MULTIPLE MYELOMA (MM) SLIDESHARE PRESENTATION

•

0 likes•146 views

A cancer of plasma cells. The plasma cells are a type of white blood cell in the bone marrow. With this condition, a group of plasma cells becomes cancerous and multiplies. The disease can damage the bones, immune system, kidneys and red blood cell count.

Health & Medicine

What is Multiple
Myeloma ?
2
✓
✓
✓
✓
✓
➢
➢
➢
➢

3 /1 /2 0 X X S AM P L E F OOT E R T E X T 4
✓
✓
✓
✓
✓
✓
Risk factors

Multiple myeloma: pathophysiology
▪
➢
➢
➢
3 /1 /2 0 X X S AM P L E F OOT E R T E X T 5

3 /1 /2 0 X X S AM P L E F OOT E R T E X T 6

Common sites for bone involvement
❑
❑
•
•
❑
❑
❑
7

Clinical manifestations of multiple
myeloma
❑
❑
❑
❑
❑
•
•
•
8

Mechanism of disease
❑
❑
❑
❑
3 /1 /2 0 X X S AM P L E F OOT E R T E X T 1 0

Symptomatic…..
❑
➢ mpairment
✓Calcium levels increased
✓Renal failure
✓Anemia
✓Bone lesion
1 2

▪ In monoclonal gammopathies &
Myeloma the single cells produce
a homogeneous monoclonal
immunoglobulin (M protein)
characterised by the presence of
a sharp, well defined band with a
single heavy chain and a similar
band with a kappa or lambda
light chain
▪ The M protein is identified as a
narrow peak or “spike” in the
gamma , beta or a 2 regions

Lab diagnosis
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
1 6

✓
✓
3 /1 /2 0 X X S AM P L E F OOT E R T E X T 1 7

▪
•
•
•
3 /1 /2 0 X X S AM P L E F OOT E R T E X T 2 2

What's hot

Acute Myeloid Leukemia

Ali Swailmeen

Acute leukemias aml-csbrp

Prasad CSBR

Multiple myeloma

Dr. Prem Mohan Jha

Chronic Myeloid Leukemia

jihady

Chronic leukemias

Vijay Shankar

Chronic Lymphocytic Leukemia

DrAyush Garg

Pathology of CNS Tumors

Shashidhar Venkatesh Murthy

Haematological malignancies - part one

ess_online

ACUTE LEUKEMIA

Suraj Dhara

Lymphoma - cancer

Areej Abu Hanieh

Myeloproliferative disorders

mukhtar ahmed

Myeloprolmiferative Neoplasms (2021)

Ahmed Makboul

Chronic Lymphocytic Leukemia (CLL)

Subhash Thakur

Acute leukaemia

NITISH SHAH

Anemia of Chronic Disease

Subhash Thakur

Acute myeloid leukemia

ajayyadav753

Leukemia and its types presentation 1

SanaYaseen8

Multiple Myeloma and Plasma cell Dyscrasias

salar nikmanesh

Melanocytic tumors-nevus and malignant melanoma

Sindhuja Yella

DIC

Mohammad Mosleh

What's hot (20)

Acute Myeloid Leukemia

Acute leukemias aml-csbrp

Multiple myeloma

Chronic Myeloid Leukemia

Chronic leukemias

Chronic Lymphocytic Leukemia

Pathology of CNS Tumors

Haematological malignancies - part one

ACUTE LEUKEMIA

Lymphoma - cancer

Myeloproliferative disorders

Myeloprolmiferative Neoplasms (2021)

Chronic Lymphocytic Leukemia (CLL)

