تبلیغات
متابولیک PKU - Phenylketonuria (PKU)
فروش محصولات غذایی رژیمی و دیابتیك (بیماران متابولیک PKU) آریانا

Phenylketonuria (PKU)

نوشته شده توسط:محمد آریانا
پنجشنبه 13 خرداد 1389-10:27 ب.ظ

Newborn Screening Case Management

Phenylketonuria (PKU)

Phenylketonuria (PKU) is an inborn error of metabolism transmitted genetically. Boy with untreated PKU. He usually shows electroencephalogram abnormalities, and may show a reduction in head size.  He is likely to have a distinct, musty, unpleasant odor, and to have lighter hair and less skin pigment than other members of his familyBoth parents must be carriers of the gene to produce a child with this condition. When both parents are carriers of the gene, chances of an affected child occurring are one in four for each pregnancy. There is a 50% chance that a child born to these parents will be a carrier of the phenylketonuria gene.

There are no known clinical signs of PKU present in a newborn. There is nothing in the appearance or behavior of a newborn phenylketonuric which distinguishes him from a normal newborn. However, early in the first year of life, the phenylketonuric may develop symptoms such as marked irritability, severe vomiting, exzema, seizures and a musty odor. Serum phenylalanine tests are required to validate any of these suspicious symptoms.

Unfortunately, warning symptoms may not be prominent early in life, and deviations from normal may not be observed until the child is well along in his first year. Delayed ability to sit alone may be the first sign that something is wrong with a child. The untreated phenylketonuric may not walk until early childhood; some may never learn to walk. Motor development is slow but of secondary concern in the presence of the profound mental retardation which is displayed. The child is irritable and often displays agitated behavior. He usually shows electroencephalogram abnormalities, and may show a reduction in head size. He is likely to have a distinct, musty, unpleasant odor, and to have lighter hair and less skin pigment than other members of his family.

The essential amino acid, phenylalanine, is contained in the protein fraction of all foods in the human diet. The phenylketonuric is born with a defect in his ability to produce the liver enzymes necessary for the metabolism of phenylalanine. Subsequent mental deterioration is a consequence of the accumulation of phenylalanine in the blood and tissues of the body and therefore related to an inherited liver dysfunction.

The phenylketonuric child's gastrointestinal processes are normal. Protein molecules are broken into their component amino acids in the intestinal tract and transported to the liver. It is at this point that the phenylketonuric child deviates from normal. The liver of a phenylketonuric child is able to produce only a small quantity of the enzyme necessary to convert phenylalanine to tyrosine and its metabolites (such as pigment and hormones). In the absence of the enzyme, phenylalanine and its metabolites accumulate in the blood and body tissues. Large amounts of by-products are excreted through the urine, but not enough to keep the serum level below the toxic point for the newborn's developing brain and nervous system.

The initial objective of treatment is to reduce the concentration of phenylalanine in the blood by reducing phenylalanine intake. After a diagnosis of PKU, the child's regular feeding will be a low phenylalanine formula carefully supplemented with other food sources of protein. This special formula, which contains significantly less phenylalanine that other formulas or milks is the main source of protein for a phenylketonuric infant. Blood tests must be performed often to determine how rapidly the serum phenylalanine level is decreasing. Care must be taken to prevent this level from falling below the therapeutic range.

After the initial reduction in serum phenylalanine levels, the objective is to adjust the phenylalanine intake to maintain the serum level within a range that will assure sufficient phenylalanine for growth, without permitting toxic assumulation of phenylalanine or its abnormal metabolites. Close supervision of diet and medical follow-up is necessary to maintain this delicate balance.

There is currently some controversy regarding the length of time a phenylketonuric should remain on a phenylalanine restricted diet. There is currently a feeling among metabolic specialists that a girl should remain on a restricted diet through her childbearing years. Keeping phenylalanine levels in a safe range for the unborn child is essential for the pregnant phenylketonuric woman. Improved mental efficiency has been noted upon return to a low phenylalanine diet in previously treated individuals (male and female). Many metabolic specialists are now recommending that the low phenylalanine diet be continued throughout life.

