njia za upimaji wa mpango wa kimataifa wa viwango vya ... · mpango wa kimataifa wa viwango vya...

Mpangowakimataifawaviwangovyachakulakwawenyematatizoyakumeza(IDDSI)namaelezoyakevimesajiriwana

CreativeCommons Attribution---Sharealike 4.0 International Licensehttps://creativecommons.org/licenses/by---sa/4.0/

10Oktoba,2016

VYAKULA

VINYWAJI

Njiazaupimajiwampangowakimataifawaviwangovyachakulakwawenye

matatizoyakumeza(IDDSI)

VYA KAWAIDA

VYEPESI SANA

LAINI NA UKUBWA WA TONGE LA

KUNG’ATA VILIVYOSAGWA NA VITEPE

VYEPESI

VIZITO KIDOGO

VIZITO KIASI

VIZITO SANA

VYA MAJIM

AJI

VILIVYOPONDW

A



10Oktoba,2016

UTANGULIZI

Mpango wa kimataifa wa viwango vya chakula kwa wenye matatizo ya kumeza “The InternationalDysphagiaDietStandardisationInitiative(IDDSI)”ulizinduliwamwaka2013kwamadhumuniyakuanzishaistilahinaufafanuzimpyawakimataifakuelezeaurekebishajiwauepesiwavyakulanauzitowavinywajivinavyotumiwanawatuwalionamatatizoyakumezawaumriwowote,katikampangiliowahudumayeyote,nautamaduniwowote.

Miakamitatumfululizoyakaziiliyofanywanakamatiyakimataifayaviwangovyavyakulakwawatuwenyematatizoyakumeza,imetoanakalayamwishoyamfumowaviwangovyavyakulakwawatuwenyematatizoyakumezaambaounahatuazaviwango8,kuanziahatuayachinimpakajuu(0-7).Viwangohivyovinatambulikakwakutumianamba,maandishinarangi.

NakalahiiinatoamaelekezoyaviwangovyotevyaIDDSIkwaundanizaidi.Vielelezivinadhihirishwananjiarahisizavipimoambazozinawezakutumiwanawatuwenyematatizoyakumeza,wahudumu,madaktari,wataalamuwahudumazachakula,amaviwandakuthibitishaviwangovyavyakulavinavyofaa.

NakalahiiinabidiisomwepamojananakalazanjiazaupimajiwaIDDSI,uthibitishajiwaIDDSI,nanakalazamaswaliyanayoulizwamarakwamara(http://iddsi.org/framework/).

Kamatiya IDDSI inapendakutambuahamunaushirikianowa jumuiyayakimataifa, ikiwanipamojanawagonjwa, wahudumu, wataalamwa afya, viwanda, vyama vya wataalam na watafiti. Pia tunapendakuwashukuruwadhaminiwetukwamsaadawaowahalinamali.

Tafadhalitembeleatovutihiiwww.iddsi.orgkwamaelezozaidi

KamatiyaIDDSI:

Wenyeviti:PeterLam(Kanada)naJulieCichero(Australia); Wanakamati:JiansheChen(China),RobertoDantas(Brazili),JaniceDuivestein(Kanada),BenHanson(Uingereza),JunKayashita(Japani),CarolineLecko(Uingereza),MershenPillay(ZAF),LuisRiquelme(Marekani),SoenkeStanschus(Ujerumani),CatrionaSteele(Kanada).

Wanakamatiwazamani:JoeMurray(Marekani)

Mpangowakimataifawaviwangovyachakulakwawenyematatizoyakumeza(IDDSI)nichombokinachojitegemeanasikwaajiliyakupatafaida.IDDSIinashukuruidadikubwayamashirikanaviwandakwamsaadawakifedhanakadhalika.WadhaminihawajashirikishwakatikakubuniwalakutengenezamfumohuuwaIDDSI.

