dr ruman
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HYE FOLKS
i know its seems repetition of all marvellous notes made by dedicated people,i want to add my effort too
these notes are amnesic notes,that is thing we usually confuse and forget,i made them while revision of my UW questions and wrote down for revision purpose,now posting here,may help some1 out there,and i be happy to contribute a bit in success of my studying folks
PEDIATRICS
·subarachnoid hemorrhage in kid: look for history of seizure and headache, reason AV malformation causing headache, seizure and may bleed intracranial
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· kid with PSOTSTREPT GN: renal function return normal when inflammation gone in a week, then complement level c3 andc50 return normal in 4 weeks, in SLE they persist for 4 month, hematuria persist for 4 month ,in IgA nephropathy, hematuria persists
· PINWORM INFESTATION: nocturnal itching or may be vulvo-vaginitis in pre-pubertal female without discharge, SCOTCH TAPE test diagnosis
· APLASTIC CRISIS in sickle cell anemia: sudden drop in Hb with Absent reticulocyte, usually parvovirus B19 inf.
· SPLENIC sequestration in sc anemia: Enlarged spleen with Reticulocytosis, hypotension may be present, vaso-occlusion can occur
· ASPERGER SYNDROM: d/d is autism buyt ?>? asperger kid more social and have normal LANGUAGE development
· HAND FOOT SYNDROM/DACTYLITIS :is earliest manifestation of VASOAOCCLUSIVE disease in sickle cell anemia, kid have swollen hand and feet, may be fever with pallor, X-ray may be normal or later show metacarpal and metatarsal osteolytic lesions
· GALACTOSEMIA: bilateral cataract, hypoglycemia, hepatic enlargement/cirrhosis, mental retardation and failure to thrive, Galactose-1-Phosphate Uridyltransferase Deficiency, if only galactokinase def, cataract is sole manifestation (hypotonia and nerve deafness additional finding if epimerase deficiency) galactosemic kid can have ECOLI neonatal sepsis
· NECROTIZING ENTEROCOLITIS: clue is increased Gastric RESIDUE in preterm kid, reason is prenatal asphyxia, causing bowel wall injury
· XY KARYOTYPE IN TURNER SYNDROM, high risk of gonadoblastoma, so do bilateral gonadectomy
· MECONIUM ASPIRATION: small for gestational age or post date babies with hyper inflated lung, flat diaphragm, patchy and streaky opacities in lungs, hypoxia, grunting ,cyanosis, rales and ronchi ,meconium acts valve like mechanism obstructing airway and keep air from exiting after inspiration ,
· GERD IN KIDNEY: failure to thrive, projectile vomiting sometime mixed with blood, child assumes typical posture WITH NECK TILTED AND BACK ARCHED to protect his airway and acid reflux pain. DX is by ph monitoring
· TODDS PARALYSIS: is motor deficit/ hemiperesis in pt after seizure and usually recovers with in 24 hours, usually indicates underlying structural abnormality
· NEONATAL SEPSIS/;suspicion if child develops jaundice t 3RD DAY TO WEEK, with lethargy and feeding poorly, do BLOODCULTURE AND LUMBAR Puncture, you may think of breast milk jaundice or other causes but in that case kid would be non-symptomatic and active besides jaundice
· MIDFASCIAL ABNORMALITIES in fetal alcohol syndrome seen, with maxillary hypoplasia, short palpaberal fissure, long nasal philtrum, thin upper lip, ASD OR VSD
· HIV in infants persistent lymphadenopathy, hepatosplenomegaly, oral thrush, intractable diarrhea
· kids with parents cholesterol>250 or risk of CAD, should get their TOTAL CHOLESTROL LEVEL CHECKED
· MECONIUM ILEUS: bilious vomiting after birth, polyhydramnios history, ground glass x-ray of lower abdomen with dilated small bowel
· INTUSSECCEPTION :current jelly stool, usually after 3 ,3 month age in cystic fibrosis kid
