Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more ➡
Download
Standard view
Full view
of .
Add note
Save to My Library
Sync to mobile
Look up keyword
Like this
2Activity
×
0 of .
Results for:
No results containing your search query
P. 1
GP Buzz March 2011

GP Buzz March 2011

Ratings: (0)|Views: 907|Likes:

More info:

Published by: Tan Tock Seng Hospital on Aug 10, 2011
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See More
See less

08/10/2011

pdf

text

original

 
NEWS
CME
S'CHEDULE20111
I'eadngl
in
the,
G,e'llIlenl'l
,Populatlion'~
Ttu'OIJ!9;tI'Th,e
Aglas
'Orgon~e,r:[:)epartimerdol
OphilhalmologyDale;21May2011Conhlia,t
Person!;
M~ilalUina
'CiO!ilta~~
'Illio:
635l7M8
1El'n'l'!!LTIaGlho_k@1'IIsh.com.,s.g
ns,iH
,Splne
D,ay
'Organlizer:Depm1menlo~OrlhoiPoedicS'iJrgef'l
Cale,:28
May
2C11
!
CQI'!I'a'C'1
fe!:$Qn:
M$Joyoborothv
Contact
,1'4:0:
63.577700
Email.:iay.ab<l;lr(;dhy..:singlefdju@lisih.com.~
,A,TR1A,LIFI8,RILL,A,'TIONI
INEW
GUIDI,ELIIINES,U"DATE'O'NMANAGIEMENT
o
IF:
HYPERTlE
N
SI0
IN
eOM,PUTEDT'OM,OGR,A,PHYAIN
G
I
O,GRA,M
!!II
WliAT'IISIT
ANDI
WHIAT
IS
rr
LIlS,EDfOR?AD'VA,N'CES
ININTERVENT'IIIOINAILeAIRDI~OL.OGY
,"RIMA,R,'
"REVIENTIONI,Q'IF:
coR,OINAIR'yARTIEIRYIDIS,E,A,SE(C"AID)
NEWSNEWS
INEWS
NEWS
 
