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Kanal postlari
اللَّهُمَّ صَلِّ عَلَى البَدْرِ المُنِيرِ سَيِّدِنَا مُحَمَّدٍ، وَعَلَى آلِهِ الأَطْهَارِ نُجُومِ الهُدَى وَمَصَابِيحِ الدُّجَى، صَلَاةً لَا تَنْقَطِعُ أَبَدًا، وَلَا تَنْفَدُ مَدَدًا، تَجْعَلُنَا بِهَا مِنْ أَهْلِ شَفَاعَتِهِ وَحُبِّهِ وَقُرْبِهِ.
| 2 | اللَّهُمَّ صَلِّ عَلَى البَدْرِ المُنِيرِ سَيِّدِنَا مُحَمَّدٍ، وَعَلَى آلِهِ الأَطْهَارِ نُجُومِ الهُدَى وَمَصَابِيحِ الدُّجَى، صَلَاةً لَا تَنْقَطِعُ أَبَدًا، وَلَا تَنْفَدُ مَدَدًا، تَجْعَلُنَا بِهَا مِنْ أَهْلِ شَفَاعَتِهِ وَحُبِّهِ وَقُرْبِهِ | 1 |
| 3 | +1 هذه ملفات approach أو diagnostic algorithm للأطفال
من الاعراض تسهلك الوصول للتشخيص مع الخطوة التالية والفحوصات
ملفات مفيدة جدا. | 19 |
| 4 | #Leishmaniasis@Clinicalpediatricround | 20 |
| 5 | 🔴Leishmaniasis
▪︎It's A Protozoal Zoonotic Infection (Parasitic Infection Comes From Animals) Caused By Unicellular Flagellated Intracellular Leishmania Family
🔷Method Of Transmission
📍1. Infection Transmitted From Animals (Dogs Act As Reservoir) Through Phlebotomine SandFly Vectors To Humans (Humans Are Incidental Host)
📍2. Then From Those Infected Patients To Other Humans (Humans Also Act As Reservoir)
🔷Types Of Leishmaniasis
📍1. Visceral Leishmaniasis (VL/Kala-Azar)
📍2. Cutaneous Leishmaniasis (CL)
📍3. Mucosal Leishmaniasis (ML)
🔰Visceral Leishmaniasis (VL/Kala-Azar)
▪︎Caused By Leishmania.DonoVani Family (DonoVani/Infantum/Chagasi)
▪︎Affects Internal Body Organs (Spleen/Liver/BM/LN) & Results in Life Threatening Infection
▪︎Usually Affects Small Children & Infants & Immunocompromised Adults (HIV-Co Infection)
🔷Clinical Features & Dx Of VL
📍1. Asymptomatic Stage (Due To Long Incubation Period Weeks-Months-Years)
📍2. Starts As High Fever With Rigor & Chills (1st Sign) Then Starts To Decrease Gradually Over Time (With Episodes Of Fever Relapse But With Less Intensity)
📍3. Progressive SplenoMegaly Over Time Until Becomes Massive
📍4. Moderate HepatoMegaly
📍5. Lymph Nodes Enlargement (Occurs More in Africa)
📍6. Black Skin Discoloration (Advanced Disease)
📍7. Confirm Dx :
🔺I. CBC (PanCytoPenia) :
▪︎Severe Anemia
▪︎Leucopenia
▪︎Thrombocytopenia
🔺II. Elevated Liver Enzymes & Immunoglobulins (IgG Then IgM) & Decrease Albumin
🔺III. +Ve Serology (Stay +Ve Even After Tx/K39 Name Of Serology)
🔺IV. Tissue Biopsy Then Microscopic Examination (To See Amastigotes [Leishman Donovan Bodies]) Or Culture Or PCR ➡️ Best Method To Confirm Dx
🔷Complications Of VL
📍1. Heart Failure (Due To Severe Anemia)
📍2. Bleeding Episodes (Due To Thrombocytopenia)
📍3. Jaundice With Edema & Ascites (Due To Liver Inflammation Or Failure)
📍4. Secondary Bacterial Infections (Risk Of Death)
📍5. Post-Kala-Azar Dermal Leishmaniasis :
▪︎Diffuse HypoPigmented Erythematous Or Nodular Skin Lesions That Usually Affects Face (Around Chin) & Trunks
▪︎Develops Shortly After Tx Or Years Later (6m-3Years After Infection)
📍6. Death If Not Tx Given
🔷DDX Of VL
1. Malaria
2. Typhoid Fever
3. TB (Miliary)