Screening for PKU in Texas was begun in 1965. Diagnosed cases are detected through the Newborn Screening Program, Texas Department of State Health Services (DSHS), in cooperation with the Newborn Screening Laboratory, DSHS.

The screening test for PKU used by DSHS was developed by Doctor Robert Guthrie and is done on dried blood on a filter paper. Known as the Guthrie Test, it is an inhibition assay test which utilizes the bacterial metabolism of Bacellus subtiles.

Test results of phenylalanine greater than 4 mg/dl is considered abnormal and reported as such to the health provider. If a test result is reported as greater than 4 mg/dl, the health provider is asked to submit a 1-2 cc serum specimen to DSHS for more specific analysis of phenylalanine levels.

When abnormal results are first discovered and reported, additional services are coordinated by telephone. Information concerning the name of a metabolic specialist at a diagnostic center in the geographic location closest to the patient is offered to the health provider. The metabolic specialist is also notified of abnormal test results. Later, follow- up telephone calls are made to the health provider from the Newborn Screening Program staff to determine status of the case and to offer the assistance of a public health nurse if needed. The Newborn Screening Laboratory, DSHS, will monitor serum specimens for phenylalanine levels to assist in diagnosing a new case or monitoring a child who has already been diagnosed.

Phenylketonuria should not be diagnosed or a child started on special formula on the basis of testing done at DSHS alone; there are many varient types of PKU for which treatment is different from classic PKU. Further testing of blood and urine should be done at a diagnostic center where more specific laboratory testing, examination by a metabolic specialist, evaluation by a nutritionist, and genetic counseling are available.

It is essential that follow-up be prompt on abnormal phenylalanine screens. Recent studies have shown that each day treatment is delayed on a child with classic PKU, furthers the chance of irreversible mental damage.

The DSHS offers additional services to the primary physician to assist in follow-up care of phenylketonuric children. The Division of Genetics and Newborn Screening maintains a list of genetic services throughout Texas and offers this information to the physician as indicated. The Newborn Screening program provides literature, videos, and speakers for seminars to assist with educating parents and health care providers concerning PKU. The Newborn Screening program provides assistance on a co-pay basis with PKU formula costs for families who are not eligible for private insurance, Medicaid, WIC, CSHCN, or CHIP.

نوزاد مورد غربالگری مدیریت
فنیل (PKU)
فنیل (PKU) به خطای ذاتی در سوخت و ساز بدن انتقال ژنتیکی. پسر با PKU درمان نشده. او معمولا نشان می دهد اختلالات منحنی هایی که توسط دستگاه ثبت امواج مغز ثبت شده است ، و ممکن است در کاهش اندازه سر نشان می دهد. او به احتمال زیاد به متمایز ، کپک زده ، بوی نامطبوع و دارای موهای روشن و پوست رنگدانه کمتر از سایر اعضای familyBoth پدر و مادر خود باید حامل ژن تولید یک کودک با این وضعیت. هنگامی که هر دو والدین حامل ژن ، شانس وقوع فرزند مبتلا هستند 1 در 4 برای هر بارداری می باشد. است احتمال 50 ٪ که کودک به این پدر و مادر متولد خواهد شد حامل ژن فنیل وجود دارد.

شناخته شده ای از علائم بالینی PKU حاضر در نوزاد. هیچ چیزی در ظاهر و یا رفتار phenylketonuric نوزاد که او را متمایز از نوزاد سالم وجود دارد. با این حال ، در اوایل سال اول زندگی ، ممکن است phenylketonuric علایمی نظیر تحریک پذیری مشخص توسعه ، استفراغ شدید ، exzema ، تشنج و عطر و بوی کپک زده. تست فنیل آلانین سرم ملزم به تایید هر یک از این نشانه ها مشکوک.