Acute leukaemia

Anemia of Chronic Disease

Acute myeloid leukemia

Leukemia and its types presentation 1

Multiple Myeloma and Plasma cell Dyscrasias

Melanocytic tumors-nevus and malignant melanoma

DIC

More from BRINCELET M BIJU

INTRODUCTION Abdominal pain refers to discomfort that is felt between the chest and the groin.,which can be acute or chronic on presentation. Categorised into 4 quadrant and 9 regions for analysis of underlying pathologies and their localization ,patient may also present with ;-Bloating, N/V, diarrhea or constipation, fever, visible swelling or tenderness. It Can occur due to Gastrointestinal pathologies like peptic ulcer ,appendicitis, obstructions, cholecystitis etc or gynecologycal, vascular, peritoneal pathologies EPIDEMIOLOGY 5 – 10% of all ED visits. Among them, 14 – 40 % patients need surgical intervention Most common diagnosis is Non specific Males were more affected than females with male to female ratio of 1.14 : 1 Highest number of patients were in 15 – 24 years of life Most common cause found to be acute appendicitis for acute abdomen in a range of 57.5 % of total admission. CAUSES Gastrointestinal Gastrointestinal Gastroduodenal Peptic ulcer Gastritis Malignancy Gastric volvulus Intestinal Appendicitis Obstruction Inverticulitis Gastroenteritis Mesentric adenitis Strangulated hernia Inflammatory bowel disease Intussusception Volvulus TB Case History of Present Illness A 26-year-old woman comes to the office because of a 3-day history of lower abdominal pain. She is 18 weeks pregnant by dates. The patient describes the pain as sharp, steady, and radiating across her lower abdomen bilaterally. Last night she developed new nausea and vomiting. She has not been able to keep down any food or drink this morning. She had a normal bowel movement yesterday. She says she felt cold and shivering this morning, followed by feeling warm; however, she did not check her temperature. She denies vaginal bleeding. General: Patient feels generally weak and ill but was in her usual state of health until 3 days ago. She has gained approximately 5 lbs (2.3 kg) in the pregnancy so far. Skin: She denies rash. HEENT: Her mouth feels dry. No headache, nasal congestion, or sore throat. Pulmonary: She denies cough or shortness of breath. Cardiovascular: She denies chest pain or palpitations. Gastrointestinal: She has had a decreased appetite for 1 day and has been unable to keep any food or drink down this morning due to nausea and vomiting. She has not had diarrhea or constipation. Genitourinary: She reports a frequent urge to urinate and a sensation of incomplete bladder emptying for the past 3 days. No dysuria or hematuria. She is G1P0A0 and has been seeing an obstetrician for all routine visits and testing. No vaginal bleeding. Musculoskeletal: She reports mild diffuse low back pain. No generalized muscle aches. Neurologic: Noncontributory Past Medical History Medical history: Mild intermittent asthma diagnosed in childhood requiring only occasional rescue inhaler use, no hospitalizations for asthma. She is otherwise healthy. Surgical history: Wisdom teeth removed at age 18. Medications: Albuterol inhaler as needed, about once a month.

ABDOMINAL PAIN CASE HISTORY FOR DIAGNOSTIC SYNDROME SLIDESHARE

BRINCELET M BIJU

Coronary plaques can be broadly categorized into different types based on their composition and characteristics. The main types include: 1. **Fibrous Plaque:** - *Description:* Composed mainly of smooth muscle cells and collagen. - *Characteristics:* Generally stable and less prone to rupture. - *Clinical Significance:* Often associated with early stages of atherosclerosis. 2. **Lipid-rich (Atheromatous) Plaque:** - *Description:* Contains a lipid core, primarily cholesterol and inflammatory cells. - *Characteristics:* More prone to inflammation and considered less stable. - *Clinical Significance:* Increased risk of rupture and thrombus formation. 3. **Calcified Plaque:** - *Description:* Involves the deposition of calcium within the plaque. - *Characteristics:* Often associated with stable and less vulnerable plaques. - *Clinical Significance:* May contribute to arterial stiffness and obstructive disease. 4. **Mixed Plaque:** - *Description:* Combination of fibrous tissue, lipid core, and calcium. - *Characteristics:* Exhibits features of both stable and unstable plaques. - *Clinical Significance:* Variable stability, with potential for progression to more vulnerable states. 5. **Vulnerable or Unstable Plaque:** - *Description:* Prone to rupture, leading to thrombus formation and acute coronary events. - *Characteristics:* Thin fibrous cap, large lipid core, and inflammation. - *Clinical Significance:* High risk of causing myocardial infarction or unstable angina. 6. **Erosion Plaque:** - *Description:* Endothelial erosion without a rupture of the fibrous cap. - *Characteristics:* May lead to thrombosis without the classic rupture seen in unstable plaques. - *Clinical Significance:* Associated with acute coronary syndromes. Understanding the composition and characteristics of coronary plaques is crucial for risk stratification and determining appropriate treatment strategies. The distinction between stable and unstable plaques is particularly important in predicting the likelihood of adverse cardiovascular events.

