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| Questions & Answers Case # 1 (Myasthenia Gravis)
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Case # 1 - Question: Fri, Jul 29, 2005 10:54 am
Be name oo ke be naghs ast salam Dr.Azmoon. haletoon chetore? Omidvaram khoob bashid. Kheyli mamnoon az barnamatoon. man dokhtari 22 sale hastam ke az hengame tavllod be bimariye myasthenia gravis (zafe shadid azolani )mobtala hastam. Dar 9 salegi baraye bardashtane timoos tahte amal gharar gereftam. Vali in amal dar behboodiyam taser nadasht. Dr chand soal daram *khahesh mikonam *javab bedahid. 1-dar morede bimariye myasthenia gravis (zafe shadid azolani) kami tozih dahid 2-aya momken ast ba masrafe modaveme ghors haye pyridostigmine bromide va mistinon be modate 22 sal (rozi 8 adad) badan dar moghabele anha moghavem shavad? 3-agar darooye jadidy be joz in 2 daroo baraye in bimari vojod darad moarefy konid. 4-bardashtane timoos dar dorane koodaki che ta’siry dar behboode in bimary darad? Ba tashakkor, ________
Case # 1 - Answer: Mon, Aug 29, 2005 9:49 am
Salam khanoom Mohtaram... omeed varam halatoon khoob bashad... beemary myasthenia gravis (MG) anibody va ya defa bar aleyhe yeki az bash-gah sistem asab dar badan dorost shodeh. in defah bar aleyhe acethylcholine receptor dar in bashgah baes meeshavad keh acetylcholine, yeki az molecule ha dar badan keh ham dar sistem asab va dar harekat azoleh estefadeh meeshavad, dorost anjom beh kar naresad, yani meghdar receptor baraye estefadeh ba in molecule kam meeshavad, va zood azole khasteh meeshavad.. chand noe vojood darad, beeshter moghe-ha + antibody, vali baazi vahgt-ha antibody vojood nadarad... dar mon dar hale hazer vojood nadarad, vali daran barayash talash meekonand, vali dar zemn rah vojood darad keh in beemary ra khamoosh koneem, ba daroo..
daroo pyridostigmine yek az avaleen daroo ha baraye in beemaree... yel mozoo ra avaal tozee meedam. dar zemn dar in sistem yek anzim vojood darad keh molcul acethycholine (ACH) ra kam meekonad beh tore mamooli keh in molcul ziad az had ham dar badan nabashad... in yek noe sistem control hast... pyridostigmine bar aleyhe in molcul kar meekonad va baes meeshad keh kamtar acethylcholine az be-in beravad va beeshtar vojood dashte bashad dar badad baraye estefadeh nesbat beh kamtar boodan receptor dar badan bekhatere antibody bar aleyhe receptor dar beemary MG. chand bar in ra bekhooneed ta begeereed agar khoob tavajo nashodeed... yeki az avarez in doroo, hast: acute myasthenia crisis, keh ACH ziad meeshavad va momken ast nafas tangee va ya moshkel hayeh deegar va hatta khastegee vojood beeyarad.. baleh khastegee bekhatere daroo ziad!! dar zemn agar ziad az had daroo vardareen, va ACH ziad dar badan bashad, in receptor haee keh baraye shoma baghee moonde, momken ast zood tar az bein beravanad bekhatere estefadeh beeshtar... albate bayad be shoma begam keh in ha faghat dar tehory ast va heech prove nashodeh, vali manzoor in mebashad keh fekr nakoneed har che beeshtar daroo vardareen behtar ast, balke momken ast bad tar bashad.. banabareen bayad moghdar dorost ra faghat beh andazeye kafee bardareen...
daroo hayeh deegar mesle corton va ya daroo baraye kam kardan defa badan mesle azathioprine, cyclosporine, cell cept, mycophenalate, vojood darad dar amrica.. in daroo ha defa ra kolee kam meekonand va banabareen receptor hayeh shoma beeshtar meeshan bekhatere inke antibody bar aleyhe recptor kam meeshad.. receptor beeshtar = estefadeh az ACH beeshtar = kamtar alaem MG... vali vaghtee sistem defa zaeef ast, ofoonat hayeh deegar ham hamle va sadame be badan rahat tar meezanand.. niaz dareen zeer tahte nazar doktor basheen va ba on takhasoos sohbat koneen...
bardashtan timoos khaily peesh raft meeshe, balke 75% mardom ba beemary MG ham beemary timoos darand.. timoos dar javanee yek jaygah meebashad keh bazi az sistem defa badan onja dorost meeshavad... vali dar sen hayeh bala, in vojood nadarad, banabareen bar dashtan timoos masaleh-ee neest...
dar zemn chand daroo vojood darad keh momken ast MG ra bad tar konad.. mesle phenytoin (baraye epilepsy), daro famil beta blockers (baraye beemary ghalb), quinine (daro anti malaria), lithium (daro beemaree roohee)
beemary MG beeshtar dar khanoom ha va dar senh 20 ta 30 vojood darad... baazi vaght ha antibody az madar rad meeshavad beh nozad va nozad dar tavalood in beemary ra peyda meekonad... esm in hast neonatal MG. mohemn in ast keh khod ra beesh az had khaste nakoneed.. arezoo hayeh gheyreh vagheh-ee az nazar varzesh hayeh sakht va ziad baraye khod nadashte basheed... ba doktor molaeje koneed.. cigar va mavad mokhader estefadeh nakoneed, zeera keh baazi az saratan ha dar MG beeshtar peesh meeyad, mesle saratan reeyeh..
shahdad
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Remember: 1) Please follow up with your physician on a routine basis as needed. 2) Please follow directions when taking medications. 3) Please do not hesitate to see a physician when concerns arise regarding your health. 4) Your health should be your most important investment, take good care of it! Sincerely, Dr. Azmoon
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