متاسفانه ، هشدار دهنده علائم ممکن است برجسته در اوایل زندگی ، و انحراف از نرمال را نمی توان مشاهده تا کودک به خوبی در طول سال اول بود. توانایی به تاخیر نشستن به تنهایی ممکن است اولین نشانه این که چیزی اشتباه است با فرزند. phenylketonuric درمان نشده ممکن است تا زمانی که در اوایل دوران کودکی راه رفتن نیست ، برخی ممکن است هرگز به راه رفتن آموخت. توسعه موتور آهسته است اما نگرانی ثانویه در حضور از عقب ماندگی ذهنی عمیق که نمایش داده میشود. کودک و اغلب تحریک پذیر را نمایش می آشفتگی رفتار است. او معمولا نشان می دهد اختلالات منحنی هایی که توسط دستگاه ثبت امواج مغز ثبت شده است ، و ممکن است در کاهش اندازه سر نشان می دهد. او به احتمال زیاد به متمایز ، کپک زده ، بوی نامطبوع و دارای موهای روشن و پوست رنگدانه کمتر از سایر اعضای خانواده اش.

اسید آمینه ضروری ، فنیل آلانین ، در کسر پروتئین از تمام غذاها در رژیم غذایی انسان موجود. phenylketonuric است که با نقص در توانایی های خود را برای تولید آنزیم های کبدی به دنیا آمد لازم برای متابولیسم فنیل آلانین. بعدی زوال ذهنی در نتیجه از انباشت فنیل آلانین در خون و بافت بدن و در نتیجه به اختلال عملکرد کبد مربوط به ارث برده است.

فرایندهای دستگاه گوارش کودکان phenylketonuric هستند طبیعی است. مولکول پروتئین دارند به آنها اسیدهای آمینه در جزء دستگاه گوارش شکسته و حمل و نقل به کبد می شود. در این نقطه است که کودک phenylketonuric انحراف از نرمال بود. کبد یک کودک phenylketonuric است قادر به تولید تنها میزان کمی از آنزیم لازم برای تبدیل فنیل آلانین به تیروزین و متابولیت های آن (مانند رنگدانه و هورمون ها). در فقدان آنزیم فنیل آلانین و متابولیتهای آن در خون و بافت های بدن جمع می شوند. مقدار بزرگ توسط - محصولات را از طریق ادرار دفع شده ، اما کافی نیست برای حفظ سطح سرمی زیر نقطه سمی برای نوزاد تکامل مغز و سیستم عصبی.

هدف اولیه درمان این است که کاهش غلظت فنیل آلانین در خون از طریق کاهش مصرف فنیل آلانین. پس از تشخیص PKU ، به طور منظم تغذیه کودک خواهد شد فرمول فنیل آلانین کم به دقت با دیگر منابع غذایی پروتئین تکمیل شد. این فرمول ویژه ، که حاوی فنیل آلانین قابل توجهی کمتر است که فرمول دیگر یا شیر است که منبع اصلی پروتئین برای نوزاد phenylketonuric. آزمایش خون باید انجام شود که اغلب به منظور تشخیص اینکه چگونه به سرعت در سطح فنیل آلانین سرم در حال کاهش است. باید مراقبت شود برای جلوگیری از این سطح از افتادن در زیر محدوده درمانی.

بعد از کاهش اولیه در سطوح فنیل آلانین سرم ، هدف است برای تنظیم مصرف فنیل آلانین به حفظ سطح سرم در محدوده که فنیل آلانین برای رشد کافی اطمینان ، بدون اجازه assumulation سمی از فنیل آلانین یا متابولیت های غیر طبیعی است. نظارت نزدیک از رژیم غذایی پزشکی و پیگیری لازم است برای حفظ این تعادل ظریف.

در حال حاضر وجود دارد برخی از چالش ها در خصوص مدت زمان phenylketonuric باید در رژیم غذایی فنیل آلانین را محدود باقی می ماند. در حال حاضر احساس در میان افراد متخصص متابولیک است که دختر باید در رژیم غذایی محدود از طریق باروری او سال باقی می ماند. نگه داشتن سطوح فنیل آلانین در محدوده امن برای جنین ضروری است برای زن باردار phenylketonuric. بهبود بهره وری روان شده است به محض بازگشت به رژیم غذایی فنیل آلانین کم در افراد قبلا تحت درمان با (مرد و زن) اشاره کرد. سوخت و ساز بسیاری از کارشناسان در حال حاضر توصیه که رژیم غذایی فنیل آلانین کم می شود در طول زندگی ادامه داد.

