SlideShare a Scribd company logo
1 of 63
PNEUMONIA Dr. Nooruddin Jaffer Professor of Medicine.
Definition ,[object Object]
Definition ,[object Object]
Clinical Definition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epidemiology ,[object Object],[object Object],[object Object],[object Object]
Epidemiology  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etiology of Community Acquired Pneumonia ,[object Object],[object Object],[object Object],[object Object]
Etiology of Community Acquired Pneumonia ,[object Object],[object Object],[object Object],[object Object]
Causes of community acquired pneumonia in North America ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Four patient categories have been defined on the basis of  information collected at the time  of initial evaluation
Outpatient Pneumonia without Comorbidity and 60 years or Younger ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Outpatient Pneumonia with Comorbidity and/or 60 years or Older ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hospitalized Patients with Community Acquired Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Severe Hospitalized Community Acquired Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PATHOGENESIS ,[object Object],[object Object],[object Object],[object Object],[object Object]
Routes of Entry ,[object Object],[object Object],[object Object],[object Object]
Classification ,[object Object],[object Object],[object Object],[object Object]
Typical or Atypical  CAP ? ,[object Object],[object Object]
Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object]
Test(s) in those who require hospital admission ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Adequate Sputum Sample ,[object Object],[object Object],[object Object]
DIAGNOSIS
DIAGNOSIS Sputum Gram Stain
Invasive diagnostic techniques ,[object Object],[object Object],[object Object],[object Object]
Features of Severe Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Severity assessment in CAP in the community (CRB-65 score) UPDATED 2004 ,[object Object],[object Object],[object Object]
Severity assessment in CAP in the community (CRB-65 score) UPDATED 2004 ,[object Object],[object Object]
Additional Clinical Adverse Prognostic Features ,[object Object],[object Object]
SEVERE CAP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management (subset of patients) ,[object Object],[object Object]
Management (subset of patients) ,[object Object],[object Object],[object Object]
Management (subset of patients) ,[object Object],[object Object],[object Object]
General Management of CAP In the community ,[object Object],[object Object],[object Object]
Decision to Hospitalize ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Decision to Hospitalize ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Decision to Hospitalize ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Management of CAP In hospital ,[object Object],[object Object],[object Object],[object Object]
Therapy Principles ,[object Object],[object Object],[object Object]
What antibiotics to use ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What antibiotics to use? ,[object Object],[object Object],[object Object],[object Object],[object Object]
What antibiotics to use? ,[object Object],[object Object],[object Object],[object Object]
What antibiotics to use? ,[object Object],[object Object],[object Object],[object Object],[object Object]
What antibiotics to use? ,[object Object],[object Object],[object Object]
ORAL OR PARENTERAL ANTIBIOTICS ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Response   ,[object Object]
Switch to oral   therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Duration of therapy ,[object Object],[object Object]
Duration of therapy ,[object Object],[object Object],[object Object],[object Object]
Complications of Pneumonia
COMPLICATIONS
 
 
Non Resolving Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Correct Diagnosis but Fail to   Respond ,[object Object],[object Object],[object Object]
SOME FACTS ABOUT CAP ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention ,[object Object],[object Object],[object Object],[object Object]
Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank You!

More Related Content

What's hot (20)

Pneumonia
PneumoniaPneumonia
Pneumonia
 
Chronic obstructive pulmonary disease2
Chronic obstructive pulmonary disease2Chronic obstructive pulmonary disease2
Chronic obstructive pulmonary disease2
 
