Leçon 34 de 62
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Exercice 32


Exercice de composition


Trouvez des groupes d’objets ou de personnes et utilisez le cadre de votre photo pour en isoler l’un des éléments. Sur votre photo, seul cet élément doit être visible, les autres éléments doivent rester hors du cadre.

N’importe quel groupe d’objets fera l’affaire : des objets posés sur votre table, des personnes qui se promènent, des véhicules sur un parking ( vous devez en isoler un seul ), les fenêtres d’un immeuble…

Le cadre d’une photo permet de simplifier votre composition et de rendre clair le message que vous voulez transmettre avec votre photo.

Vous devez toujours sélectionner avec soin les éléments que vous allez intégrer dans le cadre de votre photo et ceux que vous allez laisser volontairement en dehors.

S’il n’y a qu’un sujet à l’intérieur du cadre de votre image, les spectateurs de votre photo sauront tout de suite l’identifier, ce qui n’est pas le cas si plusieurs éléments s’affrontent et attirent l’oeil de celui qui regarde votre photo.

L’un des défauts que beaucoup de photographes font, c’est de vouloir tout montrer. Dans une image, s’il y a trop d’éléments, le spectateur va avoir du mal à comprendre ce qu’il doit regarder. Il ne parviendra pas à identifier le sujet principal de la photo, celui que le photographe voudrait qu’il regarde.

Dans la réalité, lorsque vous voyez quelque chose d’intéressant, votre oeil se focalise sur elle et votre cerveau fait abstraction de ce qu’il y a autour. Sur une photo cela ne fonctionne pas comme ça.

Il faut donc que vous simplifiiez la réalité et à isoler le sujet que vous voulez montrer dans votre image.

Il suffit souvent de vous rapprocher de quelques pas ou de changer de point de vue pour que les éléments inutiles sortent du cadre. Votre composition sera alors plus forte, elle donnera toute son importance au sujet principal de votre photo.

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    Long Term Side Effects of CJC‑1295 / Ipamorelin

    CJC‑1295 is a growth hormone releasing peptide (GHRP) that stimulates the pituitary
    gland to produce more growth hormone (GH). ipamorelin acetate side effects, another GHRP,
    works in a similar way but with a distinct profile. When used
    together, these peptides can provide significant benefits for body composition, recovery and overall vitality.
    However, as with any pharmacological intervention, there are potential long‑term side
    effects that users should be aware of.

    Hormonal Imbalance

    Chronic elevation of GH can lead to dysregulation of the
    hypothalamic‑pituitary axis. Over time, the body may reduce its
    own endogenous GH production in response to sustained external stimulation. This can result in a paradoxical drop in natural hormone levels once
    the peptide therapy is discontinued.

    Insulin Resistance and Metabolic Issues

    Growth hormone has anti‑insulin effects;
    prolonged exposure can blunt insulin sensitivity. Users who maintain high doses over months may experience elevated fasting glucose or even early signs of type 2 diabetes,
    especially if they have pre‑existing risk factors such as a sedentary lifestyle or poor dietary habits.

    Edema and Fluid Retention

    GH promotes sodium retention and fluid accumulation in tissues.

    Long‑term use can manifest as persistent swelling in the
    extremities, ankles or face. In severe cases, this may strain the cardiovascular system, leading to hypertension.

    Joint Pain and Musculoskeletal Stress

    While GH supports cartilage repair, excessive levels can accelerate wear on joints.

    Users often report chronic joint discomfort, especially in weight‑bearing areas like
    knees and hips. Regular monitoring of pain and mobility is essential.

    Cardiovascular Strain

    Sustained high GH levels can increase heart rate and blood pressure over time.
    The risk of arrhythmias or other cardiac complications
    may rise, particularly in individuals with a family history of heart disease.

    Potential for Tumor Growth

    Since GH promotes cell proliferation, there is theoretical concern that chronic stimulation could encourage growth
    of pre‑existing tumors or benign lesions. Although no
    definitive evidence links CJC‑1295 or Ipamorelin to cancer development, vigilance and routine medical screenings are advised.

    Sleep Disturbances

    Growth hormone release peaks during deep sleep.

    External modulation can disrupt natural circadian rhythms, leading to insomnia or fragmented sleep patterns over the
    long term.

    Psychological Effects

    Some users report mood swings, irritability, or decreased motivation when peptide use is paused or tapered.
    These changes are likely tied to hormonal fluctuations rather than direct drug toxicity.

    Withdrawal and Rebound Symptoms

    Abrupt cessation after prolonged use can trigger a rebound effect: sudden drops in GH and IGF‑1 levels may cause
    fatigue, muscle soreness, and temporary declines in performance.