TYPES OF CORONARY PLAQUES SLIDESHARE PRESENTATION

BRINCELET M BIJU

ANEMIA IN CHRONIC KIDNEY DISEASE,NEPHROLOGY

BRINCELET M BIJU

Anemia should not be accepted as an inevitable consequence of aging. A cause is found in approximately 80 percent of elderly patients. The most common causes of anemia in the elderly are chronic disease and iron deficiency. Vitamin B12 deficiency, folate deficiency, gastrointestinal bleeding and myelodysplastic syndrome are among other causes of anemia in the elderly. Serum ferritin is the most useful test to differentiate iron deficiency anemia from anemia of chronic disease. Not all cases of vitamin B12 deficiency can be identified by low serum levels. The serum methylmalonic acid level may be useful for diagnosis of vitamin B12 deficiency. Vitamin B12 deficiency is effectively treated with oral vitamin B12 supplementation. Folate deficiency is treated with 1 mg of folic acid daily. Clinical Presentation Even though the high prevalence of anemia in the elderly makes it a condition that clinicians might expect to find frequently, several features of anemia make it easy to overlook. The onset of symptoms and signs is usually insidious, and many elderly patients adjust their activities as their bodies make physiologic adaptations for the condition. Typical symptoms of anemia, such as fatigue, weakness and dyspnea, are not specific and in elderly patients tend to be attributed to advancing age. Pallor can be a helpful diagnostic clue, but pallor can be hard to detect in the elderly. Conjunctival pallor is a reliable sign, and its presence should prompt the clinician to order blood tests for anemia.6 Aside from conjunctival pallor, few other signs are attributable specifically to anemia. Frequently, patients have signs of a disorder that is made worse by the anemia, such as worsening congestive heart failure, cognitive impairment, dizziness and apathy. Unless clinicians consider anemia as a possibility in the elderly, it can be easily overlooked. Anemia in older persons poses a clinical challenge in daily practice as the population ages. In many cases, 1 or more etiologies are detected, and a thorough investigation immediately leads to the correct diagnosis. In these patients, management is largely dependent on the underlying etiology, and in many cases, anemia can be corrected by interventional therapy independent of age. Good examples are iron, vitamin B12, or folate deficiency. EPO deficiency with or without overt exocrine kidney insufficiency can be detected quite often in older persons. A large number of patients turn out to have an underlying (chronic) inflammatory disease. The concept of a subclinical proinflammatory state called inflammaging may be a good explanation for the development of anemia in senior persons. In other cases, a clonal myeloid or other neoplasm is detected. In a relevant proportion of patients, no underlying cause of anemia is found after a first examination, resulting in the provisional diagnosis of UA. However, in many cases no underlying etiology is found even after a thorough diagnostic workup that includes an ex…

ANEMIA IN ELDERLY slideshare ppt

BRINCELET M BIJU

Peptic ulcer disease (PUD) is the presence of one or more ulcerative lesions in the stomach or duodenum. Etiologies include infection with Helicobacter pylori (most common), prolonged NSAID use (NSAID-induced ulcer), conditions associated with an overproduction of stomach acid (hypersecretory states), and stress. Epigastric pain is a typical symptom of PUD; however, many patients remain asymptomatic. Usually, patients younger than 60 years of age can be managed with a test-and-treat strategy for H. pylori infection or with empirical acid suppression therapy. Older patients and those with high-risk clinical features benefit from an esophagogastroduodenoscopy (EGD) and biopsies to confirm the diagnosis or rule out differential diagnoses (especially gastric cancer). First-line treatment for most peptic ulcers involves symptom control (e.g., acid-lowering medication), H. pylori eradication therapy, and withdrawal of causative agents. Antisecretory drugs (e.g., proton-pump inhibitors), which reduce stomach acid production, are continued for 4–8 weeks after eradication therapy and may be considered for maintenance therapy if symptoms recur. Surgical intervention may be considered in rare cases. Some patients benefit from endoscopic surveillance, especially if symptoms persist or there is clinical suspicion for malignancy. Peptic ulcer: a defect in the gastric or duodenal mucosa with a diameter of at least 0.5 cm and a depth that penetrates through the muscularis mucosae [1] Gastric ulcer: a peptic ulcer of the gastric mucosa, typically located along the lesser curvature in the transitional portion between the corpus and antrum Duodenal ulcer: a peptic ulcer of the duodenal mucosa, usually located on the anterior or posterior wall of the duodenal bulb

PEPTIC ULCER DISEASE,SLIDESHARE PRESENTATION

BRINCELET M BIJU

uterine factor of infertility,

BRINCELET M BIJU

Ovarian apoplexy means a sudden rupture in the ovary, commonly at the site of a cyst, accompanied by sudden hemorrhage in the ovarian tissue accompanying by the damage of its integrity and bleeding into abdominal cavity. Ovary rupture may occur in the different phase of menstrual cycle, but the most frequently it occurs in the second phase, thus it is often called “rupture of yellow body”. Other names are ovary hematoma, ovary bleeding, ovary rupture. Among women operated for abdominal bleeding ovary rupture is revealed in 0.5 – 3% cases only. Among women operated for abdominal bleeding ovary rupture is revealed in 0.5 – 3% cases only. Among women operated for abdominal bleeding ovary rupture is revealed in 0.5 – 3% cases only. Among women operated for abdominal bleeding ovary rupture is revealed in 0.5 – 3% cases only. Probability of ovary bleeding is in the physiologic changes observed during menstrual cycle. The processes such as ovulation, intensive vascularization of yellow body, premenstrual ovary hyperemia may lead to forming hematoma, damaging tissue integrity and bleeding to abdominal cavity, its volume may be from 30 – 50ml to 2.0 – 3.0l. ANEMIC FORM:-Anemic form of ovary rupture is like the clinic of the damaged ectopic pregnancy. Though lack of menstrual delay and other signs subjective and objective of pregnancy indicate the ovary apoplexy, differential diagnosis is needed. USD of pelvic organs is of great importance. It is reasonable to assess echography of the ovary damaged (dimensions, structure) taking into consideration the condition of the other ovary. For apoplexy the damaged ovary is usually of normal size or slightly increased. Liquid inclusion of hypoechogenous or heterogenic structure (yellow body) which diameter doesn’t exceed the size of preovulatory follicle and doesn’t lead to the ovary sizable change is appropriate to the ovary apoplexy. At the same time normal follicular system as liquid inclusions of 4–8 mm in diameter is observed. Depending on the amount of blood loss free liquid is discovered behind of uterus PAINFUL FORM:-is observed in cases of hemorrhage into tissue of follicle or yellow body without bleeding or with slight bleeding into abdominal cavity. The disease begins with acute pain at the lower abdomen which is accompanied by nausea and vomiting secondary to the normal body temperature. There are no signs of internal bleeding: color of skin and mucosa is normal, pulse and blood pressure are normal too. The tongue is wet and pure.

