation of acidic fatty materials, gangliosides. As the brain develops, gangliosides are generated and biodegrade rapidly in the early ages of life. It is extremely rare. However, it leads to death of infants with this disorder at an early age Melillo & Leisman, 2010. Mutations that occur in the HEXA gene are responsible for causing Tay-Sachs disease. The HEXA gene gives instructions for production of the beta-hexosaminidase A enzyme. This mutation disrupts the production and activity of the enzyme leading to the signs and symptoms of Tay-Sachs disease Melillo & Leisman, 2010() Treatment options There is no treatment that has been invented for the disease itself. However, the management of the symptoms is possible to make the patient feel more comfortable. Prognosis Children who have the disease usually have symptoms which get worse as they continue to age. Death usually comes by the time they are 4 to 5 years old. Infants with the disorder usually appear to be normal till about the age of 3-6 months after which they become blind, dumb, deaf, and are unable to swallow. Muscle atrophy and paralysis also sets in followed by other neurological symptoms such as seizures, dementia and a startle reflex to the slightest noise. The disease eventually leads to death of the infant at about the age of 4 years. Support groups and referrals There are several support groups and organizations that help those with Tay-Sachs disease in their family line. One is the National Tay-Sachs and Allied Diseases Association. There is also March of Dimes, Genetic Alliance and National Organization for Rare Disorders (NORD). These organizations help to educate the public at large about Tay-Sachs and also do genetic testing which helps to detect is partners are at-risk of this condition. They also help to do counseling of those at risk of this disease. Tay-Sachs in pregnancy The National Tay-Sachs and Allied Diseases Association gives a recommendation that anyone who suspects they could be at risk of this condition should have a blood test done to ascertain if they are truly at risk. This also helps to prevent Tay-Sachs from developing in pregnancy as a result of diagnosis before conception. Evaluation 1. The patient will respond to questions on the topic of Tay-Sachs disease. 2. Patient will need to state at least one support group or organization that they can get assistance. 3. Patient will respond to questions on what needs to be done to know whether they are at risk of Tay-Sachs. Ethical implications regarding the availability of personal genetic information The ethical implications of application of personal genetic information are a serious concern for healthcare professionals. They need to make sure that their actions are ethical and that even though they have the potential to improve the well-being of the individual and the society at large, they are in tandem with the ethical guidelines in the practice. The first ethical implication is that of informed consent. The health care professional must make sure that they overcome the challenge of offering generic services in order to sufficiently prepare the individuals who are at risk of Tay-Sachs to make decisions based on information that they have. There needs to be educational preparation such as that which is embodied in this teaching plan. The health care provider needs to give assurance to the patient on the privacy and confidentiality of the genetic information that is given to them as well as that there won't be any more stigmatization or discrimination as a result of this genetic information. The second ethical issue is on policy implications. Genetic discoveries usually come with implication on the educational, medical practice and legislative policies. Genetic technology presents new tools which have the potential of being applied throughout the human continuum. Since the genotype of genetic diseases influences the response of the individual to lifestyle, environmental and physical influences which results in the predisposition for behavioral and biological problems. Therefore genetic discoveries bring about situations that need policies in place to prevent negative consequences of the genetics. The third ethical implication is that of the impact on the person and the family. Genetic discoveries can create huge disruptions in families. Therefore health care providers need to prepare individuals and families as well on the impact of their knowledge of the genetic information and thus create guidelines to assist the individual and families at large to see the usefulness of genetic testing. How ethical and legal considerations affect the couple's decision about continuing the pregnancy Health care providers are under the principle of beneficence required to ensure that their actions are legitimate and that they bring good to the patient. However, this is in conflict with the patient's right of autonomy which gives the patient a say to their own health. In the issue of continuing pregnancy after diagnosis of Tay-Sachs, the patient may decide against abortion which is a valid patient choice. However, under medical judgment, it is not the right decision. This is an ethical consideration that the health care professionals need to work with. They need to appreciate the patient's choice but strive to educate the patient on the importance of making a choice that is medically right Sherwen, Scoloveno, & Toussie-Weingarten, 1995() Abortion is a complex legal issue and has always been so. In Roe v. Wade and in legislation that was passed in the year 1995, late-term abortions were banned and this did not give any exception to the risk of the health of the mother or the child. This, therefore, create a legal implication where the legality of giving abortion as an option for those who are at risk of Tay-Sachs disease. The conflict is thus on the ethical nature of the decision against its legality. Therefore, the health care providers need to resolve this conflict by acknowledging their professional obligation to let the patient make an informed decision Murray & McKinney, 2006() References Melillo, R., & Leisman, G. (2010). Neurobehavioral Disorders of Childhood. New York City: Springer U.S.. Murray, S.S., & McKinney, E.S. (2006). Foundations of maternal-newborn nursing. Philadelphia: Elsevier Saunders. Sherwen, L.N., Scoloveno, M.A., & Toussie-Weingarten, C. (1995). Nursing care of the childbearing family. New York, NY: Appleton & Lange.  https://www.paperdue.com/customer/paper/tay-sachs-teaching-plan-desired-patient-81214#:~:text=Logout-,TaySachsTeachingPlanDesiredpatientoutcomesThe,-Length4pages Read the full article

