#hb-5 side effects

[benilos]

I don’t know anything about your timeline so bleas share 🥺🥺🥺

In case that's hard to see, synopsis is Downfall Timeline is:

-Era of the Hero of Time's (Adult Era Failure), brings on the Second Imprisoning War of this entire timeline set, which is the sealing of Ganondorf Dragmire (OOT Ganondorf)

-Era of Light and Dark (A Link to the Past, Link's Awakening and Oracle games Link, then about 60 years after we see the A Link Between Worlds/Triforce Heroes Link)

-The Golden Era (this was just in the Hyrule Historia Timeline i actually cant remember what occurs here cuz i dont really actively use this era)

-Era of the Decline (Zelda I/II), followed by the journey of Marrel Typhlo (Cartoon Link)

-Era of the Split (this about a few thousand or so years after the Decline, and includes the events of the Hero that split Ganon's soul into four as told in Hyrule Warriors, there were a number of non-named Heroes and fights against Ganon during this time, but this era specifically features a Timorine Ganondorf, as Timori often has a tribe of Gerudo that live on the opposite side of Gerudo Desert from Hyrule's end of it.)

-Era of Peace, the thousand year period between the Split and the War Across the Ages

-Era of the Merge, (Hyrule Warriors and the War Across the Ages, also the point at which the timelines re-merge into the Converged Timeline, which goes precedes BOTW and the First Calamity and all of that.)

Enjoy my word vomit that makes no sense under the cut

The Downfall Timeline includes Pierce, Tyrant, Tear, Ravio, Lucky, Linkle, Cartoon Link, etc and their buddies in their Eras and all that.

Most of these eras are kinda unique in HB as they all see a LOT more interaction with my crafted sister-country to Hyrule, Timori (which is considered the Light World counterpart to the Twilight Realm, aka Twilim.) It also sees just, a lot more space travel rather than time travel then the rest of the timelines, cuz we get to see more of Holodrum, Labrynna, Hytopia, Lorule etc, as well as a LOT more traversal of my Dark Worlds, like Trigivin (Lorule's Dark World, as Lorule is considered a Light World in my series), and Fayris (the actual Dark World to Hyrule). The only one that doesn't get shown as much is Twilim, other than Lepus's appearance, as he's a Twili. So much of this does not make sense lmao, I gotta remember not everyone was here for the days of the HB discord server.

This is like, my favorite of my timelines though, because for one it has the most people in it and is my most finished end of the Paths in HB (timeline paths). Lucky (HW Link) has probably the most fleshed out background, Pierce (ALttP Link) is my most influential Link, as him veering from the Path he's meant to take could literally wipe out the majority of Hyrule, Lorule and multiple other worlds because of his lineage and what his lineage ends up accomplishing. The Tepir line (Linka Tepir being Pierce's real name) is my most well-tracked family in this series too, cuz it includes the entirety of the Royal Family after ALttP as well as almost every Link that succeeds Pierce.

I put Hyrule Warriors into the end of the Downfall Timeline mostly cuz i just feel like it fits so perfectly there? Like, idk I always felt like it fit there best. When the Era of the Merge occurs, theres a period of time spanning maybe 4 or 5 generations, where all three timelines just, meld together? It happens in such a way that somehow, no one can tell. Once the generations that were there when it happened are dead and gone, no one actually realizes that their world is completely different. It has a slight brain fog effect on the people that come after, and also kinda has a hand in creating the idea of the Era of Myth later into the Merged Timeline, so as Hyrule progressed into the much more advanced form its in by the time of the First Calamity, that fogginess on what exactly occurred prior is what makes people so unsure whether or not that time actually existed. Which also has a hand in why Rauru and Sonia believe theirselves to be the founders and first royals of Hyrule, because there are no records left at that time. They're going off of pale remnants of legends and theories that constantly contradict each other due to how the timelines merged. Nothing seems to add up so its regarding as tall tales and bedtime stories. I'm going to freak out I could word vomit about this for ages.

#skull talk #links meet #links meet au #loz #loz au #hyrule-bound #downfall timeline #hyrule bound #hb #friend hero #totk #hyrule warriors #fuck it im not #tagging everything hhhhhhhhhhhhhhhhhhhhhhhhhhhh

[crossstitchclub]

New Post has been published on Free embroidery designs

New Post has been published on https://embroidery-designs.org/silken-orchid-embroidery-project/

Silken orchid-embroidery project

Silken orchid-embroidery project

Lily Wong captures the delicate beauty of this bloom forever with her skilful use of variegated ribbons and thread.

MATERIALS

• 45cm x 35cm (18in x 14in) rectangle of light green damask

• DMC Stranded Embroidery Cotton: 1 skein of cream (712)

• Edmar Beta thread: 1 skein of variegated green (17)

• 15mm (5/8 in) Hanah Silk Ribbon: 1.2m (1 ¹⁄³ yd) bridal ivory; 40cm (½ yd) mossy

• 10mm (³⁄s in) Hanah Silk Ribbon: 40cm (½ yd) passionate daisy (yellow/red); 20cm (¼ yd) bridal ivory

• No 16, 18 and 20 chenille needles

• No 8 crewel needle

• 30cm (12in) embroidery hoop

• HB pencil 

FINISHED SIZE Design area: 21cm x 8cm (8¼in x 3in)

STITCHES USED French knot, pistil stitch, ribbon stitch, running stitch, stem stitch

PREPARATION

Transfer the stem and flower positions from the pattern sheet to the front of the damask fabric using your preferred method.

Put the fabric in the hoop and tension it until it is drum tight.

EMBROIDERY

Note: Use the No 16 chenille needle for the 15mm (5/8 in) ribbon, the No 18 for the 10mm (3/8 in) ribbon and the No 20 for the Beta thread. The crewel is used for the stranded thread.

Flowers: Work all three in the same way. Keep the ribbon stitches loose for a full, three-dimensional effect.

Using the 15mm (5/8 in) bridal ivory ribbon, work the outer layer of petals in ribbon stitch, see diagram 1.

Cut two 5cm (2in) lengths of the same ribbon and with one strand of 712, running-stitch around three sides as shown in diagram 2.

Pull up the thread to form a rounded petal and secure it.

Place these two petals over the other three with the gathered edges together in the middle and sew them in position with the same thread, see diagram 3.

With 10mm (3/8 in) passionate daisy, bring the needle up in the centre and ribbon-stitch a petal over each side of the gathered ribbon and another one downwards between the two outer petals. Make this stitch a little longer than the other side ones, then sew a French knot in the centre with the same ribbon.

Run a pistil stitch from the centre towards the upper petal with 10mm (3/8 in) bridal ivory ribbon.

Open bud: Work two ribbon- stitch petals fanning out slightly from the centre in 15mm (5/8 in) bridal ivory ribbon. Then with 10mm (3/8 in) passionate daisy ribbon, form a short ribbon stitch on top between the first two petals.

Cut a 5cm (2in) length of 15mm (5/8 in) bridal ivory ribbon and make a gathered petal as before. Attach it to the base of the ribbon-stitch petals and then work another ribbon-stitch petal on each side of it, also with the bridal ivory ribbon.

To finish the open bud, thread one strand of 17 in the needle and bring it up at the base of the petals. Take the back of the needle under the ribbon, around the loop and then through it before pulling it in a knot. Then stem-stitch down to join the main stem line under the top flower in the same thread.

Large bud: Using the 15mm (5/8 in) bridal ivory ribbon, ribbon-stitch one petal on the fabric and two more over the first one. Then again with the back of a needle, lift these petals up a bit so they stand over the back one.

Work the loop around the base and the stem in the same way as before to join the main stem line.

Small buds: Stitch two ribbon-stitch petals over each other with 10mm (3/8 in) bridal ivory ribbon for each of the three buds at the top of the marked stem lines. Then work the stems in the same way as the previous two buds.

Leaves: Using 15mm (5/8 in) mossy rock ribbon, work these at the base of the stem in ribbon stitches of varying lengths as shown in the photograph. To make them look three-dimensional, don’t pull them too tight.

Stem: The main stem is sewn at the end as part of it goes over one leaf. Beginning under the top flower, stem-stitch down the line under the left-hand flower to join the stem on the right-hand one, then continue down to the base, taking the stitches over one of the leaves and under another so the stalk seems to emerge from it.

FINISHING

Take the work out of the hoop and have it framed as you prefer.

Download the description and charts for Silken orchid-embroidery project:

Download

#embroidery project #flowers #ribbon embroidery

[artleaguemdcnorth]

DRAWING CLASS / MIDTERM ASSIGNMENT- 2/21/24

This assignment is going to take many hours of work beyond class time.

A good assignment starts with a good prop.

I have been trying to instill that idea on all of you since the first day.  

There is no reason to have a pop tart box in your midterm assignment or an olive oil bottle unless you are making a statement about nutrition or genetically modified ingredients in foods.

There are two components to your assignment this time, narrative and technical skills.

Narrative relates to your critical thinking skills and technical relates to your ability to define form through value.

You need to find a lighting condition that can let you express form. Adding a lamp or directional light will help you create a dramatic effect.

You will be using graphite pencils that range in value from HB to B8 .

Using a pencil requires that you use the side on the lead and not the point.

You do not want to scratch the paper , you want to render soft values that are blended as you work.

Smudging the paper is not a solution to developing values.

Value is developed by using various pencil grades.

HB is middle tone.

B1 is lighter than B4 but darker than HB.

I suggest you do some value charts with your pencils on your sketchbook .