OVARIAN APOLEXY, RUPTURE OF YELLOW BODY ,OVARY BLEEDING.

BRINCELET M BIJU

Endometritis Endometritis is an inflammation or irritation of the lining of the uterus (the endometrium). It is not the same as endometriosis. Causes Endometritis is caused by an infection in the uterus. It can be due to chlamydia, gonorrhea, tuberculosis, or a mix of normal vaginal bacteria. It is more likely to occur after miscarriage or childbirth. It is also more common after a long labor or C-section. The risk for endometritis is higher after having a pelvic procedure that is done through the cervix. Such procedures include: D and C (dilation and curettage) Endometrial biopsy Hysteroscopy Placement of an intrauterine device (IUD) Childbirth (more common after C-section than vaginal birth) Endometritis can occur at the same time as other pelvic infections.

ENDOMETRITIS obstetric and gynecology .

BRINCELET M BIJU

Examination of head,neck,mammary glands,chest and abdomen

BRINCELET M BIJU

CHOLEMIC SYNFROME, ACHOLIC SYNDROME,PSYCHOLIA

BRINCELET M BIJU

INTRACRANIAL HYPERTENSION (ETIOLOGY,PPATHOPHYSIOLOGY,SYMTOMS,COMPLICATIONS,TR...

BRINCELET M BIJU

physical therapy treatment for ARTHRITIS

BRINCELET M BIJU

Paranoid schizophrenia

Arrhythmia

Breastfeeding

Pregnancy

Pulmonary embolism

More from BRINCELET M BIJU (17)

ABDOMINAL PAIN CASE HISTORY FOR DIAGNOSTIC SYNDROME SLIDESHARE

TYPES OF CORONARY PLAQUES SLIDESHARE PRESENTATION

ANEMIA IN CHRONIC KIDNEY DISEASE,NEPHROLOGY

ANEMIA IN ELDERLY slideshare ppt

PEPTIC ULCER DISEASE,SLIDESHARE PRESENTATION

uterine factor of infertility,

OVARIAN APOLEXY, RUPTURE OF YELLOW BODY ,OVARY BLEEDING.

ENDOMETRITIS obstetric and gynecology .

Examination of head,neck,mammary glands,chest and abdomen

CHOLEMIC SYNFROME, ACHOLIC SYNDROME,PSYCHOLIA

INTRACRANIAL HYPERTENSION (ETIOLOGY,PPATHOPHYSIOLOGY,SYMTOMS,COMPLICATIONS,TR...

physical therapy treatment for ARTHRITIS

Paranoid schizophrenia

Arrhythmia

Breastfeeding

Pregnancy

Pulmonary embolism

Recently uploaded

Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available WhatsApp Chat : +91-8854095900 Get More Information About Mussoorie Escorts Service Mussoorie Escorts offer their services to their clients at any time of day or night - including sex, travel and tours. Contact them via telephone or the internet. Hire an escort as your movie partner, date or party companion - they're sure to exceed all your expectations. Girls available 24/7 make for great companions who offer sensual body massages and drinks/food service during your time together. Find one who fits with your personality or budget - these girls have you covered.

Call Girls Mussoorie Just Call 8854095900 Top Class Call Girl Service Available

Janvi Singh

Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now CALL WATTSAPP 6378878445 THE MOST BEAUTIFUL INDEPENDENT ESCORT CALL GIRL SERVICE, Chennai WE ARE PROVIDING GENUINE CALL GIRL SERVICE I AM A a NATURAL BRUNETTES, SLIM BODY, NATURAL LONG HAIR AND ALL TYPE OF HAIR IS A NATURAL BRUNETTE IN THE MOST BEAUTIFUL INDEPENDENT ESCORT GIRL I AM A NATURAL BRUNETTE WITH ROOM AND HOTEL AND A NATURAL BRUNETTE WITH A BODY MADE FOR SIN AND ALL TYPE OF ME ALL THE TIME I SEND YOU A HAIR, VERY SOCIABLE AND FUNNY, READY TO ENTERTAIN TO ENTERTAIN U AND MAKE FORGET ABOUT TO GET ENTERTAIN U AND MAKE FORGET#v08 ABOUT ALL THE PROBLEMS. LET'S HAVE A WONDERFUL TIME TOGETHER AND FORGET ABOUT EVERYTHING ALL TYPE SERVICE ENJOYMENT SAFE AND SECURE IN CALL OUT CALL HOME AND HOTEL ANYTIME AVAILABLE AND ALL TYPE SERVICE ENJOYMENT

Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now

tanudubay92

In this lecture on circulatory shock, Dr. Faiza, an Assistant Professor of Physiology, delves into the profound implications of inadequate blood flow throughout the body, leading to tissue damage. The session begins by defining circulatory shock and elucidating its physiological causes, including decreased cardiac output, diminished blood volume, decreased vascular tone, obstruction to blood flow, excess metabolic rate, and abnormal perfusion patterns. Dr. Faiza categorizes shock into various types, such as cardiogenic shock, hypovolemic shock, neurogenic shock, obstructive shock, anaphylactic shock, and septic shock, and explores the pathophysiological basis of each. Furthermore, the lecture examines the stages of shock, from the non-progressive phase where compensatory mechanisms aim for full recovery to the progressive phase where shock worsens steadily without intervention, potentially leading to irreversible damage. Dr. Faiza discusses therapeutic interventions for shock, including replacement therapy, blood and plasma transfusion, sympathomimetic drugs, and other adjunctive treatments like head-down positioning, oxygen therapy, and glucocorticoids.

Circulatory Shock, types and stages, compensatory mechanisms

MedicoseAcademics

💞 Safe And Secure Call Girls Coimbatore🧿 6378878445 🧿 High Class Coimbatore Call Girl Service Available 6378878445 THE GENUINE ESCORT AGENCY VIP LUXURY CALL GIRLS HIGH CLASS MODELS CALL GIRLS GENUINE ESCORT BOOK BOOK APPOINTMENT - 6378878445 THE GENUINE ESCORT AGENCY BEST VIP CALL GIRLS & ESCORTS SERVICE 6378878445 VIP CALL GIRLS ALL TYPE WOMEN AVAILABLE INCALL & OUTCALL BOTH AVAILABLE BOOK NOW 6378878445 VIP GENUINE INDEPENDENT ESCORT AGENCY VIP PRIVATE AUNTIES BEAUTIFUL LOOKING HOT AND SEXT GIRLS AND PARTY TYPE GIRLS YOU WANT SERVICE THEN CALL THIS NUMBER 6378878445 ROOM ALSO PROVIDE HOME & HOTELS SERVICE FULL SAFE AND SECURE WORK WITHOUT CONDOMS, ORAL, SUCKING, LIP TO LIP, ANAL, BACK SHOTS, SEX 69, WITHOUT BLOWJOB AND MUCH MORE #v08-Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion FOR BOOKING 6378878445

💞 Safe And Secure Call Girls Coimbatore🧿 6378878445 🧿 High Class Coimbatore C...

dilbirsingh0889

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Available Call Mrs Leela Ji +91-8630512678 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Lucknow Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In Lucknow Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 8630512678 !! Thank you for Visiting.

Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...

soniyagrag336

Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos and Number ★ CALL US High Class Luxury and Premium Escorts ServiCe We Provide Well Educated, Royal Class Female, High-Class Escorts Offering a Top High-Class Escorts Service In the & Several Nearby All Places Of . ★ Get The High Profile, Bollywood Queens , Well Educated , Good Looking , Full Cooperative Model Services. You Can See Me at My Comfortable Hotels or I Can Visit You In hotel Our Service Available IN All SERVICE, 3/4/5 STAR HOTEL , In Call /Out Call Services.24 hrs ,$P13 ★ To Enjoy With Hot and Sexy Girls . ★ We Are Providing :- • Models • Vip Models • Russian Models • Foreigner Models • TV Actress and Celebrities • Receptionist • Air Hostess • Call Center Working Girls/Women • Hi-Tech Co. Girls/Women • Housewife • Collage Going Girls. • Travelling Escorts. • Ramp-Models • Foreigner And Many More.. Incall & Outcall Available… • INDEPENDENT GIRLS / HOUSE WIFES ★ I Guarantee You To Have An Unforgettable Experience With Me.A Curvy Body, long Hair and Silky Smooth Skin. She Is an Independent Escorts Model Will Give You More Pleasure & Full Satisfaction. Call Now Seema:- 9332606886

Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...

call girls hydrabad

Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 Neha Thakur Call Mrs Naina Ji +91-6378878445 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in bangalore Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In bangalore Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 6378878445 !! Thank you for Visiting.