    Legal and Regulatory Risks

    While not a biological side effect, continued use of these peptides outside approved indications carries legal ramifications.

    Users should remain informed about local regulations to avoid potential penalties.

    Mitigation Strategies

    Dose Management: Use the lowest effective dose for the shortest duration necessary.

    Regular Monitoring: Periodic blood tests for GH, IGF‑1,
    insulin, and lipid profiles help detect imbalances early.

    Lifestyle Adjustments: Adequate sleep, balanced nutrition, and regular exercise counteract many
    metabolic side effects.

    Medical Supervision: A healthcare professional familiar with peptide therapy can tailor
    protocols and adjust dosages based on individual responses.

    Top Posts

    “The Science Behind Growth Hormone Peptides: What You Need to Know”
    – An in‑depth look at how CJC‑1295 and Ipamorelin interact with the body’s endocrine system,
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    “Safety First: How to Safely Incorporate CJC‑1295 & Ipamorelin Into Your Regimen” –
    Practical guidelines for dosing schedules, cycling protocols, and monitoring strategies that help minimize risks while maximizing benefits.

    “Comparing Peptides: CJC‑1295 vs. Ipamorelin vs. Other GHRPs” – A side‑by‑side comparison of potency, half‑life, cost, and typical
    side‑effect profiles to aid informed decision‑making.

    “The Legal Landscape of Growth Hormone Peptides in 2024” – Updated information on FDA regulations,
    prescription requirements, and legal considerations for athletes and non‑athletes
    alike.

  4. Anabolic Steroids In Women

    **Understanding Hormone‑Replacement (Hormonal) Therapy**

    | What it is | How it works | Common uses |
    |————|————–|————-|
    | A medication that supplies hormones your body isn’t making (or isn’t making enough of).
    | The drug enters the bloodstream, mimicking or replacing natural hormone signals.
    | • Treating low‑estrogen/low‑progesterone states such as menopause symptoms or anovulatory cycles
    • Supporting fertility in women with luteal phase deficiency
    • Managing certain endocrine disorders |

    ### 1. Why it’s needed

    – **Hormonal imbalances** (e.g., low progesterone, insufficient
    estrogen) can cause irregular periods, infertility, mood changes, or bone loss.

    – In fertility work‑ups, a *luteal phase defect* may be identified; supplementing progesterone
    restores the uterine lining for implantation.

    ### 2. How it’s done

    | Hormone | Typical route | Common anavar liquid dosage (range) | Duration |
    |———|—————|———————-|———-|
    | **Progesterone** | Oral (tablet), vaginal gel/cream, intramuscular injection | 100 mg oral *or* 200–400 mg vaginal gel nightly | From ovulation until 10–12 weeks of pregnancy or for luteal support |
    | **Estrogen** (if needed) | Oral, transdermal patch, nasal spray |
    0.5–1 mg/day orally or 0.02–0.05 g/patch daily | Until withdrawal bleeding or per protocol |

    *Note: Exact dosages are individualized based on physician assessment.*

    ### 4.3 Monitoring and Follow‑Up

    | **Parameter** | **What to Monitor** | **Frequency** |
    |—————|———————|————–|
    | Hormone levels (estradiol, progesterone) | Confirm therapeutic range | Before first dose; repeat after 1–2 weeks if symptoms persist |
    | Menstrual pattern | Onset of withdrawal bleeding, cycle length | Weekly until regular cycles resume
    |
    | Side effects (e.g., nausea, headaches) | Severity and duration | Daily
    self‑report for first week; then as needed |
    | Weight & blood pressure | Detect metabolic changes | At each follow‑up visit (3–6 months)
    |
    | Breast tenderness or pain | Evaluate discomfort | As reported |

    **Note:** Some patients may experience breakthrough bleeding initially.

    This usually improves after 2–4 weeks of consistent use.

    ### 5. Follow‑Up & Long‑Term Care

    | Timeframe | Actions |
    |———–|———|
    | **1–2 weeks** | Phone call or clinic visit to check tolerance, adherence, side
    effects. |
    | **4 weeks** | Physical exam; review menstrual pattern; adjust dose if breakthrough bleeding persists
    beyond 3 months. |
    | **6 months & yearly** | Routine health maintenance: BP, weight,
    breast exam, STI screening as indicated. Discuss contraception preferences (e.g.,
    implant, IUD) for future planning. |

    ### 6. Contingency Plans

    – **If no improvement after 3–4 months**: Consider alternative therapies such as the combined oral contraceptive pill or a
    progestin-only method if contraindicated.
    – **If side effects (e.g., severe nausea, headaches)**: Reduce dose to 20 mg/day for
    one week, then resume full dose. If intolerable,
    switch to another regimen.
    – **Pregnancy risk**: Ensure patient is not pregnant; perform pregnancy test
    before starting therapy and at regular intervals
    if risk of conception remains.

