Κυτταρομεγαλοιός-CMV

ΣΥΓΓΕΝΗΣ ΛΟΙΜΩΞΗ ΑΠΟ ΚΥΤΤΑΡΟΜΕΓΑΛΟΙΟ (CMV)

Πρόκειται για μια κοινή λοίμωξη η οποία είναι μέρος της οικογένειας των ιών του έρπητα. Μόλις μολυνθεί ένα άτομο, ο ιός παραμένει αδρανής στο σώμα του για το υπόλοιπο της ζωής του.
Συγγενής λοίμωξη CMV συμβαίνει όταν μια μητέρα που έχει μολυνθεί με CMV, η λοίμωξη μεταδίδεται στο έμβρυο.

Η λοίµωξη από τον κυτταροµεγαλοϊό (cytomegalovirus, CΜV) είναι η πιο συχνή συγγενής λοίµωξη λόγω της ευρείας διασποράς του ιού και της µακροχρόνιας αποβολής του µετά από πρωτοπαθή ή υποτροπιάζουσα λοίµωξη. Οι πιθανότητες προσβολής του κυήµατος µετά πρωτοπαθή λοίµωξη της εγκύου είναι 15% – 50%, ενώ σε υποτροπή κατά την κύηση είναι 1%. Μετάδοση µπορεί να συµβεί σ όλη τη διάρκεια της κύησης, αλλά ο κίνδυνος βαριάς συγγενούς νόσου είναι µεγαλύτερος στους πρώτους 4-5 µήνες. Επίσης, ο ιός µπορεί να µεταδοθεί µε το θηλασµό.

Πώς μεταδίδεται ο CMV;

Ο CMV μεταδίδεται μέσω σωματικών υγρών: σάλιο, σπέρμα, αίμα, ούρα, τα κολπικά υγρά και το μητρικό γάλα.

Διάγνωση στην κύηση

Πρωτολοίμωξη στην κύηση συμβαίνει σε λιγότερο από 1% των γυναικών.

Συγγενής λοίμωξη CMV προκαλείται όταν μεταδίδεται ο ιός από τη μητέρα στο έμβρυο μέσω του πλακούντα. Ο πλακούντας είναι ένα όργανο που συνδέει το αναπτυσσόμενο έμβρυο στο τοίχωμα της μήτρας για να επιτρέψει πρόσληψη των θρεπτικών συστατικών, την απομάκρυνση των αποβλήτων και την ανταλλαγή αερίων μέσω της προσφοράς αίματος της μητέρας.
Οι περισσότερες περιπτώσεις συγγενούς CMV λοίμωξης προκαλούνται όταν μία έγκυος γυναίκα έχει προσβληθεί από τον ιό CMV για πρώτη φορά κατά τη διάρκεια ή λίγο πριν, εγκυμοσύνη.
Σε ορισμένες περιπτώσεις, μία προηγουμένως ανενεργή λοίμωξη CMV μπορεί να επανεμφανιστεί τη διάρκεια της εγκυμοσύνης, ως αποτέλεσμα εξασθενημένου ανοσοποιητικού συστήματος της μητέρας. Η έγκυος μπορεί επίσης να παρουσιάσει εκ νέου μόλυνση με ένα άλλο στέλεχος του ιού CMV με αποτέλεσμα να περάσει στο αγέννητο μωρό της.
Στις περισσότερες περιπτώσεις, όπου ο CMV έχει περάσει από τη μητέρα στο μωρό, ο ιός δεν προκαλεί καμία ζημιά στο έμβρυο. Ωστόσο, εάν μία μεγάλη ποσότητα του ιού έχει μεταδοθεί στο έμβρυο, μπορεί δυνητικά να προκαλέσει συμπτώματα και συναφείς ανωμαλίες.

Έλεγχος για CMV κύηση
Ανάγκη διαχωρισμού πρωτοπαθούς από δευτεροπαθή λοίμωξη.
Ανίχνευση ειδικών αντισωμάτων IgG & IgM.

  • IgG θετικα: υποδηλώνουν παλαιά λοίμωξη
  • IgM θετικά: υποδηλώνουν πρόσφατη λοίμωξη

Η δευτεροπαθής λοίμωξη διαγιγνώσκεται με την παρουσία θετικών IgG και αρνητικών IgM αντισωμάτων πριν την εγκυμοσύνη και με σημαντική αύξηση των τίτλων των αντισωμάτων IgG με ή χωρίς την παρουσία αντισωμάτων IgM.

  • CMV avidity test: πρόκειται για πιο ειδικευμένη εξέταση η οποία μπορεί να προσδιορίσει το χρόνο μόλυνσης.
  • Low avidity <30%: υποδηλώνει πρόσφατη λοίμωξη του τελευταίου τριμήνου
  • High avidity >60%: υποδηλώνει παλαιά λοίμωξη πέραν του τριμήνου ή δευτεροπαθή λοίμωξη
  • Αμνιοπαρακέντηση: συνιστάται 7 εβδομάδες μετά τη λοίμωξη (seroconversion) και μετά την 20η εβδομάδα κύησης. Η συγκεκριμένη εξέταση θεωρείται διαγνωστική και μπορεί να μας πει πραγματικά το κατά πόσον το έμβρυο έχει λοίμωξη.

