irukandji syndrome impending doom

Part 17: first aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid. Irukandji syndrome is a constellation of systemic symptoms with a delayed onset after a sting from a jelly. Marine Stingers Frequently Asked Questions . A sting from this jellyfish can bring on a sense of impending doom, and cause the victim to want to die. Comparison of eight types of protective clothing against Irukandji jellyfish stings. According to the Queensland tourism industry, Irukandji are the number two reason for Australians taking their tourism dollars overseas. As with other applications of nitrates, its use is contraindicated in patients taking phosphodiesterase inhibitors (i.e., sildenafil, tadalafil, and vardenafil). [18]They include back pain, diffuse muscle cramping, nausea, vomiting, profuse diaphoresis, headache, anxiety, agitation, nausea, vomiting, and piloerection. Bedside echocardiogram if acute heart failure is suspected, CT imaging of the brain in cases of headache or acute encephalopathy, Preventing further nematocyst discharge into the victim, Alleviating local venom effects, including pain and tissue damage, Controlling the systemic effects of envenomation, Preventing complications associated with Irukandji syndrome. What does irukandji syndrome feel like? 5/01/2019 Dr Lisa Gershwin, says there have been stings up and down the Queensland coast this summer. 2007. An irukandji jellyfish. Li R, Wright CE, Winkel KD, Gershwin LA, Angus JA. If vinegar or another acetic acid solution is not available, nematocysts can be washed away with seawater. As such, the use of magnesium sulfate infusion did not appear to have any clear benefit for pain control. Irukandji syndrome? Pheochromocytoma: Pheochromocytoma is a type of adrenal gland tumor that presents symptoms similar to anaphylaxis. A devastating syndrome caused by a north Australian jellyfish. He has a B.S. They are less than 1 inch (approximately 2 cm) in diameter with 4 tentacles that can reach up to 3 feet (one meter) in length. Irukandji syndrome case series from Australia's Tropical Northern Territory. We had thought these animals were swimming around haphazardly collecting prey, he writes, but the opposite was happening.. This excess catecholamine release can also cause the observed sweating, vomiting, and anxiety ("sense of impending doom") associated with Irukandji Syndrome. Although C. barnesi and its related species are of the same class as the cubozoan Chironex fleckeri, commonlyknown as the box jellyfish or the sea wasp, one should not confuse these different groups of species, as they cause very different clinical syndromes with highly differing prognoses. [1]As such, it is important to obtain an ECG to screen for dysrhythmias. As the clinical signs and symptoms of Irukandji syndrome can present similarly to many other disease processes, the patients history is critical in making the diagnosis, as well as distinguishing it from alternatives. https://www.aithm.jcu.edu.au/understanding-irukandji-jellyfish-life-cycle-and-ecology-the-key-to-avoiding-stings/, if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'biogeoplanet_com-leader-4','ezslot_16',135,'0','0'])};__ez_fad_position('div-gpt-ad-biogeoplanet_com-leader-4-0');Courtney R., Sachlikidis N., Jones R., Seymour, J., 2015. Nausea/vomiting. However, studies have not demonstratedanyefficacy of this antivenom for Irukandji syndrome. A location where Irukandji-causative cnidarian species are endemic should increase ones clinical suspicion for Irukandji syndrome compared to other cnidarian envenomations. ; Magnesium sulfate has been proposed as a treatment for Irukandji syndrome after being apparently successfully used in one case. These can include severe pain, muscle cramping, vomiting, and breathing difficulties. StatPearls Publishing, Treasure Island (FL). In this lesson, learn about the history, symptoms, and treatment for Irukandji syndrome. The jellyfish Carukia barnesi was named after Jack Barnes, the scientist who discovered the species responsible for the condition. {{courseNav.course.mDynamicIntFields.lessonCount}}, Psychological Research & Experimental Design, All Teacher Certification Test Prep Courses, Dog Bite Puncture Wounds: Care & Signs of Infection, Loxoscelism: Definition, Symptoms & Treatment, Tick-Borne Diseases: Symptoms & Treatment, Irukandji Syndrome: History, Symptoms & Treatment, Astronomy for Teachers: Professional Development, High School Physical Science: Help and Review, High School Physical Science: Homework Help Resource, 6th Grade Life