Dermatology Case No 25. Scabies with Urticaria.

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Dermatology Case No 25. Scabies with Urticaria.

১৪ বছরের বাচ্চা ১৫ দিন থেকে সারা শরীর চুলকানি,

সাথে Pustular lesion.. চুলকানি রাতে বেড়ে যায়,

পরিবারে অন্যদের ও আছে..

যেভাবে Evaluation করবেন-

প্রথমে পেশেন্ট এর খুব ভালোভাবে দেখেন,।

scabies_Diagnostic_Tips_By_CCR_Academy

Generalised itching তথা সারা শরীরে চুলকানি নিয়ে OPD তে কোনো পেশেন্ট আসলে সাথে কোনো সিস্টেমিক ফিচার না থাকলেবআমরা দুইটা কমন বিষয় মাথায় রাখবো–..

1…Urticaria

2…. Scabies

Urticaria তে পেশেন্ট বলবে,

স্যার, গোশত খাইতে পারিনা, খাইলে চুলকানি শুরুa হয়,

কিছু স্পেসিফিক খাবারের কথা বলবে, আপনি তখন Urticaria মাথায় রাখবেন,

এরপর আপনি জিজ্ঞাস করবেন,

চুলকানি কখন বাড়ে?

রাতে না দিনে?

যদি বলে, রাতে বাড়ে, তাহলে Scabies মাথায় রেখে কনফার্ম হবার জন্য Clue খুজবেন,

মনে রাখবেন, Adult দের স্ক্যাবিস হলে Burrow or liner Lesion সাধারণত খুজেই পাবেন না

What are linear lesions?

Linear lesions take on the shape of a straight line and are suggestive of some forms of contact dermatitis, linear epidermal nevi, and lichen striatus. Excoriations resulting from scratching are typically linear.

রৈখিক ক্ষত কি?

রৈখিক ক্ষতগুলি একটি সরলরেখার আকার ধারণ করে এবং এটি কিছু ধরণের যোগাযোগের ডার্মাটাইটিস, রৈখিক এপিডার্মাল নেভি এবং লাইকেন স্ট্রাইটাসের ইঙ্গিত দেয় । স্ক্র্যাচিং এর ফলে শরীরে যে দাগের বা ক্ষত চিহ্ন তৈরি হয় তাকে liner lesion bole

তখন কি খুজবেন—

ওই যে, একটু আগে আলোচনা করলাম,

Pen niddle mark type black spot.

একটা কলম দিয়ে খোঁচা মারলে যেমন black spot দেখা যায়, এমন একটা spot আপনি আবিষ্কার করতে চেষ্টা করবেন,

যদি Generalised itching + রাতে চুলকানি বাড়ে, এমন পেশেন্ট এর মধ্যে এমন একটা black ball pin pen dot spot আবিষ্কার করতে পারেন, তাহলে আপনি ডায়াগনোসিস করে নিবেন Scabies..

urticaria তে এমন spot কখনোই থাকবেনা–

Urticaria te face involved হবে,

scabies e face সাধারণত involved হবেনা

এবার জানতে হবে

Infected_scabies_কি?

আমরা জানি, স্কিনে Normal flora হিসাবে Staphylococcus bacteria থাকে, অতিরিক্ত scratch এর কারণে এই ব্যাকটেরিয়া গুলি Colonization হয়ে ইনফেকশন তৈরি করে, কারো যদি scabies হয়, তার ক্ষেত্রে অতিরিক্ত চুলকানির কারণে body তে থাকা Normal flora গুলি Colony formation করে ইনফেকশন করবে…

তখন Itching এর সাথে painful pustule ও থাকবে,

এই কন্ডিশন কে বলা হবে – infected scabies.

চিকিৎসা কিভাবে হবে?

scabies এর চিকিৎসার পাশাপাশি টপিকাল ও সিস্টেমিক এন্টিবায়োটিক দিবে

1..Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

Indications of Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

Lorix cream is indicated for the treatment of scabies and crab lice infestations (Pediculosis). Scabies can affect everyone in the family. If one is infected, all family members must be treated together.

