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سؤال عن البروسيلا

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  • سؤال عن البروسيلا

    السلام عليكم

    تم تكليفي لعمل محاضرة عن البروسيلا ( تصنيفها - حياتها- بيئاتها - صور لها- امراضها ....................الخ ) كل شئ عنها .


    فاتمنى منكم اخواني مساعدتي في الحصول على مقالات او روابط لمواقع قد تفيدني


    ولكم كل الشكر

  • #2


    البروسيلاّ (باللاتينية: Brucella) هي جنس من البكتيريا سلبية الغرام، عبارة عن عصيات مكوّرة لا تشكل أبواغًا وغير متحركة. تسبب المرض عند الحيوانات الداجنة والبرية، ومنها يمكن أن ينتقل إلى الإنسان مسبباً داء البروسيلات.

    الخواص المزرعية :

    هوائية ولاهوائية مخيرة أو دقية الهواء (يجب تأمين كمية لا تقل عن 10% من ثاني أكسيد الكربون عند زرعها).
    تنمو على منابت خاصة (كمنبت آغار مستخلص الكبد)، وتبدو المستعمرات عليه محدبة ملساء.
    وهي تخمر الغلوكوز فقط.

    داء البروسيلات أو الحمى المتموجة أو الحمى المالطية أو حمى البحر الأبيض المتوسط غير الوراثية أسماء لمرض واحد ينتج عن العدوى بأنواع مختلفة من بكتريا البروسيلا.
    التسمية
    من اسم العالم الاسكتلندى ديفيد بروس الذي اكتشف الميكروب المسبب في 1887
    ترجع تسمية الحمى المالطية إلى أن مكتشف الحليب كمصدر العدوى هو طبيب وعالم آثار مالطي السير تيمي زاميت في 1905.
    انتقال المرض
    ينتقل المرض عن طريق شرب اللبن( او اى من مشتقاته) الغير موبستر او الذى لم يتم غلية بطريق جيدة كافية لقتل ميكروب البروسيلا المتواجد في اللبن من الابقار المصابة باجهاض متكرر (contagious abortion) أو عن طريق الاحتكاك المباشر بالبكتريا عن طريق الحيوانات المصابة مثل الكلاب والخنازير والجمال والأبقار والماعز تحتوى مخلفات الولادة في الحيوانات المصابة على كمية كبيرة من البكتريا المعدية والتى لها القدرة على اختراق جلد الانسان إذا تعامل مع هذه المخلفات بدون قفازات في اليدين لذلك ينصح لمن يعمل في المسالخ بلبس القفازات
    فترة الحضانة
    تتراوح فترة الحضانة من اسبوع إلى ثلاثة اسابيع
    الاعراض
    حمى تختفى وتظهر على فترات ثابتة (متموجة)
    تعرق( تكون رائحتة مثل رائحة قش الارز المبلول) – فقدان للشهية – صداع – اكتئاب – تكسير في الجسم والم بالعضلات
    تترواح فترة الاعراض من اسابيع إلى شهور او حتى سنين، وإذا لم يعالج المرض واصبح مزمنا من الممكن ان تتمركز البكتريا في العظام والمفاصل

    التشخيص
    الكشف عن البكتريا بزرع دم المريض
    الكشف عن الأضداد (تفاعل رايت)
    العلاج
    ستربتومايسين لمدة 14 يوم مع دوكسى سيكلين عن طريق الفم مرتين يوميا لمدة 45 يوم
    جنتامايسين لمدة 7 ايام
    في حالة اصابة الاعصاب يمكن اخذ العلاج الثلاثي وهو (دوكسيسيكلين + ريفامبسين + كوتريموكسازول)
    الوقاية
    التاكيد على التعامل الصحى السليم مع منتجات الالبان
    الفحص المستمر لمن يتعامل مع منتجات الالبان
    اعدام الحيوانت المصابة
    تطعيم الحيوانات المنزلية وهى صغيرة السن مع الحرص في استعمال الصعم لاحتمالية اصابة الشخص الذى يقوم بعملية التطعيم مع العلم ان هذا النوع من البكتريا يعتبر من الانواع الشرسة [/

    تعليق


    • #3
      حمى البحر الأبيض المتوسط Brucellosis
      يطلق على حمى البحر الأبيض المتوسط عدة أسماء منها داء البروسيلات أو الحمى المالطية أو الحمى المتموجة Undulant أو حمى جبل طارق Gibraltar fever

      وهي عبارة عن عدوى (مرض خمجي) تتميز بطور حمي حاد قد يترافق مع أعراض موضعية قليلة ويتميز أيضا بطور مزمن يترافق مع انتكاس (عودة) الحمى وضعف عام وتعرق وأوجاع وآلام مبهمة.