    ### 7. Summary

    | Step | Action |
    |——|——–|
    | **Initial Dose** | 20 mg/day for 1 week, then 30 mg/day |
    | **Monitoring** | Blood pressure (≥3 times
    per visit), weight, BP readings at home, side‑effect diary |
    | **Adjustment** | Increase to 40 mg/day if BP <120/80 mmHg after ≥2 weeks; reduce if hypertension or adverse events |
    | **Follow‑up** | Every 4–6 weeks until stable; then every 3 months |
    | **Target** | SBP ≤130 mmHg, DBP ≤80 mmHg (per guidelines) |

    ## Key Take‑away

    – **Start low, titrate slowly**, and monitor BP closely.
    – **Blood pressure is the best indicator of safety**—if it rises above guideline targets or falls below 120/80 mmHg, adjust dose accordingly.
    – **Adverse events such as dizziness, headaches, or significant weight loss are red flags** that warrant a dose reduction or discontinuation.

    By applying this systematic approach you can safely manage the patient’s therapy and minimize risks while optimizing blood pressure control.

  5. Dianabol Cycle: FAQs And Harm Reduction Protocols

    A Comprehensive Guide to Managing the Side‑Effects of a Steroid
    Cycle

    This handbook walks you through every step you’ll need if you’re planning
    or currently on an anabolic‑steroid cycle. From dosage & schedule to post‑cycle therapy (PCT), from electrolyte balance to legal considerations,
    we cover the full spectrum of things you must monitor in order to keep your
    body healthy while maximizing performance gains.

    > Disclaimer:

    > 1. The use of anabolic steroids for non‑medical purposes is illegal in many jurisdictions and can carry serious
    health risks.

    > 2. This guide is informational only; it does not constitute medical
    advice. Consult a qualified healthcare professional before making
    any decisions regarding steroid use or related therapies.

    Table of Contents

    Section Topics Covered

    1️⃣ Overview of Steroid Use Common compounds,
    dosage regimens, and expected physiological effects

    2️⃣ Core Parameters to Monitor Hormonal levels, metabolic markers, cardiovascular health

    3️⃣ Blood Test Panels Suggested labs: CBC, CMP, lipid
    profile, hormone panel, liver enzymes

    4️⃣ Tracking and Interpretation How to read
    results, detect abnormalities, adjust protocols

    5️⃣ Adjuvant Therapies Post-cycle therapy (PCT), supplements, lifestyle recommendations

    6️⃣ Sample Testing Protocol Example schedule for a
    typical cycle

    7️⃣ Safety & Legal Considerations FDA status, anti-doping regulations, responsible usage

    1. Core Parameters to Monitor

    Parameter What It Indicates Target Range / Normal Values

    Complete Blood Count (CBC) – Hemoglobin, hematocrit, RBC count
    Anemia or polycythemia; effect of anabolic steroids on red cell mass Hgb:
    13–17 g/dL (men); Hct: 38–50%

    Serum Creatinine & eGFR Kidney function – monitor for nephrotoxicity Creatinine 90 mL/min/1.73 m²

    Urinalysis – protein, glucose, ketones Early signs of renal or hepatic stress No albuminuria or glucosuria

    AST & ALT (SGOT/SGPT) Hepatic enzyme elevations indicating liver injury ≤2× upper limit
    normal (ULN) is acceptable; >3× ULN warrants action

    ALP & GGT Monitor cholestasis or biliary damage ≤2× ULN

    Total Bilirubin Detect unconjugated vs conjugated hyperbilirubinemia ≤1.5 mg/dL in most cases; >3 mg/dL triggers investigation

    Platelet Count & PT/INR Assess for drug-induced thrombocytopenia or coagulopathy Platelets 1.5 signals
    potential liver dysfunction

    Kidney Function (Serum Creatinine, BUN) Exclude renal impairment that may confound hepatic labs Creatinine ≤1.2 mg/dL;
    BUN ≤20 mg/dL

    C-Reactive Protein & White Blood Cell Count Evaluate systemic inflammation or
    infection CRP Clinical Note:

    > A comprehensive baseline panel ensures that subsequent changes in liver
    enzymes are attributable to the therapeutic agent rather than pre‑existing hepatic or renal disease.
    It also establishes a reference point for detecting drug‑induced hepatotoxicity (elevated ALT/AST >3× ULN with symptoms, or >5×
    ULN without symptoms).