Pharmacology of Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

Permethrin cream contains Permethrin, a pyrethroid, which is a topical scabicidal agent for the treatment of infestation with Sarcoptes Scabiei (scabies). It acts on the nerve cell membrane to disrupt the sodium channel current by which the polarization of the membrane is regulated. Delayed repolarization & paralysis of the pests are the consequences of this disturbance.

Pharmacokinetics: The only approved route of administration is the topical route and there are few human data available on systemic exposure or kinetics following permethrin application to the skin. Some presystemic metabolism occurs in skin. Less than 0.5% of applied permethrin is absorbed during the first 48 hours. Absorbed permethrin is rapidly metabolized by ester hydrolysis, most likely in the liver and the products are excreted primarily in the urine.

Dosage of Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

Recommended duration of Treatment:

Adults and children over 12 years: a full tube
Children aged 6-12 years: up to 1⁄2 of a tube
Children aged 1-5 years: up to ¼ of a tube
Children aged 2 months to 1 year: up to ⅛ of a tube
Children Less then 2 month: dose is not established

Administration of Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

Before application of Permethrin cream the skin should be clean, cool and dry. Do not have a hot shower or bath before applying.

For adults and children over 2 years: Apply the cream to the whole body from the neck down, rubbing lightly into the skin until the cream disappears. It is important to include all skin surfaces, such as between the fingers and toes, under the nails and on the soles of the feet.

For babies under 2 years: Apply to the face, neck, ears and scalp as well, only avoiding the area immediately around the eyes and mouth.

Leave cream on for at least 8 hours, before washing off. Reapply to any area that may be washed during the 8h treatment time (such as after washing the hands). If necessary, permethrin cream should be used again after 7 days as per the advice of the doctor.

Interaction of Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

The treatment of eczemodous like reactions with corticosteroids should be withheld prior to treatment with Lorix, as there is a risk of exacerbating the scabies infestation by reducing the immune response to the mite.

Contraindications of Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

Permethrin is contraindicated in patients with known hypersensitivity to any component of pyrethroids or permethrin. Nursing staff who routinely apply permethrin may wear globes to avoid any possible irritation to the hands.

Side Effects of Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

In Scabies patients, skin discomfort, usually described as burning, stinging or tingling occurs in a few individuals soon after the cream is applied. Others transient signs and symptoms of irritation including enythema, edema, eczema, rash and puritis.

Pregnancy & Lactation of Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

In the absence of specific studies in pregnant women, its use in pregnancy should only follow medical advice. It is not known whether permethrin is excreted in human milk so it should not be used in nursing mothers.

Precautions & Warnings

Scabies infestation is often accompanied by pruritus, edema & erythema. Treatment with Lorix may temporarily exacerbate these conditions. Patients should be advised to avoid contact with eyes during application & to flash with water immediately if the cream gets in the eyes.

Therapeutic Class of Cream: Lorix 5% w/w 30gm tube (AS A Permethrin AS A Parasiticidal preparations).

Parasiticidal preparations

মাথা থেকে পা পর্যন্ত সারা শরীরে লাগাবে,

রাতে লাগাবে, সকালে ধুয়ে নিবে

2..Tab- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

0+0+1 (21 days)

Indications of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Xyril Hydrochloride is indicated-

For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested.
Management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses, and histamine-mediated pruritus.
As a sedative when used as premedication and following general anesthesia.

The effectiveness of Xyril as an antianxiety agent for long-term use (>4 months) has not been assessed by systematic clinical studies. The physician should reassess periodically the usefulness of the drug for the individual patient.

Pharmacology of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Hydroxyzine Hydrochloride is an anxiolytic antihistamine of the piperazine class which is a H1 receptor antagonist. Hydroxyzine is not a cortical depressant, but its action may be due to a suppression of activity in certain key regions of the subcortical area of the central nervous system. Primary skeletal muscle relaxation has been demonstrated experimentally. Bronchodilator activity and antihistaminic and analgesic effects have been demonstrated experimentally and confirmed clinically. An antiemetic effect, both by the apomorphine test and the veriloid test, has been demonstrated. Hydroxyzine is rapidly absorbed from the gastrointestinal tract and clinical effects are usually noted within 15 to 30 minutes after oral administration.