Acute bronchitis
Acute bronchitisAcute bronchitis
Acute bronchitis
 
Bronchitis ppt
Bronchitis pptBronchitis ppt
Bronchitis ppt
 
Pneumonia
Pneumonia Pneumonia
Pneumonia
 
PNEUMONIA
PNEUMONIAPNEUMONIA
PNEUMONIA
 
Pneumonia
PneumoniaPneumonia
Pneumonia
 
Pneumonia
PneumoniaPneumonia
Pneumonia
 
Bronchiectasis
Bronchiectasis Bronchiectasis
Bronchiectasis
 
Pneumonia
PneumoniaPneumonia
Pneumonia
 
Emphysema
EmphysemaEmphysema
Emphysema
 
MANAGEMENT OF PNEUMONIA
MANAGEMENT OF PNEUMONIAMANAGEMENT OF PNEUMONIA
MANAGEMENT OF PNEUMONIA
 
COPD
COPDCOPD
COPD
 
Lower respiratory tract infection: BRONCHITIS, BRONCHIOLITIS, PNEUMONIA IN CH...
Lower respiratory tract infection: BRONCHITIS, BRONCHIOLITIS, PNEUMONIA IN CH...Lower respiratory tract infection: BRONCHITIS, BRONCHIOLITIS, PNEUMONIA IN CH...
Lower respiratory tract infection: BRONCHITIS, BRONCHIOLITIS, PNEUMONIA IN CH...
 
Lung abscess
Lung abscessLung abscess
Lung abscess
 
pneumonia ppt
pneumonia ppt pneumonia ppt
pneumonia ppt
 
Emphysema
EmphysemaEmphysema
Emphysema
 
Atelectasis
AtelectasisAtelectasis
Atelectasis
 
Lower respiratory tract infection
Lower respiratory tract infectionLower respiratory tract infection
Lower respiratory tract infection
 
Pneumonia
Pneumonia Pneumonia
Pneumonia
 

Viewers also liked

Viewers also liked (20)

Pneumonia
PneumoniaPneumonia
Pneumonia
 
Pneumonias - Aula de Microbiologia
Pneumonias - Aula de MicrobiologiaPneumonias - Aula de Microbiologia
Pneumonias - Aula de Microbiologia
 
Pneumonia
PneumoniaPneumonia
Pneumonia
 
Pneumonia
PneumoniaPneumonia
Pneumonia
 
Apresentação pneumonia
Apresentação pneumoniaApresentação pneumonia
Apresentação pneumonia
 
Pneumonia management
Pneumonia managementPneumonia management
Pneumonia management
 
Asthma ppt
Asthma pptAsthma ppt
Asthma ppt
 
5.Bronchiectasis
5.Bronchiectasis5.Bronchiectasis
5.Bronchiectasis
 
Acute Respiratory Illness(Ari)
Acute Respiratory Illness(Ari)Acute Respiratory Illness(Ari)
Acute Respiratory Illness(Ari)
 
Asthma
AsthmaAsthma
Asthma
 
Pneumonia
PneumoniaPneumonia
Pneumonia
 
Renal pathology
Renal pathologyRenal pathology
Renal pathology
 
X-RAYS ON PNEUMONIA BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPOR...
X-RAYS ON PNEUMONIA BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPOR...X-RAYS ON PNEUMONIA BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPOR...
X-RAYS ON PNEUMONIA BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPOR...
 
Urology Ppt
Urology PptUrology Ppt
Urology Ppt
 
Renal pathology..at glance
Renal pathology..at glanceRenal pathology..at glance
Renal pathology..at glance
 
Ppt pneumonia
Ppt pneumoniaPpt pneumonia
Ppt pneumonia
 
Assistência de enfermagem ao paciente pediátrico com pneumonia
Assistência de enfermagem ao paciente pediátrico com pneumoniaAssistência de enfermagem ao paciente pediátrico com pneumonia
Assistência de enfermagem ao paciente pediátrico com pneumonia
 
Acute renal failure
Acute renal failureAcute renal failure
Acute renal failure
 
Clase tuberculosis i 1
Clase tuberculosis i 1Clase tuberculosis i 1
Clase tuberculosis i 1
 
Renal disease.ppt
Renal disease.pptRenal disease.ppt
Renal disease.ppt
 

Similar to Pneumonia

Modified pneumonia in geriatric population
Modified pneumonia in geriatric populationModified pneumonia in geriatric population
Modified pneumonia in geriatric populationpbprabhakar rao pv
 
Pneumonia, DBU.pptxhvkkkkkijgfddddffdd2jji4kkrjj
Pneumonia, DBU.pptxhvkkkkkijgfddddffdd2jji4kkrjjPneumonia, DBU.pptxhvkkkkkijgfddddffdd2jji4kkrjj
Pneumonia, DBU.pptxhvkkkkkijgfddddffdd2jji4kkrjjHussen39
 
