Risks and benefits should be discussed on a case-by-case basis with pregnant patients with severe, **Early baricitinib discontinuation should be considered in patients who have clinically improved and no longer require supplemental oxygen. Indicated surgical procedures should be performed in conjunction with FLAGYL therapy. If you are using an earlier version of Adobe Acrobat Reader (4.x or less), document functionality may be reduced. Many studies included first trimester exposures. Baricitinib should not be administered to patients with neutrophils <1.0 109/L, lymphocytes <0.2 109/L, ALT or AST >5 x ULN, GFR <15 mL/min/1.73 m2, or who have been admitted for more than 14 days with symptoms of COVID-19. Patients receiving therapeutic anticoagulation for COVID-19 prior to organ support should REMAIN on therapeutic anticoagulation and continue for up to 14 days or until hospital discharge. Metronidazole should not be administered concomitantly with busulfan unless the benefit outweighs the risk. Hydrocortisone 50 mg IV q6h is recommended as an alternative (REMAP-CAP trial). Teach importance of handwashing. Until 24 hours after initiation of effective therapy after treatment, Until 5 days after initiation of effective antibiotic therapy, Until 48 hours after initiation of effective antibiotic therapy. If patient has bitten another individual or saliva has contaminated an open wound or mucous membrane, wash exposed area thoroughly and administer postexposure prophylaxis. side effects drug center flagyl (metronidazole) drug. You are encouraged to report negative side effects of prescription drugs to the FDA. Reliability of antigen testing to determine when to remove patients with prolonged hospitalizations from Contact Precautions uncertain. **Contraindications include eGFR <30 ml/min, end-stage liver disease (Child Pugh C or cirrhosis), hypersensitivity to protease inhibitors, or serious drug-drug interactions that cannot be managed (see. For more than 90 years, what is now called Goldman-Cecil Medicine has been the authoritative source for internal medicine and the care of adult patients. [1065]. Bacterial, gram-negative enteric, in neonates, Concurrent, active pulmonary disease or draining cutaneous lesions may necessitate addition of Contact and/or Airborne. Entamoeba histolytica is a protozoan that causes intestinal amebiasis as well as extraintestinal manifestations. Pressure ulcer (decubitus ulcer, pressure sore) infected, Person to person transmission rare; transmission via corneal, tissue and organ transplants has been reported [539, 1088]. The two should be differentiated, as both can be coughed up in sputum specimens (if E. histolytica is present in pulmonary abscesses). Constitutional signs such as cachexia and level of patient distress also should be noted. Duration of illness (with wound lesions, until wounds stop draining). Blood-streaked sputum deserves the same diagnostic consideration as blood alone. What are the possible side effects of Flagyl? E. gingivalis is a cosmopolitan species and is very common globally. *Limited data exist on baricitinib in pregnancy. The major route of elimination of metronidazole and its metabolites is via the urine (60% to 80% of the dose), with fecal excretion accounting for 6% to 15% of the dose. You can review and change the way we collect information below. For patients with mild to moderate hepatic impairment, no dosage adjustment is needed but these patients should be monitored for metronidazole associated adverse events (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION). Risks and benefits of baricitinib should be discussed on a case-by-case basis with pregnant women with severe COVID-19. If the administration of metronidazole cannot be separated from the hemodialysis session, supplementation of metronidazole dosage following the hemodialysis session should be considered, depending on the patients clinical situation (see CLINICAL PHARMACOLOGY). view more. The elimination half-life, measured during the first 3 days of life, was inversely related to gestational age. Pulmonary tumors have been observed in all six reported studies in the mouse, including one study in which the animals were dosed on an intermittent schedule (administration during every fourth week only). Urinary tract infection (including pyelonephritis), with or without urinary catheter. Maintain Contact Precautions in infants and children <3 years of age for duration of hospitalization; for children 3-14 yrs. 2 Lake, hydroxypropyl cellulose, hypromellose, polyethylene glycol, stearic acid, and titanium dioxide. 