      ما هي المسببات؟
      الجرثومة المسببة لداء البروسيلات عند الانسان هي البروسيلة المجهضة Brucella Abortus (البقرية). وقد لوحظت إصابات فردية عن طريق البروسيلة الخنزرية (الخنزير) والبروسيلة المالطية (الأغنام والماعز) والبروسيلا الكلبية (الكلاب). وقد لوحظت إصابات لدى الغزلان، والحصان، والوعل، والأرانب والدجاج والجرذان الصحراوية.

      يمكن أن تحصل الإصابة بالبروسيلة عند الإنسان عن طريق التماس المباشر مع إفرازات أو فضلات الحيوانات المصابة أو بتناول حليب البقر أو الغنم أو الماعز أو منتجات حليبها (مثل الزبدة والجبنة) والتي تحتوي على جرثومة البروسيلات الحية. ونادرا ما تنتقل العدوى من شخص مصاب لآخر.

      يعتبر داء البروسيلات مرضا مهنيا وأكثر شيوعا في المناطق الريفية، وغالبا ما يصيب آكلي اللحوم والبيطرين والمزارعين وعمال المداجن. والأطفال أقل قابلية للإصابة. وتوزع هذا المرض عالمي.

      ما هي الأعراض؟
      تختلف مدة الحضانة من 5 أيام إلى عدة شهور (أسبوعان في المتوسط)، وتختلف الأعراض خاصة في المراحل المبكرة للمرض، ويمكن أن تكون البداية مفاجئة وحادة مترافقة بقشعريرة وحمى وصداع شديد وآلام مختلفة وإحساس بتوعك وأحيانا يحدث الإسهال ، ويمكن أن تبدأ أعراض المرض بالتدريج على هيئة توعك خفيف وآلام عضلية وصداع وألم خلف الرقبة مترافق بارتفاع الحرارة مساء. ومع تقدم المرض ترتفع الحرارة إلى 40 أو 41 درجة مئوية في المساء وتنخفض تدريجيا إلى المقدار الطبيعي أو القريب من الحرارة الطبيعية في الصباح، وعندها يحدث تعرق غزير.

      عادة تستمر الحرارة المتقطعة من أسبوع إلى 5 أسابيع يتبعها فترة من 2 إلى 14 يوم تخف فيها الأعراض كثيرا أو تزول ثم يعود الطور الحمي، وأحيانا يحدث هذا التطور مرة واحدة فقط وأحيانا أخرى يبدو المرض بشكل مزمن أو بشكل نوبات حمية متكررة (تموجات) مع فترات تحسن وذلك يحدث خلال أشهر أو سنوات عديدة.

      يلاحظ بعد هذا الطور حدوث الإمساك بشكل واضح وأعراض أخرى مثل فقدان الشهية ونقص الوزن والألم البطني والألم المفصلي والصداع وآلام الظهر والضعف العام والهيوجية والأرق والاكتئاب وعدم الاستقرار العاطفي. ويتضخم الطحال وقد تتضخم العقد اللمفية بشكل خفيف أو متوسط الشدة، أما الكبد فيتضخم في 50% من الحالات.

      ومن مضاعفات المرض النادرة التهاب الشغاف الجرثومي تحت الحاد SBE أو التهاب الدماغ أو التهاب الأعصاب أو التهاب الخصية أو التهاب المرارة أو التقيح الكبدي أو إلى آفات في العظام. والاصابة المزمنة تطيل من الفترة اللازمة للشفاء ولكن الوفيات بسبب هذا المرض نادرة الحدوث.

      كيف يشخص المرض؟
      التشخيص المؤكد يعتمد على اكتشاف جرثومة البروسيلا في الدم أو السائل الدماغي الشوكي أو الأنسجة، ولكن اكتشاف الجرثومة غير ممكن دائما وللنتائج المصلية أهمية كبرى أيضا في التشخيص. والقصة المرضية مهمة أيضا في التشخيص مثل تعرض لحيوانات مصابة أو منتجاتها (مثل تناول حليب غير مبستر) وعلى المعلومات الوبائية والموجودات السريرية المميزة للمرض.