نمایش برای PKU در تگزاس در سال 1965 آغاز شد. موارد تشخیص داده ها از طریق برنامه غربالگری نوزادان ، وزارت امور خارجه تگزاس خدمات بهداشتی درمانی (DSHS) ، با همکاری آزمایشگاه غربالگری نوزادان ، DSHS شناسایی شده است.

تست غربالگری PKU استفاده شده توسط DSHS توسط دکتر رابرت Guthrie توسعه داده شد و از خون بر روی کاغذ فیلتر خشک انجام می شود. شناخته شده به عنوان تست Guthrie ، آن را مهار آزمون سنجش که با بهره گیری از متابولیسم باکتریایی subtiles Bacellus است.

نتایج آزمون فنیل آلانین بزرگتر از 4 میلیگرم در دسیلیتر باشد غیر طبیعی محسوب و به عنوان گزارش از جمله به ارائه دهنده سلامت. اگر نتیجه تست به عنوان بزرگتر از 4 میلیگرم در دسیلیتر ، ارائه دهنده سلامت است خواسته تسلیم 1-2 سی سی سرم نمونه به DSHS برای تجزیه و تحلیل مشخص تر از سطوح فنیل آلانین منتشر شده است.

هنگامی که نتایج غیر طبیعی 1 کشف و گزارش ، خدمات اضافی به وسیله تلفن هماهنگ شده است. اطلاعات مربوط به نام متخصص متابولیک در مرکز تشخیصی در موقعیت جغرافیایی نزدیک به بیمار این است که ارائه دهنده سلامت ارائه شده است. متخصص متابولیک نیز از نتایج آزمایش غیر طبیعی مطلع شود. بعدها ، پیگیری از مکالمات تلفنی را به ارائه دهنده سلامت از نوزادان غربالگری کارکنان برنامه ساخته شده برای تعیین وضعیت پرونده و ارائه کمک پرستار بهداشت عمومی در صورت نیاز. آزمایشگاه غربالگری نوزادان ، DSHS ، خواهد نمونه سرم برای سطوح فنیل آلانین برای کمک به تشخیص مورد جدید یا نظارت بر کودکان که در حال حاضر تشخیص داده شده است نظارت داشته باشند.

فنیل نباید تشخیص داده می شود و یا فرزند شده در تاریخ فرمول ویژه ای بر اساس تست در DSHS به تنهایی انجام داده است ، انواع مختلف از PKU که برای درمان متفاوت است PKU کلاسیک وجود دارد. تست دیگری در مورد خون و ادرار باید در مرکز تشخیصی که در آن مشخص تر آزمایش ، معاینه توسط یک متخصص متابولیک ، ارزیابی توسط متخصص تغذیه ، و مشاوره ژنتیک در دسترس انجام شده است.

ضروری است که پیگیری می شود بی درنگ در صفحات غیر طبیعی فنیل آلانین. مطالعات اخیر نشان داده است که هر روز در درمان کودک مبتلا به PKU کلاسیک ، furthers احتمال آسیب غیر قابل برگشت ذهنی تأخیر افتاده است.

DSHS ارائه خدمات اضافی به پزشک اولیه برای کمک به مراقبت از پیگیری کودکان phenylketonuric. بخش ژنتیک و نوزادان غربالگری نگهداری لیستی از خدمات ژنتیکی در سراسر تگزاس و ارائه این اطلاعات به پزشک به عنوان نشان داده شود. برنامه غربالگری نوزادان فراهم ادبیات ، فیلم ، و بلندگو برای سمینارها تا با آموزش والدین و ارائه دهندگان مراقبت های بهداشتی در مورد PKU کمک کنند. برنامه غربالگری نوزادان در ارائه کمک های مشترک با پرداخت هزینه های PKU اساس فرمول برای خانواده هایی که واجد شرایط برای دریافت بیمه های خصوصی ، مدیکید ، WIC ، CSHCN ، یا تراشه نیست.




