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In both the Federation of Bosnia and Herzegovina and Montenegro, the fall in vaccination coverage occurred only after the years in which the largest number of patients was registered (9,16). The results of our study, as well as the reports on mumps outbreaks from other countries in Europe, indicate that there has been a partial shift to the right when it comes to the age at which the disease is predominant so that in the aforementioned period mumps occurred most commonly in people aged 5-29 years (children, adolescents, young adults) (8,14-16). This study did not indicate a higher incidence of mumps in any period of the year, a similar loss in the seasonal pattern of Mumps virus infections was observed in other European countries where mumps outbreaks were reported in the period covered by this study (8,14-16). The somewhat higher incidence of the disease reported in males is more likely because of the fact that, due to the possible relatively frequent complications, epidemic parotitis is easier to recognize in males and that its incidence in females is underestimated. The same situation was observed in the pre-vaccine, and during the vaccine era, the number of reported cases of mumps infection in males was almost always higher than the number of reported cases in females (17). Because of the above, epidemic occurrens of mumps is a reality, especially in environments suitable for the spread of epidemics (schools, colleges, garrisons) (2,3,5). It should be noted that genotyping of the circulating Mumps virus is not done routinely, and cold chain surveillance is an obligation of the services that are in charge of implementing national immunization programs (18-24). Firstly, we did not estimate the second dose of vaccine effectiveness since we did not have data available for that. Secondly, there might have been under-ascertainment of reported cases as several cases may have not visited a clinician. Conclusion In order to maintain a stable epidemiological situation and avoid mumps outbreaks, it is necessary to increase and maintain the immunization coverage among all persons who have to be vaccinated to a minimum of 80%. This means the implementation of all measures and activities, including continuous revision of vaccination records, inviting non-vaccinated persons to be vaccinated, conducting organized emergency immunization activities in areas where it is otherwise impossible to provide a high percentage of coverage ("Catch-up" vaccination of generation cohorts with lower vaccination coverage). It is also necessary to expand health-care work among the general population, especially among parents, then to improve knowledge of the importance of vaccination and the potential dangers that vaccine-preventable diseases are carrying with them, all in order to res to re the high level of trust in immunization that has been present for years. Institut za javno zdravlje Crne Gore, Centar za kontrolu i prevenciju zaraznih bolesti. Institut za javno zdravlje Crne Gore, Centar za kontrolu i prevenciju zaraznih bolesti, Odjeljenje za imunoprofilaksu, pripremu i kontrolu putnika u medunarodnom saobracaju. Eurostat, Europian Commission, Revision of the European Standard Population (2013) [cited 2019 November 16] Available from: ec. Mumps outbreaks in vaccinated populations: are available mumps vaccines effective enough to prevent outbreaksfi Genomic non-coding regions reveal hidden patterns of mumps virus circulation in Spain, 2005 to 2015. Bernadou A, Astrugue C, Mechain M, Le Galliard V, Verdun-Esquer C, Dupuy F, et al. Measles outbreak linked to insufficient vaccination coverage in Nouvelle-Aquitaine Region, France, Oc to ber 2017 to July 2018. Large outbreak of mumps virus genotype G among vaccinated students in Norway, 2015 to 2016. Identifying risk fac to rs associated with acquiring measles in an outbreak among age-appropriately vaccinated school children: a cohort analysis. Smetana J, Chlibek R, Hanovcova I, Sosovickova R, Smetanova L, Polcarova P, et al. Serological survey of mumps antibodies in adults in the Czech Republic and the need for changes to the vaccination strategy. Corresponding author: dr Aleksandar Obradovic, Centre for noncommunicable disease control and prevention, Institute for public health of Montenegro, Dzona Dzeksona bb, 81000 Podgorica, Montenegro; e-mail: aleksandar. Number of new cases of mumps and crude incidence rates (per 100,000) in Montenegro, from 2009 to 2018 Males Females Total Year New Incidence* New Incidence* New Incidence* Cases (per 100,000) cases (per 100,000) cases (per 100,000) 2009 5 1. Average values of age-specific incidence rates (per 100,000) of mumps in Montenegro, from 2009 to 2018 Age Average value of incidence rate* per 100,000 (minimum-maximum values) groups Males Females Total 0-4 1. Distribution of new cases of mumps by months in Montenegro, from 2009 to 2018 60 50 2018 2017 40 2016 2015 30 2014 20 2013 2012 10 2011 2010 0 2009 Month Figure 3. Pregnancy should be avoided for 1 month following fi Active untreated tuberculosis. The second dose may be administered prior to 4 years of age, provided that there is a minimum interval of one month between the doses of measles, mumps and rubella virus vaccine, live {1-2}. Children who received an initial dose of measles, mumps and rubella vaccine prior to their first birthday should receive additional doses of vaccine at 12-15 months of age and at 4-6 years of age to complete the vaccination series [see Clinical Studies (14. To reconstitute, use only the diluent supplied with the vaccine since it is free of preservatives or other antiviral substances which might inactivate the vaccine. Withdraw the entire volume of the supplied diluent from its vial and inject in to lyophilized vaccine vial.

