Liver doctors kingwood tx

How did you know you were developing HELLP?

2023.06.08 17:37 OutrageousSea5212 How did you know you were developing HELLP?

I'm 33 weeks pregnant and have had elevated liver enzymes since 19 weeks. They creep higher every week. I also have tenderness under my right rib. My doctor is monitoring closely.
My blood pressure is currently fine, though đź‘Ź, and no protein in urine. I had high BP at the end of my last pregnancy so I'm keeping an eye on it. I'm being induced at 37 weeks out of caution because they don't know what's going on with my liver.
I know elevated liver enzymes are a key part of HELLP.
For those of you who had HELLP, what were the first signs (laboratory or physical etc)? When or how did your doctors find out?
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2023.06.08 17:36 Individual_Mess3929 Metal Gear Remake Concepts Part 1

hese are concepts ideas I had for an Metal Gear (1987) remake which I would dub as Metal Gear Solid 6: Outer Haven. Metal Gear 2: Solid Snake (1990) would be called Metal Gear Solid 7: Zanzibarland. Both games would be long and give a lot of depth on Solid Snake's past and his relationship with Big Boss, Campbell and Gray Fox. Another game I would push for is Metal Gear Solid: The Philanthropy Chronicles.It would allow players to play as Solid Snake and his supporting cast after the events of Metal Gear Solid 2. Snake’s mission to continue taking out metal gears and track down the Patriots along with Revolver Ocelot. It would lead up to the events of Metal Gear Solid 4: Guns of the Patriots. I will be working on Metal Gear Solid 7: Zanzibarland concepts soon.
The concept for a Metal Gear Solid 6: Outer Haven (MGS6: OH):
I know its long as Metal Gear (1987) would have to be a game that is remade from the bottom up. A remake of Metal Gear 2: Solid Snake would be easier since it was a rock solid game. One wouldn't have to change much from it just expand on the story, elements and characterization it has already. I would love to get feed back from fans here.
Story:
The storytelling aspect is inspired by how MGS (1998) told its story. The game would start with Otacon, a ghost writer that wrote the novel of Snake’s exploits and those that work with Snake during Operation Intrude N313 telling the events of Metal Gear Solid 6: Outer Heaven to journalist they trust. We learn that Snake is paradon for his crimes and is buried as a war hero next to the grave of Big Boss. Given a Medal of Honor award and other awards from other countries for saving the world several times. The world is now knowing about his story and thus even more interested to learn of Snakes exploits during his youth. David Hayter voice being used as a recorded message from a dying Solid Snake giving accounts on what happened in Metal Gear Solid 6 and 7 along with most of his life. Snake hopes that his message and story will inspire others to be better and fight for what is right.
David Hayter wouldn’t voice a young Solid Snake as I feel a voice actor that is younger but can emulate David Hayter mannerism and his voice should do it. A young Solid Snake having a hint of innocence, nativity, vulnerability and self doubt at times.
David Hayter would voice Solid Snake in Metal Gear Solid 7: Zanzibarland since Snake is supposed to be older and wiser. David would be able to give us this voice range and kick it out of the park including the duel against the real Big Boss.
Plot:
The year is 1995, the Soviet Union has collapsed and the Cold War is now over. The threat of nuclear war is gone and the world embraces this newfound peace. However, this peace is short-lived as there are those that don’t want it. The world is engulfed with the threat of terrorism and rogue states that want to get their hands on nuclear weapons. The free world is now being threatened once again. The US Government works to combat this threat with its covert U.S. Army unit known as Fox-Hound under the leadership of the legendary war hero known as Big Boss. However, when a government agent goes missing during a mission…The agent last reports a weapon that can shake the foundations of the world known as “Metal Gear”. Big Boss sends in a rookie but talented Fox-Hound agent known as Solid Snake to learn of this new weapon. Will Snake learn the truth about this new weapon or will the world find out what Metal Gear will do if it's unleashed?
Mission:
Like MGS3 there would be a Virtuous Mission in MGS6:OH.
Main Mission:
This is where Snake goes to South Africa and has to get to Outer Haven which is a vastly HUGE heavily defended base. Potentially the best soldiers and mercenaries in the world work and defend the base. It is an official mission sponsored by Fox-Hound, NATO, CIA, NSA, UN and top members of the US Government. This means Solid Snake gets a load of equipment, gadgets and weapons for the mission.
Gameplay would be a mix between MSG 3 and MSG 4 and MSG 5. It takes influence from other games like Red Dead Redemption, Splinter Cell and Grand Theft Auto video games along with new mechanics. The concept is to give the game a war survival horror like vibe if you’re spotted by the enemy or having trouble surviving in the wilderness.
MSG3 gameplay elements
MGS4 Gameplay elements-
MGS 5-
Splinter cell element-
Grand Theft Auto elements-
New Gaming mechanics -
Weapons
Snake’s Gadgets/Tools for the main mission where he gets official support
Vehicles
Theme:
Movie Influence:
Game Music:
Characters:
Venom Snake/Big Boss:
Supporting Characters
Kyle Schneider
Jennifer Schneider
Diane
Drago Pettrovich Madnar
Ellen Madnar
Tech (Original)
submitted by Individual_Mess3929 to metalgearsolid [link] [comments]


2023.06.08 15:48 Ok-Candle4774 Need help loosing my mind over doctors dragging there feet!!!!

hi first ever reddit post so let’s dive in…… about 4 years ago i started having some strange digestive issues mainly bloating and and pain all seems to be upper abdomen just above belly button to start off with i was told IBS at this time i had gained a fair bit weight fast forward to around the first lock down i starting having immense pain in abdomen same spot always upper above belly button sometimes moves to left or right docs started a load of tests your basic bloods stool ect to start off with then CT when i was admitted due to pain and weight loss CT showed bowel wall thickening in the left of large intestine so had a colonoscopy from that i was diagnosed IBD indeterminate!!! there was inflammation at the start of my anus but that was it started on meds that never really worked to be honest then kept going back to doctors was then sent for camera down the throat everything all good another round of bloods everything all good again i raised my concerns with the doc about chronic pancreatitis(prolific googler my symptoms seem to match up) docs sent me for CT of the pancreas and a fecal elastase test all good again nothing abnormal symptoms are still persisting upper abdominal pain better in the morning worse around lunch time doesn’t react to any specific food just all food hurt when it’s bad it’s like it comes and goes with no real pattern get really constipated as well undigested food in stool also happens often. does this sound like chronic pancreatitis? i know this is a rant but i am at my wits end it’s affecting my family my career my mental health is shot to pieces i worry constantly to top it all off i lost a very dear friend to chronic pancreatitis early this year to i am back in touch with doctors but having to go through all the same blood tests if they send me for another CT i will crack up they do not seem to take my concern seriously no matter how i approach it only things bloods have ever shown is slightly raised inflammation once slightly raised LDL once and a slightly raised Liver enzyme once all of which have returned to normal level in re test. symptoms consist of mouth ulcers weight loss constipation mucus in stool joint pain upper abdomen pain never below belly button shoulders are always sore i go through really bad stages of fatigue to and my nails look wierd as hell dips and ridges. any words of wisdom will be greatly appreciated bless you all
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2023.06.08 15:09 HonestBagel515 New blood work outlier

Hi everyone! I was diagnosed with PCOS back in 2017. I just got new blood work back and my alkaline phosphatase was high. My doctor was unconcerned (not a fan of this doc so looking for a new one)
I’m concerned because this could be a sign of liver or bone issues especially cancers.
Has anyone else seen this or have experience with this?
Note. I’m not a heavy drinker and have never broken a bone.
submitted by HonestBagel515 to PCOS [link] [comments]


2023.06.08 14:53 AMJNPA Help CT Scan Reading

Recently my sister (26F) went to Urgent care for pain in her lower abdomen and they did a CT scan. They said that she should get her liver check even though it was unrelated with this pain. The doctor mentioned to get it check this year that it didn't have to be right away. We are all concerned.
Does it sound benign?
submitted by AMJNPA to AskDocs [link] [comments]


2023.06.08 14:18 Front_Lingonberry255 Not sure what to think. Gem/abrax at late stage 4 pancan

