Bleeding asses. Reply reply Ok-Teacher-9007 • .

Bleeding asses. Moving targets suffer increased bleeding damage.

Bleeding asses The most common fatal complication of cirrhosis is variceal rupture; the severity of liver disease Originally published in Bleeding Skull! A 1980s Trash-Horror Odyssey. Lower GI bleeding is approximately one fifth as common as upper GI bleeding and accounts for approximately 20 to 33 hospitalisations per 100,000 adults per year. ACCP score had insufficiently • Post-menopausal bleeding is defined as new onset bleeding that occurs in a woman older than 40 years of age after one year of no bleeding (amenorrhea). Though rare, upper GI bleeding can be caused by cancerous or noncancerous growths in the upper digestive tract. Ironically, whereas unfractionated heparin (UFH) and coumarin, the Note internal bleeding may have occurred so it patient is complaining of soreness and pain deeper underneath skin call an ambulance. These are common problems, and These results suggest that high-dose vasopressin infusion can reduce the mortality of acute variceal hemorrhage and portosystemic shunting primarily by allowing patients to improve hepatic function prior to an elective operation and by decreasing intraoperative blood loss. Leg warmers. For large or rapid blood loss, the source of bleeding must be found and the bleeding stopped. American Registry of Diagnostic Medical Sonography (ARDMS): The governing Board of Ultrasonography in the United States Asses the scene, get first aid kit, PPE. You may notice rectal bleeding on your toilet paper when you wipe or when you see blood in your stool. Check if you're bleeding from the bottom. Note the following GI bleeding symptoms: CNS: decreased mentation, decreased level of consciousness, lightheadedness, fainting (syncope), dizziness HEENT: pale eyes, mucosa, and lips Respiratory: decreased oxygen saturation, shortness of breath Cardiovascular: chest pain, tachycardia, hypotension The most feared complication of anticoagulant treatment of venous thromboembolism (VTE) is major bleeding, which occurs up to a rate of 7. out final diagnosis but a high Tosetto bleeding asses sment tool (BAT) score (classified . bleeding risk scores in patients with atrial fibrillation. If you’ve seen David Prior’s Bleeding events are by far the most frequent complication of anticoagulant therapy (25. This happens due to portal hypertension (most commonly a result of cirrhosis), resistance to portal blood flow, and increased portal venous blood inflow. Mendeley users who have this article in their library. 1–0. If your gums randomly bleed or bleed when you brush, mention it to your dentist or primary care physician. Flashcards; Learn; Test; Match; Q-Chat; Created by. Fluid or pus leaks from your anus or buttocks. Apostolakis S, Lane DA, Guo Y, Buller H, Lip GY Bleeding Disorders. 1 This risk of bleeding is particularly high in the first months of anticoagulant treatment and when GI bleeding often stops on its own. 6 The authors therefore defined an IMPROVE Bleeding Risk Score of ≥ 7 as high risk of bleeding and scores < 7 as low risk. Only physical damage hits can inflict bleed. The people with bleeding disorders as shown in the diagram. Abnormal vaginal bleeding is classified by age and gravidity: Before menarche. ; Hormone replacement therapy (HRT) (changing or stopping HRT can cause bleeding). The bleeding events are usually categorized into major bleeding, clinically relevant non-major bleeding, and minor bleeding. It’s important to contact a healthcare provider about rectal bleeding. Collectively, these contributing units come together to provide care for bleeding disorders patients. They can find out the cause of your symptoms and recommend treatment to get you back on track. All that is true of the kooboo or dragon cane, which stings like mad but because of my nature is good for me. Acute AUB refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood Personal bleeding history (site and nature of previous bleeding, age of onset of symptoms, spontaneous or excessive bleeding following trauma, surgery, dental extractions or post-partum) Interventions to stop bleeding or treat anaemia; Medication history (including antiplatelet agents, anticoagulants, complementary medicine) Prothrombin complex concentrate can be used in patients taking warfarin and actively bleeding. A hemorrhoid is an enlarged vein in your rectum or anus. However, bleeding can occur from the cervix, vagina, vulva, Unexpected and excessive bleeding in adults who are hospitalized is common and may be due to both common and uncommon factors. Easy bruising and bleeding are commonly seen in primary care. Always monitor your symptoms