4. Shistosomiasis
6. Brucellosis
7. Infectious Mononucleosis (CMV)
8. Malignancy (Leukaemia/Lymphoma)
9. Ameobic Liver Abscess
🔷Mx Of VL
📍1. Sodium StiboGluconate (Pentostam) & Meglumine Anti-Moniate ➡️ Both 20mg/Kg/Day IV Or IM For 28-30 Days (Repeated As Needed)
📍2. AmphoTericin B (0.75-1mg/Kg Every Day Or Every Other Day For 15-20 Dose) ➡️ Used in Resistant Cases & Recommended For Immunocompromised Patients
📍3. Other Drugs :
▪︎Pentamidine isethionate (4mg/Kg/Day For 2w)
▪︎ParoMoMycin (11-14mg/Kg/Day For 3-4w)
▪︎Miltefosin (Oral Drug 2.5mg/Kg For 28 Days)
▪︎Recombinant Human Interferon-Y
▪︎Drugs Combination (To Prevents Drug Resistant)
📍4. Patients Follow Up For 6-12m (Due To Risk Of Relapse) | 128 |
| 6 | تقريبآ من افضل كتب العملي في الأطفال... | 34 |
| 7 | NERVOUS System Examination in pediatric | 32 |
| 8 | #TB | 34 |
| 9 | 🔹Dx Of TB
📍1. Unexplained Cough For >2-3w
📍2. Chest Xray Changes :
▪︎Normal in Early Disease
▪︎Consolidation Or Cavitaion (Usually in Upper Lobe)
▪︎Hilar LN Enlargement
▪︎Ghon Focus (Small Rounded Well Defined Calcifications At The Periphery Indicates Healed Primary TB)
▪︎Miliary TB (1-2mm Nodules All Over The Lung Called Millet Seed)
▪︎Pleural Effusion Or Empyema
▪︎Lobar Collapse
▪︎Bronchiectasis & Pleural Scarring
📍3. Sputum Smear (At Least 3 Samples With One Taken At Early Morning) Then Do :
▪︎Ziehl-Neelsen Stain (Looking For Acid Fast Bacilli)
▪︎Lowenstein-Jensen Culture (Can Take 4-6w)
▪︎NAAT Tets
▪︎Fluorescent Microscopy
📍4. HistoPathological Dx Using Tissue Sample
📍5. Tuberculin Skin Test (Mantoux) Or Interferon Gamma Release Assay (IGRAs) ➡️ Can Used For Suspected Asymptomatic Patients (Detects Latent TB Infection)
🔹Mx Of TB
▪︎Patients Will Become Non-Infectious After 2w From The Tx
🪀Indications For TB Tx :
📍1. Smear +Ve Patients
📍2. Smear -Ve Patients But Has Typical Chest Xray Changes Not Respond To Usually Antibiotics
📍3. Strong Clinical Suspicious Of TB
🪀Duration Of Tx :
📍1. 6m For All Patients With New Onset Pulmonary & ExtraPulmonary TB
📍2. 12m For Patients With :
▪︎TB Meningitis
▪︎Spinal TB
🪀Drugs Regime :
📍1. Intensive Phase ➡️ 2m Of Isoniazid/Rifampicine/Pyrazinamide/Ethambutol
📍2. Continuation Phase ➡️ Then 4m Of Isoniazid/Rifampicine Only
📍3. Pyridoxine Alternative To Isoniazid Preferred in Pregnant Women & Malnourished Patients (Less Risk Of Peripheral Neuropathy)
📍4. Streptomycin Alternative To Ethambutol If Duration Of Tx Extended To 12m
📍5. Do Sputum Smear At 2m & 5m To Check Tx Efficacy
📍6. Tx Failure ➡️ If Sputum Smear +Ve At 5m Or Patient Has Mult-Drug Resistant TB
🪀Drugs Side Effects :
📍1. Rifampicine :
▪︎Changes Urine & Tear Colour To Orange
▪︎Reduce Efficacy Of Oral Contraceptives
▪︎Hepatitis & Rash & GIT Disturbances
▪︎Interstitial Nephritis
▪︎Haemolytic Anemia & Thrombocytopenia
📍2. Isoniazid :
▪︎Peripheral Neuropathy
▪︎Agranulocytosis
▪︎Hepatitis & Rash
▪︎Seizures & Psychosis
📍3. Ethambutol :
▪︎Optic Neuritis (RetroBulbar)
▪︎Arthralgia & Rash
▪︎Peripheral Neuropathy
