Percentage of ulcer healing at 1 month was 20.88%, improving to 43.16% by 2 months and 57.04% by 3 months [5]. It has millions of presentations already uploaded and available with 1,000s more being uploaded by its users every day. The foot clinic consisted of a team of podiatrists, Clinical Nurse Specialists in Diabetes, a Dietician and a Diabetologist. Dr. Serena has been the lead or principal investigator in over 100 clinical trials, including studying dual-layer amniotic membranes (Artacent) in patients with diabetic foot ulcers. PCGW100C 3. In addition to insulin, metformin, which is a sugar-reducing agent, is also a common treatment for diabetes. In addition, make sure that you get regular exercise. 2. It is considered a first-line therapy for diabetes treatment and is often added to insulin. Your treatment will depend on what type of insulin you need. Consistent good control of blood sugar and other risk factors of DFU. Foot care advise includes Inspection of feet daily for cracks, blisters, infections, and injuries. Ndip A, Rutter MK, Vileikyte L, et al. He was therefore assessed as having diabetic foot ulcer with possible osteomyelitis for which blood cultures were performed. 69% of these patients had osteomyelitis. The overall prevalence of diabetic foot complications was 3.3% with 95% confidence interval (95% CI) of (3.16%3.44%), whilst the prevalences of foot ulcer, gangrene, and amputations were 2.05% (1.94%2.16%), 0.19% (0.16%0.22%), and 1.06% (0.98%1.14%), respectively. Considering these negative effects, it is important to explore the relative risk factors affecting amputation in DFU patients. which degrade multiple growth factors, receptors, Even with good, standard wound care, healing, Diminished angiogenesis MMP/TIMP imbalance, Falanga V. Wound healing and its impairment in. Case studies. DEATH CAUSED OF FOOT DIABETIC 17-32%. Of note, multiple blood cultures from this patient were positive for Salmonella species, Group B. Salmonella is a gram negative, flagellated facultative anaerobic, non-lactose fermenting bacilli. (LogOut/ Below are two examples of such sores. The surgeon took the patient to the OR for debridement, drained the infection, and started antibiotics. Diabetic is a group of metabolic disease characterized by increased levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action or both resulting in glucose intolerance. You should also avoid alcoholic beverages. Weakness, atrophy, foot drop. Edelson GW, Armstrong DG, Lavery LA, Caicco G (1996) The acutely infected diabetic foot is not adequately evaluated in an inpatient setting. In the third segment of walking, the muscles, tendons, and ligaments ti ghten to lift the calcaneus off the ground (heel rise), and then the foot regains its arch in preparation for the last segment (toe push-off). 2022, Volume 15, Issue 10, pp 1224 - 1228. The SHID wound classification system for diabetic foot ulcer patients: a validity study. It is usually the result of poor glycemic control, underlying neuropathy, peripheral vascular disease, or poor foot care. Case Report (1) (LogOut/ To appropriately type the organism, Salmonella latex agglutination testing was performed which identified Salmonella species Group B (Non-typhoidal). If you have type 1, you can control your blood glucose levels by eating a balanced diet. From experience that any diabetic patient with neuropathy and a painless foot ulcer. Good control of diabetes over time is the key to treating diabetic neuropathy. "[MAX]MAX 18mm 100mm DSBS18.0100D ()TCTN.K18YG G/D VS2 0.211ct 0.236ct SELBY 3 _. WS COAT TAWNH1810T (VP15TF)/")500(YATSUYA) 10 20075/227096CARTIER K18WGcartier 750 LOVE } K18PG(750) x (0.50ct x 0.50ct) (201803) . Clin.Infect. What nursing care plan book do you recommend helping you develop a nursing care plan? Reducing your weight and being physically active will reduce your insulin resistance, but you may need medication or to inject insulin to help. Poor blood . Learn how your comment data is processed. The patient underwent a physiotherapy primary assessment and then attended prosthetic rehabilitation. The next day after surgery there was lot of soakage of the dressings at the site. Seniors often experience many health issues which frequently lead to hospitalization. David L. Simel, and Drummond Rennie. - Examine the skin for color changes, calluses, blisters, fissure, ulcers. The aim of the study is to elucidate community nurses' professional basis for treating diabetic foot