HEADO!F
'D
EPARTMENTMiIESSAGIE
_....::::II
nthisissueof
(3P
8uzz,
the
!Department
,0"
Ga!s~roefirer,oJlogIY.aJndIHepalto,llogyTISH
w~111
wcus
,01111
omeoft~le
oo:mmotnl,ga,s,tr-o~.ntestiln!a~
ndI
iVlercornldnlonss'senin'Ulle
IP.rimary
hea:~tlhlcar,s,settin'g.
I
nadi!d~rtion~'O
bringilnl,g
)I'OUihe
updates
ont~le
cernmcnconditiioJ'iU3:,we
w~n
a~so
kieepyoupos~ed.
on
a
lr,ei,aively
neW'
tE!chno,~ogy,VII
dec
capsIJJ,lelendosco,py
andits
i
nd
icaliiO~is.
C6~orn
canceris
thecommonest~ype
of
cancer
(wi£h
81
croderateof
just
under50
pier
1:00.!OOOp,sryear)inS~ngapore.,lhe:
majority
casesofcolon
cancer
are,
pot€lntiaUypil1eV,errlita
le.Mos,t
co~on
C2i1nCerS
donot
fClrm
d'e
novo.
S:tiUldi'es
had
les1abU
s~:ed
tha!t~,emajority
ofcoloncaneercases
'E!yo!vedfrom
initll:aUyberll,igln
colon
adenomarouspo~yps.
The
adeno'ma
b:~carcinoma.seqrue:nce
is,
,estimated
,at5-,10.
years
JlrnlteN~tTl1rls
Umenamehas
pmvidi)edJ
us
wi~hlil,e
OPiPol1uiIlMty
toscreelnlllfiliCI
enoiosoopicaHy
~emove
thecolon
lPo~yiP.
-
"
.
-
~
'liherebYfleducifll,g
theinoliCIe'rice,orfprogrressio,n
to,
colon
oarll!cer.lh~;s.
hasrorrnled[i'le
bas.~s,for
natJToil]:a~
g!u[de~in,es
for
colon
caneer
scrl€leni
ngfor'i:ne,g,enera'~
po'pu
IlaUorl
oVlsr
50years~n
malmiY
tCou~ltdes
(e.g.
USA,UK).
Hlaiema:rTi1o:~darlilleec;in!gisthe
COmmOir1lest
C8US19
ofper
rjecb.a~
b~eec'ing..AI~i1oiug,h
n
is
uSlll.ai~yWilot
nfe-'threa~en
inglandlisieasy
tD'tre,a~,
p:at~elnUma.ybequitealarmedoranxious
a'~sutotilii,erpossibleaet~olog~es"
Whichwi!~
bediscussed
here,
~111'ilI
ed~lcaJI
school
teach
ingl.
jaluln!:cUCS'
~soH:enCh9Jsls~fied
pialhologlical
~y
aJs
pre~he'patic"
hepatic
a.mI
pos1.-h;eiPa~ic.
.A~lho~ghl
thetCl:assificationiscomprehensive,
~,t
may
so'me:times.
resli.!tl~
n
'lin:e
bornb:t:l!rdmei~it
offtes,E5enpaUents
w~hll·aund'~oo.
Inlinlis,issueof
G,P
B·uu,
we
simpn~
m:e
ste:rn1,OIl
testsneeded
ln
the
workup
of
]allilndioe
inani
irmtlllliUvemanner.
AUhouQI!1H!eUO'oba'uIer.pylmi
ilnrfecijonl
anc'
'he:pa.ti~~sBa,~enotn&\!VIkid's,onthiSb~ock:,both
OOIFltdiitioris
are
pr:eva'llent~ai~,e~
rimpac1tso:rn
healthca~e
costaarenot
iINls~:gnifiicant
It~Sithus
impol1ant.U1:at
their
management
arer,ev~s.
te'd
and
updated.
Last
bu~not~,eaJst,themini:ma'Uy
i
nvarsive,
«("ftenpercei'v:ed
by
pratu,entsas
lm.on"iINilvaJSIVl8)
capsule
e:ncilosoop:y'
hals'galinlsdpulJ~ilc
alerdionarlld
acceptall'1l,oe
over
the
l!ieeenrtyelars,.Itlt
ls
b,eoomilnigan:incr€Hilsil~glycommon
pmoodum.
sO!11e:ti
m€l'S,(j
ffi'stllrrt
o~reqllJl'est
by
pa.Uenls
orreferringdoctors.I~t~sthliis~'mponarilt.tllm:a't~he
indicaiticH1S
andUmitationso,f:·calpsul'e
E!ndos,cop'yare'
discuss:ed,