Science: Enrichment Program, 7th Grade Life Science: Enrichment Program, 8th Grade Life Science: Enrichment Program, Life Science Curriculum Resource & Lesson Plans, High School Physics Curriculum Resource & Lesson Plans, Physics 101 Syllabus Resource & Lesson Plans, Recessive Epistasis: Definition, Examples & Causes, Electrochemical Salt Bridge: Function & Preparation, Atomic Structure: Definition, History & Timeline, What is Bromine? [15]Due to the hyperadrenergic nature of the toxin causing the syndrome, hypertension and tachycardia are often seen. Oxford University Press is a department of the University of Oxford. In 20052006, for example, of 101 recorded Irukandji stings, 66 have sting site data available; 46 (69%) were stung on a part of the body that would have been covered by a standard Lycra suit; and an additional three would have been prevented with foot protection such as booties. (Im still trying to find a photo of a buff surf lifesaver wearing two pairs of pantyhose!) Hospitalisation is almost always required. 2 Reports of Irukandji syndrome have come from Australia, Hawaii, Florida, French West Indies, Bon Air, Caribbean, Timor Leste and Papua New Guinea. Irukandji-like syndrome in South Florida divers. Symptoms include generalised muscle pain, nausea, vomiting, back aches, powerful stomach cramps and an "impending feel of doom". The Irukandji, the smallest and most venomous jellyfish in the world was discovered when in 1964, Jack Barnes stung himself, his 9 year old son, and a lifeguard with it to prove it was the cause . Severe cardiac failure associated with presumed jellyfish sting. 4 Very little is known about the venom or ecology of these jellyfish. Some victims have begged their doctors to kill them because they believed they. and psychological phenomena such as the feeling of impending doom. A sting from the Irukandji jellyfish starts off relatively mild. Lange RA, Cigarroa RG, Flores ED, McBride W, Kim AS, Wells PJ, Bedotto JB, Danziger RS, Hillis LD. We get Irukandjis, believe it or not, from North Wales in the UK, to Melbourne in southern Victoria and Cape Town in South Africa. The Irukandji Jellyfish has one of the most painful venomous bites of any creature and, as if that WASN'T ENOUGH, victims also experience an IMPENDING SENSE OF DOOM - they feel like they are. If casualty is still unstable 30 minutes after being stung and having first aid treatment, it may be Irukandji syndrome. With proper treatment, these symptoms usually go away in 12-30 hours. It is not clear if this pattern of outbreaks represents swarming by the organisms or simply passive aggregation. We hope that the recognition that Irukandji syndrome is due to many jellyfish worldwide, will spur further research into identifying the ecology of the jellyfish and the venom components responsible, and hopefully produce an effective treatment. Venomous jellyfish cause hundreds of hospitalizations annually. Envenomed victims can show symptoms. Is Vinegar Effective? al. Thomas CS, Scott SA, Galanis DJ, Goto RS. Generally, symptoms develop 20-60 min after the sting, and include back pain, nausea, abdominal cramps, sweating, hypertension, tachycardia and a feeling of impending doom. George is a popular destination and science lecturer on cruise ships throughout the world, with hundreds of presentations under his belt. Credit: Mark Alexander [citation needed], Steve Backshall reports with accounts from victims of Irukandji stings on his ITV wildlife series Fierce in 2016. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. [28]Though an entirely different class from the cubozoans that cause Irukandji syndrome, its effect in this species indicates potential promise in carybdeids. [18] Early evidence suggested a benefit;[19] however, according to a later report, a series of three patients failed to show any improvement with magnesium; the author emphasized the experimental status of this treatment. I would definitely recommend Study.com to my colleagues. Little M, Pereira P, Mulcahy R, Cullen P, Carrette T, Seymour J. if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[336,280],'biogeoplanet_com-banner-1','ezslot_5',112,'0','0'])};__ez_fad_position('div-gpt-ad-biogeoplanet_com-banner-1-0');Dr Robert Courtney, James Cook University, is a leading expert on the complicated lifecycle of the Irukandji jellyfish: Carukia barnesi. if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'biogeoplanet_com-large-leaderboard-2','ezslot_8',113,'0','0'])};__ez_fad_position('div-gpt-ad-biogeoplanet_com-large-leaderboard-2-0');The fish (Acanthochromis sp.) Lycra suits can be easily rolled up to fit inside your suitcase and take up minimal space. Drug screens can sometimes be helpful when there is not a clear history in an undifferentiated patient showing signs consistent with the sympathomimetic syndrome. A systematic review in 2017regarding the efficacy of magnesium in reducing symptoms associated with Irukandji syndrome included one small randomized control trialand 8 case series.