      كيف يمكن الوقاية؟
      لمنع الإصابة بداء البروسيلا يجب بسترة الحليب وتناول الجبنة المعروفة المصدر فقط. ويجب على الأشخاص المتعاملين مع الحيوانات ارتداء النظارات والقفازات المطاطية وحماية الجلد من التعرض للعدوى بالجرثومة. ويجب القضاء على الحيوان المصاب وتلقيح الأبقار الغير مصابة.

      كيف تتم المعالجة؟
      يتم استخدام المضادات الحيوية والمسكنات لتخفيف الآلام في الحالات الحادة مع الراحة في السرير خلال فترة الحمى.

      تعليق


      • #4
        Brucella

        Brucella is a genus of Gram-negative bacteria. They are small (0.5 to 0.7 by 0.6 to 1.5 µm), non-motile, encapsulated coccobacilli.
        Brucella is the cause of brucellosis, a true zoonotic disease (i.e. human-to-human transmission has not been identified). It is transmitted by ingesting infected food, direct contact with an infected animal, or inhalation of aerosols. Minimum infectious exposure is between 10 - 100 organisms. Brucellosis primarily occurs through occupational exposure (e.g. exposure to cattle, sheep, pigs), but also by consumption of unpasteurised milk products.
        There are a few different species of Brucella, each with slightly different host specificity. B. melitensis which infects goats and sheep, B. abortus which infects cows, B. suis infects pigs, B. ovis infects sheeps and B. neotomae. Recently a new species was discovered in marine mammals: B. pinnipediae.
        Diagnosis
        Brucella is isolated from a blood culture on Castenada medium. Prolonged incubation (up to 6 weeks) may be required as they're slow-growing, but on modern automated machines the cultures often show positive results within seven days. On Gram stain they appear as dense clumps of Gram-negative coccobacilli and are exceedingly difficult to see.
        It's crucial to be able to differentiate Brucella from Salmonella which could also be isolated from blood cultures and are Gram negative. Testing for urease would successfully accomplish the task; as it is positive for the former and negative for the latter.
        Brucella could also be seen in Bone marrow.
        Laboratory acquired brucellosis is common. This most often happens when the disease is not thought of until cultures become positive, by which time the specimens have already been handled by a number of laboratory staff. The idea of preventative treatment is to stop people who have been exposed to Brucella from becoming unwell with the disease.
        There are no clinical trials to be relied on as a guide for optimal treatment, but a three week course of rifampicin and doxycycline twice daily is the combination most often used, and appears to be efficacious; the advantage of this regimen is that it is oral medication and there are no injections, however, a high rate of side effects (nausea, vomiting, loss of appetite) has also been reported.
        Human Brucellosis
        Sir David Bruce isolated B. melitensis from British soldiers who died from Malta fever in Malta. The disease is characterized by acute undulating fever, headache, night sweats, fatigue and anorexia. Human Brucellosis is not considered a contagious disease and people become infected by contact with fluids from infected animals (sheep, cows or pigs) or derived food products like unpasteurized milk and cheese. Brucellosis is also considered an occupational disease because has higher incidence in people working with animals (slaughterhouse cases). The real worldwide incidence of Brucellosis is unknown because there is a low level of surveillance and report in brucella-endemic areas.

        Blue light study
        In a study published in Science magazine in August 2007, it was revealed that Brucella reacts strongly to the presence of the blue spectrum in natural light, reproducing at a great rate and becoming infectious. Conversely, depriving Brucella of the blue wavelengths dropped its reproductive rate by 90%, a result one of the co-authors called "spectacular."

