Aqoonsiga Astaamaha PML iyo kuwa Dhibaatada MS
Cudurka lafdhabarta ee 'multifocal leukoencephalopathy' (PML), waa cudur halis ah laakiin badanaa waa maskaxda maskaxda oo ay keento fayras JC . Fayruska waxaa caadi ahaan lagu sameeyaa jeegareynta habka difaaca jirka si uusan u keeni karin waxyeelo.
Si kastaba ha noqotee, haddii habka difaaca jidhku uu daciifiyo cudur, sida HIV / AIDS , leukemia , lymfoma, ama kansar kale, ama lagu xakameynayo daawo, fayraska ayaa laga yaabaa in uu dib u soo cusboonaado oo uu waxyeeleeyo maskaxdaada.
Dhibaatada maskaxda ee ay keento PML waxay keeni kartaa calaamado kala duwan.
Inkasta oo PML guud ahaan aad dhif u tahay, waa wax badan oo walaac ah haddii aad qabtid sclerosis multiple (MS) sababtoo ah qaar ka mid ah dawooyinka difaaca jirka ee loo isticmaalo daaweynta cudurka waxay kordhinayaan halista ah hormarinta PML.
Tysabri (natalizumab) waxay u muuqataa inay la xiriirto halista ugu weyn ee PML. Si kastaba ha ahaatee, daawooyinka kale ee difaaca jirka ee MS ayaa sidoo kale keeni kara halis, oo ay ku jiraan Gilenya (fingolimod), Tecfidera (dimetetum fumarate), Ocrevus (ocrelizumab), iyo laga yaabo inay kale.
Calaamadaha PML
MS lafteedu ma kordhinayso khatarta aad u leedahay PML. Laakiin haddii adiga ama qof aad jeceshahay uu qaato dawo isbeddel ah oo lagu xakameynayo nidaamka difaaca jirka, oo aad iskaa u ogaato astaamaha PML waxay kuu ogolaaneysaa inaad noqoto mid firfircoon oo lagu wargaliyo si loo ilaaliyo dhibaatadan culus.
Sida calaamadaha MS, kuwa la xariira PML way kala duwan yihiin, iyadoo ku xiran aagga (maskaxda) ee maskaxda ay saameysay.
Astaamaha waxaa ka mid noqon kara:
- Tabar-darrida, badanaa hal dhinac dhinac jirka ah
- Kartida fikirka liidata, oo inta badan ku muujisa jahwareer iyo / ama xusuusin la'aan
- Dhibaatada hadalka
- Isku-dubarid xumo, caadi ahaan waxay la kulantaa ciriiri ama dhibaatooyin socodka
- Dhibaatooyinka muuqaalka ah, sida aragti cawlan ama aan si cad u aragin aag gaar ah oo ka mid ah goobta muuqaalkaaga
- Isbedelka shakhsiga
- Dareenka aan caadiga ahayn ama lumitaanka dareenka jirka ee jirkaaga
- Qalalaasaha, inkastoo tani ay tahay mid aan caadi ahayn
PML iyo MS Relapse
Calaamadaha PML badanaaba lama garan karo kuwa soo noqoshada MS. Tani maaha mid la yaab leh sababtoo ah labada cudurba waxay keenaan demyelination, taasoo macnaheedu yahay burburinta walaxda ilaalinta ee ku wareegsan dareemayaasha. Lumida walaxda ilaalinta leh, oo loo yaqaan 'myelin', ayaa hakisa isku soo gudbinta calaamadaha korantada ee maskaxdaada iyo jidhkaaga.
Sababtoo ah calaamadaha PML iyo soo noqoshada MS waxay noqon kartaa mid isku mid ah, waxay ku adagtahay inay aqoonsadaan PML marxaladaha hore ee cudurka. Taasi waxay tiri, xawaaraha horumarka calaamadaha cusub waa calaamad muujinaysa in ay kala duwanaanayaan haddii ay sabab u yihiin PML ama soo noqoshada MS. Calaamadaha PML sida caadiga ah ma dhicin si lama filaan ah, laakiin waa hormarin oo horumar ka sameeyaan maalmo ilaa toddobaad.
Dhakhaatiirtu waxay si qoto-dheer u kala saari karaan PML ee MS iyaga oo si taxadar leh u qiimeynaya calaamadaha qofka. Sababtoo ah PML waa infakshan faafa maskaxda, waxay badanaa keentaa in ka badan hal calaamadaha cusub ama sii xumaanaya, halka hal calaamadahan oo kale ay u badan tahay inuu dib ugu noqdo MS. Si kastaba ha ahaatee, tani waa uun calaamad, ma aha xukun adag oo dhaqso ah.
Hab kale oo muhiim ah oo looga takhaluso PML laga bilaabo soo noqoshada MS waa in lagu baaro sawirka MRI ee maskaxda qofka ay saameysey.
Sida MS, PML waxay sababtaa xanuunnada maskaxda ee muuqda MRI, laakiin waxay u muuqdaan inay ka duwan yihiin noocyada caadiga ah ee MS ee cabbirka, qaabka, meesha, iyo dabeecadaha kale.
Tijaabada laf-dhabarta si loo tijaabiyo dheecaanka qumanka ee jadeecada JC-da ayaa sidoo kale loo isticmaalaa si loo xaqiijiyo calaamadaha PML. Ugu dambeyntii, mararka qaarkood waxaa la sameeyaa cad ka-qaadista maskaxda.
Ereyga
Waxaan fahamsanahay in xitaa fursada fog ee hormarinta PML ay tahay arrin aad uwanaagsan markaad qaadato daawooyinka cudurka MS-ga wax ka beddelaya. Haddii aad ku jirtid Tysabri, Gilenya, Tecfidera, Ocrevus, ama daawo kale oo difaaca jirka ah MS iyo ogeysi calaamado cusub ama ka sii daraya, la xiriir dhakhtarkaaga isla markiiba.
In kasta oo astaamahan aan had iyo jeer tilmaamin horumarinta PML, qiimeynta caafimaad ee degdegga ah waa lagama maarmaan maxaa yeelay infekshankan yar ee maskaxda ah waa mid khatar ku ah nolosha. Baaritaanka hore wuxuu ku siinayaa fursada ugu wanaagsan ee natiijada wanaagsan haddii aad hormariso PML.
> Ilo:
> Bloomgren G, Richman S, Hotermans C, iyo al. Khatarta Natalizumab-Associated Leucoencephalopathy Progressive Multiprocessor. N Engl J Med . 2012 Maajo 17; 366 (20): 1870-80.
> Greenlee JE. Isku-dhafan ee Multifocal Leukoencephalopathy (PML). In: Porter RS, Kaplan JL, Lynn RB, et al. Nidaamka Merck Manual Professional Professional Version .
> Maas RPPWM, Muller-Hansma AHG, Esselink RAJ, iyo al. Isku-dhafka 'Multipocal Leukoencephalopathy' oo ah 'Drug-Associated Multiprocessor Leukoencephalopathy': Daraasad Dheecaan Qalliin ah, Radiological, iyo Cerebrospinal Soodejinta 326 Kiisaska. J Neurol . 2016; 263 (10): 2004-2021.
> Ururka Qaran ee Cudurka Naaska. (2015). Isku-dhafan ee Multifocal Leukoencephalopathy.
> Wollebo HS, White MK, Gordon J, Berger JR, Khalili K. Joogista iyo Cudurka Baadhitaanka Polyomavirus Jar. Ann Neurol . 2015 Apr; 77 (4): 560-570.