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(Infectious diseases) diphtheria in pashto language by dr. kalimullah wardak

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Kalimullah Wardak
Kalimullah Wardak

Corynebacterium Diphtheriae, Clinical presentation, pathological findings, differential diagnosis, treatment

Health & Medicine
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Essentials About 1 Diphtheria ‫ډیفتريا‬ Prepared By: Dr. Kalimullah Wardak Under Supervision Of: Dr. Khoshal Farooqi 1391/12---2013/3
Kalimullah (Wardak) 2
3 ‫ډیفرتای‬ ‫د‬ ‫طیب‬ ‫تداوی‬ ‫او‬ ‫یشن‬‫سین‬‫ک‬‫ا‬‫و‬ ‫د‬ ‫کشف‬ ‫څخه‬ ‫ندې‬‫ا‬‫وړ‬ : ‫شتناکه‬‫ح‬‫و‬ ،‫انروغي‬ ‫د‬ ‫ینې‬‫ړ‬‫م‬ ‫خورا‬ ‫لوړه‬ ‫کچه‬ ‫او‬ ‫ډېر‬ ‫يع‬‫وس‬ Outbreaks ... ‫د‬ ‫دیفرتای‬ ،‫لفظ‬ ‫شخييص‬‫ت‬ ‫نښه‬ (Pathognomonic Sign) ‫؛‬ Corynebacterium Diphtheria .... (Toxigenic Strain) . ‫د‬ ‫دیفرتای‬ ،‫يل‬‫ابس‬ Klebs ۱۸۸۳ ‫؛‬ Loeffler ‫وسط‬ ‫؛‬ Klebs-Loeffler bacillus .
4 ‫نړۍ‬ : ‫د‬ ‫شلمې‬ ‫پېړۍ‬ ‫په‬ ‫جراین‬ ‫کښې‬ ‫دیفرتای‬ ‫د‬ ‫ماشومتوب‬ ‫ددوران‬ ‫هل‬ ‫نکې‬‫و‬‫وېرو‬ ‫انروغۍ‬ ‫څ‬ ‫خه‬ ‫په‬ ‫هسې‬ ‫یوه‬ ‫انروغۍ‬ ‫بدهل‬ ‫شوه‬ ‫چې‬ ‫د‬ ‫نړۍ‬ ‫په‬ ‫اخو‬‫ر‬‫پ‬ ‫ميو‬‫س‬ ‫کښې‬ ‫یوه‬ ‫اندره‬ ‫تيايي‬‫غ‬‫رو‬ ‫نزه‬‫و‬‫ت‬‫س‬ ‫ب‬ ‫لل‬ ‫کېدهل‬ ‫چې‬ ‫هل‬ ‫خمې‬ ‫یېې‬ ‫په‬ USA ‫کښې‬ ‫د‬ ۱۹۲۰ ‫هل‬ ۱۴۷۰۰۰ ‫ېښو‬‫پ‬ ‫څخه‬ ‫د‬ ۱۹۹۰-۲۰۰۳ ‫نو‬‫و‬‫لک‬ ‫په‬ ‫یوه‬‫ر‬‫ه‬ ‫کښې‬ ۲ ‫ېښو‬‫پ‬ ‫ته‬ ‫اټیته‬‫ر‬ ‫شوه‬ . ‫په‬ ‫مخ‬ ‫پر‬ ‫وده‬ ‫نو‬‫و‬‫اد‬‫و‬‫هې‬ ‫کښې‬ ‫مه‬ ‫د‬ ‫ماشومتوب‬ ‫د‬ ‫یشن‬‫سین‬‫ک‬‫ا‬‫و‬ ‫په‬ ‫ام‬‫ر‬‫پروګ‬ ‫کې‬ ‫د‬ ‫دیف‬ ‫رتای‬ ‫شاملېدلو‬ ‫د‬ ‫نوموړي‬ ‫مرض‬ ‫وقوعات‬ ‫په‬ ‫یوه‬ ‫اثبت‬ ‫سبت‬‫ن‬ ‫مخ‬ ‫په‬ ‫مکېدو‬ ،‫کړل‬ ‫د‬ WHO ‫د‬ ‫ختمني‬ ‫پر‬ ‫اساس‬ ‫هل‬ ۱۹۸۰ ‫مو‬ ‫نو‬‫و‬‫لک‬ ‫څخه‬ ‫خمکې‬ ‫او‬ ‫ندې‬‫ا‬‫وړ‬ ‫تردې‬ ‫چې‬ ‫د‬ ‫دیفرتای‬ ‫کسایډ‬‫و‬‫ټ‬ ‫ته‬ ‫الرسیس‬ ‫نه‬‫ا‬‫س‬‫آ‬ ‫يش‬ ‫ه‬ ‫اکل‬‫ر‬ ‫د‬ ‫نوموړي‬ ‫مرض‬ ‫یو‬ ‫يليون‬‫م‬ ‫اقعات‬‫و‬ ‫او‬ ۵۰۰۰-۶۰۰۰ ‫نه‬‫و‬‫مرګ‬ ‫ېدل‬‫ېښ‬‫پ‬ .
5 ‫هل‬ ‫يعو‬‫وس‬ Immunization ‫نو‬‫و‬‫ام‬‫ر‬‫پروګ‬ ‫رسه‬ ‫رسه‬ ‫نوموړی‬ ‫مرض‬ ‫د‬ ،‫هند‬ ،‫یقا‬‫ر‬‫اف‬ ‫بنګالديش‬ ، ‫یتنام‬‫و‬ ‫او‬ ‫یل‬‫ز‬‫ا‬‫ر‬‫ب‬ ‫په‬ ‫مشول‬ ‫د‬ ‫مخ‬ ‫پرودې‬ ‫نړۍ‬ ‫په‬ ‫ډېرو‬ ‫برخو‬ ‫کې‬ Endemic ‫دی‬ ‫او‬ ‫هل‬ ۸۰٪ ‫څخه‬ ‫تر‬ ۹۰٪ ‫پورې‬ ‫ال‬‫و‬‫ی‬‫ړ‬‫ن‬ ‫حصي‬ ‫اښ‬‫و‬‫ګ‬ ‫مه‬ ‫مخ‬ ‫پر‬ ‫ودې‬ ‫نړۍ‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ‫کړی‬ . ‫پداسې‬ ‫حال‬ ‫کې‬ ‫چې‬ ‫په‬ ‫تېره‬ ‫یوه‬ ‫ميه‬‫ن‬ ‫لسزيه‬ ‫کښې‬ ‫نوموړی‬ ‫مرض‬ ‫د‬ ‫خمتللې‬‫ر‬‫پ‬ ‫نړۍ‬ ‫په‬ ‫ينو‬‫ځ‬ ‫برخو‬ ‫کې‬ ‫بيا‬ ‫رس‬ ‫اپورته‬‫ر‬ ‫کړی‬ ‫او‬ ‫د‬ ‫اين‬‫و‬‫پخ‬ ‫شوروي‬ ‫احتاد‬ ‫په‬ ‫ممالکو‬ ‫کې‬ ‫یوې‬ ‫جاري‬ ‫اپيډميي‬ ‫یو‬ ‫ځل‬ ‫بيا‬ ‫نوموړی‬ ‫مرض‬ ‫د‬ ‫حصت‬ ‫عامې‬ ‫د‬ ‫هممو‬ ‫مشالکتو‬ ‫په‬ ‫لست‬ ‫ورګډ‬ ‫کړی‬ . ‫دې‬ ‫اپيډميی‬ ‫په‬ ۱۹۹۹ ‫کښې‬ ‫هل‬ ۱۵۷۰۰۰ ‫اقعاتو‬‫و‬ ‫او‬ ۵۰۰۰ ‫څخه‬ ‫زایت‬ ‫نه‬‫و‬‫مرګ‬ ‫پېښ‬ ‫کړي‬ ‫چې‬ ‫ازې‬‫و‬‫ی‬ ‫په‬ ۲۰۰۵ ‫اکل‬ ‫کې‬ ‫یېې‬ WHO ‫ته‬ ‫د‬ ۱۲۷۳۵ ‫اقعاتو‬‫و‬ ‫اپور‬‫ر‬ ‫ورکړل‬ ‫شوی‬ ‫و‬ .