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עיצוב לוגו
سه شنبه 1 مرداد 1398 09:27 ق.ظ
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Are you positive your website is designed to convert traffic?
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صیانة غسالات بیكو
دوشنبه 31 تیر 1398 12:56 ق.ظ
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וילות בצפון
یکشنبه 30 تیر 1398 06:27 ق.ظ
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Shawn
یکشنبه 30 تیر 1398 04:59 ق.ظ
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یکشنبه 30 تیر 1398 02:29 ق.ظ
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یکشنبه 30 تیر 1398 01:20 ق.ظ
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صیانة غسالة سامسونج فوق اتوماتیك
شنبه 29 تیر 1398 06:56 ق.ظ
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یکشنبه 23 تیر 1398 06:04 ب.ظ
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یکشنبه 23 تیر 1398 02:48 ب.ظ
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سه شنبه 18 تیر 1398 10:04 ب.ظ
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سه شنبه 18 تیر 1398 01:44 ق.ظ
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נערות ליווי
دوشنبه 17 تیر 1398 01:45 ب.ظ
"We have to build to an alternative crescendo, cheri," he
said. "And we will have an ending that will be as none before."

His smile was decadent, his eyes were full of lust,
plus the soft skin of his hard cock against my sex was having its intended
effect. I'm feeling a stronger arousal now as I felt his cock slide between my sensitive lips.
I felt the head of his cock push agonizingly at the doorway of my pussy, and I need to him to thrust into me hard.
Instead he pulled back and slid his hardness back up to my clit.


I was aching to acquire him inside, and I really could tell that his must push that wonderful hard
cock inside me was growing. His moans grew to match mine, and I knew the opinion of
my wet pussy lips about the head of his cock was getting an excessive amount both for of us.



"Allow finale begin," he was quoted saying, and then he slid the top of his
cock inside me.

The two of us gasped because held his cock there for a moment.
I contracted my pussy to him further inside, and then he threw his return at the sensation. Inch by excruciating inch he pushed
his cock inside me, each time I squeezed my pussy around him.

His cock felt wonderful the way it filled me, but I need to everthing inside me.

I rolled to the side and rested my leg against his
shoulder, and he plunged his cock completely in.
נערות ליווי ברמת גן
یکشنبه 16 تیر 1398 05:51 ب.ظ
We're having coffee at Nylon Coffee Roasters on Everton Park in Singapore.
I'm having black coffee, he's developing a cappuccino.
He is handsome. Brown hair slicked back, glasses that fit his face, hazel eyes and the most beautiful lips I've seen. He is quality, with incredible arms
and a chest that is different during this sweater. We're standing ahead of one another discussing people, what we would like money,
what we're seeking on another person. He starts telling me that he
has been rejected a lot of times.

‘Why Andrew? You're so handsome. I'd never reject you ',
I say He smiles at me, biting his lip.

‘Oh, I can't know. Everything happens for good reason right.

But tell me, would you reject me, could you Ana?' He said.


‘No, how could I?' , I replied

"So, you wouldn't mind if I kissed you today?' he explained as I am far better him and kiss him.

‘The next time don't ask, accomplish it.' I reply.

‘I prefer the method that you think.' , he said.

For now, I start scrubbing my calcaneus within his leg, massaging it slowly. ‘So what can you want in females? And, Andrew, don't spare me the details.' I ask.

