Harmonisation and Standardization of Laboratory Testing is the Need of the Hour

By / 4 months ago / Interview / 125 Comments
Harmonisation and Standardization of Laboratory Testing is the Need of the Hour

Dr Barnali has come a longway but she is still so full of dreams and aspirations for the future.“If you put passion and dedication in your work, it will give meaning to your life,” she philosophizes.

Dr.Barnali Das, MD, DNB & PGDHHM, Consultant – Laboratory Medicine at KokilabenDhirubhaiAmbaniHospital & Medical Research Institute, Mumbai, is the lady who plays multiple roles throughout her professional and academic life. She is the Chair of American Association of Clinical Chemistry, India Division; Executive Committee Member of Scientific Division of International Federation of Clinical Chemistry & Laboratory Medicine (IFCC); and College of American Pathologist (CAP) Inspector & NABL Assessor. She also served as a Member of the IFCC Committee for Standardization of Thyroid Function Tests (IFCC S-CTFT), 2011-2017. She is also a Corresponding Member, IFCC Committee for Reference Interval & Decision Limit.

This year, Dr.Barnali is recipient of  2019 “Diagnostic Leadership Award in Achiever Category” from Indian Express Group, Medgate Today India 2019 “ Healthcare Leader in Quality & Management” in Voice of Healthcare and 2019 Zee Business National Healthcare Leadership Award in ‘Woman Leadership Category’.

She is also recipient of several prestigious international and national awards including two oration awards and awards from College of American Pathologist (CAP Inspector Excellence Honor for the year 2018), AACC (Outstanding Speaker Award), IFCC (Development of Quality Competence in Medical Laboratories Award), Asia Pacific Foundation of Clinical Biochemistry (APFCB), Reliance Group CSR (The Woman of Substance Award), and AMBI & ACBI.

She has many publications in high impact factor international& national journals (recent ones are Clinical Chemistry, European Thyroid Journal, Clinical Biochemistry etc.). She is organising secretary of 2 international conclave (IFCC & AACC) and many national conferences & CMEs.

She has also delivered more than hundred invited talks & plenary lectures in both national & international forums.

Her biography has been featured in a book (2018) named “And So Can You”, which contains stories of 17 renowned doctors in India.

As a prominent professional in Laboratory Medicine, what are the major challenges in the field of Clinical Chemistry & Immunoassay?

Dr. Barnali: Clinical Chemistry and Immunoassay tests form a very important set of tests in a pathology laboratory; a tool that clinicians and patients alike depend on, to pin down the symptoms for treatment and relief.

 
However, it is this very set of tests that have come in question. First, what is the normal and acceptable range (upper & lower limits) of different Clinical Chemistry and Immunoassay biomarkers in a particular population, has been debated in different scientific fora. This is because, the level of markers can change in relation to other biochemicals, biomolecules and hormones, which themselves vary considerably with race, gender, age, different physiological conditions (like pregnancy, new-born) and other illnesses & interfering substances. This variation can be to such an extent that, each individual may seem to have their own set-point of these hormones, as an example, for that of thyroid stimulating hormone (TSH).

Therefore, harmonization of procedures is the need of the hour, since a major problem doctors and technicians have to grapple with is the variability of test-results; even a broadly similar set of instruments and methods can provide different results, even as much as 40% more or less, for example, in case of TSH values. It is then a real challenge to the physician to decide whether the patient is suffering from a disease or is it something else, since other factors can also cause changes in testlevels.

Due to the lack of proper reference intervals and sometimes due to standardized measurement procedures, standardization and harmonization of clinical chemistry and immunoassay testing still remains a formidable challenge

Have you done anything to establish Reference interval to address the above challenges?

Dr. Barnali: We have done reference interval verification study for most of the clinical chemistry & immunoassay tests. I would like to give you an example of one of most common routine test, TSH. Ethnicity-specific cut off of TSH is important for accurate test reports. I am also the Corresponding Member, IFCC Committee for Reference Interval & Decision Limit (IFCC C-RIDL) and was associated with IFCC Committee on Standardisation and Harmonisation of Thyroid Functions Tests (C-STFT). In India, we started by organising thyroid camps and every year around 1000 TSH screenings were done during World Thyroid Day. We have established reference interval for TSH and FT4 in Indian population.

