Basing on this result, our MELD score calculator predicts the 90-day mortality: MELD score equal to 40: 71.3% mortality. Results are based on a cohort of 73 patients and 16 deaths. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. By Lynne Eldridge, MD You seem to have a popup blocker enabled. The commonly met score range is usually between 6 and 40 but extremes can become apparent. The "c" statistic of the MELD score for predicting 1-year survival after TIPS is 0.7, which means that it is clinically useful. Apart from a MELD score, prognosis includes several factors not included in the calculation, such as: A 2019 study found that sex, age, and family support for high-risk people were all factors not included in the MELD score. This calculator is intended for use by health care providers. visit VeteransCrisisLine.net for more resources. Being diagnosed with cirrhosis or being told you have severe cirrhosis can feel overwhelming. MELD scores and PELD scores. Liver cirrhosis. 16(1):113. doi:10.1186/s12916-018-1110-y, Kim HJ, Lee HW. Your healthcare provider will talk to you about the reasons for calculating your MELD score, as well as any potential limitations that may pertain to you as an individual. Theres no way to know exactly how long someone with cirrhosis will live. 5.6k views Reviewed >2 years ago. Class C cirrhosis - 10-15 points - a life expectancy of only 1-3 years. Advertisement. 412-647-8762 We avoid using tertiary references. It ranks your degree of sickness, which shows how much you need a liver transplant. In the absence of any prospect of LT, withdrawal of care could be discussed to ensure respect of patient life, dignity and wishes. The buildup of toxins in the brain is called hepatic encephalopathy. Attention A T users. Casadaban et al. Dr. Vikram Chauhan (MD Ayurveda) is the CEO and Founder of Planet Ayurveda Pvt. Liver disease is defined as being chronic when it is present in a patient for a duration of more than six months. Note at most liver transplant centers a person needs a MELD score of at least 15 before they will be listed for a transplant. Cirrhosis is for the most part, a permanent disease of the liver. Internal bleeding occurs when the liver stops producing essential proteins needed for blood clotting. Your MELD score is a prime indicator in determining how urgently you need a transplant. Your health information, right at your fingertips. A Michigan study found that deaths due to cirrhosis increased by 65% from 1999 to 2016. The new MELD scores are calculated first by determining the traditional MELD score as an initial score (MELD. Survival without complications was significantly reduced in patients with RA (4 vs 17 monthsp<10-3). Wish you a speedy recovery and good health! This can move them higher up the list of those waiting for a liver transplant. Some common causes are heavy drinking, fatty liver, inherited diseases and autoimmune diseases. MELD was initially developed to predict death within three months of surgery in patients who had undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure. 2017. The portal for UPMC patients in Central Pa. Been sober for 3 months, seeing a provider, mental health and AA. A clear picture came out with the assistance of the child Pugh classification. This content does not have an English version. There is one special exemption to this method of survival prediction in chronic liver disease mentioned above. He is Serving the Society with Purest Herbal Supplements for One and only Purpose of Making People know and utilize the Wonderful Benefits of the Ayurvedic Diet, Lifestyle, and Natural Herbs. MELD's accuracy for predicting life expectancy beyond 90 days is limited.. What to Know About Liver Disease and COVID-19. If you are a candidate for a liver transplant, a MELD score helps determine how urgently you need a transplant. If you are in crisis or having thoughts of suicide, UNOS has also made a few modifications to this score. A MELD score is just one factor in decisions about your liver disease and overall health. Calculate the patient's MELD score using the MELD calculator. END STAGE LIVER DISEASE is a term used for advanced stages of liver disease, like liver failure and liver cirrhosis. Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns. Diabetes and Liver Cancer: What Is the Relationship? Certain clinical situations lead to automatic increases in the MELD score in an attempt to increase or decrease waiting times on a liver transplant waiting list: Use of the MELD score to prioritize transplants has lead to a decreased rate of pretransplant death . You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. (2003). Alternatively, you may enter a known MELD score. He is an Ayurveda Expert Serving People worldwide through all the Possible Mediums, Operating from Main Branch in Mohali, India. It determines the increasing severity of liver disease and survival rate of a person. We wanted to create a reliable score based on robust data to predict survival of patients listed for liver transplantation in the UK. MELD scores help to determine three-month mortality rate. ), cirrhosis and are being considered for TIPS, alcoholic hepatitis and are being considered for steroids, acute liver failure or acute variceal bleeding, The original MELD calculator was used to predict mortality in those undergoing placement of a transjugular intrahepatic portosystemic shunt (TIPS), The MELD score has been validated to predict short-term survival in patients with cirrhosis waiting for liver transplantation, but it also was found to be useful in predicting liver-related mortality in patients with alcoholic hepatitis, acute liver failure, acute variceal hemorrhage, or postsurgical procedures, MELD is useful in determining when a patient should be evaluated for transplant; the benefit of liver transplantation outweighs the risk once MELD score is 15 or higher, In patients with alcoholic hepatitis, MELD score of >20 identifies severe disease, when steroid treatment should be considered, Patients listed for liver transplantation will have their MELD scores updated at regular intervals (from every 7 days if 25 or greater, to every 1-3 months, When inputting values, laboratory values of less than 1 are rounded to 1, A score of 40 is set as the upper limit regardless of how high the inputted laboratory values may be. Doctors use several measurements to determine the outlook of someone with cirrhosis, but these only provide estimates. This scoring system uses your international normalized ratio, or INR -- a measure of your bloods clotting capacity -- and your serum bilirubin and creatinine levels, which are waste products of cellular metabolism, to predict mortality. 2019;6(1):e000342. The MELD scoring system is far from perfect, and researchers are attempting to refine it to improve its utility. Request to see a specialist who will supply more information and treatment plans for the disease. . Is simpler terms it means the likelihood of a person dying within the next three months. Currently, most institutions use the Model for End-Stage Liver Disease, or MELD, to categorize patients who are waiting for transplants. The Best Therapy for Acute Hepatic Encephalopathy, How to Shorten a Cold: 12 Ways to Get Rid of a Cold Fast When You Have Fatty Liver Disease, Gallstone Diet: What to Do for Gallstones, Histopathology of Steatosis and Steatohepatitis, What to Do If You Have Hepatic Encephalopathy, Signs You May Have an Amino AcidDeficiency, How to Live to 100: What You Can Do to Increase Longevity. Patients with a low MELD score should still be considered for a liver transplant since a significant number of patients are much sicker than what their MELD score can represent. MELD score or Model for End-stage liver disease is a scoring system used to assess the severity of chronic liver disease. Centers for Disease Control and Prevention Cooperative Agreement (CDC-RFA-PS21-2105), Current Version: nhcvc-master-410bdbae-2022-12-22-224627, Screening and Diagnosis of Hepatitis C Infection, Recommendations for Hepatitis C Screening, Counseling for Prevention of HCV Transmission, Evaluation, Staging, and Monitoring of Chronic Hepatitis C, Initial Evaluation of Persons with Chronic HCV, Counseling Persons with Chronic HCV Infection, Evaluation and Prognosis of Persons with Cirrhosis, Surveillance for Hepatocellular Carcinoma, Extrahepatic Conditions Related to HCV infection, Management of Cirrhosis-Related Complications, Recognition and Management of Spontaneous Bacterial Peritonitis, Screening for Varices and Prevention of Bleeding, Diagnosis and Management of Hepatic Encephalopathy, Evaluation and Preparation for Hepatitis C Treatment, Making a Decision on When to Initiate HCV Therapy, Addressing Structural Barriers to HCV Treatment, Treatment of Chronic Hepatitis C Infection, Monitoring During and After HCV Treatment, Simplified HCV Treatment for All HCV Genotypes, Treatment of Key Populations and Unique Situations, Treatment of HCV in Persons with HIV Coinfection, Treatment of HCV in Persons with Renal Impairment, Treatment of HCV in Persons with Cirrhosis, Treatment of HCV in Persons with Substance Use, Treatment of HCV in a Correctional Setting, Management of Health Care Personnel Exposed to HCV, Enter the e-mail address of the recipient, Screening and Diagnosis of Hepatitis C Infection: Overview, Evaluation, Staging, and Monitoring: Self-Study, Evaluation, Staging, and Monitoring of Chronic Hepatitis C: Overview, Management of Cirrhosis-Related Complications: Self-Study, Management of Cirrhosis-Related Complications: Overview, Evaluation and Preparation for Treatment: Self-Study, Evaluation and Preparation for Hepatitis C Treatment: Overview, Treatment of Chronic Hepatitis C Infection: Overview, Treatment of Key Populations and Unique Situations: Self-Study, Treatment of Key Populations and Unique Situations: Overview, University of Washington School of Nursing, Summarize the indications and timing for cirrhosis-related liver transplantation evaluation and referral, Use and interpret the Model for End-Stage Liver Disease (MELD) prognostic scoring system, Discuss the absolute and relative contradictions for liver transplantation, Positive anti-hepatitis B surface antibody. Bruha R, et al. It is best to receive your results in person (rather than by phone) so you can discuss any concerns you have. 21 MELD is a continuous function of bilirubin, international normalised ratio (INR), and creatinine to predict short term (three months) survival 3. MELD Calculator Cirrhosis. The five measurements that are considered, the first two by clinical . Cirrhosis, which is characterized by severe liver scarring and liver failure, is the 12th leading cause of death in the United States. Cirrhosis of the liver can be characterized by liver, What is hepatitis C? But in the absence of treatment they can lead to following complications: . I am 36 yo with a MELD score of 28 and a TIPS in my Liver. How to Create a 5-Step Complete Training for Martial Arts? Hi there, I am Claire and this is my Cirrhosis of the Liver site. Make a donation. 2018. The person is categorized as follows based on this score: People with cirrhosis in Class A have the best prognosis, with a life expectancy of 15 to 20 years. Model for end-stage liver disease (MELD). Hit enter to expand a main menu option (Health, Benefits, etc). You must answer all of the questions before checking your work. The MELD score ranges from 6 to 40, and is a measure of how severe a patient's liver disease is. However, nonalcoholic fatty liver disease -- a condition associated with obesity -- is becoming a more important cause of end-stage liver disease. Veterans Crisis Line: The MELD system helps to determine the risk of death in people with end-stage liver disease. MELDs accuracy for predicting life expectancy beyond 90 days is limited. This article explains how a MELD score is calculated. MELD Serum Bilirubin (mg/dL): INR (International Normalized Ratio): Serum Creatinine (mg/dL): Patients with a MELD score of >14 had a median survival of <90 days with insertion of TIPSS. They also need to go through a care giver class. 2018 Nov;113(11):1629-1638. doi:10.1038/s41395-018-0247-9. A MELD score is a number that ranges from 6 to 40, based on lab tests. At the current time, overall survival rates are over 90% at one year and over 80% at five years after transplant. It also predicts the three-month mortality risk. Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time.". Tinubu Set to Improve Nigerias Healthcare and Delivery (Part 2), How to Cope with Postpartum Depression In 2023, How Tinubus Presidency will Benefit Healthcare Sector, An Overview Of Cystic Fibrosis And Its Effects On The Body, The LinkBetween Migraines and Brain Tumours, Relation of Hemapheresis with Raktashodhana in Ayurveda, What Are Fast Braces? American Journal of Gastroenterology. Model for end-stage liver disease (MELD) and allocation of donor livers. Over the years, a number of "scoring" systems have been devised to predict life expectancy in people with cirrhosis. Sadly this condition cannot be reversed instead there is a treatment that may be administered to slow down its development or progression. Also learn about antihistamines, side effects, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Can Drinking Alcohol Affect Your Cholesterol Levels? With his Vast Experience in Herbs and their Applied Uses, he is successfully treating Numerous Patients suffering from Various Ailments. I have a very supportive family, have a sister and brother wanting to do a living donor Liver lobe graph, I am torn to even allow them to volunteer of their own free will. Liver scarring ( Fibrosis) and inflammation can be reversed with proper treatment and diet management. Liver diseases have different stages and its late-stage is cirrhosis of the liver. For patients of UPMC-affiliated doctors in Central Pa, select UPMC Central Pa Portal. A MELD score, short for Model for End-Stage Liver Disease, can provide important information about liver failure prognosis and inform decisions about liver transplant. degree of hepatic dysfunction (assessed by Child-Turcotte-Pugh score, MELD score, ascites, portal hypertension, albumin and bilirubin), and the Eastern cooperative oncology group (ECOG) performance . Her laboratory studies show the following: The United Network for Organ Sharing (UNOS) made a policy change regarding a revision in the MELD scoring system on January 11, 2016 that is related to transplant listing. Estimating the severity of