Get in the habit of testing your values as you work.

Another tip that I can share, is that you use a tissue paper so that you do not smudge and stain the paper as you work.

This assignment will be graded at 30% of your overall class grade.

It is important that you treat the execution with outmost care.

I  included below an A grade assignment from a previous student for you to consider as you begin your assignment.

You will have time to work on this beginning today through Sunday, MARCH 3rd at 5 pm,  TO COMPLETE THIS ASSIGNMENT.

You will be working on this assignment at home on your own. 

I will look into giving you class time on week two to also work on it.

You will also need to work on this asignment during homework time .

You will be working on the midterm beginning today through 3/3 and Homework time beginning this afternoon.

Monday 3/4 , bring the completed assignment to class for a critique.

The work by Lorena below took 40 hours to get to that stage of development. You can not work on this assignment for 40 hours at a time.

It will require a slow and methodic engagement of many days and weeks to complete this.

Do not procrastinate, pace yourself, it can be done.

Homework time after class beginning today :

Make sure to post progress on your Tumblr for each day you are working on this assignment. I want students to show progress on this assignment from the first day to the last.

Include a photo of your still life reference only on for the first day of this sequence , meaning tomorrow.

This is a Midterm Exam grade worth 30% of your overall class grade and you have to do it on your own.

I can not give you suggestions , I have already given you two examples of what an A grade assignment looks like.

This assignment can not look like your class work.

It needs to be superior in quality and content.

I have provided you with tools, artworks, history and other information to assist you in doing a good job.

Now you need to rise to the occasion to meet this challenge.

IMPORTANT NOTES AND TIPS :

1) Unless you are a shoemaker you should not include shoes in your drawing.

2) You should not include objects that are larger than the rest of your objects (footballs, basketballs, guitars, golf bag).

3) Your Still Life needs to be in a proper pedestal , table or platform with a backwall and proper lighting source.

4) I will include a video above of how to make a shadow box to improve your lighting and your imagery.

It is up to you if you want to use it or not.

This is a tool used by artist to create an atmosphere and lighting ambience for drama.

The shadow box can not be included in your drawing is just a tool to help you see shadows and value contrasts.

5) You cannot use charcoal pencils only Graphite Pencils.

6) Your objects cannot float so you must include reference to the horizon line , that is were your platform and the wall meet.

7) There are other students in this class, reach out to them. Feel free to seek peer support from each other back and forth. Share suggestions and photos and process of your work .

Weds (2/21) is the day to ask any questions during class.

Please see student work below in addition to the work shown in class:

Excellent execution

A

B

[imolelalade]

some random power info stuff and naijapunk scenerio/fanfic idea I randomly came up with

(A/N: All mentions of HB/Hobie refer to Nifemi’s variant of Hobie on her earth, Earth 1960, not ASTV Hobie. This still counts as an oc x canon to an extent, so if you don’t like, don't read) 

Alright here we go, 

In addition to the basic spiderpowers like wall crawling, webs and spidersense, Nifemi also has this bioluminesence thing that happens when she feels strong emotions. Like her freckles kind of glow and she has this aura thing.

So basically she’s like a human LED light or nightligt of some sort

(On as side note, GUYS DID YOU KNOW SPIDERS ACTUALLY HAVE BIOLUMINESCENE< IT’S SO FREAKING COOL)

The glowing kind of brightens and dims depending on the severity of the emotion

The colors also vary depending on the emotion:

Yellow- Happy

Blue- Sad

Red- Angry/ Annoyed

Pink- Love/Flustered

Whitish- Neutral

This power doesn’t per say, have a specific use in combat, except maybe throwing off suspicions about her identity to a certain extent, ‘cause everyone knows Anansi as a glowy superhero so who’s going to even suspect that drab Nifemi is the same person (see, I’m a genius)

 But in reality  I added it mostly to have the most effect on her civilian life.

As I said earlier in her intro, Nifemi already has problems opening up to people, whether it be in friendships or any sort of relationships. But just because she can’t physically open up to people doesn’t mean that her body can’t give her away in certain aspects.

When she developed this particular power, Bolatito being the queen and tech whiz that she is made her this Light Control Bracelet thing (Imma call it LCB for short), that put a sort of dampner on this power.  

It looks like a metal cuff bracelet and it just goes with the rest of her other bangles and stuff, 'cause she already wears a good amount of those to hide her spinnerets [organic webbing and such]

(I'll draw a pic later)

She wears it in public so she doesn’t turn into a human nightlight at every slight provocation and like expose her secret identity and what not.

Downside to the bracelet is that Nifemi can only wear it in like 5 hour spans and needs alike a 15-20 minute break in between so she doesn’t “burn up” per say. Basically like a cooling down process.

She wears it mostly at uni, at hangouts and anywhere in public

She doesn’t wear it while she’s out as Anansi or when she’s alone in apartment, or only with Bolatio, ‘cause, only wears it when it’s necessary.

In addition to this power turning her into a lightbulb, the aura she gives of also literally “burns” her calories, so this girl has a CrAzy metabolism

(Fun Fact: This is based of my own crazy metabolism)

So she’s basically a slightly less intense version of Barry Allen.

And as a result:

Ms Girl. Cannot. Get. Drunk.

Earning her the role of designated caretaker at all bar and club related hangouts

Meanwhile Bolatito (16) and Hobie (18) are drinking buddies

Constantly going out and dragging Nifemi (18) and Miles (17) along most times, mostly Nifemi though, ‘cause Miles some how finds a way get out of such matters and also, to me, he just doesn’t seem like the bar-type hangout person.

Nifemi on the other hand, literally has no choice.

If Bolatito is like “Get up we’re going out” Nifemi is like, “Ughh, fine”

Plus, if Hobie is going to be there, who is this love-struck idiot to refuse such and opportunity.

Anyways,

Bolatito gets loud and stupid when she’s drunk

Screaming, babbling mess. Flirting with Miles at every moment (even more so than usual). Laughing one second then crying the next. Bi-polar little thing [mid weight]

HB however get’s like mellow and quiet when he’s drunk [heavy weight]

Quiet groaning, not saying much, slurring his words, clingy mess.

Also no mental filter on this man when he’s this state

Like, he’s saying the first thing that comes to mind, no thinking

So,

This man will flirt with Nifemi when he’s drunk making her so flustered

BUT HE WON’T REMEMEBER WHAT HE DID WHEN HE’S SOBER!!!

Okay, back to Nifemi’s power and it’s “effects”

Before Hobie found out that Nifemi was Anansi, she always wore the LCB around him, even on one on one hangouts

B/c if she didn’t she’ll turn into a glowing pink lightbulb everytime this man talked because as I mentioned in my ‘Timeline of Love 1960’ post, his voice.

However,

There was one time that she didn’t wear the bracelet

(Luckily HB didn’t remember the full incident but-)

Basically:

- This was before she and HB officially got together

- They were both in that awkward friend phase, with Nifemi being to emotionally constipated to confess and HB liking her and unknowingly making this girl flustered

- While Techflower (Bolatito and Miles) is on the sidelines, eating popcorn and watching this trainwreck

- So Nifemi, Hobie, and Bolatio had gone to this Nigerian pub/club thing to just, hang out

- More accurately, Nifemi had been dragged out by the other two to go socialize in society

- At the club, HB and Bolatio being the buds that they are of course get stupid drunk

- While Nifemi, b/c of her light power thing, cannot get even mildly intoxicated (poor baby)

- So before HB and Bolatito do something that they would regret for the rest of their lives, she decides to be a good friend/sister and get them back home safely

- She also has to get home ‘cause before this she had been wearing the LCB already so she was like 45 minutes away from 'burn up time’

- She also makes the decision that it’ll be smarter to take both of them back to her apartment instead of dropping HB back at his place, so it’ll be easier to keep an eye on them and deal with their hangovers in the morning

(A…tiny mistake on her part)

- So she bundles up the two mess, pays the bill and gets them out of there

She has that spider strength, so it’s like no problem wrangling them back to her place

- By the time they get back to her apartment, Nifemi has like 15 minutes left on her bracelet timer, so she removes it, keeps it on its special dish next to her uni ID and decides to take care of the two idiots (lovingly)

- She carries Bolatito, who is passed out, to her room, tucks her in and then goes back for Hobie

- HB at first glance also seems knocked out cold, so Nifemi’s like,

‘Alright, this’ll be easy’

- And just picks him up as well

- Keep in mind that Nifemi’s like 5’6, 5’7, no noticeable muscle, probably would get winded climbing up the stairs if not for her powers

- And Hobie’s like a 6’3 lanky but at the same time heavy man

- So I guess he’s not like used to the feeling of being carried, so the movement kind of like jostles him awake

“You’re pretty strong luv”

- AARGHH, his accent, one of my baby’s only weaknesses

- So in Nifemi her classic Nifemi fashion, is like:

“Oh really, um-okay, I-I uh d-didn’t notice, that’s uh something-” 

- stammering, pathetic mess (oh I love her so much)

- HB just snickers at her response, closes his eyes again and presses himself closer into her, mummering slightly:

“You’re cute when ya all flustered”

Nifemi.exe is shutting down

- Nifemi is done. Finished. Over with. KO-ed

- This man don knock this girl speechless

- And her body gives her away by, you guessed it, glowing

- She was now cosplaying a glowing pink nightlight on it’s highest setting

- She, of course, panics

- Drops HB, who is once again passed out, in the guestroom and hightails it out of there

- Timeskip to the next day, HB can’t remember anything that happened in the midst of his hangover

- Except

- Some glowing pink light that his brain subconsciously links to Nifemi

- And he now has the urge to call Nifemi ‘nightlight’, which he does consistently

“Hey nightlight”

“Wha..”