        تعليق


        • #5


          Brucellosis
          Brucellosis, also called undulant fever, or Malta fever, is a highly contagious zoonosis caused by ingestion of unsterilized milk or meat from infected animals, or close contact with their secretions. Brucella spp. are small, gram-negative, non-motile, non-spore-forming rods, which function as facultative intracellular parasites that cause chronic disease, which usually persists for life. Brucellosis has been recognized in both animals and humans since the 19th century.
          History and nomenclature
          The disease now called brucellosis, under the name "Mediterranean fever", first came to the attention of British medical officers in Malta during the Crimean War in the 1850s. The causal relationship between organism and disease was first established by Dr. David Bruce in 1887.
          In 1897 Danish veterinarian Bernhard Bang isolated Brucella abortus as the agent and the additional name Bang's disease was assigned. In modern usage "Bang's disease" is often shortened to just "bangs" when ranchers discuss the disease or vaccine.
          Maltese doctor and archaeologist Sir Temi Zammit identified unpasteurized milk as the major source of the pathogen in 1905, and it has since become known as Malta Fever, or deni rqiq locally. In cattle this disease is also known as contagious abortion and infectious abortion.
          The popular name "undulant fever" originates from the characteristic undulance (or "wave-like" nature) of the fever which rises and falls over weeks in untreated patients. In the 20th Century, this name, along with "brucellosis" (after Brucella, named for Dr Bruce), gradually replaced the 19th Century names "Mediterranean fever" and "Malta fever".
          In 1989, Saudi Arabian neurologists discovered neurobrucellosis, a neurological involvement in brucellosis .
          Brucellosis in animals
          Species infecting domestic livestock are B. melitensis (goats and sheep), B. suis (pigs, see Swine brucellosis), B. abortus (cattle and bison), B. ovis (sheep), and B. canis (dogs). B. abortus also infects bison and elk in North America and B. suis is endemic in caribou. Brucella species have also been isolated from several marine mammal species (pinnipeds and cetaceans.)
          Brucellosis in cattle
          The bacterium Brucella abortus is the principal cause of brucellosis in cattle. The bacteria are shed from an infected animal at or around the time of calving or abortion. Once exposed, the likelihood of an animal becoming infected is variable, depending on age, pregnancy status, and other intrinsic factors of the animal as well as the amount of bacteria to which the animal was exposed. The most common clinical signs of cattle infected with Brucella abortus are high incidences of abortions, arthritic joints and retained after-birth. There are two main causes for spontaneous abortion in animals. The first is due to erythritol, which can promote infections in the fetus and placenta. Second is due to the lack of anti-Brucella activity in the amniotic fluid. Males can also harbor the bacteria in their reproductive tracts, namely seminal vesicles, ampullae, testicles, and epididymides.
          Dairy herds in the USA are tested at least once a year with the Brucella Milk Ring Test (BRT). Cows that are confirmed to be infected are often killed. In the United States, veterinarians are required to vaccinate all young stock, thereby further reducing the chance of zoonotic transmission.
          Canada declared their cattle herd brucellosis-free on September 19, 1985. Brucellosis ring testing of milk and cream, as well as testing of slaughter cattle, ended April 1, 1999. Monitoring continues through auction market testing, standard disease reporting mechanisms, and testing of cattle being qualified for export to countries other than the USA.
          The first state-federal cooperative efforts towards eradication of brucellosis caused by Brucella abortus in the U.S. began in 1934.
          Brucellosis in the Greater Yellowstone area
          Wild bison and elk in the Greater Yellowstone Area (GYA) are the last remaining reservoir of Brucella abortus in the U.S. The recent transmission of brucellosis from elk to cattle in Idaho and Wyoming illustrates how brucellosis in wildlife in the GYA may negatively affect cattle. Eliminating brucellosis from this area is a challenge because these animals are on public land and there are many viewpoints involved in the management of these animals.
          Brucellosis in dogs
          The causative agent of brucellosis in dogs is Brucella canis. It is transmitted to other dogs through breeding and contact with aborted fetuses. Brucellosis can occur in humans that come in contact with infected aborted tissue or semen. The bacteria in dogs normally infect the genitals and lymphatic system, but can also spread to the eye, kidney, and intervertebral disc (causing discospondylitis). Symptoms of brucellosis in dogs include abortion in female dogs and scrotal inflammation and orchitis (inflammation of the testicles) in males. Fever is uncommon. Infection of the eye can cause uveitis, and infection of the intervertebral disc can cause pain or weakness. Blood testing of the dogs prior to breeding can prevent the spread of this disease. It is treated with antibiotics as with humans, but it is difficult to cure.
          Brucellosis in humans
          Symptoms
          Brucellosis in humans is usually associated with the consumption of unpasteurized milk and soft cheeses made from the milk of infected animals, primarily goats, infected with Brucella melitensis and with occupational exposure of laboratory workers, veterinarians and slaughterhouse workers. Some vaccines used in livestock, most notably B. abortus strain 19, also cause disease in humans if accidentally injected. Brucellosis induces inconstant fevers, sweating, weakness, anaemia, headaches, depression and muscular and bodily pain.