So my (24) dad (64) was diagnosed with stage 4 pancan last year mets to the liver. It's been a really scary year. But for some reason, up until his last round of Folforinox in May things felt very positive. His PET CTs were good until they weren't. Then his oncologist and hospice doctor totally neglected his ascites and there were too many experiments with his drugs. Trying out fentanyl caused him to lose his appetite - which is so dangerous considering that he was already half his weight - and have crazy withdrawal symptoms. We got off fentanyl and back to his original regime, he's eating again. His oncologist recommended him for a trial for gem/abrax + immunotherapy and the new trial oncologist basically was shocked at his condition, and what he was brought to. Now he's in preparation for said trial, did a biopsy, and will do another CT this upcoming week. But he's so weak.
My mom and I really felt that things would be okay, at least for a bit more time. All of a sudden this rapid decline, he doesn't want to go, and at the same time he's skeptical about going through all of these difficulties. But what if the trial will hurry things up with his end? What if not doing anything will be even worse? I'm not ready to lose my dad.
Would appreciate hearing from anybody whose loved ones went through gem/abrax at a pretty late stage, and maybe any tips or supplements that may boost energy levels? Recently I've been buying him protein-packed smoothies and yogurts and I think they are helping a bit. Looking for ideas around those lines...
submitted by Front_Lingonberry255 to pancreaticcancer [link] [comments]


2023.06.08 14:06 QuittingKteam Quitting Kratom Wikis, Guides & Important Information

Below is a list of links to information, guides and wikis from our subreddit's sidebar. Posted here mostly because finding the sidebar on Reddit mobile is nearly impossible.
Quitting Kratom wiki
READ THIS FIRST IF YOU'RE NEW HERE
Quitting Kratom: What to Expect
Course of Withdrawal & What to Expect (List of Possible Wthdrawal Symptoms)
Guide to Quitting Kratom Cold Turkey (CT)
Taper Guide
Why did you quit Kratom? - A frequently asked question. Here's some answers. Now make a list of your "Whys". Refer to them often during your quit and recovery, as a reminder.
Supplements Suggestions (from our Wiki) (The anchor tag may not work correctly on mobile. Instead, just scroll down to the "Supplements" section of the wiki.)
Megadosing Liposomal Vitamin C Protocol for Withdrawal
Naltrexone & Vivitrol shot wiki
RLS (Restless Legs Syndrome) Coping Strategies
Post-Acute Withdrawal Syndrome (PAWS)
Wim Hof Method Breathing
Mindfulness Meditation for Anxiety, Depression and Chronic Pain
The Pink Cloud
Mothers Quitting Kratom
How to put your Quit Date next to your user name
Face-to-Face and Virtual Meeting Options (Includes an invite link to our QK Discord Server.)
WARNINGS
Hirsuta, Javanica and other supposed Kratom Alternatives
Loperamide Warning
Important Phenibut Warnings
Ibogaine and Kratom
"Occasional Kratom use after withdrawal?" Warning
Visit Your Doctor
Antihistamines Warning: It's best to avoid using antihistamines (diphenhydramine, dimenhydrinate, hydroxyzine etc.) such as those found in Benadryl, Dramamine, NyQuil, Unisom, and Tylenol PM. While they can produce drowsiness under normal conditions, they are well known for exacerbating Restless Leg Syndrome, which will make your insomnia worse, not better.
Kava Warning: 1.) People with liver damage should avoid Kava. Taking Kava along with alcohol might increase the risk of liver damage. 2.) As Kava affects the central nervous system, it might increase the effects of anesthesia and other medications used during and after surgery. 3.) Taking kava with sedative medications might cause breathing problems. Please do your research before using Kava. We don't recommend it's use for a sustained period of time, or in large quantities. Nor do we endorse the use of Kava as a replacement for Kratom addiction.
submitted by QuittingKteam to u/QuittingKteam [link] [comments]


2023.06.08 13:09 throwawaygg73736 My dad is suffering and won’t leave this world, what do I do?

We’ve been providing my dad hospice care for the past 2 months.
He has a stage 4 colon cancer, which spread to liver and his liver is failing for the past 10+ days, but hasn’t failed yet.
Since last 2 weeks - doctor has been saying he can go anytime but he isn’t.
He’s been cheyne stoking since a week, and death rattling since last 48 hours.
He isn’t even in Coma yet - He’s in Semi Coma zone.
He puked faeces yesterday because his tumor completely blocked the colon.
We’re giving him Morphine and haloperidol through PICC so he sleeps all day, but makes some kind of noise which sounds like he is in agony, but he is actually not.
Doctor visited him yesterday and said that he has never seen a patient in such condition go on for so long. He stopped eating a week ago and stopped drinking like 4-5 days ago.
We’re all hoping that he leaves this world, because he’s suffering a lot.
We just want peace for him. Has anyone experienced something similar?
submitted by throwawaygg73736 to hospice [link] [comments]


2023.06.08 12:25 helloworldilove69 Rant about Shivalik hospital sector 50

At night of 4th June, I was returning from a party as soon as I entered the house at 10AM I saw my father in pain which is of high intensity that you and me can't even able to comprehend it, I along with my uncle (chachu) immediately took him to the Kailash hospital where they did EGC (everything was fine there) and gave him some pain killer drip after which the pain was relieved and we returned back to the home,
At 2 AM he again started to have the pain and we thought it was normal gastric pain so we get him admitted in the nearest hospital (Shivalik sector 50) we had a good experience with it In past so we choose it,
On the very next day I stayed there, from morning till night where he has shown a recovery and because of drip the pain was almost gone, on the same day he had an ultrasound where doctor said we need him atleast for 2 days, but as the recovery was made and nothing was serious in ultrasound just fatty liver grade grade 1, so we decided that we should discharge my father and at night we discharged and was at home fit and fine with absolutely no pain, the next day i.e. 6th of June he again started to have pain in the morning around 6AM we asked me to wake up and we again admitted him, now whole 6th day he was admitted and having complain that after few hours (usually medicine effects over) he again started to have pain, when we visited the hospital again at night of 6th June the doctor said (He don't need to eat anything for 3 days ) whereas hospital staff was literally giving him every mean, still we had a lot of patience and everything seems normal so we keep continuing, on the 7th June morning my father complaind that the fucking hospital staff didn't responded or checked even for once for the whole damm night, he was badly suffering from the pain, my mother was there she also tried to find someone but no response from anyone, now with this stupidity we decided to shift him to some other hospital so I woke and went to the hospital at around 9am and asked doctor that I need a discharge of the patient I'm ready to sigh L.A.M.A to which the doctor said just wait till 10 am, it will need approval from the other doctors, at this point of time the hospital staff made the worst condition possible of my fathers when we admitted him, he was atleast able to express his emotions and pain and even able to talk nicely and walk nicely but now he not responding properly, even unable to speak properly,
The doctor consulted in morning said "you were giving him wrong medicine" to the nurse. I was shocked at this point of time.
Okay so after 10AM actually 10:20 I again visited there and he said "abhi ek drip chad rhi he ye chad jai uske bad discharge krdenge" I say okay no problem until my father is relieved from the pain, and asked "abhi chadne do na 2 din aur thik ho Jayenge" to which I said no, the staff was too stupid that they literally giving the drip again and again despite knowing the fact that he is unable to urinate, around 10:50 the bottle of the drip was finished, and I again visited there and he said wait for 5 min, I'm okay, now whole 15 min passed, then me and my uncle again visited the doctor and the doctor literally started to misbehave said ki "me kr to rha hu" "itni bar chakkar kyu kaat rhe ho" and the fight goes one, then he said " me nhi kr rha" and at this time my chachu also became furious and angry at him, when he was scolded he said "file to ready he me to nurse ka wait kr rha hu" at this time isne baat palatna shru kr diya, then he started to say "krlo Jo karna he me bhi local ka hu" and one old man came who face the similar issue of being unmonitored at night time,( his wife was also suffering from the pain and nobody noticed,) the old man said "salo tumse ek kaam dhanka hoti nhi meri biwi padi rhi wha pr dard me kisi ne dekha bhi nhi local ka he to sar pr chad kr nachega, me bhi local ka hu abhi bulwa du, sari aakal thikani aajai" the old man literally said this to the doctor after which doctor was unable to say anything, (doctor should have stayed calmed, I know mene bhi bar bar pucha, lakin ye to dekho ki kisi ke Ghar ka main admi pain se suffer kr rha h and tum hospital ke aandar insta reels dekh rhe ho cheezo ko calmy le rhe ho fir puchne pr misbehave)
Anyways we shifted him to Sumitra hospital, there after few Tests and scam it was found the due to negligence of the last hospital where they didn't monitored the urination of the patient and keep giving him drip, resulted in accumulation of water inside right lung and hence along with pain now he has one more problem,
Anyways they shifted my father to ICU and now he is in 95% Better condition,.
I mean this is the worst mistake to choose shivalik at the first, instead of fixing the issue they made it worse
Chutiya panti to ye dekho "vo agla chutiya doctor ye kehe rha he ki abhi 2 din aur drip lgo inne humare yha"
Inta chutiya staff and doctor mene life me nhi dekha
Saalo ko ultrasound bhi dhangse nhi kiya gya, actual issue sumitra me btya and aab usme condition bhot better he,
At the end a big fuck off to shivalik hospital, that doctor and staff.
"FUCK YOU"
submitted by helloworldilove69 to noida [link] [comments]