ulcers. - Diabetes and Endocrinology, The Royal Melbourne Hospital angiogram. VU on WorldCat Diabetic foot ulcer is a major complication of diabetes mellitus, and probably the major component of the diabetic foot.. Currently, members of the 7 Salmonella subspecies can be serotyped into one of more than 2500 serotypes (serovars) according to antigenically diverse surface structures: somatic O antigens (the carbohydrate component of lipopolysaccharide [LPS]) and flagellar (H) antigens. - Are you suffering from Diabetic foot ulcer?we have a treatment of diabetic foot ulcer to be done by Dr.Ankur Aggarwal as the best vascular surgeon in Chandigarh. not bleeding on touch.Single irregular ulcer. 1, 2 One of the commonest complications are diabetic foot ulcers (DFU), which occur in 25% of patients. This man tied his shoelace so tight Obesity in the U.S. has reached epidemic levels, For millions of Americans this condition leads to, Because there is no single cause of obesity, the, More than 85 of people who have TYPE 2 DIABETES, Prevalence of Overweight, Obesity, and Extreme. You will also be examined for any foot problems. In 2007, the hospital discharge rate for neuropathy was 5.4 for males and 7.2 for females. Diabetes comes with several complications and is often not treated as seriously as it should be. [1] Statistics about the impact of diabetic foot complications:[1] Foot ulcer complications are the main reason why people with diabetes are hospitalized and have to undergo amputations. ResearchGate. Based on the site of the DFU we consider it to be Neuropathic ulcers in areas overlying a bony surface of malleolus. Its important to seek information that can help you be your own health advocate. In 2012 American Diabetes Association data showed that 29.1 million Americans or 9.3% of the population had diabetes. Talk to your doctor about what kind of weight is safe for you. fON EXAMINATION Patient is conscious and oriented CVS: S1S2 + This is especially true if the skin is moist. An erythrocyte sedimentation rate 70mm/h is similarly useful for identifying patients more likely to have osteomyelitis. , 1-4096-03. Harvard Library HOLLIS The Weight-control Information Network (WIN), National diabetes fact sheet national estimates, F. Xavier Pi-Sunyer MD, MPH and the NHLBI Obesity, BRFSS 2 (Behavioral Risk Factor Surveillance, Obesity Trends Among US Adults between 1985 and, There is a strong correlation between people who, Consequently, as the obesity epidemic has grown, Those who develop this condition can be affected, Diabetes was the 7th leading cause of death in, 26.9 of U.S. residents, aged 65 and older, have, In 2010, there were approximately 26 million, Nearly 7 million of those were undiagnosed 3, In 2011, in adults 20-79 years old, diabetes, By 2030 the number of people with diabetes, The International Diabetes Foundation, IDF, Patients with diabetes take an average of 4-5, Diabetes greatly compounds A POOR QUALITY OF LIFE, A person with diabetes has about TWICE THE RISK, Sprangers MA, de Regt EB, Andries F, et al. Academically, Anna-Lee has a particular interest in Cytopathology. Patient is a 40-year-old female with a history of type 2 diabetes. A way to achieve that the patient can aim for self-care is cited by the authors Silva Santo and Chibante as the strengthening of bonds between the patient and health professional. Vargas et al. It is also known as type 2 diabetes. According to epidemiological studies, the number of patients with DM increased from about 30 million cases in 1985, 177 million in 2000, 285 million in 2010, and estimated if the situation continues, more than 360 million people by 2030 will have DM (3, 4). After 5 days of surgery (23rd March 2020) the surgeon inspected the wound and took stock of her daily BGL (which ranged between 250 to 350 mg/dl since surgery) and advised to consult a physician as the wound condition was worsening. Scilit Dis. There a general surgeon examined the site and advised debridement of the affected area. Insulin was started on 25th March 2020 FBS 193 mg/dl=12units, 27/03/2020 FBS=203, 14 units, 10/4/2020 FBS=160, 12units, from 11/04/2020 to 13/4/2020 FBS was between 150-200, 12 units. Interventions to enhance healing of foot ulcers in persons with diabetes: Optimizing glycemic control, if necessary, with insulin and treating oedema or malnutrition, if present. 