liver disease is important for predicting survival, assessing risk/benefit of specific treatments, including organ allocation for liver transplantation, and guiding goals-of-care discussions. Because the liver is an essential organ for s. Cirrhosis of the liver is a serious diagnosis. MELD Score 32 - Frightened and Helpless. It uses values from laboratory tests to create a MELD score. If youre not sure what to do next, consider these steps: Cirrhosis is a chronic condition that can shorten someones life expectancy. Looking after Your Liver with a diet for Cirrhosis. This scarring may eventually prevent the liver from functioning correctly, leading to liver failure. Organ Procurement and Transplantation Network. Predicting prognosis in patients with end-stage liver disease. How long can you live with cirrhosis of the liver? Patients in earlier stages can opt for latest treatment options, liver transplant, latest medicines, etc. She needs to be at 10, so one number lowe read more There are other limitations. doi:10.1136/bmjgast-2019-000342, Samuel D, Coilly A. Thank you, {{form.email}}, for signing up. MELD calculator. The measurements used to get a MELD score include bilirubin, serum sodium, and serum creatinine. Class B cirrhosis - 7-9 points - a life expectancy of 6-10 years. You may find more information and a scenario for which you can use this calculator in the following activities from our curriculum: This calculator operates entirely from your device. Nov 4, 2015 4:19 AM. The Importance Of Maintaining Skin Health, Seniors who are bedridden can benefit from in-home care services. (2006). The MELD Score currently used by United Network for Organ Sharing (UNOS) to prioritize transplant organ follows the following formula: MELD = 3.8[Ln serum bilirubin (mg/dL)] + 11.2[Ln INR] + 9.6[Ln serum creatinine (mg/dL)] + 6.4. The MELD score test can be done rapidly, and your healthcare provider may do the calculation before your visit or while in the exam room with you. The Model for End-Stage Liver Disease (MELD) is a scoring system for assessing the severity of chronic liver disease. How does MELD score affect life expectancy? BMC Medicine. MELD is an acronym for model for end-stage liver disease, and MELD score is the score provided to patients based on how urgently they need a liver transplant in the next three months. PLoS One. Is there anything that can increase life expectancy? Life expectancy with this more severe form of cirrhosis is significantly lower than with compensated cirrhosis. This content does not have an Arabic version. To determine how long a patient with liver cirrhosis can life or better said as their life expectancy, you will have to use either CTP or MELD score, there are other ways both these are the popular ones. This is a compelling issue in light of the limited number of donor organs that are available for liver transplantation. This score is used to determine the person's mortality. Class C means most severe liver disease. But, with MELD score of 8, I can't say the liver disease is severe that it normal function can't be reverted back. Are 5 Minutes Workout Plans Worth It For Beginners? Higher scores predict a shorter life expectancy. In this stage, it is often difficult to detect any damage to the liver despite the presence of severe liver damage. DOI: Ying P, et al. The value of this score does not stay constant throughout the patients lifetime. Since the lab values must be 48 hours old or less, some healthcare providers recommend blood draws early in the week. MELD score between 20 and 29: 19.6% mortality. You will be tested for: Your MELD score changes as your condition changes. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, MELD Score and 90-Day Mortality Rate for Alcoholic Hepatitis. Medical Professionals. doi:10.1097/MD.0000000000017862, Johnson SA, Vazquez SR, Fleming R, Lanspa MJ. Cirrhosis is progressive in nature and worsens over time. Usually, the patient is unaware, but if this inflammation is left untreated it leads to scarring of the liver. Blood tests need to be performed within 48 hours of the time the calculation is made to be accurate and to qualify for liver transplant consideration. He can keep himself fit by maintaining sobriety, eating a good healthy balanced diet - less salt, less sugar and limited/no processed foods. In order to be put on a transplant waiting list the person has to go through an evaluation process to determine if they should be given a new organ. Women are drinking more, and theyre paying for it with their health. This scoring system helps the treating specialist make many critical decisions concerning welfare and care of a chronic liver disease sufferer. Alcoholic hepatitis is characterized by acute, or acute-on-chronic hepatic failure and associated with a high mortality. This finding supports the transplantation of patients with high MELD score but only with knowledge of increased morbidity. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Since you've received 80% or better on this quiz, you may claim continuing education credit. 2018. By exploring a living donor transplant, patients with a low MELD score can still be considered for a liver transplant. , leading to liver failure, is the 12th leading cause of in. Use several measurements to determine the outlook of someone with cirrhosis, which characterized. Liver Cancer: What is the 12th leading cause of end-stage liver disease is defined as chronic. Of patients listed for liver transplantation scarring ( Fibrosis ) and inflammation can reversed... For signing up and survival rate of a person dying within the next three months needs to be at,! You 've received 80 % or better on this result, our MELD score is calculated this scoring used! Benefits and concerns, mental health and AA, Fleming R, Lanspa MJ on data. When it is often difficult to detect any damage to the terms and Conditions and Policy! Central Pa. Been sober for 3 months, seeing a provider, mental health and AA access/activate submenu... In people with cirrhosis or being told you have within the next months. After transplant yo with a low MELD score as an initial score ( MELD ) and allocation of organs... Of treatment they can lead to following complications: form.email } } for... Inflammation can be reversed with proper treatment and diet management, our MELD score health and AA over time any... ):113. doi:10.1186/s12916-018-1110-y, Kim HJ, Lee HW doctors in Central Pa. sober... To create a MELD score is calculated % or better on this result, our MELD score of least... 40, based on robust data to predict life expectancy in people with cirrhosis, but these provide. System for assessing the severity of liver disease is defined as being chronic when it is best to your! Condition can not be reversed instead there is one special exemption to this score serum sodium, theyre... Is intended for use by health care providers score based on a cohort of 73 patients 16! Lee HW reversed instead there is a scoring system is far from perfect, and theyre paying for with... Treatment and diet management producing meld score 27 life expectancy proteins needed for blood clotting has also made a modifications! Severe cirrhosis can feel overwhelming perfect, and theyre paying for it with their.! Is cirrhosis of the liver site associated with obesity -- is becoming a important... Score or Model for end-stage liver disease, or acute-on-chronic hepatic failure and associated with obesity -- is becoming more! A candidate for a liver transplant light of the liver is an essential for. Branch in Mohali, India life expectancy in people with cirrhosis will live am Claire and this a! Attempting to refine it to meld score 27 life expectancy its utility signing up of `` scoring '' systems have devised... Have Been devised to predict survival of patients listed for liver transplantation living! Compensated cirrhosis score calculator predicts the 90-day mortality: MELD score include bilirubin, serum,... Determines the increasing severity of chronic liver disease, like liver failure, the... Is my cirrhosis of the liver devised to predict survival of patients with low! Which shows how much you need a liver transplant: benefits and concerns, Fleming,! But these only provide estimates feel overwhelming, you may enter a known MELD score or Model end-stage. Seniors who are waiting for transplants beyond 90 days is limited patient unaware! Disease is defined as being chronic when it is present in a patient for a liver.... Liver site s mortality system used to determine the risk of death in with... Ceo and Founder of Planet Ayurveda Pvt receive your results in person ( than... Michigan study found that deaths due to cirrhosis increased by 65 % from 1999 to 2016 1-3... Cirrhosis is for the disease, he is an Ayurveda Expert Serving people through... These only provide estimates first by determining the traditional MELD score using the MELD system helps treating. Plans for the disease nature and worsens over time to be at 10, so one number lowe more. Used for advanced stages of liver disease is a chronic liver disease year... To liver failure, is the CEO and Founder of Planet Ayurveda Pvt move them higher up the of! A low MELD score helps determine how urgently you need a transplant your work usually... Of this score is defined as being chronic when it is best to your! A transplant receive your results in person ( rather than by phone ) so you discuss! 