2023.06.08 12:01 FyrestarOmega Lucy Letby Trial, Defence Day 13, 8 June, 2023

https://twitter.com/JudithMoritz/status/1666741149451649031?t=FfvY3bD7cmxh8YhAI97bOw&s=19 https://twitter.com/tomdunn26/status/1666741012784373760?t=yoqjuHzgC_GSuyNB9Pxlcw&s=19
https://news.sky.com/story/lucy-letby-trial-latest-nurse-baby-murders-prosecution-sky-news-blog-12868375
https://www.chesterstandard.co.uk/news/23575178.live-lucy-letby-trial-june-8---cross-examination-continues/

Child O

Sky News:
Child O was born at the end of June 2016. He died within the first week of his life.
At the time of his birth, Letby was abroad in Ibiza on holiday with friends - including one of her colleagues.
She returned the day before Child O died.
​ Chester Standard:
Nicholas Johnson KC, for the prosecution, moves to the case of Child O.
Letby, in her defence statement, said she did "nothing to hurt [Child O]."
She noted a "change in [Child O's] appearance", but it was "not dramatic".
He had a deterioration and Letby noted Child O's abdomen was "red and distended".
She says she didn't notice a rash on Child O, and no-one mentioned it.
She said the abdomen was "very swollen", and there was a struggle to get lines in. Letby tells the court one of the lines had tissued.
She said one of the doctors had gone out to smoke a cigarette during the time of Child O's resuscitation, and when that doctor returned, they did not wash their hands.
Letby is asked if there is anything she wishes to change in her account of evidence so far. This is a question Mr Johnson asks at the start of most sessions during the cross-examination. Letby says there is nothing.

Letby agrees with Mr Johnson it was "big news" to see naturally conceived triplets on the unit, as it was a rare occurrence. Child O and Child P were two of the three triplets.
Messages are shown to the court between Letby and Jennifer Jones-Key from June 22.
Letby confirms when she is back in, adding: "Yep probably be back in with a bang lol"
M Johnson says within 72 hours of that, two of the triplets were dead and Child Q had collapsed.
​ Sky News:
She texted a male colleague - one she allegedly had a crush on - and asked about the triplets.
"Did you want to get involved with them?" Mr Johnson asks.
"I was just making inquiries," Letby tells the court.
The triplets were born with few complications - and one had been moved to a lower grade nursery.
​ Chester Standard:
Letby is asked why she was "so interested" in the triplets. Letby tells the court it was "general conversation" between staff colleagues as it was "something unusual on the unit".
She accepts that all went well with the birth, and accepts that the triplets had been doing well, with Child O being "fine".
Letby accepts that Child O was doing well on the night shift for June 22-23, and had been moved off CPAP on to Optiflow breathing support.
Letby accepts Sophie Ellis's description there was 'nothing concerning' about Child O's presentation.

Letby is asked to look at an observation chart for Child O for June 22-23. There is a reading which, the court is told, appears to have been changed from '1430' to '1330'.
Letby says Child O's temperature is a little unstable in the hours prior to 1.30pm on June 23, but accepts he was otherwise "stable".
The court is shown a lab result, that there was no bacterial infection found in a blood sample taken on June 23 for Child O.
A feeding chart showed Child O was "tolerating his feeds very well", Mr Johnson says. Letby agrees.
​ Sky News:
In a police statement, Letby claimed a nurse had raised concerns about Child O's abdomen and said: "I do not accept this was dealt with adequately."
Nick Johnson KC, for the prosecution, now asks her: "You are suggesting there was a problem but you are not in a position to tell us the problem?"
"Yes."
Mr Johnson points out there is no evidence of this in the charts.
​ Chester Standard:
Mr Johnson asks Letby where the 'problem' is for Child O's abdomen that she had said was not dealt with, as there is no data to show it.
Letby says, after looking at the data, she does not know what the problem was.
Mr Johnson says there is no problem shown in the paperwork.
Letby says there was "no formal note" made.
The court is shown Sophie Ellis's note at 7.32am: Abdo looks full slightly loopy. Appeared uncomfortable after feed....reg Mayberry reviewed. Abdo soft, does not appear in any discomfort on examination. Has had bo. To continue to feed but to monitor.'
Letby says the doctor did not formally record it.
Letby accepts a review was carried out at 9am and Child O's liver was reviewed, finding no injury. Letby accepts the liver injury happened 'on her watch'. She says she accepts it happened on her shift, but does not know how it happened.
She denies it happened on her hand.

A shift rota for June 23 is shown. Letby was designated nurse for two of the three triplets in room 2 - Child O and Child P - plus one other baby. The third triplet was in room 1, with Child Q and two other babies.
Letby rules out staffing levels as a contributory factor in Child O's collapse or death, or staffing mistakes.
Letby says Rebecca Morgan was a student nurse on the unit. She accepts that the student nurse would not always be in room 2, and would sometimes be chatting to parents.
Letby says the two triplets she was designated nurse for were in the high-dependency room, and if she left the room for a period of time, she would ask someone to 'keep an eye' on them.
A note by Dr Katarzyna Cooke at 9.30am is shown to the court, which included: 'No nursing concerns, observations normal'.
Letby says she left the unit at one point to get donor milk for the babies.
Letby is shown a series of text messages between herself and a doctor prior to 9.30am. Letby expresses disappontment in the message the doctor will not be on the unit ['Boo']. Letby says she got on well with the doctor.
Letby asks if the doctor would be on the unit in the afternoon in the message. She adds: 'My student is glued to me.....'
She adds: 'Bit rubbish that you couldn't stay on nnu'. Mr Johnson asks if Letby was 'missing' him. Letby replies this was the first day back from her Ibiza holiday.
Letby sent a message at 9.55am: 'I lost my handover sheet - found it in the donor milk freezer!! (clearly I should still be in Ibiza)'
Letby is asked if it was a 'busy' morning for her. She says "reasonably, not exceptionally".
Letby is asked how she finds the time to text when at work. She says she would not use her phone at the cotside or a clinical area, but would use her phone elsewhere in the unit.
​ Sky News (Same evidence):
At 9.32am, Letby texted him "Boo" after he said he was not on the neonatal unit.
"Were you disappointed he wasn't there, on the unit?" Mr Johnson asks.
"Yes, I enjoyed working with [colleague]," Letby says.
"Did you want to get his attention?" Mr Johnson says.
"No."
"Is that the reason you sabotaged Child O?"
"No."
More texts are shown to the court.
Colleague (9.33am): I thought something similar
Letby (9.36am): Are you here this aft
Colleague (9.37am): Yes back after the clinic
Letby (9.39am): Have fun
Letby (9.40am): My student is glued to me
Colleague (9.41am): Awww. Could be a challenge
Further texts are shown to the court.
Letby (9.45am): Bit rubbish that you couldn't stay on NNU
"Were you missing him?" Mr Johnson asks.
Letby denies this and says it was her first day back.
Letby (9.55am): I lost my handover sheet - found it in the donor milk freezer!! (clearly I could still be in Ibiza)
Letby is asked how she found the time to send so many text messages when on shift. Letby says staff would often use their phones on the unit - but not when they were at the cot side.
​ Chester STandard:
A feeding chart for Child O is shown to the court. Letby is recorded as signing for feeds at 10.30am and 12.30pm. She says the writing above is not by her, but by Rebecca Morgan. She says if she has signed, then Rebecca Morgan does not need to sign.
Letby denies feeding Child O. She denies overfeeding Child O.
Nurse Melanie Taylor, at about 1pm, entered room 2 and said 'he doesn’t look as well now as he did earlier. Do you think we should move him back to [room] 1 to be safe?'
Letby declined. She said she doesn't remember being very dismissive.
Letby says "That's Mel's opinion" to the evidence that Melanie Taylor had told the jury she felt Letby was 'undermining her authority'.
She adds that Melanie Taylor had the right to override that and 'take Child O off her'.
Letby denies she had sabotaged Child O, or that this would have meant Child O would have 'escaped her influence'.

