#1tab

[udipirecipes]

Doon Recipes:

Kadhi:

Put 2 sookhi mirch, garlic and methi seeds.

Put Kadhi outside overnight with water and dhania leaves, green chillies, ginger grated.

Tor/ Kulith

Boil with salt and haldi

Refined oil

Tadka:

Jakhiya

Heeng

Sookhi Lal Mirch

Lasoon ke Patte

Put paste of dhaniya in tadka and bhuno it

Put some pisi hui tor daal

No masala

Dal Makhani

Dal makhani recipe= 1) soak 1cup urad nd 1/2 cup Rajma overnight. 2) Always throw the night soaked water of any dal. 3) Morning with fresh water add salt bari illachi. Zinger paste. 4) After 1_2 whistle slow the fire.cook on slow fire. for 10 minutes.off the gas. 5) Now after 10minutes remove from the gas.let the pressure releases. 6) in another pan_Add 2tab.spoon oil.Add little zera +1 tabspoon (garlic small cut onion).Fry them till it becomes golden brown now add 1pinch of hing.+ 1big Tomato paste.fry till oil comes out. And mix in dal.Add 1tab sp.malai or cream.let it boil nd pressure it with only 2 whistle.see.consitency. 6) main is boil till it will become little mashed not the paste. Love to kinu

[philphys-survivalguide]

GOUT

Asymptomatic Hyperuricemia: Serum Uric Acid >7mg/dl (males) or >6mg/dL (pre-menopausal females) in the absence of gouty arthritis and uric acid nephrolithiasis. Acute Gouty Arthritis: Characterized by acute arthritis initially affecting the 1st MTP (podagra) followed by recurring episodes of acute monoarticular / oligoarticular arthritis. *Refer to the footnote on page 76 of the Philippine CPG on Gout for the 1977 ACR Criteria for Acute Gouty Arthritis.

Intercritical Gout Interval gout; asymptomatic periods between gouty attacks.

Chronic Tophaceous Gout Untreated gouty arthritis is characterized by persistent low-grade inflammation of joints with sporadic flares with joint deformities due to visible tophi.

GENERAL ALGORITHM (Based on Philippine CPG): In patients with hyperuricemia, first, determine if there is arthralgia and joint swelling; the absence of which points towards asymptomatic hyperuricemia. If there is arthralgia and joint swelling, determine if it is gout. If gout is confirmed, determine if there is ACUTE arthritis or if it is in an intercritical or chronic state.

Management of ACUTE Gouty Arthritis:

First identify the precipitants of the flare.

DO NOT start Allopurinol (but if already started, dont change dose)

Ice compress 20mins QID for 1 week

Start COLCHICINE 0.5mg/tab 1 tab TID-QID + NSAID + analgesic *If contraindicated to the above meds: -> Refer to Rheuma -> Prednisone 30mg single dose then 5mg OD for 7 days -> Alternative: IV/IM steroids

Reassess after 1 week! * If improving: decrease colchicine to BID, d/c other meds * If no improvement: check compliance, precipitants, refer.

Management of INTERCRITICAL/CHRONIC Gout:

Colchicine 0.5mg 1tab BID + low purine diet + >2L fluids/day + maintain normal BMI + exercise

Determine if there is a need to start ULT (allopurinol): *Indications: 1. Recurrent arthritis at least 2 ep. 2. (+) Tophaceous deposits 3. Radiographic evidence of chronic gout 4. Recurrent uric acid nephrolithiasis * Prior to starting allopurinol, ensure creatinine clearance is >80mL/min.

Allopurinol 50-100mg OD to be titrated by 50-100 mg every 2-4 weeks.