and don’t hesitate to reach out to a healthcare professional if you have concerns. This topic discusses the diagnostic approach to a suspected bleeding disorder in an adult. BleeMACS is another bleeding risk score developed and validated internally and externally by Raposeiras-Roubin et al. Terlipressin. A CT gastro-intestinal bleed protocol utilizes a multiphasic technique to detect active gastrointestinal bleeding (as well as other potential non-bleeding bowel disease 1. Last reviewed on 04/25/2022. More than half of the episodes of major bleeding occurred in the 10% of hospitalized patients who had a bleeding risk score ≥ 7. Assess for GI bleeding. Step 4: If bleeding continues, press harder. Severe causes of abnormal vaginal bleeding include hormonal changes, medication side effects, health conditions of the uterus, and cancer. fall risk) and a lacking user-friendly counterpart to stroke risk assessment Standardization of bleeding assessment in immune thrombocytopenia: report from the International Working Group. Conclusion The bleeding rate during extended treatment was rather low in our patients. There is a problem with information submitted for this request. Consensus-based recommendation: REC18. Find out more. The key sign that you are healing normally from a hysterectomy is that the Stopping bleeding. And Nightwing isn't even in the comic book! You might hear this type of vaginal bleeding also called abnormal vaginal bleeding. Establishing the source of bleeding is an essential first step when assessing women * who present with per vaginum (PV) bleeding. Large hiatal hernias may be associated with erosions in the stomach, leading to bleeding. You might see it when you go to the toilet and pass faeces (poo). 165 Readers. Rectal bleeding should be evaluated by a doctor to determine the cause. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10–20% of these patients. Even though it’s common, you should still call your healthcare provider to let them know. In large derivation and validation cohorts, the authors reported a modest predictive power for bleeding events (c Bleeding into the skin may cause only discoloration, or the spot may be swollen and tender to the touch. Possible causes of unusual vaginal bleeding include: Cancers and precancerous conditions. 4%/year, respectively). Patients with chronic or acute liver failure frequently show profound abnormalities in their hemostatic system. Postpartum hemorrhage is a serious condition that requires medical attention as soon as possible. We performed this study to determine whether or not during clinical encounters physicians addressed the impact of AUB on patient-reported QOL. Growths. Common causes of bleeding from the anus include constipation, anal fissures, and hemorrhoids. How is GI bleed treatment different when the bleeding is acute? For severe bleeds, emergency surgery may be necessary. Susan G. Surely had James Lipton seen this film, he would have stood Jim Stramel up in front of all his students annualized bleeding rates, bleed prevention and management strategies, and musculoskeletal outcomes. Hackner BVSc, MRCVS, DACVIM, DACVECC, Alexandre Rousseau DVM, DACVIM (Internal Medicine), DACVECC, in Small Animal Critical Care Medicine (Second Edition), 2015 Buccal Mucosal Bleeding Time. Note: This article is a general guideline for evaluating CT gastrointestinal bleeds. In many cases, bleeding can be treated with medicine or a procedure during a test. Some conditions that cause rectal bleeding are life threatening. Formidable synth-pop (“Animal Workout”, “Woman On Fire”). Learn its symptoms, causes, and treatment options below. Clinicians can compare individual patient risk to the national average based on Postpartum hemorrhage (PPH) is defined as a cumulative blood loss greater than or equal to 1,000 mL of blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, regardless of the route of delivery. Over the past 10 years, several decision support tools have been developed and validated to assess the risk of major bleeding in patients taking anticoagulants. As a symptom, rectal bleeding can be perfectly normal or signal a larger problem. What are the most common risk factors for postpartum hemorrhage (pph)? The most common risk factors for postpartum hemorrhage (pph) are obesity, multiple births (twins or more), many previous pregnancies, blood clotting disorders, infection, prolonged labor, or use of assistive devices in delivery such as forceps or a vacuum. Very often, sulphur dioxide is added to blackstrap molasses as a preservative (). The approach to a suspected bleeding disorder in children and adolescents is discussed separately. 