    2. In‑Hospital Monitoring Plan

    Parameter Testing Frequency Rationale / Thresholds

    ALT (SGPT) Day 0 (baseline), then days 3, 7, 14, 21, 28; repeat every 2 weeks thereafter.
    ALT is highly specific to hepatic injury. Elevations >3× ULN warrant dose
    adjustment or discontinuation.

    AST (SGOT) Same as ALT AST can rise with extra‑hepatic damage but still indicates hepatocellular stress.

    ALP Baseline, then every 2 weeks Elevated ALP may signal cholestasis; >3× ULN requires imaging.

    GGT Baseline, then monthly GGT is sensitive to biliary injury and alcohol-related liver
    disease.

    TBIL (total bilirubin) Baseline, then every 2 weeks Hyperbilirubinemia
    (>2× ULN) indicates impaired excretion; urgent evaluation needed.

    Albumin Baseline, then monthly Low albumin (1.5 or
    PT prolongation suggests coagulopathy; monitor for bleeding
    risk.

    3.4 Interpretation and Action Points

    Mild Elevations (≤2× ULN): Recheck in 2–4 weeks; continue monitoring.

    Moderate Elevations (>2× to ≤5× ULN): Repeat testing within 1 week; consider imaging
    or additional labs.

    Severe Elevations (>5× ULN) or Rapid Rise: Immediate re-evaluation,
    imaging (ultrasound/CT), possible referral for hepatology/surgery.

    4. Non‑Pharmacologic Management of Hepatotoxicity

    4.1 Lifestyle and Dietary Recommendations

    Intervention Rationale

    Moderate Alcohol Cessation Reduces hepatic insult; avoid alcohol entirely during high‑risk periods (e.g., peri‑operative).

    Avoid Over-the-Counter NSAIDs Non‑steroidal anti‑inflammatory drugs can further impair liver function.

    Hydration Supports detoxification pathways and reduces potential nephrotoxicity of contrast agents.

    Balanced Diet Adequate protein for synthetic function; avoid excessive
    saturated fats that promote steatosis.

    4.2 Clinical Decision-Making Algorithm

    Baseline Assessment

    – Review pre‑operative labs: AST/ALT, bilirubin, INR.

    – Identify any abnormality (> 1.5× ULN or INR > 1.3).

    Determine Need for Contrast Imaging

    – If contrast required (e.g., CT angiography), proceed only if baseline
    liver function is normal.

    If Abnormal Baseline Labs

    – Option A: Delay surgery until labs normalize or consider alternative imaging (ultrasound, MRI without gadolinium).

    – Option B: If surgery cannot be delayed, avoid contrast and obtain non‑contrast imaging
    or intraoperative assessment.

    Intraoperative Monitoring

    – Avoid administering additional hepatotoxic drugs if possible.

    – Use minimal anesthetic agents with low hepatic metabolism.

    Post‑operative Follow‑up

    – Recheck liver enzymes within 48–72 h post‑op to ensure no delayed injury.

    Quick Reference Table

    Situation What to Do What Not to Do

    Pre‑op with normal LFTs, no risk factors Proceed as usual; consider standard contrast
    dose. Avoid unnecessary liver‑directed tests unless indicated.

    Pre‑op with mildly elevated AST/ALT (5× ULN Delay surgery
    if possible; treat underlying cause. Proceed without addressing
    abnormal LFTs.

    Known viral hepatitis Continue antiviral therapy; use low‑dose contrast.

    Stop antivirals abruptly; use standard contrast volume.

    Chronic alcohol abuse Evaluate for cirrhosis; consider imaging with alternative modalities.
    Assume normal liver function; ignore risk of RICF.

    5. Practical Tips and Decision‑Making Flowchart

    Quick Reference Checklist (Pre‑operative)

    Ask the patient:

    – Any known liver disease?

    – Recent alcohol consumption (> 2 drinks/day)?

    – Medications affecting liver (antivirals, steroids, etc.)?

    Obtain labs if any suspicion:

    – ALT/AST, ALP, bilirubin, INR.

    If all normal and no history → No further liver work‑up needed.

    If abnormal or history present → Order imaging + consult hepatology.

    Document findings in the operative note for future
    reference.