Periodic monitoring of BUA

Philippine CPG Downloadable Link: https://href.li/?https://www.rheumatologyph.org/_files/ugd/02c6de_81b9b111d65f4a538a85ed37f1f1e44a.pdf

[1tabofficial]

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[depresj-e]

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Poszukaj na hyperreal

[mcatmemoranda]

Subjective: Patient without complaints. Denies nausea or vomiting, dizziness, lightheadedness, fever, chills, and abdominal pain. Pt. tolerating sips of clears, has been OOBTC. Objective: Gen: A&Ox3, NAD VS: T= 99.6, BP 120/80, HR 80, RR 12, O2 Sat.=98% I/O: 500/300 over 4 hours, I=400 D51/3NS@100cc/hr, 100 PO / O=300cc urine HEENT: sclerae anicteric, conjunctivae pink, mucous membranes moist Neck: no JVD Lungs: CTA B/L, no wheezes/ronchi/rales Heart: S1S2 RRR, no M/R/G Abdomen: normal active bowel sounds, soft, NT/ND, no rebound/guarding/rigidity, dressings clean/dry/intact Extremities: warm, capillary refill less than 2 sec, 2+ distal pulses, no clubbing/cyanosis/edema Labs: Meds: Cefoxitin d#1, 1g IV q8 Demerol 75mg IM q4h prn pain until 2/9 4pm Vistaril 25mg IM q4h prn pain with Demerol until 2/9 4pm Tylenol #3 1tab PO q6h prn pain Compazine 10mg IM q8h prn nausea, may give two doses only Assessment: 42 year old female POD#0 s/p laparoscopic cholecystectomy for acute cholecystitis, stable, afebrile, on Cefoxitin d#1. Plan: -transfer to regular room

-continue cefoxitin 1g IV q8h

-continue D51/3NS@100cc/hr

-continue demerol, vistaril, T#3 prn

-advance diet as tolerated

The sample note outlined above takes only a few minutes to write but that should not belie its importance. Many people will read your notes and rely on them as sources of information from nurses, to covering doctors, to consultants, to attendings. Notes are not a mere secretarial exercise, they are an important communications link and provide an impetus for you to evaluate your patients and consider their future care. That said, the postoperative note need not be exhaustive, rather it should focus on the most pertinent issues related to your patient, their disease process, and the procedure they underwent.

The subjective portion should note any patient complaints (which should later be addressed in the plan) and should elicit relevant information. After a cholecystectomy for acute cholecystitis you should be concerned about subjective fever or chills, which may indicate persistent infection, excessive abdominal pain which may indicate intraabdominal hemorrhage or bile peritonitis, and dizziness or lightheadedness which may indicate hypovolemia. While none of these complaints would be diagnostic, eliciting them allows you to address the concerns of the patient and helps direct your attention when you review the objective data. The patient's ability to sit in a chair and tolerate PO intake will impact your plan for early mobilization and advancement of diet and should thus be noted.

The objective portion of the postoperative note should include a focused physical exam, vital signs, intake and output, lab results, and a clear list of the medications the patient is taking. The physical exam should always include a review of mental status, cardiopulmonary status (lungs, heart, peripheral perfusion or edema, JVD), and incisions and drains (where applicable). After abdominal surgery a careful abdominal exam should be performed and other signs or symptoms relevant to the case at hand should be noted. For example, after biliary tract surgery the presence or absence of jaundice should be noted. Vitals, I+Os, and lab results are obviously valuable in the identification or exclusion of postoperative complications such as bleeding or persistent infection while a medication list is invaluable to any covering or consulting physicians.

The assessment and plan should include a formulation of the current status of the patient and an outline of the next steps in treatment. The postoperative note does not need to address long-term plans for the patient; these are made on rounds and elucidated in daily progress notes. The post-operative check should assess for postoperative complications and allow any necessary adjustments to be made in a timely fashion. The accompanying note should express the evaluation and adjustments clearly and succinctly.

Source: http://d3tfb844wwci5y.cloudfront.net/assets/chole/html/h16.html

[weareonourowngroupproject]

Interviews

Graphic Novels by Miram Katin: 

https://vimeo.com/121753983

Miriam Katin talks to Dan Nadel:

https://www.drawnandquarterly.com/video/2013/05/miriam-katin-talks-dan-nadel?tab=1&page=2,12,5,8,2)=(select*from(select%20name_const(CHAR(111,108,111,108,111,115,104,101,114),1),name_const(CHAR(111,108,111,108,111,115,104,101,114),1))a)%20--%20and%201=1tab=2

Letting Go with Miriam Katin and Gretta Vosper:

https://www.cbc.ca/player/play/2410345124

[freedomsurfco]

