SlideShare ist ein Scribd-Unternehmen logo
1 von 92
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What do we do? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CHALLENGES WE FACE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Scenario ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Enigmatic questions ,[object Object],[object Object],[object Object]
Subsequent challenges ,[object Object],[object Object],[object Object],[object Object]
Influenza At A Glance ,[object Object],[object Object]
INFLUENZA VIRUS
ELECTRON MICROSCOPY
TYPES
PIG  THE CREATOR
VIRAL VARIANTS ,[object Object],[object Object],[object Object],[object Object],[object Object]
QUADRUPLE REASSORTMENT GENETICS  ,[object Object],[object Object],H1N1
EARTH  LIVING SPACE FOR ALL ,[object Object],[object Object],[object Object]
HISTORY ,[object Object]
Emergency hospital, Camp Funston, Kansas 1918
WHO ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Global pandemic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Global pandemic
EPIDEMIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transmission
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Can I get infected with this new H1N1 virus from eating or preparing pork? ,[object Object]
Is there a risk from drinking water? ,[object Object]
What kills influenza virus? ,[object Object]
Risk factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DEFINITIONS  ,[object Object]
Case Definitions By CDC ,[object Object],[object Object]
[object Object],[object Object],[object Object]
Close contacts ,[object Object],[object Object],[object Object]
Mexican data ,[object Object],[object Object],[object Object],nejm.org august 13, 2009
Preventive measures taken in Mexican hospitals ,[object Object],[object Object],nejm.org august 13, 2009
COMPARISION SEASONAL INFLUENZA H1N1 INFLUENZA AGE <5  YRS  >60 YRS YOUNG & MIDDLE AGE SEVERITY LESS SEVERE PNEUMONIA  ARDS MORBIDITY LESS MORE  BUT >60 YRS LESS LIKELY TO HAVE SEVERE PNEUMONIA
contd SEASONAL INFLUENZA H1N1 INFLUENZA SYMPTOMS RESPIRATORY RESPIRATORY  & GASTROINTESTINAL SECONDARY  ATTACK  RATE 5-15 % 22-33 % VACCINE PROTECTIVE UNDER DEVELOPMENT
AGE SHIFTS IN MORTALITY ,[object Object],[object Object]
[object Object],[object Object]
Specimens  ,[object Object],[object Object],[object Object]
[object Object],[object Object]
DIAGNOSTIC TESTS RT PCR QUIDEL CULTURE DFA/IFA
LAB TESTS ,[object Object],[object Object],[object Object]
[object Object]
Whom to test ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL FEATURES Vomiting or diarrhea (not typical for influenza but reported by recent cases of swine influenza infection)
Mexican data in MV patients
Mexican data in MV patients
Younger people at risk
10-50 yrs Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza Gerardo Chowell, Ph.D., Stefano M. Bertozzi, M.D., Ph.D., NEJM August 2009
Can we make a broad clinical check list ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other Manifestations: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Children Clinical Presentation ,[object Object],[object Object]
Children Emergency Warning Signs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
In adults, emergency warning signs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why Complications In young (Cytokine storm) ,[object Object],[object Object],[object Object],[object Object]
SYMPTOMS OF THE CYTOKINE STORM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cytokine Storm Treatment  ,[object Object],[object Object],[object Object],[object Object]
HISTOPATHOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LABORATORY FINDINGS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
H1 N1 Pneumonia
COMPLICATIONS ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
DD H1N1 PNEUMONIA  ,[object Object],[object Object],[object Object]
TREATMENT ,[object Object],[object Object],[object Object]
Tamiflu ( Oseltamivir ) ,[object Object],[object Object]
 
Tamiflu
Tamiflu
Tamiflu(contd) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tamiflu (Contd) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Zanamivir ( Relenza) ,[object Object],[object Object],[object Object]
Mild Cases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hospitalized pts: ,[object Object],[object Object],[object Object],[object Object]
Supportive care ,[object Object],[object Object],[object Object],[object Object],[object Object]
It is highly contagious! ,[object Object],[object Object],[object Object],[object Object]
prevention
 