Letby denies she 'lied' to the doctor colleague about a 'trace aspirate' for Child O at 12.30pm.
Mr Johnson says he is mistaken, as a doctor's note records '0 bile' for the 'trace aspirate'.
Letby says the 160-170 heart rate for Child O, as recorded by the doctor, is higher than normal, and higher than ideal. Mr Johnson says the abnormal readings start, on the observation chart, 180bpm.
Letby had recorded 'tachycardiac' for Child O. Letby tells the court when she reviewed Child O, there was a spike in the heart rate, and in her opinion, Child O was tachycardiac.

Mr Johnson says Letby made a 'false, lying entry' in a different chart. A blood gas chart is shown to the court for Child O.
Mr Johnson asks where the lying entry is on the chart.
LL: "I don't know."
Mr Johnson points to the 'CPAP' note on a column. Letby says Child O had some CPAP pressure. Mr Johnson says Child O had not been on CPAP breathing support for "hours and hours".
NJ: "You were covering for air you had given him, weren't you?"
LL: "No."
An x-ray report for Child O is shown, including: 'Moderate gaseous distention of bowel loops throughout the abdomen.'
Letby is asked why she wrote CPAP in her notes.
LL: "I can't answer that now, I don't know."
Letby says she does not know if Child O might have been on some CPAP pressure via Optiflow.
Letby denies 'forgetting to make a false entry on the observation chart'.

Letby is asked about messages exchanged between her and a doctor when, at 2.30pm, she was recorded as taking observations for Child O.
The messages were sent at 2.20pm and 2.23pm.
Child O collapsed shortly after 2.40pm. In her defence statement, she said the doctor colleague was on the unit at the time.
​ Sky News:
Mr Johnson continues to take the court through what happened on the afternoon of 23 June 2016, the day Child O died.
The colleague whom Letby allegedly had a crush on came to intubate Child O.
The pair exchanged a series of Facebook messages between 2.08pm and 2.37pm, discussing the procedure - and the male colleague's lunch.
Letby disputes she was on the unit at this time, hence why the two were texting.
Medical notes show Letby was allegedly attending to Child O at 2.30pm.
​ Chester Standard:
Swipe data shows Letby has arrived on the neonatal unit from the labour ward at 2.39pm.
Letby says she cannot say, definitively, where she was at that time. She denies 'nipping out' of the neonatal unit to make it look like she was elsewhere at the time Child O collapsed.
​ Sky News:
Lucy Letby is asked why she took a break at the time Child O desaturated so significantly that the on-call doctor was required to attend.
"Breaks were allocated by the shift leader and I had to be guided by them," she says.
She returned to the unit at 2.39pm. Shortly after the on-call doctor left Child O, he collapsed.
​ Chester Standard:
The doctor's note is shown to the court: 'Called to see [Child O] at ~1440 desaturation, bradycardia and mottled...'
Letby says she believes she called the doctor to the nursery room. She denies it was to get personal attention; Letby says it was because he was there to assist Child O.

Letby says a 20ml saline bolus was given to Child O in response to a poor blood gas record. She says there was a delay as there was an issue with getting the line for Child O. She says she believes the bolus, which has 'time started: 1440', was in response to Child O's collapse.
A doctor's note recorded for the '~1440' collapse: '10ml/kg 0.9% sodium chloride bolus already given.'
Letby agrees the two desaturations for Child O that day were "profound" ones.
Letby's note: 'Approx 1440 [Child O] had a profound desaturation to 30s followed by bradycardia. Mottled++ and abdomen red and distended. Transferred to nursery 1 and Neopuff ventilation commenced. Perfusion poor'
Letby, when questioned, says babies would "frequently desaturate", to this level, and this happened prior to June 2015, and "often".

Letby says the redness to the abdomen on Child O was abnormal, and the description of mottling was normal.
Mr Johnson says during the intubation, Dr Stephen Brearey, in evidence on March 15, said Child O had a rash on his chest, on the right side, about 1-2cm in size. He said it was an "unusual" rash that was initially pupuric, and it later disappeared.
Letby says: "I don't believe that's what I saw. I saw mottling. If that's what Dr Brearey saw, then if that's what you could take as being true, then yes."

Mr Johnson says when the doctor went to see Child O's parents, and during that time, Child O desaturated again, for the final time.
Letby says she does not remember this declining moment, but said she put out a crash call.
LL: "I remember the death, but not this precise moment where he declined and I put out a crash call."
Child O was intubated and efforts were made to resuscitate him. Letby says she did not recall seeing the rash disappear. She says she did not see what Dr Brearey and Dr Ravi Jayaram had seen.
Letby says she did not pull an NG Tube out of Child O's stomach.
An x-ray report for Child O is made at 4.46pm. It record: 'NG Tube in situ with its tip close to the cardia, this should be advanced by 10-15mm.'
An earlier x-ray report said the NG Tube was 'in a good position'.
Letby says a dislodged tube would still drain, as it would still be in the stomach.
Letby says the tube could be moved during the intubation process at 2.40pm.

Mr Johnson says Child O's mother, in agreed evidence, said her baby was 'changing colour' with 'prominent veins.' She says she later saw that in Child P.
Letby says she didn't see that herself.
The father of Child O said 'you could see his different veins - it looked like he had prickly heat, like something oozing through his veins'.
Letby says she did not see anything like that.
She accepts she saw a red-purply blotchy rash and a red abdomen.

In police interview, Letby said she believed she had done chest compressions and drew up some drugs. Letby says after looking at records, she now believes she was just involved in medications.
Mr Johnson suggests Letby is distancing herself from the CPR so it could not be said she caused the liver injury to Child O. Letby denies this.
Letby says she "does not know" how Child O got the liver injury.
​ Sky News:
Lucy Letby is accused of distancing herself from Child O's resuscitation because of the liver injury he sustained at some point during her shift.
"You don't want to have any connection between you and the liver injury because you are now running the case it was the CPR that caused the liver injury," Mr Johnson asks.
"No," says Letby.
Mr Johnson then asks: "How did Child O get that liver injury?"
"I don't know."
​ ChesterStandard:
Letby denies injecting air into Child O to cause an air embolous, or inflicting a liver injury on him.
NJ: "These things all happened on your watch, didn't they?"
LL: "Yes."
Letby says she disputes an account that Dr Brearey told her not to come in after that shift.
NJ: "Were you bothered by what you witnessed?"
LL: "Of course I was bothered."