Υπερηχογραφικά ευρήματα που σχετίζονται με CMV

  • Ενδομήτρια καθυστέρηση της ανάπτυξης του εμβρύου
  • Μικροκεφαλία
  • Υδροκεφαλία
  • Εγκεφαλικές αποτιτανώσεις
  • Ασκίτης, εμβρυικός ύδρωπας
  • Ολιγάμνιο
  • Υπερηχογενές έντερο
  • Ηπατικές αποτιτανώσεις

Ποια είναι τα σημάδια και τα συμπτώματα της συγγενούς λοίμωξης από CMV;

Περίπου το 90% των βρεφών που γεννιούνται με συγγενή CMV δεν εμφανίζουν κανένα σύμπτωμα κατά τη γέννηση (ασυμπτωματικά).
Ένας μικρός αριθμός των βρεφών με ασυμπτωματική συγγενή CMV λοίμωξη μπορεί να αναπτύξει κάποιο βαθμό απώλειας ακοής στα πρώτα χρόνια της ζωής του. Η απώλεια της ακοής μπορεί να κυμαίνεται από ήπια έως πλήρης.
Τα προβλήματα ακοής μπορεί να επηρεάσουν μόνο το ένα αυτί (μονόπλευρη απώλεια ακοής) ή μπορεί να προκαλέσει προβλήματα και στα δύο αυτιά (αμφοτερόπλευρη απώλεια ακοής). Τα παιδιά με αμφοτερόπλευρη απώλεια ακοής είναι πιθανό να παρουσιάσουν προβλήματα με την ομιλία και την επικοινωνία, καθώς μεγαλώνουν.

Ένα στα 10 μωρά που γεννήθηκαν με συγγενή CMV έχουν συμπτώματα κατά τη γέννηση. Αυτά περιλαμβάνουν:

  • ίκτερος – κίτρινο χρώμα του δέρματος και κιτρίνισμα του λευκού των ματιών
  • πνευμονία
  • εξάνθημα
  • ηπατο/σπληνομεγαλία
  • χαμηλό βάρος κατά τη γέννηση
  • σπασμούς
  • μικροκεφαλία (μικρό μέγεθος του κεφαλιού)
  • Ενδοµήτρια καθυστέρηση στην ανάπτυξη ή, σπανιότερα, προωρότητα.
  • Εκδηλώσεις γενικευµένης νόσου: Ηπατοσπληνοµεγαλία, ηπατίτιδα, ίκτερος, θροµβοπενία, πετεχειώδη και άλλα εξανθήµατα.
  • ΚΝΣ: Μικροκεφαλία, περικοιλιακές επασβεστώσεις και, σπανιότερα, σπασµοί, υδροκέφαλος και κυστικές βλάβες εγκεφάλου
  • Νευροαισθητηριακές: Νευρογενής βαρηκοΐα, χοριοαµφιβληστροειδίτιδα.
  • ∆ιαταραχές από τα δόντια, κυρίως τα νεογιλά (υποπλασία αδαµαντίνης).
  • Οι συγγενείς διαµαρτίες δεν είναι ιδιαίτερα συχνές και θεωρείται πιθανό ότι πρόκειται για τυχαία εµφάνισή τους σε νεογνά µε συγγενή λοίµωξη από CMV.

Ενώ μερικά από αυτά τα συμπτώματα μπορεί να αντιμετωπιστούν, μερικά μωρά θα αναπτύξουν μακροπρόθεσμα προβλήματα, ως αποτέλεσμα της μόλυνσης.

Έως και 90% των βρεφών που γεννιούνται με συγγενή CMV που έχουν συμπτώματα κατά τη γέννηση αναπτύσσουν μία ή περισσότερες σωματικές ή διανοητικές αναπηρίες.
Αυτές περιλαμβάνουν:

  • απώλεια ακοής (25-65%)
  • προβλήματα όρασης (12-22%)
  • νοητική καθυστέρηση (47-61%)
  • νευρομυικές διαταραχές (35-49%)
  • σπασμούς (11%)

Πρόγνωση και µόνιµες βλάβες.

Συµπτωµατική νόσο εµφανίζει το 10% περίπου των προσβληµένων νεογνών, από τα οποία το 20%-30% έχει κακή εξέλιξη. Η µακροχρόνια πρόγνωση των παιδιών µε συµπτωµατική συγγενή λοίµωξη που επιζούν δεν είναι καλή, επειδή των 90-95% εµφανίζουν µόνιµες βλάβες, όπως είναι η νευρογενής βαρηκοΐα (25-65%), νοητική υστέρηση (47-61%), νευροµυϊκές διαταραχές (35-49%), σπασµοί (11%) και χοριαµφιβληστροειδίτιδα (12-22%). .

Θεραπεία συγγενούς λοίμωξης από CMV

Συγγενής λοίμωξη από CMV μπορεί να αντιμετωπιστεί με αντιιικά φάρμακα (Ganciclovir). Αυτά δεν μπορούν να θεραπεύσουν τη λοίμωξη από CMV, αλλά μπορεί να επιβραδύνουν την πρόοδό της, αλλά σε ποσοστό περίπου 20% παρουσιάζουν τοξικότητα στο αίμα.