[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!

[tobrukonly]

maintaining body health

How to Recognise Healthy Body Systems? | A Complete Guide to Body Health

Maintaining a healthy body is crucial for overall well-being and a high quality of life. But how do you recognize if your body’s systems are functioning properly? In this guide, we’ll explore the key signs of a healthy body and how to keep your vital systems in top shape.

1. The Respiratory System — Are You Breathing Well?

The respiratory system is responsible for delivering oxygen to your body and removing carbon dioxide.

Signs of a Healthy Respiratory System:

✅ Clear and easy breathing without shortness of breath. ✅ No persistent coughing or wheezing. ✅ The ability to engage in physical activities without feeling exhausted too quickly.

Tips to Maintain Respiratory Health:

Avoid smoking and exposure to pollutants.

Practice deep breathing exercises.

Stay active with regular cardio workouts.

2. The Cardiovascular System — Your Heart’s Health in Every Beat!

The heart and blood vessels ensure the circulation of oxygen and nutrients throughout the body.

Signs of a Healthy Cardiovascular System:

✅ A steady, regular heartbeat. ✅ Normal blood pressure and good circulation. ✅ No frequent dizziness or fatigue.

Tips to Keep Your Heart Healthy:

Maintain a balanced diet rich in omega-3 fatty acids.

Engage in aerobic exercises like jogging or cycling.

Reduce stress and monitor your blood pressure regularly.

3. The Digestive System — Is Your Digestion Working Well?

The digestive system breaks down food and absorbs nutrients to fuel the body.

Signs of a Healthy Digestive System:

✅ No frequent bloating, constipation, or acid reflux. ✅ Regular bowel movements without discomfort. ✅ A strong metabolism and steady energy levels.

Tips for a Healthy Digestive System:

Eat fiber-rich foods and drink plenty of water.

Include probiotics in your diet for gut health.

Avoid excessive processed foods and fried meals.

4. The Nervous System — Is Your Brain Functioning at Its Best?

The nervous system controls body functions, movement, and cognitive abilities.

Signs of a Healthy Nervous System:

✅ Sharp focus and good memory. ✅ Stable mood and emotional well-being. ✅ Quick reflexes and coordination.

Tips for a Healthy Nervous System:

Get enough sleep (7–9 hours per night).

Engage in brain-stimulating activities like reading or puzzles.

Manage stress with meditation or relaxation exercises.

5. The Musculoskeletal System — Strength and Flexibility Matter!

Your muscles and bones provide structure, movement, and support.

Signs of a Healthy Musculoskeletal System:

✅ Strong muscles and flexible joints. ✅ No chronic joint pain or stiffness. ✅ Good posture and balance.

Tips to Maintain Strong Muscles and Bones:

Exercise regularly, including strength training.

Consume foods rich in calcium and vitamin D.

Maintain good posture to prevent strain.

6. The Immune System — Your Body’s Defense Against Illness!

The immune system protects you from infections and diseases.

Signs of a Healthy Immune System:

✅ Quick recovery from minor illnesses. ✅ Good wound healing. ✅ High energy levels without frequent fatigue.

Tips to Boost Your Immunity:

Eat a diet rich in fruits, vegetables, and vitamins.

Get adequate sleep and stay hydrated.

Maintain an active lifestyle and reduce stress.

Final Thoughts

Recognizing the signs of a healthy body is essential for taking preventive measures and leading a better life. By adopting a balanced diet, exercising regularly, and prioritizing sleep and stress management, you can ensure that your body systems function optimally.