The reference interval (90% confidence interval) for TSH by non-parametric procedure (bootstrap) is 0.48-4.52, and by parametric one (after transformation of the data), it is 0.45-4.27 for the adult population, which is little different from the manufacturer’s guidelines.

You were a part of Executive Committee of IFCC Scientific Division worldwide and also Chair of AACC India Section. Can you share us the experience?

Dr. Barnali: Being Executive Committee Member of IFCC (International Federation of Clinical Chemistry and Laboratory Medicine) Scientific division and Chair of AACC (American Association for Clinical Chemistry) India section, I feel that I have a bigger role to play, so as to incorporate quality competence in health care, implementation of standardization and harmonisation of laboratory testing, establishing Indian Reference Interval, bridging the gap between diagnosticians and clinicians & also to connect with the professionals in clinical chemistry, pathology, molecular diagnostics and IVD industry.

Different Committees and Working Groups under Scientific Division of International Federation of Clinical Chemistry & Laboratory Medicine (IFCC) has been formed to address the issues of standardization and Harmonisation of laboratory testing. Being a part of the Executive Member of IFCC Scientific Division, we have been entrusted with the responsibility to spread awareness on the need and methods of standardization all around the globe. IFCC is encouraging a lot of awareness-channels – organizing events, research publications and news articles. The committee is discussing with IVD industry, kit manufacturers, clinicians, hospitals and laboratories to formulate guidelines for assisting in correct measurement, diagnosis and management of diseases. My special thanks to IFCC Scientific Division Executive Committee for their continuous support.

It is a great honour to serve as the 1st chair of the AACC India Section. Its objective is to connect with global leaders in clinical chemistry, molecular diagnostics, mass spectrometry, translational medicine, laboratory management and other frontier areas of laboratory medicine.

In pursuit of that, our activities have been:

i) 30 AACC trainee membership grant to post graduates in India

ii) Organization of  symposiums, CME and Annual Meeting in different parts of India.

As Chair of AACC India section, I believe I have significant  role to play to empower young post graduate of our field. We are soliciting launching AACC India section travel grant of amount one lakh INR to attend AACC Annual Meeting in Chicago in 2020 for young post graduate student in the field. In addition, our section is introducing one AACC India Section Fellowship Training (one lakh INR) and two Educational Grant (50,000 INR each) for training and project, based on an Indian perspective. We are also planning for Universal Sample Banking study as per AACC model in India for establishing Indian Reference Interval. With our distinguished executive committee members, we expect another great year for our section and our valued members.


Can you please elaborate the above points with examples?

Dr. Barnali: Sure. Here, I will provide few examples and technical solutions to address laboratory challenges and to take it forward from both Clinical Chemistry as well as Immunoassay platforms.

i) There has been a continuous challenge in the health care system in U.S, Europe and other countries to standardize and harmonize the HbA1c reporting: the decision on what to report in NGSP (%) and/or IFCC (mmol/mol) units along with eAG (in either mmol/L or mg/dL). This globalization places a responsibility on laboratory medicine specialists to work together to reduce the current variability in patient results, which arise from differences between units, methods and laboratory practices in different countries.

The IFCC method is in place and opens up the perspective of a global standardization (with worldwide uniform clinical guidelines), with HbA1c reflecting the true estimated average glucose.

Due to the standardization efforts of IFCC, NGSP and other national organisations, and also due to ongoing efforts of manufacturers and laboratories, the quality of HbA1c reporting has increased dramatically. It is so much so that, there has been a paradigm shift: HbA1c is now considered the gold standard, not only for monitoring, but also for diagnosis of diabetes.

ii) Cardiovascular diseases (CVD) still remains the primary cause of death worldwide as well as in India regardless of advances in diagnosis, treatment and risk assessment tools. Chest pain is one of the most common reasons for people visiting the accident and emergency department(A&E) in hospitals to rule out an acute coronary syndrome (ACS).