· midgut volvulus; child less than 1 month old with BILIOUS vomiting, BLOOD stained stool, abdominal distension
· MATERNAL RUBELLA INFECTION dx by IgM (ti ??) rubella virus or IgG 4 fold increase after 4week to rubella virus
· GAUCHER DISEASE: lysosomal acid beta-glucosidase def, with cell wrinkled appearance, S/S: anemia, fatigability, pathological bone fracture, ERLENMYER FLASK deformity of distal femur, hepatosplenomegaly
· TAY-SACH DISEASE: hexoaminidase def, also called GANGLIOSIDOSIS 2:S/S:cherry red spot at macula, neurological symptoms and no hepatosplenomegaly,
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· GANGLIOSIDOSIS 1:BETA GALACTOSIDASE def not glucosidase which is gaucher, vertebral fracture, enlarged sella tursica and thickened calvarium
· NEIMAN PICK;SPHINGOMYELOINAE DEF with foamy macrophages and neurodegenerative disease more prominent though hepatosplenomegaly there
· MECONIUM ILEUS seen in CYSTIC FIBROSIS F508 at CHROMOSOME 7 ,deletion of three base pair coding for phenylalanine responsible for defect in CFTR cystic fibrosis transmembrane conductance regulator protein which is actually CHOLRIDE CHANNEL PROTIEN and failure to transport this channel protein at its location
· ????????t/m of TET SPELL IN TOF: oxygen, knee chest position, morphine, propanolol, fluids
· LARYNGOMALACIA:STRIDOR improves on prone position and worsen when lying supine or when child cries, on direct laryngoscopy, epiglottis is seen rolled in side to side treatment reassurance and ask mom never to feed child in lay position and hold baby upright 3omin after feed
· treatment of ITP in kids with platelet count more than 30,000 is just observation in absence of other abnormality ,if below 30,00 then steroids
· ZELLWEGER Syndrome peroxisome defect, typical craniofacial dysmorphism, including a high forehead, a large anterior fontanelle, hypoplastic supraorbital ridges, broad nasal bridge, micrognathia, deformed ear lobes, and redundant nuchal skin folds. severe psychomotor retardation, profound hypotonia with depressed deep tendon reflexes (DTRs), neonatal seizures, and impaired hearing {{[[fascial dysmorphism(high forehead,open sutures,cloudy cornea,hypotonia),with seizure }}]] ??
· REFSUM syndrome: Disorders of fatty acid alpha-oxidation Refsum disease is the only known type in this group. It is characterized by
retinitis pigmentosa with progressive deterioration of night vision,
polyneuropathy,
cerebellar ataxia,
elevated cerebrospinal fluid protein levels without pleocytosis.
No cognitive decline or dysmorphism is associated with this condition. Symptoms begin in adolescence.
Accumulation of phytanic acid is the only known abnormality.
[[{{Retinitis pigmentosa, ICTHYOSIS, ataxia, dysmorphic feature, deafness}}]]??
· neonatal ADRENAL LEUKDYSTRPOPHY:NO Dysmorphic face but splenomegaly, deafness,retinis pigmentosa >> NEEDS A RECHECK
· X.LINKED ADL: hyperactivity, strabismus, ataxia, poor handwriting, vision problem, neuropathy, etc.....long chain fatty acid accumulation Pneumonia
· IN CYSTIC FIBROSIS by hem inf, staph au ,pseudomonas
· IN NUTRPENIC hem inf, staph aure, aspergillus
· IN IMMUNEDEF OR TRANSPLANT PT by CMV
· IN HIV <200. pcp, Cryptococcus, histoplasmosis
· IN hIV <50 BY MAI in pt with ch glucocorticoid therapy, tb ?? and nocardia
· UNILATERAL FLANK MASS WITH PALPABLE KIDNEY AND KID>3 yr age, think of wilms tumor, originating from metanephros
· unilateral flank mass with non palpable kidney, kid <3 yr age, think of NEUROBLASTOMA, origin neural crest cell
· BILATERAL FALNK MASS, polycystic kidney infant type'
infection with RSV ,I.E ,Bronchiolitis with wheezing after upper resp tract inf, increase risk of ASTHMA
· REYE syndrome ;MICROVESICULAR steatosis in liver, treatment supportive
This is an edited version of the notes with certain rechecks and additions by NNL.