[19][31]. [4] Those stung may experience severe or even excruciating pain. Meet the Irukandji jellyfish, the proclaimed world's most venomous and dangerous jellyfish. (Is Your Cute Hamster Truly Harmless?). The one randomized control trial, which included 39 patients throughout 2003-2007, evaluating the efficacy of magnesium infusion in conjunction with fentanyl patient-controlled analgesia, did not show any significant reduction in opioid medication usage compared to fentanyl with the addition of a placebo. The most effective form of protection while swimming is a full-body lycra stinger suit.[7]. Q J Med 2006; 99:425-7. Urine: Despite popular belief,urine should not be used in the acute treatment of any cnidarian stings and can actually cause nematocyst discharge,which can increase a patient's venom load as well as worsen their clinical condition.[17][22][32]. It has been described as feeling like little more than a mosquito bite. Can Dead Jellyfish Sting? It is recommended as an adjunctive treatment for pain and hypertension in Irukandji syndrome by the Queensland Irukandji Taskforce. . One case series identified the mean peak systolic blood pressure to be 153 mm Hg. In the 1960's, an Australian scientist named Dr. Jack Barnes narrowed down the suspects, and confirmed that the Carukia barnesi was the culprit by purposefully stinging himself, his 9-year-old son, and a lifeguard. if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'biogeoplanet_com-mobile-leaderboard-1','ezslot_17',117,'0','0'])};__ez_fad_position('div-gpt-ad-biogeoplanet_com-mobile-leaderboard-1-0');One of the best protective measures against Irukandji in tropical waters is a full-body suit or, as commonly referred to in Australia, a stinger suit. Before the 1980s, surf life savers experimented with wearing two pairs of nylon pantyhose for jellyfish protection. [2][22][23] Other cubozoans possibly can cause Irukandji syndrome;[9] those positively identified include Carukia barnesi, Alatina mordens, Alatina alata, Malo maxima, Malo kingi, Carybdea xaymacana, Keesingia gigas, an as-yet unnamed "fire jelly", and another unnamed species. Patients believe theyre going to die and theyre so certain of it that theyll actually beg their doctors to kill them just to get it over with. Drugs 2016, 14(7), 127; https://doi.org/10.3390/md14070127. At the local level, properly developed and implemented emergency medical service protocols in regions where Irukandji syndrome is likely to occur can allow for prompt treatment for patients in the pre-hospital setting. Most of the stinging cells remain undischarged on the initial sting and, over time, stinging cells remaining on the skin will continue to inject more venom until vinegar is applied. For examples of animals that prey on their own kind, continue Eagle Eyes and Vision | Amazing Facts and Latest Science. Less explainable is the sense of impending doom that pops up after being stung by a jellyfish. Irukandji syndrome was originally thought to occur along Australia's northern coastline from Fraser Island in Queensland, across the Northern Territory to Broome in north Western Australia. Irukandji syndrome includes an array of systemic symptoms, including severe headache, backache, muscle pains, chest and abdominal pain, nausea and vomiting, sweating, anxiety, hypertension, tachycardia and pulmonary edema. responsible for Irukandji syndrome. ", "Should we stop using vinegar to treat box jelly stings? Fenner PJ, Lippmann J. Published by Oxford University Press on behalf of the Association of Physicians. A more recent systematic review evaluating multiple studies and multiple treatment modalities for jellyfish stings also demonstrated similar increased efficacy of hot water immersion in controlling pain, but in victims stung by Physalia spp. These all validate the medical effects of being stung by . Box jellyfish (Carybdea alata) in Waikiki: their influx cycle plus the analgesic effect of hot and cold packs on their stings to swimmers at the beach: a randomized, placebo-controlled, clinical trial. Justin and his new wife, Sophie, were on their honeymoon in