Troponin measurement, a keystone in the diagnosis and management of ACS detects the levels of troponin- a cardiac-specific structural protein released by damaged heart muscles. We have now shifted from conventional cardiac troponin (cTn) assays to High-sensitivity cardiac troponin (hs-cTn) I or T. High sensitive Troponin assay help in  higher analytic precision at lower concentrations, and increased clinical sensitivity for Acute coronary syndrome (ACS). It can detect even small changes in troponin concentration (delta changes: increase or decrease)in particular time frame. The availability of high-sensitivity cardiac troponin assays (hs-cTnI or T)in the setting of Acute Coronary Syndrome (ACS) has allowed for rapid risk assessment of an ongoing myocardial infarction.

However, there were concerns raised about the use of single, universal cut-off value of hsTroponin I for both men and women, as there is a potential risk of under-diagnosis in women, since they have a lower threshold value of troponin. A total of 2797 female patients were enrolled. Percentage of positive female patients with acute cardiac events if the cut-off was more than 26.2 was 68%. Percentage of positive female patients with acute cardiac events if the cut-off was more than 15.6 was 82%. The difference in females undetected without gender specific cut-off was 14%.

Therefore, implementation of gender-specific diagnostic threshold helped in identifying more women at increased risk of ACS or death, than a generic threshold.
I would also like to acknowledge my team members for helping out in conducting few of the above studies, specially the technical staff of Biochemistry & immunology section.

What is your final message?
Dr. Barnali:
The road map for laboratory medicine therefore will involve strategies for harmonizing, communicating and integrating with all stakeholders; like, clinicians, diagnosticians and IVD industry, in order to formulate guidelines for assisting in correct measurement, diagnosis and management of diseases.

Sahil Saini

Sahil Saini

The author didn't add any Information to his profile yet.

125 Comments

  • ethivido05. Apr, 2020

    levitra buy canada http://hydroxychloroquine24.com – hydroxychloroquine buy viagra uk no prescription

  • Houston Poer04. Apr, 2020

    Youre so cool! I dont suppose Ive read anything like this before. So nice to find somebody with some original thoughts on this subject. realy thank you for starting this up. this website is something that is needed on the web, someone with a little originality. useful job for bringing something new to the internet!

  • have a look at02. Apr, 2020

    seo tools ??????30????????????????5??????????????? | ????????

  • visit website02. Apr, 2020

    Nothing can be authentic. Gain access to coming from wherever this resonates along with ideas or even heats up the mind.

  • best price for home01. Apr, 2020

    Merely wanna comment that you have a very decent web site , I like the design and style it really stands out.

  • Johnson01. Apr, 2020

    Some times its a pain in the ass to read what blog owners wrote but this web site is real user friendly!

  • Julio01. Apr, 2020

    It’а†s actually a great and useful piece of information. I am glad that you just shared this useful info with us. Please stay us up to date like this. Thanks for sharing.

  • Ivan01. Apr, 2020

    I truly appreciate this post.Thanks Again. Will read on

  • Graham01. Apr, 2020

    Wow, fantastic blog layout! How long have you been blogging for? you make blogging look easy. The overall look of your site is great, as well as the content!

  • ivo ignatov01. Apr, 2020

    If some one needs expert view concerning blogging and site-building afterward i propose him/her to go to see this web site, Keep up the pleasant work.

  • https://ivoignatov.wordpress.com01. Apr, 2020

    Im thankful for the blog post.Really thank you! Much obliged.

  • fleshlight insert01. Apr, 2020

    wow, awesome article post.Much thanks again. Will read on

  • tsxindex today01. Apr, 2020

    Very informative blog post. Really Great.

  • co2 cartridges canada01. Apr, 2020

    we prefer to honor a lot of other world wide web web sites around the web, even when they aren

  • garage door01. Apr, 2020

    Im thankful for the post.Much thanks again. Cool.

  • girl names01. Apr, 2020

    When Someone googles something that relates to one of my wordpress blogs how can I get it to appear on the first page of their serach results?? Thanks!.

  • Adobe Designer01. Apr, 2020

    This post is worth everyone as attention. How can I find out more?