Which of these signs do you notice in yourself? Let us know in the comments! Don’t forget to like, subscribe, and stay tuned for more health tips! 🚀💙

Would you like any refinements or additions to this guide? 😊

[iqbalnabi]

How to Prepare for a Gastroscopy Procedure

A gastroscopy is a medical procedure used to examine the upper digestive tract, including the esophagus, stomach, and the first part of the small intestine. It is commonly performed to diagnose conditions such as ulcers, acid reflux, inflammation, and even detect early signs of stomach cancer. If you are scheduled for a gastroscopy in Indore, it is essential to prepare properly to ensure accurate results and a smooth procedure. Here’s a comprehensive guide on how to get ready for your gastroscopy.

1. Follow Fasting Guidelines

One of the most crucial steps in preparing for a gastroscopy is fasting. Doctors usually advise patients to stop eating and drinking at least six to eight hours before the procedure. This ensures that the stomach is empty, allowing for a clear view of the digestive tract. Even water should be avoided a few hours before the test unless specified by your doctor.

2. Discuss Medications with Your Doctor

If you are taking any medications, especially blood thinners, diabetes medications, or heart-related drugs, inform your doctor in advance. Some medications may need to be adjusted or temporarily stopped before the gastroscopy to avoid complications. The best gastroenterologist in Indore will provide clear instructions on which medications to take and which to avoid.

3. Inform Your Doctor About Allergies and Medical Conditions

Before undergoing a gastroscopy, inform your doctor about any allergies, particularly to anesthesia or sedatives. Also, disclose any pre-existing medical conditions such as heart disease, respiratory issues, or previous gastrointestinal problems to ensure a safe procedure.

4. Arrange for a Companion

If you are receiving sedation for the procedure, it is advisable to have someone accompany you to the hospital. The sedative may leave you feeling drowsy for a few hours after the procedure, making it unsafe to drive or operate heavy machinery. Having a friend or family member assist you ensures a stress-free experience.

5. Wear Comfortable Clothing

On the day of the gastroscopy, wear loose, comfortable clothing to help you feel relaxed. Avoid wearing tight belts or jewelry that may interfere with the procedure. It’s best to remove any dentures or dental appliances before the test as well.

6. Understand the Procedure

A gastroscopy is usually a short procedure lasting 10 to 15 minutes. A thin, flexible tube with a camera (endoscope) is inserted through the mouth and into the digestive tract. Depending on your condition, the doctor may take tissue samples (biopsy) for further examination. Although it may cause slight discomfort, sedation or a local anesthetic spray can minimize any pain or gag reflex.

7. Prepare for Recovery

After the procedure, you may experience mild throat discomfort, bloating, or belching, which usually subsides within a few hours. Your doctor will provide post-procedure care instructions, including dietary restrictions if necessary. If a biopsy was taken, results might take a few days.

Proper preparation for a gastroscopy ensures accurate results and a smoother experience. If you are searching for gastroscopy in Indore, make sure to consult the best gastroenterologist to receive expert guidance. By following fasting rules, discussing medications, and preparing for recovery, you can undergo the procedure with minimal stress and optimal outcomes.

[macreel]

How the Turning Brain App is Making Physiology Learning Easier

Introduction

Medical students often find physiology one of the most challenging subjects in their curriculum. The vast syllabus, complex concepts, and detailed mechanisms make it difficult to master. However, with the right guidance and resources, learning physiology can become a lot easier.

This is where the Turning Brain App comes into play. Designed specifically for MBBS, BDS, Nursing, and Paramedical students, Turning Brain is the Best Physiology Mobile Application that provides comprehensive video lectures by Dr. Preeti Tyagi, along with an MCQ test series, bilingual content, and a structured course approach.

Whether you are a first-year MBBS student or preparing for an entrance exam, Turning Brain ensures that you have all the necessary resources at your fingertips. In this blog, we will explore how this app is revolutionizing physiology learning for medical students.

Why Physiology is Crucial for Medical Students?

Before diving into the features of Turning Brain, let’s understand why physiology is a core subject in medical studies:

Foundation for Clinical Subjects – Physiology lays the groundwork for understanding pathology, pharmacology, and medicine. A strong grasp of physiology is essential for diagnosing and treating diseases.

Understanding the Human Body – It explains how the heart beats, lungs breathe, and nerves transmit signals, providing the foundation for human biology.

Exam Relevance – Physiology is a high-weightage subject in MBBS, BDS, BSc Nursing, and Paramedical courses, making it a crucial subject for passing exams.

Application in Medical Practice – Knowledge of physiology helps doctors, nurses, and paramedics in patient care, understanding disease mechanisms, and choosing appropriate treatments.

However, many students struggle with understanding and retaining physiological concepts due to outdated teaching methods, lack of interactive study materials, and language barriers. This is where Turning Brain proves to be a game-changer.