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Specific method to detect the presence of serologic reactivity to individual viral antigens ii. Multinodular infiltrates and cavitation in one or both upper lobes of the lungs ii. Symmetrical diffuse ground-glass appearance, fine reticular or miliary lesions, large nodular lesions, or multiple large confluent infiltrates iv. May be useful in making diagnosis of sarcoidosis in patient with normal or non-diagnostic chest x-ray, especially if sarcoid pulmonary disease is inactive, and the clinical suspicion, based on ocular findings, is high c. Enlarged lymph nodes are often observed in paratracheal, pretracheal, para-aortic, internal mammary, subcarinal, or axillary regions, which are not appreciated on chest radiographs b. Active pulmonary tuberculosis i) Centrilobular nodules and branching linear structures (tree-in-bud appearance) ii) Lobular consolidation iii) Cavitation iv) Bronchial wall thickening ii. Inactive pulmonary tuberculosis i) Calcified nodules or consolidation ii) Irregular linear opacity iii) Parenchymal bands iv) Pericicatricial emphysema O. Gallium scan for sarcoidosis may be considered Low sensitivity and specificity b. May demonstrate uptake in the lacrimal and salivary glands and variably in lungs if granuloma to us inflammation present c. Culture vitreous or anterior chamber fluid specimens to culture plates or culture tubes directly when possible b. Separate media may be required for aerobic, anaerobic and acid fast bacilli, as well as for fungal and viral organisms d. Give sufficient time for cultures of slow growing or fastidious organisms; these may take longer to incubate 3. Consult with the pathologist (who may want to be there when the specimen is obtained) c. False negatives can occur if insufficient material, material not handled properly or preparation delayed, or if treatment has altered the cellular material Q. Angiotensin-converting enzyme: clinical applications and labora to ry investigations on serum and other biological fluids. Interferometric technique reflected light is analyzed to produce a cross section of tissue B. Adequate pupillary dilation may be problematic if posterior synechiae present 2. Identification of morphological changes in tissue layers atrophy, thickening, dis to rtion 2. Interpretation of changes in the relative reflectivity of tissue layers hyporeflectivity, hyperreflectivity 3. Serous retinal detachments with fibrin bridges i) Can be used to quantitatively follow treatment efficacy iii. Optical coherence to mography: a key to the future management of patients with diabetic macular oedema. Uveitic macular oedema: correlation between optical coherence to mography patterns with visual acuity and fluorescein angiography. Intravenous dye injection (5 cc of a 10% solution in adults followed by a flush of saline) C. Start timer with dye injection and measure arm to eye time and moni to r transit phase in eye of greater clinical interest E. Capture pho to graphs at frequent intervals immediately following the injection of the dye until the dye disappears from the blood vessels (late phases, typically > 10 minutes after injection) F. Anaphylactic reactions (cardiovascular shock): less than 1 in 100,000 injections F. Retinal vascular staining must scan periphery retinal vasculitis, birdshot uveitis E. It can be detected with specialized infrared video angiography (modified fundus cameras, digital imaging system, scanning laser ophthalmoscope) V. Choroidal neovascularization: is seen as a focal "hot spot", plaque, or combination of both B. Appear about 10 minutes after dye injection and persist throughout the remainder of the study b. Larger and greater in number than the white dots seen clinically and by fluorescein angiography E.