to
pn~v,el1lt
overz,ea
~o,usa.dloptionof
th~,s
techno'~ogIY.
III
hopeyoul
'Win
'I1irndJthese:articlesWruJitfu~inthea,pp~~)ca:tiono,fnewkl'il.ow~ledge·
in
yourdaJlybus,ypractice.
AdjAs:s,t
'11",01Oharl:esVllI
IH~a;d
.&
Senrar'Cons~lta:rli
P,anereaito~B~ia:ryDis.ea.sesanc
Mvarnced
lherapeu1iJcGasU.oi'n1ie$<1lifl<ii1
mIloscoPY
PriVate
P'hysJd,anRelations.office
Tel:63572519Fox:62568053
Emoii.:
DEPARTMENTOF
TheDepartmentofGastroentero~ogy
&
Hepa~Cllogy
at
TanToek[SangHosp~talprovidesholisticcareinthePfSV8ntion
I
d
iagnos1&
andtreatmenf
of
diseases
d'
the
d
ige.stive
tract.
liver
.antfpancrsas.
Being
one-ofthe.~ar1JestGasbDentero'ogyunitsin'SiRgapore,we·performmorethan7QQO
simple
andcompJexeoooooopiGpmceGufesannually.
rt
fs
Q(QiInizedaraundmnsultantswithsp,s.Gialize£l
trainingfromhighreplltablecentres
in
variGLlSfieldsof
Gastroentemlo9Y-
Ourdoctorsprovideoomprehen$lvaa[ld
muli~jSt!iplinary
approacllln
caringfar
in-patiehts
as
well
as
olJ1-patrents.
Inadditifmto
servin'g
ourlecaI
~plIlatiQn.
we
atsoattractInteniationaIpatient
refarrllJl
$.
Wetake
pride
il"l
beingan
edIJcsti&nsI
eentre
formedical$tuderttsendtraineedoctorsfromvarious
countries
around1heWorld.
,Ad.j,Assti?lI'of
CltJall"les
VI
Head
&
Sen]orCoru.!.II~o!'l'It
Pancfe.do-SillialY
Ims.ea*"
]anaAlr:ivaJI1Cff1The·r;apeUl!ic
G~lfQil'ife$.~i"aJ
lnidoscop:'l
IDrYa.rl!gWeiLYIIl
Set1iIOiFCOml.ll~afll;
G~neral'G!ilslt,oflltrero.1agy
andCllnl"al
:He:p.alc~og,y
Adjj
Asst
Pr·ofChia
ChunglKil1lQ
Oons~lloim
,GetlelfailGaslroeruero!ogy
arildClin~oolHepmor.o,gy
DI1'Yeoe'hlo/m!;)Mem!;)
{)DnslLlllaTI~
Ge'ner<!l·Ga.$froenlerolQ9YlandCHln~Q;aj1eiJ)llJtofogy
Mji
Asst,
ProfYhll
HerngBoo!!!l
ID~~lyHead.
&,
Senior
cQf'ls'iJl~ant
Ipancre.aJro.8~i;3JF.Y
lJiSe.a~~s
<li!'1Id~a.ncedThera:peJ;LLic:
GastrolnteslinOlI
Efl(j~oo:py
DII'IE~li
l~l5h:e.n
SeflijOf'OOflSIJIlaFiI.
'G€'J"Ii~r;a1
Gastm~r:urerolqgy
and
NIJ.!"llriHon
DrStephen'fsao
'Oonsullard,
InibaJh1Il1il!il,IDt:yBO'l!.I'eI
iDismse,
N~I!1llona.i!1'dl..dv;anoed,G<l!SlI'ointea1linanEoooscopy
I
DrAmitabh.Monga.
Associa,t€lGonslillital'd
Pa!'l,realo>-Bdl~ary
DJ~~
andAr:ivSlnC«li
hel<:lpeul;iiC:
GIBSIJ:o[m.l1lstin!il~
Elf1!dJoscop'y
Or
ICh,lahl
Khool
IBelijl!JI
SimJOTCOMl!UaJ'lt
Upper
GaslilQinteslirntl,
MOI!iBIy
and
Adi.riI3Jrmedi
T.li!lef<lpe:1,,!'lJcG~lfotf'!te$tina1
Endostoplll'
AdjlAs,stProfLim
Wee
Clilial
$en~~
Conwlla!'!t
II1I!i'ammalD:ty
Bowea
IDilS'll'.I3i~
t8J1lr:iAJmram:€Id1
Gasirointesllnal
En.d.oscopy
DIf
Q!!!Ian
Wa~Leong
Col'1lsllilta:I"i~·&ID:iFe.DID.t;
Endo~~opy
Cenllia
l?<lflc~eaI.Q..BiliaryIOlsearse!l
arne
M;Ia!:l~Thiilli8p€iU1!iC
'Gaslliotni!es:ttlnal
Er.dIOSliOp~'
 