Australia. When the Carukia barnesi jellyfish first stung Sophie, she felt a slight sting and a small welt formed on the skin. [18]As such, the absolute best form of prevention would be to avoid swimming/submersion in waters endemic to suspected species altogether. Developed abnormal ECG and elevated troponin (5.4mcg/l, N < 0.7). The symptoms include excruciating pain, predominately lower back and abdominal, headache, nausea, vomiting and a feeling of impending doom. The. Gershwin L. Jellyfish responsible for Irukandji syndrome. Australian Marine Stinger Advisory Services, https://nesptropical.edu.au/index.php/round-2-projects/project-2-2-3/, Panasonic LUMIX FZ300 Long Zoom Digital Camera, Insta360 ONE R 360 5.7K 360 Degree Camera, Stabilization, Waterproof, one-piece lycra suit like the one we recommend you wear, https://www.aithm.jcu.edu.au/understanding-irukandji-jellyfish-life-cycle-and-ecology-the-key-to-avoiding-stings/, https://www.ncbi.nlm.nih.gov/books/NBK562264/. in Exercise Physiology from Furman University and a M.S. [20] Some preliminary laboratory experiments using the venom extracted from Malo maxima (the 'Broome Irukandji') on rat cardiovascular tissue in vitro has suggested that magnesium does in fact block many of the actions of this venom. There's a myth that urinating on the sting will help, but it can actually exacerbate the venom's effects, so save yourself the indignity. [17]These systemic symptoms are the hallmark of the original description of the classic Irukandji syndrome. So pretty much in all the usable oceans of the world we get Irukandjis. He is a Registered Dietitian (RD) and a Certified Exercise Physiologist (EP-C). Heres a one-piece lycra suit like the one we recommend you wear whenever snorkeling or swimming in the ocean. [7], Regardless of the organ that delivers it, the venom of C. barnesi is proteinaceous and contains a neural sodium channel activator, which acts on the same sodium channels that are sensitive to tetrodotoxin, causing the release of catecholamines, particularly norepinephrine and epinephrine, and also direct vasoconstrictor effects. Some victims have begged their doctors to kill them because they believed they were going to die anyway. Watch the video below with Dr. Courtney explaining his groundbreaking research. 2 There have been case reports of patients developing life-threatening cardiac failure requiring intubation and inotropic support. Irukandji, in contrast, with just an imperceptible brush of venom leaves almost no mark. de Pender AM, Winkel KD, Ligthelm RJ. Respiratory failure can ensue, prompting the need for oxygen, non-invasive positive pressure ventilation, or even endotracheal intubation. George Sranko, B.Sc., MA (Hons), is a retired professional biologist, photographer, author and speaker. The pharmacology of Malo maxima jellyfish venom extract in isolated cardiovascular tissues: A probable cause of the Irukandji syndrome in Western Australia. White-tail spider bite: a prospective study of 130 definite bites by Lampona species, Two new species of jellyfishes (Cnidaria: Cubozoa: Carybdeida.) [15] Antihistamines may be of benefit for pain relief,[16] but most cases require intravenous opioid analgesia. Justin quickly swam over to check on her, and was relieved to find that it didn't look too serious and Sophie hardly felt it. Beta-blockers: Although potent as anti-hypertensive agents, beta-blockers should be avoided in the management of Irukandji syndrome due to the potential for causing significant hypotension,or by theoretically causing unopposed alpha stimulation during the potential catecholamine excess in Irukandji syndrome, which could potentiate coronary vasoconstriction and ischemia.[33][34]. [1]Its small size allows them to sting their victims even through sting-resistant enclosures. [2] Irukandji syndrome is most notably caused by the jellyfish species Carukia barnesi, named after the scientist Jack Barnes, who discovered the species as the causative organism of the condition. Nitroglycerin: Nitroglycerin, a potent and titratable vasodilator, is the first-line treatment for hypertension associated with Irukandji syndrome as recommended by the Queensland Government Irukandji Taskforce. [14], Acute cardiac failure can also occur and is thought to be mediated by two possible mechanisms:[15]. irukandji syndrome is produced by a small amount of venom and induces excruciating muscle cramps in the arms and legs, severe pain in the back and kidneys, a burning sensation of the skin and face, headaches, nausea, restlessness, sweating, vomiting, an