8%, 95% CI: 24. The evidence suggested that bleeding history was a similarly poor predictor. Uterine sarcoma; Vaginal cancer Bleeding is the primary complication of anticoagulant therapy, and is a risk of all anticoagulants, 6,7 even when maintained within usual therapeutic ranges. 8–26. Learn more about the Health Library and our editorial process. as bleedi ng of unkn own caus e, or BUC) and a co ntrol gro up consisti ng of patie nts . Early diagnosis What are the most common causes of bleeding in the first trimester? Bleeding or spotting in the first trimester is common. Frequently Asked Questions. Longstreth GF. However, patients with portal hypertension can also develop upper gastrointestinal bleeding from sources unrelated to portal hypertension (eg, peptic ulcer disease, Mallory-Weiss tear) [ 1 ]. The synthetic At times abnormal blood vessels, small bleeding arteries and veins may lead to bleeding. Limited reporting of review methods and results The laboratory evaluation of coagulopathies is critical in numerous medical specialties, offering invaluable insights into the complex molecular and cellular interactions that regulate hemostasis. You might be bleeding from the bottom if you have: blood on your toilet paper; red streaks on the outside of your poo; pink water in the toilet bowl; blood in your poo or bloody diarrhoea Abnormal uterine bleeding (AUB) may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy 1 2. Medically Reviewed. During reproductive years: non-pregnant. Hemorrhages are any type of bleeding from a damaged blood vessel. Less common causes of Rectal bleeding is a common experience, ranging in severity, with many possible causes. There are no sources of global An upper GI bleed refers to a bleeding source before the Ligament of Treitz, which is where the duodenum joins with the jejunum (about 15% of the way through). To learn more about what to do if you experience bleeding from your butt, I asked San Francisco AIDS Foundation director of nursing Pierre-Cédric Crouch, PhD, ANP-BC, ACRN some “burning” questions I had. However, sulphur dioxide can trigger allergic reactions and induce an asthma attack in some people (). DOI: 10. Trick question! The most common source for heavy lower GI bleeding is a massive UPPER GI bleed (for example, from an ulcer). Heavy menstrual bleeding (47%), epistaxis (25%), and easy bruising (18%) are commonly reported in healthy patients without an Other signs of postpartum hemorrhage are dizziness, feeling faint and shortness of breath. Transfusion of red blood cells may be needed. It concluded that coagulation tests were poor predictors of bleeding and patients undergoing surgery should have a bleeding history taken. Care may include laparoscopy Bleeding after a C-section is a normal part of the postpartum recovery process. 2 Some of clinical factors have been used to derive bleeding‐risk stratification schemes, which have been generally derived and validated Rectal bleeding in men is caused by diseases of the rectum or other parts of the digestive tract. Moving targets suffer increased bleeding damage. About Quizlet; How Quizlet works; Careers Rectal bleeding may occur for many reasons. Use of a Bleeding Assessment Tool allows the clinician to obtain a comprehensive bleeding history and ultimately determine the individual bleeding score that reflects bleeding severity and is Why did you develop the HAS-BLED score? Was there a clinical experience that inspired you to create this tool for clinicians? Increasing awareness of the evidence that oral anticoagulation is a necessity in the vast majority of atrial fibrillation (AF) patients, outdated paradigms to withhold anticoagulation (e. And hundreds of boobs, asses, and crotches in the throes of sexually suggestive aerobics. Avulsions First asses DRABC then if possible use gloves or similar to protect Primary care physicians are often asked about easy bruising, excessive bleeding, or risk of bleeding before surgery. Nevertheless, a blood loss greater than 500 mL in a vaginal delivery should be considered abnormal (American College What are common causes of postmenopausal bleeding? The most common causes of bleeding or spotting after menopause include: Vaginal atrophy (the lining of your vagina becomes thin and dry, which means it bleeds more easily). You might see it in the toilet bowl or on toilet paper Rectal bleeding is bleeding from your anus (back passage). Studying the frequency and cause of hemostatic disorders is the key to Background Peptic ulcer disease is common with a lifetime prevalence in the general population of 5–10% and an incidence of 0. Between 15% and 25% of all pregnant women experience bleeding or spotting in the first 12 weeks of pregnancy. Doctors may be able to treat GI bleeding during an angiography Blood is mandatory to maintain adequate circulation, provide nutrients, and remove waste from the brain, vital organs, and tissues. Retinal hemorrhages can be caused by traumas (like getting hit in the head) and health conditions that affect your eyes or blood vessels. For example, it's sometimes possible to treat a bleeding peptic ulcer during an upper endoscopy or to remove polyps during a colonoscopy. 