And that concludes the end of my delusions, if you're still here thanks for reading.

Here’s my favourite pretty picture of Hobie:

#just had a random idea of them a while ago #felt like posting it #their ship name is naijapunk #Nifemi is a living nightlight and Hobie unknowingly uses it against her #lalatalks #Nifemi #Hobie #hobie x oc #oc x canon #naijapunk #spidersona #drabbles #fluff #this is so cringe actually dying #ocs #variant hobie

[impossiblemakerfire]

Hb5 Hormonal Harmony Reviews: A Full Report on Support for Hormone Balance! 

Hormonal Harmony HB-5 Supplement - hb5 hormonal harmony reviews, We talked about everything there is to know about the Hormonal Harmony HB-5 supplement. In-depth reviews of Hormonal Harmony HB-5, including pros, cons, and dosage. HB5 Hormonal Harmony is a weight loss supplement whose makers say it can change hormones to help people lose weight in a healthy way. The plan has thirteen effective herbal ingredients that are made to target the exact cause of weight gain that so many people are dealing with. The real question is whether it can help balance hormones and, more , if it has any dangerous side effects. If you read the online reviews of Hormonal Harmony (HB-5 reviews), you'll find that there are some very serious problems that need to be fixed. Go to the real website. Weight management is something that most people in the modern world give a lot of thought to. As we get older, our bodies, weight loss plans, lifestyles, and hormones all change in ways that are both good and bad. Unwanted changes include putting on weight, which can make you obese or obese. In this case, Hormonal Harmony, also called HB-5, could also play a role. You might decide to go to the gym every day for a long time to lose the extra weight that is keeping you up at night and making you fat. There are a lot of dietary supplements on the market that say they will help you lose weight faster but leave you frustrated and still overweight. Hormones in your body affect how much weight you gain or lose. For your plan to lose weight to work, these hormones need to be in balance. Many supplements try to change how a single hormone works, but hb5 hormonal concord doesn't do that. This dietary supplement affects how five hormones move in the body. These hormones have an immediate effect on your efforts to lose weight. It saves you a huge amount of time and energy that you would have spent at the gym every day. You could lose weight if you took the supplement and worked out for a few minutes.

Reviews of the Hormonal Harmony HB-5 Supplement | ConsumersCompanion

Everything about the hormone balance supplement Hormonal Harmony HB 5 was talked about. Full reviews of Hormonal Harmony HB-5, including benefits, side effects, and how much to take. Everything about the Hormonal Harmony HB five supplement was talked about. Detailed reviews of Hormonal Harmony HB-5 with pros, cons, and dosage. Hb5 hormonal harmony reviews,Everything about the supplement Hormonal Harmony HB five for hormone balance was talked about. In-depth reviews of Hormonal Harmony HB-5, including pros, cons, and dosage.  Hormonal Harmony's new HB5 dietary supplement looks like a promising way to deal with hormone blockage, and thousands of people who are trying to lose weight are interested in it. If you are one of the hundreds of people looking for real HB5 reviews, you have come to the right place. Tens of millions of women and men around the world have problems with hormone blockages. But few people know how bad it can be for our bodies. Hormone blockages can lead to anxiety, brain fog, fatigue, and weight loss, among other things. Because of this, it is important for normal health to have a good balance of hormones. In this case, a nutritional supplement like Hormonal Harmony HB5 could save your life. This HB5 review will look at the HB5 supplement, its ingredients, and its benefits in a lot more depth than any other online review of a hb5 hormone supplement.

What is the HB5 Hormonal Harmony?

Hormonal Harmony HB5 is a supplement that comes in the form of small pills. It was made by Dr. Eric J. Wood and claims to help with hormonal problems like weight loss, fatigue, brain fog, and stress. HB-5 Hormonal Harmony is a supplement to your diet that helps with five hormonal problems that make it hard to lose weight. Also, it helps with stress, brain fog, fatigue, and increasing your metabolism. This nutritional supplement was made by a group from Hormonal Harmony Labs led by Dr. Eric J. Wood. The reputable website says that to lose the most weight, five hormones need to be in balance. Thyroid, insulin, estrogen, cortisol, and leptin are some of the hormones. Also, the website says that HB-five is a dietary supplement made from natural ingredients, i.e. H. Vegetation, herbs, minerals and vitamins. When you take this dietary supplement, you can be sure that it will have a good effect on your metabolism and fat loss system, helping you lose weight with little to no effort. Did you know that your hormones play a role in how much you weigh? Or would you have never thought they had anything to do with losing weight? According to a trustworthy website, this dietary supplement helps clear up the 5 hormonal blockages that cause "weight loss resistance." The thyroid, cortisol, estrogen, insulin, and leptin are the 5 hormones that can get blocked. Clinical research has made it easier to treat all five of these hormone blockages. The HB5 supplement is the result of many years of medical research. It is made from all-natural ingredients like Kelp, Rhodiola Rosea Extract, Diindolylmethane, Cinnamon, and African Mango, which all work to fix hormones.

What are the ingredients in the HB5 Supplement?

The Hormonal Harmony HB5 Dietary Supplement is made up of 13 ingredients that have all been shown to work in clinical trials. Kelp is a type of seaweed that is high in healthy vitamins and minerals, especially iodine. According to a study published by the American College of Endocrinology, taking kelp for a short time raises TSH (thyroid hormone) levels by a lot, both at rest and after a stimulus. Studies also show that kelp restores thyroid function, normalizes UICs (urine iodine sensitivity), and helps the body make more T3 and T4. Magnesium is a mineral that is important for the body to work well. It is needed by every cell and in more than 300 enzyme reactions. The most important things it does for the body are to control blood pressure, help the immune system, and help muscles and nerves work. It also makes it possible to move the thyroid hormones T3 and T4. Zinc: Zinc is a "crucial trace mineral" that is important for health, but the body doesn't always store enough of it. Because of this, it needs to be eaten often with food. Selenium: Selenium is also a "vital trace element" that needs to come from food. It is needed for many important functions, such as brain function, metabolism, and thyroid function. Copper: Copper is an important trace element for all living things because it is a big part of the enzyme cytochrome c oxidase, which is needed for breathing. It's most often found in the bones, liver, and muscles. Copper helps keep nerves and blood vessels healthy and also plays a role in getting the thyroid hormones T3 and T4 to where they need to go. Manganese: Manganese is a small amount of a trace element that the body needs. It works with many different enzymes to help them do their jobs. It helps with many parts of the body, like the way amino acids, carbohydrates, cholesterol, and glucose are used. It is also a very important part of bone growth, blood clotting, and thyroid function. Vitamin B12, which is also called cobalamin, is a water-soluble vitamin that is important for the metabolism of every cell in the body. It is especially important for how the nervous system works, but it also affects how the thyroid works. Bladderwrack is a type of seaweed that is high in iodine and has been used for a long time in traditional medicine to treat iodine deficiency, obesity, and thyroid problems. Rhodiola Rosea Extract: Rhodiola is a perennial flowering plant that grows in the wild arctic regions of Europe and Asia. Several medical studies show that this herbal extract can help reduce stress by keeping cortisol levels steady and making the body's fat-burning system work better. Studies also suggest that it might help reduce tiredness and improve mental performance. Red Ginseng: Ginseng is the main plant in the genus Panax, and it has been used in traditional medicine for a long time. Researchers have found that pink ginseng root extract lowers the amount of cortisol in the body and makes people feel less stressed. People also say that it helps people lose weight. DIM (diindolylmethane) is a natural compound that is made when the body breaks down indole-3-carbinol, which is a chemical found in cruciferous vegetables like broccoli, cabbage, cauliflower, and kale. Scientists found that DIM changes the way estrogen is broken down in a study that was published in the journal Tumor Immunology and Immunotherapy. It is also said to stop people from getting fat from eating too much fat. Cinnamon: When used in the right amount, the spice cinnamon is said to lower the fasting plasma glucose price. A study in the Journal of Traditional and Complementary Medicine shows that cinnamon lowers insulin and cholesterol levels and stops blood sugar from going up and down. It is also said to make people less fat by lowering their BMI. African Mango: Irvingia Gabonensis is a tree that grows in central and western Africa and has a fruit that looks like a mango. It is also called African mango. Studies show that African Mango lowers the amount of leptin in the body and helps bring body weight, body fat, and waist circumference back to normal. >>>Click here to book HB5 on the website for professionals

What are the benefits of taking the Hormonal Harmony HB5 supplement?

Balancing hormones: According to Dr. Eric J. Wood, the real reason fat seems to keep moving to the stomach and thighs is that hormones are getting in the way.hb5 hormonal harmony reviews, Hundreds of thousands of men and women have these blockages, which cause something called "weight reduction resistance." The HB 5 supplement gets rid of these hormone blockages and helps keep your hormone levels balanced. Improving the skin's look: When hormones are in balance, there are many other benefits as well. The best thing, though, is the change in the texture of the skin. The herbal ingredients in the HB5 supplement help to clear up the skin, making it look better and feel softer and smoother. This product has a lot of good things going for it. Here are some of the many reasons why you should check out this product. It keeps the five hormones that cause weight loss in balance. Hb-5 helps leptin, a hormone that helps control hunger, do its job. If you don't have enough leptin, you might want to eat unhealthy foods and gain weight as a result. - Hormonal balance makes stress lessen. - It also helps your skin look better. - Boosts metabolism and makes low power better. - It makes you feel better and gives you more power. In the end, this Hormonal Harmony Supplement does a great job of focusing on all 5 hormones that cause so many people to gain weight. Improved mood and energy is another benefit of taking the HB5 supplement. The ingredients used in the supplement, which are

Supplementing with HB5 Can Cause

As far as my research can tell, the Hormonal Harmony HB5 weight loss supplement has no side effects that can be seen. In fact, I couldn't find any online or old reviews of HB5 hormone supplements that complained about side effects. But it is suggested that women who are pregnant or breastfeeding, as well as those who have a known medical condition, talk to a doctor before taking the HB5 supplement.