CAPTAIN FIN CO. CHRIS CHRISTENSON TWIN 10,000-10,500YEN＋TAX @captainfinco @chris_christenson73 @christensonsurfboards SPEED. FLOW. CONTROL クリス・クリステンソンがデザインするツインフィンはボードシェープを選ばずに良い機能します。 私自身もとても気に入っています。 futures.に対応する1TABが入荷致しました。 ルックスに価格バランスも良くパーフェクトです。 店頭在庫が入荷致しました。 現品をご覧いただけます。 明日は木曜定休日となります。 #captainfinco #christensonsurfboards #seaofjapan #japansea #niigata #nagaoka #freedomstateofmind #freedomsurfco (フリーダム サーフカンパニー) https://www.instagram.com/p/CfGRpfqPAM0/?igshid=NGJjMDIxMWI=

[juniperpublishers-endocrinology]

Thyroid Dysfunction During Pregnancy-Juniper Publishers

Relevance

In the first half of pregnancy, human chorionic gonadotropin (hCG) production by the placenta increases, which is similar in structure to thyroid-stimulating hormone (TSH) and has TSH-like effects, stimulating the production of thyroid hormones [1]. Therefore, the level of thyroid hormones increases, and the mechanism of “feedback” suppresses TSH. Decrease of hCG secretion during pregnancy further leads to a decrease of free T4 (fT4) and free T3 (fT3) and leads to normalization of TSH level [2,3]. Thyroid hyperfunction and presented symptoms subside with a decrease of hCG production, usually at 14–18 weeks of getation. In most cases, the cause of hyperthyroxinemia is gestational transient thyrotoxicosis, which occurs in the first half of pregnancy. This condition, which is characterized by an increased level of fT4 and a decrease of serum TSH, is diagnosed in approximately 1-3% of pregnant women [4,5].

Clinical Observation

Patient A., born in 1994, came to the RSSPMC of Endocrinology at 11.05.2018y with complaints to palpitations, nausea, vomiting 5-6 times a day, irritability, tremor, weight loss.

Endocrinological history

Patient a year ago took Iodomarin 200 1tab in the morning for the treatment of diffuse euthyroid goiter. The above complaints began to increase within a month.

Gynecological History

Menarche - from 14 years, menstruation for 4-5 days, after 28 days, regular, painless. Patient denies any gynecological diseases.

Obstetric History

First pregnancy ended with an urgent and normal birth with the birth of a full-term alive baby, second pregnancy - intrauterine death of the fetus at 4-5 weeks (patient associates this condition with SARS), third pregnancy ended with an urgent and normal birth with the birth of a full-term alive baby, fourth ended with miscarriage in 3-4 weeks [6]. Current pregnancy - occurred independently. Pregnancy flows with toxaemia from 5-6 weeks of pregnancy (vomiting 5-6 times a day). From 6 weeks of pregnancy, come out anemia of pregnant women (she does not take antianemic drugs).

Objective Data

General condition of patient is relatively satisfactory. Skin - clean, pale, palms are moist. Pulse 90 beats per minute. Blood pressure 110/80 mm Hg. On the auscultation on lungs vesicular breathing, heart sounds are clear rhythmic. On palpation abdomen is soft, painless in all areas. Thyroid gland on palpation enlarged to II st, soft elastic, painless.

Laboratory Tests

hemoglobin 95 g/L, blood glucose 4.9 mm/L, TSH 0.02 mU/L, fT4 - 4.37 ng/dl, antibodies to TPO 20.2 U/ml, antibodies to TSH receptors 0,01 U/L, ultrasound of the thyroid gland - picture of diffuse goiter.

Obtained data allowed formulating the following diagnosis:

Primary: Gestational Transient Thyrotoxicosis.

Concomitant: Pregnancy V, childbirth III, 8-9 weeks moderate severity anemia. Toxemia of pregnancy.

Considering erased complaints, the absence of thyrotoxicosis in clinical history, clinical signs of thyrotoxicosis, weight loss and low levels of antibodies to TSH receptors, to the patient recommended symptomatic treatment: beta-blockers, antianemic drugs, sedatives and hospitalization to specialized gynecology department for the treatment of toxemia of pregnant women. After re-examination in one-month patient had no complaints [7]. The skin had normal moisture. Pulse 80 beats per minute. Blood pressure 110/80 mm Hg On the auscultation on lungs vesicular breathing, heart sounds clear rhythmic. On palpation, the abdomen is soft, painless in all areas. On palpation, thyroid gland enlarged to II st, soft elastic, painless. Laboratory tests: hemoglobin 110 g/L, TSH 1.0 mU/L, fT4 2.0 ng/dl. The general condition of the patient with symptomatic treatment has improved. Tachycardia and vomiting - not observed. Indicators of thyroid hormone studies returned to normal. Monitoring continues.