UtengenezajiwaIDDSI(2012---2015)IDDSIinapendakutambuanakushukuruwadhaminiwafuataokwamsaadawaowahalinamalikuwezeshautengenezajiwamfumowaIDDSI:

• NestléNutritionInstitute(2012---2015)• NutriciaAdvancedMedicalNutrition(2013---2014)• HormelThick&Easy(2014---2015)• Campbell’sFoodService(2013---2015)• apetito(2013---2015)• Trisco(2013---2015)• FoodCareCo.Ltd.Japan(2015)• FlavourCreations(2013---2015)

TheIDDSIFrameworkandDescriptorsarelicensedunderthe 2CreativeCommons Attribution---Sharealike 4.0 International License

https://creativecommons.org/licenses/by---sa/4.0/October10,2016

• SimplyThick(2015)• Lyons(2015)

UtekelezajiwamfumowaIDDSIunaendelea.IDDSIinashukurusanawadhaminiwote.

MbinuzaupimajikwakutumiamfumowaIDDSIUchunguziwampangiliowaIDDSIulipendekezakuwavinywajinavyakulavigawanywekulingananamichakatoyaumboinayojishirikishakatikakutafuna,kusafirishanakuanzakusambaa.Hadisasa,vifaambalimbalivinahitajikakuelezeavizuritabiayadonge(Steelenawenzake,2015).

VinjwajinavimimikavingineUpimajisahihiwatabiazamtiririkowavimiminikanikazingumu.Hadisasa,utafitinaistilahizakimataifazilizopozimetafitiaukupendekezamchakatowavinjwajikulinagananamnato.Hatahivyo,upimajiwamnatohaupatikanikwawahudumuwaafyanawaleziwengi.

Zaidiyahayo,mnatosiokipimomuhimupekee:mtiririkowakimiminikawakatikinanywewakinaathiriwanavigezovinginevingiikiwanipamojanamsongamano,mvutano,joto,shinikizolamsukumonakiasichamafuta(O’Learynawenzake,2010;Sopadenawenzake,2007,Sopadenawenzake,2008a,b;Haddenawenzake,2015a,b).Uchunguziwampangilioumeonyeshatofautikubwakatikambinuzaupimajizilizotumikanakugunduakwambatakwimunyinginemuhimukamaviwangovyakasiyavimiminika,jotolasampuli,uwianonamvutowamgandamizoulikuwaukizungumziwamarachache(Steelenawenzake,2015;Cicheronawenzake,2013).Vinywajivilivyoongezewauzitokwakutumiaviongezauzitombalimbalivinawezakuwanakiwangokimojachamnatokatikakiwangokimojapekeechakasiyakimiminika,nabadokuwanatabiatofautisanakwamtiririkowavitendo(Steelenawenzake2015;O’Learynawenzake,2010;Funaminawenzake,2012;Ashidanawenzake,2007;Garcianawenzake,2005).Mbalinatofautikatikamtiririkounaohusiananatabiazavinywaji,viwangovyamtiririkowakatiwakumezavinatarajiriwakuwatofautikulingananaumriwamtunakiwangochakuharibikiwauwezowakumeza(O’Learynawenzake,2010).

Kwasababuhizi,upimajiwamnatohaujawekwakatikavielelezivyaIDDSI.Badalayake,jaribiolamvutowamtiririkokwakutumianchayabombalasindanolamilimeta10linapendekezwakupimamtiririkowaainazavimiminika(sampuliiliyobakikutokamililita10baadayasekunde10zamtiririko).Halizakudhibitiwazimezingatiakuwakilishaunywajikwakutumiamrijaaubika.

JaribiolaupimajiwamtiririkowaIDSSInisawanaubunifuwakanunizaupimajiwakifaachamaabarakijulikanachokamaPosthumusFunnelambachokinatumikakatikaviwandavyamaziwakupimauzitowavimiminika(vanVliet,2002;Kutternawenzake,2011).KwakweliPosthumusfunnelinaonekanakamabombakubwalasindano(vanVliet,2002;Kutternawenzake,2011).HatuazilizochukuliwakutumiaPosthumusfunnelnipamojanamudakwaajiliyakiasimaalumuchasampulikutiririka,nakiasikilichobakiabaadayamudauliopangwakutiririka.VanVliet(2002)anabainishakuwajiometriyaPosthumusfunnelinakasiyakimiminikanakurefukasehemuambayoinafananasananahaliyamtiririkomdomoni.

IngawasindanoiliyochaguliwakutumikakatikaupimajiwamtiririkoIDDSInirahisi,jaribiolimekuwalikitofautishaviwangombalimbalivyavimiminikakiuhakika,namakubalianoyavipimovyasasavinavyotumikamaabaranamaamuziyawataalamu.Napiaimeonekanakuwamakiniyakutoshakuonyeshamabadilikomadogokatikauzitokuhusiananamabadilikoyajotowakatiwakutumika.