HB5 doses and uses

According to a trustworthy website, the best way to take the HB5 supplement is three capsules every day, with or without food. Since these pills are small, it shouldn't be hard to take 3 at once. Each bottle of the HB5 hormone supplement has enough drugs for 30 days. Most of the time, it is suggested that you take the supplement every day without any side effects for at least two to a few months for the best results.

Is HB5 like a magic pill?

Hormonal Harmony Doesn't Work HB5 is no longer a miracle pill. In reality, the phrase "magic tablet" should make you suspicious, because these products are usually scams. There are no short cuts when it comes to your health. HB5 hormonal balance is a dietary supplement that has been tested and proven by science to help break down the biggest barriers to weight loss. It works on the thyroid, excess cortisol, estrogen, insulin, and leptin, which are the five hormones that can get stuck. Even though it only takes 30 seconds to take the pills and you may notice small changes within a few weeks, you will need to put in a little more work if you want to see the full effects. You should take it for at least three months and act in a healthy way. After all, nothing comes for free without some work.

How does it work?

HB complement Reviews

HB-five is a weight loss supplement that works to fix the five hormones. Different organs in the frame secrete unique hormones. These hormones are what make sure our bodies work well. If even one of them is out of balance, it can change the weight in a big way. The thyroid hormones, cortisol, estrogen, insulin, and leptin are all affected by the HB-five supplement. When all these hormones work well, a person can live a happy, healthy life. But when they're not right, it can be easy to put on weight. You can also try the Over 30 Hormonal Solution, which has some of the same components. Click here to see what people have said about us. thyroid hormone The thyroid gland makes a hormone called thyroid hormone. This hormone is important because it controls the speed of the metabolism. When the metabolic rate is high, energy and fats are burned for power. This stops fat from building up, which leads to a loss of weight. This strength makes sure that important parts of the frame are done well. Hormone cortisol The stress hormone is another name for the hormone cortisol. Cortisol levels go up when you are in a stressful situation. When this happens, the body goes into a mode that helps it stay alive. The mind stops the body's metabolism, digestion, and other important processes. When your metabolism stops, your fat and calorie levels go up, which makes you gain weight. So it will be harder to lose weight. Taking the HB-5 supplement helps keep this hormone in check, even when you're stressed. This hormone is the opposite of thyroid hormone, so when cortisol levels go up, thyroid hormone levels go down. This makes it harder to burn calories and fats. Insulin insulin The pancreas is where insulin is made. Insulin tells the organs and cells of the body that there is energy to take in. When the organs and cells don't respond to the hormone, the brain thinks there isn't enough insulin, so the pancreas makes more insulin. When insulin levels are too high, it can lead to weight gain, problems with weight, and even heart disease. Hormone leptin HB-5 also helps bring the hormone leptin back into balance when you take it. This hormone is what tells the brain that it's no longer hungry. When your leptin levels go up, your brain can't figure out what the signs mean. Because of this, you tend to eat more than you need to. Hormone estrogen Estrogen is a hormone that women have. This hormone keeps the metabolism of glucose and fat going. So, when its level goes down, girls gain weight, especially around their hips and bellies. This often happens when a woman is going through menopause. That must be worth a lot. You might think that a pill that can do everything should cost a lot, but the marketing for this pill has made it more affordable. The doctor who made this pill usually charged $5,000 for a single appointment. For many people, this fee may be very high. When he upgraded his tablet, yet, the price dropped to about $159. But he was unhappy with the high price. Working with other experts, he was able to get the price down to $49 per month for a single month's supply. Read the new Biotox reviews as well. There are also changes in volume. For example, if you buy a six-month supply, the bottle can be had for as little as $29. People who want a 3-month supply are given an offer of $39 per bottle. In this case, it will definitely pay off to buy in bulk.

Evaluations of Hormonal Harmony

Click here to see what customers have said. You should feel better. There are other things that can happen when hormones are out of balance. You might not be able to sleep well at night. You might also feel stressed out during the day. There is also something called a "brain fog." You can have all these things happen at the same time. You may also have a feeling that something is wrong, but you can't put your finger on it. Here, you are trying to find a solution to all the hormonal problems you are having. At midlife, you need to feel important, not slow. There is a check that is fair. In this unbiased report, Dr. Wood tells you a shocking secret about why you may never lose weight. This tablet has not only been made in a modern facility, but it has also been tested by a third party. So, other people have also shown that the tablet does what it's supposed to do. Because of this, SABA Communications has decided to send the AP Press a press release about the tablet. It can definitely trade lives. The New York business thinks that people want to learn more about the hormone harmony HB-5. They also make sure that the parts are of the highest quality. People have said great things about how much weight they have lost, which has let the company know that the supplement is working.

Read what customers have to say about Hb5 Hormonal Harmony.

A look at the body parts The thyroid makes T3 and T4, which are linked to losing weight. They get the metabolism going. When they work, they make sure that the food you eat gives you energy and isn't stored as fat. High levels of cortisol can cause stress and may lead to emotional eating. It also makes your metabolism move more . When you have less cortisol, you feel a lot less stressed. Your leptin makes you experience full. But it is possible to become resistant to leptin. Read the full article

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Weight Loss Video_2023

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[kevindogcare]

Famotidine Pepcid For Dogs? What is that?

The generic name for the drug used to treat esophagitis, gastroesophageal reflux disease, and excessive stomach acid production is famotidine, also referred to as famotidine hydrochloride or famotidine HCl (GERD). It is one of the most often prescribed medications in the United States right now and is obtainable both on prescription and over-the-counter. Its brand names are “Pepcid®” and “Pepcid AC®,” respectively.

What Is Famotidine (Pepcid) Quick Facts?

Famotidine is a histamine receptor-2 (H-2) antagonist and an anti-ulcer medication. Gastric acid is secreted when H-2 receptors (targets) on the cell membranes of stomach cells are stimulated. The medication reduces the formation of stomach acid, giving the ulcer time to heal. Ranitidine (Zantac®), nizatidine (Axid®), and cimetidine (Tagamet®) are additional medications with comparable effects.

Famotidine works on the chemoreceptor trigger zone to reduce nausea in dogs.

Pets with stomach ulcers, esophagitis, gastric reflux, esophageal reflux, Helicobacter infections, and/or vomiting can be treated with Pepcid.

Famotidine may have a decreased effect when used regularly and continuously for an extended period of time, according to studies (more than 14 days). Due to this, it could be advised to take the medication twice daily.

Brand Names for Famotidine

Only using this medication for human use is registered and FDA approved.

Pepcid (Merck), Pepcid AC, and other brand names such as Act, Dyspep HB, Pepzan, Arfam, Pamacid, Peptris, Famotren, Famistine, and Fluxid are examples of human formulations.

Formulations for animals: none

Is Pepcid Routinely Prescribed to Pets?

Although the FDA has not approved this medication for use in animals, veterinarians may legally administer it as an off-label medication. Although famotidine is sold over the counter, it should only be used under a veterinarian’s supervision and direction. One of the 15 human over-the-counter medications that are deemed safe for dogs is Pepcid.

Famotidine Uses in Dogs

There are several uses for famotidine in humans, canines, felines, and other pets.

Gastric and intestinal ulcers or erosions are treated and prevented with the help of famotidine (shallow depressions in the stomach lining).

Treatment for stomach irritation brought on by kidney disease or kidney failure may involve the use of famotidine.

Mast cell tumors in dogs can create a lot of histamine, so famotidine or a comparable medication may be used to treat them.

Famotidine is sometimes administered to dogs that have diminished appetites and is used to treat a variety of causes of nausea in dogs. For more information on feeding a dog that won’t eat, click here.

Famotidine inhibits histamine, therefore it is occasionally used in conjunction with other drugs to treat allergic reactions, such as steroids or diphenhydramine (Benadryl®).

Numerous conditions that result in stomach issues, ulcers, or illnesses that induce nausea and vomiting are treated with famotidine. Examples include acute pancreatitis, inflammatory bowel illness, and infections like helicobacter or PetsCareTip canine parvoviral enteritis.

How Is Famotidine Supplied?

Both prescription and over-the-counter versions of famotidine are offered.

10 mg, 20 mg, and 40 mg tablets.

Oral powder for suspension is supplied at 50 mg/5 ml.

An injectable with a 20 mg/50 mL or 20 mg/2 mL concentration.

Dogs’ Pepcid Dosage

Never provide medication without first talking to your veterinarian. Before taking Pepcid for dogs, be careful to go through the right dosage and other safety measures with your veterinarian. Every 12 to 24 hours, a dose of 0.25 to 0.5 mg per pound (0.5 to 1.0 mg/kg) of famotidine is often administered. When used for longer than 14 straight days, the impact is lessened. Due to this, it could be advised to take the medication twice daily.