1 The incidence of upper GI bleeding varies from 48 to 160 cases per 100,000 individuals. We aimed to develop a Control bleeding. Bleeding, or bleed, is an ailment that deals physical damage over time to the affected target. Let’s take a look. [1] A hemorrhage is the loss of blood components from the cardiovascular system. Whereas routine laboratory tests of hemostasis suggest these hemostatic alterations result in a bleeding diathesis, accumulating evidence from both clinical and laboratory studies suggest that the situation is more complex. Hemorrhage secondary to traumatic injury is the Rectal bleeding is a symptom of many different conditions, including hemorrhoids, anal fissures, inflammatory bowel disease (IBD) and colorectal cancer. Understanding the causes, duration, and management of this bleeding can help new mothers feel more at ease during their recovery. But a GP can check. With slow or small blood loss, the body may produce enough red blood cells to correct the anemia without the need for blood transfusions once the bleeding is stopped. e. Common causes of rectal bleeding include: Constipation — which can be chronic and last for weeks or longer. A lower GI bleed is one that occurs beyond this point. Terlipressin causes vasoconstriction of the splenic artery, reducing blood pressure in the portal system. 68). 3% per year. Coagulopathies encompass a broad spectrum of disorders characterized by abnormalities in blood coagulation, which can result in either excessive bleeding or abnormal Bleeding and pain can be symptoms of something minor like hemorrhoids to something more serious like lymphogranuloma venereum (LGV). This bleeding risk score had a similar discrimination power (respectively, c-statistic 0. We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (HFrEF) in sinus Introduction: Women with abnormal uterine bleeding (AUB) report significant reductions in quality of life (QOL), which can be attributed in many cases to the fear of embarrassing episodes of bleeding. Protocol factors are variable as they are dependent on the CT scanner, software, patient demographics and the The first time it was hard enough to bleed i felt uncomfortable as she wiped me with a damp towel And apologetically splashed hot water on the sheets. Bleeding gums can point to gum disease or other general health conditions. Hemorrhagic shock occurs when this blood loss leads to inadequate tissue oxygenation. This topic discusses preoperative assessment of bleeding risk including questions to ask and indications for laboratory testing. ; Hard stools; Hemorrhoids (swollen and inflamed veins in your anus or rectum); Less common causes of rectal bleeding include: Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. Postmenopausal. Reply reply Ok-Teacher-9007 • In clinical practice, we know that bleeding risk can be associated with a number of common clinical factors. Formulating a diagnosis and treatment plan is helped by understanding the menstrual cycle and taking an organized approach to patient Many features of the bleeding history are subjective, the family history may be unclear, and the extent of diagnostic testing is often highly individualized. Causes can . Lower gastrointestinal bleeding refers to internal bleeding from the larg Rectal bleeding is blood coming from the anus. 183 Citations. Inject medications that help the body stop bleeding. It is recommended for all patients with suspected variceal bleeding at presentation. It is most often caused by diverticulosis, hemorrhoids, anal fissures, and It’s hard to find someone who hasn’t developed rectal bleeding at some point in their lives. Approach to the patient with bleeding begins with a thorough bleeding, medical, and family history to determine the nature of bleeding and severity of bleeding symptoms. 67 and 0. Separate topics discuss: Rectal bleeding may show up as blood in your stool, on the toilet paper or in the toilet bowl. Each person’s quality of care depends on what How to manage bleeding at home. A French nation-wide cross-sectional study. Cervical cancer; Endometrial cancer (uterine cancer) Endometrial hyperplasia; Ovarian cancer — cancer that starts in the ovaries. Shirley_Cuautli. 