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JaribiolaMtiririkowaIDDSIJaribiolaupimajiwamtiririkowaIDDSIlinatumiabombalasindanolijulikanalokamahypodermic,kamainavyoonyeshwakatikapichahapochini:

Ingawamabombayasindanoyamililita10mwanzoniyalidhaniwakuwanisawakoteulimwengunikulingananakumbukumbunambayaviwangovyaISO(ISO7886---1),imegundulikakuwahatiyaISOinazungumziajuuyapuayabombalasindanotu,nakwambatofautiyavipimovyaurefunavipimovyaupanaunawezakutofautianakatiyabidhaambalimbali.HaswaupimajiwamtiririkowaIDDSunatumiakumbukumbuyabombalasindanolenyekipimochenyeurefuwamilimeta61.5kuanziamstariwasifurimpakamstariwamililita10(mabombayasindanoyaBDTMyalitumikakuandaamajaribio–kodiyawatengenezajini301604).IDDSIinafahamukuwakunamabombamengineyasindanoambayoyanaalamayamilimeta10lakinikiukweliyanauwezowakubebamilimeta12.Matokeoyakutumiamabombayasindanoyamilimeta12yatakuwatofautinayaleyakutumiamabombayasindanoyamilimeta10.Kwamsingihuo,nimuhimukuangaliaurefuwabombalasindanokamailivyoonyeshwakwenyemchorohapojuu.Maelezozaidiyakufanyamajaribioyameonyeshwahapochini.

VideozakuonyeshamajaribioyaumiminikajiwaIDDSIzinawezakutazamwakatikatovutihii:http://iddsi.org/framework/drink---testing---methods/

Vinywajinavimiminikakamasosi,mchuzinavirutubisholisheniborakufanyiwatathminikwakutumiaupimajiwaumiminikajiwaIDDSI(ngazi0hadiya3).Kwavinywajivizitosana(ngaziya4),ambavyohavipitikwanjiayabombalasindanolamilimeta10kwasekunde10niborakuliwakwakijiko.Jaribiolakudondoshamatoneyamtiririkowavyakulakwauma/kijikokilichogeuzwajuuchinilinapendekezwakamanjiazakutathminiulaini.



2. Funikapuayabombalasindanokwakutumiakidolechakokidogochamwisho,kuziba.

5. Inapofikasekunde10zibapuayabombalasindanokwakutumiakidolechakokidogochamwisho,nakusimamishamtiririkowakimiminika.

ViwangovyauainishajivyaIDSSIkutokananakimiminikakilichobakibaadayasekunde10:Kiwangocha0:Kimiminikachotekimetiririkakutokakwenyebombalasindano.Kiwangocha1:Kunakatiyamililita1namililita4zinazobaki.Kiwangocha2:Kunakatiyamililita4namililita8zinazobaki.Kiwangocha3:Kunazaidiyamililita8zinazobaki,lakinikunabaadhiyakimiminikabadokinapita.Kiwangocha4:Kamahakunakimiminikakinachotoka,itakuwanikiwangocha4auzaidi.Kiwangocha4kinawezakufahamikakwaurahisibilajaribiolabombalasindano:Sampuliinabakianaumbolake;baadhiyavimiminikavinabakiakwenyeukutawabombalasindano.Nzitosanakunywewakwakikombeaukwamrijainatakiwakuliwakwakijiko.Kijikokilichojaalazimakimwagikekikigeuzwaupande;msukumomdogosanaunawezakuhitajikalakinisampulihaitakiwikuwangumuaukunata.

1. Kusanyasaamgando(stopwatch)nabaadhiyamabombayasindanozamilimeta10:Angaliavipimozaidikwenyeukurasa.Ondoakizibochabombalasindanomojanautupe.

UpimajiwaMtiririkowaIDDSI

3. Jazakimiminikakwenyebombalasindanomkapakwenyealamayamilimeta10–inashauriwakutumiabombalasindanonyinginekufanyahivyo.

4. Ondoakidolechakokwenyepuayabombalasindanonawakatihuohuoanzishasaamgando.



10Oktoba,2016

IDDSIFlowTest

NchayaBDLuer-Lok™

Kwaujumlainatumikakwasindanoambazozinahitajikiungiosalamakuunganishabombalasindanonakifaakingine.Nchaimeunganishwakwakutoshakufunga,nainafanananaainanyinginezasindano,mirijamaalumu(catheters),navifaavingine.

