#Ruq

[zelda-without-a-licence-plate]

hehehehoohoo hoo hoo HOO

New fic is up<3 we are EXPANDING.... twilight princess stuff posted... not the full thing lmao that wont be here for a while so here<3

#mod anon #writing #loz twilight princess #LoZ TP #twilight princess link #twilight princess colin #ordon village #subtle lore in here hehehehoohoohoo #Ruq #Link Parent oc invention

[cassiekayscreams]

50 years later… 🔮Ruq and My Stupid Sons: Twisted Wonderland Twisted Halloween 1 Part 2🔮

(Part 1 cuz it’s been 50 years)

I actually had all but the last panel drawn months ago… But lost motivation so. Here it is 😅

Anyways now my random thoughts.

Love the ghosties. New best friends.

Crowley’s sus, as always.

Loved the idea of Ruq using SFX makeup to look spooky. Honestly spookier than the boys. They’re too fashion, silly boys.

Also she’s enjoying being a menace cuz she’s gotta be the responsible one all the time.

Photo op featuring some of my favorite people ever ;) Cuz they’d want a picture with the magic cat

actually super sweet of the boys to put Ruq in the parade. They’re never nice to her and she’s not used to it.

Ruq’s just constantly boutta throw hands with Leona. More on this later.

Seriously Malleus’s conversations are whack.

Okay the group picture took a while. If any of the actual game developers ever see this… I am so sorry. You put so much beautiful detail into these costumes and I have butchered them. Don’t look too close.

Okay byeeeeee

#cassiekay #cassiekayscreams #the writing and art of cassie kay #digital art #artist on tumblr #Ruq and My Stupid Sons #Twisted Wonderland #twisted wonderland oc #twisted wonderland grim #twisted wonderland fanart #twisted Halloween #twisted wonderland twisted Halloween

[timegears-moved]

oh my god the pain really is never ending isn't it

#bwark #this isn't an angst thing i have really ruq pain that came out of nowhere and im having trouble learning what could be the cause #because the pain is my only symptom so it doesn't really feel like a match with any of them :/ #if it continues for a couple more days then i'll go see a doctor. kms myself

[foreveranimegirl]

Willem

Its rare that I see you drinking anything other than tea.

Nygglatho

I'm glad you're here. I'm sick and tired of crying alone.

Willem

In the past, I wanted to fix things that couldn't be fixed, like the tragedies or unhappiness people went through. But I was always too powerless. In the end, I couldn't do anything at all. I thought I'd learned my lesson over and over by now. But I wanted to make Chtholly happy.

Seriously, what did she ever see in me?

Chtholly

How do you not know the answer to that? I mean, you gave me so many firsts.

At that market, you became the first to help me.

You were the first to take me somewhere with a great view.

You were the first to inspire many different emotions in me.

You were the first person to let me lean on them. And you were the first opponent I lost to.

Man, I can't keep count. So it's obvious that you'd be the first person I ever fell in love with.

Take a hint, dummy.

What happened to me, anyway?

I remember getting to the warehouse and having a weird dream. And you just wouldn't come back...

What's with that look?

Willem

Welcome home, Chtholly... Welcome home.

Nephren

A miracle of love?

Ithea

I don't know about love, but this is definitely a miracle.

Knowing her, though, she probably ignored the consequences and paid a huge price to make it happen.

#Anime #What Do You Do at the End of the World? Are You Busy? Will You Save Us? #Shūmatsu Nani Shitemasu ka? Isogashii Desu ka? Sukutte Moratte Ii Desu ka? #WorldEnd #SukaSuka #Nygglatho Astartus #Nygglatho #Willem Kmetsch #Willem #Chtholly Nota Seniorious #Chtholly #Ithea Myse Valgulious #Ithea #Nephren Ruq Insania #Nephren

[mcatmemoranda]

I have a pt with neuropathic RUQ pain and HgbA1c 10.5. He is on insulin, metformin, Farxiga. He is taking these as prescribed. Had extensive and negative GI w/u, so RUQ pain is most likely 2/2 DM. You can increase their basal insulin by 2 units daily until the fasting BG is under 150. Then f/u in 2 weeks for DM visit, which is what we did. You could also add sliding scale insulin.

#neuropathy #diabetic neuropathy #RUQ pain

[flyonthewallmedstudent]

Entamoeba Histolytica

Moving on from Disseminated infections.

and back to parasites, we have this amoeba.