6 ‫تان‬‫هندوس‬ : ‫د‬ ‫یشن‬‫سین‬‫ک‬‫ا‬‫و‬ ‫په‬ ‫ميل‬ ‫ام‬‫ر‬‫پروګ‬ ‫کښې‬ ‫د‬ ‫دیفرتای‬ ‫د‬ ‫سینو‬‫ک‬‫ا‬‫و‬ ‫شاملېدلو‬ ‫په‬ ‫هند‬ ‫ک‬ ‫ښې‬ ‫د‬ ‫نوموړي‬ ‫مرض‬ ‫اقعات‬‫و‬ ‫په‬ ‫یه‬‫و‬‫ل‬ ‫کچه‬ ‫مک‬ ‫کړي‬ ‫چې‬ ‫هل‬ ‫خمې‬ ‫یېې‬ ‫په‬ ۱۹۹۷ ‫کښې‬ ‫ازې‬‫و‬‫ی‬ ‫د‬ ۱۳۲۶ ‫اقعاتو‬‫و‬ ‫اپور‬‫ر‬ ‫ورکړل‬ ‫شوی‬ ‫چې‬ ‫په‬ ‫ښاکره‬ ‫ډول‬ ‫د‬ ‫اقعاتو‬‫و‬ ‫په‬ ‫اپور‬‫ر‬ ‫لو‬‫و‬‫ورک‬ ‫کې‬ ‫تيا‬‫ړ‬‫ميګ‬‫ن‬ ،‫يېې‬‫ښ‬ ‫پداسې‬ ‫حال‬ ‫ک‬ ‫ې‬ ‫چې‬ ‫د‬ ‫تېرې‬ ‫لسزيې‬ ‫په‬ ‫جراین‬ ‫کې‬ ‫د‬ ۲۰۰۰ ‫م‬ ‫اکل‬ ‫هل‬ ۵۱۲۵ ‫څخه‬ ‫د‬ ۲۰۰۷ ‫اکل‬ ۳۳۵۴ ‫ته‬ ‫د‬ ‫اقعاتو‬‫و‬ ‫مشري‬ ‫اټیټ‬‫ر‬ ‫شوی‬ ( ‫په‬ ۲۰۰۵ ‫کښې‬ ‫یېې‬ ‫مشېر‬ ‫ن‬‫آ‬ ۱۰۲۳۱ ‫ثبت‬ ‫شوی‬ ‫و‬ ) . ‫انروغي‬ ‫د‬ ‫اد‬‫و‬‫هې‬ ‫په‬ ‫خمتلفو‬ ‫ميو‬‫س‬ ‫کې‬ ‫تر‬ ‫اوسه‬ Endemic ‫ده‬ ‫او‬ ‫تر‬ ‫لو‬‫و‬‫ټ‬ ‫ډېر‬ ‫اقعات‬‫و‬ ‫یېې‬ ‫په‬ ( ‫ا‬‫ر‬‫ند‬‫ا‬ ‫ېش‬‫د‬‫پر‬ ) ‫اایلت‬ ‫کښې‬ ‫ثبت‬ ‫شوي؛‬ ‫په‬ ‫ډهلۍ‬ ‫او‬ ‫ا‬‫و‬‫شاوخ‬ ‫ميو‬‫س‬ ‫کښې‬ ‫مه‬ Sporadic Outbreaks ‫مکررا‬ ‫تر‬ ‫سرتګو‬ ‫کېږي‬ .
7 Corynebacterium Diphtheria ‫یو‬ ‫غري‬ ،‫متحرک‬ ‫پور‬‫س‬ ‫نه‬ ،‫ليدوونکی‬‫و‬‫ت‬ ‫پسول‬‫ک‬ ‫نه‬ ‫ل‬ ‫رونکی‬ ‫ام‬‫ر‬‫ګ‬ ‫ثبت‬‫م‬ ‫يل‬‫ابس‬ ‫دۍ‬ ‫چې‬ ‫د‬ Coryne ‫یوانين‬ ‫لفظ‬ ‫یېې‬ ‫د‬ ‫ميهل‬ ‫ننده‬‫ا‬‫م‬ ‫شلک‬ ‫په‬ ‫خاطر‬ ‫پرې‬ ‫ېښ‬‫ا‬ ‫ودل‬ ‫شوی‬ ‫دی‬ . ‫څلور‬ ‫نه‬‫و‬‫ل‬‫و‬‫ډ‬ ‫یېې‬ ‫ليدل‬ ‫کیږي‬ : Gravis .3 Mitis .2 Belfani .1 ‫او‬ Intermedius .4 ‫نوموړي‬ ‫اميت‬‫تقس‬ ‫یېې‬ ‫د‬ ‫اکلوين‬ ،‫مشخصاتو‬ ‫ميوالیتيک‬‫ه‬ ‫فعاليت‬ ‫او‬ ‫ختمري‬ ‫عکس‬ ‫ا‬ ‫نو‬‫و‬‫لعمل‬ ‫هل‬ ‫خمې‬ ‫شوي‬ ‫دي؛‬ ‫د‬ ‫ايرولنس‬‫و‬ ‫په‬ ‫ټالکو‬ ‫کې‬ ‫یېې‬ ‫لو‬‫و‬‫ټ‬‫ر‬‫ت‬ ‫همم‬ ‫فکتور‬ Exotoxin ‫دي‬ ‫چې‬ ‫ليد‬‫و‬‫ت‬ ‫یېې‬ ‫تر‬ Lysogenic β phage ‫پورې‬ ‫تړیل‬ . ‫د‬ ‫دیفرتای‬ ‫کسني‬‫و‬‫اکزوټ‬ ‫په‬ ‫موضعي‬ ‫او‬ ‫معويم‬ ‫توګه‬ ‫د‬ ‫اتو‬‫ر‬‫جح‬ ‫د‬ ‫یب‬‫ر‬‫خت‬ ‫ابعث‬ ‫کی‬ ‫ږي‬ . ‫پر‬ ‫کسني‬‫و‬‫اکزوټ‬ ‫بېره‬‫رس‬ ‫د‬ ‫جحروي‬ ‫جدار‬ O ‫او‬ K ‫نیت‬‫ا‬ ‫نه‬‫و‬‫جن‬ ‫مه‬ ‫په‬ ‫پتوچنزيس‬ ‫کې‬ ‫اتثري‬ ‫لري‬ .
8
9 ‫د‬ ‫یشن‬‫سین‬‫ک‬‫ا‬‫و‬ ‫هل‬ ‫عام‬ ‫کېدلو‬ ‫ندې‬‫ا‬‫وړ‬ ‫د‬ ‫یفرتای‬ ‫ازې‬‫و‬‫ی‬ ‫د‬ ‫نو‬‫ا‬‫ماشوم‬ ‫انروغي‬ ‫و‬ ‫ه‬ ‫چې‬ ‫په‬ ‫نډمييک‬‫ا‬ ‫ميو‬‫س‬ ‫کښې‬ ‫اوسه‬‫ر‬‫ت‬ ‫مه‬ ‫د‬ ‫دیفرتای‬ ‫لوړ‬ ‫اقعات‬‫و‬ ‫هل‬ ‫مکتب‬ ‫څخه‬ ‫ن‬‫ا‬‫وړ‬ ‫دې‬ ‫او‬ ‫د‬ ‫مکتب‬ ‫په‬ ‫معر‬ ‫نو‬‫ا‬‫ماشوم‬ ‫کښې‬ ‫ليدل‬ ،‫کېږي‬ ‫پداسې‬ ‫حال‬ ‫کې‬ ‫چې‬ Immunization Programs ‫د‬ ‫اقعاتو‬‫و‬ ‫د‬ ‫معر‬ ‫پر‬ ‫اساس‬ ‫ېش‬‫و‬ ‫متغري‬ ،‫کړی‬ ‫چې‬ ‫هل‬ ‫امهل‬ ‫یېې‬ ‫هل‬ ‫اين‬‫و‬‫پخ‬ ‫شورو‬ ‫ي‬ ‫احتاد‬ ‫څخه‬ ‫په‬ ‫یو‬‫و‬‫ن‬ ‫یو‬‫و‬‫جداش‬ ‫نو‬‫و‬‫اد‬‫و‬‫هې‬ ‫کې‬ ‫هل‬ ۱۹۹۰ ‫څخه‬ ‫په‬ ‫ارشوع‬‫ر‬ ‫شوې‬ ‫اپيډميي‬ ‫کې‬ ‫هل‬ ۶۰٪ ‫څخه‬ ‫ډېرې‬ ‫ېښې‬‫پ‬ ‫او‬ ‫هل‬ ۳/۴ ( ‫درۍ‬ ‫بعې‬‫ر‬ ) ‫څخه‬ ‫ډېر‬ ‫نه‬‫و‬‫مرګ‬ ‫په‬ ‫نو‬‫ال‬‫اکه‬ ‫کې‬ ‫پېښ‬ ‫شوي‬ .