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Through their action on the viral M2 protein, amantadine and rimantadine interfere with the replication of the type A virus. When administered within the first 48 hours of illness, either of these two agents improves time to recovery by 1 to 2 days. Amantadine is indicated for treating influenza in both children and adults; insufficient data have been accumulated to approve a pediatric indication for rimantadine. In addition to their therapeutic indications, both antiviral agents are also indicated to prevent the development of illness after exposure to type A viruses. The most significant safety issues associated with either amantadine or rimantadine involve the development of central nervous system side effects, such as nervousness, anxiety, lightheadedness, or impaired concentration. The frequency of these side effects is significantly greater in persons taking amantadine than in those taking rimantadine. Because transmissible viral resistance to amantadine or rimantadine can occur, it is appropriate to discontinue treatment after 3 to 5 days or within 24 to 48 hours after symp to ms resolve. The infection quickly spread by travel to Hong Kong, and from there to Vietnam, Canada, and other locations. A case was initially defined by clinical criteria that included potential exposure to an existing case and fever with pneumonia or respira to ry distress syndrome as a suspected or probable case. Labora to ry tests may be helpful but do not reliably detect infection early during the illness. Treatment: While the use of ribavirin, high-dose corticosteroids, and interferons has been attempted, it is unclear what effect they have had on clinical outcome. Empiric antibiotic treatment for community acquired pneumonia by the current American 109 Thoracic Society/Infectious Diseases Society of America guidelines is recommended pending etiologic diagnosis. An antibody response can occasionally be detected during the first week of illness, is likely to be detected by the end of the second week of illness, and at times may not be detected until >28 days after onset of symp to ms. Nipah and Hendra Viruses: They are closely related but distinct paramyxoviruses that comprise a new genus within the family Paramyxoviridae. The Nipah virus was discovered in Malaysia in 1999 during an outbreak of a zoonotic infection involving mostly pigs and some human cases. Hendra was identified in a similar outbreak involving a single infected horse and three human cases in Southern Australia in 1994. It is believed certain species of fruit bats are the natural hosts for these viruses and remain asymp to matic. The mode of transmission from animal to humans appears to require direct contact with tissues or body fluids, or with aerosols generated during butchering or culling. Personal protective equipment including gowns, gloves, respira to ry, and eye protection is advised for agricultural workers culling infected animal herds. In symp to matic cases, the onset of disease begins with flu-like symp to ms and rapidly progresses to encephalitis with disorientation, delirium, and coma. Fifty percent of those with clinically apparent infections have died from their disease. There is currently no approved treatment for these infections and therefore therapy relies heavily on supportive care. The antiviral drug, 110 ribavirin, has been used in past infections but its effectiveness remains unproven in clinically controlled studies. Although no person-person transmission is known to have occurred, barrier nursing and droplet precautions are recommended as respira to ry secretions and other bodily fluids are known to harbor the virus. The clinical labora to ry should be notified before sending specimens, as these may pose a labora to ry hazard. Specimens for viral isolation and identification should be forwarded to a reference labora to ry. Bioengineered Threats the rapid advance of biotechnology has tremendous potential to alter the present and future threat of biological weapons. Already, complete or partial genomic sequence data for many of the most lethal human pathogens (such as anthrax and plague bacilli and the smallpox virus) is published and widely available through the internet. In addition to this enormous explosion in our knowledge of human pathogens is a parallel understanding of the complexities of the human immune response to foreign agents and to xins.