Community aquired pneumonia
Community aquired pneumoniaCommunity aquired pneumonia
Community aquired pneumoniamousa elshamly
 
Community acquired pneumonia by dr md abdullah saleem
Community acquired pneumonia by dr md abdullah saleemCommunity acquired pneumonia by dr md abdullah saleem
Community acquired pneumonia by dr md abdullah saleemsaleem051
 
Update management of CAP
Update management of CAPUpdate management of CAP
Update management of CAPSaher Farghly
 
Pneumonia by Ussama
Pneumonia by UssamaPneumonia by Ussama
Pneumonia by Ussamaussamamunir
 
Community Acquired Pneumonia .pdf
Community Acquired Pneumonia .pdfCommunity Acquired Pneumonia .pdf
Community Acquired Pneumonia .pdfPinoy MD
 
Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...
Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...
Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...Riaz Rahman
 
Community Acquired Pneumonia
Community Acquired PneumoniaCommunity Acquired Pneumonia
Community Acquired PneumoniaAshraf ElAdawy
 
Gram Negative Sepsis
Gram Negative SepsisGram Negative Sepsis
Gram Negative Sepsisshabeel pn
 
Community acquired pneumonia
Community acquired pneumoniaCommunity acquired pneumonia
Community acquired pneumoniaHarsha Vardhan
 
Critical care treatment guidelines Govt of India
Critical care treatment guidelines Govt of India Critical care treatment guidelines Govt of India
Critical care treatment guidelines Govt of India Dr Jitu Lal Meena
 

Similar to Pneumonia (20)

CAP MOUSA.ppt
CAP  MOUSA.pptCAP  MOUSA.ppt
CAP MOUSA.ppt
 
Modified pneumonia in geriatric population
Modified pneumonia in geriatric populationModified pneumonia in geriatric population
Modified pneumonia in geriatric population
 
Pneumonia, DBU.pptxhvkkkkkijgfddddffdd2jji4kkrjj
Pneumonia, DBU.pptxhvkkkkkijgfddddffdd2jji4kkrjjPneumonia, DBU.pptxhvkkkkkijgfddddffdd2jji4kkrjj
Pneumonia, DBU.pptxhvkkkkkijgfddddffdd2jji4kkrjj
 
COVID 19 Updates
COVID 19 UpdatesCOVID 19 Updates
COVID 19 Updates
 
community acquired pneumonia.pptx
community acquired pneumonia.pptxcommunity acquired pneumonia.pptx
community acquired pneumonia.pptx
 
Community aquired pneumonia
Community aquired pneumoniaCommunity aquired pneumonia
Community aquired pneumonia
 
Community acquired pneumonia
Community acquired pneumoniaCommunity acquired pneumonia
Community acquired pneumonia
 
Community acquired pneumonia(2)
Community acquired pneumonia(2)Community acquired pneumonia(2)
Community acquired pneumonia(2)
 
Community acquired pneumonia by dr md abdullah saleem
Community acquired pneumonia by dr md abdullah saleemCommunity acquired pneumonia by dr md abdullah saleem
Community acquired pneumonia by dr md abdullah saleem
 
Update management of CAP
Update management of CAPUpdate management of CAP
Update management of CAP
 
Pneumonia by Ussama
Pneumonia by UssamaPneumonia by Ussama
Pneumonia by Ussama
 
Community Acquired Pneumonia .pdf
Community Acquired Pneumonia .pdfCommunity Acquired Pneumonia .pdf
Community Acquired Pneumonia .pdf
 
Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...
Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...
Diagnosis & Mangement of Community-Acquired Pneumonia, Hospital Acquired Pneu...
 