10 ‫په‬ ‫هغو‬ ‫تلليو‬‫خم‬‫ر‬‫پ‬ ‫نو‬‫و‬‫اد‬‫و‬‫هې‬ ‫کې‬ ‫چې‬ ‫د‬ ‫دیفرتای‬ ‫ېښې‬‫پ‬ ‫په‬ ‫احض‬‫و‬ ‫ډول‬ ‫مک‬ ‫ې‬ ،‫شوې‬ ‫اقعات‬‫و‬ ‫معموال‬ ‫په‬ ‫غري‬ ‫معاف‬ ،‫نو‬‫ال‬‫اکه‬ Homosexual ،‫یو‬‫ړ‬‫س‬ ‫د‬ ‫اخل‬ ‫وریدي‬ ‫اتو‬‫ر‬‫خمد‬ ‫تعاملوونک‬‫اس‬ ‫و‬ ‫او‬ ‫ينو‬‫ځ‬ ‫وړو‬ ‫ادي‬‫ژ‬‫ن‬ ‫نو‬‫و‬‫ګروپ‬ ‫کښې‬ ‫ښېږي‬‫پې‬ . ‫په‬ ‫هند‬ ‫کې‬ ‫مه‬ ‫مطالعاتو‬ ‫ښودلې‬ ‫چې‬ ‫هل‬ ۵ ‫لکنۍ‬ ‫څخه‬ ‫په‬ ‫پورته‬ ‫معر‬ ‫کې‬ ‫مصابېدل‬ ‫پ‬ ‫ه‬ ‫يب‬‫نس‬ ‫ډول‬ ‫لوړ‬ ‫شوي‬ .
11
12 ‫د‬ ‫دیفرتای‬ ‫اقعات‬‫و‬ ‫په‬ ‫مومسي‬ ‫توګه‬ ‫بدلون‬ ،‫مويم‬ ‫په‬ ‫معتدلو‬ ‫ميو‬‫س‬ ‫کښې‬ ‫ډېر‬ ‫اقعات‬‫و‬ ‫په‬ ‫ژيم‬ ‫کې‬ ‫ليدل‬ ،‫کېږي‬ ‫پداسې‬ ‫حال‬ ‫کې‬ ‫چې‬ ‫په‬ ‫حاره‬ ‫ميو‬‫س‬ ‫کې‬ ‫د‬ ‫اکل‬ ‫په‬ ‫اوږدو‬ ‫کې‬ ‫غريواحض‬ ‫وقوعي‬ ‫تغري‬ ‫ات‬ ‫مشاهده‬ ‫شوي‬ . ‫د‬ ‫نتقال‬‫ا‬ ‫ابتدايئ‬ ‫الرې‬ ‫هل‬ ‫ايي‬‫و‬‫ه‬ ‫تنفيس‬ ،‫اتو‬‫ر‬‫قط‬ ‫هل‬ ‫تنفيس‬ ‫ترحشاتو‬ ‫او‬ ‫ایمه‬ ‫د‬ ‫جدل‬ ‫ي‬ ‫ندفاعاتو‬‫ا‬ ‫هل‬ Exudate ‫رسه‬ ‫تقمي‬‫مس‬ ‫متاس‬ ‫ښودل‬ ،‫شوی‬ ‫د‬ ‫خشيص‬ ‫تعامل‬‫اس‬ ‫وسایلو‬ ‫او‬ ‫ککړو‬ ‫يدو‬‫ش‬ ‫هل‬ ‫الرې‬ ‫مه‬ ‫نتق‬‫ا‬ ‫الېدالی‬ ،‫يش‬ ‫نساانن‬‫ا‬ ‫ازين‬‫و‬‫ی‬ ‫ندل‬‫ژ‬‫پې‬ ‫شوي‬ ‫مريض‬ ‫ذخائر‬ ‫دي‬ ‫چې‬ ‫هل‬ ‫نو‬‫ا‬‫یض‬‫ر‬‫م‬ ‫او‬ ‫ينو‬‫قل‬‫ان‬ ‫څخه‬ ‫یېې‬ ‫مرض‬ ‫نور‬ ‫و‬ ‫ته‬ ‫ایت‬‫رس‬ ‫کوي‬ .
14 ‫د‬ ‫تفرخي‬ ‫دوره‬ ۱-۵ ‫ورځو‬ ‫پورې‬ ،‫غځېږي‬ ‫ا‬‫رث‬‫اک‬ ‫مساعدو‬ ‫اشخاصو‬ ‫ته‬ ‫د‬ ‫مرض‬ ‫نتق‬‫ا‬ ‫ال‬ ‫هل‬ ‫بلعويم‬ ‫نتان‬‫ا‬ ‫څخه‬ ‫صورت‬ ‫نیيس‬ ‫نه‬ ‫د‬ ‫مرض‬ ‫هل‬ ‫اقعې‬‫و‬ ‫څخه‬ ! ‫د‬ ‫دیفرتای‬ ‫ات‬‫ر‬‫تظاه‬ ‫د‬ ‫نتان‬‫ا‬ ‫د‬ ‫دخول‬ ‫تر‬ ‫ابب‬ ‫پورې‬ ،‫تړيل‬ ‫چې‬ ‫کېدالی‬ ‫يش‬ ‫تنفيس‬ ‫وي‬ ‫ای‬ ‫مه‬ ‫جدلي‬ . Corynebacterium Diphtheria ‫ډېر‬ ‫همامج‬ ‫ندی‬ ‫او‬ ‫معموال‬ ‫تر‬ ‫تنفيس‬ ‫خماطي‬ ‫غ‬ ‫شاء‬ ‫او‬ ‫تيک‬‫پوس‬ ‫پورې‬ ‫حمدود‬ ‫پاتې‬ ‫کېږي‬ ‫او‬ ‫متيک‬‫یس‬‫س‬ ‫تشار‬‫ن‬‫ا‬ ‫یېې‬ ‫غري‬ ‫معمول‬ ‫دی‬ .
15 ‫په‬ ‫هغو‬ ‫ميو‬‫س‬ ‫کې‬ ‫چې‬ ‫مرض‬ ‫ندمييک‬‫ا‬ ،‫دی‬ ‫د‬ ‫تنفيس‬ ‫الرو‬ ‫نتان‬‫ا‬ ‫کېدالی‬ ‫يش‬ ‫چې‬ ‫ازې‬‫و‬‫ی‬ ‫د‬ ‫ایت‬‫رس‬ ‫غري‬ ‫عريض‬ ‫نبع‬‫م‬ ‫وي‬ . ‫په‬ ‫تنفيس‬ ‫قو‬‫ر‬‫ط‬ ‫کښې‬ ‫د‬ ‫نتان‬‫ا‬ ‫معمول‬ ‫نه‬‫و‬‫يت‬‫قع‬‫مو‬ : ‫قدايم‬ ‫نفي‬‫ا‬ ‫حلقويم‬،‫نتان‬‫ا‬ ،‫نتان‬‫ا‬ ‫او‬ ‫بلعويم‬ ‫ای‬ Tracheobronchial Infection ‫دي‬ . ‫قدامي‬ ‫انفي‬ ‫انتان‬ Anterior Nasal Infection : ‫یض‬‫ر‬‫م‬ ‫تبه‬ ‫او‬ ‫مصيل‬ ‫ای‬ ‫مصيل‬ - ‫قيحي‬ ‫ترحشات‬ ،‫لري‬ ‫اض‬‫ر‬‫اع‬ ‫معموال‬ ‫خفيف‬ ،‫وي‬ ‫زهري‬ ‫ات‬‫ري‬‫ث‬‫تأ‬ ‫ا‬‫ر‬‫اند‬ ‫ښېږي‬‫پې‬ .
16 ‫حلقومي‬ ‫انتان‬ Faucial Infection : ‫د‬ ‫تنفيس‬ ‫دیفرتای‬ ‫تر‬ ‫لو‬‫و‬‫ټ‬ ‫معمول‬ ‫موقعيت‬ ‫دۍ؛‬ ‫یض‬‫ر‬‫م‬ ،‫تبه‬ ‫د‬ ‫عضالتو‬ ‫درد‬ ‫او‬ ‫د‬ ‫توين‬‫س‬ ‫يش‬‫ر‬‫خت‬ ‫لري‬ . ‫لو‬‫و‬‫ټ‬‫ر‬‫ت‬ ‫مشخصوونکې‬ ‫نښه‬ ‫پر‬ ‫یوې‬ ‫ای‬ ‫اړو‬‫و‬‫د‬ ‫اوو‬‫و‬‫خ‬ ‫د‬ ‫یوې‬ ‫غشاء‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ‫ک‬ ‫ېدل‬ ،‫دي‬ ‫چې‬ ‫کېدالی‬ ‫يش‬ ‫ازې‬‫و‬‫ی‬ ‫تر‬ ‫نو‬‫و‬‫نسل‬‫ات‬ ‫پورې‬ ‫حمدوده‬ ‫وي‬ ‫او‬ ‫ایمه‬ ‫تر‬ ‫بېۍ‬‫ژ‬ ( ‫اع‬‫رش‬ ‫احلنک‬ ) ، ‫نرم‬ ،‫اتلو‬ ‫مفي‬ ‫بلعوم‬ ‫او‬ ‫نفي‬‫ا‬ ‫بلعوم‬ ‫پورې‬ ‫وسعت‬ ‫کسب‬ ‫کړي‬ . ‫د‬ ‫اضو‬‫ر‬‫اع‬ ‫شدت‬ ‫د‬ ‫پ‬ ‫ردې‬ ‫تر‬ ‫وسعت‬ ‫پورې‬ ‫تړیل‬ . ‫نوموړې‬ ‫پرده‬ ‫په‬ ‫ابتداء‬ ‫کښې‬ ‫پینه‬‫س‬ ‫وي‬ ‫چې‬ ‫ته‬‫وروس‬ ‫خ‬ ‫ړ‬ ‫نګ‬‫ر‬ ‫غوره‬ ‫کوي‬ ‫چې‬ ‫په‬ ‫جدا‬ ‫لو‬‫و‬‫ک‬ ‫یېې‬ ‫ینه‬‫و‬ ،‫هبیږي‬ ‫او‬ ‫ینه‬‫و‬ ‫نه‬‫د‬‫هبې‬ ‫یېې‬ ‫خړ‬ ‫خبنه‬ ‫نه‬‫ش‬ ‫ای‬ ‫تور‬ ‫نګه‬‫ر‬ ‫کوي‬ .