Edited by new_n_lost on 02/29/08 - 06:06 PM
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| dr ruman
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part 2 paeds
crigler nijjar(severe) and gilbert syndrom(mild)udp glucoranyl transferase deficiency:both indirect hyperbilirubinemia ,while dubin jhonson and rotor syndrom defect in cnalicular system for transport of conjugated or direct bilirubin with liver pigmented in Rotor
while in biliary atresia there is dirct bilirubin increase with hepatomegaly and clay colored stool ,indicative of NEONATAL CHOLESTASIS.but dont fioget to rul out HYPOTHYROIDISM,NEONATAL SEPSIS,INBORN ERROR OF METABOLISM LIKE galctosemia
SIADH;urineosmolality>100mosm/kg,urinary sodium> 4omeq/L,hyponatremia and euvolemia
CEREBRAL PALSY d/t cerebral anoxia:S/S low apgar score at birth,decreased leraning abilitis, increased deep tendon reflexes and hypotonia with h/o prolonged labour
WERDING HOFFMAN SYNROM/infantile spinal ms atrophy :degeneration of anterior horn cell of spinal cord,cranial motor nuclei, evident at birth,hypotonia of proximal and distal ms with tomgue fibrillation,normnal kanguage and social development,abnormal deep tendomn reflexes
wils tumor,dont cross midlne,neuroblastoma crossmidline as abdominal mass
in kids less than 6 yr age,dx of sinusistis is clinical no need for radipgraphs,start oral amoxicillin
Medulloblastoma arise in VRMIS,while astroma in CErebellum
read glycogen storage diseaseE VONGIRKES :type 1,glucose .6,po4ase deficiency,hypoglycemia,hyperlipidemia,lactic acidosis,enlarge kidney with increase uric acid, liver,heart&spleen normal,kid with dool face,thin extremity,protuberant abdomen and papabel enlarge liver,hypoglycemic seizure
TYPE2 POMPes :ACID maltase def,heart involved,progressive hypetropic cardiomyopathy,macroglosia and enlarged liver,floppy baby
TYPE3 debranching enzyme def,same as 1 ,bt kidney normal,no lactic acidosis and normal uric acid,fasting ketosis and increase transaminase level in contrast to type 1
TYPE4 branching enzyme def,AMYLOpectinosis, early cirrhosis with hepatosplenmegaly
Primary Coarctation ,t/m:surgery,recurrent coactation t/m":ballon angioplasty
Friedrich ataxia,most common spinocerebellar ataxia,cardiomyopathy cause od death
PKU,due o def of phenylalanine hydroxylase:test dx is GUTHERINE URINE TEST
BORDETELLA PURTUSIS/whoping cough,catrrahal and then paroxsmal stage with svere bouts of cough with lymhocytosis,however WATEVER IMMUNIZATION STAUS or watever STAGE is t/m is 14 day course of ERYTHROMYCIN AND ALSO TO CONTACTS,hospitilization indicate if age<3 yr age or between 3 and 6 with complication or severe disese
EDWARD syndrom is ass with VSD,DIGEORGE syndrom with conotruncal abnormailities i.e,TOF,transpoistion of vessels,interrupted aortic arch,DOWN with ASD and endocardial cushion defect,
IV CEFOTAXIME t/m should be started first before CT,in kids with meningitis sign with focal neurological s/s and increased intracranial pressure,no LP otherwise herniation may occur
increased 17/OH PROGESTERONE LEVEL with h/o hirsuitism and clitoromegaly in female withprevious normal mesntruatiom history:CONGENITAL ADRENAL HYPERPLASIA
INCREASED LH/FSH ratio olycystic ovarian syndrom ,alos increase testosteron level
increased DHEA level,think of adrenal adenoma or CA,OVARIAN ANDROGEN TUMOR increased testo with dcresed LH,CUSHING SYNDROM:the characteritic fetures with increased DHEA level WITH NORMAL 17.OH PROGESTERONE