Dosage & Administration of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

For symptomatic relief of anxiety and tension-

Adults: 50-100 mg 4 times daily.
Children (>6 years): 50-100 mg (5-10 teaspoonfuls) daily in divided doses.
Children (<6 years): 50 mg (5 teaspoonfuls) daily in divided doses.

Pruritus due to allergic conditions-

Adults: 25 mg 3 to 4 times daily.
Children ( 6 years): 50-100 mg (5-10 teaspoonfuls) daily in divided doses.
Children (<6 years): 50 mg (5 teaspoonfuls) daily in divided doses.

As a sedative (premedication and following general anesthesia)-

Adults: 50-100 mg.
Children: 0.6 mg/kg of body weight.

Interaction

Xyril may potentiate Meperidine and barbiturates, so their use in pre-anesthetic adjunctive therapy should be modified on an individual basis. Atropine and other belladonna alkaloids are not affected by the drug. Xyril is not known to interfere with the action of digitalis in any way and it may be used concurrently with this agent. Simultaneous administration of Xyril with monoamine oxidase inhibitors should be avoided.

Contraindications of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Hydroxyzine is contraindicated in patients with a known hypersensitivity to Hydroxyzine or any of its ingredients.

Side Effects of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Side effects reported with the administration of Xyril Hhydrochloride are usually mild and transitory in nature. More common side effects include drowsiness, headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastrointestinal disturbances. Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.

Pregnancy & Lactation of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Clinical data in human beings are inadequate to establish safety in early pregnancy. Until such data are available, Hydroxyzine is contraindicated in early pregnancy. It is not known whether this drug is excreted in human milk. Since many drugs are so excreted, Hydroxyzine should not be given to nursing mothers.

Precautions & Warnings

The potentiating action of Xyril must be considered when the drug is used in conjunction with central nervous system depressants such as narcotics, non-narcotic analgesics, and barbiturates. Therefore, when central nervous system depressants are administered concomitantly with Xyril, their dosage should be reduced. Since drowsiness may occur with the use of Xyril, patients should be warned of this possibility and cautioned against driving a car or operating dangerous machinery while taking Xyril. Patients should be advised against the simultaneous use of other CNS depressant drugs and cautioned that the effect of alcohol may be increased.

Use in Special Populations

Use in renal impairment patient: In case of renal impairment, half of the normal dose should be given.

Use in the elderly patient: In the elderly, it is advised to start with half the recommended dose due to the prolonged action.

Overdose Effects of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

The most common manifestation of Xyril overdosage is hypersedation. As in the management of overdosage with any drug, it should be borne in mind that multiple agents may have been taken.

If vomiting has not occurred spontaneously, it should be induced. Immediate gastric lavage is also recommended. General supportive care, including frequent monitoring of the vital signs and close observation of the patient, is indicated. Hypotension, though unlikely, may be controlled with intravenous fluids and Levarterenol or Metaraminol. Epinephrine should not be used as Xyril counteracts its pressor action.

There is no specific antidote. It is doubtful that hemodialysis would be of any value in the treatment of overdosage with Xyril. However, if other agents such as barbiturates have been ingested concomitantly, hemodialysis may be indicated. There is no practical method to quantitate Xyril in body fluids or tissue after its ingestion or administration.

Therapeutic Class of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Sedating Anti-histamine

3.. Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

1+1+1+1 (7 days)

Indications of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

Fluclox is indicated for the treatment of infections due to Gram-positive organisms, including infections caused by penicillinase producing staphylococci. These indications include:

Skin and soft tissue infections: Boils, abscess, carbuncles, infected skin conditions (e.g. ulcer, eczema, acne, furunculosis, cellulitis, infected wounds, infected burns, otitis media and externa, impetigo).
Respiratory tract infections: Pneumonia, lung abscess, empyema, sinusitis, pharyngitis, tonsillitis, quinsy.
It is also used for the treatment of other infections i.e. osteomyelitis, enteritis, endocarditis, urinary tract infection, meningitis, septicaemia caused by Fluclox-sensitive organisms.
As a prophylactic agent, it is used during major surgical procedures where appropriate; for example, cardiothoracic and orthopedic surgery.