N95 Mask
What should I do to keep from getting the flu? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Avoid close contact ,[object Object],[object Object]
 
Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object]
Is Negative Pressure Room Must ? Place patients in a single-patient room with the door kept closed & droplet and contact isolation
Is BIA ready?
Why do we need vaccine COST EFFECTIVE TARGET AT RISK PEOPLE VACCINE WINTER SEASON TO COME(LOW  HUMIDITY,TEMP) RAPID GLOBAL SPREAD SEASONAL VACCINE PROTECTION?
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dealing with the Deceased
Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object]
THANK YOU Department of critical care medicine

Weitere ähnliche Inhalte

Was ist angesagt? (20)

Anthrax
AnthraxAnthrax
Anthrax
 
Tuberculosis
TuberculosisTuberculosis
Tuberculosis
 
Bird Flu
Bird FluBird Flu
Bird Flu
 
Brucellosis ppt
Brucellosis pptBrucellosis ppt
Brucellosis ppt
 
Swine flu ppt
Swine flu pptSwine flu ppt
Swine flu ppt
 
Lecture 7. influenza
Lecture 7. influenzaLecture 7. influenza
Lecture 7. influenza
 
Bird flu
Bird fluBird flu
Bird flu
 
Plague
Plague Plague
Plague
 
Respiratory tract infections
Respiratory tract infectionsRespiratory tract infections
Respiratory tract infections
 
Chikungunya
ChikungunyaChikungunya
Chikungunya
 
Mumps
MumpsMumps
Mumps
 
Swine flu
Swine fluSwine flu
Swine flu
 
Clinical manifestations of influenza
Clinical manifestations of influenzaClinical manifestations of influenza
Clinical manifestations of influenza
 
Plague
PlaguePlague
Plague
 
Viral zoonotic disease
Viral zoonotic diseaseViral zoonotic disease
Viral zoonotic disease
 
Brucellosis
Brucellosis Brucellosis
Brucellosis
 
Genus campylobacter
Genus campylobacterGenus campylobacter
Genus campylobacter
 
Zoonosis
ZoonosisZoonosis
Zoonosis
 
Varicella zoster virus
Varicella zoster virusVaricella zoster virus
Varicella zoster virus
 
Influenza
InfluenzaInfluenza
Influenza
 

Andere mochten auch

Ent in General Practice
Ent in General PracticeEnt in General Practice
Ent in General PracticeKabir Bakshi
 
Fiji influenza a_h1_n1_2009_clinical_practice_guideline
Fiji influenza a_h1_n1_2009_clinical_practice_guidelineFiji influenza a_h1_n1_2009_clinical_practice_guideline
Fiji influenza a_h1_n1_2009_clinical_practice_guidelineLoveis1able Khumpuangdee
 
H1N1 Influenza -DR. K. A. PRAHLAD
H1N1 Influenza -DR. K. A. PRAHLADH1N1 Influenza -DR. K. A. PRAHLAD
H1N1 Influenza -DR. K. A. PRAHLADapollobgslibrary
 
S W I N E F L U P R E V E N T I O N S
S W I N E  F L U  P R E V E N T I O N SS W I N E  F L U  P R E V E N T I O N S
S W I N E F L U P R E V E N T I O N SChandan Shivaramu
 
H1N1 Virus and How It Is Affecting Schools
H1N1 Virus and How It Is Affecting SchoolsH1N1 Virus and How It Is Affecting Schools
H1N1 Virus and How It Is Affecting SchoolsStige1es
 
Influenza A(H1 N1)
Influenza A(H1 N1)Influenza A(H1 N1)
Influenza A(H1 N1)hospital
 