NchailiyoingiayaLeur

Muunganishowakutoshawamsuguanoambaounahitajidaktarikuingizanchayabombalasindanokwenyekitovuchasindanoaukifaakinginekilichounganishwakwanjiayakusukumanakuzungusha.Hiiitahakikishamuunganishoambaohautawezakutenganakwaurahisi.Kusukumatukifaachakuunganishiakwenyenchayabombalasindanohakutahakikishausalamawakifaa.

Nchailiyoingiaijulikanayo

kamaEccentricLuer

Inaruhusiwakwakaziinayohitajikuwakaribusananangozi.Kwaujumlainatumikakwakutoleadamu(venipunctures)nakucheuamajimaji(piaangaliamaelekezoyakuingizaluerhapojuu).

Nchayamrijamaalumu:Catheter

Inatumikakwakusafishiamirijamaalumu(catheters),mirijayakupitishiachakula(gastrostomy)navifaavingine.Ingizanchayacatheterkwenyecatheteraumirijayagastrostomykwausalama.Kamaikitokeakuvuja,rejeakwenyemwongozowakituochako.

UpimajiwaMtiririkowaIDDSI

Nchayaluer(katiamaaccentricauLuer-Lok)

Vipimovyabombalasindanolamilimeta10

Urefuwakipomochamilimeta10



Kablayamatumizi,angaliakuonakuwapuanisafinahainamabakiyeyoteyaplastikiaukasorokutokakiwandaniambayohutokeamarachachesana.



10Oktoba,2016

NjiazaupimajiwamatumiziyavyakulakwakutumiamfumowaIDDSI

VyakulaHadisasa,utafitikatikaeneolaupimajiwamfumowachakulaunahitajimashinetatanazagharamakamavilekifaachakupimiawororowachakula(FoodTextureAnalyzers).Kutokananaugumuwaupatikanajiwavifaahivinautaalamuunaohitajikakupimanakufafanua,istihalinyinyizakitaifazimekuwazikitumiavielelezivyakinakuelezeamifumoyachakulabadalayake.

Ukaguziwampangilioumeonyeshakuwatabiazaugumu,mshikamanonautelezinivigezomuhimuvyakuzingatia(Steelenawenzake,2015).Kwakuongezea,ukubwanasurayasampuliyachakulavimetambuliwakamasababuhusikakwamadharayakukabwakoo.(Kennedynawenzake,2014;Chapinnawenzake,2013;JapaneseFoodSafetyCommission,2010;Morleynawenzake,2004;Munawenzake.,1991;Berzlanovichnawenzake1999;Wolachnawenzake,1994;CentreforDiseaseControlandPrevention,2002,Rimmellnawenzake,1995;Seidelnawenzake,2002).Kwamtazamowataharifahizi,vipimovyavyakulavinahitajikuzingatiwavyote,halizamfumo(kwamfanougumu,mshikamano,uvutikajink)nakijiometriausifazamaumbileyachakula.Maelezonatabiazamifumoyavyakula,mfumowachakulaunaohitajikanaunazuiliwaumetengenezwakutokananaistahilizataifazilizoponafasihiyakuelezeasifaambazozinaongezamadharayakukabakoo.Mchanganyikowavipimounawezakuhitajikakuamuachakulakiwekatikakiwangokipi.Njiazaupimajiwachakulakizitosana,laini,nakigumunipamojana:jaribiolakudondoshamatonekwauma,jaribiolakugeuzakijikojuuchini,jaribiolamgandamizowakijikoauuma,jaribiolavijitivyakuliachakulanajaribiolavidole.Videozinazoonyeshamifanoyanjiahizizaupimajizinapatikanakatikatovutihii:http://iddsi.org/framework/food---testing---methods/

Jaribiolakudondoshamatoneyamtiririkowavyakulakwauma

Vinywajivizitonavyakulavyamajimaji(ngaziya3naya4)vinawezakupimwakwakutathiminikamavinapitakwenyemianyayamenoyaumanakulinganishadhidiyamaelezoyakinayakilangazi.VipimovyakudondoshamatonekwaumavimeelezewakwakutumiaistahilizakitaifazilizoponchiniAustralia,Ireland,NewZealandnaUingereza(Athertonnawenzake,2007;IASLTandIrishNutrition&DieteticInstitute2009;NationalPatientSafetyAgency,RoyalCollegeSpeech&LanguageTherapists,BritishDieteticAssociation,NationalNursesNutritionGroup,HospitalCaterersAssociation2011).



