Casharka 35aad

 Habdhiska Neefsashada iyo Xanuunnada ku dhaca. 

Casharka 35aad

Oofwareenta lid-jidheedka(Hypersensitivity Pneumonitis).

Waa xaalad sambabbada ay saameyso dareensanaanteeda ay keenaan waxyaabo qalaad soo gala samababbada sida busta, borotiinnada hilibka ama oonta xolaha, kuwaasoo carinaya  difaaaca samababbada kuwaasoo ka falcelinaya. Falcelintaasi waxa uu keenayaa hafeef iyo neefsashada oo adkaata. Tani waxay dhacdaa marka uu difaaca jirka ka falcelsho wayxaabaha qalaad ee soo galay sambabbada. Difaaca waxa uu aqoonsanayaa wayxaabaha soo galay,  waxa la carinayaa unugyada difaaca sida liqaha wayn kuwaasoo laga soo daynayo farriimaha hafeefka. Jirka waxa uu abuurayaa lid-jidh gale kaasoo ku dhagaya lid-jidh dhaliye(antigen) kaasoo sameynaya difaac murakab ah(immune complexes).  

Murakab  waxa uu ka buuxsamayaa samababbada  kaaso keenaya barar. Isla waqtigaan difaaca waxa uu ka falcelinayaa carinta  unugyada(T cells activation)  waxa la soo daynayaa  kiimikaal kuwaasoo soo jiidanaya unugyada difaaa ee samababbada.  Waqti badan kaddib haddii uu difaaca hafeefka soo noqnoqdo waxa uu keenayaa adkaansho iyo nabar ku sameysma nuddaha samababada taasoo loo yaqaan miiqow(fibrosis), miiqowgaasi waxa uu yareynayaa kala baxa samababada, isbeddelka hawadda ka dhex dhacda samababbada. Haddii waqti hore  laga hortago hafeefka waxa uu noqonayaa mid markaasi samababbada xaaladda ku timid ay noqoneyso mid kabasho leh. Haddii uu waqti dheer uu sii jirro waxa uu keenayaa dhaawac aan laga soo kaban ku yimaada samababbada. 

Maxaa keena?

Hafeefka oof-samababeedka waxa keenna  waxyaabo kala duwan. Waxyaabo deegaanka la xidhiidha,  dhaska busta, iyo waxyaabaha ilma aragtada,  boodhka fangaayga(aspergillus), waxyaabaha ay soo saarto bakteeriyada (thermophilic actinomycetes), iyo borotiinnada ka yimaada xoolaha(birds), dadka beeraha ka shaqeeya, sigaarka,  busta meelaha alwaaxda lagu jeex jeexo ayaa inta badan keenna.Hafeef oofeedka samababka

 waxay dhacdaa marka nidaamka difaaca jirka uu si xad-dhaaf ah uga jawaabo walxaha qalaad ee deegaanka laga helo. Marka qofka ay galaan hawo mareenka walxahaas, nidaamka difaaca jirka wuxuu aqoonsanayaa inay waxyeelo keenayan. Tani waxay keentaa in nidaamka difaaca jirka uu weeraro walxahaas iyo sambabada.

Bilowga, unugyada difaaca jirka ee sambabada (sida T-cells) ayaa la carinayaa oo soo saara kiimikooyinka  keena hafeefka . Tani waa isku dayga jirka ee la dagaallanka waxa uu u arko inay waxyeelo yihiin. Bararkaas ayaa sababa calaamadaha sida qufaca, qandho, iyo neefsashada oo adkaata.Haddii qofku ku siinagaadaan waxyaabahaasi jirka  soo galay ama sii jiraa  muddo dheer, nidaamka difaaca jirka wuxuu sii wadi doonaa weerarka, taasoo keeni karta miiqowga (fibrosis) sambabada. Miiqowgaani waxa uu keenayaa  in ay neefsashada adkaato.

Calaamadaha. 

1: Neefsashada oo yaraata.

2: Qufac qalalan.

3: Laabta oo giigsanta.

4: Daal.

5: qandho.

6: Muqro xanuun.

7:Miisaanka oo hoos u dhaca.

8: Jarays.

Baadhitaanka. 

1:Allergy blood tests. Waxa laga qaadayaa muunad yar oo dhiig ah iyadoo la isticmaalayo cirbad.  Waxa la eegayaa haddii ay jirto Lid jidheedyo keeni kara xaaladdan.

2:Imaging. Chest X-rays and CT scans: raajada iyo iskaanka waxa lagu ogaanayaa haddii samababada ay dhaawac gaareen.

3:Pulmonary function tests. Hubbintan waxay innaga caawineysaa qiimeynta shaqada samababbada, haddii markaasi uu noqday sambabka  miiqow.

4:Bronchoscopy. Kaamiradan  waxa lagu soo qaadayaa cad si markaasi warbixin dheeri ah looga xaaladdan waxa keennay.

5:High-resolution CT

Hubbintani waxay inna tusineysaa haddii isbeddel ku yimid nuddaha sambabada ay keentay Lid jidheedka oof-samababeedka. Waxaa kaloo la eegayaa haddii uu yeeshay miiqow samababbada (fibrosis) bartamaha samababbada ka sameysma oo laga waayo. 

 Daaweynta. 

1:Corticosteroids :  dawooyinkan waxay hoos u dhigayaan ama ay xidhayaan kiimikooyinka la soo daynayo, waxay yareynayaan hafeefka samababada iyo kiish haweedka. Waxay sarre u qaadayaan inuu yaraado dhaawaca soo gaaraya samababada. Dawadda waxa ka mid ah:Prednisone (oral).

2:Immunosuppressants (tusaale., Azathioprine, Mycophenolate mofetil).  Dawooyinkan waxay ka hortagayaan inuu difaaca weeraro samababada,  waana ka hortaga dhaawaca samababbada. 

3:Oksijiinta Therapy. Xaaladdan waxay keentaa in qofka neefsashada ku adkaato, waxa uu innaga caawinayaa in jirka uu helo ogsijiin fican, tanina waxay hoos u dhigeysaa neefshada adkaanshaheeda, isla markaana jirka waxa uu muujinayaa qummaan.

 4:Rehabilitayshinka Neefsashada(pulmonary rehabilitation): hannaankani ma ahan  daaweyn laakiin waxay innaga caawineyaa wanaagsanaanta neefsashada.  Iyadoo la sameynayo jimicsi,  hannaan neefseed kale. Hannaankani waxa uu innaga caawinayaa in ay samababada si fiican u shaqeeyaan.

 References

1. American Thoracic Society (ATS) guidelines on Hypersensitivity Pneumonitis management.

2. Raghu G, et al. "Diagnosis and management of hypersensitivity pneumonitis." Chest. 2020.

3. European Respiratory Society. "Management of chronic hypersensitivity pneumonitis." Eur Respir J. 2021.

4. Mayo Clinic and Medscape for practical clinical approaches.

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