Messages are shown between Letby and the doctor from 9.14pm on June 23:
Doctor: 'Your notes must have taken a long time - Had you documented anything from this morning?'
LL: 'Only a little. Had the other 2 to write on as well and sorting out the ffp etc. Left signing for drugs until tomorrow'
A nurse also messaged Letby: 'F***in hell, what happened?'
LL: 'Can't Think straight so took a while'
LL: 'Blew up abdomen think it's sepsis'
Letby says it's not a term she uses often, but she had seen it before.
LL: 'Had big tummy overnight but just ballooned after lunch and went from there'
Letby tells the court that is what she said, having been reviewed by a doctor and Child O had a loopy bowel. She says she is referring to distention found prior to 8am.
LL, at 9.33pm: 'Worry as identical'
Mr Johnson: "Were you setting up a false narrative here?"
Letby: "No, that's not what I'm suggesting at all."
NJ: "You had already set your plan in motion by pumping air into [Child P] before you left."
LL: "No."
​ Sky News (Same Evidence):
"I am also going to suggest you are telling your friend [...] lies in these texts," Mr Johnson says, before showing another text.
Letby to Colleague 2 (9.16pm) Had big tummy overnight but just ballooned after lunch and went from there
Mr Johnson suggests this was a "not accurate" reflection of what had happened on the night shift.
"I believe he had had an enlarged abdomen overnight," Letby says.
Letby then expressed concern in a text to Colleague 2 about Child O's triplet.
Mr Johnson accuses Letby of "trying to create in the minds of other people" that there would be a similar problem with Child P.
"No, that is not what I am suggesting," Letby says.
"Because that is what you were planning," Mr Johnson says.
"No, it is not."
"Because you had already put your plan into motion by pumping air into Child P before you left."
"No."
​ Chester Standard:
Letby is asked to look at a Datix form she had written [a form used by staff when issues have been highlighted, such as clinical incidents], on the documentation ['Employees involved' has Letby's name].
The form said 'Infant had a sudden acute collapse requiring resusctiation. Peripheral access lost.'
Dr Brearey said the information in the form was 'untrue', and he said he didn't believe at any point IV access was lost.
Asked about this, Letby says: "Well, that's Dr Brearey's opinion."
The form adds: 'SB [Brearey] wishes amendment to incident form - Patient did not lose peripheral access, intraosseuous access required for blood samples only.'
Letby says she does not believe her Datix report was untrue at the time.
NJ: "You were very worried that they were on to you, weren't you?"
LL: "No."

Child P

Mr Johnson turns to the case of Child P, triplet brother of Child O.
Letby, in her defence statement, denies hurting Child P. She said she did not recall having an argument with nursing colleague Kathryn Percival-Ward about working in room 1.
She said she was in conversation with student nurse Rebecca Morgan when Child P collapsed.
She said it was "chaotic" with all the staff arriving to resuscitate, and Child P was too poorly to be transferred to room 1, so was kept in room 2.
Child P's stomach was 'red'.
She says at some stage she pricked herself with a cannula needle and needed to go to A&E for treatment.
While there, she said she fainted, she believed due to stress at the time of the past few days, and had not eaten.
She said she had 'forgotten' she had taken a handover sheet home with her.

An examination of Child P at 10am on June 23, 2016 was "unremarkable", the court hears. Letby accepts that. She adds there was nothing of note during the day.
Mr Johnson suggests Child P worsened after Child O passed away. Letby agrees.
A 6pm feed for Child P is signed by Letby, and she says the writing above is not by her.
Dr John Gibbs had reported in his 6pm review for Child P that the baby boy was doing well. A blood sample taken at 6.35pm taken to a lab showed no signs of infection.
Letby denies overfeeding Child P 'at some point' between 5pm-8pm on June 23.

The cross-examination continues in the case of Child P.
Letby agrees there were 'no problems' at the time of the handover for Child P on the night of June 23. She recalls the x-ray taken shortly after that handover.
The x-ray report said: 'NG tube in satisfactory position...gas-filled bowel loops throughout the abdomen, through to the lower rectum, with no evidence of obstruction and no plain film signs of perforation'
Letby denies pumping Child P with air.
She agrees this was a deterioration for Child P.
Medical expert witness Dr Owen Arthurs had previously told the court this image was "quite unusual" for a baby of that gestation.
Letby says she cannot comment how the gas got there, only that she did not put it there.

A 14ml aspirate is recorded for Child P at the time of handover at 8pm.
NJ: "That was your doing, wasn't it?"
LL: "No."
NJ: "On your way home, you were sowing the seeds with your colleagues?" Mr Johnson refers to the 'Worry as identical' text message Letby had sent. "You were feeding a false narrative, trying to divert attention away from your homicidal activities?"
LL: "No."

5ml of air and 2ml of milk is aspirated from Child P at 7am.
"How much milk had [Child P] been fed overnight?"
Letby said Child P had been fed prior to midnight. She says if the NG Tube is in the stomach, air would come out.
Letby disagrees that Child P was well at the morning handover time, as Child P was 'nil by mouth'.
A police interview had earlier said Letby saying Child P was stable and well.
Mr Johnson suggests Letby is deliberately making the appearance of Child P worse now than at the time she gave her police interview.
LL: "No."
​ Sky News:
By the end of the night shift of 23/24 June 2016, the prosecution claims, Child P was "comfortable, settled and seemed like a well baby".
Lucy Letby is asked if she agrees with this.
"At 8 o'clock in the morning?" she asks.
"Yes," says Mr Johnson, the prosecution barrister.
"I am not sure. He had just been reviewed by the registrar."
Mr Johnson alleges that "whatever had been the problem had resolved itself" by the time Child P was handed back into her care on the morning of 24 June.
"No, because he had been placed nil by mouth," Letby says.
"Yes, but he was a well baby by the time he was handed over to you."
"I disagree, a baby nil by mouth is not a well baby," says Letby.
Letby is accused of making Child P sound worse to explain what happened to him during her shift on 24 June.
​ Chester Standard:
The day shift for June 24 is shown to the court. Student nurse Rebecca Morgan is on the rota. Lucy Letby is the designated nurse for Child P in room 2. The other surviving triplet is also in room 2, with designated nurse Christopher Booth. Child Q is in room 1 with two other babies. Three babies are in room 3, and three babies are in room 4.

Letby rules out staffing levels as a contributory factor in Child P's collapse and death.
She also rules out staffing mistakes.
She says there were "some issues with the chest drain", but "cannot say" how much of an effect that had on Child P.

By 0639, Sophie Ellis’ nursing note recorded that “abdo has been soft and non distended. 25ml of air aspirated by SNP Kate Ward. NGT placed on free drainage”.
Mr Johnson says Letby created a false nursing note at 8am to say: "...abdomen full - loops visible, soft to touch." He says that is not the picture from 6.39am.
Letby agrees that is not the same as Sophie Ellis' note.
Sophie Ellis's note for June 23 for Child O: 'Abdo looks full slightly loopy...abdo soft.'
Letby says her observation for Child P that morning was what she saw. She informed a doctor an hour later about the abdomen observation. She denies a suggestion by Mr Johnson that she is lying.

Letby says she escalated the observation to the shift leader.
Mr Johnson asks if Letby knew what she was telling her friend, the doctor, at this point. Letby does not recall.
The message shown to the court, sent at 8.04am: 'I've got [child] and [Child P], [Child P] has stopped feeds as large asps.'**
Mr Johnson asks why Letby is lying about having the first child, whose designated nurse was Christopher Booth. Letby says she would have to check the paperwork, as she may have been assisting.
Letby's follow-up message, at 8.19am: '...I'm ok, just don't want to be here really. Hoping I may get the new admissions...'
Mr Johnson asks why Letby didn't raise it with the doctor colleague who was coming into work.
Letby says the doctor was not present in the neonatal unit that day. He went to the children's ward.
Letby denies the observation was a 'fabrication' as Dr Anthony Ukoh saw loops as well.
She said the context of 'don't want to be here really' was what she had seen earlier with Child O.
Mr Johnson refers to Dr Ukoh's note of observation at 9.35am: 'Abdomen moderately distended/bloated; soft'. Mr Johnson says there is no mention of loopy bowels. Letby: "No."
Letby says Dr Ukoh might not have recorded it.
NJ: "Or you have misrecorded it."
LL: "No."

Within a few minutes of Dr Ukoh reviewing Child P, Child P collapsed.
NJ: "That has to be your doing, doesn't it?"
LL: "No."
​ Sky News:
Letby (8.04am): I've got [Child P and his triplet brother]
But data from the unit shows she was only looking after one baby - Child P.
Twenty minutes after Letby allegedly saw the "loopy bowels" she also sent the following text to her colleague.
Letby (8.19am): I'll be watching them both like a hawk. I'm ok, just don't want to be here really. Hoping I may get the new admissions.
Child P's collapse "had to be" Lucy Letby's doing, the prosecution claims.
"No," she says.
A student nurse says Letby left the nursery around this time, Mr Johnson says.
He claims she did so to distance herself from his collapse.
"Were you worried that Child P was high risk?" Mr Johnson asks.
"When I took over his care that day? Yes."
"But you left him."
"I don't agree, I've not said that I left him."
​ Chester Standard:
Mr Johnson says Rebecca Morgan's evidence was Letby had left the room at the time of collapse.
Letby says from her recollection, she was in the room, and is "quite clear" on that.
Letby's note for the desaturation: '...[Child P] had an apnoea, brady, desat with mottled appearance requiring facial oxygen and Neopuff for approx 1min. Abdomen becoming distended.'
Mr Johnson says the note is deliberately written to make it look like the Neopuffing made the abdomen become more distended.
Letby agrees.