KIZITO ZITO KIZITO KIASI

Kinadondokataratibukwamatonekupitiamianyakatiyamenoyauma



10Oktoba,2016

JaribiolakugeuzakijikojuuchiniJaribiolakugeuzakijikojuuchinihutumikakutambuakunatakwasampuli(kuvutika)nauwezowasampulikushikanapamoja(mshikamano).JaribiolakugeuzakijikojuuchinilinaelezewakwakutumiaistahilizakitaifazilizoponchiniAustralia,Ireland,NewZealandnaUingereza(Athertonnawenzake,2007;IASLTandIrishNutrition&DieteticInstitute2009;NationalPatientSafetyAgency,RoyalCollegeSpeech&LanguageTherapists,BritishDieteticAssociation,NationalNursesNutritionGroup,HospitalCaterersAssociation2011).Jaribiolakugeuzakijikojuuchinihutumikahaswakupimasampulizangaziya4naya5.Sampuliinatakiwa:

• Kuwanamshikamanowakutoshakushikiliasurayakekwenyekijiko

• Kijikokilichojaalazimakimwagikekamakikigeuzwajuuchini,kikigeuzwakwaupande,amakikitingishwakidogo;sampulilazimaiteremkekwaurahisinakuachachakulakidogosanakwenyekijiko,yaanisampulihaipaswikunata

• Dondelililochotwalinawezakusambaaamakushukakidogosanakwenyesahani

KiasikidogokinawezakupitanakuundakitukamamkiachiniyaumaHakiundidonge,hakipiti,hakitiririkiwalakuendeleakudondoka

kupitiamianyayamenoyauma

Kinakaakamamlimaaulundojuuyauma

Jaribiolakugeuzakijikojuuchini:Chakulakinabakinaumbolakekwenyekijiko;sioimaranahakinati;chakulakidogokinabakikwenyekijiko

KILICHOPONDWA KIZITO SANA

KILICHOPONDWA KIZITO SANA



TathminiyavyakulalaininavigumuUmaumechaguliwakutumikakutathminivyakulalaininavigumukwasababuyakeyakipekeeyakuwezakutathminitabiazinazohusiananaugumu,pamojanatathminizasifazasurayakekamaukubwawachembechembe

Tathminiyausahihiwachembechembezaukubwawamilimeta4Kwawatuwazima,wastaniwaukubwawachembechembezachakulakigumukilichotafunwakablayakumezanimilimeta2hadi4(Peyronnawenzake,2004;Wodanawenzake,2010).Mianyakatiyamenoyaumawakawaidanikiasichamilimeta4,ambayoinatoakipimosahihimuhimukwachembechembezachakulaukubwawangaziya5(VilivyosagwanaVitepe).Kwakuamuaukubwawachembechembekwausalamawawatotowachanga,sampuliambazonindogokulikoupanawaupeowaukuchawakidolekidogochamwishochamtotomchanga(kidolekidogokabisa)hakitakiwikusababishahatariyakukabwakoo,maanaukubwahuuumetumikakutabirimduarawandaniwabombalijulikanalokamaendotrachealkwawatoto(Turkistaninawenzake,2009).

Tathminiyausahihiwachembechembezaukubwamilimeta15(sentimeta1.5)Kwavyakulavigumunalaini,kiwangochajuuchasampuliyachakulachasentimeta1.5kwasentimeta1.5kinapendekezwa,ambachonitakribaniyaukubwawaukuchawakidolegumbachamtumzima(Murdan,2011).Ukubwawaupanawotewaumawakawaidaunapimatakribansentimeta1.5kamainavyoonekanakatikapichahapojuu.Chembechembezaukubwawasentimeta1.5kwasentimeta1.5zinashauriwakwangaziya6(LaininaUkubwawaTongelaKung’ata)–imepimwakupunguzahatarizinazohusiananakukosahewakutokananakukabwanachakula.(Berzlanovichnawenzake,2005;Bordskynawenzake,1996;Litmannawenzake,2003...).