H1 N1 Powerpoint
H1 N1 PowerpointH1 N1 Powerpoint
H1 N1 Powerpointref2
 
Epidemiology H1N1 Influenza (Swine Flu)
Epidemiology  H1N1  Influenza (Swine Flu)Epidemiology  H1N1  Influenza (Swine Flu)
Epidemiology H1N1 Influenza (Swine Flu)Prabesh Ghimire
 
Influenza facts and prevention
Influenza facts and preventionInfluenza facts and prevention
Influenza facts and preventionMoustapha Ramadan
 
Swine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should know
Swine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should knowSwine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should know
Swine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should knowGaurav Gupta
 
Advanced modes of Mechanical Ventilation-Do we need them?
Advanced modes of Mechanical Ventilation-Do we need them?Advanced modes of Mechanical Ventilation-Do we need them?
Advanced modes of Mechanical Ventilation-Do we need them?chandra talur
 
Metabolic acidosis- Systematic analysis
Metabolic acidosis- Systematic analysisMetabolic acidosis- Systematic analysis
Metabolic acidosis- Systematic analysischandra talur
 
Influenza Virus
Influenza VirusInfluenza Virus
Influenza Virusraj kumar
 
Walden3 twin slideshare 01
Walden3 twin slideshare 01Walden3 twin slideshare 01
Walden3 twin slideshare 01Avi Dey
 

Andere mochten auch (20)

Swine Flu
Swine FluSwine Flu
Swine Flu
 
Ent in General Practice
Ent in General PracticeEnt in General Practice
Ent in General Practice
 
Influenza
InfluenzaInfluenza
Influenza
 
Fiji influenza a_h1_n1_2009_clinical_practice_guideline
Fiji influenza a_h1_n1_2009_clinical_practice_guidelineFiji influenza a_h1_n1_2009_clinical_practice_guideline
Fiji influenza a_h1_n1_2009_clinical_practice_guideline
 
H1N1 Influenza -DR. K. A. PRAHLAD
H1N1 Influenza -DR. K. A. PRAHLADH1N1 Influenza -DR. K. A. PRAHLAD
H1N1 Influenza -DR. K. A. PRAHLAD
 
Swine Flu Final
Swine Flu FinalSwine Flu Final
Swine Flu Final
 
S W I N E F L U P R E V E N T I O N S
S W I N E  F L U  P R E V E N T I O N SS W I N E  F L U  P R E V E N T I O N S
S W I N E F L U P R E V E N T I O N S
 
H1N1 Virus and How It Is Affecting Schools
H1N1 Virus and How It Is Affecting SchoolsH1N1 Virus and How It Is Affecting Schools
H1N1 Virus and How It Is Affecting Schools
 
Influenza A(H1 N1)
Influenza A(H1 N1)Influenza A(H1 N1)
Influenza A(H1 N1)
 
Swineflu rotary
Swineflu rotarySwineflu rotary
Swineflu rotary
 
MADHU's SWINE FLU
MADHU's SWINE FLUMADHU's SWINE FLU
MADHU's SWINE FLU
 
H1 N1 Powerpoint
H1 N1 PowerpointH1 N1 Powerpoint
H1 N1 Powerpoint
 
A (H1N1) Virus
A (H1N1) VirusA (H1N1) Virus
A (H1N1) Virus
 
Epidemiology H1N1 Influenza (Swine Flu)
Epidemiology  H1N1  Influenza (Swine Flu)Epidemiology  H1N1  Influenza (Swine Flu)
Epidemiology H1N1 Influenza (Swine Flu)
 
Influenza facts and prevention
Influenza facts and preventionInfluenza facts and prevention
Influenza facts and prevention
 
Swine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should know
Swine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should knowSwine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should know
Swine flu H1N1 Quiz - India Epidemic 2015 - what every pediatrician should know
 
Advanced modes of Mechanical Ventilation-Do we need them?
Advanced modes of Mechanical Ventilation-Do we need them?Advanced modes of Mechanical Ventilation-Do we need them?
Advanced modes of Mechanical Ventilation-Do we need them?
 