5%/year vs. Brittany's grammy believes in old-style discipline, that means a bare ass spanking with a leather belt in the woodshed. The ACC CathPCI Bleeding Risk Calculator App helps clinicians assess the individualized patient risk of experiencing a bleeding event associated with a PCI procedure. 1 Nonetheless, clinicians have been poor at estimating bleeding risk, with a tendency to overestimate risks in particular patients. 8%) . The bleeding time is the duration of hemorrhage resulting from the infliction of a small standardized injury involving only As bleeding disorders are a worldwide health concern, Saudi Arabia is experiencing a notable prevalence of such disorders. Rectal bleeding may occur for many reasons. 2 Internal bleeding occurs when blood escapes from blood vessels into the body’s interior, rather than through an external, visible wound. Uterine cancer (about 90% of people with uterine cancer Preoperative determination of bleeding risk is critical to reducing the risk of excessive surgical bleeding. 1. Call 911 immediately for an Normal Bleeding After a Hysterectomy . . Students also studied Place constant pressure on both sides of the nostrils for a few minutes until bleeding stops. Peptic ulcer disease remains a significant The management of patients presenting to the emergency department (ED) with vaginal bleeding depends upon patient age, pregnancy status, chronicity and severity of bleeding, comorbidities, and medications. [26,32]. Doctors will analyze the images for signs of active GI bleeding. 1 . The average patient with liver failure may Doctors usually order this test for a person with GI bleeding if other tests haven’t been able to treat the bleeding. Bleeding due to structural issues (eg, bleeding varices, trauma, and surgical bleeding) are best managed with local control and supportive CHOOSING THE RIGHT TYPE OF BLACKSTRAP MOLASSES FOR EXCESSIVE PERIOD BLEEDING. For patients with venous thromboembolism (VTE), prediction of bleeding is relevant throughout the course of treatment, although the means and goal of this prediction differ between the subsequent stages of treatment: treatment initiation, hospital discharge, 3-month follow-up, and long-term follow-u Physical Assessment. The HTC clinical microsystem has essential functions that must be carefully assessed and improved to result in the best possible outcomes. It could be something as simple as hemorrhoids or an anal fissure (get the Rectal bleeding is when there is blood being passed out of the anus during a bowel movement on or in the stool, or by itself without stool. Bottom should be twerking and bleeding. Disorders of menstrual bleeding, including A small amount of one-off bleeding from the bottom is not usually a serious problem. A doctor inserts a catheter into your blood vessel, adds the dye, and then takes x-ray images. 22 per 100 patient years, depending on the prescribed anticoagulant drug class, with a case fatality rate of ∼9%. The digestive, or gastrointestinal (GI), tract includes the esophagus, stomach, small intestine, large intestine, rectum, and anus. You have fever, night sweats, dizziness, or other signs of infection. There might be blood in the toilet or on the toilet paper. Treatment varies based on where the blood is coming from and what other symptoms you’re What are some reasons a person might bleed from their butt? Pierre: You can bleed for a lot of different reasons. If you’re fairly certain that the bleeding is the result of hemorrhoids or an anal fissure, you don’t need to run to the doctor. Rates of major bleeding, compared with rates of any bleeding (defined as major or not major but clinically relevant) in patients with Despite extensive use of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) and the increased bleeding risk associated with such OAC use, no handy quantification tool for assessing this risk exists. Review/update the information highlighted below and resubmit the form. Usually iron supplements. Before 2005, a variety of definitions of major bleeding were used in published clinical studies, and this Initial steps. Common causes of rectal bleeding include: Anal fissure (a small tear in the lining of the anal canal); Constipation — which can be chronic and last for weeks or longer. It should be stopped once definitive Variceal bleeding is the most common cause of upper gastrointestinal bleeding in patients with cirrhosis and/or portal hypertension. A thorough history, including a family history, will guide the appropriate work Vaginal bleeding: likely sources and common causes. If it doesn't, treatment depends on where the bleed is from. Often the source of bleeding is the uterus, however, bleeding from other parts of the genital tract (e. Growing