Nj\u00eb burr\u00eb 35-vje\u00e7ar \u00ebsht\u00eb paraqitur n\u00eb klinik\u00ebn e dermatologjis\u00eb me histori 4-ditore ankthi, pagjum\u00ebsie dhe dridhje pa pushim t\u00eb duarve dhe k\u00ebmb\u00ebve.
\nNj\u00eb muaj para prezantimit, pacienti kishte filluar t\u00eb merrte terapi me shum\u00eb barna p\u00ebr leb\u00ebr, e cila p\u00ebrfshinte dapsonin pasi ai rezultoi negativ p\u00ebr munges\u00eb t\u00eb glukoz\u00ebs-6-fosfat dehidrogjenaz\u00ebs. N\u00eb ekzaminimin fizik, u vu re nj\u00eb ngjyrim kalt\u00ebrosh i buz\u00ebve dhe gjuh\u00ebs (Paneli A) – nj\u00eb gjetje e njohur si cianoz\u00eb qendrore. Cianoza zbulohet m\u00eb s\u00eb miri n\u00eb zonat e trupit ku epiderma \u00ebsht\u00eb e holl\u00eb dhe furnizimi me gjak \u00ebsht\u00eb i bollsh\u00ebm, si vesh\u00ebt, hunda, buz\u00ebt dhe mukozat e goj\u00ebs. Cianoza qendrore duhet t\u00eb ngjall shqet\u00ebsim p\u00ebr uljen e ngopjes s\u00eb oksigjenit arterial ose anomalit\u00eb e hemoglobin\u00ebs. Vler\u00ebsimi i gazit t\u00eb gjakut arterial tregoi nj\u00eb presion t\u00eb pjessh\u00ebm t\u00eb oksigjenit (Pao2) prej 96 mm Hg (varg referenc\u00eb, 75 deri n\u00eb 100) dhe nj\u00eb ngopje me oksigjen prej 84%. P\u00ebr shkak t\u00eb mosp\u00ebrputhjes midis vlerave t\u00eb Pao2 dhe ngopjes me oksigjen (nj\u00eb zbulim i njohur si “boshll\u00ebk saturimi”), dyshohej methemoglobinemia e fituar nga dapsoni. Terapia me Dapsone u nd\u00ebrpre dhe iu dha kujdesi mb\u00ebshtet\u00ebs. Niveli i methemoglobin\u00ebs si\u00e7 u vler\u00ebsua nga nj\u00eb laborator i jasht\u00ebm ishte 14% (vargu i referenc\u00ebs, 0 deri n\u00eb 3). Dy dit\u00eb pas paraqitjes fillestare dhe nd\u00ebrprerjes s\u00eb terapis\u00eb me dapsone, simptomat dhe cianoza e pacientit ishin zgjidhur (Paneli B).<\/p>\n
Published April 10, 2024
\nN Engl J Med 2024;390:1311<\/p>\n
Nga faqja e Dr.Alket Koroshi<\/p>\n","protected":false},"excerpt":{"rendered":"
Nj\u00eb burr\u00eb 35-vje\u00e7ar \u00ebsht\u00eb paraqitur n\u00eb klinik\u00ebn e dermatologjis\u00eb me histori 4-ditore ankthi, pagjum\u00ebsie dhe dridhje pa pushim t\u00eb duarve dhe k\u00ebmb\u00ebve. Nj\u00eb muaj para prezantimit, pacienti kishte filluar t\u00eb merrte terapi me shum\u00eb barna p\u00ebr leb\u00ebr, e cila p\u00ebrfshinte dapsonin pasi ai rezultoi negativ p\u00ebr munges\u00eb t\u00eb glukoz\u00ebs-6-fosfat dehidrogjenaz\u00ebs. N\u00eb ekzaminimin fizik, u vu […]<\/p>\n","protected":false},"author":2,"featured_media":74907,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":{"0":"post-74906","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-te-tjera"},"_links":{"self":[{"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/posts\/74906","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/comments?post=74906"}],"version-history":[{"count":1,"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/posts\/74906\/revisions"}],"predecessor-version":[{"id":74908,"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/posts\/74906\/revisions\/74908"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/media\/74907"}],"wp:attachment":[{"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/media?parent=74906"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/categories?post=74906"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/neutrale.al\/index.php\/wp-json\/wp\/v2\/tags?post=74906"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}