  • Jacob31. Mar, 2020

    Identify who is posting about bag and the particular reason why you ought to be afraid.

  • garage door repair31. Mar, 2020

    I think you have remarked some very interesting points , appreciate it for the post.

  • garage door31. Mar, 2020

    Say, you got a nice article.Really thank you! Will read on

  • meaning of names31. Mar, 2020

    Thanks a lot for the article post.Much thanks again. Really Great.

  • affordable seo service chicago31. Mar, 2020

    Thank you for your article post.Really thank you! Much obliged.

  • why not find out more31. Mar, 2020

    Pretty! This was a really wonderful article. Thank you for providing these details.

  • Sri Lanka pioneering marriage proposal service provider31. Mar, 2020

    Thanks for the blog post.Really thank you! Cool.

  • chelmetuella31. Mar, 2020

  • coronavirus masks for sale30. Mar, 2020

    You made some nice points there. I did a search on the issue and found most guys will agree with your site.

  • radio show30. Mar, 2020

    Very informative blog article.Thanks Again. Great.

  • levitra30. Mar, 2020

    your site, how could i subscribe for a weblog website?

  • Pornhub30. Mar, 2020

    Last week I dropped by this internet site and as usual wonderful content and suggestions. Enjoy the lay out and color scheme

  • outbound jogja30. Mar, 2020

    make men and women think. Also, thank you for permitting me to comment!

  • konveksi semarang30. Mar, 2020

    Wow, what a video it is! Actually nice quality video, the lesson given in this video is actually informative.

  • joker12330. Mar, 2020

    My brother recommended I might like this web site. He was entirely right. This post actually made my day. You can not imagine just how much time I had spent for this info! Thanks!

  • dewapoker30. Mar, 2020

    Thanks for the article.Really thank you! Want more.

  • https://sites.google.com/site/fcinefilmstreaming/29. Mar, 2020

    In any case I all be subscribing to your rss feed and I hope

  • ethivido29. Mar, 2020

    cialis sale manila http://zithazi.com – zithromax buy viagra toronto

  • suba suba26. Mar, 2020

    glcdL1 victor cruz jersey have been decided by field goals. However, there are many different levels based on ability.

  • ethivido26. Mar, 2020

    п»їshould you buy cialis online http://alexa24ph.com – buy viagra viagra buy chemist

  • Christian Kernen24. Mar, 2020

    Outstanding post, I conceive people should larn a lot from this web site its very user pleasant.

  • ethivido20. Mar, 2020

    best place buy generic cialis levitra online – buy cialis eli lilly

  • The Black Party17. Mar, 2020

    Woh I enjoy your articles, bookmarked! .

  • ethivido17. Mar, 2020

    cialis sale ireland generic cialis – buy viagra yahoo answers

  • ethivido14. Mar, 2020

    cheapest cialis in uk levitra prices – viagra sale online australia

  • ethivido12. Mar, 2020

    buy genuine cialis online viagra online – buy viagra cialis line

  • ethivido05. Mar, 2020

    cheap cialis sydney cheap drugs online cialis

  • ethivido02. Mar, 2020

    order cialis from canada cheap drugs viagra buy boots

  • ethivido01. Mar, 2020

    buy viagra with paypal can you buy viagra in dubai cheap cialis brand

  • ganhar na lotofacil28. Feb, 2020

    como ganhar na lotofacil acertar na lotofacil ganhar na lotofacil como ganhar na lotofacil de verdade como ganhar na lotofacil sempre como ganhar na lotofacil 2020 como ganhar na lotofacil 100 garantido dicas lotofacil como acertar na lotofacil dicas para ganhar na lotofacil

  • como ganhar na lotofacil28. Feb, 2020

    como ganhar na lotofacil acertar na lotofacil ganhar na lotofacil como ganhar na lotofacil de verdade como ganhar na lotofacil sempre como ganhar na lotofacil 2020 como ganhar na lotofacil 100 garantido dicas lotofacil como acertar na lotofacil dicas para ganhar na lotofacil

  • ethivido28. Feb, 2020

    buy viagra from uk buy cialis delhi buy cheap levitra online

  • mobile legends cheat23. Feb, 2020

    Nice post. I used to be checking constantly this weblog and I am inspired!
    Extremely useful info particularly the last part 🙂 I handle such info much.
    I was seeking this certain info for a long time. Thank you
    and good luck.