Ειδική πρόληψη δεν υπάρχει. Έχει παρασκευαστεί εµβόλιο από εξασθενηµένους ιούς, µε το οποίο επιτυγχάνεται οροµετατροπή αλλά δε φαίνεται να ελαττώνει τη συχνότητα της συγγενούς λοίµωξης και δεν συστήνεται προς το παρόν. Έτσι, το µόνο προληπτικό µέτρο που µπορεί να εφαρµοστεί είναι η αποφυγή των εστιών µόλυνσης, που είναι οι βρεφονηπιακοί σταθµοί και τα τµήµατα όπου νοσηλεύονται νεογνά ή ανοσοκατασταλµένοι ασθενείς. Σε ύποπτη ή βέβαιη λοίµωξη της εγκύου, µπορεί να γίνει διάγνωση των προσβεβληµένων εµβρύων µε υπερηχ- γράφηµα και ανίχνευση του ιού µε καλλιέργειες ή PCR στο αµνιακό υγρό ή το εµβρυϊκό αίµα και να δοθούν ανάλογες συµβουλές στους γονείς.

789 Comments

  1. Pingback:stromectol tablets 12 mg

  2. Pingback:buy ivermectin 6 mg

  3. Pingback:prednisone capsule

  4. Pingback:clivermectayl stromectol

  5. Pingback:stromectol 875 mg

  6. Pingback:safe place to buy propecia online

  7. Pingback:mail order prednisone

  8. Pingback:cialis 5mg online canada

  9. Pingback:cheap stromectol buy

  10. Pingback:is ivermectin generic

  11. Pingback:tadalafil lowest prices canada

  12. Pingback:soolantra 6 for rosacea therapy

  13. Pingback:zinc and zithramax

  14. Pingback:ventolin vs albuterol

  15. Im obliged for the article post.Really thank you! Keep writing.
    I think other site proprietors should take this website as an model, very clean and wonderful user genial style and design, as well as the content. You are an expert in this topic!
    It as not that I want to duplicate your web site, but I really like the design. Could you tell me which style are you using? Or was it custom made?

  16. You should take part in a contest for among the best blogs on the web. I will advocate this website!
    This blog was how do you say it? Relevant!! Finally I have found something that helped me. Many thanks!

  17. Pingback:zithromax online cheap

  18. Pingback:plaquenil 200mg scabies

  19. Pingback:generic hydroxychloroquine

  20. Pingback:the medicine lisinopril

  21. Pingback:ivermectin stromectol 3 mg tablet

  22. Pingback:cost of dapoxetine

  23. Pingback:ivermectin parasite kills list

  24. Hi are using WordPress for your site platform? I’m new to the blog world but I’m trying to get
    started and set up my own. Do you require any html coding knowledge to make your own blog?
    Any help would be really appreciated!

  25. Hello just wanted to give you a quick heads up
    and let you know a few of the pictures aren’t
    loading correctly. I’m not sure why but I think its a
    linking issue. I’ve tried it in two different web browsers and
    both show the same results.

  26. ust wanted to give you a quick heads up and let you know a few of the pictures aren’t loading correctly. I’m not sure why but I think its a linking issue

  27. Pingback:azithromycin walgreens over the counter

  28. Pingback:oral ivermectin for head lice

  29. Pingback:ivermectin dosage for mange

  30. Good day! Would you mind if I share your blog with
    my facebook group? There’s a lot of people that I think would really appreciate your content.
    Please let me know. Thanks

  31. Good day I am so happy I found your blog page, I really found you by accident,
    while I was researching on Google for something else, Regardless I am here now and
    would just like to say thanks a lot for a remarkable post and a all round thrilling blog (I also love the theme/design), I don’t have time to read through it all at
    the moment but I have bookmarked it and also added your RSS feeds,
    so when I have time I will be back to read more, Please do keep up the
    great job.

  32. Pingback:azithromycin can you buy over counter

  33. Hello there! This is kind of off topic but I need some guidance from an established blog.
    Is it difficult to set up your own blog? I’m not very techincal but I can figure things out pretty quick.

    I’m thinking about creating my own but I’m not sure where to begin. Do you have any tips or suggestions?
    Appreciate it

  34. Magnificent goods from you, man. I have understand your stuff previous to and you are just too wonderful.
    I really like what you’ve acquired here, certainly like
    what you’re saying and the way in which you say it. You make it enjoyable and
    you still care for to keep it wise. I can not wait to read
    far more from you. This is actually a terrific site.

  35. Having read this I thought it was very informative. I appreciate you finding the time
    and energy to put this information together. I once again find myself
    personally spending way too much time both reading and
    posting comments. But so what, it was still worth it!

  36. Pingback:sildenafil in canada

  37. Pingback:20 mg sildenafil 680

  38. I have been exploring for a little bit for any high-quality articles or blog posts on this kind of space .
    Exploring in Yahoo I eventually stumbled upon this web site.

    Studying this information So i am satisfied to convey that I’ve a very good uncanny
    feeling I found out exactly what I needed. I such a lot surely will make sure to do not forget this site and
    provides it a glance on a relentless basis.

  39. I really like your blog.. very nice colors & theme. Did you
    design this website yourself or did you hire someone to do it for
    you? Plz answer back as I’m looking to create my own blog and would
    like to know where u got this from. appreciate it

  40. Howdy! This post couldn’t be written any better!
    Reading through this post reminds me of my previous
    room mate! He always kept talking about this.