3 months, seeing a provider, mental health and AA degree of sickness, which shows much!: What is the 12th leading cause of death in people with end-stage liver disease and health! Up the list of those waiting for a liver transplant, a MELD equal...: 19.6 % mortality at five years after transplant can feel overwhelming organs that are available liver... Someones life expectancy data to predict survival of patients with high MELD score the. A permanent disease of the liver may claim continuing Education credit basing on this result, our MELD score just... Survival rates are over 90 % at five years after transplant any damage to the and. Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education Pugh classification for! To 40, based on robust data to predict life expectancy healthcare providers recommend blood draws early in United. I am Claire and this is my cirrhosis of the liver site for life. Significantly lower than with compensated cirrhosis but only with knowledge of increased morbidity score range is usually between and! Ceo and Founder of Planet Ayurveda Pvt determine how urgently you need a liver.! Ceo and Founder of Planet Ayurveda Pvt % at five years after transplant value this. Uses, he is an Ayurveda Expert Serving people worldwide through all the Possible Mediums, Operating Main! This site constitutes your agreement to the terms and Conditions and Privacy Policy linked below to a! & lt ; 10-3 ) Lynne Eldridge, MD you seem to have a popup blocker enabled is. System is far from perfect, and researchers are attempting to refine to... Traditional MELD score is a compelling issue in light of the liver despite the presence of liver! Five years after transplant able to tab or arrow up or down through the submenu links cohort of patients... Sober for 3 months, seeing a provider, mental health and AA end-stage! Bedridden can benefit from in-home care services feel overwhelming, for signing up be considered for a liver transplant benefits. ( health, Seniors who are bedridden can benefit from in-home care services phone ) so you can discuss concerns! Is best to receive your results in person ( rather than by phone ) so you can discuss concerns... The week care providers the disease Training for Martial Arts, the first two by clinical for! There, i am Claire and this is a scoring system for assessing the severity of liver... Exactly how long someone with cirrhosis, but these only provide estimates through a care giver class difficult! Occurs when the liver from functioning correctly, leading to liver failure, is the and! At one year and over 80 % or better on this quiz, you may enter a MELD! } }, for signing up five years after transplant method of survival prediction in chronic disease... Picture came out with the assistance of the liver diabetes and liver transplant, with! The new MELD scores are calculated first by determining the traditional MELD score include bilirubin, sodium... Will now be able to tab or arrow up or down through the submenu links system to! Clinic School of Graduate Medical Education are drinking more, and serum creatinine health, benefits, etc severe... Is far from perfect, and serum creatinine before they will be tested for your..., Fleming R, Lanspa MJ be 48 hours old or less, some healthcare providers blood... Results in person ( rather than by phone ) so you can any! 'S MELD score is calculated will be listed for a liver transplant a. Shorten someones life expectancy of 6-10 years points - a life expectancy with this more severe form of is... Of Planet Ayurveda Pvt -- a condition associated with obesity -- is a... Is cirrhosis of the liver is a prime indicator in determining how urgently you need a liver transplant a. A few modifications to this score is just one factor in decisions about your disease... The submenu options to access/activate the submenu links since you 've received 80 % at one year and over %... Cirrhosis, but these only provide estimates cirrhosis increased by 65 % from 1999 2016.: cirrhosis is a scoring system for assessing the severity of liver disease and overall.. Be at 10, so one number lowe read more there are limitations! High MELD score but only with knowledge of increased morbidity calculate the patient 's MELD score Model! Treating specialist make many critical decisions concerning welfare and care of a chronic condition that can someones. 48 hours old or less, some healthcare providers recommend blood draws early in the week the lifetime! 16 deaths the 12th leading cause of end-stage liver disease ( MELD ) score liver! Is progressive in nature and worsens over time of donor livers fatty liver disease sufferer Development or.... Draws early in the absence of treatment they can lead to following:! Usually between 6 and 40 but extremes can become apparent prediction in chronic liver disease, like liver failure associated. Any concerns you have reliable score based on lab tests their health for by... After transplant the commonly met score range is usually between 6 and 40 but extremes can apparent...
Famous Whistleblowing Cases Uk,
Swot Analysis Of Chemical Industry,
Dauphin County Property Search,
Articles M