  • Seguros de autos23. Feb, 2020

    Very interesting topic, regards for putting up.

  • buy cialis online22. Feb, 2020

    tadalafil generic medicine [url=http://www.buyscialisrx.com/]cialis
    prescription[/url] effects of cialis tadalafil cialis without
    prescription what is tadalafil 20mg used for can snafi tadalafil http://buyscialisrx.com/ generic-cialis-tadalafil.com

  • ethivido22. Feb, 2020

    cialis discount coupon lowest cialis prices order viagra paypal

  • ethivido19. Feb, 2020

    buy viagra online yahoo answers 30ml liquid cialis cheap viagra australia online

  • this link19. Feb, 2020

    I have read several excellent stuff here. Certainly worth bookmarking for revisiting. I surprise how much attempt you put to create the sort of magnificent informative website.

  • ethivido16. Feb, 2020

    cheap cialis professional does cialis lower your blood pressure buy viagra no prescription

  • where to buy cialis16. Feb, 2020

    war where to buy cialis expression
    security [url=https://getcialistabsfasty.com/#]where
    to buy cialis[/url] minority https://getcialistabsfasty.com/

  • currency war13. Feb, 2020

    What¦s Taking place i am new to this, I stumbled upon this I have discovered It positively helpful and it has aided me out loads. I am hoping to contribute & aid other users like its helped me. Good job.

  • Strategic vs tactical investing13. Feb, 2020

    Only a smiling visitant here to share the love (:, btw great pattern.

  • ethivido13. Feb, 2020

    cialis film coated tablets tadalafil side effects for cialis order generic cialis canada

  • alternative to viagra12. Feb, 2020

    opposition [url=https://cialsagen.com/#]buy
    generic viagra online with mastercard[/url] generic cialis viagra samples white https://cialsagen.com/

  • Robertbroog12. Feb, 2020

    cheap generic cialis uk online discount cialis no prescription viagra cialis

  • viagra without a doctor prescription11. Feb, 2020

    successfully [url=http://viarowbuy.com/#]generic viagra[/url] viagra generic sildenafil generic huge http://www.viarowbuy.com

  • Robertbroog09. Feb, 2020

    cheap cialis eu buy cialis prescription levitra cheap canada

  • Robertbroog06. Feb, 2020

    viagra sale philippines cheap viagra no prescription canada viagra buy online usa

  • Robertbroog02. Feb, 2020

    order cialis professional online buy cialis next day delivery viagra professional sale

  • south china sea dispute02. Feb, 2020

    Have you ever thought about adding a little bit more than just your articles? I mean, what you say is fundamental and all. But just imagine if you added some great pictures or videos to give your posts more, “pop”! Your content is excellent but with images and clips, this site could certainly be one of the very best in its niche. Amazing blog!

  • convicts to be executed02. Feb, 2020

    You have remarked very interesting details! ps nice website . “Hares can gamble over the body of a dead lion.” by Publilius Syrus.

  • why the bull market will continue02. Feb, 2020

    I like the helpful information you provide in your articles. I will bookmark your blog and check again here regularly. I am quite sure I will learn a lot of new stuff right here! Best of luck for the next!

  • stock market crash is imminent02. Feb, 2020

    I am not sure where you are getting your information, but good topic. I needs to spend some time learning more or understanding more. Thanks for fantastic information I was looking for this info for my mission.

  • kratom extraction02. Feb, 2020

    strongest kratom strain for pain where can i buy kratom capsules buy kratom
    capsules with paypal [url=http://kratomsaleusa.com/#]how to make kratom
    resin[/url] most effective way to take kratom kratom dealers http://kratomsaleusa.com/

  • Free thinker definition01. Feb, 2020

    I in addition to my pals were found to be going through the good secrets and techniques from your web blog and at once I got an awful feeling I never thanked the web blog owner for those strategies. These guys came as a result very interested to read through them and have definitely been making the most of them. Appreciate your being really helpful as well as for utilizing varieties of marvelous themes most people are really desirous to understand about. My very own sincere apologies for not saying thanks to you earlier.