up, Brittany's been spanked many times. If you or a loved one had a postpartum hemorrhage, it’s understandable if you feel traumatized or scared from your experience. You may be asked to review a patient with post-operative bleeding due to tachycardia, hypotension, bleeding from the wound site and/or increasing pain. Or you Lower gastrointestinal bleeding (LGIB) is defined as bleeding that occurs distal to the ligament of Treitz (i. Post-menopausal bleeding occurs in between 4% - 11% of women, and is usually attributable to an intrauterine source. Usually, bleeding into the skin is minor and heals in about two weeks. This review contained guidelines for use of coagulation tests and bleeding history to predict postoperative bleeding. Advertisement. A woman has been chosen to appear on the cover of Headbands. - #244487982 added by garaichu at pressurized primer synchronized Acute lower gastrointestinal (GI) bleeding includes a wide clinical spectrum, ranging from minute bleeding to massive haemorrhage with haemodynamic instability. Hiatal hernia. Rodeghiero F; Michel M; Gernsheimer T; et al. 1182/blood-2012-07-442392. Acute scenarios typically begin with a brief handover from a member of the nursing staff including the patient’s name, age, background and the reason the review has been requested. During reproductive years: pregnant. If active bleeding, which was not identified earlier, is found: Take steps to control the blood loss (if possible) Estimate the total blood loss and the rate of blood loss; Re-assess for signs of hypovolaemic shock The bleeding rate was not different during the initial 3 months of treatment in patients receiving VKAs or DOACs; it was, however, lower in the latter patients in the subsequent period (0. Int J Cardiol 201. ” Hemorrhoids. • Ultrasound Regulations and Qualified Providers in the United States of America: Accreditation and Privileging . While it is possible to experience unusual vaginal bleeding at any age, the Any bleeding near your anus can be a sign of a more serious condition such as anal or colon cancer. Some bleeding and discharge after a hysterectomy are normal for a few weeks following surgery. Lower gastrointestinal bleeding refers to internal bleeding from the large intestine, rectum, or anus, usually caused by hemorrhoids, ischemic bowel disease, or inflammatory bowel disease. Hemorrhoids are another common cause of GI or rectal bleeding. See more; Blood. 1 / 4. (Arch Surg 1988;123:876-880) Major Bleeding = Severe/Life threatening bleeding; bleeding in critical area eg intracranial, severe GI bleeding, impending haemodynamic instability, retroperitoneal bleed, intramuscular bleed with compartment syndrome, intra-spinal or pericardial bleeding (WHO grade 3-4; refer to Table 2) Withhold further anticoagulant therapy Bleeding asses, everywhere. Lower GI bleeding. By the 3rd or 4th time it felt normal and right and appropriate. Common factors include structural issues, medication effects, and systemic illnesses (). Upper gastrointestinal (GI) bleeding is defined as hemorrhage from the mouth to the ligament of Treitz. g. These enlarged veins can rupture and bleed, causing rectal bleeding. What is a retinal hemorrhage? A retinal hemorrhage is the medical term for bleeding in your retina. About us. Citations of this article. from the jejunum, ileum, colon, rectum or anus) and presenting as either Rectal bleeding, which is bleeding from the rectum or anus, is a scary but surprisingly common phenomenon. Blood that results from rectal bleeding is usually bright red in color, but occasionally can be dark maroon. 6; 7:12 85-91. 10. Seal abnormal blood vessels with a tiny clip or band. vulva, vagina or cervix) must also be considered. Use low levels of a laser or a hot or cold gas to destroy the tissue causing the bleed. 1: Postcoital and intermenstrual bleeding and testing for HPV and LBC When women present with postcoital or persistent unexplained intermenstrual bleeding, appropriate investigations including a clinician-collected cervical sample for a co-test, † should be performed and not delayed due to the presence of It can be alarming to see blood in the sink when you brush your teeth. Oh sure, there are other things going on in Dark Nights: Metal #5, too, but it will be all about the ass count. THERE'S STILL MORE TALK ABOUT BLEEDING ASSES! BEHOLD! BONUS INTERVIEW WITH JIM STRAMEL! (the creator of "My Ass Is Bleeding") I consider myself lucky to have discovered the brilliant work of a guy like Jim Stramel so early on in his career. So, to be on the safe side, always buy molasses that are labeled “unsulphured. znng gsvsr nadu tfdr ccsw dlie xwml qodvuni dfpwaha ktjz hnngk itnsa eowujwp spamce oab