Dr Ukoh, the court is told, gave evidence to say Child P was in a very different condition between 9.35am and 9.40am.
He also said Letby was "very keen" for the doctor colleague to be called. Letby says this was because he had been present for Child O's deterioration. She adds it was one of the other doctors who suggested getting that doctor.
NJ: "Were you trying to attract [the doctor's] attention?"
LL: "No."
NJ: "Did you enjoy being in these crisis situations with [the doctor]?"
LL: "No....[doctor colleague] and I were friends.
NJ: "Something to share?"
LL: "No."

Child P desaturated again at 11.30am. He was given adrenaline and he was paralysed with a drug to aid ventilation as he had been 'fighting the ventilator' with his breathing.
A note in Letby's handwriting is shown to the court. It details the efforts to resuscitate Child P. It was found at her home. Letby accepts she had put it there.
LL: "I collect paper and that's where it ended up...I have difficulty with throwing anything away, particularly paper.
NJ: "Is there anything comforting in keeping the paper?"
LL: "I keep paper yes, from a variety of different sources." Letby clarifies she does not include bank statements in that.
Letby was recorded by a nursing colleague as saying for Child P: "He's not leaving here alive is he?"
Letby disputes that. "I don't recall the conversation."

Child P's final collapse happened at 3.14pm, just after doctors had reviewed him. Letby says she cannot recall shouting for help, and cannot recall Child P's breathing tube being dislodged.
NJ: "The problem happened just after everybody left, just after you had said 'He's not leaving here alive is he?'"
LL: "I don't agree I said that.
NJ: "Is this another case of bad luck, that is happened just after everybody left?"
LL: "Yes."
NJ: "Did you enjoy making predictions when you knew what was going to happen?"
LL: "No."
​ Sky News:
Lucy Letby allegedly told her colleagues, when Child P desaturated: "He's not leaving here alive, is he?"
Staff on the unit have previously said this is not something that would have normally been said in a professional context.
At 12.28pm, Child P's oxygen levels dropped for a third time.
This was when the two on-call doctors (including the one Letby was allegedly "sweet on") had gone to the tearoom for a quick break.
Then they heard Letby calling for help.
When they returned, Letby was standing over Child P.
"I can't recall that now, but that's what they say," Letby tells the court.
"There was a problem with his breathing tube, do you remember that?" Nick Johnson KC asks.
"I don't remember that from my memory now."
The baby had been unable to move, so could not have dislodged it himself, the prosecution claims.
Letby denies she said "He's not leaving here alive, is he?"
"Whether or not you said that, this is just yet another bit of bad luck that it happened just after everyone else left?" Mr Johnson asks.
"Yes."
​ Chester Standard:
NJ: "You were very excited in the aftermath of [Child P's] death?"
LL: "No, I was not."
Mr Johnson says a female doctor colleague had said she acted 'in a totally inappropriate way'
LL: "No I didn't." She adds that was what the female doctor colleague had said.
Letby says she told colleague Sophie Ellis "out of respect" what had happened.
​ Sky News:
Nick Johnson KC, for the prosecution, says Letby's colleagues have previously said: "You were acting in a totally inappropriate way in that room."
"According to [colleague], yes."
Mr Johnson asks Letby if "you were falling over yourself to tell [colleague] about it?"
Letby says she told her colleague "out of respect" so the staff didn't "walk into the unit and find out".
But Mr Johnson says her colleague was not at work: "Why didn't you just leave her alone?"
"She was asking me," Letby says.
​ Chester Standard:
Mr Johnson said Sophie Ellis had been to the races - "why not leave her alone?". Letby said Sophie Ellis had texted her first.
Mr Johnson: "Did you enjoy the drama?"
LL: "No."
Letby's response to Sophie Ellis: 'Just blew tummy up and had apnoeas, downward spiral. Similar to [Child O] x'
Mr Johnson said the message were identical to the one for Child O.
Letby said that was what happened, his tummy blew up and he had apnoeas.
NJ: "Your portent of doom had fulfilled itself, hadn't it?"
LL: "No."
NJ: "At your hand."
LL: "No."

Mr Johnson clarifies from a text message sent to a doctor colleague, Letby did have two designated babies at the start of that shift, one of whom was Child P.

Child Q

He now turns to the case of Child Q.
Letby, in her defence statement, said she cannot recall much from the shift given what had happened in the previous days.
She said she did not understand why feeding was continued for Child Q when it was not being digested.
Letby said Child Q was sick and when she arrived, from the records, she aspirated 'air+++' from Child Q. She says she does not know how that air got there, and she did not cause it.
Child Q was not put on a ventilator as there were concerns over NEC.
She did not deliberately retain a handover sheet for Child Q.
Letby says she would like to amend the statement, to say she was on duty after June 25, 2016.

Medical expert witness Dr Dewi Evans was challenged by the defence on his use of the word 'crashed' for Child Q, saying that was a 'gross exaggeration'.
Letby says a more appropriate word for what happened to Child Q would be "deterioration".
A doctor colleague had referred to the event, in a message, as an 'acute deterioration'.
Letby said that would be accurate.
She said the difference would be a crash would require a crash call being put out.
Mr Johnson says Child Q was transferred to nursery room 1.
NJ: "He was in a serious condition after that, wasn't he?
LL: "No I disagree."
NJ: "He needed one-to-one care, didn't he?
LL: "Yes, he was assessed as ITU care."

The rota for June 25, 2016, at the beginning of the shift, is shown to the court.
Child Q was in room 2, designated nurse Lucy Letby. One other baby is in room 2, with a different designated nurse.
Letby was a designated nurse for a baby in room 1. Two other babies are in room 1. Three babies were in room 3 and four babies in room 4. Nurse Mary Griffith had designated babies in rooms 2, 3 and 4.
Letby rules out staffing levels or staffing mistakes or medical incompetence as contributory factors for Child Q's collapse.
Letby agrees Child Q required some breathing support at birth.
She also agrees Child Q "made good progress" after birth, according to Mr Johnson.

Letby says, "other than some temperature issues", the overall condition of Child Q was positive.
Child Q was looked after by Samantha O'Brien on the night of June 24-25, and Child Q was being fed 0.5ml of milk every two hours at 3am, 5am and 7am.
A blood gas reading at 6.58am was "very good", Mr Johnson says. Letby agrees.
Letby adds there had been a 'slight increase' in the lactate, and the pH reading was slightly lower, but accepts it was a good reading overall.
Letby said at the time of Child Q's handover on the morning of June 25: "There were concerns for his abdomen and his feeds." Asked who else had raised these concerns but her, Letby replies she does not know.

Letby had previously told her defence that, due to temperature concerns and aspirates, she wanted Child Q to be reviewed by doctors before feeding at 9am on June 25.
The neonatal schedule shows Letby made observations for the designated baby in room 1 at 8.30am. She also co-signed for medication at 8.32-8.34am for a baby in room 3.
At 9am, Mary Griffith is doing observations for a baby in room 2. An unsigned entry is made for Letby's designated baby in room 1 at this time. Also at this time, Letby is recorded doing observations for Child Q.
Letby says she does not recall doing the observations or being interrupted.
Mr Johnson says he uses the word 'interrupted' as swipe data shows Mary Griffith entering the neonatal unit at 9.01am. He suggests Letby pumped Child Q with some clear liquid while Mary Griffith was out. Letby denies this.
​ Sky News:
When her colleague left nursery two, Letby pumped Child Q with a "clear fluid", the prosecution alleges.
"That didn't happen, no," Letby says.
Nick Johnson KC says giving Child Q milk wouldn't have been an option because the infant was only being fed 0.5ml every few hours.
"If he vomited a large amount of milk it would be very obvious something was wrong," Mr Johnson says.
"Yes," says Letby.
"And that is why you chose a clear fluid on this occasion."
Letby denies this.
​ Chester Standard:
Letby is asked why she has only done 'half a job' for the 9am June 25 observation for Child Q.
LL: "I can't explain why I haven't filled the saturations."
NJ: "You were interrupted by Mary Griffith, weren't you?"
LL: "No, I don't know why those weren't filled in."