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The risks associated with recapping needles are well documented, so recapping is no longer an accepted practice. The most common method used for the management of risk is the adoption of effective control measures. While control measures will not eliminate the risk, they can reduce the likelihood of occurrence or mitigate the severity. The combined use of these control measures results in an effective program that reduces the risk of exposure to infectious disease. However, examples of risk transfer would be 1) scheduling a routine transfer patient in protective isolation in a newer vehicle with circulating air rather than an older vehicle, and 2) contracting out the laundering of contaminated linen/clothing to a commercial laundry. The risks associated with example two have been transferred to a private contrac to r. Buying fire insurance on the station, while highly recommended to protect the assets of the department, does nothing to prevent the station from burning down. Once control measures have been implemented, they need to be evaluated to measure their effectiveness. This final step ensures that the system is dynamic, and will facilitate periodic reviews of the entire program. The intent of the risk management plan is to develop a strategy for reducing the inherent risks associated with fire department operations. Regardless of the size or type of fire department, every organization should operate within the parameters of a risk management plan. This is a dynamic and aggressive process that must be moni to red and revised annually by the health and safety officer. The risk to members providing care to a patient with a communicable disease poses a real hazard and should be properly addressed through a written infection control program. By incorporating infection control in to the risk management process, frequency and severity of risks associated with communicable diseases are adequately controlled. Most of the emphasis placed on risk management from a fire service perspective is from a safety approach. The safety component affects other risk management components in areas such as liability and finance. An aggressive, proactive occupational safety and health program will reduce accidents, injuries, occupational illnesses, and health exposures. The department shall conduct initial and annual training and education programs for all members in accordance with Federal or State regulations. Members will receive bloodborne pathogen training at the time of initial assignment of job functions (recruit training or company in-service) whenever exposure potential exists. Additional training shall be provided whenever there are changes in work assignments, job functions, or new protective clothing and equipment is placed in service. Training will include an opportunity for members to have their questions answered by the instruc to r. All training and education programs for infection control will be properly documented in writing. Each member can also participate or be represented in the research, development, implementation, evaluation, and enforcement of this program. The infection control program has the goal of identifying the risks of exposures to members and the means to prevent those exposures. All members have the individual responsibility for their own health, safety, and welfare. The health maintenance program is a significant part of the infection control process.

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A variety of modern contraceptives are sold in pharmacies to the extent that they are accessible. It is generally believed that condoms are highly unpopular with Tajik men and that condoms are only used to an insignificant degree. Abortion Clinical abortions are performed free of charge in the abortion departments of clinical hospitals and in the gynaecological departments of regional and central hospitals. Three different techniques are used for clinical abortion: curettage, vacuum aspiration and intra-amnion insertions of hyper to nic solutions. Pre-abortion counselling is performed by doc to rs in women consultations, in reproductive health centres and post-abortion counselling is performed by family doc to rs and doc to rs in health care facilities where the clinical abortion was performed. Recent trends in reproductive health the implementation of the national reproductive health policy was commenced in 1996. Adolescents are offered reproductive health care through a comprehensive service in the centres, offering information and contraceptive supplies. Three surveys concerning reproductive health care services have been conducted within the last couple of years. Breast and cervical cancer the prevalence of breast and cervical cancer appear to be very low in Tajikistan. Child health Among children under five years of age, the most important causes of morbidity and death are acute respira to ry infections, diarrhoeal diseases, vaccine-preventable diseases, malnutrition and malaria. The present national health insurance system covers approximately 74% of the population. There is no data at present on the general availability of drugs in the major regions of the country. Family planning Turkmenistan has implemented a national programme of family planning. Family planning counselling services are not offered free of charge in Turkmenistan. The counselling services are provided by general practitioners, gynaecologists and midwives. Contraceptives are free of charge and the continuity of availability is estimated to be reliable. Emergency contraceptives have been made available to the population through the reproductive health centres. There is at present no systematic data on the prevalence of unsafe abortion in Turkmenistan. Recent trends in reproductive health It appears that Turkmenistan has a reproductive health policy, but it remains unclear as to the extent of this policy. International organizations are involved in activities of financial support and information dissemination. Antenatal care It is estimated that all women in Turkmenistan are given antenatal care. Despite the routine blood sampling for syphilis, there is no systematic data on the percentage of women attending antenatal care showing a positive syphilis serology. There are 427 facilities per 500 000 population that have functioning basic essential obstetric care and 147 per 500 000 that have functioning comprehensive essential obstetric care. Breast and cervical cancer Data indicates that 1063 women have breast cancer and 918 women have cervical cancer. The frequency of intestinal infections is contributed to by the shortage of potable water and poor sanitation, increasing poverty and malnutrition.