‘I really like determined women. Someone that knows what they have to want. Somebody who won't say yes even if I said yes. Someone who's not afraid when trying something totally new,' he says. ‘I'm never afraid when you try something mroe challenging, especially on the subject of making a new challenge in the bedroom ', I intimate ‘And I like girls who are direct, who cut in the chase, like you recently did. Being
honest, that is a huge turn on.
נערות ליווי ברמת גן
جمعه 14 تیر 1398 06:13 ق.ظ
We're having coffee at Nylon Coffee Roasters on Everton Park in Singapore.
I'm having black coffee, he's possessing a cappuccino.
He could be handsome. Brown hair slicked back, glasses that suited his face, hazel eyes
and the most beautiful lips I've seen. He's well developed,
with incredible arms plus a chest that is unique on this sweater.
We're standing ahead of each other speaking about us, what we'd
like money, what we're searching for on another person. He starts saying that he has been rejected a great deal of times.


‘Why Andrew? You're so handsome. I'd never reject
you ', I only say He smiles at me, biting his lip.

‘Oh, I don't know. Everything happens for grounds right.
But identify, utilize reject me, might you Ana?' He said.


‘No, how could I?' , I replied

"So, would you mind if I kissed you at this time?' he explained as I purchase far better him and kiss him.

‘The very next time don't ask, do exactly it.' I reply.

‘I enjoy how you think.' , he said.

At the same time, I start scrubbing my your back heel as part of his leg, massaging it slowly. ‘What can you prefer in females? And, Andrew, don't spare me the details.' I ask.

‘Everyone loves determined women. Someone you will never know what they have to want. Somebody who won't say yes even if I said yes. Someone who's not scared when you attempt a new challenge,' he says. ‘I'm never afraid of attempting something totally new, especially in relation to making new things in the bed room ', I intimate ‘And Everyone loves women who are direct, who cut from the chase, like you may did. For being
honest, what a huge turn on.
فوق اتوماتیك صیانة غسالات ال جی
پنجشنبه 13 تیر 1398 01:34 ق.ظ
Undeniably believe that which you stated. Your favorite reason appeared to be on the net the simplest thing to
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side-effects , people can take a signal. Will probably be back to get more.
Thanks
שירותי ליווי ברמת גן
چهارشنبه 12 تیر 1398 03:50 ب.ظ
We're having coffee at Nylon Coffee Roasters on Everton Park in Singapore.
I'm having black coffee, he's which has a cappuccino.
He could be handsome. Brown hair slicked back, glasses
for his face, hazel eyes and the most wonderful lips I've seen. He or she is
nice, with incredible arms and also a chest that stands out
during this sweater. We're standing in front of one another speaking about people, what we would like for the future,
what we're searching for on another person. He starts telling me that he has been rejected plenty of times.


‘Why Andrew? You're so handsome. I'd never
reject you ', I only say He smiles at me, biting his
lip.

‘Oh, I wouldn't know. Everything happens for grounds right.
But let me know, would you reject me, would you Ana?' He said.


‘No, how could I?' , I replied

"So, you wouldn't mind if I kissed you right now?' he was quoted saying as I purchase nearer to him and kiss him.

‘The next time don't ask, do exactly it.' I reply.

‘I love the method that you think.' , he said.

Meanwhile, I start scrubbing my rearfoot in his leg, massaging it slowly. ‘What do you want in women? And, Andrew, don't spare me the details.' I ask.

‘Everyone loves determined women. Someone you will never know the things they want. A person who won't say yes simply because I said yes. Someone who's not scared of trying new things,' he says. ‘I'm never afraid when you attempt interesting things, especially on the subject of making new stuff in the bedroom ', I intimate ‘And I love girls who are direct, who cut through the chase, like you just did. To generally be
honest, what a huge turn on.
נערת ליווי ברמת גן
دوشنبه 10 تیر 1398 12:10 ب.ظ
We're having coffee at Nylon Coffee Roasters on Everton Park in Singapore.
I'm having black coffee, he's having a cappuccino. He is handsome.
Brown hair slicked back, glasses which fit his face, hazel eyes
and the most beautiful lips I've seen. He or she is well made, with
incredible arms including a chest that is different within this sweater.
We're standing right in front of one another discussing our everyday life, what we really wish for for
the future, what we're trying to find on another person. He starts saying that he's been rejected lots of times.