How the Turning Brain App is Making Physiology Learning Easier?

1. Full Medical Physiology Course Available

One of the biggest challenges medical students face is finding a complete and well-structured course that covers all topics of physiology in a simplified manner.

The Turning Brain App offers a full course on physiology, covering topics like:

Cardiovascular System – Blood circulation, heart function, and ECG analysis.

Respiratory System – Mechanism of breathing, oxygen transport, and gas exchange.

Endocrinology – Hormonal regulation, thyroid function, and insulin metabolism.

Neurophysiology – Brain function, nerve transmission, and reflexes.

Renal Physiology – Kidney function, urine formation, and acid-base balance.

With detailed explanations, diagrams, and concept-based learning, students can master even the most difficult topics effortlessly.

2. Best Medical Physiology Lecture Videos by Dr. Preeti Tyagi

One of the key highlights of Turning Brain is its high-quality video lectures by Dr. Preeti Tyagi, a well-known physiology expert and educator.

Dr. Tyagi’s teaching approach focuses on:

✔️ Concept clarity rather than rote memorization. ✔️ Breaking down complex topics into simpler explanations. ✔️ Real-life examples to connect physiology to clinical practice. ✔️ Diagram-based learning for better retention.

Students can re-watch lectures anytime, ensuring that they understand each concept thoroughly before moving forward.

3. Separate Courses for Different Medical & Paramedical Students

A common issue medical students face is that one-size-fits-all courses do not cater to their specific needs. The Turning Brain App solves this by offering dedicated courses for different students, including:

MBBS 1st Year Physiology Course – Designed for first-year MBBS students, covering all topics required for university exams.

BDS (Dental) Physiology Course – Tailored for dental students, focusing on oral physiology and systemic functions.

BSc Nursing Physiology Course – Covers the physiology necessary for nursing practice, including blood circulation, respiration, and nervous system functions.

Paramedical Physiology Course – Simplified for paramedical students, with an emphasis on applied physiology for clinical settings.

This structured approach ensures that students get the right content based on their syllabus and exam requirements.

4. Hindi + English Teaching for Better Understanding

One of the biggest barriers to learning for many Indian students is the language of instruction. Many students struggle with complex medical terminology in English.

To bridge this gap, the Turning Brain App provides lectures in Hindi + English. This bilingual approach makes it easier for students to grasp concepts, understand medical terms, and learn efficiently without any language barriers.

5. MCQ Test Series for Self-Assessment & Exam Preparation

No learning is complete without testing your knowledge. The Turning Brain App comes with an MCQ Test Series that helps students:

✔️ Assess their knowledge on various physiology topics. ✔️ Identify weak areas and improve them before exams. ✔️ Practice time management for competitive exams. ✔️ Get real exam-like experience with a variety of MCQs.

This feature is especially useful for MBBS, FMGE, Nursing, and Paramedical students who need constant revision and practice to retain information effectively.

Why is Turning Brain the Best Physiology Mobile Application?

With so many educational apps available, what makes Turning Brain the best?

✅ Expert Faculty – Lectures by Dr. Preeti Tyagi, an experienced physiology teacher. ✅ Structured Curriculum – Covers all topics in a logical sequence. ✅ Flexible Learning – Learn at your own pace with anytime access. ✅ Bilingual Teaching – Available in Hindi + English for better understanding. ✅ Interactive MCQs – Test yourself with a dedicated MCQ test series. ✅ Separate Courses – Tailored for MBBS, BDS, Nursing, and Paramedical students. ✅ Affordable & Accessible – Available on Android & iOS, making it convenient for students everywhere.

Download the Turning Brain App Today!

If you are a medical, dental, nursing, or paramedical student, looking for the best way to learn physiology, then Turning Brain is the perfect solution for you.

🔹 📲 Download the app now!👉 Available on Android & iOS

With its comprehensive course, expert lectures, and interactive test series, Turning Brain is truly the Best Physiology Mobile Application for mastering medical physiology.

Final Thoughts

Physiology is a subject that forms the backbone of medical education. However, with the right resources, learning can be made simpler, engaging, and more effective.

The Turning Brain App does just that by offering top-notch lecture videos, structured courses, bilingual teaching, and MCQ test series, making it easier for students to excel in their exams and build strong medical knowledge.

So why wait? Join thousands of students who are already benefiting from Turning Brain and start your journey towards mastering physiology today! 🎯

[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.

[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.

[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.

[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.

[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