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To help dispel such doubts, countries using Hib vaccines need to sustain surveillance for bacterial meningitis. Prompt detection of a resurgence of Hib disease could enable an appropriate vaccination response to be made. It is characterized by jaundice, dark urine, fever, anorexia, and abdominal discomfort, with the symp to ms related to age. Severe complications are rare, but the risk of death increases with age, and case fatality may range from zero in children under 5 years old to 1. The paradox of hepatitis A is that the very countries in which the disease is most prevalent are those where it has least visibility; in countries where its incidence is lower, outbreaks of the disease are very evident. In contrast, in industrialized countries with better sanitation, young children may not be infected, but during outbreaks, older children and adults who do not have immunity, may be ill with jaundice for up to two months, with the result that the disease is the most commonly reported of vaccine-preventable diseases in these countries. But this paradox also defnes the potential: when countries improve their socioeconomic conditions, hepatitis A becomes more visible and controlling the disease through vaccination becomes a possibility. Inactivated hepatitis A vaccines were licensed in the United States in 1996, where their use led to a dramatic decline in cases. Similar drops in incidence have been seen in other countries or areas of countries, such as Israel, Italy, and Spain. In regions of low endemicity, vaccination against hepatitis A is indicated for individuals with increased risk of contracting the infection. Evidence from use of the vaccine in the United States and other countries, suggests that universal hepatitis A vaccine introduction can reduce the disease to very low nationwide incidence rates, raising the possibility of ultimately eliminating the disease. The infection spreads by exposure to blood or other body fuids of an infected person, as in sexual contact, through a skin wound, or through use of an infected needle or syringe, and, in the case of infants, from an infected mother during childbirth. In most cases, the infection runs an acute course lasting from one to three months. Symp to ms include jaundice, malaise, loss of appetite, nausea and vomiting, fever, muscle pain, and fatigue. About 90% of infants infected during the frst year of life develop chronic infection, compared with 30% of children infected between one and four years, and less than 5% of people infected as adults (1). Several countries achieving high vaccine coverage rates have seen a substantial reduction in the prevalence of chronic infection. Even within this alarming statistic there are marked disparities between rich and poor provinces. In response, China has made major investments in improving delivery of the hepatitis B vaccine. Hepatitis B vaccination for infants was introduced in 1992, with the recommendation that the frst dose be given within 24 hours of birth. The cost of immunization, however, was a barrier to disadvantaged high-risk populations. In 2002, therefore, the Health Ministry made the vaccine universally available through the national immunization programme. This was followed, in 2005, by a Ministry decision to abolish all fees for recommended infant vaccinations. To achieve this goal, women are encouraged to give birth in hospitals, and every hospital must keep enough vaccine available for administration of the birth dose. The outcome of these measures has been dramatic: a surge in national birth dose coverage from 29% in 1997 to 82% in 2005, and a drop in the chronic infection rate over the same period to less than 2% of children under fve. Some western provinces only attained around 70% of birth dose coverage by 2006, which may be due to the higher proportion of home births in those areas. The disparity is declining, but more work is needed for China to reach its national goals (74). Efforts are under way to make mothers and immunization providers in such areas more aware of the importance of protecting newborn infants with this initial vaccine dose. Moreover, in many countries, health workers and other high-risk groups are not being vaccinated in suffcient numbers. Worldwide, and in developing countries, cervical cancer is the second most common cancer in women, after breast cancer (75).

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His colonoscopy is negative for any obvious sources of bleeding, but upper endoscopy reveals ulceration in the distal duodenum that is biopsied. The pathology report shows this to be the most common primary malignancy of the small bowel. A 23-year-old man of Middle-Eastern decent is investigated for symp to ms of chronic diarrhea, vomiting, and abdominal cramps. This form of small bowel tumor can be treated with antibiotics in its early stages. A 21-year-old woman develops acute perium-bilical pain that localizes to the right lower quadrant. She appears unwell, and on examination, there is tenderness and guarding in the right lower quadrant. A pregnancy test is negative and a pelvic examination rules out pelvic inflamma to ry disease. A clinical diagnosis of acute appendicitis is made and she has an uncomplicated laparoscopic appendec to my. The pathology report notes acute inflammation and a tumor for which the appendix is a very common site of involvement. A 57-year-old woman with a 20-year his to ry of celiac disease now presents with weight loss, cramps, and abdominal discomfort. On examination, her abdomen is soft and there is fullness in the right lower quadrant. A small bowel x-ray reveals an area of narrowing in the distal ileum, and there is thickening and nodularity of the mucosal folds. A 48-year-old man presents with periumbilical pain made worse by eating and weight loss. The differen tial diagnosis includes tumors that most commonly involve the distal part of the small bowel. A 19-year-old man has a long his to ry of weight loss, abdominal distention, bloating, and diarrhea. Investigation reveals stea to rrhea, and a small bowel biopsy reveals blunting and flattening of villi. She has had ulcers at multiple sites of the small bowel including the distal duodenum and jejunum. She also has chronic diarrhea, but not enough fat to make the diagnosis of stea to rrhea. She reports no weight loss, but does notice occasional bright red bleeding with bowel movements. Her family his to ry is negative for colon cancer and she has never had screening colonoscopy. She is referred for colonoscopy and the only abnormal finding is multiple diverticuli. A 77-year-old woman is brought to the emergency room because of symp to ms of nonspecific abdominal discomfort. On physical examination, the vital signs are normal, the abdomen is soft and nontender with no masses or organomegaly palpated. Abdominal x-rays show lots of s to ol in the colon, but no free air or air fluid levels. Which of the following conditions can cause a false-positive elevation in the serum amylasefi A 71-year-old man presents to the clinic for evaluation of progressive weight loss and dysphagia over a 3-month period. The symp to ms of dysphagia are getting worse and seem to be more pronounced with solid foods than liquids. His past medical his to ry includes coronary artery disease, hypertension, and dyslipidemia.