Courtesy of wikipaedia.

One complication is liver abscess.

Image from NEJM

Ring enhancing cysts were seen on CT (requested after the authors noted deranged liver function tests) and on percutaneous drainage (which radiology can do), they had brown cloudy fluid. Under the microscope they noted the pseudopods (leg like extensions).

Classically though, entamoeba causes amoebic dysentery or bloody diarrhoea that develops over 1-4 weeks. However, 90% are asymptomatic. Given the complications/extra-GI manifestations, it can be fatal in a very small minority.

Severe disease/Complications - toxic megacolon (always makes me think of heavy metal bands, in sad actuality it's inflammation that affects more layers and causes the colon to wide. resembling balloon animals) - fulminant colitis + perforation (from inflammation, ulceration etc. that the trophozoites induce, high mortality) - liver abscess (more common, fevers/RUQ/hepatomegaly, transamnitis and jaundice, maybe months before this develops) - rarely: pericarditis + tamponade (from liver rupture, rare but high mortality), pleural effusion & brain abscess (exceedingly rare - but acute confusion + fevers, rapid deterioration) risk factors for severe diseases/complications: malignancy, pregnancy, immunosuppression in general.

Toxic megacolon: Can actually rupture eventually. Courtesy of wiki

Transmission: faecal oral routes (contaminated food/water sources) and it's widely distributed across the world. As with many infectious diseases, it has a higher prevalence in lower socioeconomic groups and regions of the world. Africa & South/Central AMerica have higher rates than other countries (poor sanitation areas, water sources like rivers have multiple purposes for households etc.). Generally, in western countries, it develops in returned travellers who went to endemic areas or immigrants.

Detection: EIA assay for entamoeba antigen in stool, serology (relies on antibodies, so undetectable the first week and last a life time, does not differentiate acute vs past infection), stool MCS for cysts and ova, PCR and colonoscopy (ulcer/erosions, biopsy will reveal cysts and trophozoites)

Treatment: metronidazole in active/acute disease, increased doses in severe/complicated disease or invasive. depending on where you are, also paromycin if asymptomatic or following active treatment to remove cysts.

Consider this in returned travellers with high fevers, abdo pain and bloody diarrhoea lasting > 2 weeks.

Avoids while travelling to endemic areas - uncooked foods, unbottled water/ice cubes, street vendors (what a shame), just anything raw. Practice good hand hygiene.

Sources: StatPearls ON PubMed Amoebiasis on CDC

#entamoeba histolytica #medblrs #medblr #infectious diseases #parasites #parasitology #infectious disease #microbiology

[randomartsideblog]

Okay I'm very sorry but I am going to make my brainrot EVERYONES problem beware of me please

Med student Ami man,

She wears glasses.

She goes international to study, and this is post-Galaxia, so it's pretty chill n any stray monsters are weak, meaning the others won't die without her

Ami calls Mako almost daily (let me have my MakoAmi platonic or romantic) just to talk about whatever and it helps Ami remember her material for tests and Mako just likes hearing her voice/info-dump

Multiple times Ami just thinks, "What if I just dropped out. What if."

Ami is a genius but the medical field is so much and she cries after getting her very first 89%(she got the RUQ and LUQ mixed up on a question about the liver's location and it has cuased her soul to leave her body)

She has so much stress and has never had such a challenge

Ami misses Mako's cooking

Because there's So Much Work Ami only gets a good meal every month or so and her diet mainly consisted of instant-ramen for a time

Mako does not approve.

"Ami, you've mentioned you're usually really busy... when do you cook/eat?"

"Oh, I just eat instant Ramen. If I have free time, I'll eat out somewhere occasionally."

UNACCEPTABLE.

So Ami only eats ramen when there's very little time for anything else and sandwiches have made a comeback.