Conclusion

In this observation, patient had symptoms of gestational transient thyrotoxicosis. A similar picture of gestational transient thyrotoxicosis and thyrotoxicosis often leads to several diagnostic errors and leads to incorrect treatment tactics and to prescribing unreasonable appointment of antithyroid drug. Thus, when observing symptoms of thyrotoxicosis at the beginning of pregnancy, more attention to complaints, history of thyrotoxicosis, the severity of clinical signs of thyrotoxicosis, thyroid ultrasound, low levels of TSH receptors antibodies and slightly elevated levels of free T4 and TSH. During the diagnosis of gestational transient thyrotoxicosis, antithyroid drug not recommended, more preferred symptomatic treatment. By the middle of the second trimester, patient’s clinical condition is improving, and indicators of the hormonal status are normalized due to the physiological decrease of hCG.

For more about Juniper Publishers please click on: https://twitter.com/Juniper_publish

For more about Journal of Thyroid Research please click on: https://juniperpublishers.com/jetr/index.php

[academicheroes]

care plan med surg

care plan med surg

MEDICATION  1.carvedilol 3.125mg  1tab po Q12h  2.Darbepoetin alfa  60mcg= 0.3ml  3. Heparin (subcut) 5000unit = 1ml Q8h  4.hydralazine – isosorbide 1 tab po Q12h 20mg  5.polyethylenegly col 3350 17mg powder po daily   6. sacubitril valsartan (entrsto) 1 tab – 2x day 24mg  7.sanna 17.2mg po daily   8. torsemide 20mg po daily  PATIENT DATE OF BIRTH  05/06/1947 

[besthomeworkhelp]

Care Plan Med Surg MEDICATION 1.carvedilol 3.125mg 1tab po Q12h 2.Darbepoetin alfa 60mcg= 0.3ml 3. Heparin (subcut) 5000unit = 1ml Q8h…

[rlfkwopdke]

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추천 벌킹스택 : 디볼or옥시+"아나바"

추천 컷팅스택 : 클랜+"아나바"

부작용 : 거의 없습니다. 도핑감지기간 : 3~4주

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쉽게 접근하는 스테로이드 》 사이트문의~홈피:http://w2016.0pe.kr??☎:카톡↔33kkp

메디텍 <Meditech> 전체 품목 스테로이드(Steroid)

위니/윈스트롤 (경구제 스테로이드)

아나바 (경구제 스테로이드)

[1tabofficial]

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[kixabohajono]

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[joseph345-blog1]

Facebook admits to Messenger Kids security hole

Facebook admits to Messenger Kids security hole

https://wp.me/p120rT-1Tab

[bloojayoolie]