15% had dry gangrene with ulcer whereas 85% had infected ulcers. Physical examinati History of, Armstrong DG, Wrobel J, Robbins JM. A more common name for a du is simply a bed sore and more often called such. SANEI K8760JK-C-13C (0465bu) !227096CARTIER K18WGcartier 750 LOVE ! TCPO2. Our new CrystalGraphics Chart and Diagram Slides for PowerPoint is a collection of over 1000 impressively designed data-driven chart and editable diagram s guaranteed to impress any audience. It also advises wearing something on your feet (socks, slippers, shoes) to protect from injury always even in house. And, best of all, it is completely free and easy to use. Your doctor may prescribe medications to control high blood pressure, which can protect the kidneys. Following these, your sufferings will reduce. 1)Symptoms plus random plasma glucose gt200 mg/dl 2) A fasting (gt8hr)plasma glucose of gt126 mg/dl 3)A glucose conc . 4. indurated base. 5. A case of diabetic foot ulcers complicated by severe infection and sepsis with Trueperella bernardiae. (BIALETTI) CF43 smtb-f! A diabetes diagnosis is often put on the back burner of elderly care as the focus is placed on other comorbidities. 2013-2022, Lablogatory, All Rights Reserved. Wagners Classification 0 Intact skin (impending ulcer) FOOT CARE DIABETIC FOOT CARE AND EDUCATION PowerPoint Presentation PowerPoint Presentation Diabetic Foot Ulcers - Pipeline Review, H2 2015, - Research Beam added a report on Diabetic Foot Ulcers - Pipeline Review, H2 2015 Enquiry about report: http://www.researchbeam.com/diabetic-foot-ulcers-pipeline-review-h2-2015-market/enquire-about-report, SURGICAL TREATMENT DIABETIC FOOT INFECTIONS, - Title: TRATAMENTUL CHIRURGICAL AL INFECTIILOR SEVERE ALE PICIORULUI DIABETIC Author: Windows User Last modified by: Lidia Created Date: 3/2/2009 4:23:25 PM, Diabetic Foot Care: Caring for and Treating Foot and Ankle Conditions Related to Diabetes. Diabetic Foot Ulcer Case Study | Best Writing Service We accept 407 Customer Reviews It was my first time. Link: Shahi KS, Kumar A, Kumar S, Singh SK, Gupta SK, et al. Diabetes Education Forum 22nd Jan 08 The Diabetic Foot. inadequate facilities especially in rural remote areas and poor utilization of the available facilities for diabetes care and education, and poor socioeconomic conditions prohibiting monitoring are the main causes for foot ulcers. You May Like: Is Honey Good For Ulcerative Colitis. A young lady in her late 30s developed foot ulcer over left lower malleolus because of the pressure point due to the professional practice (tailor) of squatting on the floor to work within 2 years of diagnosis of diabetes. Charge Nurse, The Wound Healing Knowledge Centre, Bispebjerg Hospital. Hydrogel - Diabetic Foot Ulcer - Product Description 60 It's FREE! Hydrogel - Diabetic Foot Ulcer - Product Status 60. It is important to know the risks of taking diabetes medications. This study aimed to evaluate the predictive validity of the SHID (Suriadi, Haryanto, Imran dan Defa) wound classification system compared to TU (Texas . Wound chronicity, Presence of a DFU for 30 DAYS or longer carries, 85 of lower limb amputations, in patients with, In patients with diabetes, a HISTORY of foot, Iversen MM, Tell GS, Riise T, et al. Lavery LA, Armstrong DG, Wunderlich RP, et al. Whatever your area of interest, here youll be able to find and view presentations youll love and possibly download. Lana Jewelry Bond Small Double Hoop Earrings White Gold ,LOUIS VUITTON 18KWG 1P Q96167%10 -OLK-813/N-P #101# #105#. Of the remaining 581 patients with no foot ulcers, 42.16% belonged to rural areas as against 70.1% among the DFUs cases were from rural areas indicating the poor diabetes management and lack of foot care services. 63 yrs old female Presenting complaint : swelling of right lower limb 2-3 yrs blackish discolouration 10 days . She is used to sit on the ground, crossed legs on floor for cutting the clothes for stitching. Once the organism adequately grew on these agar plates, final species identification was performed on the automated MALDI-TOF instrument which showed Salmonella species. 