17
18 ‫جدلي‬ ‫دیفرتای‬ ‫په‬ ‫هسې‬ ‫یوې‬ ‫نه‬ ‫نکې‬‫و‬‫رغېد‬ ‫مزمنې‬ ‫قرحې‬ ‫ندې‬‫اب‬ ‫ندل‬‫ژ‬‫پې‬ ‫کېږي‬ ‫چې‬ ‫په‬ ‫یوه‬ ‫چټهل‬ ‫خړه‬ ‫پرده‬ ‫پوښلې‬ ‫وي‬ . ‫قرحات‬ ‫معموال‬ ،‫لټ‬ ‫سطحي‬ ‫او‬ ‫وسعت‬ ‫نه‬ ‫کس‬ ‫بوونيک‬ ‫وي؛‬ ،‫ایل‬‫و‬‫سور‬ ‫حساسیت‬ ‫او‬ ‫درد‬ ‫ښايي‬ ‫موجود‬ ‫وي‬ . ‫جدلي‬ ‫دیفرتای‬ ‫هل‬ ‫نورو‬ ‫جدلي‬ ‫فا‬‫آ‬ ‫تو‬ ‫رسه‬ ‫مهزمان‬ ‫مه‬ ‫اقع‬‫و‬ ‫کېدالی‬ ‫يش‬ . ‫دا‬ ‫ډول‬ ‫ندفاعات‬‫ا‬ ‫په‬ ‫ګرمو‬ ‫ميو‬‫س‬ ‫کې‬ ‫ډېر‬ ‫معمول‬ ‫دي‬ ‫چې‬ ‫د‬ ‫مرض‬ ‫د‬ ‫هممې‬ ‫ذخريې‬ ‫ای‬ Reservoir ‫په‬ ‫توګه‬ ‫ندل‬‫ژ‬‫پې‬ ‫کېږي‬ . ‫د‬ ‫نورو‬ ‫نو‬‫و‬‫يت‬‫قع‬‫مو‬ ‫مص‬ ‫اب‬ ‫کېدل‬ ‫غري‬ ‫معمول‬ ‫دي‬ ‫خو‬ Otitis Externa ، ‫د‬ ‫منضمې‬ ‫قيحي‬ ‫ای‬ ‫قرحوي‬ ‫الهتاب‬ (Purulent or Ulcerative Conjunctivitis) ، Purulent or Ulcerative Vulvovaginitis ‫او‬ ‫حیت‬ Pyogenic Arthritis ‫ليدل‬ ‫یدي‬‫و‬‫ش‬ .
19
20 ‫په‬ ‫دیفرتایيئ‬ ‫نتاانتو‬‫ا‬ ‫کې‬ ‫ینه‬‫ړ‬‫م‬ ‫معموال‬ ‫د‬ ‫تنفيس‬ ‫الرو‬ ‫د‬ ‫مصاب‬ ‫کې‬ ‫دلو‬ ‫هل‬ ‫وهجېې‬ ‫د‬ ‫ايئ‬‫و‬‫ه‬ ‫نسداد‬‫ا‬ ‫ای‬ ‫مه‬ ‫د‬ ‫دیفرتایي‬ ‫نو‬‫و‬‫سین‬‫ک‬‫و‬‫ټ‬ ‫په‬ ‫يهل‬‫وس‬ ‫د‬ ‫متيکو‬‫یس‬‫س‬ ‫اختالطات‬ ‫و‬ ‫هل‬ ‫امهل‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ‫کېږي‬ . ‫د‬ ‫نو‬‫و‬‫سین‬‫ک‬‫و‬‫ت‬ ‫د‬ ‫جذب‬ ‫مقدار‬ ‫معموال‬ ‫د‬ ‫خماطي‬ ‫غشاء‬ ‫د‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ‫شوي‬ ‫فت‬‫آ‬ ‫هل‬ ‫وسعت‬ ‫رسه‬ ‫تناسب‬‫م‬ ‫دی‬ . ‫د‬ WHO ‫ا‬‫و‬‫خل‬ ‫هغه‬ ‫ينييک‬‫لک‬ ‫نه‬‫و‬‫حالت‬ ‫چې‬ ‫د‬ ‫نو‬‫و‬‫سین‬‫ک‬‫و‬‫ټ‬ ‫هل‬ ‫امهل‬ ‫مت‬‫یس‬‫س‬ ‫يکو‬ ‫عکس‬ ‫نو‬‫و‬‫العمل‬ ‫ته‬ ‫الره‬ ‫اروي‬‫و‬‫ه‬ ‫د‬ ‫مرض‬ Catarrhal Form ‫لوي‬‫ز‬‫ن‬ ‫اشاکل‬ ( ‫لکه‬ ‫د‬ ‫بلعوم‬ ،‫ایل‬‫و‬‫سور‬ ‫د‬ ‫غش‬ ‫اء‬ ‫نه‬ ‫موجودیت‬ ) ، ‫ليکويل‬‫و‬‫ف‬ ‫اشاکل‬ ( ‫په‬ ‫بلعوم‬ ‫او‬ ‫نو‬‫و‬‫نسل‬‫ات‬ ‫د‬ ‫ېټ‬‫ډ‬‫ايکزو‬ Patches ) ، ‫نيک‬‫و‬‫ېد‬‫ر‬‫خپ‬ ‫اشاکل‬ ( ‫هغه‬ ‫پردې‬ ‫چې‬ ‫نه‬‫و‬‫نسل‬‫ا‬‫ټ‬ ‫او‬ ‫خلفي‬ ‫بلعوم‬ ‫پوښي‬ ) ‫او‬ ‫ک‬‫ر‬‫م‬ ‫ب‬ ‫اشاکل‬ ( ‫چې‬ ‫هل‬ ‫یوه‬ ‫څخه‬ ‫ډېر‬ ‫اانتوميک‬ ‫نه‬‫و‬‫يت‬‫قع‬‫مو‬ ‫مصاب‬ ‫شوي‬ ‫وي‬ ‫لکه‬ ‫توین‬‫س‬ ‫او‬ ‫جدل‬ ) ‫ښ‬ ‫ودل‬ ‫یدي‬‫و‬‫ش‬ .
21 ‫د‬ ‫دیفرتای‬ ‫کسني‬‫و‬‫ټ‬ ‫د‬ ‫بدن‬ ‫لو‬‫و‬‫ټ‬ ‫نساجو‬‫ا‬ ‫ته‬ ‫زهري‬ ‫دي‬ ‫اما‬ ‫تر‬ ‫لو‬‫و‬‫ټ‬ ‫همم‬ ‫اختالطات‬ ‫پ‬ ‫ه‬ ‫زړه‬ ‫او‬ ‫عصيب‬ ‫مت‬‫یس‬‫س‬ ‫ددوی‬ ‫هل‬ ‫ثري‬‫تأ‬ ‫څخه‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ‫کېږي‬ . ‫قلبي‬ ‫سميت‬ / ‫تسمم‬ (Cardiac Toxicity) : ‫د‬ ‫قليب‬ ‫تسمم‬ ‫اماکن‬ ‫د‬ ‫موضعي‬ ‫فت‬‫آ‬ ‫هل‬ ‫شدت‬ ‫رسه‬ ‫تړیل‬ ،‫دی‬ Myocarditis ‫د‬ ‫مرض‬ ‫هل‬ ‫لومړۍ‬ ‫څخه‬ ‫تر‬ ‫شپږمې‬ ‫نۍ‬‫و‬‫ا‬ ‫پورې‬ ‫هر‬ ‫وخت‬ ‫ېدالی‬‫ېښ‬‫پ‬ ،‫يش‬ ‫چې‬ ‫په‬ ۱۰-۲۵٪ ‫نو‬‫ا‬‫یض‬‫ر‬‫م‬ ‫کښې‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ‫کېږي‬ ‫او‬ ‫په‬ ۵۰-۶۰٪ ‫اقعاتو‬‫و‬ ‫کې‬ ‫مرګوین‬ ‫اثبت‬ ‫شوی‬ . Myocarditis ‫د‬ ‫زړه‬ ‫هل‬ ‫نو‬‫و‬‫بالک‬ ‫څخه‬ ‫تر‬ ‫احتقاين‬ ‫عدم‬ ‫کفایېې‬ ‫او‬ ‫دوراين‬ ‫کوالپس‬ ‫پورې‬ ‫نزې‬‫و‬‫ت‬‫س‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ،‫کوي‬ ‫چ‬ ‫ې‬ ‫ابید‬ ‫د‬ ‫قليب‬ ‫وضعيت‬ ‫د‬ ‫اقبت‬‫ر‬‫م‬ ‫په‬ ‫منظور‬ ‫اري‬‫ر‬‫تک‬ ECG ‫تررسه‬ ‫يش‬ .