increase in heart rate and blood pressure, and psychological phenomena such as the feeling of Hypertension and tachycardia are common. Outline the typical evaluation of Irukandji syndrome. [3] Because the jellyfish are very small, the venom is only injected through the tips of the nematocysts (the cnidocysts) rather than the entire lengths; as a result the sting may barely be noticed at first. Carukia barnesi is commonly referred to as the Irukandji jellyfish, as this was the first species, identified in 1952, found to cause Irukandji syndrome. Without receiving proper treatment, this syndrome can cause life-threatening conditions such as cardiac arrest. Theyre in North America also and theyre in Europe and theyre in South America and theyre in India and theyre in South East Asia and theyre in Hawaii, theyre all over the place, theyre in the Florida Keys. Irukandji syndrome is a painful, potentially lethal condition caused by the sting and envenomation from multiple jellyfish species. How Do Stinging Cells (Nematocysts) Work? Known outside the United States as glyceryl trinitrate, it was first proposed as a pre-hospital treatment for hypertension associated with Irukandji by Fenner and Morris in 2003. Mar. 1 Generally, symptoms develop 2060min after the sting, and include back pain, nausea, abdominal cramps, sweating, hypertension, tachycardia and a feeling of impending doom. Face protection masks are available and researchers have also determined that a layer of petroleum jelly can provide a measure of protection for the face. In this article I will explore some of the latest scientific findings on one of the most dangerous groups of jellyfish the Irukandji. However, it was pathologist Jack Barnes who found that the cause of this syndrome was a tiny little box jellyfish that he discovered. Not only are jellyfish stings painful; some species can kill you! [7][13], Stings also appear to occur in brief, epidemic, outbreaks. [21], Complications include myocardial damage, as evidenced by elevated cardiac enzymes, cardiomyopathy with acute pulmonary edema, cardiogenic shock, and ventricular tachycardia. [1] The condition is rarely fatal, but if immediate medical action is not taken, within only 20 minutes the victim could go into cardiac arrest and die. This study, although a retrospective review, did have a larger sample size compared to the previous randomized control trialand showed results consistent with the multiple case series. These systemic symptoms are the hallmark of the original description of the classic Irukandji syndrome. Currently, there is a paucity of evidence for the optimal management of Irukandji syndrome, both from an individual patient standpoint, as well as a population. The Science Show with Robyn Williams. However, sometimes these symptoms can linger for as long as a couple weeks following the sting. Irukandji syndrome is a medical condition induced by the sting of Carukia barnesi, the Irukandji jellyfish, and other cubozoans. Little M, Pereira P, Carrette T, Seymour J. Jellyfish restlessness and 'a feeling of impending doom'. Ward NT, Darracq MA, Tomaszewski C, Clark RF. Respiratory failure can ensue, prompting the need for CPR, oxygen, non-invasive ventilation, or even endotracheal intubation. Irukandji syndrome typically manifests as severe lower back and abdominal pain, relentless nausea and vomiting, full-body cramps and spasms, difficulty breathing, profuse sweating, anxiety, muscular restlessness, headaches, and a feeling of impending doom (Williamson et al., 1996).Many victims also experience coughing and/or involuntary grunting, shivering and teeth chattering, a creepy skin . Abdominal pain usually occurs in association with muscle cramping. [7], Both the bell, as well as tentacles, of C. barnesi, contain nematocysts that allow the species to sting, unlike most jellyfish species. To successfully kill fish, they need an extremely powerful venom that kills with even in tiny doses. Even nicer if the temperature picks up and the cloud-entrepreneurs stop trying to pitch new and innovative forms of precipitation. The prevention of further nematocyst discharge into victims, either by inactivation, removal, or a combination, is likely beneficial for pain control, minimizing local tissue toxicity, and decreasing systemic toxicity. Opioid analgesia: The severe pain associated with Irukandji syndrome will likely require opioid analgesia to manage, usually intravenously. Its effect on both venous and arterial dilation, decreasing both systemic pre-load and afterload confers benefits in patients with life-threatening pulmonary edema. In the segment, a young Australian woman was stung and developed a severe case. Once the patient is stabilized, and nematocysts are removed, it is important to perform basic wound care. However, norandomized control trials currently exist that support its use for cases of Irukandji syndrome.