HEPA"nTISBCARRI'ER
C!hronicIlHepaUtisBVims(HBV),infec,Hon
is:
a
sligniilicanlt
eause
,of'
globalnoorbld~ty
and
morta1'Vty.Tlhereare
,es~imated350400
Imillif,on
IHI~Vcalm'ErIfS\i'!iOriI~w,Tideitliir75%
liv:e
fin~li1eAsia~~,a,cllfilCIrngiQ.!I1.~nSing:a,po.re~6%o~ourpopulationareH8Voarlii:ers.Ti1e,speetrumofthediseaseand
the
n~tlilmlhisto.ryof
chronic
HBVinfeotionare
,ej
IIV,eili'Sendvariable~ranglilllQfrom
alow
vITem
i'o
i:naclillve
cal,lfier
s~ate
~o
IPcr'Dgr's:ss'irvect'Lronic
lhepatitis,;
'Whii(jn
Iliay
ev,enwaJtvevolv,etoIdJrrhosis
and
th,epatoce!llllll'lla!iU
aliCinoma
CHloe)..
ellrU'lOl1iG
HII13V
iIWl~c'Hon
may
Pfie:S€l1~astiJ,e,pam~s8eafl~ige1i1(H~eAg)~po~itiv'€lorH~eAg'r"negiativechr,QlI1icili!lfecUolilr.
HIB<ElA,g
IPositiVleinmeclli;onsarecommonlytermed"wildlylpe~..~~typicallyrepresernstillie'ea~y
phase
·o~chmllluoiill'lifoo~ion.
These
patientsareanti~HEle
ne,ga~iv,e
BindtheirHBV
DN_A.lev·els
arevery
l1i:g'hat>
.20,000
IUlmL
(or>100,000
oopiies/ml).•
HBeA,g
n.eg<3Jtive
dli:seasElf.alsocalledi~p.reao:re
'mllirtant.
i'"
reprSiSisntsa.
l~ail'Elf'
ph'03is.e(If
cl1runic
[li1metro:n"
Itis
dlliJ.e:lo,~plh:;a,tkJn0$
natumlly
oc()unuingl
HEI,\/'
varr:antswith~m.u::leQ,tide·Ub:stl;lUijOf'l'S
inr
the
precolle
and1/orlbasic
cor1€
pmm.ater
r1€giol1lls
,of
the
genome.
Uiiis:,cI1l19riH::rer:i!Zed
yllie'lpresencepfanti~HSea
ncllowl!lif
H6\1OINA
II:evel
of>
20[)1[)
,IIU.lmt
(or>10,00[)oopies~mL),.The
!p;fre';va'li€nceof
'llIt1eHIB€lA,g~n,€gatiiv€
~Jlfectioli'l
Iha'S
beell1inCf\9'asing
over
tllUll:
Ih3,St
ecade'
asar'8iSiliJllt~agillili9H~V'"\ll11fe~~ed1f;l0plII'l:aUor!l
andlrep:rese'n~sth,emajority0,1
q~H)es,inmanya:rea!5i,
especjally
in
Asial
and
SOl!JthemEur"Ope..
..
DI'S'EAS
EMON
ITORilNGISIMPORTANT
Morbidity
andl
mortality
efdn
WOl1liCHlE!,Vi'll1~ecHoina
re.jne
IweslII'lils'ofpelfSlsten'tvirallrelplk~atiol1lal1l!(jevQ:I:l!.ltjol1ltoaiffh,osis
or
HOC.I
t
isestim!!1jltedI26%
of
IIHIBV(farniers
will
devl!lWo:p
ilil\ie;r
o[lIThosis
ana:
ID,eannua!11
nctcence
,of
,dJerVelopJlng
He:V~rela~e:d
H,oe
r.angeiSmro~
2%
l~)
6%.
HI~V",rela~l€ld
endlsta;ge
l[irV€;u
iseaiSi9,o~HOCamffispcmsible'kJr,aver11
mililion
deaU'ls
IP€!r
year
globa'l
~y.
A
mew
lall1ldmarnsh.!I',j'[es
have
:srnowedllll1at
l1ig:h
Ibase:nl1le
H!:IVIDNA~s
.aJ1li!ooclated
w,~1l
higherrisk
'of
develo;pme'nt
o,ffll'iivercirmosis,IHCCandimorta'liityEh.l!IPipr,essi!On
f
HB,Vreiplicationwi~n,d:rugl~neraJl:Ycanimprov,e
nUl!
Cjuallity
of
Ii~
and
sliJrviva'l:.byjp,W8'V,e.ntlnglil1ese
oomplicat[o!lrI!;i
worn
ha,p,pefllTli1g..
f'QllliOiW
upofHBVcarnife:rsatregula]'
fnoorval
rlfslJJi1ere!1fom
essel1lrtialto