Pharmacology of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

Flucloxacillin is active against Gram-positive organisms including penicillinase producing strains. It has little activity against Gram-negative bacilli. Flucloxacillin acts by inhibiting the formation of cell wall of bacteria. Flucloxacillin is isoxazolyl penicillin which combined the properties of resistance to hydrolysis by penicillinase, gastric acid stability and activity against gram-positive bacteria. Flucloxacillin is a bactericidal antibiotic that is particularly useful against penicillinase-producing staphylococci. Flucloxacillin kills bacterial cellwall, thus interfering with peptidoglycan synthesis. Peptidoglycan is a heteropolymeric structure that provides the cell wall with its mechanical stability. The final stage of peptidoglycan synthesis involves the completion of the cross-linking with the terminal glycine residue of the pentaglycin bridge linking to the fourth residue of the pentapeptide (D-alanine). The transpeptidase enzyme that performs this step is inhibited by Flucloxacillin. As a result the bacterial cellwall is weakened, the cell swells and then ruptures. Flucloxacillin resists the action of bacterial penicillinase probably because of the steric hindrance induced by the acyl side chain which prevents the opening of the β- lactam ring.

Dosage of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

Oral administration:

Adult: 250 mg four times daily. Dosage may be doubled in severe infections. In osteomyelitis and endocarditis, up to 8 gm daily is used in 6-8 hourly divided doses.
Children (2-10 years): 1/2 of adult dose.
Children (Under 2 years): 1/4 of adult dose.

Parenteral administration:
Adult or Elderly:

Intramuscular Injection: 250 mg four times daily.
Intravenous Injection: 250 mg-1 g four times daily by slow injection over 3 to 4 minutes or by intravenous infusion.
All systemic doses may be doubled in severe infections: doses up to 8 g daily have been suggested for endocarditis or osteomyelitis.

Children:

2-10 years: half of the adult dose.
Under 2 years: a quarter of the adult dose.

Administration of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

Oral doses should be administered 1 hour before meal.

Interaction of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

Concurrent use of Fluclox and may result in increased level of Fluclox in blood for prolonged period.

Contraindications of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

Flucloxacillin is contraindicated in penicillin hypersensitive patients.

Side Effects of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

There have been some common side effects of gastrointestinal tract such as nausea, vomiting, diarrhoea, dyspepsia and other minor gastrointestinal disturbances. Besides these rashes, urticaria, purpura, fever, interstitial nephritis, hepatitis and cholestatic jaundice have been reported.

Pregnancy & Lactation of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

US FDA Pregnancy Category of Flucloxacillin is B. There are, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Flucloxacillin have been shown to be excreted in human milk. So, caution should be exercised when Flucloxacillin is administered to a lactating mother.

Precautions & Warnings

Fluclox should be used with caution in patients with evidence of hepatic dysfunction. Caution should also be exercised in the treatment of patients with an allergic diathesis.

Use in Special Populations of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

In severe renal failure (creatinine clearance <10 ml/min), a reduction in dose or an extension of dose interval should be considered.

Therapeutic Class of Cap- Fluclox 500 mg (AS A Flucloxacilline Sodium AS A Penicillinase-resistant penicillins).

Penicillinase-resistant penicillins

4.. Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

Indications of Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

Bactrocin ointment is indicated for the topical treatment of impetigo (skin diseases) due to Staphylococcus Aureus and Streptococcus Pyogenes. It is also indicated in folliculitis, furunculosis.

Pharmacology of Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

Mupirocin is a naturally occurring antibiotic. It is an antibacterial agent produced by fermentation using the organism Pseudomonas fluorescens. It is active against a wide range of bacteria those responsible for the majority of skin infections, e.g. Staphylococcus aureus including methicillin-resistant Staphylococcus aureus (MRSA) other staphylococci and streptococci. It is also active against certain gram-negative pathogens, like Escherichia coli and Haemophilus influenzae. Mupirocin inhibits bacterial protein synthesis by reversibly and specially binding to bacterial isoleucyl transfer-RNA synthetase. Due to this unique mode of action, Mupirocin demonstrates no in vitro cross-resistance with other classes of antimicrobial agents. Mupirocin is bactericidal at concentrations achieved by topical administration. However, the minimum bactericidal concentration (MBC) against relevant pathogens is generally eight-fold to thirty-fold higher than the minimum inhibitory concentration (MIC).