22 ‫عصبي‬ ‫سميت‬ / ‫تسمم‬ (Neurologic Toxicity) : ‫حميطي‬ ‫ای‬ ‫حقفي‬ Neuritis ‫د‬ ‫مرض‬ ‫هل‬ ‫ينييک‬‫لک‬ ‫رشوع‬ ‫څخه‬ ‫تر‬ ‫امتې‬ ‫نۍ‬‫و‬‫ا‬ ‫پورې‬ ‫ر‬ ‫نځته‬‫م‬‫ا‬ ‫کېدای‬ ،‫يش‬ ‫چې‬ ‫وقوع‬ ‫یېې‬ ‫تقامي‬‫مس‬ ‫د‬ ‫موضعي‬ ‫فت‬‫آ‬ ‫هل‬ ‫شدت‬ ‫رسه‬ ‫به‬‫متناس‬ ‫ده‬ ‫چې‬ ‫تر‬ ‫لو‬‫و‬‫ټ‬ ‫معمول‬ ‫اشاکل‬ ‫یېې‬ ‫د‬ ‫نرم‬ ‫اتلو‬ ‫او‬ ‫د‬ ‫خلفي‬ ‫بلعويم‬ ‫جدار‬ ‫موضعي‬ ‫فلج‬ ‫نه‬‫د‬‫کې‬ ‫ده‬ . ‫حم‬ ‫يطي‬ Neuritis ‫اندر‬ ‫دی‬ ‫او‬ ‫تر‬ ‫لومړي‬ ‫هغه‬ ‫ډېر‬ ‫فرصت‬ ‫ته‬ ‫رضورت‬ ،‫لري‬ ‫هغه‬ ‫یضان‬‫ر‬‫م‬ ‫چ‬ ‫ې‬ ‫ندي‬‫و‬‫ژ‬ ‫پاتې‬ ‫کېږي‬ ‫اکملې‬ ‫تيا‬‫غ‬‫رو‬ ‫ته‬ ‫اګرځي‬‫ر‬ .
23 This specimen shows the trachea and major bronchi of a six-year old child who died of diphtheria.
24 Bovine (calf) larynx necrotizing laryngitis (calf diphtheria).
25 ‫نۍ‬‫ړ‬‫بی‬ ‫تداوي‬ ‫د‬ ‫نذارو‬‫ا‬ ‫په‬ ‫ښه‬ ‫کېدلو‬ ‫کې‬ ‫ډېره‬ ‫ثره‬‫ؤ‬‫م‬ ‫ده‬ . ‫چې‬ ‫هل‬ ‫امهل‬ ‫یېې‬ ‫د‬ ‫غالب‬ ‫ګامن‬ ‫اساس‬‫ر‬‫پ‬ ‫تداوي‬ ‫ډېر‬ ‫ځهل‬ ‫ګټوره‬ ‫اثبته‬ ‫شوې‬ . ‫د‬ ‫از‬‫و‬‫آ‬ ‫د‬ ‫تلو‬‫کېناس‬ ‫او‬ ‫هل‬ ‫تشخ‬ ‫يصوونکې‬ ‫بلعويم‬ ‫غشاء‬ ‫رسه‬ ‫یوځای‬ ‫ایډر‬‫ر‬‫سټ‬ ‫د‬ ‫شخيص‬‫ت‬ ‫د‬ ‫وضع‬ ‫لپاره‬ ‫په‬ ‫هغو‬ ‫نو‬‫ا‬‫یض‬‫ر‬‫م‬ ‫کې‬ ‫چې‬ ‫تبه‬ ‫لرونکی‬ Pharyngitis ‫لري‬ ‫اکيف‬ ‫تويک‬ ‫دي‬ . ‫چې‬ ‫کېدالی‬ ‫يش‬ ‫د‬ ‫لوفلر‬ (Loeffler) ‫پر‬ ‫وسط‬ ‫د‬ ‫مسري‬ ‫د‬ ‫لو‬‫ر‬‫ک‬ ‫په‬ ‫يهل‬‫وس‬ ‫یېې‬ ‫اتئيد‬ ‫ويش‬ . ‫د‬ ‫لکچر‬ ‫لپاره‬ ‫نه‬‫و‬‫من‬ ‫ابید‬ ‫د‬ ‫نيت‬‫ا‬ ‫تيک‬‫و‬‫بي‬ ‫هل‬ ‫نې‬‫و‬‫اکر‬ ‫ندې‬‫ا‬‫وړ‬ ‫مچتو‬ ‫يش‬ ‫؛‬ ‫د‬ PCR ‫ټسټ‬ ‫لو‬‫و‬‫ټ‬‫ر‬‫ت‬ ‫د‬ ‫دقيق‬ ‫شخيص‬‫ت‬ ‫نکی‬‫و‬‫رسو‬‫می‬ ‫دی‬ .
26 Clinical Manifestations
27 Colony Characteristics, A closer view of the microorganism
28
29 ‫د‬ ‫دیفرتای‬ ‫نټي‬‫ا‬ ‫کسني‬‫و‬‫ټ‬ ‫د‬ ‫اسايس‬ ‫تداوۍ‬ ‫اصيل‬ ‫برخه‬ ‫ده‬ ‫نو‬ ‫ابید‬ ‫د‬ ‫تد‬ ‫اوۍ‬ ‫رشوع‬ ‫د‬ ‫ابکرتایلوژيکو‬ ‫نو‬‫و‬‫ټ‬‫ټس‬ ‫تر‬ ‫نتاجئو‬ ‫پورې‬ ‫نه‬‫و‬ ‫ځنډول‬ ‫يش‬ ‫ځکه‬ Antitoxin ‫ازې‬‫و‬‫ی‬ ‫هغه‬ ‫وخت‬ Toxins ‫خنیث‬ ‫کویل‬ ‫يش‬ ‫چې‬ ‫ال‬ ‫اتو‬‫ر‬‫جح‬ ‫ته‬ ‫نه‬ ‫وي‬ ‫تيل‬‫و‬‫نن‬ . ‫لکه‬ ‫نګه‬‫ر‬‫څ‬ ‫چې‬ ‫نټي‬‫ا‬ ‫نه‬‫و‬‫سین‬‫ک‬‫و‬‫ټ‬ ‫هل‬ ‫س‬‫آ‬ / ‫اسپ‬ ‫څخه‬ ‫تحصال‬‫اس‬ ‫شوي‬ ‫نو‬ ‫اب‬ ‫ید‬ ‫هل‬ ‫بيق‬‫تط‬ ‫څخه‬ ‫ندې‬‫ا‬‫وړ‬ ‫د‬ ‫فرط‬ ‫حساسیت‬ ‫ټسټ‬ ‫اء‬‫ر‬‫اج‬ ‫يش‬ ‫ځکه‬ ‫د‬ Anaphylaxis ‫احامتل‬ ‫نيش‬ ‫ېدیل‬‫د‬‫ر‬ .
30
31 ‫د‬ ‫نټي‬‫ا‬ ‫سینو‬‫ک‬‫و‬‫ټ‬ ‫ډوز‬ ‫د‬ ‫مرض‬ ‫تر‬ ‫شدت‬ ‫او‬ ‫ام‬‫و‬‫د‬ ‫پورې‬ ،‫تړیل‬ ‫چې‬ ‫معموال‬ ‫جتو‬ ‫يز‬ ‫نکی‬‫و‬‫کېد‬ ‫ډوز‬ ‫یېې‬ ‫هل‬ ۲۰۰۰۰ ‫څخه‬ ‫تر‬ ۱۰۰۰۰۰ ‫نو‬‫و‬‫نټ‬‫و‬‫ی‬ ‫پورې‬ ،‫دی‬ ‫چې‬ ‫په‬ ‫شدیدو‬ ‫اقعاتو‬‫و‬ ‫ک‬ ‫ې‬ ‫داخل‬ ‫وریدي‬ ‫او‬ ‫په‬ ‫متوسطو‬ ‫اقعاتو‬‫و‬ ‫کې‬ ‫داخل‬ ‫عضيل‬ ‫يقیږي‬‫تطب‬ . ‫نيت‬‫ا‬ ‫نه‬‫و‬‫تيک‬‫و‬‫بي‬ ‫د‬ ‫نزيم‬‫ا‬‫اورګ‬ ‫د‬ ‫وژلو‬ ‫هل‬ ‫الرې‬ ‫د‬ ‫نو‬‫و‬‫ن‬‫یس‬‫ک‬‫تو‬ ‫د‬ ‫ليد‬‫و‬‫ت‬ ‫د‬ ‫توقف‬ ‫او‬ ‫د‬ ‫مرض‬ ‫هل‬ ‫نتقال‬‫ا‬ ‫څخه‬ ‫د‬ ‫نيوي‬‫خم‬ ‫په‬ ‫منظور‬ ،‫يقیږي‬‫تطب‬ ‫چې‬ ‫یو‬ ‫تعداد‬ ‫یېې‬ ‫په‬ ‫ندې‬‫ال‬ ‫ډ‬ ‫ول‬ ‫دي‬ : Penicillin, Erythromycin, Azithromycin, Tetracyclin ‫او‬ Rifampicin .