LOUD P2 in down kid ,due to ENDOCARDIAL CUSHION DEFECT
diabetic mom with kid complication:Transposition of gteat vessels,caudal regression ,anencepahly & neural tube defect,duodenal atresia with samll lazy left colon,hypoglycemia with hyperinsulinemia
CYCLICAL vomiting in kids of MIgraine patient,with norml s/s ,resolve sponatenously
CHOANAL tresia:cyanosis on feeding,relieved by crying ,dx:ct with cntrasr ,t/m:oral airway,lavage feeding ,surgical correction
D/D of choanal laryngomalacia which is insp stridor increased by exertion but not acompanied by cyanosis
TAYSACH dusease:mental retardation,NO hepatosplenomegaly or lymhadenpathy,with chrry red macula,NIEMAN PICK may also have cherry spot on retina but it has hypotonia,hepatosplenomegaly,lymhadenopathy
EBV ;is most probable cause for arash after amixacillin treatment in patient with upper rti symptoms,resolve sponatneously 3 weeks,so thin INFECTIOUS MONONUCLEOSIS
PREMATURITY most common risk factor for intervent hemorrahage,while I.vENT hemorrhage,leding to sub archnoid hg, most common cause of COMMUNICATING HYDROCEPHALUS in premature with tense fontanella,enlarged dilate ventricles and enlarged sub arachnoid space
penicillin/cephalosporin +aminoglycoside :EMPIRIC t/m for PNEMONIA/LUNG DISESE EXACERBATIONin cystic fibrosis kid
MECKEL DIVERTICULITIS WITH PAINLESS BLOODY STOOL IN 2YR OLD KID,WHILE IF infant is just few days old and have family atopy history,and painless bloody stool with eosinophil think of milk protein intolerance
SEPTIC HIP JOINT IN KIDS,DO EMERGENCY surgical drainage otherwise avascular necrosis of femoral head
Marfan +thromboembolic event +downward lens dislocation +mental retardation_=HOMOCYSTINUREA/cystathione synthatase deficiency
asthma pt with allergic rhinitis and eczema:mast cell stabilizer cromolyn sodium is t/m of choice
mangemnt if diaphragmatic hernia:orogastric tube with contant suction ,thn do x-ray
TRICUSPID ATRESI:cyanosis at birth with left axis deviation and VSD,MAY BE with tranposition of great vessels,normal heart size anddecreased pul vas marking(tet of fellotresent bit later with cyanosis and show rtr vent hypertrphy)
TRUNCUS ARTERISOSUS:cyanosis but bivent dilatation with increased pul vas marking,and ight aortic arch
dimaond blackefen anemia:MACROCYTIC ANEMIA,with triphalngeal thumb and weebd neck and fascial anomaly and normal other counts,and decrease retic count
MENINGOCOCCUS mcc of meningitis in 2-18 yr
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Living each day as a preparation for the next is an exciting way to live. Looking forward to something is much more fun than looking back at something—so lets do it together
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| smalley
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hey dr ruman these are great....thanks for putting up so much effort and willing to share.....gl with ur test...
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| laly1
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thanks dr ruman you are great.best luck with your test
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.[96:1-5] Read! In the name of your Lord who created - Created the human from something which clings. Read! And your Lord is Most Bountiful - He who taught (the use of) the Pen, Taught the human that which he knew not.