The ailment being treated, how the patient reacts to the medication, and if any negative side effects manifest themselves all influence how long the administration will last. Except as recommended by your veterinarian, make sure to finish the prescription. To prevent a sudden relapse, follow the entire treatment schedule even if your pet feels better.

Tablets should be kept at room temperature and away from light. Formulations that are liquids need to be chilled.

Famotidine Pepcid For Dogs and Potential Side Effects

If you see any of the following adverse effects and are worried that your pet may have consumed a hazardous dosage of medication, call your veterinarian right away:

Difficulty breathing.

Difficulty walking.

Lack of appetite.

Lethargy.

Pale gums.

Vomiting.

To be sure your pet is not exhibiting any of these signs, keep a close eye on them and pay attention to their behavior, urinating, and bowel movements. If you think your pet has swallowed a potentially hazardous amount of famotidine, call your veterinarian right away.

How to Avoid Unintended Exposure to Pepcid

It’s easy for curious animals to get into stuff, and it’s always preferable to avoid poisoning than to deal with it later. To prevent your pets from accidentally consuming a lethal dose of famotidine, take the following precautions:

All drugs should be kept out of pets’ reach.

Be especially careful when handling pill bottles and weekly pill organizers. The containers’ design and the noises they create when shaken can resemble toys, luring animals to play with or chew on them.

Avoid storing medications in plastic bags. Keep your prescription pills safe if you are traveling. Bags are simple to chew through and swallow.

If you have drugs in your purse, make sure to close it, hang it up, or place it somewhere your pet cannot get it.

Encourage visitors to keep their possessions locked up and their prescriptions out of the reach of your pets.

More Resources for Pet Emergency

Call the nearest emergency clinic if your pet ingests Pepcid and you are unable to reach your veterinarian. Calling a pet poison control hotline is an additional choice.

The two most common are:

FAQs About Famotidine for Dogs

What should I do if I forget to provide a famotidine dose?

Famotidine can be administered to your dog as soon as you remember to if a dose is missed. However, if it’s almost time for the next dose, only provide the standard dose rather than doubling it.

What is the most important thing I should know about famotidine?

Pepcid belongs to the “H2 blockers” class of pharmaceuticals, which also includes ranitidine and cimetidine (Tagamet) (Zantac). The amount of stomach acid produced is reduced with famotidine. The medicine is generally safe, and overdoses are rare. Pets include dogs, cats, and other animals are frequently prescribed Pepcid.

Before giving famotidine to my pet, what should I go over with my vet?

Before giving your pet any medication, you should talk to your veterinarian about the underlying problem. For instance, if your dog isn’t eating, you should talk about possible causes and come up with a solution. Additional symptoms include vomiting, diarrhea, lethargy, blood in the vomit or stool, and any other anomalies should be kept an eye out for.

Are there alternatives to famotidine?

Famotidine is a member of the “H2 blockers” class of drugs. Cimetidine and ranitidine are two further medications in this class that can also be used in dogs. Alternative medications with better stomach acid suppression include omeprazole, also marketed as Prilosec®. Treatment options for vomiting in dogs, such as cerenia, may be suggested based on their clinical symptoms.

Can you buy famotidine over-the-counter?

Famotidine is available over the counter in several sizes (10 mg is the most common).

What are contraindications to giving famotidine?

Use of famotidine in canines with renal and liver disorders should be cautious. Toxicity is a possibility because these organs process it. Having said that, famotidine is frequently advised, though some dogs may only need to take it occasionally or at a reduced dose.

Is it necessary to give Famotidine Pepcid For Dogs?

Famotidine is best administered without food and on an empty stomach.

What drugs interact with famotidine?

There are few medication interactions with famotidine. The pH change can, however, affect the absorption of other orally taken drugs because famotidine’s main action is to reduce gastric acid. Iron supplements and antifungal medications like itraconazole, ketoconazole, and fluconazole are among these medications.

To maximize famotidine absorption, cephalosporin antibiotics like cephalexin or cefpodoxime should ideally be administered two hours prior to or after. It’s normally advised to wait one hour between oral doses of different medications. The absorption of famotidine can be reduced by several antacids.

What is the difference between famotidine (Pepcid) and ranitidine (Zantac)?

Ranitidine (Zantac) and famotidine (Pepcid) are both members of the group of medications known as H2 receptor antagonists that inhibit histamine.

Source: PetsCareTip.Com

[jiyarai]

How can I get rid of my tummy fat?

The makers of HB-5 claim you can burn 34 pounds in less than 60 days while taking the supplement.

By taking two capsules of HB-5 per day, you can purportedly lose 45 pounds in just 60 days. The supplement claims to “unclog” your hormones, leading to significant weight loss in a short period of time.

The name of the supplement is an acronym: HB-5 stands for Hormonal Block 5. The supplement targets five specific hormones in your body, balancing those hormones to make it easier to lose weight.

Typically, supplements can’t significantly impact hormone levels on their own – so let’s take a closer look at how HB-5 works and what it does once it enters your body

Which Hormones Does HB-5 Target?

HB-5 claims to target five hormones that play a crucial role in weight loss, including:

Thyroid Hormones: Your thyroid releases hormones like T3 and T4. These hormones are crucial for metabolism and energy. Many people struggle with weight loss because of thyroid issues. When someone has a thyroid problem, it typically means they’re not releasing sufficient amounts of T3 and T4 hormones. HB-5 claims to target this issue, restoring balance to your thyroid and accelerating weight loss.

Cortisol: Cortisol is the “stress hormone,” and your body releases cortisol in response to physical and mental stressors. Cortisol is a survival tactic for your body. Cortisol tells your body to store as much fat as possible to ensure its survival. Instead of burning fat for energy, your body holds onto its fat. If you are stressed, then it will impact your weight loss goals. HB-5 claims to target cortisol, making it easier to lose weight.

Insulin: Your body produces insulin in response to food. Insulin regulates the amount of sugar in your bloodstream. If your insulin levels are imbalanced, then you’ll feel a range of symptoms. Some people feel fatigued or nauseous. Others feel hunger cravings. Imbalanced insulin levels sabotage your weight loss results. Typically, you need diabetes medication (like insulin shots) to target insulin in your body, but HB-5 claims to target insulin to help you lose weight.

HB-5 Benefits

The HB-5 sales page mentions all of the following benefits:

Unblock hormones like thyroid hormones (T3 and T4), cortisol, estrogen, insulin, and leptin

Better mood and less brain fog

Burn 34 pounds in 90 days

Target the parts of your body that are sacrificing your weight loss results

30-second fix to unclog your hormones and drop a significant amount of weight within a week

HB-5 Ingredients

HB-5 sounds good – but does it have the ingredients to back up any of the claims listed above? Or is it yet another overpriced, overhyped diet pill? Let’s take a closer look at what’s inside HB-5.

HB-5 discloses some of its ingredients upfront, although it keeps other ingredients and dosages private. Here are some of the ingredients we know are in HB-5:

500mg of cinnamon extract

600mg of Rhodiola Rosea

150mg of African mango extract

A proprietary formula containing kelp, magnesium, zinc, selenium, copper, manganese, vitamin B12, DIM, and bladderwrack

How Much Does HB-5 Cost?

1 Bottle: $49 + Free US Shipping

3 Bottles: $117 + Free US Shipping

6 Bottles: $174 + Free US Shipping

Why Buy HB5 Hormonal Harmony Supplement?

HB5 contains pristine ingredients that are sustainably sourced from around the world

They use all-natural ingredients

No side effects at all

HB-5 supplement is manufactured using state-of-the-art processes in the U.S

An independent U.S. lab analyzes each batch of this supplement for purity, safety, and quality

And people keep ordering more and more of the stuff

Click Here To Order HB5 Supplement From The Official Website with 180 Days Money-Back Guarantee

Disclaimer: This product review is for informational purposes only. The information does not constitute advice or an offer to buy. Any purchase made from this story is made at your own risk. Consult an expert advisor/health professional before any such purchase. Any purchase made from this link is subject to the final terms and conditions of the website selling the product. The content on this release does not take any responsibility directly or indirectly.

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[1tools]

How A Harvard Doctor Saved My Life

With A 30-Second “Snack” That Eliminates Food Cravings

& Burns Away 34 Pounds Of Ugly Fat In Record Time!

HB 5 Advance Hormone Balance Support is a natural and effective supplement that helps regulate hormonal imbalances. Made up of natural ingredients such as Kelp, Rhodiola Rosea, Diindolylmethane (DIM), Chromium, Cinnamon, and African Mango, it improves thyroid gland function, reduces stress, and balances insulin levels leading to weight loss, improved skin health, and overall well-being. While mild side effects may occur, it is generally considered safe for use and comes with a 180-day money-back guarantee.

For more info: click here.