32 Procaine Penicillin ‫هل‬ ۱۰ ‫کيلو‬ ‫امه‬‫ر‬‫ګ‬ ‫څخه‬ ‫مکو‬ ‫نو‬‫ا‬‫ماشوم‬ ‫ته‬ ۳۰۰۰۰۰ ‫نټه‬‫و‬‫ی‬ ‫او‬ ‫هل‬ ۱۰ ‫کيلو‬ ‫امه‬‫ر‬‫ګ‬ ‫څخه‬ ‫ډېرو‬ ‫نو‬‫ا‬‫ماشوم‬ ‫ته‬ ۶۰۰۰۰۰ ‫نټه‬‫و‬‫ی‬ ‫د‬ ‫ورځې‬ ‫دوه‬ ‫ځهل‬ ‫د‬ ‫عضلې‬ ‫هل‬ ‫الرې‬ ‫ترهغو‬ ‫ورکول‬ ‫کېږي‬ ‫چې‬ ‫د‬ ‫لې‬‫و‬‫خ‬ ‫هل‬ ‫الرې‬ ‫په‬ ‫نۍ‬‫ا‬‫س‬‫آ‬ ‫ا‬‫و‬‫د‬ ‫تیل‬‫یس‬‫خ‬‫ا‬‫و‬ ‫يش‬ . ‫د‬ Erythromycin ‫ډوز‬ ۱۲۵-۵۰۰ ‫ميل‬ ‫امه‬‫ر‬‫ګ‬ ‫څلور‬ ‫ځهل‬ ‫د‬ ‫ورځې‬ ‫تر‬ ۱۴ ‫ورځو‬ ‫پورې‬ ‫دی‬ . ‫حامیوي‬ ‫تداوي‬ ‫مه‬ ‫په‬ ‫شدیدو‬ ‫اقعاتو‬‫و‬ ‫کښې‬ ‫رضوري‬ ،‫ده‬ ‫او‬ ‫د‬ ‫ايي‬‫و‬‫ه‬ ‫الرو‬ ‫د‬ ‫بندښت‬ ‫په‬ ‫څېر‬ ‫اختالطاتو‬ ‫اداره‬ ‫مه‬ ‫ابید‬ ‫جدا‬ ‫په‬ ‫نظر‬ ‫کې‬ ،‫وي‬ ‫په‬ ‫بيعي‬‫ط‬ ‫توګه‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ‫شوی‬ ‫ا‬ ‫نتان‬ ‫تل‬ ‫د‬ ‫مرض‬ ‫په‬ ‫ندې‬‫ا‬‫وړ‬ ‫معافيت‬ ‫نيش‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ،‫کویل‬ ‫او‬ ‫نه‬ ‫مه‬ ‫هل‬ ‫مور‬ ‫څخه‬ ‫نتقال‬‫ا‬ ‫شوی‬ ‫معافيت‬ ‫ت‬ ‫ر‬ ‫شپږو‬ ‫تو‬‫مياش‬ ‫ډېر‬ ‫ام‬‫و‬‫د‬ ‫کوي؛‬ ‫ځکه‬ ‫نو‬ ‫ابید‬ ‫یض‬‫ر‬‫م‬ ‫د‬ ‫اکملې‬ ‫شفاء‬ (Convalescence) ‫په‬ ‫جراین‬ ‫کښې‬ ‫فعال‬ ‫معافيت‬ ‫ترالسه‬ ‫کړي‬ .
33 ‫تماسونه‬ Contacts : ‫د‬ ‫یض‬‫ر‬‫م‬ ‫د‬ ‫نۍ‬‫ر‬‫کو‬ ‫اعضاء‬ ‫او‬ ‫نور‬ ‫په‬ ‫نیږدې‬ ‫متاس‬ ‫کې‬ ‫ملګري‬ ‫ابید‬ ‫د‬ ‫نفي‬‫ا‬ ‫س‬ ‫اب‬‫و‬ ‫په‬ ‫تلو‬‫یس‬‫خ‬‫ا‬ ‫معاینه‬ ‫يش‬ ‫او‬ ‫وقایوي‬ ‫نيت‬‫ا‬ ‫نه‬‫و‬‫تيک‬‫و‬‫بي‬ ( Penicillin ‫ای‬ Erythromycin ) ‫ابید‬ ‫د‬ ‫یوې‬ ‫نۍ‬‫و‬‫ا‬ ‫لپاره‬ ‫ته‬‫ر‬‫پ‬ ‫دلې‬ ‫چې‬ Immunization ‫په‬ ‫نظر‬ ‫کې‬ ‫نيول‬‫و‬ ‫يش‬ ‫ورکړل‬ ‫يش‬ . ‫هغه‬ ‫اشخاص‬ ‫چې‬ ‫د‬ ‫اب‬‫و‬‫س‬ ‫لکچر‬ ‫یېې‬ ‫ثبت‬‫م‬ ‫وي‬ ‫ابید‬ Active Immunization ‫ترالسه‬ ‫کړي‬ ‫او‬ ‫د‬ ‫نيت‬‫ا‬ ‫تيک‬‫و‬‫بي‬ ‫کورس‬ ‫هل‬ ‫پوره‬ ‫کېدلو‬ ‫دوه‬ ‫نۍ‬‫و‬‫ا‬ ‫ته‬‫وروس‬ ‫لکچر‬ ‫ا‬‫ر‬‫ا‬‫ر‬‫تک‬ ‫اء‬‫ر‬‫اج‬ ‫کړي‬ .
34 ‫فعال‬ ‫معافيت‬ ‫ترالسه‬ ‫کول‬ ‫د‬ ‫مرض‬ ‫په‬ ‫وقایه‬ ‫کې‬ ‫د‬ ‫مالتري‬ ،‫دی‬ ‫د‬ ‫دیفرتای‬ ‫اک‬‫و‬ ‫سني‬ ‫د‬ ‫دیفرتای‬ ‫هل‬ ‫یډ‬‫و‬‫کس‬‫و‬‫ټ‬ ‫څخه‬ ‫ترالسه‬ ‫کېږي‬ ‫چې‬ ‫د‬ ‫بکټرایيئ‬ ‫سینو‬‫ک‬‫و‬‫ټ‬ ‫یو‬ ‫اصالح‬ ‫شوی‬ ‫شلک‬ ‫دی‬ ‫او‬ ‫حمافظوي‬ ‫نټي‬‫ا‬ ‫کسني‬‫و‬‫ټ‬ ‫په‬ ‫وجود‬ ‫کې‬ ‫ليدوي‬‫و‬‫ت‬ . ‫نوموړی‬ ‫اکسني‬‫و‬ ‫یبا‬‫ر‬‫تق‬ ‫ېشه‬‫مه‬ ‫هل‬ Tetanus Toxoid (DT) ‫او‬ ‫ایمه‬ Tetanus Toxoid + Pertosis Vaccine (DPT) ‫رسه‬ ‫یوځای‬ ‫ندل‬‫و‬‫م‬ ‫کېږي‬ . ‫د‬ ‫نوموړي‬ ‫کسني‬‫و‬‫ټ‬ ‫قدرت‬ ‫د‬ Flocculation Unit (Lf) ‫په‬ ‫يهل‬‫وس‬ ‫ښودل‬ ‫کېږي‬ ‫جې‬ ‫هل‬ ‫نورو‬ ‫نو‬‫و‬‫يډ‬‫کس‬‫و‬‫ټ‬ ‫رسه‬ ‫چې‬ ‫په‬ International Units (IU) ‫ندې‬‫اب‬ ‫ښودل‬ ‫کېږي‬ ‫تفاوت‬ ‫لري‬ . ‫د‬ WHO ‫د‬ ‫اعدو‬‫و‬‫ق‬ ‫په‬ ‫اساس‬ ‫نو‬‫ا‬‫ماشوم‬ ‫ته‬ ‫د‬ ‫دیفرتای‬ ‫نيک‬‫و‬‫يقيد‬‫تطب‬ ‫اکسني‬‫و‬ ‫اب‬ ‫ید‬ ‫په‬ ‫احد‬‫و‬ ‫ډوز‬ ‫کې‬ ‫هېڅلکه‬ ‫هل‬ 30 IU ‫څخه‬ ‫مک‬ ‫نه‬ ‫وي؛‬ ‫د‬ ‫لږې‬ Potency ‫لرونيک‬ ‫اکسني‬‫و‬ ‫هل‬ ۷ ‫نو‬‫و‬‫لک‬ ‫څخه‬ ‫یو‬‫و‬‫ل‬ ‫نو‬‫ا‬‫ماشوم‬ ‫او‬ ‫اکهالتو‬ ‫ته‬ ‫يقیږي‬‫تطب‬ .