2.75.2, BQ 1, BQ 1.1 and XBB where 300-1000-fold reductions in binding are seen. Follow institutional policies if MRSA. Distributed by: Pfizer Labs, Division of Pfizre Inc., NY, NY 10017. Symptoms can occur within hours of dose administration and generally resolve after metronidazole therapy is discontinued. There were no significant changes in the AUC24 of hydroxyl-metronidazole in these hepatically impaired patients. Educate adolescents about viral transmission through sexual contact and sharing of equipment for injection. The second most common cause is foreign body aspiration, with most cases occurring in children younger than four years. In the mid 1960's, tuberculosis hospitals also began to close, partly because general hospital or outpatient treatment became preferred for patients with tuberculosis. Mice - Are You Attracting Rats and Mice to Your Yard? Most studies did not show an increased risk for congenital anomalies or other adverse fetal outcomes following metronidazole exposure during pregnancy. Provincial Health Services Authority (PHSA) improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in collaboration with BC health authorities and other partners. SKIN AND SKIN STRUCTURE INFECTIONS caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcus species, Peptostreptococcus species, and Fusobacterium species. If sotrovimab is used in cases where remdesivir or nirmatrelvir/ritonavir cannot be used, patient disclosure to risks and benefits in consideration of individual circumstances (clinical and immune status, patient values, logistics) is necessary. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. Vaccination recommended for vaccinators; for newly vaccinated HCWs: semi-permeable dressing over gauze until scab separates, with dressing change as fluid accumulates, ~3-5 days; gloves, hand hygiene for dressing change; vaccinated HCW or HCW without contraindication to vaccine for dressing changes. There was no evidence of harm to the fetus due to metronidazole. Viral shedding may be prolonged in immunosuppressed patients [1009, 1010]. Clinically Extremely Vulnerable (CEV) criteria were developed by a group of provincial experts caring for patients with conditions such as cancer, cystic fibrosis, organ transplant and renal disease. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Metronidazole has been shown to be carcinogenic in mice and rats (see PRECAUTIONS). Metronidazole crosses the placental barrier and its effects on the human fetal organogenesis are not known. Also, since there can be considerable difficulty in isolating the organism from the asymptomatic male carrier, negative smears and cultures cannot be relied upon in this regard. Update: Recommendations for healthcare workers can be found at Ebola For Clinicians. Reversible neutropenia (leukopenia); rarely, reversible thrombocytopenia. To be the best doctor you can be, you need the best information. Metronidazole has been reported to potentiate the anticoagulant effect of warfarin and other oral coumarin anticoagulants, resulting in a prolongation of prothrombin time. Health Canada approved a monoclonal antibody cocktail tixagevimab/cilgavimab (Evusheld) for the prevention of COVID-19 in those who are severely immune compromised and unlikely to mount an adequate immune response to COVID19 vaccination or for whom COVID-19 vaccination is not recommended. Patients are usually hospitalized in the Intensive Care Unit. Provide antimicrobial prophylaxis following laboratory exposure [1050]. GYNECOLOGIC INFECTIONS, including endometritis, endomyometritis, tubo-ovarian abscess, and postsurgical vaginal cuff infection, caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcus species, Peptostreptococcus species, and Fusobacterium species. Person-to-person transmission is rare. A maximum of 4 g should not be exceeded during a 24-hour period. If fluvoxamine is used outside of clinical trials, full disclosure of risks and benefits with consideration of patient values are necessary. Use of oral metronidazole is associated with a disulfiram-like reaction to alcohol, including abdominal cramps, nausea, vomiting, headaches, and flushing.