Mako guided Ami through a cooking lesson once which... went okay...(lies)

Ami talks with all her fellow guardians as well

Usagi mainly gushes about how she misses ami and then oh you better be back for my wedding it's gonna be so amazing oh and did you hear already-

(Ami has heard already. Minako probably told her)

Actually most conversations are gossip

Ami and Minako, like said, mainly consists of gossip, but also Minako mentions of visiting Ami on a vacation maybe, if she can get affordable tickets for everyone

Mina is a rising pop star and showed Ami a song she was writing dedicated to Ami that was immediately scrapped after it was responded to with silence and Ami hung up

(Ami didn't want the spotlight)

Ami n Rei just vibe, maybe vent a little. They grow a bit distant since coexisting is more of their thing

Ami and the outers is more occasional, general chit chat with all of them, more focused topics include:

Smart people stuff with Setsuna and Hotaru

Cars (not the movie automobiles in general but actually it would be funny if they did converse about Cars at one point), engines, ya get it, with Haruka

Swimming with Michiru, but maybe Ami mentions wanting to get more into art and they have a discussion about that sometimes?

Ami loves cats- hence she has tamed tons of stray cats, some of which have followed her to her... condo? Dorm? Idk place if residence and stopped letting them in after (lovingly named) Tuna literally ripped her homework to shreds.

Thankfully, Ami remembered all the answers but she stayed mad at Tuna for 3 days before she caved and forgave the kitty

I'm obsessed with this show.

#headcanon #i DO have a sketch page this is based off of but i wanna post a sketch dump with it so its not too boring #long post #i guess #its long to me ive never typed so much in a post i think idk #random shit #inner senshi #outer senshi #ami mizuno #not all da names bc yehshd

[theunemployedrogue]

God what a joke... 😒

Not only was yesterday a complete bust, but I'm still paying for it today. Woke up from unrestful sleep with back & RUQ pain already. Then I went to the gym and couldn't get thru more than 20 mins on the treadmill because my right leg was just screaming in pain the whole time. Guess that's what happens when you decide to get yourself fucked up and don't eat or sleep enough for your muscles to function, dumbass 🙄

#probably dehydrated af too #no more irrational hedonistic binges for a while 😒 #they ain't lying about that consistent sleep & good diet i feel fcking awful #past week I've been pretty stressed and not sleeping right tho tbh #bullshit #personal

[leafdlc]

can someone relieve this ruq pain for me bc I am about to become the joker.

#was waiting at a different one frkm 9 this morning for 4 hours and thwn left becaus they had a 3rd degree burn victim - #that had been waiting for an hout already. in the waiting room #doctor i know the bleedings internal and thats where the blood is supposed to be but somethingnis wrong 😳 #anyway ive switched towns and been at this one for 3 hrs now. had to call out 😔👍 #leaf talking

[walkalittleline]

attempted to make it through OCtober with npcs from my campaign until my wrist gave up but I made it pretty far!

Starting top left they are:

1st row: Ajwa, Puddle, Terinak Siphra, Aliari Iponette, Ruq

2nd row: Nikaemo, Mirabella Fonde, Virtue, Lythir Xin

3rd row: Paelias Lathe and Benjamin IV, Landon Whytecliff, Maurelian Tambor, Claather McKeague

#dnd art #d&d art #this was a lot of fun figuring some of them out I’d never drawn before! #my art

[spiceroll]

kinda late to check out his summer voicelines but i got bored

they aren't you goof!

and it's in engrish too lmao

interesting, so what I'm getting is archer has a planned future RUQ to grant him rho aias, or even better new ssr variant with aias in his kit (delusional)

might just be me but what is he talking about...? :v

#fate series #archer emiya #heroic spirit emiya #fate grand order

[cassiekayscreams]

Livin’ the dream

#forgot to post to tumblr again #whoops #Ruq and My Stupid Sons #Twisted Wonderland #Twisted Wonderland OC #gotta love pockets #all girls love pockets #digital art #cassiekay #cassiekayscreams #the writing and art of cassie kay #artist on tumblr

[kneehoming-knee]

MACHINE "PROCESSED TOO FAST RUQ PAKI BABY THE BABIES "IPASSED YOU THEY SLEEP" PLAID YELLOW RED ROBIN HIS BEARD NORMALLY "MESOPOTAMIAN"

[mcatmemoranda]

Decompensated cirrhosis

Albumin, INR, and platelets tell you about decompensated cirrhosis

Get MELD score (tells you about prognosis) and Child Pugh score (estimates cirrhosis severity). MELD-Na is a new version of the MELD score that is better than the MELD and includes Na+; it's based on whether pt goes for dialysis twice weekly, Cr, bilirubin, INR, and sodium. MELD-NA tells you the severity of end stage liver disease. Pts who present with bleeding varices or ascites have decompensated cirrhosis and worse prognosis. So calculate the MELD score to educate the pt about his/her prognosis. Child-Pugh is based on total bilirubin, albumin, INR, Ascites, Encephalopathy.