35
36 ‫د‬ Potency ‫دا‬ ‫مکښت‬ ‫د‬ ‫بيق‬‫تط‬ ‫په‬ ‫انحيه‬ ‫کې‬ ‫د‬ ‫عکس‬ ‫العمل‬ ‫د‬ ‫لو‬‫و‬‫خفيف‬ ‫پ‬ ‫ه‬ ‫منظور‬ ،‫يږي‬‫ز‬‫ي‬‫و‬‫جت‬ ‫رسه‬ ‫دلې‬ ‫چې‬ ‫ينې‬‫ځ‬ ‫نه‬‫و‬‫وخت‬ ‫مهدا‬ ‫مقدار‬ ‫مه‬ ‫کویل‬ ‫يش‬ ‫په‬ ‫یو‬‫و‬‫ل‬ ‫ما‬ ‫نو‬‫ا‬‫شوم‬ ‫او‬ ‫نو‬‫ال‬‫اکه‬ ‫کې‬ ‫د‬ ‫نټي‬‫ا‬ ‫ابډي‬ ‫عکس‬ ‫العمل‬ ‫پېښ‬ ‫کړي‬ . ‫د‬ ‫هند‬ ‫په‬ ‫ميل‬ ‫یشن‬‫سین‬‫ک‬‫ا‬‫و‬ ‫ام‬‫ر‬‫پروګ‬ ‫کې‬ ‫د‬ ‫ليت‬‫و‬‫طف‬ ‫د‬ ‫دورې‬ ‫د‬ ‫ي‬‫ز‬‫امييواني‬ ‫شن‬ ‫همال‬ ‫يش‬‫و‬ ‫د‬ DPT ‫سینو‬‫ک‬‫ا‬‫و‬ 0.5 ml ‫داخل‬ ‫عضيل‬ ‫زرقيات‬ ‫دي‬ ‫چې‬ ‫د‬ ‫معر‬ ‫په‬ ،‫شپږمه‬ ‫لسمه‬ ‫او‬ ‫څورلسمه‬ ‫هفته‬ ‫کښې‬ ‫يقیږي‬‫تطب‬ . ‫دا‬ ‫ابتدايئ‬ ‫سلسهل‬ ‫په‬ ۱۶ ‫مه‬ ‫او‬ ۲۴ ‫مه‬ ‫مياشت‬ ‫کې‬ ‫د‬ 0.5 ml ‫داخل‬ ‫عضيل‬ ‫نو‬‫و‬‫زرق‬ ‫په‬ ‫يهل‬‫وس‬ ‫بیږي‬‫تعقي‬ .
37 ‫د‬ DT ‫یو‬ ‫بوسټر‬ ‫مه‬ ‫په‬ ۴-۶ ‫لکین‬ ‫کښې‬ ‫ورکول‬ ‫کېږي؛‬ ‫هغه‬ ۱-۷ ‫لکن‬ ‫ماشومان‬ ‫چې‬ ‫هل‬ ‫پورتنيو‬ ‫زرقياتو‬ ‫پاتې‬ ‫شوي‬ ‫وي‬ ‫د‬ WHO ‫د‬ ‫نو‬‫ړ‬‫څی‬ ‫هل‬ ‫خمې‬ ‫ابید‬ ‫د‬ DPT ‫دوه‬ ‫نه‬‫و‬‫ډوز‬ ‫چې‬ ‫دوه‬ ‫تې‬‫مياش‬ ‫هل‬ ‫بل‬‫و‬‫ی‬ ‫رسه‬ ‫فاصهل‬ ‫لري‬‫و‬ ‫او‬ ‫درمي‬ ‫ډوز‬ ۶-۱۲ ‫تې‬‫مياش‬ ‫ته‬‫وروس‬ ‫هل‬ ‫دومه‬ ‫ډوز‬ ‫څخه‬ ‫ورکړل‬ ،‫يش‬ ‫تردې‬ ‫د‬ ‫ډېر‬ ‫معر‬ ‫لرونيک‬ ‫نو‬‫ا‬‫ماشوم‬ ‫او‬ ‫نو‬‫ال‬‫اکه‬ ‫ته‬ ‫ابید‬ ‫د‬ DT ‫سینو‬‫ک‬‫ا‬‫و‬ ‫عني‬ ‫کورس‬ ‫بيق‬‫تط‬ ‫يش‬ . ‫د‬ ‫دیفرتای‬ ‫ید‬‫و‬‫کس‬‫و‬‫ت‬ ‫لرونيک‬ ‫اکسني‬‫و‬ ‫ابید‬ ‫په‬ 2-8 C° ‫ارت‬‫ر‬‫ح‬ ‫کښې‬ ‫وساتل‬ ،‫يش‬ ‫په‬ ‫تصاديف‬ ‫ډول‬ ‫کنګل‬ ‫شوي‬ ‫اکسني‬‫و‬ ‫ابید‬ ‫تعامل‬‫اس‬ ،‫نيش‬ ‫د‬ ‫دیفرتای‬ ‫اکسني‬‫و‬ ‫تر‬ ‫لو‬‫و‬‫ټ‬ ‫د‬ ‫نو‬‫ؤ‬‫مص‬ ‫سینو‬‫ک‬‫ا‬‫و‬ ‫هل‬ ‫مجلې‬ ‫څخه‬ ‫دي‬ ‫چې‬ ‫شدید‬ ‫عکس‬ ‫نه‬‫و‬‫العمل‬ ‫یېې‬ ‫اکمال‬ ‫اندر‬ ‫دي‬ .
38 ‫د‬ ‫دیفرتای‬ ‫لفظ‬ ‫په‬ ‫یوانين‬ ‫کښې‬ ‫د‬ ( ،‫چرم‬ ‫څرمن‬ ) ‫په‬ ‫معین‬ ‫دی‬ ‫چې‬ ‫د‬ ‫بلعوم‬ ‫د‬ ‫هغ‬ ‫ې‬ ‫خړې‬ ‫غشاء‬ ‫نه‬‫د‬‫ښو‬ ‫کوي‬ ‫چې‬ ‫د‬ ‫دیفرتای‬ ‫انروغۍ‬ ‫وصفي‬ ‫نښه‬ ‫بلهل‬ ‫کېږي‬ . ‫د‬ ‫دیفرتای‬ ‫اب‬ ‫يل‬‫س‬ ‫لومړی‬ ‫ځل‬ ‫د‬ Klebs ‫په‬ ‫يهل‬‫وس‬ ‫په‬ ۱۸۸۳ ‫م‬ ‫اکل‬ ‫کښې‬ ‫معريف‬ ‫شو‬ ‫چې‬ ‫په‬ ۱۸۸۴ ‫م‬ ‫اکل‬ ‫کښې‬ ‫د‬ Loeffler ‫په‬ ‫يهل‬‫وس‬ ‫دده‬ ‫پخپل‬ ‫اين‬‫ز‬‫ډي‬ ‫شوي‬ ‫وسط‬ ‫کښې‬ ‫کرل‬‫و‬ ،‫شو‬ ‫په‬ ۲۰۰۵ ‫م‬ ‫اکل‬ ‫کښې‬ WHO ‫ته‬ ‫مجموعا‬ ‫د‬ ۱۲۷۳۵ ‫اقعاتو‬‫و‬ ‫اپور‬‫ر‬ ‫ورکړل‬ ‫شوی‬ . ( ‫د‬ ‫تان‬‫هندوس‬ ) ‫په‬ ‫ميل‬ ‫معافييت‬ ‫ام‬‫ر‬‫پروګ‬ ‫کې‬ ‫د‬ ‫دیفرتای‬ ‫د‬ ‫اکسني‬‫و‬ ‫شاملېدلو‬ ‫د‬ ‫نوموړي‬ ‫مرض‬ ‫په‬ ‫ېښو‬‫پ‬ ‫کې‬ ‫څرګند‬ ‫ایل‬‫و‬‫مک‬ ‫تیل‬‫اوس‬‫ر‬ ‫چې‬ ‫هل‬ ‫خم‬ ‫ې‬ ‫ئې‬ ‫په‬ ۲۰۰۷ ‫م‬ ‫اکل‬ ‫کې‬ ‫هل‬ ‫ټول‬ ‫هند‬ ‫څخه‬ ‫د‬ ۳۳۵۴ ‫اقعاتو‬‫و‬ ‫اپور‬‫ر‬ ‫ورکړل‬ ‫شو‬ . Corynebacterium Diphtheria ‫غري‬ ،‫متحرک‬ ‫پور‬‫س‬ ‫نه‬ ،‫ليدوونکی‬‫و‬‫ت‬ ‫پسول‬‫ک‬ ‫نه‬ ‫لرونکی‬ ‫ام‬‫ر‬‫ګ‬ ‫ثبت‬‫م‬ ‫يل‬‫ابس‬ ‫دي‬ ‫چې‬ ‫څلور‬ ‫نه‬‫و‬‫ل‬‫و‬‫ډ‬ ‫یېې‬ ‫ندل‬‫ژ‬‫پې‬ ‫شوي‬ ‫دي‬ : Gravis, Mitis, Belfani ‫او‬ Intermedius .