Call Girls Bangalore - 450+ Call Girl Cash Payment 💯Call Us 🔝 6378878445 🔝 💃 ...

gragneelam30

Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Rajasthan Booking Details Are here 05-May-2024( Mj) Click On WhatsApp Chat +91-9521753030 Jaipur Escorts Make You Feel Like Royalty Jaipur Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days! Siya Khan | FOR BOOKING CALL Our All Services :- 1 )★ (Oral to consummation) bjnonCovered 2 )★ Special Massage 3 )★ O-Level (Oral sex) 4 )★ Blow Job; 5 )★ COB (Come On Body) 6 )★. Extraball (Have sex ordinarily) 7 )★ A-Level (5 star escort) 8 )★ Strip-bother 9 )★ BBBJ (Bareback Blowjob) 10 )★ Spending time in my rooms 11 )★ BJ (Blowjob Without a Condom) 12 )★ COF (Come On Face) 13 )★ Completion

Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...

Janvi Singh

Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Available 24*7 Book Chat On WhatsApp: +91-📞 7427069034 📞 Book A Meeting Now With Our Call Girls Chennai Call Girls Chennai are available for any special event from birthday parties to romantic dinners, and provide an unforgettable experience that will have you wanting more. Their seductive presence will leave you wanting more; these air hostesses escorts are guaranteed to get your kink on and provide hours of sexual fun - they will become your personal fantasy girl; making every event that much better. They truly stand out as some of the finest professionals available; their services cannot be rivalled. Call Now :- 📞 7427069034 📞 Independent Call Girls Chennai dance will leave #N06 you breathless with breathtaking performances that'll take away all your worries while making you feel like royalty - they're sure to leave an impactful impression that leaves you feeling empowered. From providing you with a romantic date night full of excitement and sex to just hanging out and talking, they're there for whatever it is you require. Listening attentively as you share stories or telling theirs, these ladies provide great conversation as well as delicious dinner or beverages to remember the experience by. Just one encounter with Call girls in Chennai will have you calling back for more. They're sure to transform any party into an unforgettable night of fun and adventure - you won't be the only one smitten. Don't miss this chance; arrange your next date with an exotic Foreign Escort today. Chennai offers many beautiful call girls Not only are they enjoyable companions, but travelling is something they truly love to do and will happily go on weekend tours with you. Additionally, businessmen can hire one of these young ladies as an escort during business trips. ★OUR BEST SERVICES: - FOR BOOKING ★ A-Level (5-star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob) ★ Spending time in my rooms ★ BJ (Blowjob Without a Condom) ★ COF (Come on Face) ★ Completion ★ (Oral to completion) noncovered ★ Special Massage ★ O-Level (Oral) ★ Blow Job; ★ Oral fun uncovered) ★ COB (Come on Body) ★. Extra ball (Have ride many times) ☛ ☛ ☛ ✔✔ secure✔✔ 100% safe

Call Girl in Chennai | Whatsapp No 📞 7427069034 📞 VIP Escorts Service Availab...

amritaverma53

Russian Call Girls In Pune 👉 Just CALL ME: 9352988975 ✅❤️💯low cost unlimited hard sex call girls VIP Call Girl Pune As Enjoy Never Ending Pune VIP Call Girls is highly qualified professionals. #S07 They will offer only top quality services and never try to scam or drain you of money; in fact, they strive to give complete satisfaction so that each cent spent was worth its worth. Furthermore, these professionals pride themselves in keeping customer details confidential; any information gleaned will never be shared with any third party. Two shots with one girl: ₹4500/in-call, ₹7500/out-call Body to body massage with : ₹5500/in-call Full night for one person: ₹7000/in-call, ₹12000/out-call •𝐂𝐨𝐥𝐥𝐞𝐠𝐞 𝐆𝐢𝐫𝐥𝐬 •𝐇𝐨𝐮𝐬𝐞𝐰𝐢𝐯𝐞𝐬 •𝐇𝐢𝐠𝐡 𝐏𝐫𝐨𝐟𝐢𝐥𝐞 𝐆𝐢𝐫𝐥𝐬 •𝐑𝐚𝐦𝐩 𝐌𝐨𝐝𝐞𝐥𝐬 •𝐅𝐨𝐫𝐞𝐢𝐠𝐧𝐞𝐫 𝐆𝐢𝐫𝐥𝐬 𝐎𝐮𝐫 𝐞𝐬𝐜𝐨𝐫𝐭 𝐬𝐞𝐫𝐯𝐢𝐜𝐞𝐬 •𝐇𝐉 (𝐇𝐚𝐧𝐝 𝐉𝐨𝐛) •𝐁𝐉 (𝐁𝐥𝐨𝐰𝐣𝐨𝐛) # Completion # (Oral To Completion) # Special Massage # O-Level (Oral ) # Oral With A Noncondom) # COB (Come On Body) # Extraball (Have Many Times) # All Meetings 100%Safe Call Vindiya:-- 9352988975