Maddrey's discriminant function suggests which patients with alcoholic hepatitis have a poor prognosis and would benefit from steroids. It's based on PT and total bilirubin.

Cirrhosis is decompensated if the pt has varices or ascites.

Pts who present with bleeding have 50% mortality in 6 months.

All cirrhotics should get an EGD to evaluate for presence of varices.

In pts with ascites, calculate the SAAG score, which tells you whether the ascites is due to portal HTN.

Patients with SAAG greater than or equal to 1.1 gm/dL is considered as having high SAAG, indicating the presence of portal hypertension, while those with SAAG less than 1.1 gm/dL are considered as having low SAAG, indicating the absence of portal hypertension.

This is an example of a GI note for a pt who came in with decompensated cirrhosis:

Pt is a ----- w/ a PMH of hepatitis C, EtOH abuse, tobacco use, and IVDU who was admitted for acute decompensated liver cirrhosis w/ascites. 1. Acute decompensated liver cirrhosis w/ascites New diagnosis of liver cirrhosis likely 2/2 EtOH/hepatitis C. MELD score = 21, indicating 19.6% estimated 3-month mortality. Notable symptoms include scleral icterus and abdominal ascites. Low concern for SBP in the absence of fever, leukocytosis, or peritonitis. Initial labs include hemoglobin 14.5, platelet count 113, INR 1.6, PTT 29.2, total bilirubin 8.3, AST 125, ALT 58, albumin 2.7, total protein 9.3. No evidence of anemia. Parsaesophageal varices suggested on CT imaging require eventual EGD for further evaluation.

Ceruloplasmin and AFP normal. Iron studies and alpha-1 antitrypsin indicative of inflammation. Additional labs pending. 4L ascitic fluid removed during 9/7 paracentesis. PMN less than 250, which is not indicative of SBP. Ascites albumin pending for SAAG calculation. RUQ U/S demonstrates slowed portal vein flow, though no evidence of masses or thrombosis.

-acute hepatitis panel, ANA (anti-Nuclear Antibody), ASMA (Anti-Smooth Muscle Antibody), AMA (antimitochondrial), SPEP (Serum Protein Electrophoresis) pending -less than 2 g daily sodium restriction -ascites fluid analysis w/ cell count, albumin, and protein for calculation of SAAG -ammonia level pending -confirm vaccination status of HAV, HBV, influenza, Pneumovax, Prevnar -avoid NSAIDs + counsel for alcohol cessation -steroids for EtOH liver disease contraindicated due unclear hepatitis C status -MRI abdomen for evaluation of portal vein thrombosis/masses -100 mg spironolactone + 40mg lasix qd

2. EtOH use Hx of significant alcohol use over the past 6 years w/o reported hospitalization. Reported taper from 3-4 glasses of vodka daily to several ounces daily; last drink 3 days ago. No withdrawal symptoms at this time. EtOH level less than 3 on admission. Suspected primary etiology of liver cirrhosis.

-management of potential withdrawal symptoms per primary team (CIWA protocol without ativan) -cessation counseling strongly recommended in setting of liver cirrhosis -potential options for medication assisted therapy include acamprosate, naltrexone, baclofen, or gabapentin -nutrition therapy including multivitamin, thiamine, and folate -recommend nutrition consult

3. Hepatitis C Reported hx of hepatitis C not previously treated, unknown genotype. Last seen by GI prior to COVID.

-HCV viral load + genotype pending -outpatient GI f/u for further management

4. Paraesophageal varices on CT Confirm CT findings w/ EGD prior to considering initiation of beta-blocker. -outpatient EGD, unless concern for GI bleed or masses seen on abdominal MRI

5. Family hx of colon cancer

Sister diagnosed w/colon cancer. Pt has not had colonoscopy to date. -outpatient colonoscopy recommended

#cirrhosis #decompensated cirrhosis #liver failure #SAAG

[nsepath-blog]

Empowering Muslim Voices: Asmaa Hussein's Inspirational Journey with Ruq...

#youtube

[theunemployedrogue]

Woke up with RUQ pain and a black hole of despair in my brain.

#overate last night not surprised by one of these #guess I'll drag myself to the grocery store or smth but i have a feeling it's not gonna be a productive day #personal #negative