39 ‫د‬ ‫دیفرتای‬ ‫د‬ ‫يل‬‫ابس‬ ‫د‬ ‫ايرولنس‬‫و‬ ‫لو‬‫و‬‫ټ‬‫ر‬‫ت‬ ‫همم‬ ‫نکی‬‫و‬‫ټاک‬ ‫عامل‬ Exotoxin ‫دي‬ . ‫د‬ ‫نتقال‬‫ا‬ ‫ابتدايئ‬ ‫يهل‬‫وس‬ ‫یېې‬ ‫د‬ ‫تنفيس‬ ‫اتو‬‫ر‬‫قط‬ ‫ايئ‬‫و‬‫ه‬ ‫نه‬‫د‬‫ې‬‫د‬‫لېږ‬ ،‫ده‬ ‫د‬ ‫تنفيس‬ ‫ترحشاتو‬ ‫او‬ ‫د‬ ‫جدل‬ ‫د‬ ‫ندفاعاتو‬‫ا‬ ‫څخه‬ ‫مه‬ ‫خ‬ ‫ېدالی‬‫ر‬‫پ‬ ‫يش‬ . ‫د‬ ‫تفرخي‬ ‫دوره‬ ‫ئې‬ ۱-۵ ‫ورځې‬ ‫ده‬ . ‫په‬ ‫تنفيس‬ ‫قو‬‫ر‬‫ط‬ ‫کښې‬ ‫یېې‬ ‫د‬ ‫مصاب‬ ‫کېدلو‬ ‫معمول‬ ‫انحيېې‬ ‫قدايم‬ ‫نفي‬‫ا‬ ،‫جدار‬ ‫حلقويم‬ ،‫نتان‬‫ا‬ ‫او‬ ‫بلعويم‬ ‫ای‬ ‫اکيو‬‫ر‬‫ت‬ ‫يل‬‫انش‬‫ر‬‫ب‬ ‫نتاانت‬‫ا‬ ‫دي‬ . ‫ینه‬‫ړ‬‫م‬ ‫معموال‬ ‫د‬ ‫تنفيس‬ ‫الرو‬ ‫د‬ ‫بندښت‬ ‫او‬ ‫ایمه‬ ‫د‬ ‫سینو‬‫ک‬‫و‬‫ټ‬ ‫په‬ ‫يهل‬‫وس‬ ‫د‬ ‫نځته‬‫م‬‫ا‬‫ر‬ ‫شوي‬ ‫متيک‬‫یس‬‫س‬ ‫عکس‬ ‫العمل‬ ‫هل‬ ‫وهجېې‬ ‫وي‬ . ‫د‬ ‫شخيص‬‫ت‬ ‫ات‬ ‫ئيد‬ ‫د‬ Loeffler ‫ای‬ Tellurite ‫په‬ ‫وسط‬ ‫د‬ ‫پردې‬ ‫څخه‬ ‫د‬ ‫مچتو‬ ‫شوي‬ ‫مسري‬ ‫د‬ ‫لو‬‫ر‬‫ک‬ ‫په‬ ‫يهل‬‫وس‬ ‫ېښودل‬‫ا‬ ‫کېږي؛‬ ‫د‬ ‫دی‬ ‫فرتای‬ Antitoxin ‫د‬ ‫تداوي‬ ‫اساس‬ ‫جوړوي‬ . ‫نيت‬‫ا‬ ‫نه‬‫و‬‫تيک‬‫و‬‫بي‬ ‫د‬ ‫کسني‬‫و‬‫ټ‬ ‫د‬ ‫ليد‬‫و‬‫ت‬ ‫د‬ ‫نيوي‬‫خم‬ ‫په‬ ‫منظ‬ ‫ور‬ ‫د‬ ‫نو‬‫و‬‫نزيم‬‫ا‬‫اورګ‬ ‫د‬ ‫حموې‬ ‫او‬ ‫د‬ ‫مرض‬ ‫هل‬ ‫نتقال‬‫ا‬ ‫څخه‬ ‫د‬ ‫نيوي‬‫خم‬ ‫په‬ ‫خاطر‬ ‫يقیږي‬‫تطب‬ . ‫د‬ ‫نۍ‬‫ر‬‫کو‬ ‫غړي‬ ‫او‬ ‫نیږدې‬ ‫اش‬ ‫خاص‬ ‫ابید‬ ‫وقایوي‬ ‫نيت‬‫ا‬ ‫تيک‬‫و‬‫بي‬ ( ‫يلني‬‫نس‬‫پ‬ ‫ای‬ ‫یرتومايسني‬‫ر‬‫ا‬ ‫د‬ ۷ ‫ورځو‬ ،‫لپاره‬ ‫ته‬‫ر‬‫پ‬ ‫دلې‬ ‫چې‬ ‫د‬ ‫یض‬‫ر‬‫م‬ ‫معافيت‬ ‫ای‬ ‫عدم‬ ‫معافي‬ ‫ت‬ ‫په‬ ‫نظر‬ ‫کې‬ ‫نيول‬‫و‬ ‫يش‬ ) ‫ترالسه‬ ‫کړي‬ . ‫د‬ ‫مرض‬ ‫په‬ ‫نيوي‬‫خم‬ ‫کې‬ ‫فعال‬ ‫معافيت‬ ‫اسايس‬ ‫ارزښت‬ ‫ل‬ ،‫ري‬ ‫په‬ ‫هند‬ ‫کې‬ ‫د‬ DPT ‫سینو‬‫ک‬‫ا‬‫و‬ ‫درۍ‬ 0.5 ml ‫داخل‬ ‫عضيل‬ ‫نه‬‫و‬‫ډوز‬ ‫په‬ ۶ ،‫مه‬ ۱۰ ‫مه‬ ‫او‬ ۱۴ ‫مه‬ ‫نۍ‬‫و‬‫ا‬ ‫کې‬ ‫ورکول‬ ‫کېږي‬ .
40

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(Neurology) trigeminal neuralgia and facial paralysis in pashto language by d...
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(Gastroenterology) GI gasses text in pashto language by dr. kalimullah wardak
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(Gastroenterology) GI gasses ppt-pdf in pashto language by dr. kalimullah wardak
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(Hematology) alpha and beta thalassemias in pashto language by dr. kalimullah...
(Hematology) alpha and beta thalassemias in pashto language by dr. kalimullah...(Hematology) alpha and beta thalassemias in pashto language by dr. kalimullah...
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(Hematology) alpha and beta thalassemias in english by dr. kalimullah wardak
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(Forensic medicine) asphyxia and strangulation in english by dr. kalimullah w...
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(Gastroenterology) swallowing & swallowing disorders in English by dr. kalimu...
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(Gastroenterology) swallowing & swallowing disorders in English by dr. kalimu...
 
(Dermatology) fungal infections in pashto language by dr. kalimullah wardak
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(Anesthesia) spinal anesthesia english by dr. kalimullah wardak
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(Orthopedics) ant. tarsal tunnel syndrome in Pashto language by Dr. Kalimulla...
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(Orthopedics) muscles of sternum and clavicle, the dynamic and static physics...
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(Orthopedics) muscles of sternum and clavicle, the dynamic and static physics...
 
Handout (Orthopedics) muscles of sternum and clavicle by dr. kalimullah wardak
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(Orthopedics) some of the modern surgical materials/instruments that improve ...
(Orthopedics) some of the modern surgical materials/instruments that improve ...(Orthopedics) some of the modern surgical materials/instruments that improve ...
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(Orthopedics) post. approach to the humerus by dr. kalimullah wardak
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(Orthopedics) ant. approach to the cubital fossa in pashto language (by dr. k...
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(Orthopedics) ant. approach to the humerus in Persian/Dari language (by dr. k...
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(Infectious diseases) diphtheria in pashto language by dr. kalimullah wardak