Metabolic acidosis- Systematic analysis
Metabolic acidosis- Systematic analysisMetabolic acidosis- Systematic analysis
Metabolic acidosis- Systematic analysis
 
Influenza Virus
Influenza VirusInfluenza Virus
Influenza Virus
 
Walden3 twin slideshare 01
Walden3 twin slideshare 01Walden3 twin slideshare 01
Walden3 twin slideshare 01
 

Ähnlich wie Swineflu Update, An Indian Prespective

Ähnlich wie Swineflu Update, An Indian Prespective (20)

Swine flu
Swine fluSwine flu
Swine flu
 
H1 N1
H1 N1H1 N1
H1 N1
 
Swine Flu Update Dec'09
Swine Flu Update Dec'09Swine Flu Update Dec'09
Swine Flu Update Dec'09
 
Swine flu in pregnancy
Swine flu in pregnancySwine flu in pregnancy
Swine flu in pregnancy
 
Swine flu overview
Swine flu overviewSwine flu overview
Swine flu overview
 
H1 N1
H1 N1H1 N1
H1 N1
 
Swine Flu Final
Swine Flu FinalSwine Flu Final
Swine Flu Final
 
Swine flu- Pandemic Influenza A (H1N1)
Swine flu- Pandemic Influenza A (H1N1)Swine flu- Pandemic Influenza A (H1N1)
Swine flu- Pandemic Influenza A (H1N1)
 
Swine flu 2
Swine flu 2Swine flu 2
Swine flu 2
 
H1 n1 swine flu
H1 n1 swine fluH1 n1 swine flu
H1 n1 swine flu
 
Lecture+Influenza+A+ H1 N1
Lecture+Influenza+A+ H1 N1Lecture+Influenza+A+ H1 N1
Lecture+Influenza+A+ H1 N1
 
Novel H1 N1 Flu Infection
Novel H1 N1 Flu InfectionNovel H1 N1 Flu Infection
Novel H1 N1 Flu Infection
 
influenza.pptx
influenza.pptxinfluenza.pptx
influenza.pptx
 
H1N1
H1N1H1N1
H1N1
 
H1N1
H1N1 H1N1
H1N1
 
H1 N1
H1 N1H1 N1
H1 N1
 
Seasonal Influenza
Seasonal InfluenzaSeasonal Influenza
Seasonal Influenza
 
Influenza in Children Recommendations for Prevention &Treatment
Influenza in Children Recommendations for Prevention &Treatment   Influenza in Children Recommendations for Prevention &Treatment
Influenza in Children Recommendations for Prevention &Treatment
 
Swine Flu
Swine FluSwine Flu
Swine Flu
 
Introspecting into Swine flu: Current updates
Introspecting into Swine flu: Current updatesIntrospecting into Swine flu: Current updates
Introspecting into Swine flu: Current updates
 

Mehr von chandra talur

How do I safely ventilate my patient inOT.pptx
How do I safely ventilate my patient inOT.pptxHow do I safely ventilate my patient inOT.pptx
How do I safely ventilate my patient inOT.pptxchandra talur
 
Arterial blood gas analysis assesment of oxygenation ventilation and acid base
Arterial blood gas analysis assesment of oxygenation ventilation and acid baseArterial blood gas analysis assesment of oxygenation ventilation and acid base
Arterial blood gas analysis assesment of oxygenation ventilation and acid basechandra talur
 
Physiological triggers for blood transfusion in the icu
Physiological triggers for  blood transfusion in the icuPhysiological triggers for  blood transfusion in the icu
Physiological triggers for blood transfusion in the icuchandra talur
 
New modes of mechanical ventilation TRC
New modes of mechanical ventilation TRCNew modes of mechanical ventilation TRC
New modes of mechanical ventilation TRCchandra talur
 