  • Stock market forecast01. Feb, 2020

    It’s actually a cool and useful piece of info. I am glad that you shared this useful information with us. Please keep us up to date like this. Thanks for sharing.

  • Waynereind31. Jan, 2020

    Colossal website! It looks acutely good! Bear up under the critical fit in! http://publica-pr.de/pflanzliche-potenzmittel-apotheke/

  • Waynereind31. Jan, 2020

    Giant looking website. Ruminate over you did a classify of your least own coding. erogan medicament

  • Waynereind31. Jan, 2020

    hold responsible a lot on your cobweb neighbourhood it assists a unforgivable deal. http://ko21.fr/deseo-valencia/

  • Robertbroog30. Jan, 2020

    levitra buy germany cialis cheap prices cheap cialis in australia

  • Waynereind30. Jan, 2020

    Charge of up the stunning appointment !! Lovin’ it! http://nnet.it/migliori-integratori-per-crescita-capelli/

  • Waynereind30. Jan, 2020

    How goes it, unbelievable website you’ve got a time. http://it.global-box.net/dieta-disintossicante-le-iene-pdf/

  • Waynereind30. Jan, 2020

    Wow, enticing placement. Thnx … allungare il pene è possibile

  • Waynereind29. Jan, 2020

    Incredibly enlightening look forward to coming shy away from. testosteron creme kopen

  • Waynereind29. Jan, 2020

    Thanks for furnishing this brand of wonderful details.
    classifica peni mondo

  • Waynereind28. Jan, 2020

    You bring into the world got anybody of the most superbly online websites. avis sur eroxel

  • Waynereind28. Jan, 2020

    Thanks, this locale is exceedingly at the ready. http://nnet.it/allungare-pene-naturale/

  • Waynereind28. Jan, 2020

    Wow, satisfactory website. Thnx … http://juventusdomo.it/proteine-per-fare-massa/

  • Waynereind28. Jan, 2020

    Altogether a-ok web-site you’ve got in here. detoxification in 1 day

  • Waynereind28. Jan, 2020

    Important internet website! It looks outrageously expert! Keep in repair the lofty manipulate! http://fr.testosteron.space/terrestris-tribulus-testosterone/

  • Waynereind27. Jan, 2020

    Extraordinary such a momentous webpage. knaus deseo occasion

  • Waynereind27. Jan, 2020

    Upstanding needed to speak Under i’m glad that i came onto your area. http://es.global-box.net/centro-de-desintoxicacion-madrid/

  • Waynereind27. Jan, 2020

    Very much meet Website, Endure to the wonderful work. Thanks a a mass! http://newtargetgroup.it/extension-capelli-ricci-cheratina/

  • Waynedaf27. Jan, 2020

    Cialis tadalafil vs cialis generic cialis

  • Waynereind27. Jan, 2020

    thank so a grouping in support of your situate it assists a first-rate deal. http://it.t-booster2020.com/testosterone-vegetal-origin/

  • Waynereind27. Jan, 2020

    Wow cuz this is extensive position! Congrats and take care it up. http://speed-com.fr/marlon-brando-un-tranvia-llamado-deseo/

  • Waynereind27. Jan, 2020

    Fondness the locate– surely special euphonious and whole lots to take in! http://umbb-handball.fr/testoplus-avis/

  • Waynereind26. Jan, 2020

    Many thanks! It is an terrific purlieus! metodi allungamento pene

  • Stacybikaf25. Jan, 2020

    Appreciation you! This is positively an astonishing website! testosteron seviyesi

  • Stacybikaf25. Jan, 2020

    divulge thanks to so considerably on your web situate it helps a drawing. http://fr.cgtribc.org/detoxification-kya-hai/

  • HerbertHal24. Jan, 2020

    Really want to express I’m relieved I came in your web site. http://depresszio.eu/probiox-plus/

  • HerbertHal24. Jan, 2020

    You’re an extremely helpful site; could not make it without ya! http://machinalansu.pl/ktora-kreatyna-jest-najmocniejsza/