Russian Call Girls In Pune 👉 Just CALL ME: 9352988975 ✅❤️💯low cost unlimited ...

chanderprakash5506

Dr. Faiza delivers an insightful lecture on the distinguishing characteristics of skeletal, smooth, and cardiac muscles, offering a comprehensive understanding of their histology, physiological anatomy, electrophysiological properties, and contractile mechanisms. Through meticulous tabulation and comparison, she aims to equip learners with a detailed comprehension of the unique features and functionalities of each muscle type. Beginning with a detailed exploration of histological differences, Dr. Faiza outlines key distinctions such as multinucleation in skeletal muscle, mononucleation in smooth and cardiac muscles, and the presence of striations in skeletal and cardiac muscles. She meticulously elucidates the structural arrangement of each muscle type, highlighting their cellular morphology and organization within tissues. Transitioning to physiological anatomy, Dr. Faiza navigates through various aspects including innervation, level of control, initiation of contraction, and modification by hormones. By delineating the role of the somatic nervous system in skeletal muscle control, and contrasting it with the autonomic nervous system's influence on smooth and cardiac muscles, she offers a nuanced understanding of neural regulation in muscle physiology. Furthermore, Dr. Faiza delves into electrophysiological properties, elucidating the mechanisms underlying action potential generation, duration, and ionic basis in each muscle type. Through insightful analysis, she reveals how differences in action potential characteristics contribute to variations in muscle contraction speed, duration, and resistance to fatigue. Finally, Dr. Faiza meticulously examines the contractile mechanisms of skeletal, smooth, and cardiac muscles, shedding light on the sliding filament theory, mechanisms of calcium action, and speed of contraction. By comprehensively comparing these mechanisms, she provides learners with a deep understanding of the intricate processes governing muscle contraction and function. Through engaging presentation and meticulous analysis, Dr. Faiza's lecture serves as a valuable resource for students seeking a thorough understanding of the fundamental differences between skeletal, smooth, and cardiac muscles.

Difference Between Skeletal Smooth and Cardiac Muscles

MedicoseAcademics

Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP Escorts Service Available 24*7 Book Call Mrs Janvi Ji +91-6378878445 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Bangalore Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In Bangalore Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 6378878445 !! Thank you for Visiting.

Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...

dishamehta3332

💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalore Call Girls Service 💰 Call Girls In Bangalore Call Mrs Naina Ji +91-6378878445 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in bangalore Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In bangalore Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 6378878445 !! Thank you for Visiting.

💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...

gragneelam30

Lucknow Call Girls Just Call 👉👉8630512678 Top Class Call Girl Service Available Call Mrs Leela Ji +91-8630512678 We offer all types of girls of your choice with space. Our escorts are fully cooperative and understand your needs. All types of call girls like Housewives, College girls,#J11 Russian girls, Muslim girls, Afghani girls, Bengali girls, Working girls, south Indian girls, Punjabi girls, etc. In-Call: — You Can Reach At Our Place in Lucknow Our place Which Is Very Clean Hygienic 100% safe Accommodation. Out-Call: — Service for Out Call You have To Come Pick The Girl From My Place We Also Provide Door-Step Services Hygienic: — Full Ac Neat And Clean Rooms Available In Hotel 24 * 7 Hrs In Lucknow Our Services and Rates: – One Shot — 2500/in call (time ½ hour), 5000/out call Two shot with one girl — 5000/in call (time 1 hour), 6000/out call Body to body massage with sex- 3000/in call (time 1 hour) full night for one person– 8000/in call, 10000/out call (shot limit 4 shot) We are available 24*7 all days of the year Call us — 8630512678 !! Thank you for Visiting.

Lucknow Call Girls Just Call 👉👉8630512678 Top Class Call Girl Service Available

soniyagrag336

Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts service book now CALL WATTSAPP THE MOST BEAUTIFUL INDEPENDENT ESCORT CALL GIRL SERVICE, WE ARE PROVIDING GENUINE CALL GIRL SERVICE I AM A a NATURAL BRUNETTES, SLIM BODY, NATURAL LONG HAIR AND ALL TYPE OF HAIR IS A NATURAL BRUNETTE IN THE MOST BEAUTIFUL INDEPENDENT ESCORT GIRL I AM A NATURAL BRUNETTE WITH ROOM AND HOTEL AND A NATURAL BRUNETTE WITH A BODY MADE FOR SIN AND ALL TYPE OF ME ALL THE TIME I SEND YOU A HAIR, VERY SOCIABLE AND FUNNY, READY TO ENTERTAIN TO ENTERTAIN U AND MAKE FORGET ABOUT TO GET ENTERTAIN U AND MAKE FORGET ABOUT ALL THE PROBLEMS. LET'S HAVE A WONDERFUL TIME TOGETHER AND FORGET ABOUT EVERYTHING ALL TYPE SERVICE ENJOYMENT SAFE AND SECURE IN CALL OUT CALL HOME AND HOTEL ANYTIME AVAILABLE AND ALL TYPE SERVICE ENJOYMENT

Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...