          The symptoms are like those associated with many other febrile diseases, but with emphasis on muscular pain and sweating. The duration of the disease can vary from a few weeks to many months or even years. In first stage of the disease, septicaemia occurs and leads to the classic triad of undulant fevers, sweating (often with characteristic smell, likened to wet hay) and migratory arthralgia and myalgia. In blood tests, is characteristic the leukopenia and anaemia, some elevation of AST and ALT and positivity of classic Bengal Rose and Huddleson reactions. This complex is, at least in Portugal, known as the Malta fever. During episodes of Malta fever, melitococcemia (presence of brucellae in blood) can usually be demonstrated by means of blood culture in tryptose medium or Albini medium. If untreated, the disease can give origin to focalizations or become chronic. The focalizations of brucellosis occur usually in bones and joints and spondylodisciitis of lumbar spine accompanied by sacroiliitis is very characteristic of this disease. Orchitis is also frequent in men.
          Diagnosis of brucellosis relies on:
          1. Demonstration of the agent: blood cultures in tryptose broth, bone marrow cultures. The growth of brucellae is extremely slow (they can take until 2 months to grow) and the culture poses a risk to laboratory personnel due to high infectivity of brucellae.
          2. Demonstration of antibodies against the agent either with the classic Huddleson, Wright and/or Bengal Rose reactions, either with ELISA or the 2-mercaptoethanol assay for IgM antibodies associated with chronic disease
          3. Histologic evidence of granulomatous hepatitis (hepatic biopsy)
          4. Radiologic alterations in infected vertebrae : the Pedro Pons sign (preferential erosion of antero-superior corner of lumbar vertebrae) and marked osteophytosis are suspicious of brucellic spondylitis.
          The disease's sequelae are highly variable and may include granulomatous hepatitis, arthritis, spondylitis, anaemia, leukopenia, thrombocytopenia, meningitis, uveitis, optic neuritis and endocarditis.
          Treatment and prevention
          Antibiotics like tetracyclins, rifampicin and the aminoglycosides streptomycin and gentamicin are effective against Brucella bacteria. However, the use of more than one antibiotic is needed for several weeks, because the bacteria incubates within cells.
          The gold standard treatment for adults is daily intramuscular injections of streptomycin 1 g for 14 days and oral doxycycline 100 mg twice daily for 45 days (concurrently). Gentamicin 5 mg/kg by intramuscular injection once daily for 7 days is an acceptable substitute when streptomycin is not available or difficult to obtain. Another widely used regimen is doxycycline plus rifampin twice daily for at least 6 weeks. This regimen has the advantage of oral administration. A triple therapy of doxycycline, together with rifampin and cotrimoxazole has been used successfully to treat neurobrucellosis. Doxycycline is able to cross the blood-brain barrier, but requires the addition of two other drugs to prevent relapse. Ciprofloxacin and co-trimoxazole therapy is associated with an unacceptably high rate of relapse. In brucellic endocarditis surgery is required for an optimal outcome. Even with optimal antibrucellic therapy relapses still occur in 5-10 percent of patients with Malta fever. The main way of preventing brucellosis is by using fastidious hygiene in producing raw milk products, or by pasteurization of all milk that is to be ingested by human beings, either in its pure form or as a derivate, such as cheese. Experiments have shown that cotrimoxyzol and rifampin are both safe drugs to use in treatment of pregnant women who have Brucellosis.
          Biological warfare
          In 1954, B. suis became the first agent weaponized by the United States at its Pine Bluff Arsenal in Arkansas. Brucella species survive well in aerosols and resist drying. Brucella and all other remaining biological weapons in the U.S. arsenal were destroyed in 1971-72 when the U.S. offensive biological weapons (BW) program was discontinued.
          The United States BW program focused on three agents of the Brucella group:
          • Porcine Brucellosis (Agent US)
          • Bovine Brucellosis (Agent AB)
          • Caprine Brucellosis (Agent AM)
          Agent US was in advanced development by the end of World War II. When the U.S. Air Force (USAF) wanted a biological warfare capability, the Chemical Corps offered Agent US in the M114 bomblet, based after the 4-pound bursting bomblet developed for anthrax in World War II. Though the capability was developed, operational testing indicated that the weapon was less than desirable, and the USAF termed it an interim capability until replaced by a more effective biological weapon. The main drawbacks of the M114 with Agent US was that it was incapacitating (the USAF wanted "killer" agents), the storage stability was too low to allow for storing at forward air bases, and the logistical requirements to neutralize a target were far higher than originally anticipated, requiring unreasonable logistical air support.
          Agents US and AB had a median infective dose of 500 org/person, and AM was 300 org/person. The rate-of-action was believed to be 2 weeks, with a duration of action of several months. The lethality estimate was based on epidemiological information at 1 - 2%. AM was always believed to be a more virulent disease, and a 3% fatality rate was expected.
          Historical names
          In addition to "Malta Fever" and "undulant fever", the following obsolete names have previously been applied to brucellosis:
          • Mediterranean fever
          • continued fever
          • Cyprus fever
          • goat fever
          • Gibraltar fever
          • Crimean fever
          • mountain fever
          • Neapolitan fever
          • rock fever
          • slow fever
          • febris melitensis
          • febris undulans
          • Bruce's septicemia
          • melitensis septicemia
          • melitococcosis
          • Brucelliasis
          • Milk Sickness