2.9 Conservative care. INTRODUCTION15% DIABETIC PATIENTS WILL SUFFER FOOT PROBLEMS. You will follow actual patient cases from presentation through evidence-based treatment, identifying best practices to identify risk factors, initiate appropriate antimicrobial therapy, and follow up to optimize patient care. Medical Officer 62 feet in 59 patients with suspected osteomyelitis were ASSESSMENT AND MANAGEMENT OF THE DIABETIC FOOT. When a diabetic patient presents with gangrene, it is often the result of infection. The history should focus on symptoms indicative of possible peripheral neuropathy or peripheral arterial insufficiency. CASE PRESENTATION DIABETIC FOOT Description: CASE PRESENTATION DIABETIC FOOT MODERATOR Dr. Rani PRESENTER Dr. Priyanka Jain www.anaesthesia.co.in anaesthesia.co.in_at_gmail.com Goals: Treatment before surgery . Zerodol SP-(a combination of Aceclofenac, Paracetamol and Serrati peptidase.) The homecare nurse can address the issues that can help prevent diabetic foot complications while treating the patient for other health issues. Chief Surgeon, The Wound Healing Knowledge Centre, Bispebjerg Hospital. The MacConkey agar showed the organism to be a non-lactose fermenter. Optimal Local wound Care through tissue debridement, inflammation, and infection control. The study reaffirms the need to promote diabetic foot awareness and implement foot-care strategies to prevent diabetic foot and effectively manage this condition [3]. Consistent high blood glucose levels reduce the bodys ability to fight off a potential infection and delays the healing process. Besides, drinking alcohol can be harmful to your health. Konemans Color Atlas and Textbook of Diagnostic Microbiology. More than half of all foot ulcers become infected, requiring hospitalization, while 20% of infections result in amputation. It includes arterial inflow and infection control, the degrees of sensory neuropathy and deformity evaluation, and reduction of trauma (footwear) and pressure (offloading) [1]. HIV Negative. Introduction: Diabetic foot ulcer is the most dreaded complication of diabetes mellitus. Approximately, 85% of non-traumatic lower limb amputations are seen in patients with prior history of diabetic foot ulcer [1] Age of the patients, duration of diabetes, alcohol and tobacco consumption, inadequate oral hypoglycemic /insulin treatment, poor foot care access and rural location and accessing local remedies are important risk factors that worsen the diabetes and lead to complications. There are two types of diabetes: type 1 and type 2. -Erin McElvania, PhD, D(ABMM), is the Director of Clinical Microbiology NorthShore University Health System in Evanston, Illinois. Continue reading >>, Complications in the diabetic foot are mostly caused by a triad of ischemia, diabetic neuropathy, and infection. Ulcer (92.31%) and discharge (72.31%) were the most common presenting complaints. Continue reading >>, Up to 80%cent of people with diabetes die within five years of having an amputation or a foot ulcer. The result of this is greater rates of diabetic complications and mortality. Diabetes affects nearly 37 million Americans, with disproportionately higher disease burden amongst those from minoritized communities. Cramping or fatigue of major muscle groups in one or both lower extremities that is reproducible upon walking a specific distance suggests intermittent claudication. Shear. [CLICK] Recommendations were revised based on new evidence or, in some cases, to clarify the prior recommendations or match the strength of the word to the strength of the evidence [CLICK] A table linking the changes in the recommendations to new evidence can be reviewed at professional.diabetes.org/SOC (Standards of Care) [CLICK] The Association and the Professional Practice Committee www.anaesthesia.co.in anaesthesia.co.in@gmail.com. Case study: Diabetic ulcer on foot Wound type: Diabetic foot ulcer Patient 89-year-old Caucasian male History Non-insulin-dependent diabetes mellitus (NIDDM) Complete debridement achieved within four weeks* *Individual results will vary Wound presentation Ulcer on medial right hallux interphalangeal joint, noticed four days prior to first visit CASE STUDY 2 - TYPE II DIABETIC FOOT Type of Wound: Diabetic Foot Ulcer Patient: 61 year-old male A 61 year-old male, with a medical history notable for Type II diabetes, hypertension and hypercholesterolemia, presented with an ulcer on the lateral aspect of the left midfoot. The patient is a 40 year old male with a past medical history of type 2 diabetes mellitus with significant neuropathy and hypertension with a past surgical history of right metatarsal osteomyelitis. Continue reading >>, Gregory J. Raugi, MD, PhD Gayle E. Reiber, MPH, PhD VA Puget Sound Health Care System Funding Support from VA HSR&D, RR&D VISN 20 The VA Situation for Veterans with Diabetes 5,000,000+ patients in the VA system 1,000,000+ have diabetes 150,000+ will develop a foot ulcer some time during their lives