Dipal Arora

❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Chandigarh Call Girls Service ☎️ Call Girls In Chandigarh BEST CALL GIRL ESCORTS SERVICE IN CHANDIGARH CALL WATTSAPP 98151-579OO THE MOST BEAUTIFUL INDEPENDENT ESCORT CALL GIRL SERVICE In Chandigarh WE ARE PROVIDING GENUINE CALL GIRL SERVICE I AM A a NATURAL BRUNETTES, SLIM BODY, NATURAL LONG HAIR AND ALL TYPE OF HAIR IS A NATURAL BRUNETTE IN THE MOST BEAUTIFUL MODELS INDEPENDENT ESCORT GIRL I AM A NATURAL BRUNETTE WITH ROOM AND HOTEL AND A NATURAL BRUNETTE WITH A BODY MADE FOR SIN AND ALL TYPE OF ME ALL THE TIME I SEND YOU A HAIR, VERY SOCIABLE AND FUNNY, READY TO ENTERTAIN TO ENTERTAIN U AND MAKE FORGET ABOUT TO AGET ENTERTAINMENT YOU AND MAKE FORGET ABOUT ALL THE PROBLEMS. LET'S HAVE A WONDERFUL TIME TOGETHER AND FORGET ABOUT EVERYTHING ALL TYPE SERVICE ENJOYMENT SAFE AND SECURE IN CALL OUT CALL HOME AND HOTEL ANYTIME AVAILABLE AND ALL TYPE SERVICE ENJOYMENTPANCHKULA INDEPENDENT BEST CALL GIRL ESCORTS SERVICE IN PANCHKULA INDEPENDENT CALL GIRL Chandigarh Call Girls In Chandigarh BEST Call Girls in CHANDIGARH Escort Service provide Cute Nice sweet and Sexy Models in beautiful CHANDIGARH city cash in hand to hand call girl in CHANDIGARH and CHANDIGARH escorts. HOT & SEXY MODELS // COLLEGE GIRLS IN CHANDIGARH AVAILABLE FOR COMPLETE ENJOYMENT WITH HIGH PROFILE INDIAN MODEL AVAILABLE HOTEL & HOME ★ SAFE AND SECURE HIGH CLASS SERVICE AFFORDABLE RATE ★ 100% SATISFACTION,UNLIMITED ENJOYMENT. ★ All Meetings are confidential and no information is provided to any one at any cost. ★ EXCLUSIVE Profiles Are Safe and Consensual with Most Limits Respected ★ Service Available In: - HOME & 24x7 :: 3 * 5 *7 *Star Hotel Service .In Call & Out call Services : ★ A-Level (5 star escort) ★ Strip-tease ★ BBBJ (Bareback Blowjob)Receive advanced sexual techniques in different mode make their life more pleasurable. ★ Spending time in hotel rooms ★ BJ (Blowjob Without a Condom) ★ Completion (Oral to completion) ★ Covered (Covered blowjob Without a Condom)-❤️ Chandigarh Call Girls Service☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Chandigarh Call Girls Service ☎️ Call Girls In Chandigarh

❤️ Chandigarh Call Girls☎️98151-579OO☎️ Call Girl service in Chandigarh ☎️ Ch...

Rashmi Entertainment

7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta

Lifecare Centre

Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...

Cara Menggugurkan Kandungan 087776558899

(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of High Profile Jaipur Call Girls | Party Escorts Booking Details Are here 05-May-2024(king) Click On WhatsApp Chat +91-8445551418 Jaipur Escorts Make You Feel Like Royalty Jaipur Escorts catering to high profile clients are available 24-7 to meet their clients' needs and are also available for dinner dates, business conferences, foreign travel trips and clubbing activities. Their customers are contacted directly through in order to prevent risky situations from developing.is home to some of India's most beautiful women. These girls come highly educated with great backgrounds; furthermore they are extremely beautiful and will make you feel like royalty if hired for hours or days!

(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...

TanyaAhuja34

Call Girls in Lucknow Just Call 👉👉8875999948 Top Class Call Girl Service Available WhatsApp Chat : +91-8875999948 Get More Information About Lucknow Escorts Service Lucknow Escorts offer their services to their clients at any time of day or night - including sex, travel and tours. Contact them via telephone or the internet. Hire an escort as your movie partner, date or party companion - they're sure to exceed all your expectations. Girls available 24/7 make for great companions who offer sensual body massages and drinks/food service during your time together. Find one who fits with your personality or budget - these girls have you covered.

Call Girls in Lucknow Just Call 👉👉 8875999948 Top Class Call Girl Service Ava...

Janvi Singh

Recently uploaded (20)