          تعليق


          • #6

            Granuloma and necrosis in the liver of a guinea pig infected with Brucella suis

            تعليق


            • #7
              Brucella canis
              Related to the crippling Brucella abortus, Brucella canis affects dogs through feeding, close contact, bodily fluids, and contaminated products. It causes brucellosis in dogs.

              Researchers have discovered the potential that Brucella canis might be a zoonotic organism. Signs of this disease are different in both genders of dogs; females who have Brucella Canis face an abortion of their pre-devolped fetus. Males face the chance of infertility; the reason is that they develop an antibody against the sperm. This may be followed by inflammation of the testes which will generally settle down a little while after. Symptoms do not only include testicular inflammation, infertility in males, and abortion in females. Another symptom is the infection of the spinal plates or vertebrae, which is called diskospondylitis.

              Treatment for B. canis is very hard to find; but when you do find some, it is often very expensive. The combination of minocycline and streptomycin is thought to be useful, but it is often unaffordable. Tetracyline can be a less expensive substitute for minocycline, but it also lowers the effect of the treatment. However, dogs with Brucella canis should be handed with full body protection because the Brucella family is a zoonotic organism and has a higher chance of mutating rather than bacteria because they are eukaryotic. Contamination will result in potential mutation of the organism and may harm the victim.

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              • #8

                Brucella melitensis is one of the species of bacteria that cause brucellosis, a disease affecting sheep, cattle, and sometimes humans. It is primarily considered to be associated with caprine brucellosis, but is also found in sheep. It causes reproductive disease such as orchitis, epididymitis, mastitis, and abortions. It is zoonotic, unlike Brucella ovis, causing Malta fever or localized brucellosis in humans.

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                • #9


                  Swine brucellosis
                  Swine brucellosis is a contagious disease in pigs caused by the bacteria, Brucella suis. The disease spreads in semen during breeding and by ingestion, inhalation, or eye contact with bacteria in milk, reproductive fluids, placenta, aborted fetuses and urine. The disease primarily occurs in adult pigs which show non-specific infertility, abortion or lack of sexual drive. Boars can show signs of orchitis, lameness, arthritis, abscesses and posterior paralysis. There is no treatment for the disease and no effective vaccine.

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                  • #10
                    Species
                    B. abortus
                    B. canis
                    B. melitensis
                    B. neotomae
                    B. ovis
                    B. suis
                    B. pinnipediae

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                    • #11
                      الملف المرفق به معلومات مفيدة
                      الملفات المرفقة

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                      • #12
                        المشاركة الأصلية بواسطة المتميزة مشاهدة المشاركة
                        الملف المرفق به معلومات مفيدة
                        شكرا لك أختي المتميزة دائما سباقة لمساعدة الآحرين ومتميزة بمشاركاتك
                        جزاكي الله خيرا و حعله في ميزان حسناتك
                        عيادة الدكتور أحمد بكور لطب الأطفال
                        أهم مواضيع عيادة الدكتور أحمد بكور لطب الأطفال

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                        • #13
                          ممكن هذا يفيدك........................... تقبل مروري

                          http://www.arabslab.com/vb/attachment.php?attachmentid=1644&d=1234677098

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                          • #14
                            شكرا للمتميزه على جهودها المتميزه

                            وأشكر الجميع على المساعدة

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                            • #15
                              معلومات كافية ووافية
                              جزاااااكم الله الف خير جميعا
                              Life is different than a teacher, A teacher teaches u a lesson & then keeps the exam..
                              But the LIFE keeps the exam first & then teachs u the lesson
                              ..

                              :sm198:

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