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| dr ruman
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hye
thx for encouraging,i want to acknowledge here that there are terms and words which i use short versions and didnt type notes in proper format and it may be difficult to understand ,as it will take me some time to go through these notes again and edit ,so if i cause any inconvenience ,i hope u will overcome it
will post the notes again after edition 
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| sadiq naveed
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thanxz do u hav notes of other subjects
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| dr ruman
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i am working on other subject notes as i am revisisng ,again these are just amnesic notes ,there lot more other basic info that u need to revise ,these notes merely revison of confusing zebras than horses,so do revise horses first then grab the zebra heheheh
so surgery zebra
SURGERY
ct scan of abdomen with oral contrast :diagnostic choice for duodenal rupture 2nd part most commonly ,shoen as retroperitoneal air on xray
BRONCHOSCOPY:is choice in patient who developed atelectasis,to remove mucus plug and patecy,prevntion by incentive spirometry,chest phys
io
Degenerative cervical spondylosis plus hypeextension inj in old:central cord syndrom
BLAST FRACTURE VERTEBRAE:think of ant spinal syndrom
2ND NECK ZONE:all gun shot and penetrating wounds in 2ND ZONE needs surgical exploration,but asymptomatic stab wounds can b left alone for observation
1st and 3rd ZONE urgical intervention depends on vasular,hemodynamic,resp and digestive indication
gunshot wound in lower or 1st zone needs bronchoscopy and esophagogram
all nexk injuries with cervical spine xray needed
MAMMARY FAT NECROSIS:not premalignant seen as MACROCALCIFICATION AND COARSE,with fat globules and foamy macrophages,whle malignanat one are fine microcalcification,
MOST COMMON NOSOCOMIAL INFECTION developed 48 hr after hospitalization ,is UTI ,2nd is surgical wound site,and 3rd is nosocomial pnemonia
any gunshot wound to abdomen,:do laprotomy,wetehr pt hemodynamically stable or not
INHALATIONAL INJU;DIAGNOSIS BY BRONCHOSCOPY
NURSEMAID ELBOW IN KIDS;in kids by holding by elbow or arm,subluxation of radial head at elbow,kid dont move arm,treatment by closed reduction by flexion and supination if forearm,
OPEN FRACTURE:needs wound dressing ,stabilization and delay closure,primary early closure can cause infection
INTRADUCTAL PAPILLOMA with bloody discharge in young female;management is GALACTOGRAM guided RESECTION,mammo not helpful in young,as intraductal papilloma not discreyte mass found,mfna or excision biopsy aant b done
PATIENT WITH FACIAL INJ: chin lift with face mask is way for airway and breathing
EXCISISON THERAPY should be used for partial and full thickness burn to allow early healing or grafting if required,
CT is best choice for solid organ damadge in STABLE patient,solid organ are kidney,spleen ,etc
SCOLIOSIS":if <20 degree careful observation until reaches max skeletal growth
if >30 at initial evaluation then ,bracing is required or if progression of >5 degree from initial degree of scoliosis,in follow up.If >45 degree surgical intervention,as that much degree of scoliosis effects pulmonary functions
PENILE FRACTURE:do retrograde urethrogram first to rule out associated vasular inj followed by emergency surgical exploration
OXALATE STONES:in fat malabsorption,inflammatory bowel disease as chrons,small intestinal resction,as excessive fat binds calcium,leaving unavailable to bid oxalate resulting in oxalate stones
ISOLATED DIPHYSEAL OR MIDSHAFT HUMERAL FRACTURE:treatment of choice is closed reduction,though sign of radial nerve stretching by limited wrist extension may present ,but its reversible and dont need nereve reapir or surgical exploration
SIMPLE BOWEL OBSTRUCIONconservative management ,usually presnt with met ,alkalosis,BOWEL OBS. WITH MET.ACIDOSIS:sign of bowel ischemia or necosis,do LAPROTOMY
PULSE RATE 1st to change in hemorrhage and hypovolemic shock
INTRAPERITONEAL BLADDER RUPTURE in patient with distended or full bladder,pt presents with gross hematuria,nonpalpable bladder and inability to void along with supra puv=bic pain
ABDOMEN cavity starts below 4th ic space ,while lung border ends at 6th intercostal space in midclavicular line and 8th ic space in mid axillary line
PNEUMOMEDIASTINUM respond to chest tube suction,so just need observation,however if pt doesnt improve and chest tube doesnt work and pt get signs of circulatory compromise then need surgical decompression
MYOGLOBINURIA and rush injuries needs,osmotic diuresis with alkalanization of urine by NaHCO3,to prevent renal injuries
BAN the bone in vasular and surgical repair i.e,B:bone,A:artery,N:nerve follow sequence
BASILar skull fracture:expectant management plus ct scan head to rule out intracranial injury,i.e, imaging with expactant therapy
PATIENT ON WARFARIN if need to undergo surgery first give fresh frozen plasma to prevent severe bleeding,not vit k
TETANUS TOXOID AND IMMMUNOGLOBIN both given in injuries,when less than 3 doses of tet vaccine plus dirty wound,all other just toxoid with more than 10 yr in clean and more than 5 yr of last dose with dirty wound (3doses vacine completed)
Ogilvie syndrome is a type of colonic dysfunction often seen in elderly patients who are not too active to begin with and are then further immobilized by extra-abdominal surgery.That means pt presesnt with s/s of intestinal obstruction though there is no obstruction .Colonoscopy rules out obstructing cancer (always a consideration in this age group) and allows the gas to be sucked out as the instrument advances. A long tube is then left in place
There are two malignant tumors of the eye for which enucleation would be performed: retinoblastoma and melanoma.Retinoblastoma kills pstient quite rapidly while Only melanoma would have this weird timetable, in which 20-some years may elapse between primary tumor and metastatic manifestations. In fact, the patient with a glass eye and a liver full of tumor is one of the two classic examples that are given (the other one has a missing toe) to illustrate the unpredictable behavior of melanoma.