id:e:nti~ypa~el"lltswino
reqlllilre
weatmentand
te
detectcomplication
ealri,iier
when
it,
Qoours.
Most
g:uide!llil1l,es
Irecom!1lT1e:nd
16~m.ontl1l'liy
HOC
surveilMmcewi~hij:lrllaS!o~mcl
scan
e,fW1eliver
andl
alpl1la,'l'e,to:pr,otein(AFP).
Uiverluncti:o:nte.stis
dOIil:El:n'~hesa:me,v'f'S:it
'WHEN
TOSTARTTREATMENT?
TIll:€)!gO'alof
'91erapyfori
chronicHlBVinfection
~s
toachiev€)!pm:l~ng:ed
,alildsliJstaili!,oo
viralslJll~pr,e:s'8iron
andta,
p.rev€'ntprogn~,s'SitO.lilKl,cinhcoslits,d:ecom;per:l!Sat:edlCirrihosls,
liHCCa.nd
de8Jlitl,
H
oweverall1lili
'Vir,al
Umera:py
may'not
be\!Vill1li'al1i~edforallonro:nicHBVpatfents..IFelWma,ctors
mUist
be~a~l!;.en
~nWconsideration
beitior,e
init~a,tingti1erapy..TI1!,ep:l1ysicianml.l!lstweig'l11l1e
potetil~ial
b€!ne~~ofadihieVlngl
Illong
lasting
IresponSEl:Vr€ml!l!s
U1e
IHk:elihoooo~adi\lerse
effi~ctsa;s.'Soc!atOO
Wllllh
~he
'tffialtmel!lil~
~he
IPossibilityoff
d'Ngl
lwesrst:anoeand!theIPotentialadverseclini:ca:11
olll'toomes
in~he
,a'bsel1lJoo
of
trealtme.nL
Thephysiici'an
mustaJiso,
oonS:idJI!,r
the
patienJt's
a"ge,prefeirenooa.nd
the,oos~of
U1H!!'
me~'i:catioJ1l,s.1iI1e
ind'i!catlOrIJiS
rortreatment
arelbased
mail1l'~Yon
IDeoocmbina,tioi1l'of
:rourontBiria:S,erlJl.m.!HBVDNIAlevlllil.se:rumAlTLW€!I"his~QIQgi.calgr,ade/dise8Joostage,asW'€J1I
as,~leaQ;eof
:tlle
patiel1ltF'orlFlIBeAg~po'Bltive.'cl'i1~l1lIic
HlBVinfe:c~i,on,~rea,tmelilitis
r\1lioo{1l11m!snd
l
!1ldhen
HI~,V
DNlAle:v,eWIs
above
.20,000
1!J/ml
andserumALTIlevel
iis
peilrSis~en~l~tle,vated.For
~hoseagied
above3540years,withHB,VIDINA>
:20,eGO
IUlml
blili~.ormal
AtT,Il'iive;rIbIopsyornCin
IlnvasW,eflbrosC2In
shol.l!'l~
becon!sTdered
and
trealtmenlt
is
ri:commeincledl
i~
l1,E!
(fi:sease,
slMwsmodreralte
In
S€:v:ere
active
n~cfo:ilnftalllmo1tion
or~brosis,"F'O:lI'lhos@willl1
H
BV!J'NA
<
:20,000
jllUlm'lla~nd
nor,mallALT.
n8ilmsnt
fitS
n,otfeq,uillredi
butrooon~lnu:ewilli
'6-mcmthlyALTI'iIilOnito~iIIg..
WI~~fieg,ard~,oHBeAgI-{leglaUvl'lclilronlcHBVir:Jifeaticm,lreatmeliltisrecommended!w,nenHe.V
ltolNA1,(lj'V'€I1
isabove:2;,000
1!J1m1
a.ndseruffil
All
il',evel
ispersistently
'eleva:tect
IF'oflhose
with
IHISVDNIA
;>
2:,000
IUlml
bu~
1'il,0nTIiai
AlT,
Il'irver
biopsyow
1M,
fibJosc-an
:SIMIJtolbe!oonsiole;re:dla
ncI~reatmenrtis
lrecommendedlilf
me
disease
snows
moderaJre
to
se'vere
active
n,scfiQT:l1l1arrrmatio:nQrfibr'o.s:fs"For
~Iil,o;se
Wi~~hH~VD~A
<:
2:•000~U]rmlaMnormall
Al,T.lreatment
isInotrequired
!but.
regular
AIL,.monif.o~ing
is
wawant.edl.
MEDICATIONS
US,ED
FOR
T'R'EATIMENT
OFCHRONICHBVI
N,FE,CT'ION
lWO,
dli~ellent'typesof
medicatiol1lSioain