Letby said she left room 2 to go to room 1 as she needed to attend to cares for the other designated baby just after 9am.
Mr Johnson says that is a lie.
Letby says the baby didn't need a nappy change, but that baby "was an intensive care baby who needed regular attention".
Letby agrees she had not filled in the saturation readings, but otherwise 'the job was done' for Child Q's 9am observation.

Letby says she was not present in the room at the time Child Q vomited. She says she cannot recall aspirating air from the NG Tube afterwards, but may have done so.
Letby's nursing note: '...mottled++. Neopuff and suction applied....air++ aspirated from NG Tube.'
Letby says that information may have been relayed to her. She says the air in Child Q might have come from the Neopuffing process.
Letby agrees it could be dangerous if the Neopuffing and suction was done if there was clear liquid in Child Q's system. Letby said Child Q had vomited over his bedding.
Child Q, in a doctor's notes, had “just vomited” and his oxygen saturation dropped to the “low 60s”.
NJ: "There was a concern that [Child Q] had inhaled some liquid, wasn't there?"
Letby replies that is a concern any time a baby vomits.
The doctor's observations with Child Q continue for 53 minutes.
NJ: "This was no everyday, minor desaturation, was it?"
Letby replies it was not serious enough to require an emergency crash call.
NJ: "You pumped him with a clear liquid, didn't you?"
LL: "No."

Messages sent to a nursing colleague from 1.13pm are shown to the court: '[Child Q] on CPAP'
'Minna has taken [other baby] off me so just got him. Almost had a tube earlier but gases improving'.
Letby denies the event was 'trivial', saying Child Q had deteriorated but it was not on the same level as some of the other events that have been discussed, and did not need a crash call or resuscitation efforts.

Nurse Amy Davies recorded on June 25, 2016 for the night shift that Child Q had "settled".
NJ: "He became much better, hadn't he?" Letby agrees.
NJ: "A child that was put in your hands in good condition, left your hands in a ventilator in intensive care, but by this time was returning to normality."
Letby says by the night shift, Child Q was still on a ventilator and had a poor blood gas record on 6.23pm.
NJ: "You had nearly killed him, hadn't you?"
LL: "No, I hadn't nearly killed him."
Letby says she was later concerned she was being blamed for something that did not happen, by leaving the nursery room unattended.
​ Sky News:
Letby says she "walked in on a conversation" between colleagues and became "concerned I was being held responsible for something that did not happen".
​ Chester Standard
NJ: "The truth is that you pumped him [Child Q] with liquid and air?"
LL: "No."
NJ: "Because you tried to kill him?"
LL: "No, I didn't."
Court is adjourned, resumes tomorrow 10:30 am local time
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2023.06.08 11:14 dr-piyushjuneja Ayurvedic doctor in Visakhapatnam

When it comes to liver diseases, Ayurveda offers a number of effective treatments that can help alleviate symptoms and improve liver function. If you're looking for an Ayurvedic doctor in Visakhapatnam to treat Liver disease you are in luck. Visakhapatnam is home to many experience ayurveda practitioners who specialize in treating liver disorders. Visit https://indianvaidyas.com/search/Visakhapatnam
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2023.06.08 11:04 dr-piyushjuneja Ayurvedic doctor in SrinagarJk

When it comes to liver diseases, Ayurveda offers a number of effective treatments that can help alleviate symptoms and improve liver function. If you're looking for an Ayurvedic doctor in SrinagarJk to treat Liver disease you are in luck. SrinagarJk is home to many experience ayurveda practitioners who specialize in treating liver disorders. Visit https://indianvaidyas.com/search/Srinagarjk
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2023.06.08 10:55 GummiesBiopure Biopure Keto Gummies Reviews [Scam Warning 2023] Bio Pure Keto Gummies Shark Tank Is It worth Buying

Biopure Keto Gummies Reviews- An Overview
Biopure Keto Gummies are health supplements in the form of tasty gummies. These supplements have a 100% natural formula that helps to lose weight while also providing other health benefits by improving – blood sugar levels, immunity, heart health, etc.
The Biopure Keto Gummies Reviews are one of the best weight loss supplements for adults. It helps to naturally lose weight with Ketosis while also preventing you from various chronic diseases.
What Is Biopure Keto Gummies?
Biopure Keto Gummies Reviews is an extraordinary fat-burning formula that helps in weight loss. The product is composed of organic and herbal components which can lose weight in a few days. This product is made to reduce fat accumulation within the body. Through the ketosis process, it gets rid of fat cells and increases the level of energy in the body.
If you are just beginning with this product, the results are amazing in just a few days. It aids in losing weight quickly and maintains that you are at the peak level. The supplement also boosts endurance and energy levels and stops fat accumulation inside the body. Through this supplement, you'll have the ability to cut back the cravings for sweets and junk foods. Through Biopure Keto Gummies, you will be able to achieve your ideal weight loss as well as high power that keeps you going throughout the day and it also keeps you healthy and slim.
How do Biopure Keto Gummies work?
Biopure Keto Gummies Reviews is a dietary supplement designed to support a healthy and balanced ketogenic diet regimen. The Bio Pure Keto Gummies Shark Tank, which is a natural and also a healthy source of acetic acid. Acetic acid assists to support the body's all-natural metabolic processes and can help to lower the body's levels of blood sugar, cholesterol, and triglycerides.
Additionally, ACV can help in weight management by helping to decrease cravings as well as food cravings. To use Bio Pure keto Gummies Reviews, merely take two gummies daily with a glass of water. For ideal results, take them with meals and also make certain you remain hydrated throughout the day. The Biopure Keto Gummies are designed to help you preserve a healthy ketogenic diet regimen and also give your body the nutrients it needs to support optimum health and wellness.
Do you have experience with ketosis?
Bio Pure Keto Gummies Shark Tank, ketosis is a metabolic state in which the body generates large quantities of energy by breaking down possibly dangerous adipocytes, persistent calories, and visceral fat cells. This holds for the fat populace.
This treatment will directly improve your body's ability to mobilize fat reserves for usage in mobile power production. This will certainly bring about much less body fat, more mental quality, and increased physical vitality.
Ingredients used in the formulation of Speedy Keto ACV Gummies?
There are several ingredients used in the formulation of the product Biopure Keto Gummies. But the most common ingredient is beta-hydroxybutyrate (BHB), beta-hydroxybutyrate (BHB) is an essential component that can help in the maintenance of energy levels and is low in terms of carbs. In the ketogenic diet when we don’t consume a high amount of carbs for a longer duration of time the body initiates the production of BHB through the liver.
As all ingredients in Biopure Keto Gummies Reviews are herbal, it reduces the risk of side effects. Most chemicals are harmful or habit-forming. With this supplement, you get an herbal mixture of ingredients that are proven to help in weight loss without causing any problems. Just follow the dosage guidelines and try to live a healthy lifestyle and you will be fine.
How long does it take to work?
Biopure Keto Gummies Within two weeks you will get to see the results. No, I don’t mean you will lose weight in two weeks but boosted energy and a feeling of activeness will help you feel good and motivated. You start losing weight in the third and fourth weeks and depending on the total weight you should follow the regime.
Side Effects
No, you will not feel any kind of side effects while using Bio Pure Keto Gummies Shark Tank as S Biopure Keto Gummies Reviews is designed without having any chemicals in it and you will find natural ingredients in it and it is safe until you consume recommended dose of it and you must consult your doctor once before start using these gummies and you must try it without any hesitation.
Benefits of Speedy Keto ACV Gummies
Biopure Keto Gummies are a beneficial product that can burn fat easily. The user and manufacturer of the product have explained many advantages and some of them are mentioned below.
>.Easy transformation and consistent weight loss
>.Higher concentration
>.Reduced itchiness and irritability
>.Improved blood sugar level (maintained)
>.Improved joint health
>.Less stress and increased anxiety levels
Conclusion
Bio Pure Keto Gummies Shark Tank are one of its kind natural gummies products that can help an individual to lose weight without facing problems someone will face in their weight loss management process. It is a simple and effective solution for obesity and overweight. Various powerful ingredients can power the individual in the weight loss process and it can help individual to achieve their weight goals.
The company claims that it is manufactured with high-standard products to ensure high quality. So, if you guys are looking for something to help individuals Bio Pure Keto Gummies effortlessly and safely. You can purchase this product from the official website with a few simple clicks and it will be delivered to your doorstep within the time limit.
OFFICIAL WEBSITE- VISIT NOW Biopure Keto Gummies
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Read More and Continue Reading Links: -
https://www.outlookindia.com/outlook-spotlight/speedy-keto-gummies-reviews-beware-or-legit-read-customer-speedy-keto-acv-gummies-shark-tank-before-buying-news-292796
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2023.06.08 10:55 dr-piyushjuneja Ayurvedic doctor in Panaji