Mechanical ventilation in COPD Asthma drtrc
Mechanical ventilation in COPD Asthma drtrcMechanical ventilation in COPD Asthma drtrc
Mechanical ventilation in COPD Asthma drtrcchandra talur
 
Snake Bite Icu Management
Snake Bite Icu ManagementSnake Bite Icu Management
Snake Bite Icu Managementchandra talur
 
Hemodynamic Stabilisation In Septic Shock
Hemodynamic Stabilisation In Septic ShockHemodynamic Stabilisation In Septic Shock
Hemodynamic Stabilisation In Septic Shockchandra talur
 
Patho Physiology And Icu Management Of Septic Shock
Patho Physiology And Icu Management Of Septic ShockPatho Physiology And Icu Management Of Septic Shock
Patho Physiology And Icu Management Of Septic Shockchandra talur
 
How Best To Prevent & Manage Acute Renal failure
How Best To Prevent & Manage Acute Renal failureHow Best To Prevent & Manage Acute Renal failure
How Best To Prevent & Manage Acute Renal failurechandra talur
 

Mehr von chandra talur (9)

How do I safely ventilate my patient inOT.pptx
How do I safely ventilate my patient inOT.pptxHow do I safely ventilate my patient inOT.pptx
How do I safely ventilate my patient inOT.pptx
 
Arterial blood gas analysis assesment of oxygenation ventilation and acid base
Arterial blood gas analysis assesment of oxygenation ventilation and acid baseArterial blood gas analysis assesment of oxygenation ventilation and acid base
Arterial blood gas analysis assesment of oxygenation ventilation and acid base
 
Physiological triggers for blood transfusion in the icu
Physiological triggers for  blood transfusion in the icuPhysiological triggers for  blood transfusion in the icu
Physiological triggers for blood transfusion in the icu
 
New modes of mechanical ventilation TRC
New modes of mechanical ventilation TRCNew modes of mechanical ventilation TRC
New modes of mechanical ventilation TRC
 
Mechanical ventilation in COPD Asthma drtrc
Mechanical ventilation in COPD Asthma drtrcMechanical ventilation in COPD Asthma drtrc
Mechanical ventilation in COPD Asthma drtrc
 
Snake Bite Icu Management
Snake Bite Icu ManagementSnake Bite Icu Management
Snake Bite Icu Management
 
Hemodynamic Stabilisation In Septic Shock
Hemodynamic Stabilisation In Septic ShockHemodynamic Stabilisation In Septic Shock
Hemodynamic Stabilisation In Septic Shock
 
Patho Physiology And Icu Management Of Septic Shock
Patho Physiology And Icu Management Of Septic ShockPatho Physiology And Icu Management Of Septic Shock
Patho Physiology And Icu Management Of Septic Shock
 
How Best To Prevent & Manage Acute Renal failure
How Best To Prevent & Manage Acute Renal failureHow Best To Prevent & Manage Acute Renal failure
How Best To Prevent & Manage Acute Renal failure
 

Kürzlich hochgeladen

Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426jennyeacort
 
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...parulsinha
 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...chennailover
 
Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...Namrata Singh
 
8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In AhmedabadGENUINE ESCORT AGENCY
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...chandars293
 
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋TANUJA PANDEY
 
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...chennailover
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...chandars293
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...khalifaescort01
 
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...parulsinha
 
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...karishmasinghjnh
 
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Availableperfect solution
 
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...mahaiklolahd
 
Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...
Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...
Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...khalifaescort01
 
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...chetankumar9855
 
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableGENUINE ESCORT AGENCY
 
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...BhumiSaxena1
 

Kürzlich hochgeladen (20)

Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
 
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
 
Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
Call Girls Kolkata Kalikapur 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
 
8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
8980367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
 
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
 
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
 
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
 
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
 
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
 
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
 
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
 
Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...
Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...
Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...
 
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
 
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
 
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
 
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
 

Swineflu Update, An Indian Prespective