    I will forward this write-up to him. Pretty sure he will have
    a good read. Thanks for sharing!

  41. Hey I am so glad I found your site, I really found you by accident, while I was searching on Digg for something
    else, Anyhow I am here now and would just
    like to say thanks a lot for a fantastic post and a
    all round thrilling blog (I also love the theme/design), I
    don’t have time to look over it all at the minute but I have bookmarked it and also added your RSS feeds, so when I
    have time I will be back to read a lot more, Please do keep up
    the great work.

  42. I like the valuable information you provide in your articles.
    I will bookmark your weblog and check again here regularly.
    I’m quite certain I’ll learn lots of new stuff right here!
    Best of luck for the next!

  43. You’ve made some really good points there. I looked
    on the internet to learn more about the issue and found most individuals will go along with your views on this website.

  44. Good day! I just wish to offer you a huge thumbs up for the
    excellent information you have got right here
    on this post. I am returning to your web site for more soon.

  45. Attractive section of content. I just stumbled upon your site and in accession capital to assert that I acquire actually enjoyed account your blog posts.
    Anyway I’ll be subscribing to your augment and even I achievement you
    access consistently quickly.

  46. You’re so awesome! I don’t suppose I’ve read through anything like this before.

    So nice to discover someone with some original thoughts on this issue.
    Really.. thank you for starting this up. This site is something that’s needed on the web, someone with a bit
    of originality!

  47. Hello to all, how is the whole thing, I think every one is getting more from this website, and your views are
    pleasant in support of new viewers.

  48. Pingback:how to get prescription drugs without doctor

  49. I like the helpful info you provide in your articles. I’ll bookmark your
    weblog and check again here frequently. I am quite
    sure I will learn plenty of new stuff right here! Best of luck
    for the next!

  50. Nice post. I learn something totally new and challenging on blogs
    I stumbleupon on a daily basis. It will always be useful to read articles from
    other writers and practice a little something from their sites.

  51. I got this web site from my friend who shared with me concerning this web page
    and at the moment this time I am browsing this web site and reading very informative articles at this place.

  52. My spouse and I stumbled over here coming from a different web address and thought I should
    check things out. I like what I see so i am just following you.
    Look forward to looking at your web page repeatedly.

  53. Good day I am so excited I found your weblog,
    I really found you by error, while I was researching on Digg for something else,
    Anyways I am here now and would just like to
    say thank you for a fantastic post and a all round enjoyable blog (I also love the
    theme/design), I don’t have time to look over it all at the moment but I have saved
    it and also included your RSS feeds, so when I have time I will be back to read a lot more,
    Please do keep up the superb job.

  54. Pingback:meritroyalbet

  55. After looking into a handful of the blog posts on your website, I really
    like your technique of writing a blog. I saved as a favorite it to my bookmark website list and will be checking back in the near future.
    Take a look at my web site as well and tell me what you think.

  56. I like the valuable information you supply on your articles.
    I’ll bookmark your blog and check once more here regularly.

    I am somewhat sure I will be informed many new stuff right right here!
    Good luck for the following!

  57. I was curious if you ever thought of changing the page
    layout of your blog? Its very well written; I love what youve
    got to say. But maybe you could a little more in the way of content so people could connect with it better.
    Youve got an awful lot of text for only having one or two images.
    Maybe you could space it out better?

  58. Pingback:meritroyalbet

  59. Pingback:madridbet

  60. Pingback:meritroyalbet

  61. Pingback:makrobet

  62. Pingback:Google

  63. Pingback:slot siteleri

  64. Pingback:arzbet

  65. Pingback:arzbet

  66. Pingback:hydroxychloroquine for sale walmart

  67. Pingback:aspercasino

  68. Pingback:aspercasino

  69. Pingback:aspercasino

  70. Pingback:stromectol pills for sale

  71. Pingback:meritroyalbet

  72. Pingback:can you buy viagra over the counter in south africa

  73. lasix iv dosage can furosemide get you high a nurse is reviewing the ecg of a client who is receiving iv furosemide for heart failure

  74. Hello there! Quick question that’s totally off topic.
    Do you know how to make your site mobile friendly? My web site looks weird when browsing from my
    apple iphone. I’m trying to find a template or
    plugin that might be able to resolve this issue.
    If you have any recommendations, please share.
    With thanks!

  75. Nice blog here! Also your site loads up fast!
    What web host are you using? Can I get your affiliate
    link to your host? I wish my web site loaded up as quickly
    as yours lol

  76. Admiring the persistence you put into your website
    and in depth information you present. It’s awesome to
    come across a blog every once in a while that isn’t
    the same out of date rehashed information. Wonderful read!
    I’ve bookmarked your site and I’m adding your RSS feeds to my Google account.

  77. Howdy! Do you know if they make any plugins to assist with Search Engine Optimization? I’m trying to get my blog to
    rank for some targeted keywords but I’m not seeing very good results.
    If you know of any please share. Thanks!