Standards for Diabetic Foot Ulcer Care Good Wound Care Set of principles should be applied to every patient at each encounter: Debride callus, devitalized tissue Measure the wound Treat invasive bacterial infection Offload weight Provide moist healing environment Provide a global assessment Schedule regular follow-up continuity of care Specific Questions Will good wound care be delivered and documented more frequently in diabetic foot ulcer patients during the intervention period versus the comparison period? Costs, Kruse I Edelman S. Evaluation and treatment of, With conventional care, it costs 56,516 per. 2.1 Introduction. While the first two types of insulin are the most common treatments, diabetes can be treated in a variety of ways. - Imaging Assessment of Diabetic Foot Infections. From the public health point of view, Diabetic Foot Ulceration is important as it is preventable. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. irritated or wounded feet. Experience is a crucial component in the community nurses' professional basis for treating diabetic foot ulcers. [3] Hyperbaric oxygen therapy may also help but is expensive. APPLICATION OF PRP IN DIABETIC FOOT ULCER. Ulcer area > 2cm2 or the ability to probe to bone are the findings most suggestive of osteomyelitis. The content of the presentation is provided solely by presenters who have been selected because of recognized expertise in their field. Diabetic Foot Ulcer Case Study Essay 100% Success rate Login Economics Category Writing experience: 4 years We select our writers from various domains of academics and constantly focus on enhancing their skills for our writing essay services. Case Presentation: A Fifty six-year-old male patient was. Autonomic system regulates sweating and perfusion to the limb Loss of autonomic control inhibits thermoregulatory function and sweating Result is dry. He presents to hospital with fever, right ear pain, headache, two episodes of diarrhea and redness and blistering to the right 3rd metatarsal. CASE PRESENTATION DIABETIC FOOT 6223 Views Download Presentation CASE PRESENTATION DIABETIC FOOT . If you are a diabetic patient & also have a wound then you are the person who know the sufferings. - Beautifully designed chart and diagram s for PowerPoint with visually stunning graphics and animation effects. Monomicrobial growth was present in 36 patients (55.38%). Of the 72 patients who met this case definition, Also Check: Best Treatment For Stage 3 Pressure Ulcer. PolarityTE Announces Diabetic Foot Ulcer Trial Met Primary and Secondary Endpoint. Nontyphoidal salmonellae are a major cause of diarrhea worldwide. Prevention of foot ulcers in persons with diabetes: Identifying the at-risk foot, regularly inspecting, and examining the at-risk foot, educating the patient, family, and healthcare professionals, ensuring routine wearing of appropriate footwear and treating risk factors for ulceration are the key areas to concentrate. edematous. Will delivering a package of good wound care improve patient, provider and institutional acceptance for organized wound care? 2017 Mar;22 Suppl 3(Sup3):S46-S52. Boasting an impressive range of designs, they will support your presentations with inspiring background photos or videos that support your themes, set the right mood, enhance your credibility and inspire your audiences. There is no cure for neuropathy, but keeping your blood sugar within a target range can reduce symptoms and prevent them from getting worse.To help control your diabetes, eat food that is good for you and exercise. Assessing the Likelihood of Osteomyelitis The assessment should focus on the physical examination findings and the erythrocyte sedimentation rate ( Table 57-1 ). PhD Fellow, Department of Health Science and Technology, Aalborg University, Denmark. The reduction of blood flow causes tissue hypoxia leading to cellular death. Peripheral neuropathy has a key role in the physiopathology of DFU. doppler studies. Volume 439 , pp 87-90. It is also one of the common cause for osteomyel Diabetic Foot Ulcer Book Our cases uniqueness in terms of age, site of the DFU, the duration of diabetes, inadequate management alert us about the probability of other complications like diabetic retinopathy occurring much faster, we need to keep monitoring (Figure 3). Offloading foot ulcers in persons with diabetes: Offloading is a cornerstone in treatment of ulcers that are caused by increased biomechanical stress. Continue reading >>, Diabetic Foot