[lupine-publishers-juns]

Lupine Publishers | Safety and Efficacy Assessment of Pcnl in The Pediatric Population: A Single Centre Experience

Abstract

Introduction and Objective: Renal stone disease in children is on the rise with increased incidence and better modalities to diagnose the disease. Hence there is a necessity to strategize the evaluation and treatment of children with kidney stones. Our study was conducted to assess stone distribution, stone burden, and efficacy of PCNL in pediatric age group. Methods: All paediatric patients with renal stone disease who subsequently underwent PCNL at our department from January 2017 to December 2020 were analysed. Results: 84 patients ranging 1-18 years were analysed. Pain abdomen was the most common presenting symptom (61.9%) followed by fever (19.04%). The mean stone size was 2.16cm with equal side distribution. Most stones were located in the lower calyx (38%). The mean operative time was 65 minutes. Exposure to radiation from C arm ranged from 1.6-8.3 minutes. Complete stone clearance was achieved in 90.47% with a mean post- drop in Hb value to 0.72 gm/dl. Mean duration of nephrostomy tube in situ was 2.4 days and with a mean hospital stay of 3.8 days. Calcium oxalate was the most common type of stone (48%) Conclusion: PCNL is safe and effective treatment for pediatric renal calculi with minimal morbidity and increased stone free rates irrespective of stone size. Proper patient selection, surgical skill and postoperative care contribute towards the success of the procedure

Keywords: Pediatric PCNL; Pediatric Renal Calculi; Renal Stone Disease

Introduction

The prevalence of renal stone disease in children ranges from 5 to 15%. Stone disease has a higher risk of recurrence in the pediatric age group making it crucial to identify the most effective method for complete stone removal to prevent recurrence from residual fragments. The optimal management of for pediatric stone disease is still evolving [1,2]. Currently, ESWL is the procedure of choice for treating most upper urinary tract calculi in the pediatric population. However, a higher incidence of metabolic and anatomical abnormalities in pediatric patients has led to increased recurrence. Moreover, ESWL has relatively less efficacy for stones >1.5cm. Surgical intervention should be preferred in such cases so as to minimize the need for retreatment [3-5]. Percutaneous nephrolithotomy (PCNL) is less invasive than open surgery which can be a good candidate for complex and large burden stones [6]. Several studies over time with different power and limitations have reported safety and efficacy of PCNL leading to its consideration as the treatment of choice for children with stone larger than 15mm [7-9]. The advent of newer, finer instruments and increase in experience of endourological techniques such as tubeless PCNL, mini-perc, ultra-mini perc and micro-perc has resulted in reducing the morbidity rate among patients without affecting the outcomes in terms of clearance [10-14]. Therefore, our study was conducted to assess the safety and efficacy of PCNL in the pediatric age group in terms of (1) renal stone distribution & stone burden (2) the outcomes of PCNL including stone clearance, operative time, hospital stay, haemoglobin changes and (3) the associated complications of PCNL.

Materials and Methods

A prospective study was conducted at our hospital from January 2017 to December 2020 after obtaining institutional ethical committee clearance. All pediatric patients posted for PCNL at MS Ramaiah Medical College were considered in the study. The patients compatible for the study were interviewed and after obtaining informed and written consent they were enrolled in the study. Inclusion Criteria: All the patients below the age of 18 years undergoing PCNL. Exclusion Criteria: Anatomic abnormalities of the kidney (horseshoe kidney/malrotated kidney); Bleeding disorders; deranged renal function. Patients were initially evaluated with a detailed medical history and a thorough clinical examination followed by a battery of investigations including CBC, RFT, Serum electrolytes, serum levels of calcium, phosphorus, alkaline phosphatase, uric acid, total protein, carbonate, albumin, parathyroid hormone (if there is hypercalcaemia), blood group & Rh typing, HbsAg, HIV, HCV, Urine: Routine & Microscopy, Urine: Culture & Sensitivity. For imaging –ultrasonography was used as a first study followed by spiral CT KUB if no stone was found. Intravenous pyelography was performed when a need arose to delineate the calyceal anatomy prior to percutaneous or open surgery. A sterile urine culture was confirmed before surgery. In patients with evidence of infection, antibiotics were given preoperatively to clear the infection prior to surgery. All patients received broad-spectrum antibiotics beginning 12 h prior to the procedure and these were continued until 5 days postoperatively. All PCNL are performed under general anaesthesia. The patient initially placed in lithotomy position and a ureteric access catheter was placed under fluoroscopic guidance. The patient was then turned prone. After initial puncture, the tract was dilated using metallic or Teflon dilators. Paediatric PCNL was performed using adult instruments and clearance assessed intraopeartively by fluoroscopy. Ureteric stents and nephrostomy tubes were placed in most patients at the end of the procedure. Baseline patient characteristics, intraoperative and post-operative data were collected and analysed. Perioperative complications were classified using the modified Clavien Dindo system. In case of a supra-costal puncture, a chest X-ray was obtained subsequently in the post op period. An x ray of kidney ureter bladder was taken at 48 hours after PCNL. If needed a re-look procedure was done. The patient was followed up with an ultrasound & serum creatinine at 3 months, DMSA scan after 6 months to know the functional status of kidney & amount of renal scarring. Statistical analysis was performed using SPSS 22. Categorical variables were presented as number and percentage (%), whereas continuous variables were presented as mean ± standard deviation and median (Table 1).

Results

84 patients ranging between 1-18 years of age were analysed with the mean age of study population of 11.04 years. Pain abdomen was the most common presenting symptom (61.9%) followed by fever (19.04%) with 4/84 having had prior surgical intervention for stone disease (Figure 1). The mean stone size was 2.16cm with equal side distribution. Most stones were located in the lower calyx (38%) followed by renal pelvis – 33%, middle calyx 17% and upper calyx 12% (Figure 2a). The total operative time ranged from 30 minutes to 120 minutes with a mean of 65 minutes. Exposure to radiation from C arm ranged from 1.6-8.3 minutes. Intraoperative location of stone, puncture and after clearance are shown in Figures 1a,1b,1c. Complete stone clearance was achieved in 90.47% with a mean post- drop in Hb value to 0.72 gm/dl. Mean duration of nephrostomy tube in situ was 2.4 days and with a mean hospital stay of 3.8 days. Intra-operative and post-operative complications in the study population are depicted in Table 2. Calcium oxalate was the most common type of stone (48%) (Figure 3).

Discussion

Although short wave lithotripsy (SWL) is considered the treatment of choice for symptomatic upper urinary tract calculi in children, but not a preferred option in patients with large stone burden, owing to higher rates of failure and residual stones. In such cases, PCNL with proven advantages can be safely advocated as a suitable treatment option in order to avoid numerous SWL sessions under anesthesia. Despite pediatric PCNL being described as early as 1985 by Woodside et al. [6], pediatric surgeons had their reservation in performing PCNL in children. This apprehension was due to the fear of parenchymal damage, early exposure to radiation and risk of major complications associated with the surgery. However, Dawaba et al. [9] proved the fear to be baseless by demonstrating that PCNL in paediatric population improved overall renal function without causing renal scarring. Similarly, Mor et al. reported no significant scarring or loss of renal function in radionuclide renal scans (19). He concluded that adult type tract dilation to 24Fr to 26Fr was not associated with significant renal function loss [19]. The size, number and site of tracts are not well defined in pediatric PCNL. While Gunes et al. reported a higher complication rate in children <7 years operated with adult sized instruments [17], Desai et al. observed that intraoperative bleeding during PCNL in children is related to the size and number of tracts and suggested the need for technical modifications in children [20]. Although this calls for reduction in tract size, it may have an effect on the clearance rates. In our study, 54(64.28%) underwent standard PCNL vs 30(35.71%) underwent Miniperc. We used amplatz sheath sizes in the range of 16F-28F. Size of tract dilatation was based on dilatation of pelvicalyceal system, the stone burden and no of punctures. Our clearance rates & transfusion rates were found to be similar in miniperc & standard PCNL. Our results are in concurrence with Bilen et al. who reported that smaller tracts did not significantly affect stone-free rates but achieved lower transfusion rates [21]. They concluded that a 20Fr tract was as effective as working with adult sized devices and did not significantly increase the operative time. (18) Provided the quality of the puncture and subsequent tract is high, there is no greater morbidity than that reported from miniperc. Large tracts and instruments can facilitate more rapid and complete stone clearance (Table 3).

Most of the stone burden was located in lower calyx (38%) in most of our cases with staghorn calculus noted in 4 patients. Single tract access was done in 72 patients with lower calyceal puncture being used mostly (43%) (Figure 2b). Multiple punctures were required in 12 cases (14.2%). We did not find any significant increase in complications following an upper calyceal puncture or with multiple punctures in our study which is comparable to Sedat Oner et al. who concluded that an upper pole approach did not prolong operative time or add to the complications, making it a good alternative. A surgeon who has reached competence at performing PCNL should therefore not hesitate to use a superior caliceal approach in pediatric patients if deemed appropriate for stone removal [22]. Our length of hospital stay duration of nephrostomy tube in situ is comparable to previously published data. 42.85% of our cases were tubeless, which is safe when performing uncomplicated PCNL [34]. Prior renal surgery on the same side didn’t have any impact on outcome of PCNL [35]. Aldaqadossi et al. have suggested that a previous open pyelolithotomy or nephrolithotomy does not affect the efficacy and morbidity of subsequent PCNL in pediatric patients [35]. We achieved a complete clearance rate of 90.47% which is similar to the published literature. Residual calculi noted in 8 cases were managed by ESWL. The complication rate during and after PCNL in paediatric patients varies widely in the literature. The difference in complication rates may be explained by the difference in stone burden location and experience of the surgical team. Our complication rate was 9.52% with fever being the most common. The lower incidence in complications could be attributed to the surgeon expertise at our center.

Limitations

Our study population was from single referral center, which may not be generalizable considering small sample size. Another limitation is the lack of comparative groups such as ESWL/RIRS while evaluating the efficacy of PCNL.

Conclusion

PCNL is safe and effective treatment for pediatric renal calculi with minimal morbidity and increased stone free rates irrespective of stone size. Proper patient selection, surgical skill and postoperative care contribute towards the success of the procedure and reduces the complications.