  78. Pingback:generic tadalafil australia

  79. Hi would you mind sharing which blog platform you’re
    working with? I’m going to start my own blog in the near future but I’m having a hard time selecting between BlogEngine/Wordpress/B2evolution and Drupal.
    The reason I ask is because your layout seems different then most blogs and I’m looking for
    something unique. P.S Sorry for getting off-topic but I had to ask! http://herreramedical.org/acyclovir

  80. Hi would you mind sharing which blog platform you’re working with?
    I’m going to start my own blog in the near future but I’m having a hard time selecting between BlogEngine/Wordpress/B2evolution and Drupal.
    The reason I ask is because your layout seems different then most blogs and I’m looking for something unique.
    P.S Sorry for getting off-topic but I had to ask! http://herreramedical.org/acyclovir

  81. Pingback:can you purchase viagra over the counter in mexico

  82. Pingback:eurocasino

  83. Pingback:kronosslot

  84. office colleagues to visit your web site at least thrice every week to learn the newest tips you have. And of course, I’m just actually happy considering the wonderful knowledge you give. Selected 3 ideas in this posting are easily the most beneficial we have had.

  85. Pingback:meritking

  86. Excellent beat ! I wish to apprentice while you amend your web site, how could i
    subscribe for a blog site? The account helped
    me a acceptable deal. I had been tiny bit acquainted of this your broadcast offered bright
    clear concept

  87. Do you mind if I quote a few of your articles as long as
    I provide credit and sources back to your website?
    My blog site is in the exact same area of interest as yours and my users would really benefit from some of the information you present here.
    Please let me know if this alright with you. Thank you!

  88. Pingback:elexusbet

  89. Aw, this was a really nice post. Taking a few minutes and actual
    effort to create a superb article… but what can I say… I put things off
    a lot and never seem to get anything done.

  90. I have been browsing online more than 4 hours today, yet I
    never found any interesting article like yours. It’s pretty worth enough for
    me. In my view, if all webmasters and bloggers made good content as you did, the web
    will be much more useful than ever before.

  91. Wonderful beat ! I would like to apprentice at the same time
    as you amend your site, how can i subscribe for a blog website?
    The account helped me a appropriate deal. I had been tiny bit familiar of this your broadcast provided vivid transparent idea

  92. I believe this is among the such a lot significant info for
    me. And i am happy reading your article.
    But should statement on some normal things, The site style is wonderful, the articles is in point
    of fact excellent : D. Just right activity, cheers

  93. Hello, i think that i saw you visited my site thus i
    came to “return the favor”.I’m trying to find things to enhance my
    site!I suppose its ok to use a few of your ideas!!

  94. Hi there! This is kind of off topic but I need some guidance
    from an established blog. Is it hard to set up your own blog?
    I’m not very techincal but I can figure things out pretty fast.
    I’m thinking about creating my own but I’m not sure where to begin. Do you
    have any tips or suggestions? Appreciate it

  95. Do you mind if I quote a few of your articles as long as I provide credit
    and sources back to your webpage? My website is in the very same niche as yours and my visitors would genuinely benefit from some of the information you present here.
    Please let me know if this ok with you. Thanks!

  96. With havin so much content do you ever run into any
    problems of plagorism or copyright infringement?
    My blog has a lot of exclusive content I’ve either created myself or outsourced
    but it appears a lot of it is popping it up all over
    the web without my authorization. Do you know any ways to help prevent content from being ripped off?
    I’d really appreciate it.

  97. What i do not understood is if truth be told how you are no longer
    actually much more smartly-liked than you might be now.
    You’re very intelligent. You recognize therefore considerably
    in relation to this topic, produced me personally consider it from so
    many numerous angles. Its like women and men don’t seem to be involved except it’s something
    to do with Woman gaga! Your personal stuffs great.
    At all times take care of it up!

  98. I’ve read several good stuff here. Certainly worth bookmarking for revisiting.

    I surprise how so much effort you place to make such a excellent informative web site.

  99. Pingback:stromectol ivermectin

  100. Pingback:meritroyalbet

  101. Pingback:meritking

  102. Pingback:child porn

  103. Pingback:child porn

  104. Pingback:madridbet

  105. Pingback:viagra or cialis

  106. You can certainly see your enthusiasm in the work you write.

    The arena hopes for even more passionate writers such as you who aren’t afraid to
    say how they believe. All the time go after your
    heart.

  107. I’ve been browsing online greater than three hours today, yet I by
    no means found any interesting article like yours.
    It’s lovely price sufficient for me. In my view,
    if all web owners and bloggers made just right content
    material as you probably did, the internet will likely
    be a lot more helpful than ever before.

  108. Oh my goodness! Awesome article dude! Many thanks,
    However I am encountering difficulties with your RSS.
    I don’t know why I can’t join it. Is there anyone else getting the same RSS issues?
    Anybody who knows the solution can you kindly respond?
    Thanks!!

  109. Pingback:perabet

  110. Pingback:madridbet

  111. Hey there! I just wanted to ask if you ever have any problems with hackers?
    My last blog (wordpress) was hacked and I ended up losing several weeks of hard work due to no data backup.
    Do you have any solutions to prevent hackers?

  112. Pingback:eurocasino

  113. Pingback:trcasino

  114. Pingback:elexusbet

  115. Pingback:trcasino

  116. Pingback:tombala siteleri

  117. Pingback:tombala siteleri

  118. Pingback:tombala siteleri

  119. chwilówka za darmo darmowe chwilówki Bazy mogą także pożyczać bardziej wartościowe sumy kasy niż własna instytucja pożyczkowa, ponieważ pełnią dostęp zarówno do kapitału, jak i również innych instytucji pożyczkowych, które oferują kredyty osobiste i biznesowe. Pożyczki własne są przeważnie najłatwiejsze do uzyskania, dlatego, że są niezabezpieczone i jest dozwolone je dostać bez konieczności ustanawiania bezpieczeństwa.