▪︎Renal Impairment
📍4. Pyrazinamide :
▪︎HyperUricaemia & Gout
▪︎Myalgia & Hepatitis & Rash & GIT Disturbances & PhotoSensitivity
📍5. Streptomycin :
▪︎8th Cranial Nerve Damage (Vestibulo-Cochlear)
▪︎Renal Impairment
▪︎Agranulocytosis & Rash
🔹Prevention Of TB
📍1. Vaccination (BCG)
📍2. Detection Of Asymptomatic Carriers (Tuberculin Skin Test Or Interferon Gamma Release Assay)
📍3. ChemoProphylaxis For Contact Patients ➡️ 3m Of Isoniazid (Then Continue For 6m If Patient Confirmed Has TB) | 34 |
| 10 | 🔴Tuberculosis (TB)
▪︎It's A Bacterial infection Caused By Mycobacterium Species (Mostly M.TB) That Results in Granulomatous Inflammation (Granuloma Formation) in Different Body Systems
▪︎More Common in The Developing Countries الفقرة
▪︎Usually Droplet Transmission (Respiratory Route)
🔹Features Of M.TB Bacteria
▪︎Curved Rod Shape
▪︎Aerobic تحب المناطق الهوائية العالية
▪︎Non-Motile
▪︎Non-Spore Forming
▪︎Weakly Gram +Ve
▪︎Acid Fastness
🔹Risk Factors For TB Infection
1. Children & Recent Measle Infection
2. Close Contact With Infected Person & Overcrowding
3. Smoking & Alcohol & Immunocompromised (Diabetes/Steroids/HIV)
4. Malignancy & Chronic Kidney Disease
5. Malnutrition & Vitamin Deficiency (A-D)
6. Silicosis
7. Hx Of Previous TB
8. Live in Endemic Region
🔹Clinical Features Of TB
🔸A. Pulmonary TB
📍1. Primary TB Usually Asymptomatic (Only Chest Xray Findings) & Occurs More in Children
📍2. Non Specific Flu Like Symptoms
📍3. Chronic Productive Cough With Haemoptysis
📍4. Pyrexia Of Unknown Origin & Night Sweats
📍5. Weight Loss & General Malaise
📍6. Spontaneous Pneumothorax
📍7. Exudative Pleural Effusion
📍8. Unresolved Pneumonia
📍9. Miliary TB :
▪︎Pulmonary TB Dissemination Through The Blood To Other Body Organs
▪︎Present As Acute Or 2-3w Symptoms Of :
I. Fever/Night Sweats/Anorexia/Weight Loss/Dry Cough
II. ExtraPulmonary Features (HepatoSplenoMegly/Headache/Anemia/Leucopenia/Choroidal Spots On The Eye)
📍10. Post-Primary TB :
▪︎Gradual Slow Onset Of TB Symptoms in Patient Previously Dx With TB
▪︎Due To Reactivation Of Latent TB Or Due To Acquisition Of New TB Infection
▪︎More in Adults & Usually Present As Pulmonary Symptoms Only & Xray Changes More in Upper Lobes
▪︎More Risk Of Pulmonary Complications
🔸B. ExtraPulmonary TB (Common in HIV Patients)
📍1. Painless LN Enlargement :
▪︎1st Seen At Cervical Then Mediastinal Then Axillary Then Inguinal Then SupraClavicular LN
▪︎Start As Mobile LN Then Become Matted Together & Fluctuant طرية
▪︎Nodes May Discharge into The Skin (Collar-Stud Abscess & Sinus Formation)
📍2. GIT TB :
▪︎Usually Affects Ileo-Caecal Loop Of The Bowel
▪︎Present As :
I. Palpable Right iliac Fossa Mass
II. Acute Abdomen (30%)
III. Bowel Wall Or Mesenteric Thickening
IV. Bowel Narrowing & Shortening & Distortion (Increase Risk Of Bowel Obstruction)
V. Ascites
VI. Abdominal LN Enlargement & Mesenteric Adenitis
VII. TB Peritonitis (Abdominal Pain & Distention With Fever)
VIII. Jaundice
📍3. Pericardial Diseases Present As :