For more Lupine Journals please click here: https://lupinepublishers.com/index.php

For more  Journal of Urology & Nephrology Studies  articles please click here: https://lupinepublishers.com/urology-nephrology-journal/index.php

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[lupine-publishers-ctgh]

Lupine Publishers | Safety and Efficacy Assessment of PCNL in the Pediatric Population: A Single Centre Experience

Abstract

Introduction and Objective: Renal stone disease in children is on the rise with increased incidence and better modalities to diagnose the disease. Hence there is a necessity to strategize the evaluation and treatment of children with kidney stones. Our study was conducted to assess stone distribution, stone burden, and efficacy of PCNL in pediatric age group.

Methods: All paediatric patients with renal stone disease who subsequently underwent PCNL at our department from January 2017 to December 2020 were analysed.

Results: 84 patients ranging 1-18 years were analysed. Pain abdomen was the most common presenting symptom (61.9%) followed by fever (19.04%). The mean stone size was 2.16cm with equal side distribution. Most stones were located in the lower calyx (38%). The mean operative time was 65 minutes. Exposure to radiation from C arm ranged from 1.6-8.3 minutes. Complete stone clearance was achieved in 90.47% with a mean post- drop in Hb value to 0.72 gm/dl. Mean duration of nephrostomy tube in situ was 2.4 days and with a mean hospital stay of 3.8 days. Calcium oxalate was the most common type of stone (48%).

Conclusion: PCNL is safe and effective treatment for pediatric renal calculi with minimal morbidity and increased stone free rates irrespective of stone size. Proper patient selection, surgical skill and postoperative care contribute towards the success of the procedure.

Keywords:COVID-19; post-covid manifestations; long covid; gastrointestinal disorders; dysbiosis; dyspepsia; microbiome; probiotics

Introduction

The prevalence of renal stone disease in children ranges from 5 to 15%. Stone disease has a higher risk of recurrence in the pediatric age group making it crucial to identify the most effective method for complete stone removal to prevent recurrence from residual fragments. The optimal management of for pediatric stone disease is still evolving [1, 2]. Currently, ESWL is the procedure of choice for treating most upper urinary tract calculi in the pediatric population. However, a higher incidence of metabolic and anatomical abnormalities in pediatric patients has led to increased recurrence. Moreover, ESWL has relatively less efficacy for stones >1.5cm. Surgical intervention should be preferred in such cases so as to minimize the need for retreatment [3-5]. Percutaneous nephrolithotomy (PCNL) is less invasive than open surgery which can be a good candidate for complex and large burden stones [6]. Several studies over time with different power and limitations have reported safety and efficacy of PCNL leading to its consideration as the treatment of choice for children with stone larger than 15mm [7-9]. The advent of newer, finer instruments and increase in experience of endourological techniques such as tubeless PCNL, mini-perc, ultra-mini perc and micro-perc has resulted in reducing the morbidity rate among patients without affecting the outcomes in terms of clearance [10-14].

Therefore our study was conducted to assess the safety and efficacy of PCNL in the pediatric age group in terms of

a) Renal stone distribution & stone burden

b) The outcomes of PCNL including stone clearance, operative time, hospital stay, haemoglobin changes and

c) The associated complications of PCNL.

Materials and Methods

A prospective study was conducted at our hospital from January 2017 to December 2020 after obtaining institutional ethical committee clearance. All paediatric patients posted for PCNL at M.S. Ramaiah Medical College were considered in the study. The patients compatible for the study were interviewed and after obtaining informed and written consent they were enrolled in the study.

Inclusion Criteria:

All the patients below the age of 18 years undergoing PCNL.

Exclusion Criteria:

Anatomic abnormalities of the kidney (horseshoe kidney/malrotated kidney); Bleeding disorders; deranged renal function.

Patients were initially evaluated with a detailed medical history and a thorough clinical examination followed by a battery of investigations including CBC, RFT, Serum electrolytes, serum levels of calcium, phosphorus, alkaline phosphatase, uric acid, total protein, carbonate, albumin, parathyroid hormone (if there is hypercalcaemia), blood group & Rh typing , HbsAg, HIV, HCV, Urine: Routine & Microscopy, Urine: Culture & Sensitivity. For imaging –ultrasonography was used as a first study followed by spiral CT KUB if no stone was found. Intravenous pyelography was performed when a need arose to delineate the calyceal anatomy prior to percutaneous or open surgery. A sterile urine culture was confirmed before surgery. In patients with evidence of infection, antibiotics were given preoperatively to clear the infection prior to surgery. All patients received broad-spectrum antibiotics beginning 12h prior to the procedure and these were continued until 5 days postoperatively. All PCNL are performed under general anaesthesia. The patient initially placed in lithotomy position and a ureteric access catheter was placed under fluoroscopic guidance. The patient was then turned prone. After initial puncture, the tract was dilated using metallic or Teflon dilators. Paediatric PCNL was performed using adult instruments and clearance assessed intraoperatively by fluoroscopy. Ureteric stents and nephrostomy tubes were placed in most patients at the end of the procedure. Baseline patient characteristics, intraoperative and post-operative data were collected and analysed. Perioperative complications were classified using the modified Clavien Dindo system. In case of a supra-costal puncture, a chest X-ray was obtained subsequently in the post op period. An x ray of kidney ureter bladder was taken at 48 hours after PCNL. If needed a re-look procedure was done. The patient was followed up with an ultrasound & serum creatinine at 3 months, DMSA scan after 6 months to know the functional status of kidney & amount of renal scarring. Statistical analysis was performed using SPSS 22. Categorical variables were presented as number and percentage (%), whereas continuous variables were presented as mean ± standard deviation and median.

Results

84 patients ranging between 1-18 years of age were analysed with the mean age of study population of 11.04 years. Pain abdomen was the most common presenting symptom (61.9%) followed by fever (19.04%) with 4/84 having had prior surgical intervention for stone disease. The mean stone size was 2.16cm with equal side distribution. Most stones were located in the lower calyx (38%) followed by renal pelvis – 33%, middle calyx 17% and upper calyx 12% . The total operative time ranged from 30 minutes to 120 minutes with a mean of 65 minutes. Exposure to radiation from C arm ranged from 1.6-8.3 minutes. Intraoperative location of stone, puncture and after clearance are shown in figures 1a,1b,1c. Complete stone clearance was achieved in 90.47% with a mean post- drop in Hb value to 0.72 gm/dl. Mean duration of nephrostomy tube in situ was 2.4 days and with a mean hospital stay of 3.8 days. Intra-operative and post-operative complications in the study population are depicted. Calcium oxalate was the most common type of stone (48%).

Discussion

Although short wave lithotripsy (SWL) is considered the treatment of choice for symptomatic upper urinary tract calculi in children, but not a preferred option in patients with large stone burden, owing to higher rates of failure and residual stones. In such cases, PCNL with proven advantages can be safely advocated as a suitable treatment option in order to avoid numerous SWL sessions under anesthesia. Despite pediatric PCNL being described as early as 1985 by Woodside et al, [6] pediatric surgeons had their reservation in performing PCNL in children. This apprehension was due to the fear of parenchymal damage, early exposure to radiation and risk of major complications associated with the surgery. However, Dawaba et al, [9] proved the fear to be baseless by demonstrating that PCNL in paediatric population improved overall renal function without causing renal scarring. Similarly, Mor et al reported no significant scarring or loss of renal function in radionuclide renal scans [15-19]. He concluded that adult type tract dilation to 24Fr to 26Fr was not associated with significant renal function loss [19]. The size, number and site of tracts are not well defined in pediatric PCNL. While Gunes et al reported a higher complication rate in children <7 years operated with adult sized instruments [17]. Desai et al observed that intraoperative bleeding during PCNL in children is related to the size and number of tracts and suggested the need for technical modifications in children [20]. Although this calls for reduction in tract size, it may have an effect on the clearance rates.

In our study, 54(64.28%) underwent standard PCNL vs 30(35.71%) underwent Miniperc. We used amplatz sheath sizes in the range of 16F-28F. Size of tract dilatation was based on dilatation of pelvicalyceal system, the stone burden and no of punctures. Our clearance rates & transfusion rates were found to be similar in miniperc & standard PCNL. Our results are in concurrence with Bilen et al who reported that smaller tracts did not significantly affect stone-free rates but achieved lower transfusion rates [21]. They concluded that a 20Fr tract was as effective as working with adult sized devices and did not significantly increase the operative time [18]. Provided the quality of the puncture and subsequent tract is high, there is no greater morbidity than that reported from miniperc. Large tracts and instruments can facilitate more rapid and complete stone clearance.

Most of the stone burden was located in lower calyx (38%) in most of our cases with staghorn calculus noted in 4 patients. Single tract access was done in 72 patients with lower calyceal puncture being used mostly (43%) (Figure 2b). Multiple punctures were required in 12 cases (14.2%). We did not find any significant increase in complications following an upper calyceal puncture or with multiple punctures in our study which is comparable to Sedat Oner et al who concluded that an upper pole approach did not prolong operative time or add to the complications, making it a good alternative. A surgeon who has reached competence at performing PCNL should therefore not hesitate to use a superior caliceal approach in pediatric patients if deemed appropriate for stone removal [22-25].