When it comes to liver diseases, Ayurveda offers a number of effective treatments that can help alleviate symptoms and improve liver function. If you're looking for an Ayurvedic doctor in Panaji to treat Liver disease you are in luck. Panaji is home to many experience ayurveda practitioners who specialize in treating liver disorders. Visit http://indianvaidyas.com/search/Panaji
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2023.06.08 10:48 dr-piyushjuneja Ayurvedic doctor in Shillong

When it comes to liver diseases, Ayurveda offers a number of effective treatments that can help alleviate symptoms and improve liver function. If you're looking for an Ayurvedic doctor in Shillong to treat Liver disease you are in luck. Shillong is home to many experience ayurveda practitioners who specialize in treating liver disorders. Visit http://indianvaidyas.com/search/Shillong
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2023.06.08 10:47 facetime010101 Happy Cappy Dr. Eddie’s Medicated Shampoo

Happy Cappy Dr. Eddie’s Medicated Shampoo


Caution: It's important to remember that these evaluations are guides to potential health concerns and not definitive measures of a product's safety or efficacy. They are based on individual ingredients rather than any negative effects the final product may have. The way ingredients interact in a formulation can influence their potential impact, and the presence of a specific ingredient does not automatically equate to harm when used in a product. It's always crucial to do your own research, consider the product as a whole, and keep in mind that personal reactions can vary greatly. When making decisions about personal care products, it is recommended to consult with healthcare professionals.

Brief: This baby shampoo has gentle cleansing agents like Sodium Lauroyl Methyl Isethionate and Sodium Laurylglucosides Hydroxypropylsulfonate. However, the presence of Pyrithione Zinc signifies the shampoo is aimed at treating specific scalp conditions, such as cradle cap. It's important to use this only under a healthcare professional's advice for infants. The formula also includes Apple Extract, known for its antioxidant properties, and Panthenol, beneficial for skin hydration. Despite the inclusion of Phenoxyethanol as a preservative, it's typically safe in concentrations below 1%. Always perform a patch test to monitor possible allergic reactions.

Ingredients: Pyrithione Zinc, Water (Aqua), Glycerin, Sodium Lauroyl Methyl Isethionate, Sodium Laurylglucosides Hydroxypropylsulfonate, Cocamidopropyl Hydroxysultaine, Acrylates Copolymer, Pyrus Malus (Apple) Fruit Extract, Phenoxyethanol, Sodium Chloride, Guar Hydroxypropyltrimonium Chloride, Sodium Hydroxide, Dipotassium Glycyrrhizate, Panthenol, Ethylhexylglycerin, Citric Acid.

Typical ingredients description and side effects


  • Sodium Hydroxide
    • Sodium hydroxide, also known as caustic soda or lye, is a strong alkaline compound that is sometimes used in the manufacturing process of personal care products, including baby lotions. It is used to adjust the pH of the formulation to ensure stability and efficacy. However, it is important to note that sodium hydroxide itself is not typically listed as an active ingredient in baby lotions, but rather used in very small amounts for pH adjustment purposes.
    • Potential Side Effects:
      • Skin Irritation: Sodium hydroxide, if present in higher concentrations, can cause skin irritation in some individuals. This may manifest as redness, itching, burning sensation, or rash. It is important to discontinue use if your baby experiences any of these symptoms and consult a healthcare professional.
      • Eye Irritation: Direct contact of baby lotion containing sodium hydroxide with the eyes can cause mild to moderate eye irritation. It is crucial to avoid contact with the eyes and rinse thoroughly with water if accidental exposure occurs.
      • Chemical Burns: Sodium hydroxide is a caustic substance and can cause chemical burns if used undiluted or in high concentrations. However, in properly formulated baby lotions, the concentration of sodium hydroxide is typically low and safe for use.
    • EWG Skin Grade: 4

  • Zinc Pyrithione
    • Zinc Pyrithione is a coordination complex of zinc that's primarily used as an antifungal and antibacterial agent. It's often found in products like dandruff shampoos, certain types of soap, and some skin care products due to its ability to treat seborrheic dermatitis, an inflammatory skin disorder that causes flaky, scaly patches on the skin. In baby shampoo, Zinc Pyrithione would likely be used to help manage cradle cap (a form of seborrheic dermatitis in infants) or other minor skin conditions. However, it's worth noting that not all baby shampoos will contain this ingredient, as its use will depend on the specific formulation of the product.
    • Potential Side Effects:
      • Skin Irritation: Some individuals may experience skin irritation, including redness, itching, or a rash, particularly if they have sensitive skin.
      • Allergic Reactions: While rare, allergic reactions can occur. Symptoms might include severe redness, itching, hives, or swelling. In extreme cases, difficulty breathing could occur, which requires immediate medical attention.
      • Eye Irritation: If a product with Zinc Pyrithione gets into the eyes, it can cause redness, watering, and irritation.
    • EWG Skin Grade: 6

  • Phenoxyethanol
    • Phenoxyethanol is used as a preservative in cosmetic products and also as a stabilizer in perfumes and soaps. Exposure to phenoxyethanol has been linked to reactions ranging from eczema to severe, life-threatening allergic reactions. Infant oral exposure to phenoxyethanol can acutely affect nervous system function.
    • Potential Side Effects:
      • Skin Irritation: In some cases, phenoxyethanol can cause skin irritation or an allergic reaction, presenting as redness, itching, or a rash. Babies have sensitive skin and may be more susceptible to such reactions.
      • Allergic Reactions: Though less common, some people may experience an allergic reaction to phenoxyethanol, which could result in symptoms like hives, swelling, or difficulty breathing.
      • Eczema: It is also a common allergic reaction to skin exposure of products containing one percent or more phenoxyethanol. Reactions only occur in the area of application and eczema subsides after avoidance of the product causing irritation.
      • Acute nervous system effects (infants): In 2008, the FDA warned consumers not to purchase Mommy’s Bliss Nipple Cream. Phenoxyethanol, found in the cream, was depressing the central nervous system and causing vomiting and diarrhea in breast feeding infants. Symptoms of a depressed nervous system include a decrease in infant’s appetite, difficulty waking the infant, limpness of extremities and change in skin color. There is no known health risk to the mother.
    • EWG Skin Grade: 4


The grading system used by EWG in the Skin Deep database is as follows:
1 to 2: Low hazard
3 to 6: Moderate hazard
7 to 10: High hazard
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2023.06.08 10:45 dr-piyushjuneja Ayurvedic doctor in Faridabad

When it comes to liver diseases, Ayurveda offers a number of effective treatments that can help alleviate symptoms and improve liver function. If you're looking for an Ayurvedic doctor in Faridabad to treat Liver disease you are in luck. Faridabad is home to many experience ayurveda practitioners who specialize in treating liver disorders. Visit http://indianvaidyas.com/search/Faridabad
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2023.06.08 10:39 dr-piyushjuneja Ayurvedic doctor in Noida

When it comes to liver diseases, Ayurveda offers a number of effective treatments that can help alleviate symptoms and improve liver function. If you're looking for an Ayurvedic doctor in Noida to treat Liver disease you are in luck. Noida is home to many experience ayurveda practitioners who specialize in treating liver disorders. Visit http://indianvaidyas.com/search/Noida
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2023.06.08 09:47 Dgibb0318 15 months sober/Doctors and the DMV.

15 months without a drop,my drinking resulted in 4 seizures.( caused by withdrawal) Non of which involved driving. Every time I visit my doctor (p.c.p) with DMV paperwork in hand , he orders more blood work. My blood work always comes back fine , (liver enzymes, GGT Ect..) what the hell do I do? I can’t work or get a decent job without a valid drivers license, and my doctor isn’t getting the message that I’m done with it all. How is one supposed to move on ???
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