  120. Pingback:meritroyalbet

  121. Pingback:meritroyalbet

  122. Pingback:meritroyalbet

  123. Pingback:Anonymous

  124. Awesome website you have here but I was wondering if you
    knew of any discussion boards that cover the same topics discussed here?
    I’d really love to be a part of group where I can get feed-back from other experienced people that share the same interest.
    If you have any recommendations, please let me know.
    Thanks a lot!

  125. Pingback:Anonymous

  126. Pingback:Anonymous

  127. Magnificent site. Lots of helpful info here. I am sending it to several buddies ans additionally sharing in delicious. And of course, thanks to your effort!

  128. Pingback:duricef

  129. Pingback:ciprofloxacin ivpb

  130. Pingback:bactrim ds

  131. Pingback:erythromycin prices

  132. Pingback:bactrim lawsuits

  133. pożyczki za darmo pożyczki za darmo Banki są wspaniałym źródłem kredytów mieszkaniowych osobistych, bo sam bank jest pożyczkodawcą i pojmuje procesy powiązane z większością pożyczek. C, sposób ANOVA glówny wynik Eksperymentu, ps <, demonstrujacy zalamanie iluzji przedramienia w stanie drewna, nawet w celu niewielkich róznic.

  134. chwilówki za darmo darmowe chwilówki Regresja logistyczna ze stalymi efektami na Perspektywie jak i również Cialo a także efektami losowymi na osobnikach pokazuje, ze nie bylo efektu interakcji p =. Niedobry kredyt nie w każdym przypadku oznacza, że nie potrafisz skorzystać zręcznością pożyczki.

  135. Pingback:keflex injection

  136. You actually make it seem so easy along with your presentation however I to find this topic to be actually one thing which I think I might by no means understand. It kind of feels too complex and very extensive for me. I am having a look forward in your subsequent submit, I will try to get the hang of it!

  137. Today, I went to the beach front with my kids. I found a sea shell and gave it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She placed the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is completely off topic but I had to tell someone!

  138. Whoa! This blog looks exactly like my old
    one! It’s on a entirely different subject but it has pretty much the
    same layout and design. Wonderful choice of colors!

  139. I am genuinely grateful to the owner of this website who has shared this
    great post at at this time.

    My website … buy

  140. Pingback:meritroyalbet

  141. Pingback:madridbet

  142. Pingback:eurocasino

  143. Hi there! This article could not be written any better! Reading through
    this post reminds me of my previous roommate! He always
    kept preaching about this. I most certainly will send this post to him.

    Fairly certain he’s going to have a great read. Thank you for sharing!

  144. It’s appropriate time to make some plans for the future and it’s time to be happy.
    I have read this post and if I could I desire to suggest
    you few interesting things or suggestions. Maybe you could write next articles referring to this article.
    I desire to read even more things about it!

  145. That is very attention-grabbing, You’re an excessively professional blogger.
    I’ve joined your rss feed and look ahead to searching for more of
    your great post. Additionally, I’ve shared your web
    site in my social networks

  146. Hi are using WordPress for your blog platform? I’m new to the blog world but I’m trying to get started
    and create my own. Do you need any coding knowledge to make
    your own blog? Any help would be really appreciated!

  147. You are so interesting! I do not think I have read through a single thing like
    that before. So good to find someone with some genuine thoughts on this subject matter.
    Really.. thanks for starting this up. This web site is something that’s needed on the internet, someone with a bit of originality!

  148. I’m not sure exactly why but this blog is loading incredibly slow for
    me. Is anyone else having this problem or is it a problem on my end?
    I’ll check back later and see if the problem still exists.

  149. excellent issues altogether, you just gained a emblem new reader.
    What could you suggest in regards to your publish that you
    just made a few days in the past? Any certain?

  150. Fantastic goods from you, man. I’ve understand your stuff
    previous to and you’re just extremely fantastic.
    I really like what you have acquired here, certainly like what you’re stating and the way in which
    you say it. You make it enjoyable and you still
    care for to keep it smart. I can’t wait to read much more from you.
    This is really a great site.

  151. That is a really good tip especially to those fresh to the
    blogosphere. Simple but very precise information… Thanks for sharing this one.
    A must read post!

  152. Unquestionably believe that which you stated. Your favorite
    justification appeared to be on the net the simplest thing to be aware of.

    I say to you, I definitely get annoyed while people think about worries that they just do not know
    about. You managed to hit the nail upon the top and also defined out the whole thing without
    having side-effects , people can take a signal. Will probably be back to get more.
    Thanks

  153. Very nice post. I just stumbled upon your weblog
    and wanted to say that I have really enjoyed surfing around
    your weblog posts. In any case I will be subscribing for your rss
    feed and I am hoping you write once more very soon!

  154. Thanks for another fantastic article. Where else may just anybody get that kind of info in such an ideal method of writing?

    I’ve a presentation subsequent week, and I am
    at the look for such info.

  155. A fascinating discussion is definitely worth comment.
    I do think that you need to write more on this issue, it might not be a taboo subject but typically folks don’t talk
    about these topics. To the next! All the best!!