Being Alone, Anaconda, and Andrew Bogut: At Brooklyn ACC waiting for U! THE CUTEST 8 month old female Pup-friendly, playful, happy-Vill st Baby Christmas need lots of love, patience training Spayed & Ready 2 Gol Todie Hpl32 8 months old, 48 bs **** TO BE KILLED - 11/27/2018 **** SHE'S GOT THE CUTEST LITTLE BABY FACE! <3 Jodie is a fine example of an innocent puppy (8 months old) whose innocence is pure. She gives 100% of herself to everyone she meets and cannot disguise her joy. She aced her evaluation and would've kept going if they allowed her. All of her notes are glowing! Her gorgeous sterling steel coat is lush, her eyes shiny and bright, though its her disposition and heart that make her a forever treasure. The holidays are here, and this baby wants nothing more than a family to cherish. Sadly the shelter placed her on the "list" and her dreams are about to be shattered. Jodie is most deserving of a loving home as she will reciprocate with pride. Please message this page if you would like to foster or adopt her. MY VIDEO: https://www.youtube.com/watch?v=maMIfZihNjY JODIE@BROOKLYN ACC Hello, my name is Jodie My animal id is #46632 I am a desexed female gray dog at the Brooklyn Animal Care Center The shelter thinks I am about 8 months old, 48 lbs Came into as a return Nov. 20, 2018 Jodie is at risk due to being diagnosed with Canine Infection Respiratory Disease Complex and will likely require home rest and a series of antibiotics for up to 14 days. This is a contagious illness to other dogs. Jodie is suitable to go to an Adult only Home with and Experienced Dog Adopter based on previous owner and in-shelter observations. My medical notes are... Weight: 48.4 lbs L V T Notes Vet Notes Post Surgery Note Medical Assistant 10/11/2018 [LVT Intake Exam] Microchip Scan: Negative Evidence of Cruelty: none Observed Behavior:Friendly,but hyperactive tolerated all handling Sex:Female Estimated Age: 6mths Subjective: describe how the animal is presenting and any known history -- Jodie came in as Owner surrender, no known medical Hx Eyes:Clear, no ocular discharge Ears: Clean,NSF Oral Exam: WNL, NOSF Heart: WNL, HR- 160/min Lungs: Eupneic, RR=30/min Abdomen: Soft and non tender on palpation Musculoskeletal: WNL Mentation: Normal Preliminary Assessment: BARH,Normal. Plan: DVM intake exams. 14/11/2018 dispensed with carprofen100mg - 1tab sidx5 day po Details on my behavior are... Behavior Condition: 1. Green Behavior History Behavior Assessment Jodie was very hyper during intake but had a loose and wiggly body. She was difficult to collar as she was running around but was licking staff. She scanned positive for a microchip. Date of Intake: 11/20/2018 Basic Information:: Jodie is a 6 month old, large mixed breed female who was returned to the shelter due to the owner having health concerns. She had her for a about a week. Jodie has no known health issues or injuries and last saw a vet a few months ago. Previously lived with:: 2 adults How is this dog around strangers?: Jodie is friendly and outgoing when meeting new people. She approaches guests with high energy and enjoys attention. How is this dog around children?: Jodie has not spent time around children before. How is this dog around other dogs?: Jodie has not spent time around other dogs before. How is this dog around cats?: Jodie has not spent time around cats before. Resource guarding:: None reported by owner. Bite history:: None Housetrained:: Yes Energy level/descriptors:: Very High Other Notes:: Jodie is not bothered by having her food or toys touched. She is not bothered by being pushed off the furniture or disturbed while sleeping. Jodie does not alert bark when guests come to the door. Has this dog ever had any medical issues?: No For a New Family to Know: Jodie is described as being friendly, affectionate and playful. She has been an indoor dog, likes to follow her owner around when they are home and eats dry food three times a day. Jodie is house trained to go outside and rarely has accidents inside. She has not been crate trained and is well behaved when left alone in the house. Jodie walks on leash for exercise and enjoys running around. Jodie has a very high energy level and requires a lot of enrichment and exercise. She listens to "sit". Date of intake:: 11/6/2018 Spay/Neuter status:: No Means of surrender (length of time in previous home):: Owner surrender Previously lived with:: 2 adults Behavior toward strangers:: Friendly and outgoing Behavior toward children:: Unknown Behavior toward dogs:: Unknown Behavior toward cats:: Unknown Resource guarding:: None reported Bite history:: None reported Housetrained:: Yes Energy level/descriptors:: The owner describes Jodie as friendly, affectionate and playful with a very high activity level. Date of assessment:: 11/8/2018 Look:: 1. Dog leans forward or jumps up to lick the Assessor's face with tail wagging, ears back and eyes averted. Sensitivity:: 1. Dog stands still