be
u!5led
fur
me
tf1eatm,ento~
chronic
HBV
infe,oUon:inleml'emn
alma
and:
nucleosid:e{nU!CllieoUd'eamalo~M!eS(NUCs).Currentlry
tlM!!;WSJ
are!
"7
medicaltO'nslilicensecj~f;orusein
Singa,pol1e'.
n;ame1:y
Qcmven~ronalin~.e.mI"eron,.
egyla~oo
ifllit'erfe:t1OflI
.a],fa~2:a,and5NIIlJCs~.II!a.rnj\futJine.,ad€:fi:rvir!e:ntecalv!]r,l'€lbivl!1dfi
i
9
and!
~en.ofovlr..
Niue15
pr'l9'fermdIbymos~ofth€
patvents
[nvi~o~
tlil,eeasy
(:)mladmin:~sllmtio[J1,alnd
mInima'lladvS'use
efifects"'Hle.m:ajor
d'i!sadv8Jl'litages
.of
NIiJCsareindefinitetreatffilen~durationand
associateddlru:gl
resistsnee,
IOill~he
contmrj.
interfeiwn
alfa
trea~mentrepresents;afinitecourseof'
tI1Iena
I
P'Y"andi
itisnot,associa~e:d
wli~n
emerge:rlce
of
anl1'
resis~ant
v:i'rus
v:ariants.
HoW€ver.
th,Ll!sl:I:bcutalneQus.
routt€ofadminIsllJratioll1andcertain-adv~r.;eeli3ictsmake
it
ili€<Ssa,ppeaiIJIilQ
ascomparoo
wlthl
NUCs.
Iln~erfer()na:lf:a
canbe
oonsideredi
in
YOllllllgpatienltswhomayroleratelheaiCIverse
·effec,ts
be,U:er,and
young
women
,d,esiringlil'ut!,!!rE!
p.reg.nanICY!beca~se'ofits,definMper[od'of'~he:rapy.
iClltm:rlilicH
~V
infilldion
isalsigiilificanltcause:
,of
globa'fr
mOl1bidity
and:
rlIIOrta:l'i,ty.Umayprese,lII[as,HBeAg~p.ositiveor
IIHB'eA'kH~egaUived'fiseases.
Followupandmonito:nngl,of
chronicHBVpa~ienits,alt.regulalr
m,t€lVa'll
is€ssel!liM:altohliti.aiteal"litiiviralIher:ap'y'
;irf
trea~m.ef1lrtisindio8'ledandto
detectcomIYJ:ca~iol11ieairlierwl1!en
it
eccurs..
Tlher'e
3,lfe
two
typesofmr€dica!liio'ns.lIlJsedi
ojj~h€:
treatm.ent
,Qfc!1iU'Onlc
HBVIin~eclioJ11
namely
I5!l!JbOOrl:aneolls
ifnt:erfer-on
aim
injedi:onand
1
ora'l:
fr'.iJ
UCs.
SF(@)UGHT
H!epl~i~is:EI,
""rutS
Dr
Yeo
ChOIIl1!g'IMe:lI1!gl
Consulitanl
'GeneralG'r!stroenterolagy'
aniGI
Clinical
Hlep:atal~gy'
Dr
YeoC'MnglMeng
grad:~atecl
fromtheUniver:sity
,of
OHltgO•.~,ewZeala,nd.wh,erel1erecE!ivedInis
mediceiJI
degreeami~~he
basic
medlica'l:
trainingl"
He
sllI'bseql:i,ently
r€:trumedand
,obtainoo
Ih,Iis
'f€lill~~hip
in
iQastroent,€f!dl~gy
'&
IlFIep:atolo'£fyinSil1lga,po.we.liHeha'Srecen~returnedft'lOm
Yale
University.IlISA,sifterhisa.dvanoed:subspecialtytrainingTnPO:rilalllFlypel'ltension.
DrYr€o,is'CliIiir&.nUya
C.onslJlitant
in(~astroel"lll:€lr.QlOgy
&.
Hepa,tologyof'fanTookSengi
H.osp:ita'II"
nda.clinical~lU~or
of
"{:o.l"lrQ
LOG
Un
Sohodil
o~
Medicine,
INat~onalUnirversity
oif'Singe;pore..
Heis
also
a
me,mber.of
IR.oyal
C~llliegeo~,
Physi.cians,UK,as
weilll8:S
a
memberof
Gia's,1n)en~erolog~S(J;t::ielty
,of
S:ingapore..

You're Reading a Free Preview

Download
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->