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JaribiolamgandamizowaumanamgandamizowakijikoUmaunawezakutumikakuchunguzatabiayachakulawakatikimegandamizwa.Mgandamizoambaounawekwakwenyesampuliyachakulaumehesabiwakwatathminiyamgandamizounaohitajikakufanyaukuchawakidolegumbakuonekanacheupe,kamainavyoonyeshwakwamshalekwenyepichahapochini.Mgandamizouliotumikakufanyaukuchawakidolegumbakuwacheupenikiasichakukaribiakilopaskali17.Mgandamizohuonisawananguvuinayotumiwanaulimiwakatiwakumeza(Steelenawenzake,2014).Katikamchorowaupandewakulia,mgandamizoumeonyeshwakwakilopaskalikwakutumiakifaachaIOWAchaupimajiutendajikaziwamdomo.Katikapichayaupandewakulia,mgandamizoumeonyeshwakatikakilopaskalikwakutumiakifaachaIOWAchaupimajiutendajikaziwamdomo.Hikinikifaakimojawapoambachokinawezakutumikakupimamgandamizowaulimi.Kwatathminiyakutumiajaribiolamgandamizowauma,inashauriwakuwaumaugandamizwejuuyasampuliyachakulakwakuwekakidolegumbajuuyauma(usawawachinikidogoyamenoyauma)mpakaweupeuonekane,kamainavyoonyeshwakwenyepichayaupandewakushotohapochini.Inafahamikakuwaumahaupatikanikwaurahisikatikasehemunyingineduniani.Mgandamizounaotumikajuuyakijikounawezakutoambadalaunaotakiwa.

LAINI NA UKUBWA WA TONGE Ukuchawakidolegumba

unapaukakuwamweupe

Sampuliinasambaratikanakuharibika,nahairudiisurayakeyaawaliwakatimgandamizoumeondolewa



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JaribiolavijitivyakuliachakulanajaribiolavidoleTathminiyavijitivyakuliaimewekwakatikaIDDSI.Jaribiolavidolelimeingizwakatikakutambuakwambahiiinawezakuwanjiapekeekatikabaadhiyanchi.

TathminiyavyakulavyampitoChakulaambachokinaanzanawororommoja(mfanokigumu)halafukinabadilikakuwawororomwingine,hasawakatikinaunyevu(mfanomajiaumate)yanapotumika,auwakatimabadilikoyahaliyajotoyametokea(mfanokupashamoto).Chakulahikihutumiwakatikaufundishajiwamaendeleoaukujifunzatenakutafuna.Kwamfano,kimekuwakikitumikakatikamaendeleoyakutafunakwawatotonamaendeleokwawalemavu(Gisel1991;Doveynawenzake,2013).Kutathminikamasampuliinafaaufafanuziwachakulakinachobadilika,njiaifuatayoimetumika:Tumiasampuliukubwawaukuchawakidolegumba(sentimeta1.5kwasentimeta1.5),wekamililita1yamajijuuyasampulinausubiridakikamoja.Gandamizakwakutumiamgongowaumampakaukuchawakidolegumbaupaukenakuwamweupe.Sampuliniyachakulakinachobadilikaikiwabaadayakuondoamgandamizowauma:

• Sampuliimepondekanakusambaratikanahaionekanikatikasurayakeyaawaliwakatiumaumeondolewa.

• Sampuliinatakiwaivunjikekwaurahisikwakutumiavijitivyakuliakwakugandamizakidogo.• Sampuliitasambaratikakabisakwakusuguasampulikatiyakidolegumbanakidolechakunyooshea.

Sampulihaitarudiasurayakeyaawali.• Ausampuliimeyeyukakwakiasikikubwanahaionekanitenakatikasurayakeyaawali(mfanokipandecha

barafu).•Wekamajimilimeta1juuyasampuli•Subiridakika1

VYAKULA VYA MPITO

Ukuchawakidolegumbaunapaukakuwamweupe

Sampuliinasambaratikanakuharibika,nahairudiisurayakeyaawaliwakatimgandamizoumeondolewa



10Oktoba,2016

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