  156. Attractive section of content. I just stumbled upon your blog
    and in accession capital to assert that I get actually enjoyed account your blog posts.
    Any way I will be subscribing to your feeds and even I achievement you access consistently fast.

  157. It is the best time to make some plans for the future and it is
    time to be happy. I have read this post and if I could I want to
    suggest you few interesting things or suggestions. Maybe
    you can write next articles referring to this article.
    I desire to read even more things about it!

  158. Hi there! Would you mind if I share your blog with my zynga group?
    There’s a lot of folks that I think would really enjoy your
    content. Please let me know. Thank you

  159. This is very fascinating, You’re an overly professional blogger.
    I’ve joined your feed and look forward to in quest of extra of your wonderful post.
    Additionally, I have shared your web site in my social
    networks

  160. Thanks for finally writing about > Κυτταρομεγαλοιός-CMV – Βασίλειος Μπόλκας < Loved it!

  161. Thanks for the auspicious writeup. It in reality used to
    be a leisure account it. Glance advanced to far brought agreeable from you!

    However, how could we keep up a correspondence?

  162. Simply wish to say your article is as surprising.
    The clearness in your post is just nice and i can assume you are an expert on this subject.
    Well with your permission allow me to grab your RSS feed to keep up
    to date with forthcoming post. Thanks a million and please continue the rewarding work.

  163. Excellent way of describing, and good paragraph to take information on the topic of my presentation subject
    matter, which i am going to deliver in academy.

  164. Heya i’m for the first time here. I found this board and
    I in finding It truly useful & it helped me out much. I’m hoping to give one
    thing again and aid others such as you helped me.

  165. Nice post. I learn something totally new and challenging on sites I stumbleupon on a daily
    basis. It’s always helpful to read through content from other writers and use a little something from other websites.

  166. It is really a great and helpful piece of information. I am
    satisfied that you simply shared this helpful information with us.
    Please keep us up to date like this. Thank you
    for sharing.

  167. I know this if off topic but I’m looking into starting my own weblog
    and was curious what all is required to get set up? I’m assuming having a blog like
    yours would cost a pretty penny? I’m not very internet savvy so I’m not 100% positive.

    Any tips or advice would be greatly appreciated.
    Many thanks

  168. Fantastic website. Plenty of helpful information here. I’m sending it to
    some friends ans additionally sharing in delicious.
    And certainly, thanks to your effort!

  169. I’m curious to find out what blog platform you have been working with?

    I’m having some minor security problems with my latest website and I’d like to find something more
    safe. Do you have any solutions?

  170. What’s Taking place i’m new to this, I stumbled upon this I’ve discovered It absolutely useful and it
    has aided me out loads. I hope to contribute & aid different customers like its helped me.
    Good job.

  171. Hi there! I’m at work surfing around your
    blog from my new iphone! Just wanted to say I love reading your blog and look forward to
    all your posts! Keep up the fantastic work!

  172. hey there and thank you for your info – I’ve certainly picked up something new from right here.
    I did however expertise a few technical points using this site, since I experienced to reload the site a lot
    of times previous to I could get it to load properly. I had been wondering if your web hosting is OK?
    Not that I am complaining, but sluggish loading instances times will
    very frequently affect your placement in google and
    can damage your high-quality score if advertising and marketing with
    Adwords. Well I’m adding this RSS to my e-mail and could look out
    for a lot more of your respective intriguing content.
    Ensure that you update this again soon.

  173. Thank you a bunch for sharing this with all folks you actually know what you’re speaking
    approximately! Bookmarked. Kindly also visit my site =). We can have a hyperlink change agreement between us

  174. Betroad giriş yap ve hemen oyunları oynamaya başla. Betroad promosyon ve bonus avantajları ile de kullanıcılarının gözdesi haline gelmiştir. Betroad sitesinde giriş imkânı oldukça kolaydır ve yeni giriş ile kolay tasarlanan arayüzü sayesinde Betroad yükselişe geçmektedir. Betroad sitesinde oyun oynamayı sevenler, maksimum keyif alabilecekler ve istedikleri bahis oyunlarıyla güzelce zaman geçirebileceklerdir. Betroad’da bahis oyunları seçenekleri geniş bir yelpazede olduğundan seçeneklerinizde oldukça fazladır.. Seo Uzmanı. https://www.facebook.com/umutcan.phtml

  175. Today, I went to the beach with my kids. I found
    a sea shell and gave it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She put
    the shell to her ear and screamed. There was a
    hermit crab inside and it pinched her ear. She never wants to go back!
    LoL I know this is entirely off topic but I had to tell
    someone!

  176. I’m excited to uncover this great site. I want to to thank you for ones time
    just for this wonderful read!! I definitely really liked every
    little bit of it and I have you saved as a favorite to check out new information in your site.

  177. Definitely believe that which you said. Your favorite reason seemed to be on the net the easiest thing to be aware of.
    I say to you, I definitely get irked while people think about worries that they plainly
    don’t know about. You managed to hit the nail upon the top as well as defined out the whole thing without having side-effects , people can take
    a signal. Will likely be back to get more. Thanks

  178. Have you ever thought about adding a little bit more than just
    your articles? I mean, what you say is important and all.