Pneumonia
PneumoniaPneumonia
Pneumonia
 
Community Acquired Pneumonia
Community Acquired PneumoniaCommunity Acquired Pneumonia
Community Acquired Pneumonia
 
HIV IN THE ICU
HIV IN THE ICUHIV IN THE ICU
HIV IN THE ICU
 
Gram Negative Sepsis
Gram Negative SepsisGram Negative Sepsis
Gram Negative Sepsis
 
Community acquired pneumonia
Community acquired pneumoniaCommunity acquired pneumonia
Community acquired pneumonia
 
Pulmonary Renal Syndorme
Pulmonary Renal Syndorme Pulmonary Renal Syndorme
Pulmonary Renal Syndorme
 
Critical care treatment guidelines Govt of India
Critical care treatment guidelines Govt of India Critical care treatment guidelines Govt of India
Critical care treatment guidelines Govt of India
 

More from drnooruddin

Introduction to endocrinologyfinal
Introduction to endocrinologyfinalIntroduction to endocrinologyfinal
Introduction to endocrinologyfinaldrnooruddin
 
Ppt heart attack.pptxfinal (2)
Ppt heart attack.pptxfinal (2)Ppt heart attack.pptxfinal (2)
Ppt heart attack.pptxfinal (2)drnooruddin
 
Understanding mental illness final
Understanding mental illness finalUnderstanding mental illness final
Understanding mental illness finaldrnooruddin
 
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)drnooruddin
 
History taking in Medicine
History taking in MedicineHistory taking in Medicine
History taking in Medicinedrnooruddin
 
History taking in Medicine
History taking in MedicineHistory taking in Medicine
History taking in Medicinedrnooruddin
 
Symptoms Signs & Investigations in Cardiovascular Diseases
Symptoms Signs & Investigations in Cardiovascular DiseasesSymptoms Signs & Investigations in Cardiovascular Diseases
Symptoms Signs & Investigations in Cardiovascular Diseasesdrnooruddin
 
Symptoms Signs Investigations in Cardiovascular Diseases
Symptoms Signs Investigations in Cardiovascular DiseasesSymptoms Signs Investigations in Cardiovascular Diseases
Symptoms Signs Investigations in Cardiovascular Diseasesdrnooruddin
 

More from drnooruddin (10)

Introduction to endocrinologyfinal
Introduction to endocrinologyfinalIntroduction to endocrinologyfinal
Introduction to endocrinologyfinal
 
Ppt heart attack.pptxfinal (2)
Ppt heart attack.pptxfinal (2)Ppt heart attack.pptxfinal (2)
Ppt heart attack.pptxfinal (2)
 
Understanding mental illness final
Understanding mental illness finalUnderstanding mental illness final
Understanding mental illness final
 
Typhoid Fever
Typhoid FeverTyphoid Fever
Typhoid Fever
 
Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)Pyrexia Of Unknown Origin (PUO)
Pyrexia Of Unknown Origin (PUO)
 
Dengue Fever
 Dengue Fever Dengue Fever
Dengue Fever
 
History taking in Medicine
History taking in MedicineHistory taking in Medicine
History taking in Medicine
 
History taking in Medicine
History taking in MedicineHistory taking in Medicine
History taking in Medicine
 
Symptoms Signs & Investigations in Cardiovascular Diseases
Symptoms Signs & Investigations in Cardiovascular DiseasesSymptoms Signs & Investigations in Cardiovascular Diseases
Symptoms Signs & Investigations in Cardiovascular Diseases
 
Symptoms Signs Investigations in Cardiovascular Diseases
Symptoms Signs Investigations in Cardiovascular DiseasesSymptoms Signs Investigations in Cardiovascular Diseases
Symptoms Signs Investigations in Cardiovascular Diseases
 

Recently uploaded

💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...Taniya Sharma
 
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...astropune
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeCall Girls Delhi
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Servicevidya singh
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...narwatsonia7
 
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...vidya singh
 
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Dipal Arora
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...astropune
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...chandars293
 
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiRussian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiAlinaDevecerski
 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...tanya dube
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Genuine Call Girls
 
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...narwatsonia7
 

Recently uploaded (20)

💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...
 
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
 
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
 
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Aurangabad Just Call 9907093804 Top Class Call Girl Service Available
 
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
 
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
 
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
 
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiRussian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
 
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
 

Pneumonia