    Flowchart (Textual)

    START
    |
    |– Patient has known liver disease? — Yes –> Hepatology
    consult, preop imaging, adjust anesthetic plan.
    |
    |– No: Any abnormal LFTs or elevated INR? — Yes
    –> Imaging (US), further workup; if significant → Hepatology consult.

    |
    |– No: No history of liver disease and normal labs?
    — Yes –> Proceed to surgery without further hepatic evaluation.
    END

    Practical Tips for the Operating Room

    Pre‑op Checklist

    – Verify LFTs, INR/PTT on the same day (or within 48 h).

    – Confirm no recent hepatotoxic drugs.

    Intra‑operative Monitoring

    – Use arterial line if major liver resection planned.

    – Consider tranexamic acid in patients with prolonged PT to
    reduce bleeding risk.

    Post‑op Follow‑up

    – Repeat LFTs on postoperative day 1–3 for all hepatic resections; routine repeat not
    needed for minor procedures unless symptoms arise.

    Documentation

    – Record baseline liver function and any intraoperative events affecting
    the liver (ischemia, blood loss).

    Practical Take‑away Checklist

    Step Action

    1 Order CBC, BMP, LFTs (ALT, AST, ALP, GGT, bilirubin), PT/INR, aPTT pre‑op.

    2 For major hepatic resection → full panel; for minor → CBC +
    LFTs only.

    3 Repeat PT/INR and INR before incision if INR >1.5 or patient on warfarin.

    4 Monitor intraoperative blood loss & hemodynamics; consider transfusion thresholds (Hb

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  23. The 6‑week Anavar cycle is a popular choice among bodybuilders and fitness enthusiasts who want to gain lean muscle mass while minimizing the risk of water retention and significant fat gain. In 2025, many users are turning to carefully calculated dosages that balance effectiveness with safety, taking advantage of newer formulations and better understanding of how oxandrolone interacts with the body over a short cycle.

    Anavar Cycle Guide: Safe Dosage & Best Results 2025

    A typical 6‑week Anavar (oxandrolone) protocol begins with a lower dose to assess tolerance, then gradually ramps up. The most common regimen in 2025 looks like this:

    Weeks 1–2: 20 mg per day

    Weeks 3–4: 30 mg per day

    Weeks 5–6: 40 mg per day

    This progression keeps the total weekly exposure within a range that is generally considered safe for most users, while still delivering noticeable strength gains and muscle definition. The final dose of 40 mg per day is usually the maximum recommended for a short cycle; staying at or below this level reduces liver strain and other potential side effects.

    Key points to maximize results:

    Timing: Taking Anavar in the morning with breakfast helps maintain stable blood levels throughout the day.

    Diet: A protein‑rich diet (1.5–2 g per kilogram of body weight) supports muscle repair, while a slight caloric surplus (200–300 calories above maintenance) promotes growth without excessive fat gain.

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    Supplements: A high‑quality multivitamin, omega‑3 fatty acids, and a liver support supplement (e.g., milk thistle) can help mitigate any hepatic stress from steroid use.

    By following this schedule, most users report increased strength by 10–15 % in the upper body and up to 20 % in the lower body. Visible improvements in muscle tone, reduced subcutaneous fat, and better joint stability are common outcomes after a six‑week cycle when combined with disciplined nutrition and training.

    What is Oxandrolone?

    Oxandrolone is a synthetic anabolic steroid derived from dihydrotestosterone (DHT). It was first developed in the 1960s for medical purposes such as treating muscle wasting diseases, bone fractures, and severe burns. In bodybuilding circles, it has become synonymous with “Anavar” because of its reputation for being one of the mildest yet effective https://www.valley.md/anavar-results-after-2-weeks.

    The compound works by binding to androgen receptors in muscle cells, encouraging protein synthesis and nitrogen retention—key factors that drive muscle growth. Unlike many anabolic agents, oxandrolone does not convert into estrogen, which means users typically experience minimal water retention and gynecomastia risk. However, it is still metabolized by the liver, so proper dosing and support are essential to avoid hepatic strain.

    Medical uses of oxandrolone include:

    Accelerating weight gain after surgery or trauma

    Treating chronic wasting conditions such as HIV/AIDS or cachexia

    Managing bone loss in osteoporosis patients

    Its therapeutic benefits have made it a valuable tool for patients who need muscle preservation without the hormonal side effects associated with other steroids. In the fitness community, oxandrolone’s safety profile and clear-cut results make it an attractive option for short‑term performance enhancement.

    Sign up for Newsletter

    If you’re interested in staying updated on the latest steroid protocols, safety guidelines, and supplement reviews, consider signing up for a specialized newsletter focused on legal and controlled substances. Many reputable sources offer monthly updates that cover:

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