▪︎Pericardial Effusion
▪︎Constrictive Pericarditis
▪︎Pericardial Calcifications
📍4. TB Meningitis :
▪︎High Risk Of Mortality (30%)
▪︎Risk Of Neurological Dysfunction
📍5. Bone & Joint TB (Pott's Disease) :
▪︎Usually Affects Lower Thoracic & Lumbar Spine
▪︎Present As :
I. Chronic Back Pain (Cord Compression)
II. Kyphosis
III. Para-Vertebral & Psoas Abscess
IV. Large (Cold) Inguinal Abscess
V. Hip Or Knee Joint Inflammation (Poncet's Arthropathy)
📍6. Genito-Urinary TB Present As :
▪︎Hematruia/Frequency/DysUria
▪︎Sterile PyUria
▪︎Women Infertility (Due To EndoMetritis)
▪︎Women Pelvic Pain & Swelling (Salpingitis)
▪︎Women Tubo-Ovarian Abscess
▪︎Men Epididymitis Or Prostatitis
🔹Complications Of TB
1. Permanent Lung Damage (Fibrosis/Bronchiectasis/Emphysema/Calcification)
2. Cor Pulmonale (Right Heart Failure Due To Lung Disease)
3. Massive Haemoptysis
4. Bronchopleural Fistula
5. Pleural Calcification
6. TB Meningitis (More in Children Younger Than 5 Years & Usually Develops 6m After Primary TB) | 27 |
| 11 |  Mentzer Index: differentiate iron deficiency anemia and thalassemia. | 25 |
| 12 | #Diphtheria@Clinicalpediatricround | 27 |
| 13 | 🔴Diphtheria
▪︎Bacterial Infection Of URT Mucus Membranes & Skin By Toxin Producing Corynebacterium Diphtheria (Gram +Ve/Club Shape Rods With Beaded)
▪︎Respiratory & Direct Contact Transmission
▪︎Psuedomembrane Formation
▪︎Mostly Affect Tonsils/Pharynx/Nose & Larynx
🔹Clinical Features
📍1. Pharyngeal Diphtheria
▪︎Sore Throat & Mild Fever
▪︎Serosanguineous Rhinitis
▪︎Ulcerations Of Upper Lip & External Nares
▪︎Dysphagia & Hoarseness
▪︎Gray Adherent Psuedomembrane Formation On Tonsils/Pharynx/Nasopharynx/Trachea ➡️ Bleed On Removal
▪︎Cervical LN Enlargement With Neck Edema ➡️ Produce Bull Neck Appearance
▪︎Stridor & Upper Airway Obstruction ➡️ If Diphtheria Reach Larynx
📍2. Skin Diphtheria ➡️ Superficial Ecthyma Like NonHealing Ulcer With Gray-Brown Psuedomembrane Formation With Pain & Tenderness & Erythema
🔹Dx ➡️ Clinical + Culture On Loeffler-Tellurite Agar For 16-48h
🔹Complications
1. Myocarditis (Most Common Cause Of Death) ➡️ Present After 2-3w As Tachycardia/PR Prolongation/ST Changes/Arrhythmia/HF/Cardiomyopathy
2. Polyneuritis ➡️ Paralysis Of Soft Palate & Pharyngeal & Laryngeal & Facial Muscles ➡️ Produce Nasal Speech/Difficult Swallowing/Regurgitation & Aspiration/Diplopia & Strabismus
3. Secondary Pneumonia
🔹Mx
📍1. Diphtheria AntiToxin Within 48h (Single Dose 20k-100k Unit)
📍2. Penicillin G (150k Unit/Kg/Day IV Or IM Every 6h) For 10 Days
▪︎Alternative AB
•Erythromycin (40mg/Kg/Day Orall Or IV Every 6h)
•Oral Penicillin V (250mg 4x)
📍3. Carriers Tx ➡️ Erythromycin (40mg/Kg/D Orally)/Penicillin V (50mg/Kg/D For 10D)/Penicillin G (600k-1200k IM)
📍4. Prevention ➡️ DTAP Vaccination | 29 |
| 14 | Exam_Preparatory_Manual_for_Undergraduates_Pediatrics,_2e_Jan_1.pdf | 24 |
| 15 | #Mumps@Clinicalpediatricround | 25 |
| 16 | 🔴Mumps النكاف
▪︎Viral Infection (RNA Paramyxo Virus) Affecting The Salivary Glands