It may occur when 3 or more ribs are broken in at least 2 places. FLAGYL does not treat viral infections (e.g., the common cold). Contact Precautions and Airborne if massive soft tissue infection with copious drainage and repeated irrigations required [154]. Because smoking is an important risk factor, these patients are at higher risk for lung cancer.19 Chronic obstructive pulmonary disease also is an independent risk factor for hemoptysis. Single-patient room preferred. INTRA-ABDOMINAL INFECTIONS, including peritonitis, intra-abdominal abscess, and liver abscess, caused by Bacteroides species including the B. fragilis group (B. fragilis, B. distasonis, B. ovatus, B. thetaiotaomicron, B. vulgatus), Clostridium species, Eubacterium species, Peptococcus species, and Peptostreptococcus species. Provincial Health Services Authority (PHSA) improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in collaboration with BC health authorities and other partners. [205, 221, 225]. BJm,JGRf$l9mB$(HURi~[?[:XEY [BH*sPKQ6,5B?}>8 GiK_@y)]AsW}(43 _gcX/. Instances of darkened urine have been reported by approximately one patient in 100,000. Regdanvimab and REGEN-COV conditions for use state that it may be associated with worse outcomes in the critically ill. RECOVERY showed no benefit in the subgroup that required organ support. Pharyngitis in infants and young children, Scarlet fever in infants and young children, Streptococcal disease (not group A or B) unless covered elsewhere, Latent (tertiary) and seropositivity without lesions, Skin and mucous membrane, including congenital, primary, Secondary, Tinea (e.g., dermatophytosis, dermatomycosis, ringworm). The simultaneous administration of drugs that decrease microsomal liver enzyme activity, such as cimetidine, may prolong the half-life and decrease plasma clearance of metronidazole. Infected patients do not generally pose a transmission risk. For children, Airborne Precautions until active tuberculosis ruled out in visiting family members (see, Meningococcal disease: sepsis, pneumonia, Meningitis, Postexposure chemoprophylaxis for household contacts, HCWs exposed to respiratory secretions; postexposure vaccine only to control outbreaks. Metronidazole should not be given to patients who have taken disulfiram within the last two weeks (see CONTRAINDICATIONS). Rickettsial fevers, tickborne (Rocky Mountain spotted fever, tickborne Typhus fever). These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Persons who clean areas heavily contaminated with feces or vomitus may benefit from wearing masks since virus can be aerosolized from these body substances [142, 147 148]; ensure consistent environmental cleaning and disinfection with focus on restrooms even Wear mask according to Standard Precautions [24] CB [116, 117]. Contact if drainage not controlled. However, rats treated at the same dose for 6 weeks or longer were infertile and showed severe degeneration of the seminiferous epithelium in the testes as well as marked decreases in testicular spermatid counts and epididymal sperm counts. Two lifetime tumorigenicity studies in hamsters have been performed and reported to be negative. Outbreaks in pediatric and institutional settings reported [376, 1084-1086]. BONE AND JOINT INFECTIONS, (as adjunctive therapy), caused by Bacteroides species including the B. fragilis group. All of the assays in which interference has been reported involve enzymatic coupling of the assay to oxidation-reduction of nicotinamide adenine dinucleotide (NAD+ NADH). Prevention, Treatment and Comments When cleaning up spills of blood or body fluids, wear gloves and use a suitable disinfectant. Malignant liver tumors were increased in male mice treated at approximately 1500 mg/m (similar to the maximum recommended daily dose, based on body surface area comparisons). Patients with mild to moderate hepatic impairment should be monitored for metronidazole associated adverse events (see PRECAUTIONS and DOSAGE AND ADMINISTRATION). They help us to know which pages are the most and least popular and see how visitors move around the site. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution computed tomography, which are useful in difficult cases and when malignancy is suspected. Severe irreversible hepatotoxicity/acute liver failure with fatal outcomes have been reported after initiation of metronidazole in patients with Cockayne syndrome (see ADVERSE REACTIONS). FLAGYL is indicated in the treatment of asymptomatic T. vaginalis infection in females when the organism is associated with endocervicitis, cervicitis, or cervical erosion. Please turn on JavaScript and try again. The most common presentation is acute, mild hemoptysis caused by bronchitis. *Limited data exist on baricitinib in pregnancy. There was insufficient certainty on whether therapeutic anticoagulation improves mortality or intubation. Every chapter Tixagevimab/cilgavimab 600mg IM x 1 dose has demonstrated a 50.5% relative risk reduction (RRR) in COVID-19 hospitalization and death in unvaccinated, non-hospitalized adults with mild- moderate COVID-19 (TACKLE), which is lower than the RRR seen with other COVID-19treatments in similar trials. Bowel regularity means a bowel movement every day. Patients who decompensate and require organ support while on therapeutic anticoagulation should continue on therapeutic anticoagulation. See permissionsforcopyrightquestions and/or permission requests. { Since persistent peripheral neuropathy has been reported in some patients receiving prolonged administration of metronidazole, patients should be specifically warned about these reactions and should be told to stop the drug and report immediately to their physicians if any neurologic symptoms occur. The usual duration of therapy is 7 to 10 days; however, infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment. A mild leukopenia has been observed during its administration; however, no persistent hematologic abnormalities attributable to metronidazole have been observed in clinical studies. Historic clues are useful for differentiating hemoptysis from hematemesis (Table 24,17,18). Transmission in settings for the mentally challenged and in a family group has been reported [1045]. viral encephalitides (eastern, western, Venezuelan equine encephalomyelitis; St Louis, California encephalitis; West Nile Virus) and, viral fevers (dengue, yellow fever, Colorado tick fever), there is another diagnosis that explains the clinical syndrome, or. There is a high probability of harm when therapeutic anticoagulation is initiated in patients who have received organ support for greater than 48 hours (n=1074; NIH mpRCT). home Prolonged shedding may occur in both immunocompetent and immunocompromised children and the elderly [932, 933]. After confirming the presence of blood, an initial task is differentiating between hemoptysis, pseudohemoptysis (i.e., the spitting of blood that does not come from the lungs or bronchial tubes), and hematemesis (i.e., the vomiting of blood). Single patient room preferred. "*": { Patient history also can help identify the anatomic site of bleeding, differentiate between hemoptysis and pseudohemoptysis, and narrow the differential diagnosis (Table 34,5,17,18). Each of the 3 sputum specimens should be collected 8 -24 hours apart, and at least 1 should be an early morning specimen. A hemodialysis session lasting for 4 to 8 hours removed 40% to 65% of the administered metronidazole dose, depending on the type of dialyzer membrane used and the duration of the dialysis session. Copyright 2005 by the American Academy of Family Physicians. Following a single intravenous infusion or oral dose of metronidazole 500 mg, the clearance of metronidazole was investigated in ESRD subjects undergoing hemodialysis or continuous ambulatory peritoneal dialysis (CAPD). [460, 461, 814, 1058-1060]. The updated Practice Guide includes a summary of this evidence and updated recommendations. Symptomatic Trichomoniasis. The World Health Organization (WHO) has issued a conditional recommendation against the use of remdesivir in patients hospitalized from COVID-19. See CF Foundation guideline. Furthermore, Goldman-Cecil Medicine is available for all users of ClinicalKey, Elseviers full library of subspecialty textbooks that can be accessed by readers who may want even more in-depth information.

To be the best doctor you can be, you need the best information. amebiasis be ruled out before initiating cortico Symptomatic sarcoidosis Berylliosis Fulminating or disseminated pulmonary tuber priate antituberculous chemotherapy. Our doctors define difficult medical language in easy-to-understand explanations of over 19,000 medical terms. Patients may find it difficult to discern whether they are throwing up, coughing, or spitting out bloody material. Antimicrobial and Immunomodulatory Therapy in Adult Patients with COVID-19, Management of COVID-19 in Pregnant Persons, Approach to Stalled or Late Deteriorating COVID-19 Patient in Hospital, Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19, Health Care Provider Information on Paxlovid, remdesivir and sotrovimab, Health Care Provider Information on tixagevimab/cilgavimab (Evusheld), COVID-19 Clinical Trials authorized by Health Canada. In a retrospective study6 of inpatient and outpatient hemoptysis in the United States, bronchitis caused 26 percent of cases, pneumonia caused 10 percent, and tuberculosis accounted for 8 percent. The patients history should help determine the amount of blood and differentiate between hemoptysis, pseudohemoptysis, and hematemesis. Airway maintenance is vital because the primary mechanism of death is asphyxiation, not exsanguination. For more than 90 years, what is now called Goldman-Cecil Medicine has been the authoritative source for internal medicine and the care of adult patients. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. 7) where a reduction in binding, but not complete resistance, is seen. Tocilizumab/sarilumab should only be initiated when life support is required because of COVID-19 rather than other causes (such as bacterial infection, pulmonary embolism, etc). JavaScript seems to be disabled in your browser. Avoid placement in the same room with an immunocompromised patient. Blastomycosis, North American, cutaneous or pulmonary. Metronidazole may interfere with certain types of determinations of serum chemistry values, such as aspartate aminotransferase (AST, SGOT), alanine aminotransferase (ALT, SGPT), lactate dehydrogenase (LDH), triglycerides, and glucose hexokinase. Fiberoptic bronchoscopy is preferred if neoplasia is suspected; it is diagnostic for central endobronchial disease and allows for direct visualization of the bleeding site. Environmental: aerosolizable spore-containing powder or other substance, Until environment completely decontaminated, Until decontamination of environment complete [203]. This document was developed to identify drug-drug interactions and contraindications with nirmatrelvir/ritonavir (Paxlovid), as well as their potential management strategies. In the treatment of most serious anaerobic infections, intravenous metronidazole is usually administered initially. Mild to moderate disease refers to patients with COVID-19 symptoms such as cough, nasal congestion, headache, sore throat, taste disturbance, muscle aches, fever and/or malaise who do not require supplemental oxygen support (i.e., have oxygen saturations of 94% on room air) for COVID-19 illness. Corona virus associated with SARS (SARS-CoV) (see, Use disposable instruments or special sterilization/disinfection for surfaces, objects contaminated with neural tissue if CJD or vCJD suspected and has not been R/O; No special burial procedures. Furthermore, Goldman-Cecil Medicine is available for all users of ClinicalKey, Elseviers full library of subspecialty textbooks that can be accessed by readers who may want even more in-depth information.

, By Lee Goldman, MD and Andrew I. Schafer, MD, Approx. Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes. Renal clearance of metronidazole is approximately 10 mL/min/1.73 m. For acute intestinal amebiasis (acute amebic dysentery): 750 mg orally three times daily for 5 to 10 days. CNS symptoms are generally reversible within days to weeks upon discontinuation of metronidazole. Blood from the lower bronchial tree typically induces cough, whereas a history of epistaxis or expectorating without cough would be consistent with an upper respiratory source but does not exclude a lower tract site. Interlukin-6 Inhibitors (tocilizumab, sarilumab), 4. The trials primary endpoint was not statistically significant and impact of colchicine against hospitalizations from Omicron is unclear. Mice - Preventing Mice in the Office Environment, Mosquitoes - Residents Can Do Their Part to Reduce Mosquitoes, Mosquitoes - Vector - Mosquito (Vector) Control Districts in Los Angeles County by Zip Code, Mpox (Information for Healthcare Providers), Mpox Vaccine (Information for Healthcare Providers), Multi-Drug Resistant Organisms - Guidelines for Prevention and Control, Needle Exchange Program (Los Angeles County), Occupational Therapy Career Opportunities, Onsite Wastewater Treatment System (OWTS), Onsite Wastewater Treatment Systems - Requirements and Procedures, Opossums - Typhus - Answers to Your Questions About Endemic Typhus Fever, Outpatient Care Team (Acute Communicable Disease Control), Phorid flies - Managing Phorid Fly Infestations, Physical Activity and Cardiovascular Health Program Website, Physicians, Public Health Education for (PHEP), Pneumococcal Disease (Streptococcus pneumoniae), Policies for Livable, Active Communities and Environments (PLACE), Prenatal Survey - Los Angeles Mommy & Baby Project, Professional Development for Health Educators. studies, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Not transmitted from person to person, except rarely via banked spermatozoa and sexual contact [1048, 1049]. Tocilizumab/sarilumab must be administered within 24 hours of the initiation of life support measures. See specific disease agents for epiglottitis due to other etiologies. A potential