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Review of developments with possible beneficial consequences: fi Detection; fi Diagnostics; fi Prevention and prophylaxis; fi Therapeutics: fi Response capacity. Overview of enabling technologies: fi Characterising biological systems and networks; fi Manipulating biological systems and networks; fi Engineering biological systems and networks; fi Gathering and manipulating biological information; fi Converting it in to digital data and back; fi Generic enabling technologies. Summary of a workshop held by the international scientific organisations Individual contributions from State Parties. At the Review Conference in 2011, State Parties agreed that five-yearly reviews of developments in science and technology were insufficient to keep pace with progress. They created a Standing Agenda Item on reviewing such developments, as part of their 2012-2015 inter-sessional work programme. Each year State Parties under to ok to consider new science and technology developments that: (1) have potential for uses contrary to the Convention; (2) have potential benefits for the Convention; and (3) are relevant to the activities of other relevant international bodies (such as the regime to prohibit chemical weapons). In addition, State Parties would look at measures: (4) for strengthening national biological risk management (including biosafety, biosecurity and identifying and overseeing dual-use research); (5) to encourage responsible conduct by scientists; and (6) for furthering education and awareness raising 11 measures. Although these figures do not take in to account impromptu interventions and smaller contributions, it does suggest that there is a limited willingness or capacity to engage in this format of review. To the extent practicable, the Unit has also attempted to give back by participating and contributing to scientific endeavours. The ability to engineer biology effectively would clearly have significant implications for the Convention both positive and negative. This was the fourth in a series of global scientific congresses on synthetic biology. At this last meeting, an initiative by the Unit in coordination with the Organisation for the Prohibition of Chemical Weapons and with the support of the World Health Organization, held an awareness-raising side event. Each event provided a unique opportunity to : (1) raise awareness of the Convention and the potential for science to be misused by others to cause deliberate harm; (2) highlight how engagement with the to pic could be integrated in to broader efforts on responsible conduct; (3) help advance scientific careers; and (4) open doors to the best science. It also provided an opportunity to illustrate how scientists can contribute to, and influence, international policy processes that impact their work. A member of the Unit has contributed to Federal Bureau of Investigation outreach events (see Chapter 12 for more details), helping to raise awareness amongst this community of the need to actively engage in safeguarding good science. In 2008, the Unit, jointly with the Geneva Forum, hosted an introduction to synthetic biology for policy makers. This event included a briefing on options for the governance of synthetic genomics. The second event, on the margins of the last meeting prior to the 2011 Review Conference, addressed security. The Unit has helped ensure that synthetic biologists were present amongst guests invited to technical meetings. The Unit also liaised closely with relevant scientists and helped them organise their own events on the margins of Convention meetings: for example, sessions on developments in science and technology, dealing with dual-use technology, and strengthening the web of prevention, have accompanied every meeting in the current intersessional process. For example, the Unit participated as a member of the Temporary Working Group on the Convergence of Biology and Chemistry, of the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons (see Chapter 9). The Unit also provided to the Temporary Working Group briefings on relevant scientific and technical developments which it had identified through its work with scientists. Opportunities for scientists to contribute to the Biological and Toxin Weapons Convention 24.


  • http://www.jpccr.eu/pdf-71468-8700?filename=Herbal%20medicine%20for.pdf
  • https://www.abta.org/wp-content/uploads/2018/03/metastatic-brain-tumor.pdf
  • https://www.gutenberg.org/files/24440/24440-pdf.pdf
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