▪︎Mostly Affect Unimmunized Children
▪︎Gives Life Long Immunity
▪︎Respiratory Transmission & Infectivity Period 1-2 Days Before & 5 Days After Onset Of Symptoms
🔹Clinical Features & Complications
📍1. Prodromal Symptoms Of Mild Fever & Myalgia & Malaise
📍2. Tender Swelling Of Salivary Glands
▪︎Usually Starts As Unilateral Then Becomes Bilateral Parotid Swelling With Ear Protruding & Stensen Duct Swelling
▪︎Pain Increase By Eating Sour Food & Mouth Opening Then Disappears After 1w
📍3. Mumps MeningoEncephalitis
▪︎Most Common Cause Of Aseptic Meningitis in Unimmunized Children
▪︎Present As Mild Headache/Fever/Nausea & Vomiting/Neck Stiffness/Convulsions/Or Asymptomatic
▪︎Present 5 Days After Parotid Swelling
📍4. Epidydimo-Orchitis
▪︎More in Postpubertal Men (Adolescents & Adults)
▪︎Present As Testicular Pain & Swelling & Erythema
▪︎Mostly Unilateral & Resolve in 1-2w
▪︎Risk Of Testicular Atrophy & Infertility (Rare)
📍5. Oophoritis (Girls) ➡️ Pelvic Pain & Tenderness Confused With Appendicitis
📍6. Acute Hemorrhagic Pancreatitis ➡️ Acute Epigastric Pain & Tenderness With Fever & Vomiting & Increase Pancreatic Enzymes (Amylase & Lipase)
📍7. CSF Lymphocytosis & Elevated Proteins
📍8. Long Term Complications ➡️ Deafness/Aqueductal Stenosis & Hydrocephalus/Myocarditis/Transverse Myelitis/Facial Paralysis
🔹DDX
1. Cervical Adenitis ➡️ Leukocytosis & Neutrophilia/Normal Ear Position & Normal Stensen Duct
2. Bacterial Parotitis ➡️ Pus & Systemic Toxicity With High Fever Due To Staph.Aureus
3. Recurrent Parotitis ➡️ Intermittent Swelling & Pain Increase By Chewing Due To Parotid Stones
4. Endemic Parotitis ➡️ Bilateral Painless Swelling Due To Malnutrition & Chronic Anemia
5. HIV Parotitis ➡️ Bilateral & Chronic & Less Painful
🔹Mx (Supportive)
📍1. 5 Days Patient Isolation
📍2. IV Fluids & Analgesia
📍3. Prevention By MMR Vaccine | 31 |
| 17 |  Status epilepticus | 39 |
| 18 |  Status epileptics | 32 |
| 19 |  Status epilepticus | 25 |
| 20 | 🔰Erythema Infectiosum (5th Disease)
▪︎Viral Infection Caused By DNA ParvoVirus B19
🔹Clinical Features & Dx
📍1. Start As Mild Fever/Headache/Malaise/Myalgia/Pharyngitis/Conjunctivitis
📍2. Then Rash After 7-10 Days :
▪︎Start As Slapped Check Rash With Circumoral Pallor (Like Lupus)
▪︎Then Rash On Trunk
▪︎Then Central Clearing Of Rash ➡️ Giving Appearance Of Lacy Reticulated Rash
على شكل شبكة من الخطوط
📍3. Hematological Abnormalities (Aplastic Crisis)
🔹Complications
📍1. Transient Aplastic Crisis For 7-10 Days
📍2. Congenital Fetal Infection ➡️ Results in Severe Anemia/Heart Failure/Hydrop Fetalis & Fetal Death
📍3. Arthritis/Hepatitis/Myocarditis/Purpuric Gloves & Stocks Syndrome
🔹Mx (Supportive)
📍1. Blood Transfusion For Transient Aplastic Crisis
📍2. IVIG For Immunocompromised Patients
🔰Scarlet Fever الحمى القرمزية
▪︎Bacterial Infection Caused By GA Beta Hemolytic Streptococcus (GAS)
▪︎Primary Focus Of Infection ➡️ Pharyngitis/Skin Infections
🔹Clinical Features & Dx