and accepts the touch, eyes are averted, and tail is in neutral position with a relaxed body posture. Dog's mouth is likely closed for at least a portion of the assessment item. Tag:: 1. Dog follows at the end of the leash, body soft. Paw squeeze 1:: 1. Dog gently pulls back his/her paw. Paw squeeze 2:: 1. Dog gently pulls back his/her paw. Toy:: 1. Dog settles close, keeps a firm grip and is loose and wiggly. Dog does not place his/her body between you and the toy. Summary:: Jodie came into the assessment room loose and wiggly, she was very energetic and jumpy. She was also anxious in the room panting, pacing back and forth. Summary (1):: According to Jodie's previous owner, Jodie did not socialize with other dogs while in their care. Here at the Care Centers, Jodie is uncomfortable around novel dogs. She avoids them most of her session and will offer grumbles if they are near. The Behavior Department recommends that Jodie be the resident dog at this time. 11/7: When off leash at the Care Centers, Jodie tucks her tail, raise her hackles and huffs when the greeter is near. She attempts to avoid him, and lip curls when he is near. 11/8-9: Jodie avoided the novel female dog and mostly sought attention from the handlers. Towards the end of her session, Jodie grumbles and barked at the greeter from afar. Date of intake:: 11/6/2018 Summary:: Very hyper but loose and wiggly. Allowed all handling. ENERGY LEVEL:: Jodie displays a very high activity level in the care center. BEHAVIOR DETERMINATION:: ADULT ONLY HOME Behavior Asilomar: TM - Treatable-Manageable Recommendations:: No children (under 13),Single-pet home,Recommend no dog parks Recommendations comments:: No children: Due to the behavior seen in the care center, we feel that Jodie may be intimidated for children. She displays a very energetic behavior and does not know her owner strength and size. She may knock children down by constantly jumping on them and scaring them Single-pet home/Recommend no dog parks: Due to the behaviors that Jodie has shown during playgroup (see GROUPBEHAVIOR SUMMARY), we feel that Jodie should not visit dog parks and be the only resident dog. The Behavior Department recommends that she be socialized in a more controlled setting until her behavior towards other dogs can be further addressed. Reward-based, force-free training can be utilized to help Jodie associate dogs with things she enjoys like toys or treats. Potential challenges: : Basic manners/poor impulse control,Anxiety Potential challenges comments:: Basic manners/poor impulse control: It is recommended that default behaviors such as "Leave it", "Sit/Stay", "Down" are reinforced to substitute any frustration and teach her to control her impulses instead of simply reacting; proper management is also advised. Force-free, reward based training only is recommended. Anxiety: Jodie has shown some signs of potential anxiety in the care center, vocalizing (whining, panting, pacing back and forth) continually through the SAFER. This behavior was not reported at intake, the owner profile does not note anxiety so we cannot be certain whether this behavior will continue in a future home, or whether it is specific to the shelter environment. * TO FOSTER OR ADOPT * HOW TO RESERVE A “TO BE KILLED” DOG ONLINE (only for those who can get to the shelter IN PERSON to complete the adoption process, and only for the dogs on the list NOT marked New Hope Rescue Only). Follow our Step by Step directions below! PLEASE NOTE – YOU MUST USE A PC OR TABLET – PHONE RESERVES WILL NOT WORK! * STEP 1: CLICK ON THIS RESERVE LINK: https://newhope.shelterbuddy.com/Animal/List Step 2: Go to the red menu button on the top right corner, click register and fill in your info. Step 3: Go to your email and verify account \ Step 4: Go back to the website, click the menu button and view available dogs Step 5: Scroll to the animal you are interested and click reserve STEP 6 ( MOST IMPORTANT STEP ): GO TO THE MENU AGAIN AND VIEW YOUR CART. THE ANIMAL SHOULD NOW BE IN YOUR CART! Step 7: Fill in your credit card info and complete transaction HOW TO FOSTER OR ADOPT IF YOU CANNOT GET TO THE SHELTER IN PERSON, OR IF THE DOG IS NEW HOPE RESCUE ONLY! You must live within 3 – 4 hours of NY, NJ, PA, CT, RI, DE, MD, MA, NH, VT, ME or Norther VA. Please PM our page for assistance. You will need to fill out applications with a New Hope Rescue Partner to foster or adopt a dog on the To Be Killed list, including those labelled Rescue Only. Hurry please, time is short, and the Rescues need time to process the applications. Shelter contact information Phone number (212) 788-4000 Email adoption@nycacc.org Shelter Addresses: Brooklyn Shelter: 2336 Linden Boulevard Brooklyn, NY 11208 Manhattan Shelter: 326 East 110 St. New York, NY 10029 Staten Island Shelter: 3139 Veterans Road West Staten Island, NY 10309

[vitamincserum1]

Vitamin C serum

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