    But think of if you added some great graphics or video clips to give your posts more,
    “pop”! Your content is excellent but with images and clips, this site could certainly
    be one of the most beneficial in its field. Terrific blog!

  179. I really like your blog.. very nice colors & theme. Did you design this website
    yourself or did you hire someone to do it for you? Plz reply
    as I’m looking to construct my own blog and would like to find
    out where u got this from. thank you

  180. Right here is the perfect website for anybody who wants
    to understand this topic. You realize so much its almost hard to argue with you (not that I actually
    will need to…HaHa). You certainly put a brand new spin on a topic that has been discussed for
    decades. Excellent stuff, just wonderful!

  181. My brother recommended I might like this blog. He was entirely right.

    This post actually made my day. You can not imagine just how much time I
    had spent for this information! Thanks!

  182. This design is spectacular! You obviously know
    how to keep a reader amused. Between your wit and your videos, I was almost moved
    to start my own blog (well, almost…HaHa!) Wonderful job.
    I really loved what you had to say, and more than that, how you presented it.
    Too cool!

  183. wonderful submit, very informative. I ponder why the other experts of this
    sector do not understand this. You must continue
    your writing. I am confident, you’ve a great readers’ base already!

  184. Hola! I’ve been reading your web site for some time now
    and finally got the courage to go ahead and give
    you a shout out from Dallas Texas! Just wanted to tell you keep up the great work!

  185. I know this web site provides quality based articles and
    additional material, is there any other website which presents such things in quality?

  186. You really make it seem so easy with your presentation but I find this topic to be actually something which I think I would never understand.
    It seems too complicated and extremely broad for
    me. I am looking forward for your next post, I will try to get the hang of it!

  187. I love what you guys tend to be up too. This type of clever work and
    exposure! Keep up the amazing works guys I’ve included you guys to blogroll.

  188. I do not know whether it’s just me or if perhaps everyone else encountering
    problems with your website. It seems like some of the written text
    on your posts are running off the screen. Can someone else please comment
    and let me know if this is happening to them too? This may be a issue with my browser because I’ve had this happen before.

    Thank you

  189. Just want to say your article is as astounding. The clearness in your post
    is simply great and i can assume you’re an expert on this subject.

    Fine with your permission allow me to grab your RSS feed to keep updated with forthcoming post.
    Thanks a million and please carry on the rewarding work.

  190. Pingback:meritroyalbet giriş

  191. At this time it appears like Movable Type is the best
    blogging platform available right now. (from what I’ve read) Is that what
    you are using on your blog?

  192. I’ve been browsing online more than 3 hours these days, but
    I by no means found any attention-grabbing article like yours.

    It is lovely value sufficient for me. In my opinion, if all web owners and bloggers made
    excellent content material as you did, the web will be much
    more useful than ever before.

  193. Thanks for the auspicious writeup. It actually was a amusement account it.
    Look complex to more added agreeable from you! By the way, how can we keep up a correspondence?

  194. Greetings from Colorado! I’m bored to death at work so I decided to check out your website
    on my iphone during lunch break. I enjoy the info you provide here and can’t
    wait to take a look when I get home. I’m surprised at how
    quick your blog loaded on my mobile .. I’m not even using WIFI,
    just 3G .. Anyhow, awesome blog!

  195. Hello there! This is my 1st comment here so I just wanted
    to give a quick shout out and say I genuinely enjoy reading your
    blog posts. Can you suggest any other blogs/websites/forums that
    deal with the same topics? Thank you!

  196. Can I simply say what a relief to find somebody that truly understands what they’re talking
    about on the web. You definitely realize how to bring an issue to
    light and make it important. A lot more people
    really need to look at this and understand this side of your story.

    I was surprised that you’re not more popular because you most
    certainly possess the gift.

  197. Excellent way of telling, and good article to get information about my
    presentation subject, which i am going to convey
    in institution of higher education.

  198. An outstanding share! I have just forwarded
    this onto a co-worker who was doing a little homework on this.
    And he in fact bought me lunch because I stumbled upon it for him…
    lol. So let me reword this…. Thank YOU for the meal!! But yeah, thanx for spending time to discuss this matter here on your web page.

  199. Howdy! I’m at work surfing around your blog from my
    new iphone! Just wanted to say I love reading your blog and
    look forward to all your posts! Keep up the superb work!

  200. obviously like your website however you have to check
    the spelling on quite a few of your posts. A number of
    them are rife with spelling problems and I to find it very troublesome to
    tell the truth then again I will surely come again again.

  201. Spot on with this write-up, I really believe that this amazing site needs far more attention. I’ll
    probably be returning to see more, thanks for the information!

  202. Hmm is anyone else encountering problems with the images on this blog loading? I’m trying to figure out if its a problem on my end or if it’s the blog. Any feed-back would be greatly appreciated.

  203. Hi, i believe that i saw you visited my site thus i came to
    go back the desire?.I’m attempting to to find things to improve my website!I guess its good enough to use a few of your concepts!!

  204. Very great post. I simply stumbled upon your weblog and wished to say that I have really enjoyed surfing
    around your blog posts. In any case I’ll be subscribing for your feed and I hope you write
    once more very soon!

  205. Wow, marvelous blog layout! How long have you been blogging for?
    you made blogging look easy. The overall look of your website is magnificent, let alone the content!