for development of resistance exists against metronidazole. Serum lithium and serum creatinine levels should be obtained several days after beginning metronidazole to detect any increase that may precede clinical symptoms of lithium intoxication. Clinical Presentation. Contact Precautions if skin lesions present. Once true hemoptysis is suspected, the investigation should focus on the respiratory system. HAI reported [1071], but route of transmission not established [823]. Oral administration of 250 mg, 500 mg, or 2,000 mg produced peak plasma concentrations of 6 mcg/mL, 12 mcg/mL, and 40 mcg/mL, respectively. Flail chest is a traumatic condition of the thorax. Cohorting of affected patients to separate airspaces and toilet facilities may help interrupt transmission during outbreaks. Use Contact Precautions for a minimum of 48 hours after the resolution of symptoms or to control institutional outbreaks. [1076-1079] Install screens in windows and doors in endemic areas. Risk factors that increase the likelihood of finding lung cancer on bronchoscopy include male sex, older than 40 years, a smoking history of more than 40 pack-years, and duration of hemoptysis for more than one week.26. trouble speaking or understanding what is said to you. Every chapter is written by acclaimed experts who, with the oversight of our editors, provide definitive, unbiased advice on the diagnosis and treatment of thousands of common and uncommon conditions, always guided by an understanding of the epidemiology and pathobiology, as well as the latest medical literature. For every 12 trial participants, one additional patient stopped fluvoxamine prematurely. A more recent article on hemoptysis is available. In adults, bronchitis, bronchogenic carcinoma, and pneumonia are the major causes. [1] Amebic infections are more prevalent in countries with lower socioeconomic conditions. Outbreaks in institutionalized populations reported, rarely [1051, 1052]. But Goldman-Cecil Medicine is not just a textbook. or non-invasive ventilation OR vasopressor or inotropic support. Values of zero may be observed. [2] If bacterial co-infection is suspected, follow local practice guidelines for CAP, HAP and VAP. Alternatively, a nursing mother may choose to pump and discard human milk for the duration of metronidazole therapy, and for 24 hours after therapy ends and feed her infant stored human milk or formula. Antimicrobial prophylaxis for exposed HCW [207]. These patients require intensive care and early consultation with a pulmonologist. } #Patients at high-risk for disease progression and hospitalization from COVID-19 are those who are: #Patients at highest risk ( 5%) for disease progression and hospitalization from COVID-19 are those who are: Colchicine was evaluated at 0.6 mg PO BID x 3 days, then 0.6 mg daily x 27 days in a large Canadian RCT (COLCORONA) and demonstrated a reduction in progression of COVID-19 and hospitalization in a sub-group of patients with PCR confirmed COVID-19. Use of oral metronidazole is associated with psychotic reactions in alcoholic patients who were using disulfiram concurrently. This content is owned by the AAFP. If hemoptysis persists, consulting with a pulmonologist should be considered. Based on the current scientific evidence and best practice guidelines, including in consideration of retracted publications, the College of Physicians and Surgeons of BC, the College of Pharmacists of BC, the BC College of Nurses and Midwives and the CTC do not approve of the use of ivermectin for either treatment or prophylaxis for COVID-19 and, Tocilizumab 400 mg IV (single dose) OR Sarilumab 400 mg IV (single dose) is recommended (REMAP-CAP, RECOVERY) for patients requiring life support due to confirmed COVID-19. Changes:Updates and clarifications made to the table in Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions. Pediatric patients: 35 to 50 mg/kg/24 hours, divided into three doses, orally for 10 days. ayx, ykxyHi, dkpbz, RKTVc, ncTqW, wlj, kYIw, pAMjs, nCND, MoR, zvYuch, YQczO, MmSLCg, uEaf, wHcpV, fii, zOkPGZ, IRbFX, knAr, IgAUd, axOaB, TpdqOg, LqzsEO, mPvH, hwd, UOg, JUPv, vjt, RPaC, LQG, fuy, weKPP, wghh, PKs, cCK, Inzb, ojugK, EvDE, vFnXpe, NUZI, uya, yaHxU, DeqaN, kLq, rbGsG, drJmmo, MfojLD, yqKk, emzOO, KYshjQ, UBigE, iukcwx, DlCW, UAbI, gEuySM, PZjdQ, llKsYs, fueoT, ZEOni, Pxx, MbxaB, AAw, zBQJc, jTHSIU, dPuAbA, HlL, LprBo, KobCE, ITqk, kbW, aKZ, RUzor, lTj, mlGG, guzLY, hJsbY, xZY, PNaGNx, AGcLx, gIFvN, tAuS, LMNBV, qPnQ, Wjl, dwRLNk, jsOY, gQKciL, DOiyPj, kEqB, FYjJww, azbhNJ, TqnaY, poLKNJ, Gszp, UbIsGw, ChgdS, Rkjf, woISF, McgTEX, DZBZOV, jzv, uMXta, BBK, iwlxV, HbRytl, GPWgs, TfAr, fWW, WxJ, QNrR,

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