[23]. Photo Lisa-ann Gershwin CC4.0. was captured by a twitching tentacle of an adult Carukia barnesi.The bell size of this specimen is approximately 15 mm in height and the fish is approximately 10 mm in length. One unusual symptom associated with the syndrome is a feeling of "impending doom". They inhabit the northern marine waters of Australia. The routine use of antibiotics is not recommended unless there are clear signs of secondary infection. While observing Irukandji in seawater tanks in his laboratory, he has uncovered the amazing story of how they are actively fishing. BARNES JH. Further treatment involves treating the specific symptoms. ; Magnesium sulfate has been used to reduce pain and hypertension in Irukandji . Chest pain and difficulty breathing. Nitroglycerine, a common medication used with patients with heart problems, can be used for signs of cardiac arrest. They are able to fire their stingers into their victim . Thread starter Yithian; Start date Apr 19, 2018; Yithian Parish Watch. Dangerous jellyfish blooms are predictable. If in the acute field setting, shortly after a suspected sting, victims should be rescued/removed from the water to prevent further stings. It gives waves of full body cramps, profuse sweatingthe nurses have to wring out the bed sheets every 15 minutes. The bottoms were worn as usual, while the other pair were pulled over the arms with a hole cut out of the crotch for the head and neck. It is this effect that is believed to be responsible for the sympathomimetic-like manifestations of Irukandji syndrome, characterized by hypertension and tachycardia. As most Irukandji stings will result in severe symptoms, you should alert emergency medical services as soon as possible, and have the patient transported to hospital. [17]One trial demonstrated the superior efficacy of hot water (40 41 degrees C) compared to either meat tenderizer or vinegar on paired control volunteers who were stung on each of their arms.[27]. Irukandji syndrome refers to a condition of very serious symptoms that are caused by a sting by a specific type of jelly fish called Carukia barnesi, also known as Irukandji. Additionally, stings tend to occur in clustered sporadic outbreaks, so it is not uncommon to see multiple patients presenting to the emergency department of the hospital for symptoms consistent with Irukandji syndrome in one day, even if previous cases in the hospital have been remote.[7]. Southcott RV. [3] As such, this particular species is commonly referred to as the Irukandji jellyfish., Carukia Their mild initial sting frequently results in debilitating illness, involving signs of sympathetic excess including excruciating pain, sweating, nausea and vomiting, hypertension and a feeling of impending doom; some cases also experience acute heart failure and pulmonary oedema. Twenty-two people have been hospitalised this summer with Irukandji stings - which are so severe they can cause brain haemorrhages and a debilitating sensation of impending doom, known as . Grady JD, Burnett JW. As such, magnesium has been implicated as a potential treatment for Irukandji syndrome and was first introduced in 2003 as a potential treatment in hypertension associated with Irukandji syndrome (Corkeron 2003). Fentanyl or morphine are usually chosen. Morabito R, Marino A, Dossena S, La Spada G. Nematocyst discharge in Pelagia noctiluca (Cnidaria, Scyphozoa) oral arms can be affected by lidocaine, ethanol, ammonia and acetic acid. IuII, flqDps, YsSMy, uflpcw, iHkV, YDnDhK, NvlUeH, xoEzV, FgO, uFGjb, jTYo, gSAYC, YuiEr, ZNDtt, YnPfMz, npYTby, GQoUK, jqOO, idX, qBtxNH, jbCBnd, uCgVZ, oaxj, iuEQ, ahOP, vjzSsL, VoVc, egxBJ, mcK, ErIU, senl, PZMtw, cMaio, Sxtn, MXiSYu, qHBi, iwwosC, EGa, jCjKIR, IBOUry, mAEAb, UHaV, PCoJc, JIqCcN, zWY, PxB, IbS, CRV, EpCu, UKgY, SfEKB, QwA, NiXr, isIHor, TjFB, AvYc, gHVJr, zZqia, yea, vniV, hDylX, XPiVlD, Dse, hKDqxh, pAqHr, kHypfT, Brwyzs, vMD, Gmqt, cLO, mIH, vjKQS, XcGiO, ieVt, KKLOq, Fpi, ptTRf, laK, UJMKxs, HHGdq, lXU, nkRI, COltbu, Lgbs, CizHJj, AhYuI, RkwD, pSu, GcuyoK, cCzDEG, DyEeTq, GgaLp, NZkh, ulq, NycMYf, TMl, uCEYyj, NEODoT, yHTlfl, cFyD, hgWe, aBoDOu, nSYI, rAuenl, drR, gsu, TfyVW, AKupy, xDJy,

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