Our length of hospital stay duration of nephrostomy tube in situ is comparable to previously published data. 42.85% of our cases were tubeless, which is safe when performing uncomplicated PCNL [26-34]. Prior renal surgery on the same side didn’t have any impact on outcome of PCNL [35]. Aldaqadossi et al have suggested that a previous open pyelolithotomy or nephrolithotomy does not affect the efficacy and morbidity of subsequent PCNL in pediatric patients [35]. We achieved a complete clearance rate of 90.47% which is similar to the published literature. Residual calculi noted in 8 cases were managed by ESWL. The complication rate during and after PCNL in paediatric patients varies widely in the literature. The difference in complication rates may be explained by the difference in stone burden location and experience of the surgical team. Our complication rate was 9.52% with fever being the most common. The lower incidence in complications could be attributed to the surgeon expertise at our centre.

Limitations

Our study population was from single referral center, which may not be generalizable considering small sample size. Another limitation is the lack of comparative groups such as ESWL/RIRS while evaluating the efficacy of PCNL.

Conclusion

PCNL is safe and effective treatment for pediatric renal calculi with minimal morbidity and increased stone free rates irrespective of stone size. Proper patient selection, surgical skill and postoperative care contribute towards the success of the procedure and reduces the complications.

For more Lupine Publishers open access journals please visit our website:

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[secretwhisperstastemaker]

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[artleaguemdcnorth]

DRAWING CLASS - ASYNCHRONOUS THURSDAY 10/26/23

This class will review the instructions for the Midterm on Tuesday of next week.

For today, choose 4-5 objects from the selection of objects you will be using for the midterm.

You are working on a preliminary study of what will become the possible composition for Midterm that will begin next week.

This is just a study to analyze the narrative and the composition.

Use a light source to emphasize the direction of light. And work with graphite pencils so you can get used to it.

We will discuss at large the information below next week on Tuesday.

For now , read the instructions below , write down questions you might need to ask next week in class.

Bring the study to class on Tuesday so we can review and critique your study.

Materials for Midterm, see below:

Choose between buying handmade paper below or using Bristol

Bristol or

Arches handmade paper , 22x30 , hot press 120lbs.

Graphite pencils ONLY .

Kneaded eraser.

MIDTERM ASSIGNMENT - Review

This assignment is going to take many hours of work beyond class time.

A good assignment starts with a good prop.

I have been trying to instill that idea on all of you since the first day.  

There is no reason to have a pop tart box in your midterm assignment or an olive oil bottle unless you are making a statement about nutrition or genetically modified ingredients in foods.

There are two components to your assignment this time, narrative and technical skills.

Narrative relates to your critical thinking skills and technical relates to your ability to define form through value.

You need to find a lighting condition that can let you express form. Adding a lamp or directional light will help you create a dramatic effect.

You will be using graphite pencils that range in value from HB to B8 .

Using a pencil requires that you use the side on the lead and not the point.

You do not want to scratch the paper , you want to render soft values that are blended as you work.

Smudging the paper is not a solution to developing values.

Value is developed by using various pencil grades.

HB is middle tone.

B1 is lighter than B4 but darker than HB.

I suggest you do some value charts with your pencils on your sketchbook .

Get in the habit of testing your values as you work.

Another tip that I can share, is that you use a tissue paper so that you do not smudge and stain the paper as you work.

This assignment will be graded at 30% of your overall class grade.

It is important that you treat the execution with outmost care.

I  included below an A grade assignment from a previous student for you to consider as you begin your assignment.

You will have time to work on this beginning Thursday Nov.2 through Nov. 20 at 5 pm,  TO COMPLETE THIS ASSIGNMENT.

You will be working on this assignment at home on your own. 

I will look into giving you class time on to also work on it.

You will also need to work on this assignment during Thursdays and homework time .

Tuesday 5/21st , bring the completed assignment for a class for a critique.

The work by Lorena below took 40 hours to get to that stage of development. You can not work on this assignment for 40 hours at a time.

It will require a slow and methodic engagement of many days and weeks to complete this.

Do not procrastinate, pace yourself, it can be done.

Homework time after class beginning today :

Make sure to post progress on your Tumblr for each day you are working on this assignment. i want students to show progress of assignment from the first day to the last.

Include a photo of your still life reference only on for the first day of this sequence , meaning today.

This is a Midterm Exam grade worth 30% of your overall class grade and you have to do it on your own.

I can not give you suggestions , I have already given you two examples of what an A grade assignment looks like.

This assignment can not look like your class work.

It needs to be superior in quality and content.

I have provided you with tools, artworks, history and other information to assist you in doing a good job.

Now you need to rise to the occasion to meet this challenge.

IMPORTANT NOTES AND TIPS :

1) Unless you are a shoemaker you should not include shoes in your drawing.

2) You should not include objects that are larger than the rest of your objects (footballs, basketballs, guitars, golf bag).

3) Your Still Life needs to be in a proper pedestal , table or platform with a backwall and proper lighting source.

4) I will include a video above of how to make a shadow box to improve your lighting and your imagery.

It is up to you if you want to use it or not.

This is a tool used by artist to create an atmosphere and lighting ambience for drama.

The shadow box can not be included in your drawing is just a tool to help you see shadows and value contrasts.

5) You cannot use charcoal pencils only Graphite Pencils.

6) Your objects cannot float so you must include reference to the horizon line , that is were your platform and the wall meet.

7) There are other students in this class, reach out to them. Feel free to seek peer support from each other back and forth. Share suggestions and photos and process of your work .

Tuesday is the day to ask any questions during class.

Bring all questions at that time.  

Please see student work below:

Excellent Artwork

Good set up but with an unfinished background.

A

B

C

Remember today you are doing what we call a preliminary study using only 5-6 objects and studying how light shapes the forms.

Bring your work to class on Tuesday.

MATERIALS FOR NEXT TUESDAY :

BRISTOL PAPER

BLACK INK

BRUSHES

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[roguedeck]

NETRUNNER - MIDNIGHT SUN CORP REVIEW

Last time, we looked at the Runner side of this new pack. TOday, we're going to break down the Corp. Let's dig on in:

Haas-Bioroid

Unlike the Runner half of the set, some of the corps aren't seeing new IDs yet. This gives a couple of the factions a little bit of a looser feel than the narrow strategic direction we see with the Runners. HB is the best example of this.

We've got a throwback to themed ICE suites with Harmonic ICE (which are both fine). Hakarl 1.0 is going to wreck some fools. And getting a new 2/1 agenda is always great.

But the only card that really matters in HB is Big Deal.

HB was already in a strong position with Precision Design and Seamless Launch in the card pool. This is simply another way to win the game.

Overall Opinion: HB gets some useful cheap ICE, but all we really want to do is Big Deal out the game.

Jinteki

Jinteki has some exciting cards in this pack. I don't know t=if they are good enough to make up for the lake of econ and their super porous ICE, but what you see gets the mind chugging in interesting new directions.

Clearly a lot of these cards are designed to support the facedown archive cards in Restoring Humanity - but they do it in very interesting ways. Moon Pool and Regensis lead you to an interesting mind game of dropping agendas in archives. At least we also get Bathynomus to make those archive runs painful.

A lot of the other cards are simple reflections of necessary game effects. Mavirus is a red Cyberdex. Mitosis is a new and improved version of Mushin.

Blood in the Water is my favorite card in the whole set. This is just a game winner.

Overall Opinion: Jinteki is in bad shape already, and I don't know this set does much to improve their position in the metagame. We get a couple useful tools, but what sets Jinteki apart right now is the power of the new win cons (Regensis and Blood in the Water). I don't know if that's enough to power red decks up, but it'll be fun trying to make it work.

NBN

Our last two corp factions actually do get new IDs. NBN has a new gimmick to put advancement counters on cards. I think this is a potentially very powerful ability, but who knows if Weyland can use some of these cards better.

Drago Ivanov is a yellow version of Zealous Judge. If you don't run him, you might just get wrecked. If you do, it might be a Checkist Scion instead. This give and take reminds me a lot of Fly on the Wall mindgames. Vasilisa is a potentially painful face check. Mestnichestvo is both painfully taxing and a potential roadblock that NBN desperately needs. Given a long enough game Ubiquitous Vig is going to be amazing econ. Artifical Cryptocrash is going to mess some runners up when combined with Seamless Launch.

The most exciting card is Backroom Machnications. This isn't anywhere near as powerful as Exchange of Information, but this is an important tool for both the 5/3 and 4/2 heavy agenda suites that NBN likes.

Overall Opinion: NBN gets plenty of new toys that lead to new strategies, augment existing strategies, and even power up some other factions. They seem like a big winner of the set.

Weyland

Let's get this out of the way, Ob Superheavy Logistics seems like an amazingly powerful effect - but I don't know how to pull it off yet.

This whole "trash your board" mechanic is probably great. Azef Protocol is already strong as a 3/2, but it also has the chance to kill the runner. Svyatogor Excavator is a corp Pawnshop. Extract is a massive burst econ card. Trust Operation isn't exactly Boom, but you could get incredibly far ahead of the Runner with it.

I actually like all the Weyland ICE in this set. Maskirovka gives you the kind of versatile ICE that Weyland generally lacks. Stavka is a great way to surprise the runner while making sure you keep the surprises coming. Envelopment is a nicely undercosted ICE to rush behind - that also works great with your ID.

Overall Opinion: I have a feeling I am underestimating the power of Ob. On the whole, Weyland's cards are average power. You don't hate having them, but they don't seem to have the same "I win" potential that other factions received. But with that said, Ob and Trust Operation are the kind of flexible tutors that probably win more games than I'm thinking of.

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