Before all the operative steps are completed, the patient develops a significant coagulopathy, a core body temperature less than 34 C (93.2 F), and refractory acidosis. The anesthesiologists are administering fresh frozen plasma and platelet packs. Following is the most appropriate next step in management for the surgeon:.. is to pack the bleeding surfaces and close the abdomen temporarily with towel clips
pain in heel on puttin weight in obse old,reason is PLANTAR FASCITIS not bony spur
The diagnosis is acute ascending cholangitis:This deadly disease is seen in patients with long-standing gallstones who get one or more stones in the common duct, where they produce partial obstruction that allows ascending infection. The fact that the sonographer cannot see the offending stones is irrelevant, as stones in the common duct are often not seen in sonograms. The study shows the indirect evidence of obstruction: dilated ducts. The chills, very high fever, and extremely elevated alkaline phosphatase are diagnostic. An advanced clinical form is present here, with obtundation, right upper quadrant tenderness, and hypotension. The key component of therapy is immediate decompression of the common duct, which is full of pus. How it is achieved is less important. Emergency endoscopic retrograde cholangiopancreatography (ERCP) is usually the first choice, but it can be done by percutaneous transhepatic cholangiography (PTC) or by open surgery
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Living each day as a preparation for the next is an exciting way to live. Looking forward to something is much more fun than looking back at something—so lets do it together
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| dr ruman
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hye here are very nice notes subject wise ,downloaded from a site,
now all pain paid off ,enjoy these notes
Attached Files:
notes.txt (329 KB, 65 downloads)
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Living each day as a preparation for the next is an exciting way to live. Looking forward to something is much more fun than looking back at something—so lets do it together
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| Ujk
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Thanks. This is great stuff
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| dr ruman
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thx
hay folks dont forget to pray in return,for my exam ,comin closer
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Living each day as a preparation for the next is an exciting way to live. Looking forward to something is much more fun than looking back at something—so lets do it together
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| hir
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hey, dr. ruman, thank u so much.......gr8 effort....all d best for ur exam!!!!!!!
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| dr ruman
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thx NNL for ur eefort and time,i apprecite it,though i wished but cud not do edition,and thx hir hows ur prep goin
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Living each day as a preparation for the next is an exciting way to live. Looking forward to something is much more fun than looking back at something—so lets do it together
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| amybmc
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Hi Dr. Ruman .. very nice notes ..thanks a lot ..
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| doctor_mhl
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thank you very much buddy , this is so generous of you.
good luck
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| dr ruman
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thx folks
happy studying and best luck
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Living each day as a preparation for the next is an exciting way to live. Looking forward to something is much more fun than looking back at something—so lets do it together
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| anuba
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hey dr ruman,
those notes are great! thanks!!
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| Feyza
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thaaaaank youuuuuu
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O my Lord! Open my chest for me ( grant me self-confidence ) and ease my task for me.Ta-Ha 25-26.
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| dr ruman
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u r welcome buddies
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Living each day as a preparation for the next is an exciting way to live. Looking forward to something is much more fun than looking back at something—so lets do it together
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| dr ruman
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HAPPY EASTER AND EID MILAD-NABI MUBARAIK TO ALL,
best luck ,its holy month ful of blessings of GOD
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Living each day as a preparation for the next is an exciting way to live. Looking forward to something is much more fun than looking back at something—so lets do it together
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| dr_puma
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thanks
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