📍1. Sudden Onset Of Fever & Sore Throat/Vomiting/Headache/Systemic Toxicity
📍2. Tonsils & Pharynx Swelling & Covered With Patches Of Exudates
📍3. Tongue Change Colour ➡️ White Strawberry (1st Two Days) Then Red Strawberry (At 5th Day)
📍4. Skin Rash (Scarlatiniform) At Same Time With The Fever :
▪︎Diffuse Red Punctate Feels Like SandPaper (Goose Skin Rash نقاط ناعمة)
▪︎Flushed Face & CircumOral Pallor (Like Lupus)
▪︎Blanch On Pressure
▪︎More Intense At Skin Folds (Axilla/Groin/Neck) ➡️ Here Don't Blanch
▪︎Residual Petechial Rash in The AnteCubital Fossa May Be Seen (Pastia’s sign)
📍5. Confirm Dx :
▪︎Typical Clinical Features
▪︎Neutrophilia
▪︎+Ve Throat Culture
▪︎ASO Titer >250
🔹Mx Of Scarlet Fever
📍1. Oral Penicillin V For 10 Days
📍2. Amoxicillin (50mg/Kg) For 10 Days
📍3. Single IM Benzathine Penicillin G
📍4. Erythromycin Or Azithromycin (For Penicillin Allergic Patients)
📍5. Clindamycin Or Rifampin ➡️ For Eradication Of Chronic Carrier State
🔹Complications
📍1. PostStrept Glomerulonephritis
📍2. Acute Rheumatic Fever
📍3. Strept Toxic Shock Syndrome
📍4. Reactive Arthritis
📍5. Chronic Carrier State
🔰ChickenPox
▪︎Primary Viral Infection Caused By Varicella Zoster (VZV) Member Of Herpes Family Transmitted By Droplets & Skin Contact
▪︎Gives Life Long Immunity & Latent Infection
🔹Clinical Features
📍1. Start As Fever With Malaise & Anorexia (Prodromal Stage)
📍2. After 24-48h Very Itchy Rash (Start On Scalp & Face & Trunk Then Descend To Limbs) :
▪︎About 200-500 Lesions
▪︎Rash Start As Erythematous Macules Then Papules Then Vesicles Then Crusts
▪︎Different Stages Of Rash Present At Same Time
▪︎Vesicles in Mouth Mucus Membrane May Ulcerate
📍3. Patient is Infective 2 Days Before Rash Onset Until Rash Crusted
🔹Complications Of ChickenPox
1. Permanent Scars If Lesions Scratched
2. Secondary Bacterial Infection (Staphylococci/GA Streptococcus) ➡️ Risk Of Toxic Shock Syndrome & Necrotizing Fasciitis
3. Encephalitis ➡️ Week After Onset Of Rash & Associated With Cerebellar Signs (Cerebellitis)
4. Purpura Fulminas ➡️ Large Area Of Skin & Subcutaneous Tissue Inflammation After VZV Infection
5. in Immunocompromised ➡️ Severe Vesicular & Hemorrhagic Eruption/Pneumonitis/DIC
6. Congenital Varicella Syndrome ➡️ Risk Of LBW/Mental Retardation & Congenital Anomalies
7. Rye's Syndrome If Aspirin Used
8. Shingles (Secondary Herpes Zoster) ➡️ ReActivation Of Latent VZV Causing Vesicular Eruption in Specific Dermatomes (Mostly At Thorax) & Risk Of Chronic Neuralgic Pain
🔹Mx Of ChickenPox
📍1. Acyclovir (20mg/Kg 4x Per Day For 5 Days)
📍2. Anti-Pruritics (Anti-Histamines/Calamine Lotion)
📍3. Anti-Pyretics (Paracetamol/Never Use Aspirin)
📍4. Antibiotics (If Secondary Bacterial Infection Developed)
📍5. Prevention & Prophylaxis :
▪︎ChickenPox Vaccine At 12-18m Age (Also Given 3-5 Days After Exposure As Prophylaxis)
▪︎Anti-VZV IVIG (IM 1 Vial For Each 10Kg Of Body Weight) ➡️ Post Exposure Prophylaxis For Immunocompromised & Pregnants & Newborns | 35 |