  • HerbertHal23. Jan, 2020

    You’re a really useful internet site; could not make it without ya! http://baraita.net/the-best-slimming-pills/

  • HerbertHal23. Jan, 2020

    How goes it, great internet site you’ve got going here. http://depresszio.eu/green-barley-plus/

  • HerbertHal23. Jan, 2020

    Hello, cool web-site you’ve here. http://baraita.net/african-mango-for-slimming/

  • HerbertHal23. Jan, 2020

    You’re a very helpful web site; could not make it without ya! http://baraita.net/reliable-remedy-for-slimming/

  • HerbertHal23. Jan, 2020

    Great looking internet site. Think you did a great deal of your very own coding. http://machinalansu.pl/najczestsze-przyczyny-zaburzen-erekcji/

  • HerbertHal23. Jan, 2020

    Passion the website– very user pleasant and whole lots to see! http://depresszio.eu/profolan/

  • HerbertHal22. Jan, 2020

    I enjoy the knowledge on your web site. With thanks! http://laboratoriogiganti.it/pro-flexen/

  • Hectorspuct22. Jan, 2020

    http://es.t-booster2020.com/testosterona-libre-en-mujeres/

    Great internet site! It looks extremely professional! Maintain the helpful job!

  • Hectorspuct22. Jan, 2020

    top rated male enhancement pills 2013

    Thanks a lot! It is definitely an wonderful web-site!

  • Waynedaf22. Jan, 2020

    Cialis generic cialis at walgreens pharmacy cialis 100 mg lowest price

  • Hectorspuct22. Jan, 2020

    disintossicazione alluminio

    Love the site– extremely user friendly and great deals to see!

  • Meggan Kunkler22. Jan, 2020

    This design is incredible! You certainly 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!) Great job. I really enjoyed what you had to say, and more than that, how you presented it. Too cool!

  • Hectorspuct22. Jan, 2020

    http://dearjoy.fr/member-xxl-avant-apres-photo/

    Great website! It looks very expert! Keep up the helpful job!

  • Hectorspuct21. Jan, 2020

    enzymes de détoxification de phase ii

    Love the website– really user pleasant and lots to see!

  • Waynedaf19. Jan, 2020

    Cialis coupon for cialis by manufacturer real cialis without a doctor’s prescription

  • Leonardvoice18. Jan, 2020

    Many thanks really useful. Will share website with my friends.

    http://fr.global-box.net/

  • Waynedaf15. Jan, 2020

    Cialis how much does cialis cost at walmart buy cialis online canadian

  • Mandela Elizah15. Jan, 2020

    Hello ! This is a remarkably gripping post that you made

    Save up it up ! Luxury interior design companies London

  • Andrei Elizah14. Jan, 2020

    Hello ! This is a very compelling advise that you made

    Keep it up ! https://crearesitedeprezentarex.blogspot.com/

  • Rupa Andygi14. Jan, 2020

    This is a to a great extent important post. Thanks for posting this.

    What do you over close by my website: firma creare site

  • Rupa Giudiau13. Jan, 2020

    This is a to a great extent important post. Thanks instead of posting this.

    What do you over nearby my website: web design bucuresti

  • Cristi Muranoe13. Jan, 2020

    This is a to a great extent weighty post. Thanks instead of posting this.

    What do you think nearby my website: https://crearesitebucurestii.blogspot.com/

  • Johnny Caniog13. Jan, 2020

    This is a very signal post. Thanks quest of posting this.

    What do you over nearby my website: https://crearesitedeprezentaree.blogspot.com/

  • Peterwal12. Jan, 2020

    Hello, boat thanks you http://cialisxtl.com in look upon to facts! cialis 20 mg best price
    viagra pill

  • EverettJag06. Jan, 2020

    Hello, recognition you for word! generic viagra 100mg http://viapwronline.com I repost in Facebook.
    viagra generic availability

  • п»їcialis01. Jan, 2020

    Hello, thank you looking for word! I repost in Facebook

Leave a comment

Your email address will not be published. Required fields are marked. *