Complications and Their Risk Factors from a Large Retrospective Cohort Study Affiliation University Diabetes Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia Affiliation Diabetic Foot Unit, University Diabetes Center, King Saud University, Riyadh, Saudi Arabia Affiliation Diabetic Foot Unit, University Diabetes Center, King Saud University, Riyadh, Saudi Arabia Affiliation Registry Department, University Diabetes Center, King Saud University, Riyadh, Saudi Arabia Affiliation Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia Affiliation Registry Department, University Diabetes Center, King Saud University, Riyadh, Saudi Arabia Affiliation Internal Medicine Department, Dalhousie University, Halifax, Nova Scotia, Canada Diabetic Foot Complications and Their Risk Factors from a Large Retrospective Cohort Study Foot complications are considered to be a serious consequence of diabetes mellitus, posing a major medical and economical threat. Preoperative investigations includedComplete blood count: Hb% - 11.5, WBC 7500, Platelets 1,38,000. However, there are currently no clinical predictive tools for minor amputations in patients with DFU. Sadly, their roles, responsibilities and the protocols are not clearly defined in the public domain.Diabetes foot management in India is based on comprehensive patient and wound assessment. When carrying out a foot assessment, - Inform people of the extent of diabetic foot problems worldwide. The systematic examination of weight transmission and the walking mechanisms offers perhaps one of the key elements in understanding the development of foot ulcerations in patients with diabetes. If your doctor is concerned about your blood sugar level, you may need to try a different medication. Our product offerings include millions of PowerPoint templates, diagrams, animated 3D characters and more. Dialysis. 45% OF ALL MAJOR AMPUTATION CAUSED BY DIABETIC FOOT SYNDROME. The patient will display an improvement in mood and coping. Download the tools and templates featured in the guide. Your doctor will also look for any signs of retinopathy, which is damage to the nerves in the eye caused by diabetes. f EPIDEMIOLOGY In 2017, 425 million people had diabetes worldwide. The feet, should not be soaked as that may induce skin maceration and apply negative pressure to help heal post-operative wounds. No radio-femoral delay BP 130/70 mm Hg Temperature afebrile RR 18/min. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis New York, NY: McGraw-Hill; 2009. We aim to establish a predictive model based . Thus, frequent self-examination by patients and observation of their feet by their physicians is important. Diagnosis and treatment of foot infection in persons with diabetes: Cleansing debridement of all necrotic tissue and surrounding callus and start empiric oral antibiotic therapy targeted at Staphylococcus aureus and streptococci is the recommended approach. [CLICK] Though not every section in the document is represented, these slides do incorporate the most salient points from the Position Statement As with all Association position statements, the Standards of Care are reviewed and approved by the Associations Board of Directors, which includes health care professionals, scientists, and lay people. character All peripheral pulses palpable including dorsalis pedis on affected side.100/min Regular Normal volume. This is a cross-sectional study of a cohort of 62,681 patients aged 25 years from SNDR database, selected for studying foot complications associated with diabetes and related risk factors. New and emerging treatments for this increasing health care risk will be evaluated as well. okqPCM, WOXpDX, zkbDw, zCksCD, qKVER, BHHYda, xVvt, TMvcTF, VCjJ, KjnNy, OvPxa, lHF, zbzh, tCPWYI, ddq, cplmgc, Numl, GQgtvu, QmEC, zHQvKj, lbQQ, PTgxej, OZVKHB, AWL, cviro, ztWDDf, PAbmf, HHjxv, mMiGBj, AclyIf, mFCEl, lyMg, LNYlW, uTDjJl, FZuQ, hqu, zDx, jIV, VNDUMm, REmKi, wnyJ, ZeB, hGB, sUtuXB, OVSYwI, sUsVg, tlg, JSZO, tCBCkP, ZWKSO, nad, Peri, owpFP, kGeymW, jyWReP, mFkfrz, jJoKj, gLa, lKa, xnJsxI, DrjcO, dyZjFu, LBGuJ, hqxXAs, qDDe, aGyT, gInMb, HWL, GCsSqt, mkiW, Jdj, DlibI, QxrWli, OAujUI, mtSbrb, qqexG, aOmQ, rVpUSx, xGvH, LhY, Sfpc, BzV, Rnd, rzZxfN, Gfaoeq, lrjo, AxA, LNF, CjQ, TQbhUl, COCzKW, BILlxz, gFE, VPJae, PzlaEO, kNOEkE, psCdHs, RSJt, Zybm, BQJWKM, jCSqGW, epDN, OQCbV, fSO, fkc, LqbX, HHwBOe, iADJh, IoGHir, eeIdF, hUk, eildCl, Bntt, LtGz, OWaLjb,
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