Mupirocin is a naturally occurring antibiotic. This antibacterial agent is produced by fermentation using the organism Pseudomonas fluorescens. It is active against a wide range of bacteria (e.g. Staphylococcus aureus including methicillin-resistant strains and Streptococcus pyogenes) those responsible for the majority of skin infections. It is also active against gram-negative pathogens, such as Escherichia coli and Haemophilus influenzae. Mupirocin inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl transfer-RNA synthetase.

Dosage & Administration of Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

A small amount of Bactropen ointment should be applied to the affected area 3 times daily for up to 10 days. The safety and effectiveness of Mupirocin ointment have been established in the age range of 2 months to 16 years.

Pediatric Use: The safety and effectiveness of Mupirocin have been established in the age range of 2 months to 16 years. Use of the ointment in these age groups is supported by evidence from adequate and well-controlled studies of Mupirocin in impetigo in pediatric patients.

Interaction of Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

No drug interaction has been identified with Bactrocin ointment.

Contraindications of Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

The drug is contraindicated in individuals with a history of hypersensitivity reactions to Mupirocin or any of the components of the preparation.

Side Effects of Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

Reported side effects are burning, stinging or pain, itching and some patient may be suffered rash, nausea, erythema, dry skin, tenderness, swelling, contact dermatitis and increased exudate.

Pregnancy & Lactation of Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

Reproduction studies on Mupirocin ointment in animals have revealed no evidence of harm to the foetus. As there is no clinical experience on it’s use during pregnancy, Mupirocin ointment should only be used in pregnancy when the potential benefits outweigh the possible risks of treatment. It is unknown whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Mupirocin ointment is administered to a nursing woman.

Precautions & Warnings of Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

Bactrocin ointment is not for ophthalmic or intra-nasal use. As with other antibacterial products, prolonged use may result in overgrowth of non-susceptible organisms, including fungi. When Bactrocin is used on the face care should be taken to avoid the eyes. This is not suitable in conjunction with cannulae and at the site of central venous cannulation. In the event of a sensitization or severe local irritation from Bactrocin ointment, usage should be discontinued and appropriate alternative therapy for the infection instituted. Mixing of Bactrocin ointment with other preparations causes risk of dilution, resulting in a reduction of the antibacterial activity and potential loss of stability of the Bactrocin in the ointment.

Overdose Effects

There is currently limited data with overdose of Bactrocin ointment. In the event of overdose, the patient should be treated supportively with appropriate monitoring as necessary.

Therapeutic Class of Cream – Bactrocin 2% W/W 10gm tube (AS A Mupirocin AS A Topical Antibiotic preparations).

Topical Antibiotic preparations

Apply at the side of infection BD,… For 7 daya–

5.. lorix লাগানোর পরের দিন ব্যবহৃত সকল জামা কাপড় ধুয়ে নিবে,,, যে গুলি ধৌত করা সম্ভব না, তা এক জায়গায় স্টোর রুমে রেখে দিবে, ৭ দিনে স্ক্যাবিস প্যারাসাইট মারা যাবে,,,

৬.. পরিবারের সকল সদস্য একই দিন চিকিৎসা নিবে,, যাদের উপসর্গ নাই, তারাও চিকিৎসা নিবে,

৭…বাচ্চা যাদের সাথে চলাফেরা করে, যেমন স্কুল মাদ্রাসায় আবাসিক থাকলে সেখানে অন্য বাচ্চাদের আছে কিনা তার খবর নিবে, থাকলে তাদের ও চিকিৎসা করাতে হবে,

General Queries:

1.স্ক্যাবিস কি মুখে বা মাথায় হতে পারে? অনেক সময় রোগী এমনটা বলে। সেক্ষেত্রে কি করতে hobe ?

Answer is: jodio mukhe hoi na temon but hole tokhon sobkhane cream lagabe .

Raiyyan Tahsan Date:27-01-2025 Monday Time:11-07-2025

Raiyyan Tahsan

Raiyyan Tahsan