‘Why Andrew? You're so handsome. I'd never reject you ', I say He smiles at
me, biting his lip.

‘Oh, I can't know. Everything happens for good reason right.

But inform me, utilize reject me, do you Ana?' He
said.

‘No, how could I?' , I replied

"So, utilize mind if I kissed you at the moment?' he explained as I am more detailed him and kiss him.

‘The next time don't ask, function it.' I reply.

‘I love how you think.' , he said.

In the meantime, I start scrubbing my heel bone in their leg, massaging it slowly. ‘What can you enjoy in women? And, Andrew, don't spare me the details.' I ask.

‘I like determined women. Someone that knows whatever they want. Somebody that won't say yes even if I said yes. Someone who's unafraid of trying something totally new,' he says. ‘I'm never afraid when trying something totally new, especially in regards to making a new challenge in the sack ', I intimate ‘And I adore females who are direct, who cut throughout the chase, like you simply did. To be
honest, this is a huge turn on.
נערת ליווי ברמת גן
دوشنبه 10 تیر 1398 12:16 ق.ظ
We're having coffee at Nylon Coffee Roasters on Everton Park
in Singapore. I'm having black coffee, he's which has a cappuccino.
They're handsome. Brown hair slicked back, glasses that fit his face, hazel eyes and the most amazing
lips I've seen. He is well-built, with incredible arms including a
chest that is unique during this sweater. We're standing
ahead of each other referring to how we live, what you want for the future,
what we're interested in on another person. He starts saying
that bigger been rejected a lot of times.

‘Why Andrew? You're so handsome. I'd never reject you ', I say He smiles at
me, biting his lip.

‘Oh, I can't know. Everything happens for reasons right.
But analyze, utilize reject me, do you Ana?'
He said.

‘No, how could I?' , I replied

"So, utilize mind if I kissed you at this time?' he explained as I buy closer to him and kiss him.

‘The next time don't ask, simply do it.' I reply.

‘I love how you think.' , he said.

At the same time, I start scrubbing my your back heel in the leg, massaging it slowly. ‘So what can you prefer ladies? And, Andrew, don't spare me the details.' I ask.

‘I like determined women. Someone you will never know the things they want. Somebody that won't say yes because I said yes. Someone who's unafraid when you attempt a new challenge,' he says. ‘I'm never afraid when you try interesting things, especially when it comes to making a new challenge in the bedroom ', I intimate ‘And I enjoy girls who are direct, who cut in the chase, like you simply did. To generally be
honest, that's a huge turn on.
נערת ליווי ברמת גן
یکشنبه 9 تیر 1398 08:25 ب.ظ
We're having coffee at Nylon Coffee Roasters on Everton Park in Singapore.
I'm having black coffee, he's having a cappuccino.
They are handsome. Brown hair slicked back, glasses that fit his face, hazel eyes and the prettiest lips I've seen.
He is quality, with incredible arms and also a chest that shines during
this sweater. We're standing in-front of each other referring to how
we live, what we would like for future years, what we're looking for on another person. He starts saying that he's
been rejected many times.

‘Why Andrew? You're so handsome. I'd never reject you ', I have faith that He smiles at me, biting his lip.


‘Oh, I really don't know. Everything happens for grounds right.
But identify, would you reject me, does one Ana?' He said.


‘No, how could I?' , I replied

"So, you would not mind if I kissed you at the moment?' he said as I recieve nearer to him and kiss him.

‘Next occasion don't ask, simply do it.' I reply.

‘I'm keen on how you would think.' , he said.

At the same time, I start scrubbing my rearfoot in his leg, massaging it slowly. ‘What do you wish in females? And, Andrew, don't spare me the details.' I ask.

‘Everyone loves determined women. Someone who knows whatever they want. A person who won't say yes simply because I said yes. Someone who's not afraid of attempting something mroe challenging,' he says. ‘I'm never afraid of attempting something totally new, especially with regards to making a new challenge in bed ', I intimate ‘And Everyone loves girls who are direct, who cut with the chase, like you merely did. To become
honest, which is a huge turn on.
 
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